Knobloch Karsten, Grasemann Ruth, Spies Marcus, Vogt Peter M
Plastic, Hand and Reconstructive Surgery, Medical School Hannover, Hannover, Germany.
Am J Sports Med. 2008 Nov;36(11):2128-38. doi: 10.1177/0363546508319313. Epub 2008 Jul 18.
The effect of combined cryotherapy/compression versus cryotherapy alone on the Achilles tendon is undetermined.
Standardized combined cryotherapy/compression changes in midportion Achilles tendon microcirculation are superior to those with cryotherapy during intermittent application.
Controlled laboratory study.
Sixty volunteers were randomized for either combined cryotherapy/compression (Cryo/Cuff, DJO Inc, Vista, California: n = 30; 32 +/- 11 years) or cryotherapy alone (KoldBlue, TLP Industries, Kent, United Kingdom: n = 30; 33 +/- 12 years) with intermittent 3 x 10-minute application. Midportion Achilles tendon microcirculation was determined (O2C, LEA Medizintechnik, Giessen, Germany).
Both Cryo/Cuff and KoldBlue significantly reduced superficial and deep capillary tendon blood flow within the first minute of application (43 +/- 46 arbitrary units [AU] vs 10 +/- 19 AU and 42 +/- 46 AU vs 12 +/- 10 AU; P = .0001) without a significant difference throughout all 3 applications. However, during recovery, superficial and deep capillary blood flow was reestablished significantly faster using Cryo/Cuff (P = .023). Tendon oxygen saturation was reduced in both groups significantly (3 minutes Cryo/Cuff: 36% +/- 20% vs 16% +/- 15%; KoldBlue: 42% +/- 19% vs 28% +/- 20%; P < .05) with significantly stronger effects using Cryo/Cuff (P = .014). Cryo/Cuff led to significantly higher tendon oxygenation (Cryo/Cuff: 62% +/- 28% vs baseline 36% +/- 20%; P = .0001) in superficial and deep tissue (Cryo/Cuff: 73% +/- 14% vs baseline 65% +/- 17%; P = .0001) compared with KoldBlue during all recoveries. Postcapillary venous filling pressures were significantly reduced in both groups during application; however, Cryo/Cuff led to significantly, but marginally, lower pressures (Cryo/Cuff: 41 +/- 7 AU vs baseline 51 +/- 13 AU; P = .0001 and KoldBlue: 46 +/- 7 AU vs baseline 56 +/- 11 AU; P = .026 for Cryo/Cuff vs KoldBlue).
Increased tendon oxygenation is achieved as tendon preconditioning by combined cryotherapy and compression with significantly increased tendon oxygen saturation during recovery in contrast to cryotherapy alone. Both regimens lead to a significant amelioration of tendinous venous outflow.
Combined cryotherapy and compression is superior to cryotherapy alone regarding the Achilles tendon microcirculation. Further studies in tendinopathy and tendon rehabilitation are warranted to elucidate its value regarding functional issues.
冷冻疗法与压迫疗法联合应用对比单独冷冻疗法对跟腱的影响尚未明确。
标准化的冷冻疗法与压迫疗法联合应用对跟腱中部微循环的改变优于间歇性应用冷冻疗法。
对照实验室研究。
60名志愿者被随机分为冷冻疗法与压迫疗法联合应用组（Cryo/Cuff，DJO公司，加利福尼亚州维斯塔市：n = 30；32±11岁）或单独冷冻疗法组（KoldBlue，TLP工业公司，英国肯特郡：n = 30；33±12岁），间歇性应用3次，每次10分钟。测定跟腱中部的微循环（O2C，LEA Medizintechnik公司，德国吉森）。
Cryo/Cuff和KoldBlue在应用的第一分钟均显著降低了浅层和深层毛细血管的肌腱血流（43±46任意单位[AU]对10±19 AU以及42±46 AU对12±10 AU；P = .0001），在所有3次应用过程中无显著差异。然而，在恢复过程中，使用Cryo/Cuff时浅层和深层毛细血管血流的重建明显更快（P = .023）。两组的肌腱氧饱和度均显著降低（Cryo/Cuff 3分钟时：36%±20%对16%±15%；KoldBlue：42%±19%对28%±20%；P < .05），使用Cryo/Cuff时效果显著更强（P = .014）。与KoldBlue相比，在所有恢复阶段，Cryo/Cuff导致浅层和深层组织的肌腱氧合显著更高（Cryo/Cuff：62%±28%对基线36%±20%；P = .0001）（Cryo/Cuff：73%±14%对基线65%±17%；P = .0001）。应用过程中两组的毛细血管后静脉充盈压均显著降低；然而，Cryo/Cuff导致的压力显著但略微更低（Cryo/Cuff：41±7 AU对基线51±13 AU；P = .0001以及KoldBlue：46±7 AU对基线56±11 AU；Cryo/Cuff对比KoldBlue，P = .026）。
与单独冷冻疗法相比，冷冻疗法与压迫疗法联合应用作为肌腱预处理可提高肌腱氧合，在恢复过程中肌腱氧饱和度显著增加。两种方案均导致肌腱静脉流出显著改善。
在跟腱微循环方面，冷冻疗法与压迫疗法联合应用优于单独冷冻疗法。有必要在肌腱病和肌腱康复方面进行进一步研究以阐明其在功能问题上的价值。
