颈部不同姿势侧卧位时颈肌表面肌电信号分析及其意义

目的观察颈部不同屈伸姿势侧卧位时颈部肌肉表面肌电信号的变化,探讨侧卧位睡姿时头颈部的良好摆放姿势。 方法表面肌电图观察30例青年志愿者左侧卧位下,颈部前屈、中立及后伸时双侧胸锁乳突肌、斜方肌上部、颈竖脊肌的表面肌电信号,采用积分肌电值（IEMG）和中位频率（MF）分析。 结果胸锁乳突肌前屈位与后伸位比较, IEMG数值较低,差异有统计学意义（P<0.05）;颈竖脊肌在颈后伸位与颈前屈位比较,IEMG数值较低,差异有统计学意义（P<0.05）,斜方肌上部在3种体位时IEMG值比较差异无统计学意义（P&rt;0.05）,3对肌肉在3种体位时MF值比较差异无统计学意义（P&rt;0.05）。 结论侧卧位头颈部后伸时颈背部肌肉紧张度较小,提示侧卧位睡眠时头颈部较佳姿势为稍后伸位。     

头颈前屈和后伸运动中胸锁乳突肌作用的肌电图测定和力学分析

目的研究双侧胸锁乳突肌收缩在头颈前屈和后伸运动中的作用。方法以24名正常学生为受试对象,在仰卧位颈部放松和前屈运动时、俯卧位颈部放松和后伸运动时分别进行肌电图测定,并利用解剖学标本及模型进行力学测量和生物力学分析。结果在仰卧位颈部放松、俯卧位颈部放松和后伸时,胸锁乳突肌均为电静息电位;在仰卧位颈部前屈时,胸锁乳突肌运动单位电位募集类型均为混合相。结论在颈椎关节不固定状态下,双侧胸锁乳突肌收缩使头颈部前屈;在固定寰枕关节以下颈部关节时,双侧胸锁乳突肌收缩使头后伸。     

表面肌电图的信度研究

目的：探讨表面肌电图参数的变异性,为拓展表面肌电图的临床应用建立可靠的依据.方法：健康受试者进行伸膝等长收缩,以及10m自由步行的动态运动,分别记录下肢相关肌群表面肌电,考察各参数的变异系数.结果：对于静态收缩,即使分析时宽短至1s,除了AEMG以外,各参数的变异系数均＜0.100.对于动态的步行运动,取1s的分析时宽,MF、MPF的平均变异系数近于0.100,ZCR、AEMG的平均变异系数在0.150左右.结论：无论静态收缩,还是动态收缩,表面肌电图的基本参数MF、MPF、ZCR、AEMG稳定可靠,变异系数一般不大于0.100-0.150.频域指标较时域指标的信度更高.     

头颈部弹力带渐进抗阻训练治疗慢性颈痛患者的疗效观察

目的 观察头颈部弹力带渐进抗阻训练治疗慢性颈痛患者的疗效及对患者胸锁乳突肌表面肌电（sEMG）的影响。 方法 采用随机数字表法将40例慢性颈痛患者分为观察组及对照组,每组20例。2组患者均给予传统物理治疗及药物治疗,在此基础上对照组辅以颈椎姿势训练,观察组则辅以头颈部弹力带渐进抗阻训练。于治疗前、治疗4周后分别采用疼痛视觉模拟评分法（VAS）及颈椎功能障碍指数（NDI）对2组患者进行疗效评定,同时采集患者坐位时胸锁乳突肌sEMG信号,并对其频域指标中位频率（MF）及时域指标振幅均方根值（RMS）进行比较。 结果 治疗4周后观察组患者疼痛VAS评分［（1.8±0.2）分］、NDI评分［（13.4±0.8）%］及对照组疼痛VAS评分［（2.6±0.3）分］、NDI评分［（17.4±1.2）%］均较治疗前明显改善（P＜0.05）;并且观察组疼痛VAS评分、NDI评分亦显著优于对照组水平（P＜0.05）;治疗后观察组患者颈部放松时RMS［（12.3±1.4）μＶ］、MF［（57.3±5.1）Ｈｚ］及颈部后伸时RMS［（23.3±1.7）μＶ］、MF［（49.2±4.3）Ｈｚ］均较治疗前及对照组明显改善（P＜0.05）,对照组上述肌电指标较治疗前均无明显变化（P>0.05）。 结论 头颈部弹力带渐进抗阻训练能有效减轻慢性颈痛患者疼痛,改善颈椎功能,其治疗机制可能与提高患者胸锁乳突肌抗疲劳能力及增强肌肉收缩功能有关。     

