CAJ | 학술논문

目的：研究低强度脉冲超声波(low-intensity pulsed ultrasound， LIPU)促进肌腱愈合以及减少肌腱粘连的作用机理。方法2010年7月—2012年10月，将我院急诊收治的指屈肌腱Ⅱ区切割损伤患者120例(138指)按照前瞻、随机、双盲的方法分为单纯肌腱损伤治疗组(LIPU组，33例，39指)，单纯肌腱损伤对照组(Shame LIPU组，34例，41指)，肌腱伴神经损伤治疗组(NLIPU组，28例，31指)，肌腱伴神经损伤对照组(Shame NLIPU组，25例，27指)。所有病例行肌腱修复术2周后，治疗组(LIPU组与NLIPU组)于每日接受低强度超声刺激，对照组(Shame LIPU组和Shame NLIPU组)给予假刺激，治疗周期为2周，分别于术后4周，8周及12周对治疗组(LIPU组与NLIPU组)与对照组(Shame LIPU组和Shame NLIPU组)的切口痊愈程度、患手疼痛程度、患手功能、屈指肌力等方面进行评估，探讨LIPU促进肌腱愈合以及减少肌腱粘连的作用机理。结果术后4周患手切口均为甲级痊愈，无肌腱断裂情况；治疗组（LIPU与NLIPU）患手功能在术后12周较术后4周均有明显改善(P＜0.01)；术后4周，8周以及12周，LIPU组与Shame LIPU组、NLIPU组与Shame NLIPU组比较，LIPU组和NLIPU组患手功能具有明显的提高(P＜0.01)；术后12周，LIPU组与Shame LIPU组治疗的良、中、差率相比，差异均具有显著性(P＜0.05)；术后12周，LIPU组与Shame LIPU组、NLIPU组与Shame NLIPU组比较，LIPU组和NLIPU组患手屈指肌力均有明显改善，差异均具有显著性(P＜0.05)。结论 LIPU可有效促进肌腱愈合和手功能恢复，为防止肌腱粘连找到了新方法。
목적：연구저강도맥충초성파(low-intensity pulsed ultrasound， LIPU)촉진기건유합이급감소기건점련적작용궤리。방법2010년7월—2012년10월，장아원급진수치적지굴기건Ⅱ구절할손상환자120례(138지)안조전첨、수궤、쌍맹적방법분위단순기건손상치료조(LIPU조，33례，39지)，단순기건손상대조조(Shame LIPU조，34례，41지)，기건반신경손상치료조(NLIPU조，28례，31지)，기건반신경손상대조조(Shame NLIPU조，25례，27지)。소유병례행기건수복술2주후，치료조(LIPU조여NLIPU조)우매일접수저강도초성자격，대조조(Shame LIPU조화Shame NLIPU조)급여가자격，치료주기위2주，분별우술후4주，8주급12주대치료조(LIPU조여NLIPU조)여대조조(Shame LIPU조화Shame NLIPU조)적절구전유정도、환수동통정도、환수공능、굴지기력등방면진행평고，탐토LIPU촉진기건유합이급감소기건점련적작용궤리。결과술후4주환수절구균위갑급전유，무기건단렬정황；치료조（LIPU여NLIPU）환수공능재술후12주교술후4주균유명현개선(P＜0.01)；술후4주，8주이급12주，LIPU조여Shame LIPU조、NLIPU조여Shame NLIPU조비교，LIPU조화NLIPU조환수공능구유명현적제고(P＜0.01)；술후12주，LIPU조여Shame LIPU조치료적량、중、차솔상비，차이균구유현저성(P＜0.05)；술후12주，LIPU조여Shame LIPU조、NLIPU조여Shame NLIPU조비교，LIPU조화NLIPU조환수굴지기력균유명현개선，차이균구유현저성(P＜0.05)。결론 LIPU가유효촉진기건유합화수공능회복，위방지기건점련조도료신방법。
Objective To investigate the mechanism of low-intensity pulsed ultrasound (LIPU) in promote tendon healing and reducing tendon adhesions. Methods In accordance with the prospective, randomized, double-blind approach, the 120 cases (138 figures) were divided into tendon injury and tendon associated with nerve injury. The patients with flexor tendon injury in zone Ⅱ from emergency department were divided into treatment group (LIPU group, 33 cases, 39 figures) and control group (Shame LIPU group, 34 cases, 41 figures), and the patients with tendon associated with nerve injury were divided into treatment group (NLIPU group, 28 cases, 31 figures) and control group (Shame LIPU group, 25 cases, 27 figures). For two weeks after tendon repair operation, the treatment group (LIPU group and NLIPU group) received LIPU therapy daily, and the control group (Shame LIPU group and Shame NLIPU group) received sham stimulation. The treatment period was 2 weeks, and the effect of treatment were evaluated by the incision healing, the degree of pain, the hands function and muscle force 4 weeks, 8 weeks and 12 weesk after taking the operation. Results All the patients with stage I wound healed after 12 weeks. The hand function of treatment group (LIPU group and NLIPU group) was improved at 12 weeks compared to 4 weeks (P<0.01). The hand function of treatment group (LIPU group and NLIPU group) was also improved compared to the control group (Shame LIPU group and Shame NLIPU group) (P<0.01) at 4 weeks, 8 weeks and 12 week. There was significant statistical difference of the rates of good, middle and poor in the LIPU group compared to the NLIPU group after 12 weeks (P<0.05). It was obviously improved in muscle force, and there was significant statistical difference in the treatment group (LIPU group and NLIPU group) compared to the control group (Shame LIPU group and Shame NLIPU group) after 12 weeks (P<0.05). Conclusion LIPU has reliable effect on tendon healing and restoration of hand function, and it is a new way of preventing tendon adhesion.