Tipton C M, Vailas A C, Matthes R D
Acta Med Scand Suppl. 1986;711:157-68. doi: 10.1111/j.0954-6820.1986.tb08945.x.
The clinical practices of the future depend upon the experimental findings of today. Because of the uniqueness of connective tissue, animal experimentation will be essential for advances in this field. During the last decade, the improvements in technology and the increased interest of basic scientists and research clinicians on the effects of physical activity has markedly enhanced the amount of information available to practicing physicians. Studies spanning the appearances of structure to the changes in the crosslinks of collagen, clearly demonstrate that limb immobilization (inactivity) is deleterious to all structures involved whether evaluated anatomically, physiologically, or biomechanically. Furthermore, when surgical repair is included, there are stages when the deleterious processes become accelerated with or without immobilization. Hence, clinical immobilization must be utilized in a prudent and careful manner. There is sufficient experimental evidence for clinicians to utilize motion and mechanical stimuli as a means to improve the structure and function of tendons, ligaments, and joints. However, the unresolved issues are the mode, time of initiation, or the intensity of application. Even when used with repair, recovery of normal structures and function is protracted. The primary or secondary mechanisms associated with these effects of physical activity are unknown and virtually uninvestigated at the present time.
未来的临床实践取决于当今的实验结果。由于结缔组织的独特性,动物实验对于该领域的进展至关重要。在过去十年中,技术的进步以及基础科学家和临床研究人员对身体活动影响的兴趣增加,显著增加了执业医师可获得的信息量。从结构外观到胶原蛋白交联变化的研究清楚地表明,肢体固定(不活动)对所有涉及的结构都是有害的,无论从解剖学、生理学还是生物力学角度进行评估。此外,当包括手术修复时,在有或没有固定的情况下,有害过程在某些阶段会加速。因此,必须谨慎使用临床固定。有足够的实验证据表明,临床医生可以利用运动和机械刺激来改善肌腱、韧带和关节的结构和功能。然而,尚未解决的问题是方式、开始时间或应用强度。即使与修复一起使用,正常结构和功能的恢复也很漫长。目前,与身体活动这些影响相关的主要或次要机制尚不清楚,实际上也未得到研究。