2016-08-012024-05-13https://scholars.lib.ntu.edu.tw/handle/123456789/645730摘要：肌腱是連結肌肉與骨骼的重要組織，所以分析骨骼肌肉系統失能的研究，必須進一步探討肌腱組織以了解失能的原因和機制。本研究計畫為期三年，其目的在分析患有骨骼肌肉系統失能、系統性或退化性共病(如膝關節退化性關節炎、糖尿病與冠狀動脈疾病)的情況下，接受為期十二週之治療性膝關節運動訓練對膝關節髕骨肌腱之療效，藉以了解這些需搭配運動治療的疾病，其運動訓練除了增強關節功能和髕骨肌腱機械特性外，如何影響到肌肉肌腱複合體適應和修補之重要特徵(如微循環)。本計畫首先招募健康族群40 位，做為後述退化或共病族群之間數據差異的參考以及訓練效果的比較。研究將於第一年招募30 位患者，至少單側膝關節出現第二級以上退化性膝關節炎特徵之患者，以及另外40 位(30 到70 歲)無明顯退化性膝關節炎的族群做為健康組；這些健康受試者將再以隨機分配方式被分為”訓練組”與”對照組”，健康人之訓練組將與30 位膝關節炎患者接受為期十二週中等阻力強度的膝關節運動訓練，而”健康對照組”則在十二週中維持一般生活型態，且不特別作介入性之運動訓練。所有健康受試者以及退化性膝關節炎患者都接受未訓練前的各項測量，以分析健康組與退化性膝關節炎患者在未訓練前的各項參數差異；再者，在為期十二週運動訓練後，也再比較健康訓練組與退化性關節炎受訓練患者，在接受運動訓練前、後對其髕骨肌腱的療效。本研究第二年將招募60 名第二型糖尿病患者，並對其糖化血色素進一步分析及追蹤；第三年預計招募60 位冠狀動脈疾病患者(經侵入式心導管證實)。第二與第三年的各60 名患者將再以隨機分配方式，分配為訓練組與對照組，訓練組接受為期十二週中等強度的膝關節運動訓練，而對照組內容則維持原有一般生活型態與活動。這些患者都將接受訓練前、後測量，以分析訓練組與對照組在訓練前、後測量的差異，以了解糖尿病與冠狀動脈疾病患者的膝關節運動訓練，對髕骨肌腱訓練的療效。本計畫健康受試者與糖尿病或冠狀動脈疾病患者，將選用慣用腳膝關節做為觀察部位，而退化性膝關節炎患者則選擇關節炎特徵較嚴重的一側。本計畫訓練前、後測量的項目除包括膝關節伸直肌力和平衡等功能性動作外，也包含以非侵入性為主的肌腱超音波影像如機械特性分析及彈力數據檢測，和磁振造影針對髕骨肌腱微循環/微結構灌注、肌腱成分結構等特性之技術(含磁振掃描之特殊程式，如DWI, DTI, IVIM, UTE, CEST, DEC-MRI等)。本研究預期可釐清，髕骨肌腱在老年化及共病存在的情況下，所產生的適應行為，如何有別於未罹患共病之健康對照組以及未接受運動訓練之對照組，並對日漸增加的老年醫療需求，提升診斷與醫療品質。<br> Abstract: Novel approaches of this research are interested on knowledge in how common comorbidities influencetendon adaptations and its outcomes after training. The patellar tendon, a common tendon of the knee, isresponsible for force transmission and elastic energy utilization from the quadriceps, patella to tibia.Therapeutic exercises to populations with ageing or common comorbidities, such as diabetes (DM) orcoronary artery disease (CAD), are often recommended with a lower extremity resistance training to reducetheir symptoms. However, characteristics regarding microcirculation and mechanical properties, and effectsof the exercise training on the patellar tendon in the interested groups of this research project are unclear.This 3-year project aims to investigate the characteristics of the patella tendon of the knee in patients withcommon comorbidities, and exercise effects for the knee extensor muscle/tendon on the above characteristics.Furthermore, healthy subjects will be also recruited for reference in baseline measurements and comparisonsof training effects between healthy and patient populations. For the 1st year, forty healthy individuals (agefrom 30-70 y/o) will be recruited as a healthy group. These healthy subjects will be randomly assigned intoeither one group (n=20) with exercise training or another group (n=20) with routine daily activity only.Further, thirty subjects who older than 40 y/o with a diagnosis of knee osteoarthritis greater than grade II (theOA group) will be recruited. For the 2nd year, sixty patients with type 2 DM without known coronary arterydisease will be enrolled. For the 3rd year, sixty patients with cardiac catheterization proven CAD will beenrolled. These patients with DM or CAD in the 2nd and 3rd year respectively will be randomly assigned intoeither a group with