躯干肌慢速等速向心收缩肌力的测试研究

目的:研究不同速度对躯干肌慢速等速肌力测试的影响,探讨用于躯干肌肌力评定的慢速等速肌力测试合理的速度参数。方法:健康受试者43例,使用美国产BiodexⅡAP型多关节等速测试系统测定躯干肌峰力矩(PT)、相对峰力矩(PT/BW)、总功(TW)、相对总功(TW/BW)和屈伸比值(F/E),测试角速度分别选用30°/s和60°/s。结果:伸展收缩测试时两组间的PT、PT/BW、TW和TW/BW比较差异有显著性意义(P<0.05),屈曲收缩测试时上述指标比较差异无显著性意义(P>0.05),两组间F/E差异有显著性意义(P<0.05)。结论:躯干肌慢速等速测试中,速度明显影响伸展测试值,30°/s比60°/s等速测试似更能反映躯干肌的力学特征,而对屈曲测试值的影响并不明显,在慢速范围内,屈肌肌力测试值似处于稳定的峰值状态。     

躯干肌屈曲、伸展等长收缩肌力测试的信度研究

目的:探讨躯干肌屈曲、伸展等长收缩肌力测试的信度,为临床应用提供可靠依据。方法:20例健康受试者,在1周内采用BiodexⅡAP型多关节等速测试系统对每位受试者进行了2次躯干肌屈曲、伸展等长收缩肌力测试,获得躯干肌屈曲、伸展最大平均力矩、最大重复做功、总做功和平均功率等结果,并采用组内相关系数进行信度分析。结果:躯干肌屈曲、伸展2次等长收缩肌力测试的各指标高度相关(ICC>0.90),呈现良好的稳定性。结论:躯干肌屈曲、伸展等长收缩肌力测试在反映躯干肌肌力的变化方面具有较高的信度,测试指标稳定可靠。     

躯干肌等长收缩角度对测试结果的影响

目的:研究不同角度对躯干肌等长收缩测试的影响,探讨躯干肌等长收缩测试的合理角度参数。方法:32例健康在校男性军人作为受试者,使用美国产BiodexⅡAP型等速测试系统进行躯干肌等长收缩测试,测定其最大平均力矩(MAT)、相对最大平均力矩(MAT/BW)、最大重复做功(MRW)、相对最大重复做功(MRW/BW)、总做功(TW)、平均功率(AP)和最大平均力矩屈伸比值(F/E)等指标,测试角度分别选用后伸15°位、中立0°位和前屈15°位,利用方差分析对结果进行统计学分析。结果:伸展测试时三组间上述所有指标的差异有显著性意义(P<0.05),屈曲测试时上述指标的差异无显著性意义(P>0.05);三组间F/E差异亦有显著性意义(P<0.05)。结论:在躯干肌等长收缩测试中,角度的选择对于伸展测试的结果影响是明显的,而对屈曲测试的结果影响并不明显;中立0°位可作为躯干肌等长收缩测试的推荐角度。     

慢性下腰痛患者腰椎曲度与躯干肌等长收缩肌力的关系

目的:观察慢性下腰痛患者腰椎曲度与躯干肌肌力的变化,为慢性下腰痛的康复和预防提供依据。方法:选择2004-08/12第二军医大学长海医院康复医学科门诊接诊慢性下腰痛患者36例,均为女性;平均(44.2±3.9)岁;平均体质量(61.9±7.7)kg;平均身高(160.3±5.6)cm。对36例患者分别进行躯干肌屈伸等长收缩肌力测试和腰椎曲度测量,并根据腰椎曲度测量结果分为曲度正常组19例和曲度异常组16例,评价两组间等长收缩肌力测试的屈伸峰力矩及屈、伸峰力矩之比。结果:两组屈、伸峰力矩和屈、伸峰力矩之比值的比较:两组躯干肌等长收缩肌力测试中前屈峰力矩无显著差别(t=0.525,P=0.603>0.05),曲度异常组后伸峰力矩值显著小于曲度正常组[(86.50±10.30),(117.21±23.32)N·m,t=4.875,P=0.000<0.05],曲度异常组前屈和后伸峰力矩之比值显著大于曲度正常组(0.359±0.050,0.286±0.099,t=2.699,P=0.011<0.05)。结论:慢性下腰痛患者躯干肌后伸肌力的显著降低和腰椎曲度的降低可能存在着互为因果的密切关系,加强躯干肌后伸肌力训练和调整腰椎曲度的训练可能会促进慢性下腰痛的康复和预防慢性下腰痛的发生和发展。     

