针刀干预对膝骨关节炎兔股四头肌肌腱拉伸力学的影响

目的:观察针刀干预对膝骨关节炎(KOA)兔行为学、形态学及拉伸力学的影响,探讨针刀治疗KOA的生物力学效应。方法:24只新西兰雄兔随机分为4组:正常组、模型组、电针组、针刀组,每组各6只。模型组以改良Videman左后肢伸直位固定制动固定6周建立兔KOA模型。电针组电针左侧梁丘、血海、内膝眼、外膝眼,每周3次,治疗3周。针刀组以针刀松解左侧股四头肌肌腱,每周1次,治疗3周。分别于造模措施解除1周后和治疗结束1周后应用Lequesne MG膝关节评估法进行行为学检测,治疗结束1周后进行HE染色和力学测试。结果:行为学治疗前观察显示:在局部疼痛、步态反应、关节活动和关节肿胀方面,正常组与模型组比较差异有统计学意义(P0.05),而模型组、电针组和针刀组之间差异无统计学意义(P0.05)。治疗后结果显示:与正常组相比,模型组、电针组和针刀组在局部疼痛、步态反应、关节活动和关节肿胀上差异均有统计学意义(P0.05);在局部疼痛上,电针组较模型组降低,差异无统计学意义(P0.05),针刀组与模型组比较差异有统计学意义(P0.05),电针组和针刀组之间比较差异无统计学意义(P0.05);在步态改变上,模型组与电针组比较差异有统计学意义(P0.05);针刀组与模型组比较差异无统计学意义(P0.05);在关节活动度方面,电针组、针刀组与模型组相比,差异均有统计学意义(P0.05);在关节肿胀上,电针组和针刀组分别与模型组比较,差异均有统计学意义(P0.01),而电针组和针刀组之间比较差异无统计学意义(P0.05)。力学方面:与空白组相比,模型组的极限载荷显著降低(P0.01),电针组极限载荷有下降趋势(P0.05),针刀组极限载荷有上升趋势(P0.05);与模型组比较,电针组极限载荷升高(P0.05),针刀组极限载荷显著升高(P0.01);与电针组相比,针刀组极限载荷有上升趋势(P0.05)。与空白组比较,模型组的最大位移显著降低(P0.01),电针组和针刀组最大位移均有下降趋势(P0.05),与模型组比较,电针组最大位移有升高趋势(P0.05),针刀组最大位移显著升高(P0.05),与电针组相比,针刀组最大位移有上升趋势(P0.05)。在刚度方面各组数据间均无统计学意义(P0.05)。结论:针刀干预可使行为学及形态学发生明显改变,可显著改善股四头肌肌腱拉伸力学特性,并发挥其生物力学效应从而达到治疗KOA的目的。     

针刀治疗膝骨关节炎研究进展

随着中国社会目前逐渐步入老龄化,膝骨关节炎(KOA)发病率逐年升高,KOA的治疗也成为了临床热点.在众多KOA临床治疗方案中,针刀疗法简便高效、经济安全,具有独特优势.本文从KOA针刀治疗的理论基础、相关机制以及临床应用三个角度对目前针刀治疗KOA的进展进行综述.     

针刀疗法对L3横突综合征兔血浆血栓素B2及6-酮-前列腺素水平的影响

目的:观察针刀疗法对L3横突综合征兔血浆TXB2、6-keto-PGF1α水平的影响.方法:将实验兔18只随机分为针刀干预组、模型对照组、正常对照组,每组6只,于造模后10 d、15 d、25 d、30 d检测结果,进行统计学分析.结果:针刀干预组10 d、15 d、25 d、30 d TXB2含量与模型组比较差异无显著性(P>0.05),6-keto-PGF1α含量、TXB2/6-keto-PGF1α比值与模型组差异有非常显著性(P<0.01).结论:针刀干预使6-keto-PGF1α、TXB2/PGF1α比值呈良性改变,从而改善局部微循环,促进炎症吸收,增强了组织修复再生能力.     

