A型肉毒毒素联合低频体外冲击波治疗脑卒中后小腿三头肌痉挛的疗效观察

目的 观察A型肉毒毒素(BTX-A)联合低频体外冲击波(ESWT)治疗脑卒中后小腿三头肌痉挛的疗效。 方法 采用随机数字表法将36例脑卒中后小腿三头肌痉挛患者分为观察组及对照组,每组18例。2组患者在常规康复训练基础上均给予BTX-A局部注射,观察组患者于BTX-A注射后辅以低频ESWT治疗,对照组则辅以伪体外冲击波治疗。于治疗前、治疗2周、4周后分别采用改良Ashworth量表(MAS)、关节活动度、简化Fugl-Meyer运动功能评分(FMA)及改良Barthel指数（MBI）对2组患者进行疗效评定。 结果 治疗前2组患者MAS、下肢FMA、MBI评分及PROM组间差异均无统计学意义（P>0.05）。治疗2周后发现2组患者上述指标均较治疗前明显改善(P<0.05);并且观察组MAS评分［(2.15±0.56)分］及PROM［(44.37±8.02)°］亦显著优于对照组水平(P<0.05);治疗4周后2组患者MAS、下肢FMA、MBI评分及PROM均较治疗前进一步改善(P<0.05),并且上述指标均以观察组患者的改善幅度较显著,与对照组间差异均具有统计学意义（P<0.05）。 结论 BTX-A联合低频ESWT治疗可显著缓解脑卒中后小腿三头肌痉挛,降低肌张力,改善患肢运动功能及日常生活能力,可作为治疗脑卒中后小腿三头肌痉挛的有效手段在临床推广、应用。     

踝足矫形器早期应用对卒中患者足踝控制能力的sEMG研究

目的：本文探讨足踝矫形器早期应用对脑卒中偏瘫患者足踝控制能力的作用及价值。方法：诊断明确的脑卒中患者48例,随机分为早期支具组（ZJ组）和对照组（D组）各24例,均按常规对症支持治疗。ZJ组早期患足加穿定制的硬塑固定踝足矫形器,D组则病程〉1个月后开始穿戴或不戴。2组均在治疗前后进行表面肌电图（sEMG）检测及下降Fugl-Meyer（FMA）评定。结果：治疗1个月后,小腿胫前肌、腓肠肌积分肌电值（iEMG值）与治疗前比较,2组均明显增加,下肢简化FMA评分均明显提高（均P〈0.01）。腓肠肌iEMG值在踝关节背伸等长收缩时小腿肌群的协同收缩率,ZJ组明显低于D组（P〈0.05）。结论：早期使用踝足矫形器可有效缓解踝背伸活动时拮抗肌的痉挛、增强胫前肌肌力,改善踝关节活动范围,对促进足下垂的恢复有明显作用。     

静态渐进性牵伸对痉挛型脑性瘫痪患儿尖足疗效的观察

目的:观察静态渐进性牵伸治疗对痉挛型脑瘫患儿尖足的疗效。方法:60例(年龄4—12岁)痉挛型脑瘫患儿随机分为观察组(30例)和对照组(30例),观察组进行静态渐进性牵伸治疗,再配合常规康复治疗。对照组仅进行常规康复治疗。治疗前后,两组分别进行踝关节背屈活动度(ROM)、小腿三头肌肌张力评分(MAS)和GMFM量表D区(站立)、E区(走跑跳)评估。结果:两组治疗前踝关节ROM、肌张力和GMFM量表D、E区评分间差异均无显著性(P0.05),治疗3个月后,两组各项指标较治疗前均改善(P0.05),且以观察组的改善幅度较为显著,与对照组比较,组间差异有显著性(P0.05)。结论:静态渐进性牵伸治疗配合常规康复治疗能增加痉挛型脑瘫患儿踝关节背屈活动度,降低小腿三头肌肌张力,提高患儿站立和走跑跳的运动功能。     