慢性下腰痛患者腰椎曲度与躯干肌等长收缩肌力的关系

目的：观察慢性下腰痛患者腰椎曲度与躯干肌肌力的变化,为慢性下腰痛的康复和预防提供依据.方法：选择2004-08/12第二军医大学长海医院康复医学科门诊接诊慢性下腰痛患者36例,均为女性;平均（44.2&;#177;3.9）岁;平均体质量（61.9&;#177;7.7）kg;平均身高（160.3&;#177;5.6）cm.对36例患者分别进行躯干肌屈伸等长收缩肌力测试和腰椎曲度测量,并根据腰椎曲度测量结果分为曲度正常组19例和曲度异常组16例,评价两组间等长收缩肌力测试的屈伸峰力矩及屈、伸峰力矩之比.结果：两组屈、伸峰力矩和屈、伸峰力矩之比值的比较：两组躯干肌等长收缩肌力测试中前屈峰力矩无显著差别（t=0.525,P=0.603＞0.05）,曲度异常组后伸峰力矩值显著小于曲度正常组[（86.50&;#177;10.30）,（117.21&;#177;23.32）N&;#183;m,t=4.875,P=0.000＜0.05],曲度异常组前屈和后伸峰力矩之比值显著大于曲度正常组（0.359&;#177;0.050,0.286&;#177;0.009,t=2.699,P=0.011＜0.05）.结论：慢性下腰痛患者躯干肌后伸肌力的显著降低和腰椎曲度的降低可能存在着互为因果的密切关系,加强躯干肌后伸肌力训练和调整腰椎曲度的训练可能会促进慢性下腰痛的康复和预防慢性下腰痛的发生和发展.     

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     

基于等速技术的健康成人膝关节屈伸肌肌力的年龄和性别特征的研究

目的:应用等速技术研究200例健康成人膝关节屈伸肌肌力的年龄和性别特征,为膝关节运动功能的康复提供参考依据。方法:将200例健康成人按性别分组,再按年龄分为20-29岁、30-39岁、40-49岁、50-59岁、60-70岁5组,共10组,每组20例。对所有受试者进行膝关节的等速向心肌力测试,采集屈伸肌最大峰力矩值(PT)、屈伸肌相对峰力矩(PT/BW)和屈伸肌峰力矩比值(F/E)指标。利用Pearson相关系数分析各测试指标与年龄的相关性,采用独立样本t检验分析不同性别组内相邻两年龄组之间的差异性。结果:(1)膝关节屈伸肌PT值、PT/BW值及屈伸肌峰力矩比值F/E均与年龄之间具有显著相关性(P<0.01)。(2)男性屈伸肌PT值和PT/BW值40岁以后下降显著(P<0.05);F/E值60岁以后显著增加(P<0.05)。(3)女性屈肌PT值在20-70岁之间呈缓慢下降趋势;屈肌PT/BW值与伸肌PT值60岁以后下降明显(P<0.05);伸肌PT/BW值分别于30岁和60岁以后下降明显(P<0.05);F/E值20-70岁呈平稳增长趋势。(4)同一年龄段男性屈伸肌PT值与PT/BW值均大于女性(P<0.05),F/E无显著差异(P>0.05)。结论:膝关节屈伸肌肌力具有显著的年龄和性别特征。膝关节屈伸肌肌力随年龄增长呈下降趋势,40岁以后下降更加明显且屈伸肌肌力下降呈现不平衡现象,伸肌较屈肌下降显著。     

