肌肉硬度检测仪评估健康男性小腿三头肌肌肉硬度及其信度研究

摘要 目的：检验肌肉硬度检测仪量化评估不同状态下（俯卧位、等长收缩、站立位）健康男性小腿三头肌肌肉硬度的信度,并分析小腿三头肌肌肉硬度的差异性、肌肉硬度与踝关节主被动力矩的相关性。 方法：健康男性受试者30例,应用肌肉硬度检测仪评估俯卧位、40%、80%最大自主等长收缩及站立位时右侧腓肠肌内侧头（medial head of the gastrocnemius, MG）、腓肠肌外侧头（lateral head of the gastrocnemius, LG）和比目鱼肌（soleus, Sol）的肌肉硬度。分别由评估者A和评估者B进行测量,其中评估者A在5天后重复测量一次。 结果：不同状态下,评估者间信度和重测信度均为良好至优秀（0.86—0.98, 0.75—0.98）。站立位时MG、LG及Sol的肌肉硬度高于其俯卧位（P＜0.001）,且均表现为Sol＞LG＞MG;肌肉硬度随着收缩强度的增长而增长（P＜0.001）,但两者增长比例不相对应;被动和主动肌肉硬度均与踝关节主被动力矩不相关（P＞0.05）。 结论：肌肉硬度检测仪评估健康男性MG、LG及Sol肌肉硬度的信度较高,能用于小腿三头肌肌肉硬度的评估,有助于明确MG、LG及Sol在不同状态下的生理硬度特性。     

基于新型肌肉定量评估仪分析影响小腿三头肌硬度的因素

目的分析健康人群性别、体质量对肌肉硬度的影响。方法经过培训的测评人员用新型Myoton PRO数字化肌肉检测仪分别对40例健康志愿者双侧腓肠肌内、外侧头硬度进行测量。分析性别、体质量对肌肉硬度的影响,并比较利脚与非利脚腓肠肌内、外侧头的硬度。结果男性两侧腓肠肌内、外侧头硬度明显大于女性(t2.523,P0.01)。体质量与两侧腓肠肌内、外侧头硬度均呈正相关(r0.322,P0.05)。利腿与非利腿外侧头、内侧头硬度均无显著性差异(t0.851,P0.05)。结论性别和体质量对左右两侧腓肠肌肉硬度有影响,且下肢左右两侧肌肉硬度对称。     

小儿先天性马蹄内翻足小腿肌肉超声改变

目的探讨小儿先天性马蹄内翻足(CCF)小腿肌群声像图改变的特点。方法对3组128例小儿(单侧CCF组44例患儿、双侧CCF组19例患儿和对照组65例小儿)小腿比目鱼肌、胫骨后肌、腓肠肌内侧头、腓肠肌外侧头及胫骨前肌肌肉的厚度行超声测量,采用目侧法观察肌肉内部回声变化。结果 (1)对照组5块肌肉(比目鱼肌、胫骨后肌、腓肠肌内侧头、腓肠肌外侧头及胫骨前肌)超声测值分别为(5.30±1.00)mm、(8.50±1.11)mm、(7.26±0.95)mm、(6.45±1.03)mm及(9.88±1.15)mm;(2)单侧CCF组5块肌肉超声测值分别为(4.28±1.28)mm、(7.64±1.25)mm、(6.06±1.81)mm、(5.11±1.31)mm及(9.53±1.16)mm;(3)双侧CCF组5块肌肉超声测值分别为(4.27±1.45)mm、(6.96±1.26)mm、(6.01±1.26)mm、(4.70±1.03)mm及(8.24±1.71)mm;(4)单侧CCF组患儿患侧小腿比目鱼肌、胫骨后肌、腓肠肌内侧头、腓肠肌外侧头4块肌肉厚度的超声测值小于对照组;双侧CCF组患儿两小腿比目鱼肌、胫骨后肌、腓肠肌内侧头、腓肠肌外侧头、胫骨前肌5块肌肉厚度的超声测值均小于对照组;单侧CCF组患儿患侧小腿后肌群肌肉、双侧CCF组患儿两侧小腿肌肉超声测值与对照组比较差异均有统计学意义(P0.05);(5)单侧CCF组患儿患侧小腿胫骨前肌厚度的超声测值与对照组比较,差异无统计学意义(P0.05);(6)单侧CCF组44例患儿中检出肌肉回声增强16例,双侧CCF组19例患儿中肌肉回声增强7例,肌肉回声呈均一弥漫性增强,胫骨前肌和胫骨后肌的中心肌内腱膜结构模糊。结论与对照组小儿比较,CCF患儿患侧小腿肌肉的厚度变薄,肌肉内部回声增强,超声测量肌肉厚度比超声目测肌肉回声改变对评估CCF患儿小腿肌肉萎缩更为敏感。     