针刀疗法对L3横突综合征兔血浆血栓素B2及6-酮-前列腺素水平的影响

目的 :观察针刀疗法对L3 横突综合征兔血浆TXB2 、6 keto PGF1α水平的影响。方法 :将实验兔 18只随机分为针刀干预组、模型对照组、正常对照组 ,每组 6只 ,于造模后 10d、15d、2 5d、30d检测结果 ,进行统计学分析。结果 :针刀干预组 10d、15d、2 5d、30dTXB2 含量与模型组比较差异无显著性(P >0 0 5 ) ,6 keto PGF1α含量、TXB2 /6 keto PGF1α比值与模型组差异有非常显著性 (P <0 0 1)。结论 :针刀干预使 6 keto PGF1α、TXB2 /PGF1α比值呈良性改变 ,从而改善局部微循环 ,促进炎症吸收 ,增强了组织修复再生能力。     

射频针刀联合臭氧注射治疗对膝骨关节炎软组织张力特征影响的临床研究

目的:观察射频针刀联合臭氧注射对II级膝骨性关节炎(KOA)周围软组织张力的改善作用。方法:选择天津中医药大学第一附属医院骨伤科收治的单侧KOA患者60例,治疗组采用射频针刀联合臭氧治疗,对照组采用手法治疗,治疗前后采用疼痛VAS评分、骨关节炎WOMAC指数进行疗效评价,用软组织张力测试仪测量健患侧治疗前后膝周4个点在200×g压力时所对应的位移值(FDD值)。结果:治疗组与对照组治疗后患者VAS评分减小,WOMAC指数较治疗前改善,差异均有统计学意义(P0.05)。治疗组VAS评分和WOMAC指数较对照组明显改善,差异有统计学意义。治疗组与对照组治疗后髌上2 cm处股内侧肌、股中间肌、股外侧肌,髌韧带中点的FDD值均较治疗前改善,差异有统计学意义(P0.05)。结论:射频针刀联合臭氧注射与手法治疗KOA均能改善患者膝关节疼痛、功能,但在疼痛、功能改善程度以及临床疗效方面前者要优于后者。两种治疗均能对膝关节周围软组织张力产生影响,使膝关节周围软组织张力降低,改善力学微环境。     

铍针与针刀治疗膝骨关节炎对重心指数影响的临床观察

目的 :观察铍针松解与针刀松解治疗膝骨关节炎对患者双足负重的影响。方法 :将113例早中期KOA患者采用随机数字表法分为铍针组(38例)、针刀组(38例)和扶他林组(37例)。其中铍针组男13例,女25例,平均年龄(55.87±7.72)岁,采用铍针治疗,每周治疗1次,2周为1个疗程;针刀组男11例,女27例,平均年龄(57.11±7.07)岁,采用针刀治疗,每周治疗1次,2周为1个疗程;扶他林乳胶剂组男12例,女25例,平均年龄(57.62±8.08)岁,采用扶他林乳胶剂3~5 cm涂抹膝关节疼痛部位,每日3次,2周为1个疗程。另取正常人36例为正常组,男11例,女25例,平均年龄(55.28±7.55)岁,不进行任何治疗。治疗前后分别以重力四格秤测量双足前后四点负重的方法来观察3组患者双足负重情况,测算重心到原点的距离d值,并以d值为观察指标,以JOA膝骨关节炎疗效标准进行临床疗效评价。结果:5例患者脱落,其中铍针组2例、针刀组2例、扶他林组1例。其余108例患者获得随访,时间28~35 d,平均30 d,均未出现不良反应。各组患者治疗前及治疗后1个月与正常组d值组间比较,差异均有统计学意义(P0.05),各组患者治疗前与治疗后1个月d值组内比较,差异均有统计学意义(P0.05),且治疗后较治疗前d值均减小。参照JOA膝骨关节炎疗效标准评价临床疗效,治疗前及治疗后1个月各组患者JOA评分比较差异无统计学意义(P0.05);各组患者治疗前与治疗后1个月JOA评分组间比较,差异有统计学意义(P0.05)。结论:铍针松解、针刀松解及扶他林乳胶剂外用治疗早中期KOA患者后,治疗后重心更接近原点、负重情况得到改善。四格秤测试KOA患者治疗前后重心的变化简便易行。     

