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研究生： 楊昌斌
論文名稱： 不同的運動介入對大鼠阿基里斯肌腱修復的影響
The Effects of Different Exercises Intervention on the Achilles Tendon Recovery in Rats
指導教授： 謝伸裕
學位類別： 博士
Doctor
系所名稱： 體育學系
Department of Physical Education
論文出版年： 2008
畢業學年度： 96
語文別： 中文
論文頁數： 119
中文關鍵詞： 肌腱修復 、游泳 、膠原蛋白
英文關鍵詞： tendon recovery, swimming, collagen
論文種類： 學術論文
相關次數： 點閱：124  下載：2 
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    • 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.

    目 次 第壹章 緒論 一、前言…………………………………………………………………1 二、研究目的……………………………………………………………4 三、研究假設……………………………………………………………4 四、名詞操作性定義……………………………………………………5 第貳章 文獻探討 一、肌腱的結構…………………………………………………………6 二、肌腱的組成…………………………………………………………9 三、肌腱的血流調解……………………………………………………13 四、肌腱的生物力學特性………………………………………………13 五、肌腱的相關疾病……………………………………………………16 六、肌腱的復原過程……………………………………………………17 七、肌腱損傷分類與處裡………………………………………………21 八、身體活動對肌腱的相關研究………………………………………26 第參章 研究方法與步驟 一、實驗流程……………………………………………………………35 二、實驗方法……………………………………………………………36 第肆章 結果 一、體重…………………………………………………………………43 二、阿基里斯肌腱功能…………………………………………………44 三、肌腱組織觀察………………………………………………………47 四、肌腱最大抗拉強度…………………………………………………62 第伍章 討論 一、阿基里斯肌腱功能…………………………………………………67 二、組織觀察……………………………………………………………69 三、肌腱最大抗拉強度…………………………………………………79 四、『跑步』與『游泳』對阿基里斯肌腱修復影響比較……………82 五、結論…………………………………………………………………82 引用文獻…………………………………………………………………84 附 錄 附錄一 組織固定、冷凍切片 …………………………………………95 附錄二 紫木蘇及伊紅（haematoxylin-eosin stained）………96 附錄三 膠原蛋白染色（Picro-Sirius Red for Collagen）…97 附錄四 免疫化學染色（Immunohistochemistry）………………98 附錄五 藥品與試劑 …………………………………………………100 附錄六 原始資料 ……………………………………………………101 附錄七 動物實驗管理小組審查同意書 ……………………………105 表 次 表2-1 肌腱的復原過程 ………………………………………………21 表2-2 臨床上不同修復期的處理原則 ………………………………23 表2-3 人類阿基里斯肌腱傷害分類與處裡 …………………………25 表4-1 不同處理組別與天數的體重變化表 …………………………43 表4-2 第0天體重變異數摘要表………………………………………43 表4-3 第28天體重變異數摘要表 ……………………………………44 表4-4 第28天體重事後比較摘要表…………………………………44 表4-5 不同處理組別間AFI值變異數摘要表 ………………………45 表4-6 不同天數間AFI值事後比較摘要表 …………………………46 表4-7 不同處理組別膠原蛋白比例變異數摘要表 …………………57 表4-8 不同處理組別膠原蛋白比例事後比較摘要表 ………………57 表4-9 不同處理組別與天數的最大抗張強度值 ……………………63 表4-10 不同處理組別第7天最大抗拉強度變異數摘要表…………63 表4-11 不同處理組別第7天最大抗拉強度事後比較摘要表 ………64 表4-12 不同處理組別第28天最大抗拉強度變異數摘要表…………64 圖 次 圖2-1 肌腱結構圖………………………………………………………7 圖2-2 膠原蛋白間的橫向連結…………………………………………9 圖2-3 應力-應變曲線…………………………………………………15 圖2-4 抗拉強度－位移曲線 …………………………………………16 圖3-1 實驗流程圖 ……………………………………………………35 圖3-2 阿基里斯肌腱的手術方式 ……………………………………37 圖3-3 老鼠阿基里斯肌腱功能測量模式圖 …………………………39 圖3-4 圖像採集分析 …………………………………………………41 圖3-5 Instron萬能材料試驗機夾具 ………………………………42 圖4-1 不同處理組別阿基里斯肌腱功能曲線圖 ……………………45 圖4-2 控制組第14天左、右腳肌腱…………………………………47 圖4-3 控制組受傷後第2天 …………………………………………48 圖4-4 控制組受傷後第5天 …………………………………………48 圖4-5 控制組受傷後第14天…………………………………………48 圖4-6 控制組受傷後第28天…………………………………………48 圖4-7 控制組正常腳肌腱 ×200………………………………………49 圖4-8 控制組受傷後第2天 ×200……………………………………49 圖4-9 控制組受傷後第5天 ×200……………………………………49 圖4-10a 控制組受傷後第7天 ×200…………………………………50 圖4-10b 跑步組受傷後第7天 ×200…………………………………50 圖4-10c 游泳組受傷後第7天 ×200…………………………………50 圖4-11a 控制組受傷後第14天 ×200 ………………………………51 圖4-11b 跑步組受傷後第14天 ×200 ………………………………51 圖4-11c 游泳組受傷後第14天 ×200 ………………………………51 圖4-12 控制組正常腳肌腱 ×200 ……………………………………52 圖4-13 控制組受傷後第2天 ×200 …………………………………52 圖4-14 控制組受傷後第5天 ×200 …………………………………52 圖4-15a 控制組受傷後第7天 ×200…………………………………53 圖4-15b 跑步組受傷後第7天 ×200…………………………………53 圖4-15c 游泳組受傷後第7天 ×200…………………………………53 圖4-16 控制組正常腳肌腱 ×200 ……………………………………54 圖4-17 控制組受傷後第2天 ×200 …………………………………54 圖4-18a 控制組受傷後第7天 ×200…………………………………55 圖4-18b 跑步組受傷後第7天 ×200…………………………………55 圖4-18c 游泳組受傷後第7天 ×200…………………………………55 圖4-19 控制組正常腳肌腱 ×100 ……………………………………58 圖4-20 控制組受傷後第2天 ×100 …………………………………58 圖4-21 控制組受傷後第5天 ×100 …………………………………58 圖4-22a 控制組受傷後第7天 ×100…………………………………59 圖4-22b 跑步組受傷後第7天 ×100…………………………………59 圖4-22c 游泳組受傷後第7天 ×100…………………………………59 圖4-23a 控制組受傷後第14天 ×100 ………………………………60 圖4-23b 跑步組受傷後第14天 ×100 ………………………………60 圖4-23c 游泳組受傷後第14天 ×100 ………………………………60 圖4-24a 控制組受傷後第28天 ×100 ………………………………61 圖4-24b 跑步組受傷後第28天 ×100 ………………………………61 圖4-24c 游泳組受傷後第28天 ×100 ………………………………61 圖4-25a 第7天控制組未受傷 ………………………………………65 圖4-25b 第7天控制組受傷 …………………………………………65 圖4-25c 第7天跑步組受傷 …………………………………………65 圖4-25d 第7天游泳組受傷 …………………………………………65 圖4-26a 第28天控制組未受傷………………………………………66 圖4-26b 第28天控制組受傷…………………………………………66 圖4-26c 第28天跑步組受傷…………………………………………66 圖4-26d 第28天游泳組受傷…………………………………………66

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