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。     

踝关节被动牵拉角度和腓肠肌内外侧头肌肉硬度的关系

正被动肌肉牵拉通常被广泛应用于训练或比赛前后,预防损伤、缓解疼痛和提高运动表现,此外,其亦被应用于康复治疗中,以降低肌肉硬度和恢复关节活动度~([1—2])。腓肠肌包括腓肠肌内侧头(medial head of the gastrocnemius,MG)和腓肠肌外侧头(lateral head of the gastrocnemius,LG),作用是屈曲踝关节和膝关节,能够为人类行走、跑步和跳跃提供重     

脑卒中患者小腿肌肉形态结构变化的定量超声研究

目的:应用定量超声评价脑卒中患者小腿肌肉形态结构的变化。方法:选择30例脑卒中患者和30例正常人,选取踝关节0°(解剖中立位)时,分别在静息状态与最大等长收缩状态下,应用高频超声测量脑卒中患者健侧、患侧和正常人的一侧小腿的胫骨前肌(TA)及腓肠肌内侧头(MG)的形态结构参数,包括羽状角、肌肉厚度及肌纤维长度。结果:静息状态及最大等长收缩状态下,脑卒中患者患侧TA和MG的羽状角和肌肉厚度均较健侧和正常人减小(P0.05)。静息状态及最大等长收缩状态下,脑卒中患者患侧TA和MG的肌纤维长度均较健侧和正常人长(P0.05)。而健侧和正常人无显著性差异(P0.05)。结论:脑卒中后患者TA和MG的形态结构参数发生了改变,超声可量化评估脑卒中患者肌肉结构参数。     

腓肠肌内外侧硬度与跟腱硬度的相关性研究

摘要 目的：使用新型软组织弹性触诊仪（MyotonPRO）对健康受试者的跟腱硬度进行信度研究，探究腓肠肌内侧、外侧硬度与跟腱硬度相关性。 方法：招募40例健康受试者，测试者A、B使用MyotonPRO对受试者跟腱硬度进行测量，测量点为根骨结节上方2cm（AT-2）和4cm（AT-4），测试者A单独对腓肠肌硬度进行测量。分别计算了测试者之间及同一测试者前后测试指标的组内相关系数（ICC）、最小检测变化值（MDC）及肌肉硬度与肌腱硬度之间的相关系数。 结果：测试者之间以及同一测试者前后所测指标信度良好（ICC=0.86—0.93）。踝关节中立位时，腓肠肌内、外侧与AT-4硬度的相关性分别为0.60和0.49（P＜0.05），腓肠肌内侧与AT-2硬度的相关性为0.36（P＜0.05），腓肠肌外侧与AT-4硬度无相关性（P＞0.05）。踝关节背屈10°位时，仅腓肠肌外侧与跟腱AT-4硬度存在相关性，相关系数为0.34（P＜0.05）。 结论：MyotonPRO测量跟腱硬度的可信度较高，腓肠肌内、外侧肌肉硬度与跟腱硬度的相关性具有一定差异，并且受踝关节角度变化的影响。     

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。     

帕金森病和脑血管病恢复期患者肌肉硬度的定量测定方法

目的：探讨一种新的肌肉硬度的定量测定方法。方法：用自行研制的肌肉硬度计，在不同预加负荷下，对正常人群组、脑血管病（ＣＶＤ）恢复期患者和帕金森病（ＰＤ）患者组的肌肉硬度分别进行了测量。结果：预加负荷是１０ｋＰａ时，ＣＶＤ组和ＰＤ组的肌肉硬度均显著高于正常对照组（Ｐ＜００５）；预加负荷是５０ｋＰａ时，ＣＶＤ组的肌肉硬度明显高于ＰＤ组（Ｐ＜０．０５）。结论：预加负荷是１０ｋＰａ时的肌肉硬度，反映了肌肉组织的静态张力；预加负荷是５０ｋＰａ时的肌肉硬度，对于鉴别ＣＶＤ和ＰＤ不同特征的肌张力增高很有价值     