躯干肌在不同速度等速运动中的特征

目的分析健康人群躯干屈肌和伸肌在等速运动中的力学变化。方法 2018年3月至9月,选取27例健康受试者,收集其在30°/s、60°/s和90°/s角速度下躯干屈伸肌群的峰力矩。结果受试者躯干屈曲和伸展峰力矩随着速度的增大略微减小,但无显著性差异(F 2.070, P 0.05)。30°/s和60°/s时,伸展峰力矩明显大于屈曲(t 3.138, P 0.01);90°/s时,屈曲与伸展峰力矩无显著性差异(t=-0.946, P 0.05)。屈曲和伸展峰力矩在30°/s和60°/s时比值均约为0.79∶1。相同速度下第2次和第10次收缩时峰力矩比较,屈曲峰力矩均下降,但只有30°/s时有非常显著性差异(t=5.159, P 0.01);伸展峰力矩均增加,但只有60°/s时有显著性差异(t=-2.142, P 0.05)。结论等速运动角速度在60°/s以下时,躯干屈肌和伸肌肌力存在差异,且在30°/s和60°/s角速度下,两者比值约相等。     

腰椎间盘突出症患者的腰背等速肌力评定

背景躯干生物力学的变化可能是腰椎间盘突出症发病和病后不愈的重要因素.目的通过对腰椎间盘突出症患者进行腰背肌力测试,以了解其躯干生物力学变化.设计以患者为研究对象,非随机化同期对照的回顾性研究.单位解放军第二军医大学长海医院康复医学科.对象2001-02/2002-01在第二军医大学长海医院康复医学科门诊治疗的腰椎间盘突出症患者30例为测试组,同期治疗非腰椎间盘突出症患者30例做对照组,均知情同意.方法利用多关节等速测试系统对受试者躯干的等速力矩进行测试.观察记录指标为腰背屈伸肌群的峰力矩(PT)、相对峰力矩(PT/BW)、到达峰力矩的时间(TPT)、0.2 s的力矩(T@0.2)、总功(TW)和平均功率(AP).同时测试了腰背屈/伸比值(F/E).结果利用SPSS 9.0软件包分析,采用t检验进行统计学处理.主要观察指标主要结局腰背部屈肌、伸肌等速肌力评定结果.次要结局腰背部屈伸比值评定结果.结果各种收缩速度时测试组患者的屈、伸肌力量均显著下降,肌肉的爆发力和做功的效率指标也变化明显,屈肌力量的下降比伸肌力量的下降更严重.F/E评定测试组等速向心收缩60°/s,180°/s分别为57.99±5.68,65.74±8.12;对照组分别为95.25±5.18,83.03±7.61,两组比较差异有显著性意义(P＜0.01).结论腰椎间盘突出症患者其力学改变是明确的,康复治疗应在准确评定这种改变的基础上,制订合适的、有针对性的训练方案,彻底纠正这种力学平衡,打断恶性循环.     