一种新型数字化肌肉检测仪用于评估腓肠肌内外侧头硬度的信度研究

目的:用新型MyotonPRO数字化肌肉检测仪评估健康成年人腓肠肌肉内外侧头硬度信度研究,对比小腿三头肌内外侧头硬度。方法:两名经过培训的测试人员A、B分别用新型MyotonPRO对40例健康志愿者双侧腓肠肌内外侧头硬度进行测量,其中测试人员A在5天之后重复测量一次。计算组内相关系数(ICC)和最小检测变化值(MDC),并对利腿侧进行Bland-Altman分析,同时比较利腿与非利腿侧腓肠肌内外侧头硬度的差异性。结果:测试人员A与测试人员B的评估者间信度ICC两侧均为优秀(ICC=0.94—0.96),测试人员A的重测信度均为好(ICC=0.75—0.87),最小检测变化值为18.3 N/m;Bland-Altman分析显示,同一测试者与不同测试者之间均有较好的一致性。利腿和非利腿侧腓肠肌肉内外侧头硬度均有显著性差异(P0.00)。结论:新型MyotonPRO数字化肌肉检测仪评估健康成年人小腿腓肠肌肉内外侧头硬度信度较高,腓肠肌外侧头硬度比内侧头大。     

小儿股骨头无菌性坏死术后康复治疗

Background: Aseptic necrosis of head of femur of children is a kind of ischemic necrosis of the center of epiphysis of femoral head. Currently we treat it with synovectomy, transplantation of vessel tract, intertrochanteric osteotomy and every kinds of pelvic truncation to improve head-mortar relation, but the effect is not satisfying. After head of femur conversion and self-ilium transplantation operation, the follow-up effect is satisfying. Objective: Discussing the treatment effect of operation on children aseptic necrosis of head of femur. Unit:Second People's Hospital of Ningxia Municipality.     

声触诊组织量化技术对糖尿病患者小腿后侧肌群弹性的研究

目的应用声触诊组织量化（VTQ）技术研究糖尿病患者腓肠肌及比目鱼肌的剪切波速度变化。 方法应用VTQ技术选取2017年10月至2018年3月在温州医科大学附属第二医院确诊的35例糖尿病患者及22例健康人的小腿后侧肌群进行检测,分别于踝关节自然位、最大背屈位及最大跖屈位下在纵切获得双侧小腿腓肠肌内侧头、腓肠肌外侧头、比目鱼肌的剪切波速度。比较糖尿病组小腿后侧不同肌肉在踝关节同一体位下剪切波速度的差异,比较糖尿病组与正常对照组间同一体位下对应小腿肌肉的剪切波速度,同时分析小腿后侧不同肌肉在不同体位下获得剪切波速度的重测信度。 结果在踝关节自然位置、最大背屈位,最大跖屈位下,糖尿病组的左右侧小腿腓肠肌内侧头、腓肠肌外侧头及比目鱼肌的剪切波速度对应比较,差异无统计学意义（P>0.05）。糖尿病组患者踝关节在同一体位下,腓肠肌内侧头与腓肠肌外侧头剪切波速度比较,差异无统计学意义（P>0.01）,腓肠肌内侧头与比目鱼肌的剪切波速度在3种体位下,差异均有统计学意义（H=35.348、52.364、30.348、45.697、51.621、39.318,P均<0.001）,而腓肠肌外侧头与比目鱼肌的剪切波速度仅在最大背屈位时,差异有统计学意义（H=46.636、47.288,P均<0.001）。分别于踝关节自然位置、最大背屈位、最大跖屈位下正常对照组与糖尿病组的小腿腓肠肌内侧头、腓肠肌外侧头及比目鱼肌的剪切波数据比较,差异均有统计学意义（t=2.768、4.110、2.202、10.852、2.246、2.682、2.493、2.541、2.355、2.139,Z=-3.203、2.829、-2.698、-2.912、-3.185、-3.177、-5.439、-2.796,P均<0.05）。腓肠肌内外侧头及比目鱼肌在3种体位下剪切波速度的重复测量组内相关系数值均大于0.75,重测信度较好。 结论糖尿病可能会导致小腿腓肠肌内侧头、腓肠肌外侧头及比目鱼肌肌肉的剪切波速度降低,并且糖尿病患者小腿腓肠肌内侧头、腓肠肌外侧头及比目鱼肌的剪切波速度与踝关节体位相关,不同肌肉肌肉的剪切波速度也有差异。     

