运动与按摩对损伤骨骼肌转归过程中组织形态及C-反应蛋白的影响

发布时间：2018-07-12 20:58

本文选题：骨骼肌损伤 + 运动疗法　；参考：《安徽师范大学》2017年硕士论文

【摘要】：骨骼肌急性损伤是指骨骼肌组织遭到瞬间暴力地牵拉、挤压、扭转所引起的损伤[1]。多数情况下损伤骨骼肌愈合以不完全性再生愈合为主,肌内膜纤维化和瘢痕组织的形成使肌纤维部分失去正常的结构和功能[2]。如何促进骨骼肌再生,预防肌肉纤维化,提高骨骼肌的愈合质量是运动医学界研究的热点。运动疗法、按摩疗法对于肌肉损伤修复和功能重建,具有常规医学如手术和药物等治疗不可替代的特点和优点。其作为一种经济有效,无损易行的康复手段,具有深远的临床潜力。但是直到目前为止,运动疗法与按摩疗法在肌肉损伤及修复的过程中是如何影响骨骼肌结构、功能的生物学研究仍然处于探索阶段。研究目的本课题以大鼠骨骼肌急性钝挫伤模型作为研究对象,以肌肉组织形态和C-反应蛋白(C-reactive protein,CRP)为观察指标,研究运动疗法和按摩疗法对肌肉损伤及修复过程中肌肉组织形态变化和急性炎症的病理生理反应;根据损伤肌肉组织的图像和炎性C-反应蛋白的反应程度,筛选出最优康复方案,其结果将更好地帮助临床医生、患者把握运动疗法与按摩疗法的介入时机,并为广大健身者、运动员提供骨骼肌损伤的康复方法。研究方法选用成年健康雄性SD大鼠60只(360±22.7g),以自制损伤模型打击大鼠右侧胫骨前肌,随后随机分为四组,分别是:自然康复组(A组)、运动疗法组(B组)、按摩疗法组(C组)、运动疗法加按摩疗法组(D组),每组各15只大鼠。自然康复组不做任何处理,运动疗法组、按摩疗法组、运动疗法加按摩疗法组等三组于损伤造模后72小时开始各自的康复方案。四组分别于造模前和造模后的第2天、5天、8天、12天、16天取下大鼠损伤腿胫骨前肌肌肉组织,将肌肉样本HE染色后,观察肌肉组织在康复过程中的形态变化;并在同一时间取下大鼠血液,将其分离后提取血清,以ELISA(酶联免疫法)测定血清中CRP含量,以反映损伤所致的炎症程度和持续的时间。研究结果(1)一般观察:损伤模型引起所有大鼠的胫骨前肌重度损伤,表现为右后肢肿胀、皮下瘀血、走路跛行和毛发暗淡、食欲差、易怒、不愿意跑动等症状。采用四种康复方案后症状在不等时间内得到消除,具体是第6天按摩疗法组、第8天运动疗法加按摩疗法组、第10天运动疗法组、第16天自然康复组。(2)组织学观察:损伤模型引起所有大鼠右后肢胫骨前肌的组织结构破坏,肌纤维断裂、排列紊乱、肌小节不清、间隙增大。四种康复方案后,胫骨前肌的组织形态在不等的时间得到修复。自然康复组:损伤后第8-12天,肌纤维之间结缔组织填充明显,周围组织粘连,肌纤维萎缩,肌细胞较大范围坏死;第16天时,肌纤维之间结缔组织相互交织,肌纤维排列仍然紊乱,肌小节不清,以瘢痕组织修复为主,部分组织尚在修复中。运动疗法组:损伤后第2-6天,炎症细胞浸润损伤骨骼肌组织,肌细胞大面积死亡,肌纤维断裂明显,排列零乱;第6-12天,结缔组织填充减少,肌纤维排列逐渐有序,组织结构趋于完整。第12-16天,肌纤维有序排列,肌小节结构清晰,骨骼肌组织基本正常。按摩疗法组:损伤后第2-6天,炎症细胞浸润损伤骨骼肌组织,骨骼肌细胞大面积死亡,幸存肌纤维排列扭曲,肌小节结构破坏;第6-12天,成肌细胞增殖明显,肌纤维少量结缔组织填充,肌纤维排列整齐,肌小节清楚,接近正常组织。第12-16天,损伤骨骼肌与周围组织之间无结缔组织填充,肌细胞排列整齐,骨骼肌组织形态完整。运动疗法加按摩疗法组:损伤后第2-6天,肌纤维撕裂、扭曲,肌小节结构破坏,炎症细胞浸润损伤骨骼肌组织;第6-12天,肌纤维之间可见结缔组织,有少量瘢痕形成,肌纤维扭曲,但整体排列走向一致;第12-16天,肌纤维之间无结缔组织,肌细胞排列整齐,肌小节结构完整。(3)C-反应蛋白:损伤模型导致血清CRP含量上升至损伤前的37倍,大鼠产生严重的炎症反应。四种康复方案后CRP在不等的时间回落并恢复和接近损伤前水平,分别为:自然康复组第16天时仍然上升3倍,基本接近正常;运动疗法组第12天时下降至损伤前水平;按摩疗法组第8天时已经恢复损伤前水平;运动疗法加按摩疗法组第12天时下降至损伤前水平。按摩疗法组、运动疗法加按摩疗法组、运动疗法组等三组比较自然康复组的CRP回落时间、程度均呈显著性差异(p0.05);按摩疗法组比较运动疗法组、运动疗法加按摩疗法组的CRP回落速度、程度也呈显著性差异(p0.05)。研究结论运动疗法、按摩疗法对骨骼肌损伤组织形态重建产生积极的影响,康复损伤骨骼肌肌肉力量,矫正损伤骨骼肌肌纤维排列,组织结构的完整;同时改善肌肉微环境,减少炎症细胞浸润和肌细胞的坏死,加速炎症细胞消除,降低由于肌肉纤维降解造成的细胞应激反应,缩短反应时间。由此,运动疗法、按摩疗法是急性骨骼肌损伤康复的有效疗法。
[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.
【学位授予单位】：安徽师范大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：G804.2

【参考文献】