痛点针刀松解对膝关节骨性关节炎患者部分运动步态和血清TNF-α及IL-1的影响

目的:探讨痛点针刀松解对于膝关节骨性关节炎(knee osteoarthritis,KOA)患者疼痛,功能,步态以及血清炎性因子的影响。方法:自2017年12月至2019年6月收集110例KOA患者,采用随机数字表法分为针刀组(56例)和西药组(54例)。针刀组男16例,女40例;年龄46~74(62.98±6.68)岁;病程24.50(15.25,33.00)个月;于膝关节周围各痛点行针刀松解治疗,每周1次,共3周。西药组男18例,女36例;年龄47~73(64.19±5.98)岁;病程25.00(13.75,33.00)个月;口服塞来昔布胶囊,每日1次,每次200 mg,共3周。分别于治疗前、治疗后3周和3个月时行英国牛津膝关节评分(Oxford Knee Score,OKS),治疗前和治疗后3周时行步态运动学分析和血清肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)和白细胞介素-1β(interleukin-1β,IL-1β)水平检测。结果:所有患者获得随访,时间6~24(15.03±4.55)个月。两组患者治疗后3周和3个月时各项OKS较治疗前均显著下降(P<0.001);治疗后3个月与治疗3周比较,针刀组功能评分和总体评分显著下降(P<0.001);而且治疗后3周和3个月时针刀组各项OKS均显著低于西药组(P<0.05)。两组患者治疗后3周时步速、步频、步长与治疗前比较差异有统计学意义(P<0.001);治疗后3周时针刀组步频较西药组改善明显(P<0.05)。两组患者治疗后3周时TNF-α、IL-1β与治疗前比较,均显著降低(P<0.05);西药组IL-1β水平较针刀组更低(P<0.05),而TNF-α水平组间比较,差异无统计学意义(P>0.05)。结论:痛点针刀松解可以显著改善早中期KOA患者的疼痛、功能、步态以及降低血清炎性因子,尤其在膝关节功能恢复和步频改善方面优于非甾体抗炎药。     

针刀松解法对膝骨关节炎大鼠中枢不同部位亮氨酸-脑啡肽的影响

目的：通过观察针刀松解法干预后膝骨关节炎（KOA）大鼠中枢不同部位亮氨酸-脑啡肽（L-ENK）的变化并与电针干预相比较,探讨针刀松解法在脊髓及脊髓以上水平的镇痛机制。方法：将60只健康SD大鼠随机分为空白组、模型组、电针组和针刀组。将4%木瓜蛋白酶溶液与0.3mol/L半胱氨酸溶液按1：1混合静置0.5h后分别于造模第1、4、7天注射于后3组大鼠左膝关节腔,每次20μl。造模第36天开始,相应给予针刀松解治疗或电针治疗,治疗3周后取大鼠腰膨大处脊髓及脑组织,分别测定脊髓、延髓、中脑、丘脑、海马的L-ENK含量。结果：造模后,模型组大鼠L-ENK含量在脊髓、中脑、海马较空白组差异均有统计学意义（P〈0.01）,延髓和丘脑L-ENK含量与空白组差异无统计学意义（P〉0.05）。针刀和电针干预后,针刀组海马中L-ENK含量较模型组升高,差异有统计学意义（P〈0.05）;针刀组中脑L-ENK含量较模型组降低,差异有统计学意义（P〈0.05）;海马中L-ENK含量针刀组较电针组高,差异有统计学意义（P〈0.05）;其余部位差异均无统计学意义（P〉0.05）。结论：针刀松解法对KOA大鼠中枢各水平的L-ENK有一定调节作用,其镇痛作用的发挥可能与其对中枢L-ENK的调节有关。     