肌肉状态检测系统评估脑卒中患者肌肉张力的信度研究

目的：测试肌肉状态检测系统评估在脑卒中患者肌肉张力的信度。方法：恢复期脑卒中的患者20例,由2位治疗师分别使用Myoton-3肌肉状态检测系统进行肌肉张力测试,其中1个治疗师在3d后重复测试1次。计算组内相关系数(ICC)。结果：同一测试者应用Myoton-3肌肉状态检测系统测量肱二头肌弹性的重复性测量信度为优秀（ICC>0.90);2个测试者之间的测量信度为好（0.75相似文献   

hIGF-1转基因抑制失神经肌肉萎缩的实验研究

目的了解人胰岛素样生长因子-1（hIGF-1）体内转基因抑制肌肉萎缩的作用。方法30只雄性Wistar大鼠,建立坐骨神经再生室动物模型后随机分为3组。hIGF-1治疗组：挤压伤处神经外膜下即刻注射pcDNAhIGF-1和LipfectAmine混合液10μl（hIGF-1 DNA为4μg）;模型组：注射pcDNA3.1、LipfectAmine和生理盐水混合液10μl;空白对照组：不注射任何物质。术后8周行神经-肌电检查和腓肠肌肌湿重与肌纤维横截面积检测。结果术后8周检查小腿三头肌复合肌肉活动电位（CMAP）的最大波幅和潜伏期,腓肠肌肌湿重和肌纤维横截面积,hIGF-1治疗组明显好于模型组和空白对照组（P〈0.01）。结论周围神经损伤后胰岛素样生长因子-1体内转基因能有效抑制靶肌肉的萎缩。     

冲击波对兔复合肌肉动作电位及肌组织形态学的影响

目的:评估单侧小腿后方放散式体外冲击波(radial extracorporeal shock wave treatment,rESWT)处理后兔的双侧腓肠肌复合肌肉动作电位和肌组织形态学。方法:体重2±0.2kg雄性新西兰兔63只,其中3只兔进行预实验确定rESWT强度,对剩余60只兔左小腿三头肌肌腹最粗大的位置稍偏外侧行强度1.5bar,频率10Hz的2000次冲击。分为6组,在放散式体外冲击波处理当天和处理后第1、2、4、6、8周在麻醉情况下用日本光电MEB-9100K肌电图仪记录双侧腓肠肌外侧头复合肌肉动作电位,比较两侧波幅、潜伏期,每组抽取一个样本对其双侧腓肠肌外侧头行重复电刺激,记录不同频率刺激后波幅衰减情况。肌电图检查完成立即取下双侧腓肠肌外侧头肌组织,冰冻切片后进行HE染色,观察肌肉组织形态学变化。结果:前三组实验兔(处理当天和处理后第1、2周)实验侧动作电位波幅降低,与对照侧比较差异显著(P0.05),后三组实验兔实验侧动作电位波幅与对照侧无明显差异。所有实验兔双侧动作电位潜伏期差异不明显,HE染色未见肌组织形态学明显异常。结论:运用rESWT对兔小腿三头肌肌腹最肥大处行强度1.5bar,频率10Hz的2000次冲击可降低其复合肌肉动作电位的波幅但作用持续时间较短且对肌组织形态学不会产生较大影响。     

脑卒中患者小腿肌肉运动协调性的表面肌电特征研究

目的探讨脑卒中恢复期患者小腿前后肌群在踝关节屈伸周期性运动时的表面肌电特征变化。 方法选取10例脑卒中恢复期偏瘫患者作为病例组和10例年龄、性别与之相匹配的健康者作为健康对照组。在进行踝关节屈伸运动的同时，采用表面肌电图仪记录患者患侧、健侧及健康对照组的胫骨前肌、腓肠肌外侧头、腓肠肌内侧头和比目鱼肌的肌电信号，并对积分肌电值（iEMG）、收缩率等指标进行分析比较。 结果在周期性踝屈伸运动过程中，踝背伸时，患者患侧胫骨前肌、腓肠肌内侧头、腓肠肌外侧头、比目鱼肌的iEMG均明显小于健侧（P<0.05），患侧腓肠肌外侧头、腓肠肌内侧头、比目鱼肌的iEMG也明显小于健康对照组（P<0.05）；踝跖屈时，患侧胫骨前肌、腓肠肌外侧头、腓肠肌内侧头的iEMG明显小于健康对照组（P<0.05），患侧腓肠肌内侧头的iEMG明显小于健侧（P<0.05），患侧比目鱼肌收缩率明显大于健侧及健康对照组（P<0.05）。 结论脑卒中恢复期患者在周期性踝屈伸运动时，患侧小腿前后肌群除比目鱼肌外，肌肉收缩功能均明显下降；患侧踝跖屈时，比目鱼肌取代正常跖屈时的腓肠肌外侧头或腓肠肌内侧头成为主要的主动跖屈肌。     

