多數運動員肌腱病變的源頭: 筋骨交接處之"著骨點"修補不足, 而非發炎(AJSM 2009) By 英國的Dr. Nochola Maffulli

Gaby Maliqilic April 20, 2009

Management of Tendinopathy  
多數運動員肌腱病變的源頭: 筋骨交接處之"著骨點"修補不足, 而非發炎(AJSM 2009)

By Jonathan Rees, MSc, MRCP (UK), FFSEM (UK) (--), Nicola Maffulli, MD, MS, PhD, FRCS(Ortho) (osa14@keele.ac.uk) and Jill Cook, PhD (--)

這篇由國際知名的肌腱研究大師, 英國的Dr. Nochola Maffulli教授發表在2009二月份的"美國運動醫學雜誌(American Journal of Sports Medicine, AJSM)的研究, 再次確認了之前我們所強調的事實:

"多數運動員肌腱病變的源頭: 筋骨交接處之著骨點(osteotendinous junction, or enthesis)修補不足, 而非發炎"

一般我們在看醫生時, 常會聽到類似'肌腱炎"的診斷, 但一而再, 再而三的臨床與基礎研究結果, 卻越來越指向"修補不足所產生的肌腱退化"才是疼痛真正的來源; 疼痛的肌腱裡, 鮮少有真正可證明的發炎現象! 故而, 治療運動員或一般民眾肌腱退化(更精確的說:著骨點退化)的中心思想, 就集中在如何使退化或修補不足的著骨點再度修補, 才能真正且根本地解決疼痛的問題.

文中已經提到我們之前說過的"生長因子(growth factor)注射", "幹細胞注射(stem cell injection)", 甚至著骨點的微創手術等等; 但因為這些治療目前在台灣還並不普遍, 而且價格十分昂貴, 筆者還是建議以局部在著骨點注射葡萄糖作為修補刺激劑之"增生注射療法" , 作為現階段治療的主要手段.

 

圖片: http://www.schusterchiropractic.org/img/img_soft_tissue03.jpg


參考文獻

Management of Tendinopathy Am J Sports Med published 2 February 2009

http://ajs.sagepub.com/cgi/content/abstract/0363546508324283v1?papetoc

Abstract


Overuse disorders of tendons, or tendinopathies, present a challenge to sports physicians, surgeons, and other health care professionals dealing with athletes. The Achilles, patellar, and supraspinatus tendons are particularly vulnerable to injury and often difficult to manage successfully. Inflammation was believed central to the pathologic process, but histopathologic evidence has confirmed the failed healing response nature of these conditions. Excessive or inappropriate loading of the musculotendinous unit is believed to be central to the disease process, although the exact mechanism by which this occurs remains uncertain. Additionally, the location of the lesion (for example, the midtendon or osteotendinous junction) has become increasingly recognized as influencing both the pathologic process and subsequent management.

The mechanical, vascular, neural, and other theories that seek to explain the pathologic process are explored in this article. Recent developments in the nonoperative management of chronic tendon disorders are reviewed, as is the rationale for surgical intervention. Recent surgical advances, including minimally invasive tendon surgery, are reviewed. Potential future management strategies, such as stem cell therapy, growth factor treatment, and gene transfer, are also discussed.