由IL-10/JAK2/STAT3通路探讨养血柔筋方对兔膝骨关节炎软骨损伤的研究

目的 由白细胞介素(IL)-10/Janus激酶(JAK2)/信号传导与转录激活因子3(STAT3)通路探讨养血柔筋方对兔膝骨关节炎(knee osteoarthritis, KOA)软骨损伤的影响及机制。方法 将新西兰雄兔分为空白组、KOA模型组、养血柔筋方组(50 mg/kg)、塞来昔布组(24 mg/kg)、JAK2激活剂组(50 mg/kg养血柔筋方+0.11 mg/kg AG490),每组6只。通过木瓜蛋白酶诱导KOA兔模型，造模成功后给予相应治疗。运用HE染色观察软骨组织病理变化，Mankin评分进行定量评分；透射电镜观察软骨组织的超微结构；ELISA测量血清IL-1β、IL-6含量；免疫组织化学检测软骨组织基质金属蛋白酶13(MMP13)、转化生长因子-β₁(TGF-β₁)、Ⅱ型胶原蛋白(COl-Ⅱ)蛋白表达；Western Blot检测软骨组织IL-10/JAK2/STAT3通路蛋白表达。结果 与空白组比较，KOA模型组中软骨组织病变严重，Mankin评分、IL-1β和IL-6含量、MMP13、p-JAK2和p-STAT3蛋白...     

L-型钙通道在NFAT1调节兔膝骨关节炎软骨细胞基质代谢中的作用

[目的]探讨L-型电压依赖性钙通道在NFAT1调节软骨细胞基质代谢中的作用。[方法]Hulth法制作兔骨关节炎(KOA)模型。使用q RT-PCR法观察对照组和KOA组兔软骨细胞5种NFAT亚型的m RNA表达情况,然后使用L-型钙通道阻断剂硝苯地平,检测软骨细胞NFAT各亚型和基质代谢各标记物的改变,以及膜片钳技术观察KOA细胞膜电位的变化。[结果]与对照组相比,KOA组软骨细胞5种NFAT的m RNA表达变化并不一致。KOA组软骨细胞NFAT1明显升高,是对照组的2.42倍(P<0.01),NFAT2显著降低,是对照组的0.34倍(P<0.01),而NFAT3、NFAT4和NFAT5的m RNA表达没有改变。与单纯DMSO培养基对照组相比,10μmol/L硝苯地平对KOA软骨细胞的活力没有影响,但完全阻断了KOA软骨细胞Cav1的m RNA表达,增加了软骨细胞内基质成分II型胶原(7.46倍,P<0.01)、聚集蛋白聚糖(4.98倍,P<0.05)和转化生长因子-β的m RNA表达(4.37倍,P<0.01),降低了分解酶基质金属蛋白酶-1(0.17倍,P<0.01),含血小板反应蛋白基序的解聚蛋白样金属蛋白酶-4(ADAMTS)(0.29倍,P<0.01)和ADAMTS-5的表达(0.10倍,P<0.01),与对照组的差异均具有统计学意义。同时,硝苯地平显著降低了NFAT1的表达,是对照组的0.20倍(P<0.05),但对NFAT2的m RNA表达没有影响。此外,硝苯地平使KOA组细胞膜电位显著增加(P<0.01)。[结论]L-型钙通道通过上调NFAT1.的m RNA表达参与调控KOA软骨细胞基质代谢。     

针刀松解术治疗膝骨关节炎的临床观察

目的 :观察针刀松解术治疗膝骨关节炎的临床疗效。方法 :2010年3月至2013年3月上海曙光医院骨伤科门诊诊治的膝骨关节炎患者,按照纳入、排除标准筛选后,纳入230例患者,分针刀组和针灸组。针刀组115例,男43例,女72例,年龄43~70岁,平均(51.4±1.7)岁,病程0.25~12年,平均(1.2±0.3)年,治疗前WOMAC总评分43.75±11.35,针刀松解术治疗1次;针灸组115例,男40例,女75例,年龄41~78岁,平均(52.4±2.0)岁,病程0.25~15年,平均(1.1±0.3)年,治疗前WOMAC总评分41.51±13.07,采用传统针灸疗法,每日治疗1~2次,共治疗2周。两组患者在性别、年龄、病程及WOMAC总评分上差异均无统计学意义,具有可比性;治疗后采用通用的WOMAC评分问卷调查方式来评价两组患者膝关节功能改善情况。结果:两组疗效比较结果采用秩和检验,差异有统计学意义(Z=-2.24,P=0.025),针刀组总体疗效优于针灸组。两组治疗前后WOMAC各项评分,针刀组:疼痛5.98±2.27及2.80±1.57,行走痛7.19±1.41及3.34±1.34,久坐站立痛5.54±1.91及2.31±1.40,僵硬6.57±1.40及3.11±1.44,上下楼梯7.24±1.12及3.70±1.22,下蹲屈膝5.44±1.81及2.45±1.63,日常活动5.79±1.44及2.76±1.32;针灸组:疼痛6.07±2.00及4.09±1.46,行走痛6.50±1.75及3.20±1.64,久坐站立痛5.23±2.88及3.65±1.84,僵硬6.06±1.38及2.97±1.01,上下楼梯6.74±1.16及3.41±0.62,下蹲屈膝5.79±1.97及3.65±1.62,日常活动5.12±1.93及3.30±0.00。两组组间比较,在疼痛、久坐站立痛、下蹲屈膝及日常活动改善方面,两组差异有统计学意义;在行走痛、僵硬及上下楼梯差异无统计学意义;两组组内比较,在疼痛、久坐站立痛、下蹲屈膝及日常活动改善方面,治疗后均优于治疗前。结论:针刀及针灸对改善膝关节功能均有效;针刀松解术对于缓解整体疼痛和恢复关节活动的疗效优于针灸,但对于僵硬和行走痛方面,针刀与针灸疗效相差不大,两者疗效相当。     