Measurement of stiffness changes in immobilized muscle using magnetic resonance elastography

Background

The isolated evaluation of changes in muscle following immobilization and disuse is a challenge in living subjects. The purpose of this study was to determine whether magnetic resonance elastography is capable of detecting these changes.

Methods

An animal model was created to produce a mild joint contracture following 42 days of one forelimb immobilization in a maximally flexed position with twice-daily passive exercise. Eight pairs of dog forelimbs were harvested. Magnetic resonance elastography scans were performed on the experimental limb in an extended elbow position with a torque of 0.6 N m. Scans of the contralateral limb were performed in two conditions, position matching and torque matching. Furthermore, wet weight, cross sectional area, resting muscle length, and range of elbow joint motion were measured.

Findings

The muscle from the experimental limb showed significant reduction in muscle mass, cross sectional area, slack length, and range of elbow motion. When comparing limbs in position matching condition, the muscle lengths were similar, and the experimental muscle had a significantly higher shear modulus (79.1 (SD 12.0) kPa) than the contralateral muscle (31.9 (SD 24.4) kPa). When comparing limbs in torque matching conditions, the muscle strains were similar, and the experimental muscle had a significantly lower shear modulus than the contralateral muscle (113.0 (SD 24.8) kPa).

Interpretation

These findings suggest that following immobilization, magnetic resonance elastography has the potential to be used as a clinical tool to guide rehabilitation and as a research tool to study the loss of passive elastic components of muscle.     

Myometry revealed medication-induced decrease in resting skeletal muscle stiffness in Parkinson's disease patients

Background

Based on combined analysis of clinical assessment of parkinsonian rigidity (constant resistance force generated during passive movement in a joint), electromyography and/or dynamometry many studies showed objectively that anti-parkinsonian medication decreases the rigidity in Parkinson's disease (PD). Rigidity-related changes in resting muscle stiffness (changed muscle's mechanical property related to its structural changes and changed neural drive) in PD patients have been revealed by myometry, a simple, sensitive, and reliable method for measuring mechanical properties in human soft tissues.However, an application of myometry in estimation of medication effects on the PD rigidity-related muscle stiffness has not been reported yet. Therefore, our study aimed to assess medication-induced changes in resting muscle stiffness in PD patients using myometry.

Methods

We measured resting muscle stiffness by myometry and recorded a surface electromyogram of relaxed biceps brachii, brachioradialis and triceps brachii muscles in ten patients with PD (age: 51–80 years; Hoehn and Yahr stage: 2.5–4) during medication on-phase (when subjects felt best comfort and fitness after medication: Levodopa, Piribedil, Ropinirol) and medication off-phase (12 h after withdrawal of the medication).

Findings

Our patients had significantly lower myometric stiffness and electromyogram amplitude in all tested muscles, and also lower clinical rigidity scores during the medication on-phase compared with the medication off-phase.

Interpretation

Myometry revealed that anti-parkinsonian medication decreases not only rigidity in PD, but also rigidity-related stiffness in resting skeletal muscles in PD patients. These findings show that myometry can enrich neurological practice, by allowing objective and reliable assessment of parkinsonian rigidity treatment effectiveness.     

Creation of an asymmetrical gradient of back muscle activity and spinal stiffness during asymmetrical hip extension

Background

Low back pain is often associated with increased spinal stiffness which thought to arise from increased muscle activity. Unfortunately, the association between paraspinal muscle activity and paraspinal stiffness, as well as the spatial distribution of this relation, is unknown. The purpose of this investigation was to employ new technological developments to determine the relation between spinal muscle contraction and spinal stiffness over a large region of the lumbar spine.

