髌腱末端病运动员膝关节屈伸峰力矩和表面肌电图的特征(英文)

背景:髌腱末端病是腱止点部位的微细损伤,股四头肌群中的股内侧肌与股外侧肌之间的力量平衡发生变化,可直接导致髌骨产生异常运动从而对腱止点部位产生影响。目的:分析髌腱末端病发生机制和髌腱末端病对膝关节及其周围肌肉活动产生的影响。方法:选择10名患有髌骨肌腱病的男运动员及10名运动项目、身高和年龄匹配的正常男运动员,采用瑞士CON-TREX等速肌力测试与训练系统,分别进行膝关节力量和表面肌电图的测试,比较与分析膝关节屈肌力矩、伸肌力矩和股四头肌表面肌电图的变化。结果与结论:发现在等长运动时,末端病组的伸肌伸肌峰力矩明显小于对照组、峰值转矩比比值明显大于对照组;在等速运动时,末端病组的伸肌伸肌峰力矩明显小于对照组,并随着运动角速度增加而变化显著,而峰值转矩比比值均不同程高于对照组;末端病组的股内侧肌/股外侧肌的整合肌电图比值在等长运动和等速运动时,均明显低于对照组。提示髌腱末端病运动员膝关节屈肌与伸肌的力量差距较为突出,存在股内侧肌活动低下和股内侧肌与股外侧肌之间不平衡的现象。     

髌腱末端病运动员膝关节屈伸峰力矩和表面肌电图的特征（英文）

背景：髌腱末端病是腱止点部位的微细损伤,股四头肌群中的股内侧肌与股外侧肌之间的力量平衡发生变化,可直接导致髌骨产生异常运动从而对腱止点部位产生影响。目的：分析髌腱末端病发生机制和髌腱末端病对膝关节及其周围肌肉活动产生的影响。方法：选择10名患有髌骨肌腱病的男运动员及10名运动项目、身高和年龄匹配的正常男运动员,采用瑞士CON-TREX等速肌力测试与训练系统,分别进行膝关节力量和表面肌电图的测试,比较与分析膝关节屈肌力矩、伸肌力矩和股四头肌表面肌电图的变化。结果与结论：发现在等长运动时,末端病组的伸肌伸肌峰力矩明显小于对照组、峰值转矩比比值明显大于对照组;在等速运动时,末端病组的伸肌伸肌峰力矩明显小于对照组,并随着运动角速度增加而变化显著,而峰值转矩比比值均不同程高于对照组;末端病组的股内侧肌/股外侧肌的整合肌电图比值在等长运动和等速运动时,均明显低于对照组。提示髌腱末端病运动员膝关节屈肌与伸肌的力量差距较为突出,存在股内侧肌活动低下和股内侧肌与股外侧肌之间不平衡的现象。     

髌腱末端病运动员膝关节动作反应的变化特征

目的:通过对股四头肌收缩过程中的电机械应答现象分析,探讨髌腱末端病运动员膝关节动作反应特征。方法:选择单侧膝关节患有髌腱末端病(PT)的男性运动员11例,分别在屈膝30°、60°和90°条件下,进行膝关节最大伸膝力量(MVC)、动作反应时(TRT)和股四头肌sEMG的测试,比较PT侧和对侧膝关节的TRT和股四头肌的反应前时(PMT)、电机械延迟(EMD)以及sEMG积分值的变化。结果:屈膝30°、60°和90°时,PT侧膝关节TRT均较对侧延长(P<0.05),PT侧膝关节在屈膝30°时的股内侧肌PMT和屈膝90°时的股外侧肌PMT,与对侧比较均延长(P<0.05);PT侧膝关节股内侧肌、股外侧肌和股直肌的EMD与对侧比较均延长,且以股内侧肌EMD变化最为显著。结论:髌腱末端病股四头肌存在肌电激发和收缩时间延迟现象,股四头肌收缩非同步化增加是引起膝关节动作反应迟缓和力量下降的主要因素。     

离心训练治疗髌腱末端病的系统评价

目的:在已经发表的随机对照试验中,系统地回顾、总结,并比较治疗髌腱末端病的各种离心训练方法。方法:在各大数据库中检索关于离心训练治疗髌腱末端病的研究,纳入类型为随机对照试验,9篇文献共计229例患者最终被纳入研究。结果:现有的证据表明离心训练是治疗髌腱末端病的有效手段,但由于研究质量差异较大,未能进行meta分析。结论:离心训练对于髌腱末端病来说是一种有效的治疗措施,但是否比其他形式的运动疗法(如向心训练、牵伸训练)更有效,仍缺乏足够的证据支持。多数方案采用在25°斜面上进行缓慢的离心下蹲这种运动形式,运动中疼痛应在可接受的范围内,从自身体重开始,出现疼痛减轻或无痛等适应训练表现时逐渐增加负荷。     