膝关节骨性关节炎等速离心收缩肌力的研究

目的评价单侧膝关节骨性关节炎(OA)患者患侧和健侧膝关节股四头肌和腘绳肌的向心收缩和离心收缩肌力的变化,重点研究膝OA股四头肌和腘绳肌离心收缩功能的变化。方法应用BiodexSystem-3型等速测试系统对42例单侧膝关节骨性关节炎患者进行患侧和健侧的股四头肌及腘绳肌的向心和离心收缩功能测试。结果患侧和健侧股四头肌及健侧腘绳肌向心收缩时,当速度增加,峰力矩值显著减小;离心收缩时,随着角速度增加峰力矩未见下降;相同速度下,患侧和健侧股四头肌和腘绳肌离心收缩肌力明显大于向心收缩;膝OA患者存在股四头肌向心收缩和离心收缩肌力的下降(P<0.05),肌力缺失百分比>10%,以及腘绳肌低速向心肌力下降(P<0.05),肌力缺失百分比为14.33%。膝OA股四头肌的离心/向心肌力比值(E/C比值)低于腘绳肌,随运动速度增加,股四头肌的E/C比值明显增大。患侧股四头肌60°/s角速度下的E/C比值较健侧有显著增高(P<0.05)。结论膝OA患者股四头肌存在向心和离心收缩功能异常,提示膝OA患者的肌肉功能测试应增加离心测试,并注意加强膝OA患者股四头肌的离心收缩训练。     

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.     

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.     

正常男性下肢等速向心收缩的研究

利用ＢＩＯＤＥＸ多关节等速测试及康复系统提供的闭合链附件,测试了２０ 例正常男性青年学生下肢的等速向心收缩数据。结果发现：峰力矩、相对峰力矩、到达峰力矩的时间、总功、相对总功、平均功率以伸展时大于屈曲时,两侧峰力矩的差异无差异,屈／伸比值不受速度影响,同非闭合链测试结果接近,可为深入研究提供参考。     

Physiological and methodological aspects of rate of force development assessment in human skeletal muscle

Rate of force development (RFD) refers to the ability of the neuromuscular system to increase contractile force from a low or resting level when muscle activation is performed as quickly as possible, and it is considered an important muscle strength parameter, especially for athletes in sports requiring high‐speed actions. The assessment of RFD has been used for strength diagnosis, to monitor the effects of training interventions in both healthy populations and patients, discriminate high‐level athletes from those of lower levels, evaluate the impairment in mechanical muscle function after acute bouts of eccentric muscle actions and estimate the degree of fatigue and recovery after acute exhausting exercise. Notably, the evaluation of RFD in human skeletal muscle is a complex task as influenced by numerous distinct methodological factors including mode of contraction, type of instruction, method used to quantify RFD, devices used for force/torque recording and ambient temperature. Another important aspect is our limited understanding of the mechanisms underpinning rapid muscle force production. Therefore, this review is primarily focused on (i) describing the main mechanical characteristics of RFD; (ii) analysing various physiological factors that influence RFD; and (iii) presenting and discussing central biomechanical and methodological factors affecting the measurement of RFD. The intention of this review is to provide more methodological and analytical coherency on the RFD concept, which may aid to clarify the thinking of coaches and sports scientists in this area.     

同心圆硬化2例

病例1:患者女,43岁,以"10天前感冒后出现全身乏力、食欲减退,2天前出现言语不能、吞咽困难"入院.查体:生命体征平稳,神智恍惚,口唇干燥.脑电图示中度广泛性异常.脑脊液常规未见异常.生化:白蛋白0.46 g/L、氯化物131 mmol/L、葡萄糖5.36 mmol/L、腺苷脱氨酶0.46 U/L.CT示双侧放射冠及半卵圆中心区多发片状低密度影.MRI示双侧半卵圆中心、放射冠区、内囊-丘脑区、侧脑室周围白质区、左侧桥臂见多发类圆形斑块,大部分病变T2WI呈中央高信号,周边稍高信号,呈"靶"征(图1).增强扫描病灶环形强化.诊断为同心圆硬化(Balo's concentric sclerosis, BCS).     

