Knobloch Karsten, Grasemann Ruth, Spies Marcus, Vogt Peter M
Sports Traumatology of the Hand and Wrist, Plastic, Hand and Reconstructive Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany.
Br J Sports Med. 2007 Jun;41(6):e4. doi: 10.1136/bjsm.2006.030957. Epub 2006 Nov 30.
Neovascularisation and microcirculatory changes have been reported in Achilles tendinopathy. Cryotherapy and compression, as part of a rest, ice, compression and elevation regimen, are shown to decrease pain and improve function. However, the microcirculatory changes following a given dosage of cryotherapy on mid-portion Achilles tendon remain unclear.
Prospective clinical cohort study, level of evidence 2.
30 people (12 males, 33 (SD 12) years, body mass index 25.6 (5.3) kg/m2) were included in the cohort. 3x10 min KoldBlue ankle-cooling bandages were applied and microcirculation of Achilles tendon mid-portion was real-time and continuously assessed using a laser-Doppler-spectrophotometry system (O2C, Germany).
Superficial capillary blood flow was reduced from 42 to 6, 5 and 3 relative units (rU) in the first, second and third cryotherapy periods, respectively (-65%, p = 0.001), with no significant capillary hyperaemia. Deep capillary tendon blood flow was reduced from 180 to 82, 53 and 52 rU (-71%, p = 0.001) within 6-9 min of application without hyperaemia. Superficial tendon oxygen saturation dropped significantly from 43% to 26%, 18% and 11% (p = 0.001) after repetitive cryotherapy, with persisting increase of tendon oxygenation during rewarming (51%, 49% and 54%, p = 0.077) up to 27% of the baseline level. At 8 mm tendon depth, cryotherapy preserved local oxygenation. Relative postcapillary venous tendon filling pressures were favourably reduced from 41 (11) to 31, 28 and 26 rU (-36%, p = 0.001) superficially and from 56 (11) to 45, 46 and 48 rU (-18%, p = 0.001) in deep capillary blood flow during cryotherapy, facilitating capillary venous clearance.
Intermittent cryotherapy of 3x10 min significantly decreases local Achilles tendon mid-portion capillary blood flow by 71%. Within 2 min of rewarming, tendon oxygen saturation is re-established following cryotherapy. Postcapillary venous filling pressures are reduced during cryotherapy, favouring capillary venous outflow of the healthy Achilles tendon.
跟腱病中已报道有新生血管形成和微循环变化。作为休息、冰敷、加压和抬高疗法的一部分,冷冻疗法和加压疗法已显示可减轻疼痛并改善功能。然而,特定剂量的冷冻疗法对跟腱中部微循环的影响仍不清楚。
前瞻性临床队列研究,证据等级为2级。
该队列纳入了30人(12名男性,年龄33(标准差12)岁,体重指数25.6(5.3)kg/m²)。应用3次,每次10分钟的KoldBlue踝关节冷却绷带,并使用激光多普勒分光光度系统(德国O2C)实时连续评估跟腱中部的微循环。
在第一次、第二次和第三次冷冻治疗期间,浅表毛细血管血流量分别从42相对单位降至6、5和3相对单位(rU)(-65%,p = 0.001),未见明显的毛细血管充血。在应用6 - 9分钟内,深部毛细血管肌腱血流量从180 rU降至82、53和52 rU(-71%,p = 0.001),无充血现象。重复冷冻治疗后,浅表肌腱氧饱和度从43%显著降至26%、18%和11%(p = 0.001),在复温过程中肌腱氧合持续增加(51%、49%和54%,p = 0.077),最高可达基线水平的27%。在肌腱深度为8 mm处,冷冻疗法可维持局部氧合。毛细血管后静脉肌腱充盈压在浅表处从41(11)rU有利地降至31、28和26 rU(-36%,p =