综合康复干预对脑卒中偏瘫患者肢体功能恢复的影响

目的 观察综合康复干预（包括常规康复训练、肌电生物反馈训练及穴位按摩等）对脑卒中偏瘫患者肢体功能恢复的影响。 方法 采用随机数字表法将60例脑卒中后偏瘫患者分为观察组及对照组,每组30例。对照组患者给予常规康复训练,观察组患者在此基础上辅以肌电生物反馈训练及患肢肌肉、穴位按摩治疗。于治疗前、治疗10周后分别采用Fugl-Meyer运动功能量表（FMA）、改良Ashworth痉挛量表(MAS)及改良Barthel指数评分（MBI）对2组患者进行疗效评定。 结果 治疗前2组患者屈腕肌、踝跖屈肌MAS评分、上肢及下肢FMA评分、MBI评分组间差异均无统计学意义（P>0.05）;经10周治疗后发现2组患者上述疗效指标均较治疗前明显改善（P<0.05）,并且观察组屈腕肌、踝跖屈肌MAS评分［分别为（1.5±0.5）分、（1.8±0.4）分］、上肢及下肢FMA评分［分别为（51.3±2.1）分、（26.4±4.1）分］、MBI评分［（62.7±20.9）分］均显著优于对照组水平,组间差异均具有统计学意义（P<0.05）。 结论 在常规康复干预基础上辅以肌电生物反馈训练及患肢肌肉、穴位按摩治疗,能进一步促进脑卒中偏瘫患者肢体功能恢复,提高患者生活质量。     

放散式体外冲击波对脑卒中患者下肢痉挛及三维步态参数的效果研究

摘要 目的：观察放散式体外冲击波对脑卒中偏瘫患者下肢痉挛,步态时空、对称性参数以及运动学参数的影响。 方法：选取40例符合入选标准的脑卒中偏瘫患者,将其随机分为试验组及对照组,每组20例。试验组进行常规康复治疗和患侧下肢放散式体外冲击波治疗（每周2次）,连续3周,对照组进行常规治疗和安慰性冲击波治疗。分别于治疗前、第三周全部治疗结束后使用三维步态分析仪器检测并获得两组患者的步态参数。同时比较两组患者治疗前后腘绳肌、股四头肌、小腿三头肌改良Ashworth分级（MAS）评分,以及患侧下肢的Fugl-Meyer（FMA）评分。 结果：在第三周治疗结束后,两组患者步频、步幅、步速、患侧摆动相和健侧摆动相、踝关节最大背屈角度、踝关节最大跖屈角度均较治疗前明显提高（P<0.05）,步态周期、双支撑相、患侧支撑相、健侧支撑相、步长偏差、患侧健侧摆动相比值均较治疗前明显减小（P<0.05）。组间对比显示,治疗后试验组患者步幅、步频、步速、步态周期、步长偏差、踝关节最大背屈角度、踝关节最大跖屈角度均优于对照组（P<0.05）。治疗后试验组腘绳肌、股四头肌、小腿三头肌MAS评分及患侧下肢FMA评分均较治疗前改善(P<0.05),并优于对照组(P<0.01,P<0.05)。 结论：放散式体外冲击波能有效改善脑卒中偏瘫患者步态时空、运动学、对称性参数,提高脑卒中偏瘫患者的步行功能和步态的对称性。同时可以降低患侧下肢的痉挛,提高下肢运动功能。     

