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標題: | 振動治療對於阿基里氏肌腱修補的療效成果 The Effect of Vibration on Patients' Outcomes after Achilles Tendon Repair |
作者: | Pei-Yun Wang 王姵云 |
指導教授: | 王興國(Hsing-Kuo Wang) |
關鍵字: | 阿基里氏肌腱,振動治療,肌腱微循環,肌腱機械特性,功能表現, Achilles tendon,vibration intervention,tendon microcirculation,mechanical properties of tendons,functional outcomes, |
出版年 : | 2018 |
學位: | 碩士 |
摘要: | 研究背景:阿基里氏肌腱斷裂常以手術進行修補,已知在癒合過程中,斷裂的阿基里氏肌腱局部血流產生變化、機械特性和運動功能表現變差1,因此須藉由早期介入以減少健患兩側在上述參數之差異,而機械性刺激被證實可增加下肢微循環,但尚未有足夠的文獻支持局部的振動治療可以增加肌腱微循環,進而改善斷裂後的肌腱癒合,以利患者進行術後的復健計畫。
研究目的:本研究旨在探討振動治療對於阿基里氏肌腱修補後患者在第一、二、三、六個月的病患自評量表、肌腱微循環、機械特性和運動功能表現之差異。同時探討手術後第一、二個月的病患自評量表、肌腱微循環分別與第三、六個月的運動功能表現之相關性。 實驗設計:本研究屬於歷史控制型的病例世代研究。 實驗對象:收錄單側阿基里氏肌腱修補手術後第二週至十二個月之患者,年齡介於20至60歲,過去半年內沒有任何其他下肢傷害,且無任何系統性疾病。 實驗方法:受試者於阿基里氏肌腱修補手術後,分別於第二週和第一、二、三、六個月接受追蹤,包括病患自評量表、肌腱微循環、機械特性和運動功能表現。 統計分析:本實驗使用曼恩惠尼U檢定比較振動治療組與控制組之病患自評量表、肌腱微循環、機械特性和運動功能表現是否有顯著差異;使用魏克生符號檢定比較健患兩腳的肌腱微循環、機械特性和運動功能表現是否有顯著差異;並使用斯皮爾曼等級相關係數分析病患自評量表、肌腱微循環和運動功能表現是否具有相關性。 結果:第一部分研究結果顯示,在肌腱微循環方面,未接受振動治療組在手術修補後第三個月患側腳的總血紅蛋白含量顯著高於振動組(p=0.043)。機械特性方面,振動組的剛性和最大自主等長收縮在第三個月時均顯著高於控制組(p=0.002-0.005),但在第六個月振動組雖有高於控制組的趨勢,卻未達顯著差異。運動功能方面,在手術修補後第三個月時,抬腳跟指數、健患兩腳的單腳抬腳跟高度和單腳前跳測試,振動組均顯著高於控制組(p<0.05),而在第六個月時僅有健患兩腳的單腳抬腳跟高度有顯著差異(p=0.039;p<0.001)。病患自覺方面,維多利亞學會運動評估量表在第三和第六個月中,振動組顯著高於控制組(p=0.008;p=0.002);而下肢功能量表中,振動組僅在第六個月時顯著高於控制組(p=0.002)。第二部分相關性分析結果顯示,手術修補後前兩個月的肌腱微循環和第三個月以後的運動功能表現有顯著相關(p=0.03-0.042),病患自評量表僅有維多利亞學會運動評估量表在手術修補後第一個月,和第六個月患側腳的星狀平衡距離顯著負相關(p=0.023)。 結論:阿基里氏肌腱術後修補的早期肌腱微循環可用於預測後期下肢肌耐力和爆發力的程度,而振動治療可於術後固定時施打以促進肌腱微循環,並且增加肌腱剛性和肌肉力量、改善運動功能表現,也有助於提升患者對自身健康狀況的自信以及日常生活品質。因此,振動治療可視為一項新的處置方式,幫助患者儘早返回日常生活,甚至運動競賽。 Background: Achilles tendon rupture is often treated through surgical repair. During the healing process, patient-reported outcomes, tendon microcirculation, the mechanical properties of the tendon, and functional outcomes can change. Mechanical stimulation has been shown to increase microcirculation of the lower limbs; however, there is a paucity of existing evidence supporting the potential for local vibration intervention increasing tendon microcirculation and facilitating postoperative rehabilitation. Purpose: The aim of the present study was to investigate differences in patient-reported outcomes, tendon microcirculation, the mechanical properties of tendon, and functional outcomes between a vibration intervention group and a control group. This study also investigates the correlation between patient-reported outcomes, tendon microcirculation, and functional outcomes. Design: Case cohort study with historical controls. Participants: Patients with unilateral Achilles tendon repair aged between 20 and 60 years old were recruited for the present study. Included patients did not possess any other lower extremity injuries or any systemic diseases. Methods: Participants were followed up in the second week, and then the first, second, third, and sixth month following Achilles tendon repair surgery. Investigated parameters included patient-reported outcomes, tendon microcirculation, tendon stiffness, and functional outcomes. Statistical analysis: Mann-Whitney U test, Wilcoxon signed-rank test, and Spearman correlation analysis were utilized for data analysis. Results: Total hemoglobin among affected legs in the vibration group was significantly lower than that of the control group in the third month following Achilles tendon repair surgery (p=0.043). In the third month following repair surgery, tendon stiffness, maximal voluntary isometric contraction, heel raise index, heel raise height, one-legged hopping distance, and VISA-A questionnaire scores in the vibration group were significantly higher than that of the control group (p<0.05). At the sixth month following surgery, only heel raise height and VISA-A and LEFS scores in the vibration group were significantly higher than that of the control group (p<0.05). Furthermore, the present study indicated that tendon microcirculation over the first 2 months was correlated with functional outcomes in the third and sixth month following repair surgery. Also, a significantly negative correlation was observed between VISA-A scores in the first month and SEBT scores in the sixth month (p=0.023). Conclusion: Tendon microcirculation in the early stages following Achilles tendon repair surgery could be used to predict the recovery of muscle power and endurance. Additionally, the early application of vibration during immobilization could increase microcirculation, which may benefit the tendon healing process. The application of vibration could also increase tendon stiffness and muscle strength, and subsequently improve functional outcomes, patient self-confidence, and quality of life. Therefore, vibration therapy can be regarded as a new treatment for helping patients with unilateral Achilles tendon repair, allowing them to return to their normal daily lives, or even sports, as soon as possible. |
URI: | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/69613 |
DOI: | 10.6342/NTU201800970 |
全文授權: | 有償授權 |
顯示於系所單位: | 物理治療學系所 |
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