本文選題：骨骼肌損傷 + 運(yùn)動(dòng)療法　； 參考：《安徽師范大學(xué)》2017年碩士論文

【摘要】：骨骼肌急性損傷是指骨骼肌組織遭到瞬間暴力地牽拉、擠壓、扭轉(zhuǎn)所引起的損傷[1]。多數(shù)情況下?lián)p傷骨骼肌愈合以不完全性再生愈合為主,肌內(nèi)膜纖維化和瘢痕組織的形成使肌纖維部分失去正常的結(jié)構(gòu)和功能[2]。如何促進(jìn)骨骼肌再生,預(yù)防肌肉纖維化,提高骨骼肌的愈合質(zhì)量是運(yùn)動(dòng)醫(yī)學(xué)界研究的熱點(diǎn)。運(yùn)動(dòng)療法、按摩療法對(duì)于肌肉損傷修復(fù)和功能重建,具有常規(guī)醫(yī)學(xué)如手術(shù)和藥物等治療不可替代的特點(diǎn)和優(yōu)點(diǎn)。其作為一種經(jīng)濟(jì)有效,無損易行的康復(fù)手段,具有深遠(yuǎn)的臨床潛力。但是直到目前為止,運(yùn)動(dòng)療法與按摩療法在肌肉損傷及修復(fù)的過程中是如何影響骨骼肌結(jié)構(gòu)、功能的生物學(xué)研究仍然處于探索階段。研究目的本課題以大鼠骨骼肌急性鈍挫傷模型作為研究對(duì)象,以肌肉組織形態(tài)和C-反應(yīng)蛋白(C-reactive protein,CRP)為觀察指標(biāo),研究運(yùn)動(dòng)療法和按摩療法對(duì)肌肉損傷及修復(fù)過程中肌肉組織形態(tài)變化和急性炎癥的病理生理反應(yīng);根據(jù)損傷肌肉組織的圖像和炎性C-反應(yīng)蛋白的反應(yīng)程度,篩選出最優(yōu)康復(fù)方案,其結(jié)果將更好地幫助臨床醫(yī)生、患者把握運(yùn)動(dòng)療法與按摩療法的介入時(shí)機(jī),并為廣大健身者、運(yùn)動(dòng)員提供骨骼肌損傷的康復(fù)方法。研究方法選用成年健康雄性SD大鼠60只(360±22.7g),以自制損傷模型打擊大鼠右側(cè)脛骨前肌,隨后隨機(jī)分為四組,分別是:自然康復(fù)組(A組)、運(yùn)動(dòng)療法組(B組)、按摩療法組(C組)、運(yùn)動(dòng)療法加按摩療法組(D組),每組各15只大鼠。自然康復(fù)組不做任何處理,運(yùn)動(dòng)療法組、按摩療法組、運(yùn)動(dòng)療法加按摩療法組等三組于損傷造模后72小時(shí)開始各自的康復(fù)方案。四組分別于造模前和造模后的第2天、5天、8天、12天、16天取下大鼠損傷腿脛骨前肌肌肉組織,將肌肉樣本HE染色后,觀察肌肉組織在康復(fù)過程中的形態(tài)變化;并在同一時(shí)間取下大鼠血液,將其分離后提取血清,以ELISA(酶聯(lián)免疫法)測(cè)定血清中CRP含量,以反映損傷所致的炎癥程度和持續(xù)的時(shí)間。研究結(jié)果(1)一般觀察:損傷模型引起所有大鼠的脛骨前肌重度損傷,表現(xiàn)為右后肢腫脹、皮下瘀血、走路跛行和毛發(fā)暗淡、食欲差、易怒、不愿意跑動(dòng)等癥狀。采用四種康復(fù)方案后癥狀在不等時(shí)間內(nèi)得到消除,具體是第6天按摩療法組、第8天運(yùn)動(dòng)療法加按摩療法組、第10天運(yùn)動(dòng)療法組、第16天自然康復(fù)組。(2)組織學(xué)觀察:損傷模型引起所有大鼠右后肢脛骨前肌的組織結(jié)構(gòu)破壞,肌纖維斷裂、排列紊亂、肌小節(jié)不清、間隙增大。四種康復(fù)方案后,脛骨前肌的組織形態(tài)在不等的時(shí)間得到修復(fù)。自然康復(fù)組:損傷后第8-12天,肌纖維之間結(jié)締組織填充明顯,周圍組織粘連,肌纖維萎縮,肌細(xì)胞較大范圍壞死;第16天時(shí),肌纖維之間結(jié)締組織相互交織,肌纖維排列仍然紊亂,肌小節(jié)不清,以瘢痕組織修復(fù)為主,部分組織尚在修復(fù)中。運(yùn)動(dòng)療法組:損傷后第2-6天,炎癥細(xì)胞浸潤(rùn)損傷骨骼肌組織,肌細(xì)胞大面積死亡,肌纖維斷裂明顯,排列零亂;第6-12天,結(jié)締組織填充減少,肌纖維排列逐漸有序,組織結(jié)構(gòu)趨于完整。第12-16天,肌纖維有序排列,肌小節(jié)結(jié)構(gòu)清晰,骨骼肌組織基本正常。按摩療法組:損傷后第2-6天,炎癥細(xì)胞浸潤(rùn)損傷骨骼肌組織,骨骼肌細(xì)胞大面積死亡,幸存肌纖維排列扭曲,肌小節(jié)結(jié)構(gòu)破壞;第6-12天,成肌細(xì)胞增殖明顯,肌纖維少量結(jié)締組織填充,肌纖維排列整齊,肌小節(jié)清楚,接近正常組織。第12-16天,損傷骨骼肌與周圍組織之間無結(jié)締組織填充,肌細(xì)胞排列整齊,骨骼肌組織形態(tài)完整。運(yùn)動(dòng)療法加按摩療法組:損傷后第2-6天,肌纖維撕裂、扭曲,肌小節(jié)結(jié)構(gòu)破壞,炎癥細(xì)胞浸潤(rùn)損傷骨骼肌組織;第6-12天,肌纖維之間可見結(jié)締組織,有少量瘢痕形成,肌纖維扭曲,但整體排列走向一致;第12-16天,肌纖維之間無結(jié)締組織,肌細(xì)胞排列整齊,肌小節(jié)結(jié)構(gòu)完整。(3)C-反應(yīng)蛋白:損傷模型導(dǎo)致血清CRP含量上升至損傷前的37倍,大鼠產(chǎn)生嚴(yán)重的炎癥反應(yīng)。四種康復(fù)方案后CRP在不等的時(shí)間回落并恢復(fù)和接近損傷前水平,分別為:自然康復(fù)組第16天時(shí)仍然上升3倍,基本接近正常;運(yùn)動(dòng)療法組第12天時(shí)下降至損傷前水平;按摩療法組第8天時(shí)已經(jīng)恢復(fù)損傷前水平;運(yùn)動(dòng)療法加按摩療法組第12天時(shí)下降至損傷前水平。按摩療法組、運(yùn)動(dòng)療法加按摩療法組、運(yùn)動(dòng)療法組等三組比較自然康復(fù)組的CRP回落時(shí)間、程度均呈顯著性差異(p0.05);按摩療法組比較運(yùn)動(dòng)療法組、運(yùn)動(dòng)療法加按摩療法組的CRP回落速度、程度也呈顯著性差異(p0.05)。研究結(jié)論運(yùn)動(dòng)療法、按摩療法對(duì)骨骼肌損傷組織形態(tài)重建產(chǎn)生積極的影響,康復(fù)損傷骨骼肌肌肉力量,矯正損傷骨骼肌肌纖維排列,組織結(jié)構(gòu)的完整;同時(shí)改善肌肉微環(huán)境,減少炎癥細(xì)胞浸潤(rùn)和肌細(xì)胞的壞死,加速炎癥細(xì)胞消除,降低由于肌肉纖維降解造成的細(xì)胞應(yīng)激反應(yīng),縮短反應(yīng)時(shí)間。由此,運(yùn)動(dòng)療法、按摩療法是急性骨骼肌損傷康復(fù)的有效療法。
[Abstract]:Acute skeletal muscle injury refers to the injury of skeletal muscle tissue that is caused by sudden and violent pull, extrusion, and torsion. In most cases, [1]. damages the healing of skeletal muscle with incomplete regenerative healing, and the formation of intimal fibrosis and scar tissue causes the muscle fibers to lose normal structure and function [2]. how to promote skeletal muscle regeneration. The prevention of muscle fibrosis and the improvement of the healing quality of skeletal muscle are the hot spots in the field of sports medicine. Exercise therapy and massage therapy have the irreplaceable features and advantages of conventional medicine, such as surgery and