Effects on neovascularisation behind the good results with eccentric training in chronic mid-portion Achilles tendinosis?
Effects on neovascularisation behind the good results with eccentric training in chronic mid-portion Achilles tendinosis?
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DOI：
10.1007/s00167-004-0494-8
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发表时间：
2004-09-01
影响因子：
3.8
通讯作者：
Alfredson, H
中科院分区：
文献类型：
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作者：
Öhberg, L;Alfredson, H
使用疼痛性偏心小腿肌肉训练治疗慢性疼痛性中部跟腱炎的良好临床结果的背景尚不清楚。最近，利用超声和彩色多普勒技术，我们发现疼痛性肌腱病与局部新生血管有关。此外，在一项初步研究中，通过硬化疗法破坏这些新生血管治愈了大多数患者的疼痛。动态超声和彩色多普勒检查表明，在踝关节背屈时，新生血管中的血流停止。因此，研究离心训练前后新生血管的发生是有意义的。对30例（男22例，女8例，平均年龄48岁）慢性疼痛性跟腱中段病患者的41条肌腱进行超声和彩色多普勒检查，在12周的离心小腿肌肉训练前后。治疗前，所有肌腱中肌腱变化（低回声区，不规则纤维结构）区域均出现局部新生血管形成。在治疗后随访（平均28个月）时，36/41个肌腱的临床结果良好（活动期间无肌腱疼痛），5/41个肌腱的结果较差。在34/36个具有良好临床治疗结果的肌腱中，肌腱结构更正常，在32/36个肌腱中，没有剩余的新血管形成。在515个临床结果较差的肌腱中，肌腱中存在剩余的新生血管形成，2/5的肌腱存在剩余的结构异常。总之，在慢性疼痛性中部跟腱病患者中，离心训练后良好的临床结果似乎与更正常的肌腱结构和无残留的新血管形成相关。在离心训练方案中对新生血管区域的作用可能是良好临床结果的原因。
The background to the good clinical results reported using painful eccentric calf-muscle training as treatment for chronic painful mid-portion Achilles tendinosis is not known. Recently, using ultrasound and colour Doppler technique, we showed that painful tendinosis was associated with a local neovascularisation. Furthermore, in a pilot study, destroying these neovessels by sclerosing therapy cured the pain in most patients. Dynamic ultrasound and colour Doppler examination has shown that the flow in the neovessels stops during dorsiflexion in the ankle joint. Therefore, it was of interest to study the occurrence of neovascularisation before and after eccentric training. Forty-one tendons in 30 patients (22 men and 8 women, mean age 48 years) with chronic painful mid-portion Achilles tendinosis were examined with ultrasonography and colour Doppler, before and after 12 weeks of eccentric calf-muscle training. Before treatment, there was a local neovascularisation in the area with tendon changes (hypo-echoic areas, irregular fibre structure) in all tendons. At follow-up after treatment (mean 28 months), there was a good clinical result (no tendon pain during activity) in 36/41 tendons, and a poor result in 5/41 tendons. In 34/36 tendons with a good clinical result of treatment there was a more normal tendon structure, and in 32/36 tendons there was no remaining neovascularisation. In 515 tendons with a poor clinical result there was a remaining neovascularisation in the tendon, and in 2/5 tendons there were remaining structural abnormalities. In conclusion, in patients with chronic painful mid-portion Achilles tendinosis, a good clinical result after eccentric training seems to be associated with a more normal tendon structure and no remaining neovascularisation. Action on the area with neovessels during the eccentric training regimen might possibly be responsible for the good clinical results.