核心肌群稳定性训练对髌股关节疼痛综合征的疗效观察

目的:观察增强核心肌群稳定性训练(CST)对髌股关节疼痛综合征(PFPS)的影响。方法:将44例PFPS患者按照随机数字法分为治疗组和对照组,两组各22例,对照组患者给予常规治疗(膝周肌群力量训练和超短波治疗),治疗组在此基础上增加核心肌群稳定性训练,每周3次,持续6周。分别在治疗前后对两组患者评估疼痛VAS评分、膝关节Lysholm评分,以及等速肌力测定膝关节屈、伸向心收缩峰力矩(PT)进行记录。结果:在治疗前,两组患者各项评估指标差异无明显的显著性意义(P0.05),治疗后治疗组疼痛VAS评分显著小于对照组(P0.05),而膝关节Lysholm评分显著优于对照组(P0.05),此外,治疗组膝关节屈伸肌PT值也显著优于对照组(P0.05)。结论:在常规膝周力量训练以及超短波治疗基础上辅以CST,有助于减轻PFPS患者疼痛程度,改善膝关节功能,增强屈伸膝肌群的力量。     

离心运动训练对髌股疼痛综合征患者膝关节功能和神经肌肉控制的效果

目的 探讨离心运动训练对髌股疼痛综合征患者膝关节功能及神经肌肉控制的影响。方法 2016年9月至2019年9月,本院门诊髌股疼痛综合征患者39例,随机分为对照组(n = 19)和试验组(n = 20)。两组均接受常规康复训练,试验组加用股四头肌离心运动训练,共8周。治疗前后采用疼痛视觉模拟评分(VAS)、膝关节Lysholm评分进行评定,采用等速测试与训练系统测量加速时间,平衡测试仪测量稳定指数。结果 治疗后,两组VAS评分,各肌肉加速时间,总体、左右和前后稳定指数均降低(t > 2.521, P < 0.05),Lysholm评分显著提高(|t| > 13.628, P < 0.001)。试验组VAS评分、各肌肉加速时间、总体及前后稳定指数低于对照组(|t| > 2.174, P < 0.05),Lysholm评分显著高于对照组(t = 11.947, P < 0.001)。结论 股四头肌离心运动训练可缓解髌股疼痛综合征患者膝关节疼痛,提高膝关节功能和神经肌肉控制能力。     

等速练习治疗髌股疼痛综合征的效果

评价等速练习对改善髌股疼痛综合征患者功能和缓解其疼痛的效果。 2 2例髌股疼痛综合征患者 (共37个膝关节 )进行等速练习治疗 ,治疗前、后评测患者的功能、等速参数以及疼痛程度。经 6周等速练习 ,患者的功能和等速参数均明显改善 ,疼痛评分也明显减少。等速练习可以防止髌股疼痛综合征患者伸肌肌力的丧失     

闭链与开链运动对髌股疼痛综合征股四头肌作用的表面肌电图研究

摘要 目的：利用表面肌电图(sEMG)对髌股疼痛综合征（patellofemoral pain syndrome, PFPS）患者双足半蹲伴或坐位伸膝动作下股四头肌进行评估,比较不同开链与闭链动作对股四头肌的作用差异。 方法：PFPS病例组及正常对照组各30例,分别在双足半蹲以及坐位伸膝动作时检测股外侧肌(vastus lateralis, VL)及股内斜肌（vastus medialis oblique, VMO）表面肌电图,分析时域、频域指标,比较其平衡关系。 结果：病例组双足半蹲动作与坐位伸膝动作时各肌电指标的VL/VMO比值在时域、频域指标均有显著性差异,在坐位单侧完全伸膝动作时VL/VMO肌电比值大于双足半蹲动作且>1。 结论：VL、VMO表面肌电指标在双足半蹲动作时较坐位单侧完全伸膝动作时更接近平衡,提示适当屈膝时的闭链运动能够更有选择性地激发VMO,这为PFPS的康复治疗的动作选择提供参考。     