Methods

Thirty-two male subjects performed graded isometric prone right hip extension at four different exertion levels (0%, 10%, 25% and 50% of the maximum voluntary contraction) to induce asymmetric back muscle activity. The corresponding stiffness and muscle activity over bilateral paraspinal lumbar regions was measured by indentation loading and topography surface electromyography, respectively. Paraspinal stiffness and muscle activity were then plotted and their correlation was determined.

Findings

Data from this study demonstrated the existence of an asymmetrical gradient in muscle activation and paraspinal stiffness in the lumbar spine during isometric prone right hip extension. The magnitude and scale of the gradient increased with the contraction force. A positive correlation between paraspinal stiffness and paraspinal muscle activity existed irrespective of the hip extension effort (Pearson correlation coefficient, range 0.566–0.782 (P < 0.001)).

Interpretation

Our results demonstrate the creation of an asymmetrical gradient of muscle activity and paraspinal stiffness during right hip extension. Future studies will determine if alterations in this gradient may possess diagnostic or prognostic value for patients with low back pain.     

Measurement of muscle stiffness using robotic assisted gait orthosis in children with cerebral palsy: a proof of concept

Purpose.?To evaluate the feasibility and reliability of a novel stiffness assessment tool implemented in the driven gait orthosis Paediatric Lokomat; to investigate the influence of single robotic-assisted gait training (RAGT) on muscle stiffness in children with cerebral palsy (CP).

Methods.?Ten children with spastic CP conducted a single standard RAGT session and stiffness was assessed before and after the RAGT. Nine of the ten subjects were tested twice on the same day to investigate test–retest reliability, intraclass correlation coefficients (ICCs), standard error of measurement (SEM), coefficient of variation of the method error (CV_ME) and resistive torques during passive leg movements (stiffness in Nm/°) were calculated.

Results.?ICCs showed high reliability (0.83–0.97) for hip and knee movements. SEM and CV_ME indicated 0.028–0.085 Nm/°, 9.5–23.0% of test–retest variability in hip and 0.018–0.064 Nm/°, 13.3–43.5% in knee measures. Using the assessment tool, a significant decrease in muscle stiffness in participants, especially in children with high levels of muscle tone, could be shown after a single session of RAGT.

Conclusions.?The assessment tool L-STIFF is a feasible tool for automated measurement of stiffness in children with CP, but it is not sensitive enough to record small changes in muscle tone.     

Immediate decrease of muscle biomechanical stiffness following dry needling in asymptomatic participants

BackgroundBiomechanical muscle stiffness has been linked to musculoskeletal disorders. Assessing changes in muscle stiffness following DN may help elucidate a physiologic mechanism of DN. This study characterizes the effects of dry needling (DN) to the infraspinatus, erector spinae, and gastrocnemius muscles on biomechanical muscle stiffness.Method60 healthy participants were randomized into infraspinatus, erector spinae, or gastrocnemius groups. One session of DN was applied to the muscle in standardized location. Stiffness was assessed using a MyotonPRO at baseline, immediately post DN, and 24 h later. The presence of a localized twitch response (LTR) during DN was used to subgroup participants.ResultsA statistically significant decrease in stiffness was observed in the gastrocnemius, the LTR gastrocnemius, and the LTR erector spinae group immediately following DN treatment. However, stiffness increased after 24 h. No significant change was found in the infraspinatus group.ConclusionsDN may cause an immediate, yet transitory change in local muscle stiffness. It is unknown whether these effects are present in a symptomatic population or related to improvements in clinical outcomes. Future studies are necessary to determine if a decrease in biomechanical stiffness is related to improvement in symptomatic individuals.     