床旁超声定量评估下肢肌肉诊断重症监护病房获得性衰弱

目的 观察床旁超声定量评估下肢肌肉用于诊断重症监护病房（ICU）获得性衰弱（AW）的价值。方法 纳入40例ICU重症患者,根据医学研究委员会（MRC）评分判断ICU-AW。分别于进入ICU第1、4、7日以床旁超声定量评估右下肢肌肉,测量股直肌、股中间肌及胫骨前肌厚度,以及羽状角和股直肌横截面积,以首日为基线数据,计算第4、7日各肌肉萎缩率;对比ICU-AW与非ICU-AW患者之间上述参数的差异;绘制受试者工作特征（ROC）曲线,评估下肢肌肉参数对ICU-AW的诊断效能。结果 40例中,21例ICU-AW （ICU-AW组）,19例非ICU-AW （非ICUAW组）。进入ICU首日各肌肉参数组间差异均无统计学意义（P均>0.05）;第4日ICU-AW组股直肌厚度及横截面积的萎缩率均高于非ICU-AW组（P均<0.05）;在第7日,除胫骨前肌羽状角外,ICU-AW组其余肌肉参数萎缩率均高于非ICU-AW组（P均<0.05）。根据第4日股直肌横截面积及厚度萎缩率诊断ICU-AW的曲线下面积（AUC）分别为0.708、0.684;以第7日股直肌厚度萎缩率诊断ICU-AW的AUC为0.844。结论 床旁超声定量评估下肢肌肉有助于早期诊断ICU-AW;进入ICU第7日股直肌厚度萎缩率对于ICU-AW的诊断价值较高。     

锂剂抑制脊髓损伤后大鼠细胞凋亡的机制研究

目的 :研究锂剂是否通过抑制脊髓损伤(spinal cord injury,SCI)后大鼠神经细胞的凋亡产生神经保护作用。方法:将42只SD雄性大鼠,体重为200~250 g,按随机数字法分成3组:空白对照组(6只)不做手术;生理盐水(NS)组(18只)经腹腔注射NS(40 mg/kg);氯化锂(Licl)组(18只)经腹腔注射Licl(40 mg/kg)。按照Allen法对大鼠建模后,Licl组于脊髓损伤术后15 min内开始腹腔注射Licl溶液(40 mg·kg~(-1)·d~(-1))2周,NS组在同时间内注入等量的NS作为对照。分别于术后3、7、14 d进行BBB评分,利用免疫组化染色观察Bcl-2和Bax的表达,并采用TUNEL染色观察神经细胞凋亡。结果:BBB评分:空白对照组大鼠为21±0,Licl组与NS组比较,术后7、14 d时Licl组大于NS组(P0.05)。Bcl-2蛋白表达:空白对照组大鼠为0.081±0.003,术后7、14 d两个时间点Bcl-2蛋白表达Licl组分别为0.151±0.003和0.163±0.003,NS组为0.143±0.003和0.154±0.002,Licl组能明显升高其表达(P0.05)。Bax蛋白的表达:空白对照组大鼠为0.071±0.003,术后7、14 d两个时间点Bax蛋白的表达Licl组分别为0.121±0.002和0.106±0.002,NS组为0.126±0.001和0.120±0.002,Licl组可以明显降低其表达(P0.05)。神经细胞凋亡:TUNEL染色显示,空白对照组阳性细胞较少,凋亡指数(AI)为1.98±0.19,术后7、14 d两个时间Licl组分别为13.12±0.69和4.29±1.00,NS组为18.26±0.87和5.48±0.70,Licl组能显著抑制细胞凋亡(P0.05)。结论 :锂剂能够促进SCI后大鼠的神经元细胞内Bcl-2蛋白的表达,抑制神经元内Bax蛋白的表达,从而起到了抑制神经细胞凋亡的作用,这可能是锂剂促进大鼠运动功能恢复的机制之一。     