exercise training or a control group with routine daily activity only. All subjects in theexercise group, including healthy subjects and patients with DM, CAD, and OA will undergo a 12-weekexercise training for the knee extensor muscles at a moderate level of resistance. All subjects in this researchwill received comprehensive evaluations “before” (pre-) and “after” (post-) the exercise training in theirdominant knee; for the OA subjects, the measures will be preferentially performed at the side with a higherradiographic grade. These measurements include functional tests (quadriceps muscle strength, one-legbalance and knee joint proprioception) and measures for the patellar tendon character, such as shear-waveelastography of real-time ultrasound, tendon microcirculation by near infrared spectroscopy, magneticresonance methods (DCE-MRI, Diffusion-weighted imaging, Diffusion tensor image, Intra-Voxel IncoherentMotion, Ultra-short TE sequence, Chemical Exchange Saturation Transfer). Meanwhile, no exercise trainingprogram, except routine daily activity, will be given to the control groups of healthy subjects and patientswith DM or CAD during the training period. We aim to investigate new understanding in how differentcomorbidities affect the adaptation process of the patellar tendon and how well-designed exercise trainingprogram may be integrated into the current therapy to optimize the treatments.肌腱是連結肌肉與骨骼的重要組織，所以分析骨骼肌肉系統失能的研究，必須進一步探討肌腱組 織以了解失能的原因和機制。本研究計畫為期三年，其目的在分析患有骨骼肌肉系統失能、系統性或 退化性共病(如膝關節退化性關節炎、糖尿病與冠狀動脈疾病)的情況下，接受為期十二週之治療性膝 關節運動訓練對膝關節髕骨肌腱之療效，藉以了解這些需搭配運動治療的疾病，其運動訓練除了增強 關節功能和髕骨肌腱機械特性外，如何影響到肌肉肌腱複合體適應和修補之重要特徵(如微循環)。本 計畫首先招募健康族群40 位，做為後述退化或共病族群之間數據差異的參考以及訓練效果的比較。 研究將於第一年招募30 位患者，至少單側膝關節出現第二級以上退化性膝關節炎特徵之患者，以及 另外40 位(30 到70 歲)無明顯退化性膝關節炎的族群做為健康組；這些健康受試者將再以隨機分配方 式被分為”訓練組”與”對照組”，健康人之訓練組將與30 位膝關節炎患者接受為期十二週中等阻力強度 的膝關節運動訓練，而”健康對照組”則在十二週中維持一般生活型態，且不特別作介入性之運動訓練。 所有健康受試者以及退化性膝關節炎患者都接受未訓練前的各項測量，以分析健康組與退化性膝關節 炎患者在未訓練前的各項參數差異；再者，在為期十二週運動訓練後，也再比較健康訓練組與退化性 關節炎受訓練患者，在接受運動訓練前、後對其髕骨肌腱的療效。本研究第二年將招募60 名第二型 糖尿病患者，並對其糖化血色素進一步分析及追蹤；第三年預計招募60 位冠狀動脈疾病患者(經侵入 式心導管證實)。第二與第三年的各60 名患者將再以隨機分配方式，分配為訓練組與對照組，訓練組 接受為期十二週中等強度的膝關節運動訓練，而對照組內容則維持原有一般生活型態與活動。這些患 者都將接受訓練前、後測量，以分析訓練組與對照組在訓練前、後測量的差異，以了解糖尿病與冠狀 動脈疾病患者的膝關節運動訓練，對髕骨肌腱訓練的療效。本計畫健康受試者與糖尿病或冠狀動脈疾 病患者，將選用慣用腳膝關節做為觀察部位，而退化性膝關節炎患者則選擇關節炎特徵較嚴重的一 側。本計畫訓練前、後測量的項目除包括膝關節伸直肌力和平衡等功能性動作外，也包含以非侵入性 為主的肌腱超音波影像如機械特性分析及彈力數據檢測，和磁振造影針對髕骨肌腱微循環/微結構灌 注、肌腱成分結構等特性之技術(含磁振掃描之特殊程式，如DWI, DTI, IVIM, UTE, CEST, DEC-MRI 等)。本研究預期可釐清，髕骨肌腱在老年化及共病存在的情況下，所產生的適應行為，如何有別於未 罹患共病之健康對照組以及未接受運動訓練之對照組，並對日漸增加的老年醫療需求，提升診斷與醫 療品質。Novel approaches of this research are interested on knowledge in how common comorbidities influence tendon adaptations and its outcomes after training. The patellar tendon, a common tendon of the knee, is responsible for force transmission and elastic energy utilization from the quadriceps, patella to tibia. Therapeutic exercises to populations with ageing or common comorbidities, such as diabetes (DM) or coronary artery disease (CAD), are often recommended with a lower