跟腱延长术治疗痉挛型脑性瘫痪患儿马蹄足的效果北大核心CSCD

目的评估跟腱延长术治疗痉挛型脑瘫马蹄足的效果。方法 2013年12月至2014年6月接受跟腱延长术治疗的痉挛型脑瘫马蹄足患儿17例(34足),于术前、术后8~12个月分别进行踝关节背屈关节活动度(ROM)、小腿胫前后肌群表面肌电测试,记录踝关节被动背屈、主动背屈ROM,站立位胫前肌、腓肠肌肌电均方根值(RMS)和拮抗肌协同收缩率(CR)。结果术后踝关节主动、被动背屈ROM显著增加(Z>4.867,P<0.001);被动背屈时腓肠肌RMS减少(t=4.31,P<0.001),站立时胫前肌、腓肠肌RMS无显著性差异(Z<1.291,P>0.05),CR降低(t=2.38,P<0.05)。结论跟腱延长术可以改善痉挛型脑瘫马蹄足患儿小腿胫前后肌群协调收缩,增加踝ROM。     

肉毒毒素注射后功能性电刺激与运动平板同步治疗脑卒中后足下垂及足内翻的疗效观察

目的观察A型肉毒毒素(BTX-A)注射后功能性电刺激同步减重平板治疗对脑卒中患者足下垂及足内翻的影响。 方法采用随机数字表法将67例脑卒中后出现足下垂及内翻的患者分为联合治疗组（22例）、电刺激组（23例）及常规治疗组（22例）。3组患者均在B超及电刺激引导下进行BTX-A注射治疗,24h后常规治疗组患者给予常规干预（包括使用脑保护剂及进行肢体功能锻炼、步态训练、平衡训练、日常生活活动能力训练等）,联合治疗组在常规治疗基础上辅以功能性电刺激与减重平板同步治疗,电刺激组则在常规治疗基础上辅以功能性电刺激。于治疗前、治疗6周后对各组患者进行疗效评定,具体疗效评定指标包括胫骨前肌与腓肠肌外侧头积分肌电值（iEMG）、踝背伸协同收缩率(CR)、改良Ashworth量表(MAS)评分、Berg平衡量表(BBS)评分、功能性步行分级(FAC)、踝背伸与外翻活动度(ROM)等。 结果治疗后3组患者胫骨前肌iEMG、腓肠肌外侧头iEMG、踝背伸CR、MAS评分、BBS评分、FAC评分、踝背伸与外翻ROM均较治疗前明显改善（P<0.05）;通过组间比较发现,治疗后3组患者腓肠肌外侧头iEMG组间差异无统计学意义(P>0.05);联合治疗组胫骨前肌iEMG［(1.54±0.23)mV］、踝背伸CR［(13.32±8.47)%］、MAS评分［(0.29±0.35)分］、BBS评分［(42.37±4.28)分］、FAC评分［(4.26±1.14)分］、踝背伸ROM［(15.58±1.32)°］与外翻ROM［(14.33±1.41)°］均显著优于电刺激组及常规治疗组水平(P<0.05)。 结论于BTX-A注射后同步进行功能性电刺激及减重平板训练,能进一步改善脑卒中患者足下垂及足内翻畸形,促其步行功能改善,该联合疗法值得临床推广、应用。     

肉毒素治疗脑瘫患儿小腿三头肌痉挛的疗效观察

目的：观察A型肉毒毒素（BTX-A）局部注射结合康复训练治疗脑瘫患儿小腿三头肌痉挛的疗效.方法：将20例脑瘫患儿随机分为观察组和对照组各10例,2组均接受常规康复训练,观察组增加小腿三头肌BTX-A局部注射治疗,于治疗前后给予下肢改良Ashworth评分（MAS）,并评定伸膝踝关节背屈度.结果：治疗1、2、3个月后,观察组MAS评分明显低于治疗前及同时间点对照组（P＜0.01,0.05）;2组伸膝踝关节背屈度均较治疗前及同时间点对照组明显提高,且观察组更高于对照组（P＜0.01,0.05）;对照组在治疗3个月后MAS评分才低于治疗前（P＜0.05）.结论：BTX-A局部注射结合康复训练比单纯康复训练治疗小腿三头肌痉挛疗效更好.     