Electromyographic analysis of the knee using fixed-activation threshold after anterior cruciate ligament reconstruction

The aim of this study was to establish whether there are any electromyographic (EMG) differences after two different surgical techniques in two years follow-up after anterior cruciate ligament (ACL) reconstruction. Study participants were divided into three groups. The control group included healthy athletes (C), the first study group (E1) consisted of injured athletes who were treated by ACL reconstruction using patellar tendon graft and the second study group (E2) comprised injured athletes treated by gracilis and semitendinosus tendon graft. The threshold of muscle activity was defined as 30% of maximum amplitude of EMG signal medial envelope of individual muscles in the control group. Two years after reconstruction, the E2 group achieved the maximum amplitude of biceps femoris muscle signal in the takeoff phase statistically significantly later than the E1 group (0.0166, p = 0.05 and 0.015152, p = 0.05/3 = 0.016), whereas the rectus femoris muscle in the flight phase in the E2 group improved statistically significantly earlier than in the C group (0.0393, p = 0.05 and 0.025974, p = 0.05/3 = 0.016). The results of this study show particularly statistically significant differences between observed surgery techniques, which led to the change of the neuromuscular pathway during simple and controlled knee movements even two years after ACL reconstructions in athletes who returned to active training. These disturbances of muscle work coordinations in the knee joint could be tied to the function and location from which the graft was taken rather than the quality of the transplant itself. This may result in an increased risk of repeated knee injury, including potential permanent health consequences in athletes. Based on the results of this research, we were unable to establish which of the presented ACL reconstruction techniques is more appropriate. This study may be useful for athletes and their coaches, who could plan, programme and adequately adjust their training process, thereby improving knee function in the best possible way, which in turn would maintain and extend athletes’ respective sports careers.     

Bone Mineral Density and Muscle Strength in Young Men with Mental Retardation (With and Without Down Syndrome)

The objective of this study was to compare the bone mineral density (BMD) of men with Down syndrome (DS) to otherwise mentally retarded (MR) men and to investigate whether leg muscle strength of these patients is related to BMD. Two groups with MR (with and without DS) participated in the study, having met the following criteria: similar age, moderate to mild mental retardation, Tanner stage V of sexual development, similar age of beginning to walk, and equal motor activities. The DS group consisted of 8 men 23.9 ± 4.2 years, and the MR group without DS consisted of 8 men 23.5 ± 3.6 years. The two groups were compared with 10 sedentary students of the same age range (25.9 ± 2.9 years) attending our University. The BMD of the 2^nd to 4^th lumbar vertebrae was measured in the PA projection and the mean density was expressed as g/cm². The isokinetic muscle strength of the right quadriceps femoris and hamstrings muscles was measured on a Cybex II isokinetic dynamometer. The value measured was peak torque at angular velocities at 60, 120, and 300°.sec⁻¹. The results showed that BMD in DS individuals versus young adults (reference group of the scanner) was lower at the 26% level (T-score − 2.66 ± 0.29) and significantly lower (P= 0.002) than that of the MR group. Significantly different muscle strength was observed between the DS and non-DS MR group (in quadriceps at 300°.s⁻¹: P < 0.01, at 120 and 60°.s⁻¹: P < 0.05; in hamstrings at 300°.s⁻¹: P < 0.05). Higher differences in muscle strength were found between MR and control men, but no significant difference existed in BMD between them. Bivariate correlation showed that quadriceps strength significantly predicted the BMD in the DS patients. Active lifestyle and increased physical exercise to improve muscular strength should be instituted to avoid the development of osteoporosis in DS patients. Received: 22 July 1998 / Accepted: 30 September 1999     