慢性非特异性下背痛患者悬吊运动疗法治疗后表面肌电信号的变化

摘要 目的：研究慢性非特异性下背痛患者（CNLBP）悬吊运动疗法治疗前后竖脊肌、多裂肌的表面肌电信号的变化特征。 方法：15例CNLBP患者,给予患者每周3次,持续4周的悬吊运动疗法（SET）治疗,分别在治疗前后采集患者在做半桥动作时痛侧竖脊肌和多裂肌的肌电信号,取时域指标：平均肌电值（AEMG）及频域指标：平均功率频率（MPF）、中位频率（MF）,进行统计学比较。 结果：治疗后竖脊肌、多裂肌痛侧频域指标MF、MPF较治疗前下降(治疗前MF 74.95±6.85、MPF 98.10±5.45,治疗后MF 62.90±4.02、MPF 83.89±3.84);痛侧时域指标AEMG较治疗前增高(治疗前AEMG 48.76±5.08,治疗后AEMG 86.27±9.43),差异有显著性意义（P<0.05）。 结论：SET治疗后,CNLBP患者痛侧竖脊肌、多裂肌的疲劳程度下降,收缩能力增强。     

针刺对神经根型颈椎病患者颈部肌肉表面肌电信号的影响

目的观察神经根型颈椎病患者经针刺治疗前、后其颈部肌肉表面肌电中位频率值（MF）的变化,并探讨针刺治疗神经根型颈椎病的作用机制。 方法采用随机数字表法将27例神经根型颈椎病患者分为治疗组及对照组。治疗组给予针刺治疗,对照组给予颈椎牵引及中频电疗。于治疗前、治疗2周后分别采用视觉模拟评分法（VAS）对2组患者颈痛程度进行评定,同时对其颈部肌肉进行表面肌电图检查。 结果治疗2周后对照组疼痛VAS评分［（1.87±0.99）分］、颈部前屈持续时间［（67.4±16.1）s］、后伸持续时间［（86.1±10.8）s］及治疗组疼痛VAS评分［（2.00±0.95）分］、颈部前屈持续时间［（68.5±23.1）s］、后伸持续时间［（91.6±19.7）s］均较治疗前明显改善（P<0.05）,并且上述指标2组间差异均无统计学意义（P&rt;0.05）。治疗后对照组患侧颈伸肌MF值［（70.77±10.44）Hz］及治疗组患侧颈伸肌MF值［（73.21±9.41）Hz］均较治疗前明显增高（P<0.05）,并以治疗组患侧颈伸肌MF值的改善幅度较显著,与对照组间差异具有统计学意义（P<0.05）。 结论针刺可通过改善神经根型颈椎病患者颈部肌肉功能获得良好临床疗效,其短期疗效与颈椎牵引、中频电联合疗法类似。     

应用表面肌电图评定乒乓球运动员的上肢肌疲劳

目的：对北京市优秀乒乓球运动员进行提拉弧圈球训练时握拍上肢主要做功肌肉表面肌电(surface electromyography，sEMG)信号进行分析，利用时、频域指标的变化来评价上肢肌疲劳情况。方法：北京市乒乓球队7名男性运动员，进行乒乓球训练的主要内容为提拉弧圈球训练，采集准备活动后训练开始与训练结束前各20min的握拍上肢：肱三头肌、肱二头肌、肱桡肌、三角肌、腕屈肌和腕伸肌肌电信号，利用Megawin软件进行平均功率频率(mean power frequency，MPF)，中位频率(median frequency，MF)．均方根振幅(root—mean—square，RMS)的分析，两个实验测试阶段的频域和时域值的差异性利用t检验进行统计处理。结果：第2阶段所测六块肌肉的MPF，MF均比第1阶段的明显降低(P&;lt;0．001)，具有非常显著性差异；第2阶段与第1阶段的RMS值相比，所测肌肉的RMS值变化趋势不稳定。结论：频域指标MPF，MF可较敏感地反映乒乓球训练上肢肌肉功能状况，可作为评价肌肉动态负荷水平的生理学指标。     

