Plastic, Hand and Reconstructive surgery, Hannover Medical School, Germany.
J Orthop Surg Res. 2008 Apr 30;3:18. doi: 10.1186/1749-799X-3-18.
Tendinopathy is of distinct interest as it describes a painful tendon disease with local tenderness, swelling and pain associated with sonographic features such as hypoechogenic texture and diameter enlargement. Recent research elucidated microcirculatory changes in tendinopathy using laser Doppler flowmetry and spectrophotometry such as at the Achilles tendon, the patellar tendon as well as at the elbow and the wrist level. Tendon capillary blood flow is increased at the point of pain. Tendon oxygen saturation as well as tendon postcapillary venous filling pressures, determined non-invasively using combined Laser Doppler flowmetry and spectrophotometry, can quantify, in real-time, how tendon microcirculation changes over with pathology or in response to a given therapy. Tendon oxygen saturation can be increased by repetitive, intermittent short-term ice applications in Achilles tendons; this corresponds to 'ischemic preconditioning', a method used to train tissue to sustain ischemic damage. On the other hand, decreasing tendon oxygenation may reflect local acidosis and deteriorating tendon metabolism. Painful eccentric training, a common therapy for Achilles, patellar, supraspinatus and wrist tendinopathy decreases abnormal capillary tendon flow without compromising local tendon oxygenation. Combining an Achilles pneumatic wrap with eccentric training changes tendon microcirculation in a different way than does eccentric training alone; both approaches reduce pain in Achilles tendinopathy. The microcirculatory effects of measures such as extracorporeal shock wave therapy as well as topical nitroglycerine application are to be studied in tendinopathy as well as the critical question of dosage and maintenance. Interestingly it seems that injection therapy using color Doppler for targeting the area of neovascularisation yields to good clinical results with polidocanol sclerosing therapy, but also with a combination of epinephrine and lidocaine.
腱病是一种具有局部压痛、肿胀和疼痛的疼痛性肌腱疾病，与超声特征如低回声纹理和直径增大相关。最近的研究使用激光多普勒血流仪和分光光度法阐明了腱病中的微循环变化，例如在跟腱、髌腱以及肘部和腕部水平。在疼痛点，肌腱毛细血管血流增加。使用激光多普勒血流仪和分光光度法联合非侵入性地测定肌腱氧饱和度和肌腱后毛细血管静脉充盈压，可以实时定量肌腱微循环随病理变化或对特定治疗的反应而变化。在跟腱中，通过重复、间歇性的短期冰敷可以增加肌腱氧饱和度；这对应于“缺血预处理”，这是一种用于训练组织耐受缺血性损伤的方法。另一方面，降低肌腱氧合可能反映局部酸中毒和恶化的肌腱代谢。疼痛性离心训练是一种常见的治疗跟腱、髌腱、肩袖和腕部腱病的方法，它可以降低异常的毛细血管肌腱血流，而不会损害局部肌腱氧合。与单独进行离心训练相比，使用跟腱气动包裹结合离心训练会改变肌腱的微循环；这两种方法都可以减轻跟腱病的疼痛。还需要研究体外冲击波治疗和局部硝酸甘油应用等措施的微循环效应，以及剂量和维持的关键问题。有趣的是，似乎使用彩色多普勒注射治疗靶向新生血管化区域可以产生良好的临床效果，包括聚多卡醇硬化疗法和肾上腺素加利多卡因的联合治疗。