腰椎间盘突出症患者腰骶部多裂肌脂肪变化的影像学研究

目的：比较腰椎间盘突出症患者腰骶部多裂肌退变情况。方法：招募健康志愿者和单侧L_4,5腰椎间盘突出患者各35例,每组男20例,女15例,年龄25~55岁。健康志愿者组年龄（35.66±8.73）岁,BMI指数（21.85±1.94）kg/m²;腰椎间盘突出症患者组年龄（36.09±7.70）岁,BMI指数（21.50±1.78）kg/m²,VAS评分（4.40±0.88）分,病程（11.2±7.14）个月,采用核磁共振波谱成像分析,观察L_4,5间隙腰骶部多裂肌脂肪比例、去脂肪化横截面积比例。结果：健康志愿者左侧多裂肌脂肪比例（0.169±0.035）%、去脂肪化横截面积比例（0.699±0.070）%和右侧多裂肌脂肪比例（0.168±0.031）%、去脂肪化横截面积比例（0.712±0.056）%比较,差异无统计学意义（P>0.05）。腰椎间盘突出症患者健侧多裂肌脂肪比例（0.173±0.021）%、去脂肪化横截面积比例（0.695±0.054）%和患侧多裂肌脂肪比例（0.228±0.027）%、去脂肪化横截面积比例（0.629±0.048）%比较,差异有统计学意义（P<0.05）。患者患侧与志愿者左右两侧多裂肌脂肪比例、去脂肪化横截面积比例比较,差异均有统计学意义（P<0.05）;患者健侧与健康志愿者左右侧多裂肌脂肪比例、去脂肪化横截面积比例比较,差异均无统计学意义（P>0.05）。结论：单侧L_4,5腰椎间盘突出症患侧腰骶部多裂肌存在退变,表现为多裂肌面积萎缩、脂肪浸润。     

Assessment of the Quadriceps Femoris Muscle in Women after Injury Induced by Maximal Eccentric Isokinetic Exercise with Low Angular Speed

The objectives of this study were to propose a model for exercise- induced muscle injury by way of a maximal eccentric isokinetic exercise at low angular speed, and assess the time course of functional recovery of the injured quadriceps femoris muscle from the maximal voluntary contraction (MVC) torque and electrical activity (root mean square - RMS and median frequency - MDF). The effectiveness of the proposed eccentric exercise in inducing injury was assessed from the activity of creatine kinase (CK). In addition, the presence of edema of the quadriceps femoris muscle was assessed by a visual inspection of the intensity of the magnetic resonance imaging (MRI) signal. These measurements were carried out before and after the exercise. Ten healthy women (21.9 ± 1.5) took part in this study. The injury was induced by 4 series of 15 maximal eccentric isokinetic contractions at 5°/s. The MVC torque reduced up to the 4^th day after the exercise (p < 0.05). The RMS of the vastus medialis oblique (VMO) and the rectus femoris (RF) muscles decreased on the 2^nd (VMO and RF; p < 0.05) and 3^rd (RF; p < 0.05) days after. The MDF of the VMO increased immediately after (p < 0.05), whilst the MDF of the RF and VL decreased immediately after (RF; p < 0.05), on the 1^st (RF and VL; p < 0.05) and on the 2^nd (VL; p < 0.05) days after. The CK activity increased on the 2^nd day after (p < 0.05). An increase in the intensity of the MRI signal was observed on the 2^nd and 7^th days after. In conclusion: 1- the eccentric exercise with low angular speed was effective in inducing injury, 2- the quadriceps femoris already started its functional recovery, as shown by the MVC torque and electrical activity, in the first week after the exercise, despite the presence of an increase in the intensity of the MRI signal.

Key points

• The low angular speed eccentric exercise was effec-tive in inducing injury of the quadriceps femoris muscle, and could be used as a muscle injury induc-ing model in future studies;
• The quadriceps femoris muscle injured by eccentric exercise started its functional recovery in the first week after low angular speed eccentric exercise.