medicine, for the repair of muscle damage and functional reconstruction. It is an economical, effective and nondestructive method of rehabilitation. Clinical potential. But until now, the biological research of the skeletal muscle is still at the exploratory stage in the process of muscle injury and repair. The objective of this study is to study the acute blunt injury model of skeletal muscle in rats as the research object, with the form of muscle tissue and the C- reactive protein. C-reactive protein, CRP), as an observation index, studies the changes of muscle tissue morphology and the pathophysiological response of acute inflammation in the process of muscle injury and repair by motor therapy and massage therapy. According to the image of the injured muscle tissue and the degree of reaction of inflammatory C- reaction protein, the optimal compound case is screened out, and the results will help the clinical practice better. Doctors, the patient grasped the timing of the intervention of the exercise therapy and the massage therapy, and provided the rehabilitation methods for the skeletal muscle injury for the majority of the health workers and athletes. 60 adult healthy male SD rats (360 + 22.7g) were selected to attack the right tibial anterior muscles of the right side of the rats by self-made injury model, and then randomly divided into four groups: the natural rehabilitation group (group A). ), the exercise therapy group (group B), the massage therapy group (group C), the exercise therapy plus the massage therapy group (group D), each group of 15 rats. The natural rehabilitation group does not do any treatment, the exercise therapy group, the massage therapy group, the exercise therapy plus the massage therapy group and other groups begin their respective rehabilitation programs at 72 hours after the injury model. The four groups are respectively before the model and after the model building. After second days, 5 days, 8 days, 12 days and 16 days, the muscle tissue of the injured leg of the tibia was removed. After the muscle samples were stained with HE, the morphological changes of the muscle tissue during the recovery process were observed. The blood was removed from the rat at the same time and the serum was extracted after the separation, and the serum CRP content was measured by ELISA (ELISA) to reflect the inflammation caused by the injury. The degree and duration of the disease (1) general observation: the damage model caused the severe injury of the anterior tibial muscle of all rats, which showed the swelling of the right hind limbs, the subcutaneous ecchymosis, the walking limp and the dim hair, the poor appetite, the irritability, and the unwillingness to run. The symptoms were eliminated in unequal time after the four kinds of Kang compound cases, specifically Sixth Day massage therapy group, eighth days of exercise therapy plus massage therapy group, tenth days exercise therapy group, sixteenth days natural rehabilitation group. (2) histological observation: damage model caused the damage of the tissue structure of the anterior tibial muscle of all right hind limbs of all rats, the fracture of muscle fibers, the disorderly arrangement, the indistinct muscle segments and the gap enlargement. After four kinds of rehabilitation programs, the tissue of the tibia anterior muscle In the natural rehabilitation group: after 8-12 days after injury, the connective tissue between muscle fibers was filled obviously, the surrounding tissue was adhered, the muscle fibers atrophied, and the muscle cells were necrotic in a large range. At the sixteenth day, the connective tissue between the muscle fibers interlaced each other, the