不同的運動介入對大鼠阿基里斯肌腱修復的影響

Abstract

目的：比較『跑步』與『游泳』運動介入對阿基里斯肌腱修復的差異。 方法：本實驗以81隻Spraque Dawley大鼠為實驗對象，隨機分為控制組、跑步組、游泳組。先將大鼠的阿基里斯肌腱以手術做橫向割斷，受傷後第5天進行運動介入，其中，跑步運動每天1次，每次15分鐘，前2天速度為4公尺/分鐘，之後為12公尺/分鐘；游泳運動每天1次，每次15分鐘，每次6隻同時進行，尾巴沒有負重。觀察受傷組織的外觀、發炎情形、膠原蛋白的生長與排列和肌腱的最大抗拉強度。 結果：（一）受傷後第7天，跑步組的發炎細胞比游泳組多，且新、舊組織接合較差。（二）受傷後第28天，阿基里斯肌腱功能指數（Achilles Functional Index；AFI）分別為控制組（-3.76 ± 13.68）、跑步組（-14.23 ± 12.01）、游泳組（-12.2 ± 10.67），均與受傷前未達顯著差異（p＝.277）；最大抗拉強度分別為控制組 (53.51 ± 3.68N)、跑步組 (62.9 ± 7.68N)、游泳組 (58.19 ± 8.15N)，均與受傷前未達顯著差異（p＝.184）；跑步組與游泳組的第一類型膠原蛋白比例較控制組低，但新生膠原蛋白排列較控制組整齊且具緩衝的能力。跑步組的組織切片有微小的波紋結構，最接近正常肌腱組織，其他兩組沒有。 結論：由於運動可以促進新生膠原蛋白的排列更整齊，因此受傷後第5天應選擇運動介入，但為了避免造成新、舊組織接合較差，且發炎較嚴重的現象，應以游泳為優先考量；由於跑步可使新生膠原蛋白產生波紋結構，因此建議受傷後第14天即可取代游泳方式介入。Purpose: To compare the intervention of different exercises – running or swimming on the recovery of injured Achilles tendon. Methods: Eighty-one Spraque Dawley rats were randomly assigned to three groups; control, running and swimming. The rats’ Achilles tendon were cut first and then intervened by different exercises after the 5th day of Achilles injury. The running was once each day, 15 minutes each time, at the speed of 4 meters / minute for the first two days, then the speed was increased to 12 meters / min. In swimming, six rats swam at the same time, 15 minutes each time, once a day, and their tails was free of weight. The control group did not do either running or swimming. The tissue inflammation, arrangement and growth of collagen and ultimate tensile strength of tendon were observed and measured during the recovery period. Results: (1) On the 7th day, running group have more inflammation cells than the swimming group. In addition, the adhesion of new growth and previous tissues was worse in the running group. (2) On the 28th day, the AFI of control, running, and swimming group was -3.76±13.68, -14.23±12.01, and -12.2±10.67, respectively. There was no significant difference between pre- and post-injury in each group (p＝.277); The ultimate tensile strength of tendon for control, running, and swimming group was 53.51±3.68N, 62.9±7.68N, and 58.19±8.15N, respectively. No significant difference was found between pre- and post-injury in each group (p＝.184). The proportion of type I collagen was lower in the running and the swimming group than in the control group. However, arrangement of new growth collagen and the ability of cushion were observed in running and swimming groups. Moreover, the tendon biopsy of running group had a minute crimp structure, and, the other groups did not have this characteristic. Conclusion: Exercise should be intervened after the 5th day of Achilles injury, because exercise could enhance tidier arrangement in collagen. Nevertheless, swimming should be the first exercise intervention for better adhesion of new growth and the old tissues and to avoid inflammation. Also, it is suggested that swimming should be replaced by running after the 14th day of injury, because running can lead to a microscopic crimp structure in new collagen.