Key words: Muscle damage, torque, electromyography, magnetic resonance imaging, creatine kinase     

改良硬化剂注射法大鼠椎动脉颈椎病模型建立的实验研究

目的：对硬化剂注射法制作法制作椎动脉颈椎病（cervical spondylosis of vertebral artery type,CSA）大鼠模型进行改良,评价改良硬化剂造模法制作大鼠CSA模型的有效性。方法：健康SPF级SD大鼠40只,雌雄各半,随机分为空白组20只,模型组20只。模型组采用改良硬化剂造模法造模,造模4周后观察大鼠的一般情况,经颅多普勒超声（transcranial Doppler,TCD）检测大鼠椎动脉血流速度、搏动指数、阻力指数,旷场试验检测大鼠精神紧张度。结果：造模后1～2 d,模型组大鼠均出现不同程度蜷缩喜卧、颤抖、眯眼、眼分泌物增多等情况,实验过程中未出现大鼠脱落及死亡情况。模型组的平均血流速度比空白组低（P<0.05）,模型组的搏动指数、阻力指数比空白组高（P<0.05）,模型组大鼠精神紧张度较空白组明显增高,组间差异具有统计学意义。结论：改良硬化剂造模法可成功制备CSA大鼠模型,具有成功率高、稳定性高、死亡率低、操作简单等优势。     

Expression of heat shock protein 72 in rat quadriceps muscles following anterior cruciate ligament resection

 This study investigated the expression of heat shock protein 72 (HSP 72) in quadriceps femoris muscle following anterior cruciate ligament (ACL) resection and running training in rats. A group of 15 Wistar strain male rats (10 weeks old) were divided into three groups: sham-operated (S), ACL resection (A), and running training following ACL resection (R). In the A and R groups, the ACL of the right knee was resected using microsurgical techniques. Rats in the R group were subjected to running training for 9 weeks on a motor-driven treadmill for rodents 1 week after ACL resection. At 10 weeks after ACL resection, glycerinated single fibers were prepared from vastus lateralis (VL), vastus medialis (VM), rectus femoris (RF), and semimembranosus (SM) muscles. To determine the levels of HSP72 (HSP-inducible) in each muscle, we used the Western blotting technique. HSP72 expression in VL and VM increased following ACL resection (P < 0.05) but not in RF or SM. Exercise training caused an elevation in HSP72 expression in VL and VM. There were no significant changes in HSP72 expression in RF or SM following exercise training. These results suggest that some stress would be generated by ACL resection in VM and VL and might cause atrophy in VM and VL. Received: July 29, 2002 / Accepted: October 18, 2002 Acknowledgments. We especially thank Professor H. Aoki of the Department of Orthopaedic Surgery at St. Marianna University School of Medicine for his encouragement and many valuable comments. We also thank Vice President T. Yoshioka of Aomori University of Health and Welfare for his valuable criticism and advice. This study was supported in part by a Grant-in-Aid for Encouragement of Young Scientists (B) from The Ministry of Education, Culture, Sports, Science and Technology (MEXT) to K.G. Offpring requests to: R. Okuyama     

超声介导药物联合针刀治疗腕管综合征

目的探讨超声介导药物联合针刀治疗腕管综合征(CTS)的临床应用价值。方法对62侧来自56例CTS患者的手腕行超声检查,观察正中神经的改变及毗邻关系,选择最佳穿刺点,实时超声介导下行药物注射及针刀治疗。术后1、4、12周进行随访,应用视觉模拟评分法(VAS)评定术前、术后患者疼痛程度。结果超声显示58侧患腕正中神经有异常改变,4侧正中神经未见异常;1侧术前评估不宜接受超声介导药物联合针刀治疗,另61侧超声介导药物联合针刀治疗均操作成功,未发生神经损伤及其他并发症。术前及术后1、4、12周的VAS评分分别为8.25±0.81、4.27±0.72、3.00±0.54及1.44±0.54,差异均有统计学意义(P0.05)。结论超声介导药物联合针刀治疗CTS具有可视化、安全有效、无辐射等优点,值得临床推广。