Rectus “wrap around” flap for salvage of an infected ascending aortic graft

An application of the rectus abdominis muscle flap to salvage an infected prosthetic graft of the ascending thoracic aorta is presented. The length of this flap along with its width and thickness allows it to be wrapped around prosthetic grafts of the ascending aorta in a spiral fashion. This rectus muscle wrap around flap method is straightforward involving the use of one muscle rather than multiple muscles. The abdominal cavity is not opened as with the use of omentum. The procedure can be accomplished in a short time which is important in the critically ill patient.     

正常人眼球直肌Pulley功能位置的动态磁共振成像研究

目的研究正常人眼球运动动态磁共振成像（MRI）4条直肌Pulley（滑车）的功能性位置。方法采用西门子公司Sonata1.5T超导型MRI扫描仪,应用眼球运动动态MRI技术,获取20名正常人（20个眼眶）眼球原在位及上转、下转、内转、外转20度时垂直于眶轴的眼眶冠状位MRI图像。以眼球中心为原点建立三维坐标系,应用ScionImage医学图像测量软件分别测量各层面眼球垂直转动时水平直肌、眼球水平转动时垂直直肌的横截面质心。根据各层面直肌横截面质心的坐标值建立直线回归方程,分别求得眼球垂直转动时内、外直肌径路及眼球水平转动时上、下直肌径路直线回归曲线斜率变化最大的一点,即为该直肌Pulley的功能性位置。对4条直肌Pulley相对于眼球中心的坐标值（X、Y）进行统计。结果内直肌Pulley位于眼球中心后4mm,内14.7mm,下0.3mm;外直肌Pulley位于眼球中心后8mm,外9.8mm,下0.3mm;上直肌Pulley位于眼球中心后6mm,内1.6mm,上11.5mm;下直肌Pulley位于眼球中心后6mm,内4.4mm,下12.7mm。结论应用眼球运动动态MRI技术,分析眼球转动时直肌径路的变化,可证实4条直肌Pulley的存在并确定其功能位置。     

骨骼肌最大收缩力与最适初长度及其参数的研究

本实验以免载体股直肌为实验模型,研究了该肌在一定脉冲电流刺激下其初长度与收缩力、肌张力及肌力变化的相互关系。同时测定了正常生理状态下兔伸屈膝时股直肌拉长度的变化。结果表明:兔股直肌延长在1.0cm内时,肌力随初长度的延长而增大,超过1.0cm时增大已不明显(p<0.0 1),1.0cm与股直肌的生理最大延长度1.1cm相似。说明兔股直肌的初长度变化不应超过生理最大延长度。而人的骨骼肌与哺乳动物的骨骼肌没有本质的区别,因此,人骨骼肌的初长度变化也不应超过生理最大延长度。肌腱转位后的活动范围应在原位的生理活动范围内,才能发挥最佳收缩效应。     

Management of sacral and perineal defects following abdominoperineal resection and radiation with transpelvic muscle flaps

PURPOSES: In this study we present our experience with treating persistent sacral and perineal defects secondary to radiation and abdominoperineal resection with or without sacrectomy. METHODS: Fifteen consecutive patients were treated with an inferiorly based transpelvic rectus abdominis muscle or musculocutaneous flap. RESULTS: Fourteen of the 15 patients achieved healing, and 7 patients had no complications. The remaining eight patients required one or more operative debridements and/or prolonged wound care to accomplish a healed wound. Our technique for the dissection and insetting of the transpelvic muscle flap is presented. CONCLUSION: The difficult postirradiated perineal and sacral wounds can be healed with persistent surgical attention to adequate debridement, control of infections, and a well-vascularized muscle flap. The most satisfying aspects for patients are the discontinuance of foul-smelling discharge, discontinuation of multiple, daily dressing changes, and reduction in the degree of chronic pain.Read at the meeting of the Midwestern Association of Plastic Surgeons, Bismarck, North Dakota, June 15 to 18, 1992.     