练功十八法之颈部六法对缓解伏案后颈肌疲劳的表面肌电研究

目的:通过表面肌电研究颈部功法对颈肌疲劳的缓解效应,并分析其规律和机制。方法:将60例健康大学生随机分为空白对照组:不做颈部运动、实验A组:趴桌休息、实验B组:做练功十八法中的颈部六法,每组各20例。三组伏案90min之后干预15min。观察双侧胸锁乳突肌(SMC)、头夹肌(MSC)的以下表面肌电(s EMG)指标:均方根值(RMS)、平均功率频率(MPF)及过零率(ZCR)的伏案前初始值、伏案前负重值、伏案中30min值、60min值、90min值、干预后终末值和后负重值。结果:1不同干预方法下三组间比较:右侧MSC的RMS干预后负重值较伏案前负重值差异有显著性意义(P0.05)。2两侧SMC和两侧MSC在伏案前和伏案90min期间的自身前后比较:伏案30min和60min期间,左侧SMC的RMS、MPF、ZCR自身前后比较差异有显著性意义;伏案60min和90min期间,左侧SMC的RMS、ZCR有显著性意义。结论:1伏案一定时间后,不做颈部运动和趴桌休息均不能缓解颈肌疲劳,颈部功法可有效缓解颈肌疲劳;2伏案开始到60min时SMC为主动肌,60min以后MSC由拮抗肌转换为主动肌;3肌肉的负重测试是检测其耐力和疲劳性的一个重要客观指标。     

青少年特发性脊柱侧弯症患者椎旁肌表面肌电信号频域指标变化规律

目的采用表面肌电图（sEMG）检测技术对青少年特发性脊柱侧弯症（AIS）患者脊柱旁椎旁肌肌电活动频域指标变化规律进行初步探讨。方法AIS患者25例,男7例,女18例,年龄11～21岁;所有患者均执行BST实验、抬物实验,采用芬兰ME6000型表面肌电仪记录患者凸、凹侧椎旁肌表面肌电信号频域指标中位频率（MF）、平均功率频率（MPF）、过零点率（ZCR）。结果AIS患者顶椎区凸、凹侧MF、MPF、ZCR波形曲线波幅较其他测试部位低平、数值降低,MF斜率（MFslope）、MPF斜率（MPFs-lope）、ZCR斜率（ZCRslope）随运动负荷时间的延长均呈线性递减。结论AIS患者脊柱旁顶椎区椎旁肌耐力较差,容易疲劳,表面肌电图可用作评定AIS脊柱旁凸、凹侧肌电活动差别的客观指标之一,具有较好的临床应用价值。     

肌电图变化分析先天性肌性斜颈患儿胸锁乳突肌的病变特征

目的：通过对先天性肌性斜颈患儿作肌电图检查，分析胸锁乳突肌的病变特征与病因之间的关系。方法：选取武汉市儿童医院矫形外科2002-12／2003-12经临床确诊为先天性肌性斜颈患儿，共22例，男14例，女8例；右14例，左8例。按年龄分为新生儿组，日龄20～50d，共8例，均可扪及患侧胸锁乳突肌包块。幼儿少年组14例，年龄2～14岁，痉挛型8例，肥厚型6例。行患侧胸锁乳突肌肌电图检查，检测项目包括轻收缩及强收缩时运动单元电位的时限、波幅及相位。同时对健侧胸锁乳突肌进行相同检测作为正常对照组。结果：新生儿组中轻收缩运动单元电位时限缩短(4．15&;#177;1．23)ms，波幅降低(0．28&;#177;0．11)mV，多相波增多(65&;#177;10)％，强收缩波幅明显降低(0．42&;#177;0．14)mV，各项检测值与正常对照组差异有显著性意义(P&;lt;0．01)。幼儿少年组中痉挛型轻收缩运动单元电位时限(4．53&;#177;1．28)ms、波幅(0．28&;#177;0．15)mV均降低，多相波增多(65&;#177;15)％，强收缩波幅明显降低(0．52&;#177;0．25)mV，且呈病理干扰相，与正常对照组差异有显著性意义(P&;lt;0．05)。肥厚型轻收缩运动单元电位时限(5．52&;#177;0．33)ms，波幅(0．48&;#177;0．23)mV稍降低，强收缩波幅降低(0．92&;#177;0．2)mV也呈病理干扰相，与正常对照组差异有显著性意义(P&;lt;0．05)。幼儿少年组痉挛型与肥厚型检测结果对比分析，差异有显著性意义(P&;lt;0．05)。结论：患侧胸锁乳突肌存在肌源性病变，痉挛型胸锁乳突肌的病变较肥厚型重。依据肌电图检测结果推测先天性肌性斜颈病因为胸锁乳突肌血循环障碍所致。     