髌股关节疼痛综合征患者手术前后表面肌电图的比较分析

目的:了解表面肌电图(s EMG)评定髌股疼痛综合征(PFPS)患者手术治疗前后股内侧肌(VM)和股外侧肌(VL)动态平衡的变化。方法:分别对PFPS患者6例手术前后和健康者10例行s EMG测试、视觉模拟评分法(VAS)疼痛和Lysholm膝关节功能评分。结果:健康人、PFPS术前和术后3组间平均振幅右VM∶VL比值分别为1.09±0.36、0.90±0.28和0.94±0.35,3组间的差异无显著性意义(P0.05);3组VM与VL达峰值时限的差值(ΔTBP)分别为-1.45±4.02、7.55±5.84和-1.82±2.93,差异有显著性意义(P0.01),PFPS者术后较术前明显改善(P0.01),恢复到健康人水平(P0.05)。PFPS者VAS术后1.60±0.91较术前3.09±1.14减小(P0.01),Lysholm评分术后71.27±16.52较术前54.82±17.50明显提高(P0.01)。结论:本研究s EMG标准化测试VM和VL的峰值时限,能敏感反映PFPS患者手术治疗前后髌骨在冠状面上动态平衡的变化。     

青年女性髌股痛综合征的综合治疗

<正> 髌股痛综合征(PFPS)是指排除了关节内病变、髌骨周围腱炎和滑囊炎的膝前痛,是好活动的青少年常见的膝部疾患。PFPS是由于髌股关节在运动中超负荷所致。由于髌股关节疼痛以及运动减少或有所变动,特别是在离心收缩的时候,导致膝伸肌所产生的力量下降,有证据表明股四头肌发生选择性功能失调,尤以膝关节处在某些角度时为显。通常建议患者采用运动疗法,但各作者所推荐的方法和侧重点有所不同。     

膝骨关节炎患者股内侧肌、股直肌和股外侧肌间的协调性

目的应用表面肌电图和等速肌力测定方法比较膝骨关节炎患者与正常人股内侧肌、股直肌和股外侧肌间的协调性改变。方法34例膝骨关节炎患者和34名膝关节健康者在膝关节屈曲10°、60°、100°等长伸膝和等速60°/s、180°/s伸膝运动测试模式下,进行股内侧肌(VM)、股直肌(RF)和股外侧肌(VL)的表面肌电图和股四头肌肌力的评测,包括肌肉激活启动顺序和VM/VL神经肌电比值。结果与正常人对比,膝骨关节炎患者在等速180°/s伸膝运动时VM相对于VL启动延迟（P＜0.05）;在膝屈10°等长伸膝运动时,VM/VL神经肌电比值降低（P＜0.05）。结论膝骨关节炎患者患侧股四头肌的协调性减退。     

膝骨关节炎患者膝屈伸肌群等速肌力及其与功能的相关性

目的观察膝关节骨关节炎(KOA)患者膝屈伸肌群等速肌力变化及其与膝关节功能的关系。方法23 例双侧KOA患者及14 名正常人进行膝屈伸肌等速肌力检查、五次坐-起试验(FTSST)、静态平衡测试、步态分析。KOA组还完成疼痛视觉模拟评分(VAS)及WOMAC骨关节炎指数评定。结果KOA组伸肌及屈肌峰力矩、峰力矩均值、平均功率、单次最佳做功及总功主患侧均小于对侧(P<0.05);峰力矩屈肌/伸肌(H/Q)百分比主患侧大于对侧(P<0.05)。组间比较,伸肌所有观察指标、屈肌平均功率KOA组均小于正常对照组(P<0.05);峰力矩H/Q 百分比KOA组大于正常对照组(P<0.05)。KOA组伸肌等速肌力峰力矩与FTSST、步行速度、步行距离、跌倒指数、VAS 评分、WOMAC-疼痛评分之间存在相关性(P<0.05),屈肌等速肌力峰力矩与FTSST、步态参数、跌倒指数、VAS评分、WOMAC评分之间无明显相关性(P>0.05)。结论KOA患者伸肌及屈肌等速肌力主患侧较对侧减弱,伸肌等速肌力较正常人减弱,膝伸屈肌肌力变化不同步。KOA患者伸肌等速肌力峰力矩与膝关节疼痛、功能之间存在相关性。     

基于多通道表面肌电探讨不同角速度下膝骨关节炎患者生物力学基础的研究

目的：应用表面肌电图观察和分析膝骨关节炎（knee osteoarthritis,KOA）患者股四头肌表面肌电活动。方法：采用全无线肌电测试系统评测30例KOA患者（KOA组）和30例健康受试者（CON组）在不同角速度（60°/s、90°/s、180°/s）膝关节屈伸运动等速肌力测试下,股内侧肌、股直肌和股外侧肌的表面肌电图,并记录KOA组受试者股内侧肌、股直肌和股外侧肌肌肉厚度与膝痛程度,以评估肌电数据和临床指标的相关性。结果：KOA患者和健康受试者在各不同角速度60°/s(P<0.001)、90°/s(P<0.01)、180°/s(P<0.01)膝关节屈伸运动中屈膝最大力矩与伸膝最大力矩均具有显著性意义,且KOA组膝关节屈伸最大力矩平均值均低于CON组。在角速度为60°/s等速肌力测试时,KOA组股外侧肌的中值频率差值率（P<0.05）、股直肌的均方根值（P<0.01）与相应对照组具有显著性意义;在角速度为90°/s等速肌力测试时,两组受试者的股直肌均方根值存在显著性差异（P<0.05）;在角速度为180°/s时,两组的股直肌中值频率差值率（P&...     