基于交叉迁移理论的健侧肢体力量训练对偏瘫患者运动功能的影响

目的 观察健侧力量训练后脑卒中偏瘫患者是否能产生交叉迁移现象。 方法 选取脑卒中偏瘫患者30例,按随机数字表法分为实验组和对照组,每组患者15例。2组患者均接受常规康复治疗,实验组给予健侧肢体踝背屈等长抗阻训练。2组患者在训练前、训练6周后测定最大随意收缩力量(MVC)和表面肌电变化,采用简化Fugl-Meyer运动功能评定量表(FMA)下肢部分评定下肢运动功能。 结果 训练后,治疗组FMA评分为（26.53±2.64）分,与组内治疗前和对照组治疗后比较,差异均有统计学意义(P<0.05);训练后,治疗组胫骨前肌IEMG、腓肠肌IEMG与组内治疗前和对照组治疗后同侧比较,差异均有统计学意义(P<0.05)。治疗后,治疗组双侧胫骨前肌MVC和腓肠肌MVC与组内治疗前和对照组治疗后同侧比较,差异均有统计学意义(P<0.05)。 结论 健侧踝背屈等长抗阻力量训练可引起脑卒中偏瘫患者对侧胫骨前肌和拮抗肌的力量增长,存在力量训练的交叉迁移现象;健侧等长抗阻力量训练可改善下肢运动功能。     

脑卒中患者痉挛上肢肌肉协调性的表面肌电研究

目的探讨脑卒中患者痉挛上肢各关节最大等长收缩（MIVC）时的表面肌电（sEMG）信号变化，定量分析异常协同运动模式，为上肢肌肉协调性的康复提供客观依据。 方法选取10例脑卒中偏瘫患者和10例健康成人纳入研究，在进行屈腕、屈伸肘及肩外展MIVC时，记录尺侧腕屈肌、肱二头肌、肱三头肌及三角肌的sEMG信号，计算协同收缩率（CR）和共激活比值，对两者进行分析比较。 结果屈伸肘时，病例组患侧肱二头肌CR大于健侧及对照组（P<0.05），患侧肱三头肌CR大于对照组（P<0.05），患侧、健侧及对照组肱二头肌CR均大于肱三头肌CR（P<0.05），患侧肱二头肌、肱三头肌CR差值大于健侧及对照组（P<0.05）；屈肘时，患侧尺侧腕屈肌、肱三头肌、三角肌的共激活比值大于健侧及对照组（P<0.05），患侧尺侧腕屈肌的共激活比值大于肱三头肌（P<0.05）；伸肘时，患侧尺侧腕屈肌、肱二头肌、三角肌的共激活比值大于健侧及对照组（P<0.05），患侧尺侧腕屈肌的共激活比值大于肱二头肌（P<0.05）；屈腕时，患侧肱二头肌、三角肌的共激活比值大于健侧及对照组（P<0.05），患侧肱二头肌的共激活比值大于三角肌及肱三头肌（P<0.05）；肩外展时，患侧肱二头肌的共激活比值大于健侧及对照组（P<0.05）。 结论脑卒中患者痉挛上肢常表现为屈肌痉挛和典型异常的协同运动模式，在康复治疗中，应注重抑制屈肌痉挛，改善上肢异常协同运动模式，促进上肢肌肉整体协调性的康复。     