剪切波弹性成像在慢性踝关节不稳者肌肉硬度评估中的应用

目的:讨论剪切波弹性成像在慢性踝关节不稳(CAI)腓肠肌及腓骨长肌硬度的评估和临床应用价值。方法:选择2019年8月—2020年5月在我院收治的单侧慢性踝关节不稳(CAI)的患者50例作为观察组(均经病史、影像辅助检查及CAI的问卷表等考虑为CAI患者),另外选择50例健康者作为本次对照组。通过二维超声及剪切波弹性成像的检查方式,分别对观察组和对照组双下肢腓骨长肌及腓肠肌内侧头的肌肉厚度(mm)、杨氏模量均值(kPa)及剪切波速度均值(m/s)的测值进行比较。结果:观察组健侧腓肠肌内侧头、腓骨长肌的杨氏模量值及剪切波速度均大于患侧腓肠肌内侧头、腓骨长肌的杨氏模量值及剪切波速度(P<0.05)。结论:慢性踝关节不稳患者的患侧腓肠肌内侧头及腓骨长肌肌肉硬度下降,超声剪切波成像对于慢性踝关节不稳的肌肉硬度定量评估具有一定的价值。     

人工肱骨头假体在治疗肱骨近端骨肿瘤中的应用

目的 探讨人工肱骨头假体在肱骨近端骨肿瘤治疗中的临床应用效果.方法 回顾性分析15例行骨肿瘤切除和人工肱骨头假体置换术肱骨近端骨肿瘤患者,其中骨肉瘤8例,骨巨细胞瘤4例,软骨肉瘤2例,纤维肉瘤1例.结果 术后随访平均(39±5)个月,手术时间平均(110±10)min,术中出血平均(600±41)ml.1例骨肉瘤患者于术后20个月死于复发伴全身多处转移,余14例按Enneking评分标准,末次随访时评分(23.3±3.7)分,总体优良率为84.6%(11/15).结论 采用人工肱骨头假体能有效地治疗肱骨近端骨肿瘤,具有良好的近期临床效果.

Abstract：

Objective To evaluate the clinical effects of the artificial humeral head prosthesis in the treatment of proximal humerus bone tumors. Methods Fifteen patients with proximal humerus bone tumor had excision of bone tumor and application of artificial humeral head prosthesis were analyzed retrospectively. Among them,8 patients had osteosarcoma,4 patients had giant cell tumor of bone,2 patients had chondrosarcoma, 1 patient had fibrosarcoma. Results All cases were followed up for average (39 ± 5 ) months after the surgery.The duration time of operation were( 110 ± 10) minutes in average. The bleeding volume during operation were (600 ± 41 ) ml in average. One patient with osteosarcoma died of recurrence and metastasis 20 months after the surgery. The functions of the other 14 patients were assessed by Enneking system and the average score was 23.3 ± 3.7. The overall rate of excellent or good results was 84.6% ( 11/15 ). Conclusion Limb salvage surgery with the artificial humeral head prosthesis is an efficacious treatment for proximal humerus bone tumors,which can improve short-term clinical outcome.     

亚低温治疗对重型颅脑损伤血糖降低改善预后功能的影响

Background: It is a common phenomenon that serum glucose would increase after head injury due to stress response,in general,the more severe the injury was,the higher the serum glucose was.Research had shown that hyperglycemia after head injury would aggravate extent of brain tissue secondary damage,and the higher of the serum glucose was,the worse the prognosis was.Therefore,control hyperglycemia after head injury as soon as possible was very important to improve prognosis.The utility of mild hypothermia has been confirmed,therapeutic mild hypothermia is widely used for the treatment of severe head injury.     

Correlation of neuron specific enolase serum concentration and prognosis in patients with severe head injury

AIM:To eluciate the role of neuron specific enolase(NSE) in predicting prognosis after severe head injury.METHODS:30 patients with severe head injury were involved into this study,ranging from 26 to 64 years old.Concentration of NSE in serum was measured in all cases within 12 hours after head injury.And prognosis of all patients were evaluated by GOS.RESULTS:The concentration of NSE in serum of both groups,with good or poor outcome,were higher than normal group.The concentrations within 12 hours after head injuries had a cose relationship with the prognosis.As a serum marker to assess the prognosis,NSE had high positive prediction ratio.CONCLUSION:The finding suggested that NSE may be a promising predictor for assessing the prognosis after severe head injury.