muscle fibers were arranged in disorder, the muscle segments were not clear and the scar tissue was repaired mainly. Some tissues were still in repair. On the 2-6 day after injury, the inflammatory cells infiltrated and damaged the skeletal muscle tissue, the muscle cells died in large area, the muscle fibers were fractured and scattered. On the 6-12 day, the connective tissue filling decreased, the muscle fibers arranged gradually and the structure tended to complete. The 12-16 day, the orderly arrangement of the muscle fibers, the muscle nodules were arranged on day 12-16. The skeletal muscle tissue is normal. The massage therapy group: 2-6 days after the injury, the inflammatory cells infiltrate and damage the skeletal muscle tissue, the skeletal muscle cells die in large area, the muscle fiber arrangement is distorted, the muscle section structure is destroyed; on the 6-12 day, the myoblasts proliferate obviously, the muscle fibers are filled with a small amount of connective tissue, the muscle fibers are arranged neatly and the muscle section clear. Chu, close to normal tissue. On day 12-16, no connective tissue was filled between the skeletal muscle and surrounding tissue, the muscle cells arranged orderly and the skeletal muscle tissue was complete. Exercise therapy plus massage therapy group: the 2-6 day after injury, muscle fiber tearing, distortion, muscle substructure destruction, inflammatory cell infiltration and injury of skeletal muscle tissue; the 6-12 day, muscle fiber. Connective tissue is seen between the connective tissue, a small number of scar formation, muscle fiber distortion, but the overall arrangement of the same direction; on the 12-16 day, no connective tissue between the muscle fibers, the muscle cells arranged neatly, the muscle segments complete. (3) the C- reaction protein: the damage model leads to the increase of the serum CRP content to 37 times before the injury. The rats produce severe inflammatory reaction. Four kinds of healthy rats. After the compound case, CRP fell back and recovered and approached the level before the injury. The natural rehabilitation group was still up 3 times in sixteenth days and nearly normal; the exercise therapy group dropped to the pre injury level at twelfth days; the massage therapy group had recovered before the injury at eighth days, and the exercise therapy plus the massage therapy group decreased to twelfth days. Before injury level, the three groups, such as massage therapy group, exercise therapy plus massage therapy group and exercise therapy group, were compared with the natural rehabilitation group for CRP fall time, the degree was significantly different (P0.05); the massage therapy group compared the movement therapy group, the exercise therapy plus the massage therapy group's CRP fall speed, the degree also showed significant difference (P0.05). Research conclusions Dynamic therapy, massage therapy has a positive effect on the reconstruction of tissue damage in skeletal muscle, rehabilitate the muscle strength of the skeletal muscle, rectify the injury of the muscle fibers arrangement and the integrity of the tissue structure, improve the muscle microenvironment, reduce the infiltration of inflammatory cells and the bad death of the muscle cells, accelerate the elimination of inflammatory cells, and reduce the loss of muscle fiber. To solve the cellular stress reaction and shorten the reaction time, exercise therapy and massage therapy are effective therapies for acute skeletal muscle injury rehabilitation.
【學(xué)位授予單位】：安徽師范大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：G804.2

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本文編號(hào)：2118445