大腿膕繩肌肌腱拉傷

大腿膕繩肌肌腱拉傷

概說

大腿膕繩肌肌腱拉傷，又稱為「膕繩肌腱牽拉」，是最常見的運動損傷之一，最常於短跑，足球與欖球的運動員身上出現。曾經有大腿膕繩肌拉傷病史，年紀較大的運動員或是參與高水平競技運動的運動員，最容易拉傷大腿膕繩肌腱。誘發的主因是 膕繩肌肌力不足，肌肉疲勞或柔韌度不足等。

解剖結構

膕繩肌是由大腿背後三條肌肉組成：半膜肌(Semimembranosus)、半腱肌(semi-tendenosus)及股二頭肌(Biceps femoris)。三組肌肉都源自骨盆的坐骨並連接到小腿脛骨與腓骨的近端（小腿骨）。這些肌肉的功能是伸展髖關節與彎曲膝關節。它們橫越髖及膝兩個關節，在劇烈的肌肉收縮，快速的關節活動，以及肌肉的伸展幅度需求大的情況下會容易受傷。大部份的膕繩肌肌腱拉傷都發生在膕繩肌肉與筋腱之間的連接帶。

成因與徵狀

當大腿膕繩肌伸展過度，會造成肌肉纖維耗損，這種非直接的拉傷最為普遍。直接重擊大腿膕繩肌筋腱也會撕裂肌肉。運動員通常會突然間感到大腿後的肌肉疼痛乏力，好像後腿從後被人踢中。在傷勢嚴重的情況下，甚至會聽到「卜」的聲響。

診斷方法

醫生可以透過檢查大腿的局部壓痛點，觀察肌肉的紅腫情況來診斷大腿膕繩肌拉傷的程度。若是後腿有瘀傷，即顯示皮下膕繩肌的受傷部位出血。若大腿膕繩肌筋腱完全撕裂，肌肉缺損部位會明顯可見。假如懷疑出現骨折或其他的骨頭斷裂，或需要做較詳細的 X光檢查。

雖然超聲波或核磁共振造影掃描(MRI)可以更詳細了解拉傷的部位及範圍；不過仔細體檢的方式，通常都足以提供診斷資料。

非手術治療

大部份大腿膕繩肌肌腱拉傷都是勞損，部份肌肉纖維組織在不同時期撕裂，一般不需要手術治療。若是深度、幅度較大的大腿膕繩肌肌腱損傷，在受傷後的最初數天，可透過RICE的治療模式，配合使用非類固醇抗炎藥物來治療。

R代表「休息」

I代表「冰敷」

C代表「使用彈性繃帶或彈性長襪來包扎及施壓，以控制腫脹」

E代表「抬高患肢」

這四個步驟可以緩和痛楚，減少腫脹與控制皮下肌肉出血。一星期後，當痛楚及腫脹消減時，應循序漸進地開始物理治療。嚴重肌腱拉傷能引致瘸著腿走路，這種情況下，患者可使用拐仗等助行器輔助步履。

手術治療

只有很少情況需要手術治療。然而，對運動表現有要求的人士，假若出現撕脫性的拉傷或大腿膕繩肌變成軟弱無力，或許便要手術治療，加快康復。惟延誤手術治療，可增加坐骨神經受損的風險，減低治療效果。因此，若醫生表明須做手術治療，建議盡早進行。

復康訓練

適量的康復物理治療可提升動作幅度及肌肉力量。當運動員恢復膕繩肌筋的動力及疼痛消除後，便可以重返運動場。因應不同程度的拉傷，所需的康復期是有分別的，過早重返運動場可能加重傷勢，不應逞强。

預防方法

要有足夠及正確的熱身運動

經常做靜態的伸展運動可以改善身體的靈活性和膕繩肌的柔軟性

維持四頭肌（大腿前的肌肉）與大腿筋之間的肌肉強度

經常運動，鍛鍊肌肉

魏偉奇醫生

Hamstring Strain

Introduction

Hamstring strain is also called pulled hamstring. This is one of the most frequent sports injuries especially in sprinting sports such as soccer and rugby. Athletes who had previous hamstring injury, older age and participate in high level of competitive sports are more prone to hamstring strain. Lack of hamstring power, muscle fatigue and inadequate flexibility are also significant predisposing factors. 

Anatomy

Hamstrings are composed of three muscles at the back of the thigh, namely semi-membranosus, semi-tendinosis and biceps femoris. All three muscles originate from the ischium of pelvis and insert to the proximal part of tibia and fibula (leg bones). They serve as hip extensors as well as knee flexors. As hamstring cross both hip and knee joints, they are easily injured during violent eccentric muscle contractions. Most of the hamstring strain occurs at the junction between muscle and its tendon. 

Cause and Symptoms

Indirect injury is more common which occurs when hamstring stretches beyond its limits leading to muscle strain. Direct blow to hamstring could also result in muscle tear. Athletes usually reported sudden pain at the back of thigh that seems someone had kicked them from behind. Sometimes there is an audible “pop” sound in severe grade of injury.

Diagnosis

Hamstring strain could be diagnosed clinically with localized tenderness and swelling in the area of muscle involvement. There may be bruises at the back of the thigh representing underlying hamstring bleed at the injured site. For severe complete hamstring tear, muscle defect may be palpable. X-rays may be needed if avulsion fracture or other bony injury is suspected.

Ultrasound or MRI is sometimes used to provide more information about the location and extent of the hamstring injury, but physical examination is usually sufficient for the diagnosis

Non-surgical treatment

Most of the hamstring injury are strain, that means only part of muscle is torn and therefore non-surgical treatment is adequate. For acute hamstring strain, RICE regime with the use of analgesics such as non-steroidal anti-inflammatory drugs (NSAID) is the hallmark of treatment during the first few days of injury:

R means Rest 

I means application of Ice

C means Compression by use of elastic bandage orstockings

E means Elevation of injured thigh

This helps in relieving the pain, reducing the swelling and controlling the underlying muscle bleeding. As the pain and swelling subsided by the first week, progressive functional physical therapy should be started. Crutches may be recommended, if the strain is severe and the patient is limping for a short period of time to reduce pain during walking.

Surgical treatment

Surgery is rarely needed. However, it may be indicated for avulsion injury or in cases with complete disruption of hamstring with loss of strength, especially in active athletic population. As delay in surgery increases the chance of sciatic nerve involvement and tends to have less favorable functional outcomes, early surgical repair is recommended if indicated. 

Rehabilitation

Rehabilitation in terms of supervised physical therapy improves the range of motion as well as muscle strength. Return to sports is allowed when athletes achieve pain-free full range of motion with satisfactory hamstring power. The time needed will depend on the severity of injury, too early return to sports will predispose further hamstring injury and thus not recommended.

Prevention

Ensure sufficient proper warm-up before exercise

Regular static stretching exercise improves flexibility.

Maintain muscle strength balance between quadriceps (thigh muscles in front) and hamstrings

Condition your muscles with regular program of exercise

Dr. Wilkie Ngai