髌股关节炎患者膝周肌群表面肌电信号特征研究

目的:观察髌股关节炎患者膝周肌群肌肉功能和协调活动差异,及其与膝关节疼痛的关系.方法:选择20例髌股关节炎患者,记录屈膝90°最大等长收缩(MVIC)、下蹲和站起时,双侧股外侧肌、股内侧肌、股二头肌和半腱肌的表面肌电图.计算均方根值(RMS)和协同收缩率(CCR),并观察CCR与疼痛的关系.将单膝患病患者健侧及双膝患病...     

Cardiovascular responses induced during high-intensity eccentric and concentric isokinetic muscle contraction in healthy young adults

The purpose of this study was to determine the differences in cardiovascular response between high-intensity eccentric (ECC) and concentric (CON) contractions, and to obtain the basic data applicable to resistance training in middle-aged and elderly individuals. The subjects who participated in this study were nine healthy men (age 24.1 +/- 1.3 years). ECC and CON were randomly selected, as each test consisted of a high-intensity (80% of peak torque) bout of 60 s of ECC and CON isokinetic contractions of the flexor carpi radialis. Systolic pressure (SBP), diastolic pressure (DBP) and heart rate (HR) during ECC and CON were measured using a Finometer. Mean arterial pressure (MAP) was calculated by SBP and DBP. Rate-pressure product (RPP) was calculated by SBP and HR. SBP, DBP, MAP and RPP during ECC were significantly smaller compared with CON. It is clear that cardiovascular response by high-intensity contraction is smaller in ECC than in CON. High-intensity ECC has been suggested to exert only small stress to the cardiovascular system. Thus, being a contraction mode it may be applicable to resistance training.     

超声心动图对等容收缩期内心肌收缩形式的再认识

目的 通过M型及组织多普勒超声心动图探讨等容收缩波时间内心肌的收缩形式。方法 通过M型超声心动图获取等容收缩波时间内左心室横向上前后径及心肌厚度的变化;组织多普勒超声心动图获取左心室心肌等容收缩波时间内纵向上的位移及形变。结果 横向上左心室前后径在等容收缩波时间内增大,心肌变薄;纵向上左心室心肌在等容收缩波时间内缩短,即纵向上左心室上下径减小。结论 左心室心肌在等容收缩期内的收缩并不是等长的收缩。     

慢性下腰痛患者腰屈伸肌的等速肌力评价

目的：通过对慢性下腰痛患者腰屈伸肌进行等速向心、离心肌力测试,定量评价患者腰屈伸肌肌力的变化,为慢性下腰痛患者腰屈伸肌肌肉功能的康复训练提供依据。方法：运用Ｃｙｂｅｘ － ６０００ 型等速测力系统分别对３０ 例慢性下腰痛患者及３０ 例正常人在慢速（３０°／ｓ） 和中速（９０°／ｓ） 条件下进行腰屈伸肌的等速向心和离心肌力测试,评价屈肌与伸肌的峰力矩／ 体重比值,以及腰屈伸肌向心与离心的峰力矩／ 体重比值。结果：两种测试速度下,患者组与正常组相比,腰屈肌向心测试和屈、伸肌离心测试的峰力矩／ 体重值降低,伸肌向心测试的峰力矩／ 体重值较正常组显著下降（ Ｐ＜ ０ ．００１） ;向心测试屈、伸肌峰力矩与体重比值显著增大（ Ｐ＜ ０ ．０１） ,离心测试屈、伸肌峰力矩与体重比值增大;屈肌向心、离心测试的峰力矩与体重的比值降低,伸肌向心、离心测试的峰力矩与体重的比值显著降低（ Ｐ＜ ０ ．０１） 。结论：慢性下腰痛患者腰屈伸肌存在屈伸肌力的下降及失衡,需针对性地进行屈伸肌肌力训练,以恢复屈伸肌对腰椎主动稳定和功能性活动的作用,避免肌源性下腰痛的反复发作和牵延难愈     