Biceps brachii muscle oxygenation in electrical muscle stimulation

The purpose of this study was to compare between electrical muscle stimulation (EMS) and maximal voluntary (VOL) isometric contractions of the elbow flexors for changes in biceps brachii muscle oxygenation (tissue oxygenation index, TOI) and haemodynamics (total haemoglobin volume, tHb = oxygenated‐Hb + deoxygenated‐Hb) determined by near‐infrared spectroscopy (NIRS). The biceps brachii muscle of 10 healthy men (23–39 years) was electrically stimulated at high frequency (75 Hz) via surface electrodes to evoke 50 intermittent (4‐s contraction, 15‐s relaxation) isometric contractions at maximum tolerated current level (EMS session). The contralateral arm performed 50 intermittent (4‐s contraction, 15‐s relaxation) maximal voluntary isometric contractions (VOL session) in a counterbalanced order separated by 2–3 weeks. Results indicated that although the torque produced during EMS was approximately 50% of VOL (P<0·05), there was no significant difference in the changes in TOI amplitude or TOI slope between EMS and VOL over the 50 contractions. However, the TOI amplitude divided by peak torque was approximately 50% lower for EMS than VOL (P<0·05), which indicates EMS was less efficient than VOL. This seems likely because of the difference in the muscles involved in the force production between conditions. Mean decrease in tHb amplitude during the contraction phases was significantly (P<0·05) greater for EMS than VOL from the 10th contraction onwards, suggesting that the muscle blood volume was lower in EMS than VOL. It is concluded that local oxygen demand of the biceps brachii sampled by NIRS is similar between VOL and EMS.     

Defining smooth muscle cells and smooth muscle injury

For 3 decades, terms such as synthetic phenotype and contractile phenotype have been used to imply the existence of a specific mechanism for smooth muscle cell (SMC) responses to injury. In this issue of the JCI, Hendrix et al. offer a far more precise approach to examining the mechanisms of SMC responses to injury, focused not on general changes in phenotype but on effects of injury on a single promoter element, the CArG [CC(A/T)6GG] box, in a single gene encoding smooth muscle (SM) alpha-actin. Since CArG box structures are present in some, but not all, SMC genes, these data suggest that we may be progressing toward establishing a systematic, molecular classification of both SMC subsets and the response of SMCs to different injuries.     

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。     

Nerve growth factor improves the muscle regeneration capacity of muscle stem cells in dystrophic muscle

Researchers have attempted to use gene- and cell-based therapies to restore dystrophin and alleviate the muscle weakness that results from Duchenne muscular dystrophy (DMD). Our research group has isolated populations of muscle-derived stem cells (MDSCs) from the postnatal skeletal muscle of mice. In comparison with satellite cells, MDSCs display an improved transplantation capacity in dystrophic mdx muscle that we attribute to their ability to undergo long-term proliferation, self-renewal, and multipotent differentiation, including differentiation toward endothelial and neuronal lineages. Here we tested whether the use of nerve growth factor (NGF) improves the transplantation efficiency of MDSCs. We used two methods of in vitro NGF stimulation: retroviral transduction of MDSCs with a CL-NGF vector and direct stimulation of MDSCs with NGF protein. Neither method of NGF treatment changed the marker profile or proliferation behavior of the MDSCs, but direct stimulation with NGF protein significantly reduced the in vitro differentiation ability of the cells. NGF stimulation also significantly enhanced the engraftment efficiency of MDSCs transplanted within the dystrophic muscle of mdx mice, resulting in the regeneration of numerous dystrophin-positive muscle fibers. These findings highlight the importance of NGF as a modulatory molecule, the study of which will broaden our understanding of its biologic role in the regeneration and repair of skeletal muscle by musclederived cells.     

Immunoglobulin deposition in skeletal muscle in primary muscle diseases

Using direct immunofluorescence the deposition of IgG, IgM, IgA, Clq and C3 was studied on muscle biopsies from 39 patients with polymyositis/dermatomyositis, 21 patients with muscular dystrophy, 57 other disease controls and 10 healthy volunteers. Three staining patterns were observed, sarcolemma/basement membrane blood vessel wall and intrafibrous. Sarcolemma/basement membrane staining, but not blood vessel wall or intrafibrous staining, occurred more frequently (p less than 0.05) in the polymyositis/dermatomyositis group compared with the two other disease groups. Immunoglobulin deposition was useful in distinguishing myopathic from neuropathic disorders. Grouping the patients into those with connective tissue diseases and those without, sarcolemma/basement membrane and blood vessel wall staining were shown to distinguish the two groups (p less than 0.05). An analysis of the histological abnormalities in the polymyositis/dermatomyositis group was performed and related to immunoglobulin/complement deposition. Fibre damage, rather than the presence of a mononuclear perivascular infiltrate, was shown to be the best correlate with each of the three staining patterns. Immunoglobulin and/or complement deposition in skeletal muscle is an abnormal finding and the results described support the notion that humoral abnormalities may be detected frequently in polymyositis/dermatomyositis. In addition, the inability to distinguish polymyositis/dermatomyositis from muscular dystrophy limits the potential value of direct immunofluorescence as a diagnostic tool.     

