簡介肌腱,以及肌腱治療證據等級 (by 林杏青醫師)
武俠小說常說腳筋被斷就成了廢人。這裡講的廢人不是廢宅的那種廢人,而是再也無法正常行走與施展武功的人。那為什麼腳筋那麼重要呢?
其實東方俗稱的筋就是肌腱,斷腳筋就是切斷阿基里斯腱,阿基里斯腱是小腿後側底部靠近腳底板那條有彈性又有點硬的東西。不過現在醫學發達,Kobe Bryant 曾經阿基里斯腱斷裂也接回來過!
肌腱的功能
你的肌肉收縮時,靠著連接肌肉和骨頭的肌腱,把拉力傳遞到骨頭上身體才會動。如果肌腱斷了,力量無法傳遞到骨頭,骨頭無法帶動肢體,那身體就不會動了。
肌腱常常和韌帶搞混,肌腱叫 Tendon ,天燈;韌帶叫 Ligament ,力哥們。肌腱是連接肌肉和骨頭,韌帶是連結骨頭和骨頭。其實真的很容易搞混,翻譯的時候也會常常寫顛倒。
肌腱大體上而言是由膠原蛋白組成的,為了連結肌肉和骨頭並且承受肌肉拉動的力量,它必須非常強韌。我們用顯微鏡仔細看肌腱的纖維的話,可以看到膠原纖維一條一條組成小捆,再組成大捆,就像纜繩一樣拉著骨頭和肌肉。
圖片改自:https://docplayer.fi
肌腱為何會受傷?
那麼強韌的肌腱什麼情況下會受傷?常見的有過度使用造成的傷害,和一瞬間承受過大力量時造成的傷害。其他的例如被砍、笑話太難笑肌腱尷尬斷掉的、被異形溶掉的暫時先不討論。
假如一個不運動的肥宅喜歡上一個愛慢跑的女孩,在沒進時光屋好好鍛鍊之前,就追在女孩後面跑了十幾公里,那肥宅的肌腱就有可能受傷。這種受傷就可能屬於第一種的過度使用。不過肥宅可能會先進警局(?)
另一種過度使用是運動員經年累月的操勞下產生的撕裂傷,有時可能毫無預警的發生。很多運動選手都曾發生過。
假如一個巨宅(壯宅)為了表演舉起超重啞鈴給健身房旁邊的正妹看,然後一個不小心姿勢不正確,同時又超過自己平時能負荷的重量太多,也有可能造成肌腱斷裂。這次就屬於第二種的一瞬間承受過大力量造成的受傷。這時候巨宅的手臂會鼓起來,因為二頭肌連肩關節那邊的肌腱斷了,肌肉會縮起來跑到上臂的中間。(這種狀況下常見的還有肌肉拉傷)
所以這兩個故事告訴我們,不要用體力去追女生。不是啦,講錯了,是不要隨便做超過自己體能極限的運動,那樣會增加很多運動傷害的風險。況且肥宅跑得氣喘吁吁、壯宅猙獰表情舉啞鈴,就算沒受傷樣子也不會太好看,女孩也不見得就會欣賞呀。
接下來是關於肌腱受傷的一些醫學知識:
- 如果你肌腱真的受傷了,除了斷掉那種要直接送醫院縫起來以外,一般的受傷或發炎適合用冰敷(冷敷)作為第一天時的緩和處理,一次敷十分鐘,中間間隔二十分鐘,敷兩到三次便可。接著盡快到醫院復健科掛號看診或是復健科診所做診斷和治療。(建議後者,一來是分流二來是比較不用等太久)
這一項的證據等級:B - 短期內使用非類固醇的止痛藥是合理的,因為你真的會很痛。短期指的是大約兩週內。
這一項的證據等級:B - 假如短期內非類固醇的止痛藥效果不好,那可能要使用注射類固醇的方式來緩解疼痛。
這一項的證據等級:B - 電療、治療性超音波、雷射治療的證據並不明確。但超音波對鈣化性肌腱炎、網球肘等等特定部位的肌腱炎較有效。
這一項的證據等級:B - 適當的休息有好處,但是目前醫學上還未有定論休息多久最好。
這一項的證據等級:C - 對於肌腱受傷的物理治療裡,目前運動治療中離心收縮的證據強度最高,但不是所有研究都顯示這個比其他訓練或用超音波儀器治療還要好。
這一項的證據等級:B - 如果你的肌腱一直都沒有完全好起來,假如變成慢性肌腱炎,那使用震波治療安全效果通常也不錯,但是貴貴der。
這一項的證據等級:B - 目前還不確定輔具來固定或輔助肌腱相關的受傷到底有沒有效,可能和使用與固定的方式有關。
這一項的證據等級:B - 肌腱受傷接受三到六個月的保守治療,平均有八成的人能復原。如果你不幸是那兩成,可以把開刀當成最後的選項。
這一項的證據等級:B
什麼是證據等級?
並不是所有的醫學研究的可靠程度都一樣,所以我們分了ABC這幾種等級。
A級的意思是最讚的,研究的成果非常一致、品質良好、並且以臨床為基礎。
B級的意思是第二讚,以臨床為基礎但是研究結果不夠一致,或者品質不夠。
C級再弱一些,他是一個共識的想法,通常是實用的專家建議,或者是一系列案例的結果。
延伸閱讀可以看實證醫學這篇,雖然這邊講的ABC分法和實證醫學那篇的牛津證據等級不一樣,但精神是一樣的。
另外像是增生療法與自體血小板血漿注射(PRP)這些新興的治療方式,也有許多小規模研究認為對肌腱的恢復有幫助。
整體來說,雖然綜合了一百七十七篇綜合性研究和臨床試驗,但對於如何最有效治療肌腱的受傷,我們還是只有一個粗略的方向可以依循。因為每個人的體質和受傷方式都不一樣,採取什麼樣的治療也不一樣。還需要更多的研究來釐清各種因素與治療效果。
如何搭配各種治療方式,很仰賴醫生與物理治療師的專業與經驗,來判斷最適合你的治療方式。
合作撰寫:
好痛痛(粉絲頁)、林杏青復健科總醫師(專欄連結)
參考資料:
1.Common Overuse Tendon Problems: A Review and Recommendations for Treatment, JOHN J. WILSON, M.D., and THOMAS M. BEST, M.D., PH.D., University of Wisconsin Medical School, Madison, Wisconsin Am Fam Physician. 2005 Sep 1;72(5):811-818.
2.Treatment of Tendinopathy What Works, What Does Not, and What is on the Horizon , Brett M. Andres MD, George A. C. Murrell MD, Dphil, Clin Orthop Relat Res (2008) 466:1539–1554
3.Platelet-rich therapies for musculoskeletal soft tissue injuries. Moraes VY1, Lenza M, Tamaoki MJ, Faloppa F, Belloti JC. Cochrane Database Syst Rev. 2014 Apr 29;(4)
4.Effectiveness and safety of prolotherapy injections for management of lower limb tendinopathy and fasciopathy: a systematic review, Lane M. Sanderson and Alan Bryant, J Foot Ankle Res. 2015; 8: 57.
感謝撰文
去年底手指過度使用 滑手機+電腦長時間筆記造成大面積發炎 非常需要指點QQ
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