Potassium and ventilation during positive and negative work inpatients with chronic obstructive pulmonary disease

In patients with chronic obstructive pulmonary disease (COPD),reduced ventilatory reserves limit exercise tolerance. In these patients, the ventilatoryrequirements of eccentric exercise (negative work, W_neg) are lower thanthose of concentric exercise (positive work, W_pos) at similar workloads.In this study, we investigated the relationship between plasma potassium levels and ventilationduring W_pos and W_neg in these patients. Twelvepatients with stable COPD [mean (SD) FEV₁ 46% (16) of predicted]performed W_pos and W_neg on a cycle ergometer(6 min of exercise; interval ≥1 h) in a randomized order at a constant workload of50% of the individual maximum (positive) work capacity. Minute ventilation (V_E) and arterial plasma potassium concentration ([K⁺]_a) were measured at rest, and at 1-min intervals during exercise and during 3 min ofrecovery. V_E increased less during W_neg thanduring W_pos [6 (range 3–26) vs. 18 (range 8–28) l min^?1; P<0·01]. V_E during W_neg was reduced in proportion to VCO ₂.The increase in [K⁺]_a during W_pos and W_neg [0·45 (range 0·26–0·75) and0·34 (range 0·1–0·97) mM ] did not differsignificantly. V_E was closely correlated with VCO ₂ during both types of exercise. V_E was also closelycorrelated with [K⁺]_a, but the slope of the relationship between[K⁺]_a and V_E was steeper during W_pos than during W_neg [39·1 (range15·2–88·6) vs. 18·3 (range7·2–37·3) l min^?1 mM ^?1; P=0·012]. In contrast, the slope of the relationship betweenVCO ₂ and V_E was similar during bothtypes of exercise [27?8 (range 19·2–37·1) vs. 32·1 (range19·8–48·4)]. Thus, for a given increase in [K⁺]_a, the increase in V_E was significantly less during W_neg. In patients with COPD, potassium did not explain the difference inexercise ventilation between W_neg and W_pos, andmay not play a significant role in the control of breathing during low-intensity exercise.     

1例同心圆硬化随访报告

患者男,40岁,以“头晕1个月,言语减少,行为幼稚,伴右侧肢体麻木、乏力一周”入院。查体:生命体征平稳,神萎,计算力、定向力、记忆力均差。右眼睑紧闭较左侧差,颈阻阳性,四肢肌力对称Ⅳ级,右下肢病理征阳性。辅助检查:脑干听觉诱发电位示:左侧颅内段、桥脑上段及右侧颅脑内段、桥脑下段电活动差;VEP:正常。脑脊液检查:颜色透明,微浑,蛋白含量弱( ),细胞总数:98×106/L,蛋白0.76g/L、氯化物图1横断面T1WI像,左侧图1同层面,同心圆病灶呈大病灶缩小呈环形高信号影121mmol/L、糖3.4mmol/L。结合MR影像表现,诊断为同心圆硬化(Ba-lo病)。经临…     

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。     

A novel method of eliciting pain-related potentials by transcutaneous electrical stimulation

BACKGROUND: Electrophysiological techniques such as laser and contact heat evoked pain-related potentials are very useful for studying trigeminal and somatic pain transmission in humans. These methods are, however, partly invasive, expensive, and therefore not available for broad clinical use. We recently proposed a novel technique of noninvasive transcutaneous electrical stimulation. OBJECTIVE: To elicit pain-related evoked potentials (PREP) by using a concentric planar electrode and demonstrate their nociceptive specificity. METHODS: We registered PREP following stimulation of the forehead and hand in 14 healthy volunteers. Latencies, peak-to-peak amplitudes, and conduction velocities of nociceptive fibers have been estimated. Effects of temporal and spatial summation and of cutaneous anesthesia were evaluated. RESULTS: Stimulation with the concentric planar electrode produced pinprick-like painful sensation. Cutaneous anesthesia led to abolishment of PREP responses. Estimated mean conduction velocity was 11.61 +/- 5.12 m/s, which corresponded well with conduction via A-delta fibers. Spatial as well as temporal summation resulted in a parallel increase of perceived pain intensity and PREP amplitudes. CONCLUSION: The technique is noninvasive, affordable, and easy to perform and allows quantitative assessment of human nociceptive pathways.