Previous hamstring muscle strain injury alters passive tissue stiffness and vibration sense

BackgroundHamstring strain is one of the most common among sports injuries. A previous history of this injury is considered a strong predictor of recurrent hamstring strain injury. It has been suggested that fascial tissue alters after muscle strain injury. However, the association between previous hamstring strain injury and tissue stiffness and vibration sense detection has not been investigated.ObjectivesWe aimed to determine whether a previous history of hamstring strain injury affects tissue stiffness and vibration sense in professional soccer players.MethodThe stiffness (MyotonPRO®) and vibration disappearance threshold (tuning fork) were measured in eight professional soccer players with previous history of hamstring strain and eight uninjured players. The differences between two groups’ means were analyzed. Side-to-side differences between injured and uninjured legs were also analyzed. Results: The tissue stiffness was higher, and the vibration disappearance threshold was lower, in previously injured players when compared to uninjured players. Similar differences were found between injured and uninjured legs. No significant relationship was detected between the age or body mass index (BMI) for both tissue stiffness and vibration disappearance threshold (all P < 0.05).ConclusionsSoccer players with a previous history of hamstring strain injury exhibited higher tissue stiffness and lower vibration sensitivity in the injured leg, regardless of the age and BMI. The results that players who have a previous hamstring strain injury with altered tissue stiffness and vibration sense will be useful and feasible evaluation for chronic muscle strain condition.     

中国僧侣素食时间对动脉僵硬度的影响

背景动脉异常是引起严重心血管事件的直接原因。动脉僵硬度增加目前已认为是重要的心血管危险信号。在众多的导致心血管(CV)疾病危险因素当中,预防和控制CV疾病进展的首要措施是生活方式改善。僧侣是一特殊的素食人群,针对其动脉僵硬度的改变未见报道。目的评价僧侣人群素食时间对动脉僵硬度的影响。方法本研究入选了71名生活在山西五台山的僧侣。所有受检者均为男性,平均年龄41．49±13．64岁(范围15～67岁)。平均素食时间10．42±8．97年。所有受检者均进行了肱动脉血压测量及血液生化检查。应用自动测量系统(Complior,法国)对动脉僵硬度进行了测定,颈动脉-股动脉脉搏波速度(C-FPWV)用于反映动脉功能。结果受检被试根据其素食时间与年龄的比值被分为两组。结果发现素食时间与年龄比值＞0．2组(35．83±15．47岁)比素食时间与年龄比值＜0．2组年龄较小(44．38±11．8岁,P=0．011),但其脉压水平(47．79±9．13 mm Hg)显著高于素食时间与年龄比值＜0．2组人群(42．47±6．63 mm Hg,P=0．006)。C-FPWV在素食时间与年龄比值＞0．2组(8．72±1．24 m/s)比素食时间与年龄比值＜0．2组明显降低(9．44±1．03)m/s,(P=0．011)。结论生活方式改善对于血管健康非常重要。素食时间超过年龄的五分之一有助于降低动脉僵硬度。     

Reliability and discriminative validity of real-time ultrasound elastography in the assessment of tissue stiffness after calf muscle injury

ObjectiveTo investigate the reliability and discriminative validity of real-time ultrasound elastography (RTE) measures of soft-tissue elasticity after calf muscle tear.DesignCross-sectional, intra/inter-examiner reliability and comparative validity study.SettingDepartment of Physical Therapy.ParticipantsTwenty-one recreational athletes were included and examined 6 weeks after sustaining a grade I-II calf musculature tear.Main outcome measuresSoft-tissue elasticity was measured by two experienced assessors using RTE assessments in both the longitudinal and transverse planes of the athletes’ injured and uninjured calf muscles. Elasticity was estimated by using the strain ratio (SR), which was calculated by dividing the strain (displacement) value taken at the medial gastrocnemius-soleus myotendinous junction (reference) by the strain value taken at the centre of the injury (index) as visualized on B-mode sonogram. Intra- and inter-observer reliability was estimated calculating intra-class correlation coefficients (ICCs) and standard error of measurement (SEM). Differences in elasticity between injured and healthy legs were assessed using t-tests or Wilcoxon tests for repeated measures.ResultsAll RTE assessments in both planes showed ICC values ranging from 0.77 to 0.95 and SEM values ranging from 0.72 to 0.99. Additionally, RTE enabled both assessors to determine differences in elastic properties between injured and control legs (p < 0.001).ConclusionRTE measures of calf muscles demonstrated good reliability and were able to differentiate injured from non-injured muscle tissue. RTE may provide a fast and objective measure in sports medicine to improve the detection of risk factors for muscle injury related to alterations of the mechanical behaviour of soft tissues during healing process.     

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。