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研究生:周婉婷
研究生(外文):Wan-ting Chou
論文名稱:使用老鼠模型以力學及功能性評估指數評估不同縫合技術對損傷阿基里斯腱癒合之影響
論文名稱(外文):Functional and mechanical evaluation of the suturing repairs for Achilles tendon injury in rat model
指導教授:葉明龍葉明龍引用關係
指導教授(外文):Ming-Long Yeh
學位類別:碩士
校院名稱:國立成功大學
系所名稱:醫學工程研究所碩博士班
學門:工程學門
學類:綜合工程學類
論文種類:學術論文
論文出版年:2009
畢業學年度:97
語文別:中文
論文頁數:73
中文關鍵詞:阿基里斯肌腱縫合技術勁度力學強度
外文關鍵詞:Achilles tendonsuture methodtendon rupturestiffnessmechanicsKrackowBunnellKessler
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  • 被引用被引用:1
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  • 下載下載:31
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阿基里斯肌腱斷裂常見於運動員與久坐的患者身上,對於急性阿基里斯斯腱的斷裂時裂口兩端的修復,可靠的軟組織固定是必要的。三種主要的阿基里斯肌腱裂的治療是打開傷口進行肌腱縫合的手術、穿越皮膚進行肌腱縫合的手術和保守性非手術的治療方式。對於治療這種損傷的爭論一直存在著。很多的學者主張手術治療,然而也有一些學者贊成非手術治療的方法。使用在阿基里斯肌腱斷裂的修復的數種手術技術從簡單的端對端的縫合到更複雜的縫合都有,然而至今,對於阿基里斯肌腱修復的縫合方法的影響很少被報導與闡明。
本實驗將系統性的討探阿基里斯肌腱斷裂的最佳縫合方式。目前沒有人用大鼠模型對於不同縫法使用功能性評估以及生物力學復原的評估,本實驗將先建立大鼠阿基里斯肌腱斷裂以及修復之主要模型,再分別使用Modified Kessler、Bunnell和Krackow三種縫法作為參數比較找出最適合阿基里斯腱癒合的手術方法,並且在不同的術後癒合時間點使用功能性評估以及力學測試為依據來評量手術方法之優劣,希望能為臨床肌腱斷裂修復手術提供良好的指標。
本實驗結果發現大鼠阿基里斯腱之抗拉強度以及勁度會隨體重和年齡變化,以離體實驗作三種縫法力學測試,Bunnell縫法和Krackow縫法可以提供相較於Kessler縫法較大的抗拉強度,另外進一步探討三種縫法在癒合後表現,Bunnell縫法在術後抵抗肌腱鍵腱隙形成,以及功能性指術恢復為四組最佳,也能在癒合初期提供一個較大的抗拉強度以及勁度,為本實驗建議之最佳縫法。
Complete rupture of the Achilles tendon can be experienced by both sedentary patients and athletes. Secure soft-tissue fixation is essential to direct end-to-end repair for acute tendon rupture. The three main treatments for ruptured Achilles tendon are open operative, percutaneous operative, and nonoperative. The controversy exists about the treatment of this injury. Many investigators advocate primary operative repair whereas other investigators favor a nonoperative method. Several operative techniques used to repair ruptured Achilles tendons ranging from simple end-to-end suturing to more complex repairs. However, the effect of suture methods on Achilles tendon repair have rarely been reported and interpreted so far.
To our knowledge, no investigation studies the functional and biomechanical recovery of the transected rat’s Achilles tendon repaired with different suture methods such as Modified Kessler, Bunnell, and Krackow. The purpose of this study is to investigate the optimization of suture method for Achilles tendon repair by temporal mechanical and functional evaluation and histological observation. We expect the results from this study can provide better guideline for operative ruptured tendon repair. The rat Achilles tendon repair model will be established. After sutured the rupture Achilles tendons with Modified Kessler, Modified Bunnell, and Krackow methods, the foot print of rats, the stiffness and fracture strength of healing tendon will be evaluated at 4, 7, 14, and 21 days.
The results showed that the tensile strength and stiffness of rat Achilles tendon change with body weight and age. Bunnell and Krackow methods can provide stronger tensile strength than Kessler method in ex-vivo study. In vivo study, Bunnell method had the best functional performance and the smallest gap formation. Besides, Bunnell method can provide the highest tensile strength and stiffness for stable mobility at early healing stage. In conclusion, Bunnell method is the best suture mechanically in three suture methods investigated in this study.
目錄
Abstract I
中文摘要 III
誌謝 V
圖目錄 X
表目錄 XII
第一章 緒論 1
1.1阿基里斯腱結構以及力學特性探討 1
1.2流行病學 1
1.3阿基里斯腱損傷理論 2
1.3.1肌腱的慢性退化理論 2
1.3.2 力學理論 3
1.4阿基里斯腱斷裂的治療 4
1.4.1.手術治療 4
1.4.2傳統治療 6
1.5相關文獻 7
1.5.1使用不同縫合方法修復肌腱之力學特性探討 7
1.5.2 肌腱間間隙形成對肌腱癒合影響探討 8
1.5.3功能性評估 9
1.5.4使用動物模型探討不同治療方式對阿基里斯腱癒合影響 11
1.5.5 縫合方式探討 11
1.6動機 14
1.7目的 14
第二章 實驗方法與材料 15
2.1實驗設備與材料 15
2.1.1高解析微力試驗機 15
2.1.2照相擷取系統 16
2.1.3夾具 17
2.1.4縫線 18
2.1.5 實驗動物-大鼠 19
2.2.1 實驗設計 19
2.2.2 動物實驗 20
2.2.3功能性評估 22
2.2.4力學測試 23
2.2.5 組織切片染色 26
2.2.6統計分析 27
第三章 結果 28
3.1 大鼠正常肌腱力學性質探討 28
3.2三種縫合方式提供之抗拉強度 31
3.3 不同縫合方式術後癒合表現 33
3.3.1癒合後解剖外觀 33
3.3.2 肌腱間間隙 35
3.3.3術後癒合力學測試之破壞模式 38
3.3.4 術後癒合之抗拉強度 39
3.3.5術後癒合之勁度 44
3.3.6功能性評估指數 48
3.3.7 組織學切片染色 51
第四章 討論 56
4.1 大鼠阿基里斯腱基本特性 56
4.2離體實驗抗拉強度比較 57
4.3 綜合探討各個參數 58
4.4 功能性評估指數 61
4.5 拉伸速率之選擇 62
4.6 文獻比較考量因素 63
4.7 樣本處理探討 64
4.8實驗限制 64
4.9未來研究 65
第五章 結論 67
第六章 參考文獻 68
自述 73
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