Thickness of the middle trapezius muscle measured by rehabilitative ultrasound imaging: description of the technique and reliability study

A technique is described for measuring the thickness of the middle trapezius muscle using rehabilitative ultrasound imaging (RUSI). A test–retest study was employed to investigate the reliability of the technique in a convenience sample of 16 asymptomatic participants aged 20–41 (12 women). The middle trapezius muscle was imaged using RUSI with participants in a standardized sitting position. The principal investigator took measurements on two consecutive days to examine intra‐rater reliability, and two additional investigators took measurements on the second day to investigate inter‐rater reliability of the measurement technique. Reliability was examined using intra‐class correlation coefficients (ICC), standard error of measurement (SEM), and Bland and Altman plots. The results demonstrated that inter‐rater reliability was good between raters (ICC_2,3 = 0·81, SEM = 0·94 mm) and was moderate for the same rater between days (ICC_3,2 = 0·67, SEM = 1·0 mm). This study demonstrates that RUSI can be used reliably to measure muscle thickness of the middle trapezius muscle following the procedure described.     

The relationship between exercise‐induced muscle fatigue,arterial blood flow and muscle perfusion after 56 days local muscle unloading

In the light of the dynamic nature of habitual plantar flexor activity, we utilized an incremental isokinetic exercise test (IIET) to assess the work‐related power deficit (WoRPD) as a measure for exercise‐induced muscle fatigue before and after prolonged calf muscle unloading and in relation to arterial blood flow and muscle perfusion. Eleven male subjects (31 ± 6 years) wore the HEPHAISTOS unloading orthosis unilaterally for 56 days. It allows habitual ambulation while greatly reducing plantar flexor activity and torque production. Endpoint measurements encompassed arterial blood flow, measured in the femoral artery using Doppler ultrasound, oxygenation of the soleus muscle assessed by near‐infrared spectroscopy, lactate concentrations determined in capillary blood and muscle activity using soleus muscle surface electromyography. Furthermore, soleus muscle biopsies were taken to investigate morphological muscle changes. After the intervention, maximal isokinetic torque was reduced by 23·4 ± 8·2% (P<0·001) and soleus fibre size was reduced by 8·5 ± 13% (P = 0·016). However, WoRPD remained unaffected as indicated by an unchanged loss of relative plantar flexor power between pre‐ and postexperiments (P = 0·88). Blood flow, tissue oxygenation, lactate concentrations and EMG median frequency kinematics during the exercise test were comparable before and after the intervention, whereas the increase of RMS in response to IIET was less following the intervention (P = 0·03). In conclusion, following submaximal isokinetic muscle work exercise‐induced muscle fatigue is unaffected after prolonged local muscle unloading. The observation that arterial blood flow was maintained may underlie the unchanged fatigability.     

Skeletal muscle characteristics in children 9–15 years old: force,relaxation rate and contraction time

Summary. Relaxation rate (RR), half contraction time to tetanus (CTT1/2) and force-frequency curves were investigated in 77 children, aged 9–15 years, using supramaximal stimulation of the ulnar nerve and recording from the adductor pollicis muscle. No sex differences were found in these variables. The RR was independent of age and similar to that in adults. The CTT1/2 was least at the age of 15. The only age-dependent parameter in the force-frequency curves was the relative force developed at a stimulus frequency of 10 Hz, which increased with increasing age. A fatiguability test was performed in 25 children. Reference values for the different parameters are given.     