The effects of voluntary contraction effort on quadriceps femoris electromyogram median frequency in humans: a muscle and sex comparison

The purpose of this study was to examine the effect of voluntary contraction efforts on the median frequency (f _med) of the electromyogram (EMG) recorded from the quadriceps femoris muscle in healthy men and women. A group of 30 healthy volunteers (15 men, 15 women) were assessed for EMG activity of the vastus medialis (VM), vastus lateralis (VL), and rectus femoris (RF) muscles during isometric contractions with the knee at 60° flexion. Subjects performed a series of 5 s maximal voluntary isometric contractions that anchored the perceptual range with a "10" on a 10-point scale. Sub-maximal isometric contractions were then separately performed at the following perceived effort levels on the 10-point scale: 1, 2, 3, 4, 5, 6, 7, 8 and 9, in a random order. Subjects were instructed to maintain the contraction at each perceived level of effort for 5 s. The f _med of the three muscles was assessed using a power spectrum analysis performed over 11 consecutive, 512 ms, epochs overlapping each other by half their length during the middle 3 s of each contraction. The f _med for each of the 11 epochs was then determined for each muscle, followed by calculation of the means and normalized coefficients of variation [(standard deviation/mean)×100%] for each contraction. The results demonstrated that the mean f _med of VL was significantly greater than those of the other two muscles, and that f _med of RF was significantly greater than that of VM. The VL muscle demonstrated a significant increase in mean f _med across the contraction efforts, compared to the VM and RF muscles that displayed a significant decrease. The men displayed significantly higher f _med values for the VM muscle than did the women, as well as showing a significantly greater increase across the contraction efforts for the VL muscle. The variability of f _med was shown to be significantly higher for the VM muscle, compared to the VL and RF muscles. The findings of this study suggest that the f _med statistic is most sensitive to contraction intensity efforts for the VL muscle, and that men display significantly higher values for the VL and VM muscles, compared to women. Electronic Publication     

Eccentric and concentric torque-velocity characteristics of the quadriceps femoris in man

Summary The primary purpose of this investigation was to study the eccentric and concentric torque-velocity characteristics of the quadriceps femoris in man using a recently developed combined isometric, concentric and eccentric controlled velocity dynamometer (the SPARK System). A secondary purpose was to compare the method error associated with maximal voluntary concentric and eccentric torque output over a range of testing velocities. 21 males (21–32 years) performed on two separate days maximal voluntary isometric, concentric and eccentric contractions of the quadriceps femoris at 4 isokinetic lever arm velocities of 0° · s^–1 (isometric), 30° · s^–1 120° · s^–1 and 270° · s^–1. Eccentric peak torque and angle-specific torques (measured every 10° from 30° to 70°) did not significantly change from 0° · s^–1 to 270° · s^–1 (p>0.05) (with the exception of angle-specific 40° torque, which significantly increased;p<0.05). The mean method error was significantly higher for the eccentric tests (10.6%±1.6%) than for the concentric tests (8.1%±1.7%) (p<0.05). The mean method error decreased slightly with increasing concentric velocity (p>0.05), and increased slightly with increasing eccentric velocity (p>0.05). A tension restricting neural mechanism, if active during maximal eccentric contractions, could possibly account for the large difference seen between the present eccentric torque-velocity results and the classic results obtained from isolated animal muscle.     