Isometric muscle torque in children 5 to 15 years of age: normative data

OBJECTIVE: To establish reference values of arm and leg muscle strength as measured by isometric torque production in healthy children. DESIGN: Measurement of isometric muscle strength in healthy children. SETTING: Public school. PARTICIPANTS: Healthy children (N=149; 76 boys, 73 girls) ages 5 to 15 years. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Isometric torque values of 12 arm and leg muscle groups of healthy children as measured by a handheld dynamometer. RESULTS: Normative data were obtained for children 5 to 15 years of age. There was an increase in torque with age and weight and a strong correlation with both age and weight. There were few differences between boys and girls. Equations for predicted torque taking into account age, weight, and sex were calculated. The agreement between examiners was excellent. CONCLUSIONS: Studies on growing children require comparison to healthy (normal) children to assess the amount of deviation from normal and to be able to draw conclusions of change over time. The reference values for torque in combination with a predicted value based on the child's age, weight, and sex make it possible to compare over time and between subjects and provide a tool for evaluation of physical status and efficacy of therapy.     

Relationship between plasma endothelin-1 concentration and cardiovascular responses during high-intensity eccentric and concentric exercise

The present study investigates the relationship between plasma endothelin-1 (ET-1) concentrations and cardiovascular responses during eccentric (ECC) and concentric (CON) resistance exercises. Eight healthy males (aged 24.3 +/- 1.2 years) performed dynamic forearm exercises for 60 s at an angular velocity of 60 masculine s(-1). Each test comprised 60-s high-intensity (80% of peak torque) bouts of randomly selected ECC and CON contractions, and the plasma ET-1 concentrations were measured before and after each type of contraction. Systolic pressure (SBP), diastolic pressure (DBP), pulse pressure and heart rate (HR) during ECC and CON contraction were also measured. Mean arterial pressure (MAP) was calculated from SBP and DBP. The rate-pressure product (RPP) was calculated from SBP and HR. The plasma ET-1 concentration was significantly increased after CON, compared with ECC contraction (P<0.01). Moreover, SBP, DBP, MAP and RPP were significantly increased (P<0.05, P<0.01, P<0.001, respectively) during CON, compared with ECC contraction. Correlations between plasma ET-1 concentration and MAP were not significant during ECC contraction, but significantly positive during CON contraction (P<0.05). These results showed that CON contraction is associated with ET-1 production and a greater increase in blood pressure compared with ECC contraction.     

躯干屈伸肌等长与等速向心收缩肌力测试的相关研究

目的探讨躯干屈伸肌等长与等速向心收缩肌力测试结果的相关性。方法对50例健康受试者分别进行躯干肌屈曲、伸展等长收缩与等速向心收缩肌力测试,将二种方法测试的屈曲、伸展峰力矩(peak torque,PT)和屈曲、伸展峰力矩之比(F/E)进行相关与回归分析。结果躯干屈伸肌等长收缩、等速向心收缩肌力测试中PT值呈显著正相关(r伸=0.827,P=0.000<0.05,r屈=0.873,P=0.000<0.05);等长收缩和等速向心收缩肌力测试获得的屈曲、伸展PT值建立的回归方程式分别为y^=8.158+1.097x和y^=-12.375+0.781x,经检验成立并有统计学意义(P<0.05);而屈曲、伸展峰力矩之比(F/E)无相关性(r=0.18,P=0.208>0.05),二者差异有统计学意义(t=-7.588,P=0.000<0.05)。结论躯干屈伸肌等长收缩肌力测试能准确地反映躯干肌肌力的变化,并且用中立位等长收缩肌力测试的F/E比值反映躯干的稳定性更合理。     

Effects of Tizanidine Administration on Exteroceptive Suppression of the Temporalis Muscle in Patients with Chronic Tension-Type Headache

SYNOPSIS
The aim of this study was to clarify the changes of inhibitory interneuronal activity in patients with chronic tension-type headache with disorder of pericranial muscle after treatment, and the pharmacological mechanisms of tizanidine- an alpha2 adrenergic agonist. The effects of tizanidine on exteroceptive suppression (ES) of the temporalis muscle were examined in eighteen patients with chronic tension-type headache with disorder of pericranial muscles, before and two weeks after the administration of tizanidine. The left mental nerve was stimulated, under the maximal voluntary contraction of the temporalis muscles. Two types of stimulation were used: weak stimulation with four times the sensory threshold, and strong stimulation with 10 times the sensory threshold. The rectified electromyographic activity was recorded from the right temporalis muscle. ES2 produced by four times the sensory threshold was lengthened after tizanidine administration. This fact suggests that tizanidine improves the inhibitory function in the central nervous system, and then relieves headache. However, ES produced by 10 times the sensory threshold did not change. This suggests that the effect of tizanidine may be relatively mild. The interneurones mediating ES2 may be modified by the alpha2 agonist.     