Muscular adaptations to fatiguing exercise with and without blood flow restriction

The purpose of this study was to determine the muscular adaptations to low‐load resistance training performed to fatigue with and without blood flow restriction (BFR). Middle‐aged (42–62 years) men (n = 12) and women (n = 6) completed 18 sessions of unilateral knee extensor resistance training to volitional fatigue over 6 weeks. One limb trained under BFR, and the contralateral limb trained without BFR [free flow (FF)]. Before and after the training, measures of anterior and lateral quadriceps muscle thickness (MTh), strength, power and endurance were assessed on each limb. The total exercise training volume was significantly greater for the FF limb compared with the BFR limb (P<0·001). Anterior quadriceps thickness and muscle function increased following the training in each limb with no differences between limbs. Lateral quadriceps MTh increased significantly more (P<0·05) in the limb trained under BFR (BFR: 3·50 ± 0·61 to 3·67 ± 0·62 cm; FF: 3·49 ± 0·73 to 3·56 ± 0·70 cm). Low‐load resistance training to volitional fatigue both with and without BFR is viable options for improving muscle function in middle‐aged individuals. However, BFR enhanced the hypertrophic effect of low‐load training and reduced the volume of exercise needed to elicit increases in muscle function.     

The reliability of assessing sternocleidomastoid muscle length and strength in adults with and without mild neck pain

Background: The sternocleidomastoid (SCM) is an important cervical spine muscle. Weakness of the SCM muscle has been implicated with cervical problems. No studies have examined the reliability of assessing the SCM muscle length or strength. Also no studies exist that have looked to see if imbalances in SCM muscle length or strength exists between the left and right sides in those with and without neck pain. Objective: To determine the reliability of assessing the SCM muscle for length and strength and to see if SCM length could predict SCM strength in those with and without neck pain. Design: Cross-sectional study. Methods: Fifty-one subjects with and without mild neck pain. Analysis: Intratester reliability was assessed for SCM muscle length and SCM muscle strength. Differences in SCM length and strength were examined in those with and without neck pain. Results: Intratester reliability was shown to be excellent (ICC (2,2) > 0.90) for the left and right SCM when assessing muscle length and muscle strength for those with and without neck pain. No differences were noted when comparing left to right SCM between those with and without neck pain regarding muscle length or muscle strength. Neither regression models were able to predict SCM muscle strength from SCM muscle length. Conclusion: SCM muscle length and SCM strength can be reliably assessed using a bubble goniometer and HHD. No differences were found when comparing left to right SCM muscle length or strength in those with or without mild neck pain.     

Use of uniformly sized muscle fiber fragments for restoration of muscle tissue function

Treatment of extensive muscle loss due to traumatic injury, congenital defects, or tumor ablations is clinically challenging. The current treatment standard is grafting of autologous muscle flaps; however, significant donor site morbidity and graft tissue availability remain a problem. Alternatively, muscle fiber therapy has been attempted to treat muscle injury by transplanting single fibers into the defect site. However, irregularly organized long fibers resulted in low survivability due to delay in vascular and neural integration, thus limiting the therapeutic efficacy. Therefore, no effective method is available to permanently restore extensive muscle injuries. To address the current limitations, we developed a novel method that produces uniformly sized native muscle fiber fragments (MFFs) for muscle transplantation. We hypothesized that fragmentation of muscle fibers into small and uniformly sized fragments would allow for rapid reassembly and efficient engraftment within the defect site, resulting in accelerated recovery of muscle function. Our results demonstrate that the processed MFFs have a dimension of approximately 100 μm and contain living muscle cells on extracellular matrices. In preclinical animal studies using volumetric defect and urinary incontinence models, histological and functional analyses confirmed that the transplanted MFFs into the injury sites were able to effectively integrate with host muscle tissue, vascular, and neural systems, which resulted in significant improvement of muscle function and mass. These results indicate that the MFF technology platform is a promising therapeutic option for the restoration of muscle function and can be applied to various muscle defect and injury cases.     