extremity resistance training to reduce their symptoms. However, characteristics regarding microcirculation and mechanical properties, and effects of the exercise training on the patellar tendon in the interested groups of this research project are unclear. This 3-year project aims to investigate the characteristics of the patella tendon of the knee in patients with common comorbidities, and exercise effects for the knee extensor muscle/tendon on the above characteristics. Furthermore, healthy subjects will be also recruited for reference in baseline measurements and comparisons of training effects between healthy and patient populations. For the 1st year, forty healthy individuals (age from 30-70 y/o) will be recruited as a healthy group. These healthy subjects will be randomly assigned into either one group (n=20) with exercise training or another group (n=20) with routine daily activity only. Further, thirty subjects who older than 40 y/o with a diagnosis of knee osteoarthritis greater than grade II (the OA group) will be recruited. For the 2nd year, sixty patients with type 2 DM without known coronary artery disease will be enrolled. For the 3rd year, sixty patients with cardiac catheterization proven CAD will be enrolled. These patients with DM or CAD in the 2nd and 3rd year respectively will be randomly assigned into either a group with exercise training or a control group with routine daily activity only. All subjects in the exercise group, including healthy subjects and patients with DM, CAD, and OA will undergo a 12-week exercise training for the knee extensor muscles at a moderate level of resistance. All subjects in this research will received comprehensive evaluations “before” (pre-) and “after” (post-) the exercise training in their dominant knee; for the OA subjects, the measures will be preferentially performed at the side with a higher radiographic grade. These measurements include functional tests (quadriceps muscle strength, one-leg balance and knee joint proprioception) and measures for the patellar tendon character, such as shear-wave elastography of real-time ultrasound, tendon microcirculation by near infrared spectroscopy, magnetic resonance methods (DCE-MRI, Diffusion-weighted imaging, Diffusion tensor image, Intra-Voxel Incoherent Motion, Ultra-short TE sequence, Chemical Exchange Saturation Transfer). Meanwhile, no exercise training program, except routine daily activity, will be given to the control groups of healthy subjects and patients with DM or CAD during the training period. We aim to investigate new understanding in how different comorbidities affect the adaptation process of the patellar tendon and how well-designed exercise training program may be integrated into the current therapy to optimize the treatments.髕骨肌腱膝關節共病運動治療機械特性微循環超音波磁振造影退化性膝關 節炎糖尿病冠狀動脈疾病patella tendonknee jointcomorbiditiesexercise trainingmechanical propertymicrocirculationultrasoundshear-wave elastographyMRIosteoarthritisdiabetescoronary artery disease