股后区主要穿支的形态学分析与皮瓣设计

目的：为股后区穿支皮瓣的临床应用提供解剖学依据。方法：6具（12侧）动脉灌注明胶．氧化铅混悬液的新鲜成人整尸标本，解剖观测股后区外径≥0．5mm的穿支，测量其管径及其走行、分支与分布情况等。取下整个下肢被覆组织拍摄X线片，观测皮动脉的数量以及彼此间的吻合情况等。利用Photoshop与Scion Image分析穿支供血的趋向性及每个分支的供血面积等。结果：股后区共有穿支（外径≥0．5mm）27支，其中65％为皮穿支，35％为肌皮穿支。平均外径为0．8mm，平均蒂长为2．93cm。自股深动脉之穿动脉发出者平均长度为6．81cm。每侧穿动脉在股后区供血面积平均为229cm^2，平均每个穿支供血面积为43cm^2。结论：股后区的皮肤穿支管径较粗，营养皮肤面积较大，以股后诸穿支为蒂设计的穿支皮瓣可为下肢或身体其它部位皮肤移植提供：①游离皮瓣；②近端蒂皮瓣；③远端蒂皮瓣。     

Functional combination of tapering profiles and overlapping arrangements in nonspanning skeletal muscle fibers terminating intrafascicularly

Using digital image analysis and several anatomical methods, morphometric analysis of nonspanning fibers which had tapering profiles at their intrafascicular termination sites and represented overlapping arrangements within the fiber fascicles was performed in the rat rectus abdominis. Special emphasis was focused on dimensional relationships occurring between overlapping portions and tapering segments and sarcomere lengths in non- and overlapping portions. Nonspanning fibers were found to overlap each other for more than 40% of their length. In length, their overlapping portions generally corresponded to their tapering segments, which were also greater than 40% of the fiber length. In addition, despite the presence of overlapping linkages, nonspanning fibers maintained a fairly uniform length irrespective of their overlapping and non-overlapping portions. Overlapping linkages in fibers without tapering profiles have a larger cross-sectional area in the overlapping portion than in the non-overlapping one, resulting in a phenomenon which will cause different sarcomere lengths between the two portions during fiber stretching. The present results suggest that tapering profiles in the overlapping portion ensure uniform sarcomere lengths within nonspanning fibers, thereby providing mechanical stability in each fiber. © 1993 Wiley-Liss, Inc.     

Quadriceps-hamstring EMG activity during functional, closed kinetic chain exercise to fatigue

It has been hypothesized that the ability of the neuromuscular system to co-contract muscles for joint stabilization may be impaired during the development of fatigue. The purpose of this study was to examine muscle activation of the quadriceps and hamstring muscles during a prolonged closed kinetic chain exercise, the forward lunge. Eight males and two females [mean (SD) age 26.0 (2.3) years, height 177.2 (13.6) cm, body mass 82.8 (17.1) kg] with no prior knee pathology volunteered for this study. Subjects performed repeated forward lunges onto their dominant leg at the cadence of one full lunge cycle every 2 s, until the point of volitional failure. Digital switches were positioned to record foot-strike and knee-strike of the lunge leg at the midpoint of the lunge, as well as heel-strike upon return to stance. During the lunge performance, surface electromyographic (EMG) signals of the vastus lateralis (VL), vastus medialis (VM), biceps femoris (BF), and semitendinosus (ST) muscles of the supporting leg were measured. Heart rate was also monitored every 30 s during the performance. All EMG data were full-wave rectified, partitioned into up and down phases, and integrated over the entire exercise period. The results demonstrated a significant increase in activation of the VL, VM, and BF during performance of the forward lunge to volitional failure (P < 0.05). No significant increase was shown for the ST. Heart rate increased significantly over the course of the lunge. These findings suggest that activation of the VL, VM, and BF muscles occurs as a unit during performance of the forward lunge during both concentric and eccentric lunge phases. Accepted: 25 October 1999     

腹直肌肌电图运动单位电位正常值的建立

目的:建立腹直肌肌电图(EMG)运动单位动作电位(MUAP)各参数正常值。方法:测定109例正常人腹直肌EMG的MUAP的时限、波幅及多相波。结果:腹直肌EMG的MUAP参数分别为:波幅373．78±56．46μV,时限9．95±1．13 ms,多相波19．40％±1．52％。结论:腹直肌EMG各参数能可靠、稳定地测出,有助于脊髓胸段下运动神经元病变的检测。