深层肌肉刺激结合手法肌肉放松治疗延迟性肌肉酸痛的疗效观察

目的:观察深层肌肉刺激结合手法肌肉放松治疗延迟性肌肉酸痛的临床疗效,探讨更为有效的临床治疗方法。方法:将48名受试者随机分为联合治疗组(n=24)、手法肌肉放松组(n=24),两组患者诱发延迟性肌肉酸痛后,分别给予不同干预措施,联合治疗组进行深层肌肉刺激结合手法肌肉放松,而手法肌肉放松组给予单纯肌肉放松,对两组患者的治疗效果进行比较和分析。结果:联合治疗组在运动后24 h的血液肌酸激酶浓度、乳酸浓度和肌红蛋白浓度下降幅度显著高于手法肌肉放松组(P0.05,P0.01,P0.01);联合治疗组在运动后24 h肌肉酸痛的改善显著优于常规手法治疗组(P0.01),踝关节活动范围和小腿周径恢复程度显著优于手法肌肉放松组(P0.05,P0.05)。结论:深层肌肉刺激仪结合手法肌肉放松对延迟性肌肉酸痛有优越的治疗效果,是一种值得临床推广应用的治疗方法。     

Sonographic appearance of a partial rupture of the supinator muscle

We report the case of a 51-year-old woman who experienced pain and swelling in the right forearm after spinning cotton. History taking and physical examinations helped identify a tear of the supinator muscle, which was confirmed via sonographic examination. To our knowledge, this article is the first report of a supinator muscle tear diagnosed with sonography.     

Ultrasound imaging of the serratus anterior muscle at rest and during contraction

The purpose of this study is to describe a clinically feasible method for measuring the thickness of the serratus anterior (SA) muscle using rehabilitative ultrasound imaging (RUSI) and to determine the reliability of repeated measures of that method. An exploratory clinical measurement study using a test–retest methodology was utilized to determine the reliability of the measurements in a sample of 20 healthy subjects. While sitting with the arm flexed 120°, the SA of each subject was imaged at rest, during an active hold and while holding a three pound weight. On Day 1, images were repeated three times for each condition by the same examiner. On Day 2, Examiner 1 and Examiner 2 repeated the scans. Images were examined offline by Examiner 1 with SA thickness measured superior to the most distal rib in the image. Reliability was evaluated using intraclass correlation coefficients (ICCs) and Bland–Altman plots. The intra‐examiner reliability (same day) during rest, active hold and active hold with resistance was ICC_3,3 = 0·892; ICC_3,3 = 0·951; and ICC_3,3 = 0·869–0·971, respectively. Intra‐examiner reliability between days ranged from ICC_3,2 = 0·613 at rest to ICC_3,2 = 0·736 during active hold with resistance. Interexaminer reliability was moderate during active hold (ICC_2,2 = 0·526) and active hold with resistance (ICC_2,2 = 0·535) and poor during rest (ICC_2,2 = 0·425). This study demonstrates that SA thickness can be measured reliably using RUSI by the same examiner and suggests that active movements may increase that reliability.     

Adaptation of the Threshold IMT® with double spring load allows higher inspiratory pressure for muscle training

Purpose: We aimed to evaluate the functionality of an adapted inspiratory muscle training device designed to allow pressures higher than 41 cmH₂O that can be precisely controlled. The adaptation was made in a commercially available Threshold IMT^® device, and the opening pressures and linearity of load were evaluated in an experimental setting. Methods: The original IMT Threshold^® device was modified by inserting a second spring load juxtaposed to the original spring and then the modified device was coupled to a system designed to assess the range of opening pressures. Linear regression was used to test the correlation between the visual pressure scale of the original device and the opening pressure load obtained from the adapted device. Results: For the modified device, we found a range of load from 13·9 ± 0·7 to 85·6 ± 0·7 cmH₂O. Linear regression analysis of our data found an excellent relation between the modified device’s opening pressure and the preset opening pressure marked on the visual scale in the original device, y = ?1·275 + 2·08x, r² = 0·99 and P = 0·0001. Conclusion: The Threshold IMT^® adaptation proposed here is simple, affordable, precise, safe and allows for a high degree of reproducibility. It also achieves pressures higher than 41 cmH₂O that can be used when training inspiratory muscles.