骨骼肌损伤肌肉疼痛的病因分析

过度的骨骼和肌肉运动后能引起软组织损伤。其病因主要是由于超过习惯的肌肉工作引起工作后肌肉收缩蛋白的分解代谢强于合成代谢的降解优势导致延迟性肌肉收缩结构的改变或解体,在这样的结构改变背景条件下后续负荷过大,就可能引起肌肉的急性或慢性劳损。肌肉疼痛除常规治疗外,还需要设计康复治疗计划,包括:放松练习,水中运动,物理治疗,放松疗法等,争取达到最大限度的恢复。     

Rhomboid muscle electromyography activity during 3 different manual muscle tests

OBJECTIVE: To determine which of 3 previously published rhomboid manual muscle tests (MMTs) elicits the maximal rhomboid electromyographic activity in an asymptomatic population. DESIGN: Criterion standard. SETTING: Motion analysis laboratory at tertiary care medical center. PARTICIPANTS: Eleven male volunteers (age range, 24-40y) without shoulder or neck pain. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Peak 1-second normalized electromyographic activity in the rhomboid muscle during 8 different MMT positions, including 3 different rhomboid MMT positions (Kendall, Kendall-Alternative, Hislop-Montgomery). RESULTS: The Kendall MMT (78% maximal voluntary contraction [MVC]) produced higher rhomboid electromyographic activity than the Kendall-Alternative (71% MVC) or the Hislop-Montgomery MMT (52% MVC), but the differences were not statistically significant. The posterior deltoid MMT generated the greatest rhomboid electromyographic activity of all MMTs, and 4% to 30% greater rhomboid electromyographic activity than the 3 rhomboid MMTs (P=.0001; posterior deltoid > Hislop-Montgomery). Electromyographic profiles of the Kendall and Kendall-Alternative MMTs were similar, whereas the Hislop-Montgomery MMT produced less upper trapezius activity (P=.0001 vs Kendall and Kendall-Alternative) and more latissimus dorsi activity (P=.0001 vs Kendall-Alternative). The standard MMT positions for the middle trapezius, levator scapula, posterior deltoid, and latissimus dorsi produced the maximal electromyographic activity for their respective target muscles. CONCLUSIONS: The posterior deltoid MMT position should be used to produce maximal rhomboid electromyographic activity for normalization purposes during kinesiologic studies. The Kendall and Kendall-Alternative rhomboid MMT are likely to be clinically indistinct. It is unlikely that clinicians can use standard MMT positions to distinguish rhomboid strength from synergists, such as the levator scapula and middle trapezius muscle, for diagnostic purposes.     

Respiratory muscle fatigue

When respiratory muscle demands for energy exceed supplies, the energy stored within the muscles is depleted and the force of contraction diminishes. This state is called inspiratory muscle fatigue. When it occurs alveolar ventilation decreases, arterial carbon dioxide tension (PaCO₂) increases and hypercapnic respiratory failure ensues. It has also been suggested that such a dysfunction of the respiratory muscles contributes to the pathogenesis of acute respiratory failure. The purpose of this article is to review those factors that predispose to respiratory muscle fatigue and determine energy demand and supply and the principal means of investigation available to detect respiratory muscle fatigue in the clinical setting.