不同角速度下正常人髋关节屈曲,伸展等速测试结果的比较

借助Ｋｉｎ－ｃｏｎ等速装置，以６０°／ｓ、１８０°／ｓ两种角速度对３０名男性、３０名女性的髋关节屈曲、伸展力量进行测定，获得了相应的向心收缩、离心收缩力矩峰值。对不同角速度下力矩值、拮抗肌比、向心收缩／离心收缩比、峰值／均值比、同名肌群缺失百分比等有关比值及性别间力量改变情况进行比较分析，结果表明，伴随角速度增大，一般表现为向心收缩力矩值降低，离心收缩力距值增高，并可出现显著性差异。可能的原因为收缩机制、中枢神经的抑制作用，介入运动的肌纤维类型及受试者平素运动水平等因素。由此使得拮抗肌比、向心收缩／离心收缩比、峰值／均值比等有关比值也相应变化。左右侧同名肌群力矩缺失百分比随角速度增大而降低，原有的左右侧同名肌群间显著性差异消失。不同角速度下性别间差异的改变在一定程度上表明了运动水平在性别差异中所占有的角色。     

Joint position dependence of weakness during maximum isometric voluntary contractions in subjects with hemiparesis

OBJECTIVE: To determine the distribution of weakness across elbow range of motion (ROM) in subjects with hemiparesis. DESIGN: A detailed analysis of elbow torque and associated electromyographic signals of 5 prime elbow muscles generated during maximum isometric voluntary flexion (MIVF) and extension (MIVE) at 8 different elbow positions. SETTING: Rehabilitation center research laboratory. PARTICIPANTS: Convenience samples of 5 controls and 10 subjects with hemiparesis with sufficient passive (>90 degrees ) and active (>60 degrees ) ROM on their paretic side. INTERVENTIONS: Not applicable. Main Outcome Measures: Measured and normalized MIVF and MIVE torques and normalized moving average electromyographic signals of each muscle at each testing position. RESULTS: Measured MIVF and MIVE torques generated by the hemiparetic group were marginally and significantly smaller than those of the control group (2-factor repeated-measures analysis of variance [ANOVA]: P=.053 for MIVF, P=.011 for MIVE). Distribution of weakness was nonuniform across elbow positions, as shown by normalized torque-position curves. Normalized MIVE torque of the hemiparetic group was significantly and marginally smaller than that of the control group at 15 degrees and 30 degrees (Student t test: P<.0001, P=.054), respectively. Although statistically not significant, the normalized MIVF torque of the hemiparetic group was slightly larger than that of the control group but became smaller than the control group's as the elbow flexed beyond 90 degrees. Our electromyographic recordings supported the normalized MIVF torque findings, showing a significant increase in brachioradialis activation in the control group at flexed positions during MIVF (1-factor repeated-measure ANOVA, P=.003), but not in the hemiparetic group (P=.392). CONCLUSION: Our findings suggest that measuring the strength in multiple joint positions is useful for characterizing the basic changes in muscle activation strategies and properties and provides a relevant measure of elbow weakness from a clinical and functional perspective. Various mechanisms of action are discussed to better understand the relation between joint position and weakness.     

频发性室性期前收缩的射频导管消融治疗

目的探讨射频导管消融治疗室性期前收缩（PVC）的疗效及安全性。方法对129例PVC[右心室流出道（RVOT）107例,右心室流人道游离壁近瓣环处4例、前壁间隔部近瓣环处1例,左心室前上间隔3例、左心室流出道（LVOT）左冠窦内5例、左冠窦下1例,左心室下后间隔5例,左心室前侧壁、左心室前侧壁近瓣环处、右心室心尖部各1例]分别采用起搏标测或起搏与激动顺序标测结合的方法进行消融。结果消融即刻成功122例、失败7例。手术操作时间12—171min,X线曝光时间2—48min。术后随访3个月～4年,4例复发。结论射频导管消融治疗PVC是一种安全、有效的方法,其适应证可适当放宽。