体外冲击波治疗国家队运动员髌腱末端病的疗效分析

目的观察体外冲击波治疗髌腱末端病的效果。方法 2006年1月-2010年12月67例髌腱末端病患者全部采用非手术治疗,其中38例采用体外冲击波治疗,11例采用手法按摩疗法,5例采用体外擦药酒、药膏,4例注射醋酸泼尼松龙加普鲁卡因,9例采用针灸疗法。观察体外冲击波治疗与其他非手术疗法之间的效果有无差异。结果经相同疗程治疗后,采用体外冲击波治疗者显效25例,有效10例,效果不明显3例;采用其他非手术疗法者显效9例,有效12例,效果不明显8例;两组治疗结果差异有统计学意义(Z=?2.966,P=0.003)。结论应用体外冲击波治疗髌腱末端病方法简便,操作安全,疗效显著,较其他非手术治疗方法有明显的优势。但对运动员患者应用此方法时,应与训练安排紧密结合起来,才能收到最大的效果。     

体外冲击波治疗运动员髌腱末端病疗效分析

目的:观察体外冲击波治疗髌腱末端病的效果。方法:对收治的67例运动员髌腱末端病患者全部采用保守治疗,其中38例采用体外冲击波治疗,29例采用手法按摩、针灸等其他常规治疗方法。观察体外冲击波治疗与其他疗法之间的效果有无差异。结果:经相同疗程治疗后,采用体外冲击波治疗者显效65.79%,有效26.32%,效果不明显7.89%。采用其他保守疗法者显效31.03%,有效41.38%,效果不明显27.59%。两组治疗结果有显著性差异。结论:应用体外冲击波治疗髌腱末端病方法简便,操作安全,疗效显著,较其他保守治疗方法有明显的优势。     

物理疗法在运动员髌腱末端病治疗中的研究现状与应用

髌腱末端病(Patellar Tendinopathy,PT)是一种因长期过度使用所致的髌腱损伤,主要表现为髌腱疼痛、局限性或弥漫性肿胀以及运动功能受限,常见于长期进行跳跃或落地等相关体育项目的年轻运动员[1]。据报道,排球和篮球运动员的PT患病率约占32%~45%,而田径运动员、手球运动员以及足球运动员的患病率约占13%~25%[2]。     

髌腱末端病二维超声与临床、X线综合研究

目的：评价二维超声对髌腱末端病的诊断价值。方法：对２１例髌腱末端病患者及３６例正常人,共１０６髌腱的声像图资料进行分析,同时与临床、Ｘ线检查结果进行比较。结果显示：（１）末端病组９５％伴有髌下滑膜囊积液,且积液的位置与髌尖疼痛的临床表现相关;（２）临床与二维超声检查结果符合率达９６％,表明二维超声检查对髌腱末端病的诊断具有较高的临床价值。     

MRI诊断女子排球运动员髌腱腱病

目的 探讨女子排球运动员髌腱腱病(PT)的MRI表现。方法 回顾性分析34名中国国家女子排球队运动员60个膝关节的MRI资料。结果 60个膝关节中,41个(26例)有PT(PT组),患病率76.47%,其中信号增强2级以上占82.93%(34/41)。13名19个膝关节阴性为对照组。PT组髌腱近端、中点、下止点前后径分别为(9.21±2.31)mm、(5.39±1.01)mm、(6.53±1.32)mm,与对照组相比差异有统计学意义(P<0.01)。PT组髌腱近端前后径与分级相关(r=0.334,P<0.01)。PT急性期髌腱近端增粗,T1WI低信号,T2WI中、高信号,FS-PDWI高信号;慢性期髌腱近端呈"V"形增粗增厚,T1WI低信号,T2WI中、低信号,FS-PDWI中等信号。髌腱近端后缘紊乱不清晰、髌腱中部和下止点信号增强以及髌骨下极增生等在两组间差异均有统计学意义(P<0.05)。所有患膝可见髌骨下极不规则片状、大小不一的信号增强。结论 女子排球运动员PT患病率较高。MRI有助于明确诊断、分期分级,鉴别髌骨下极损伤,监控康复效果以及评估运动能力。     

身体运动功能训练对患髌腱末端病的职业击剑运动员运动功能和平衡能力的影响

目的观察身体运动功能训练对患髌腱末端病的职业击剑运动员膝关节疼痛分级、功能动作评分和平衡能力的影响。 方法随机数字表法将24例有髌腱末端病的职业击剑运动员（患者）分为实验组和对照组,每组患者12例。对照组运动员接受常规物理治疗,实验组运动员则在常规物理治疗基础上增加身体运动功能训练。于干预前和干预8周后（干预后）对2组患者进行疼痛分级、功能动作筛查和平衡能力评定。 结果干预后,实验组膝关节NRS和FMS评分分别为（2.08±1.24）分和（16.25±0.97）分,显著优于组内干预前和对照组干预后,差异均有统计学意义（P<0.05）。干预后,实验组睁眼和闭眼单脚状态下,压力重心在X轴的摆幅、线形图总长度、最大摆幅和线形图面积与组内干预前和对照组干预后比较,差异均有统计学意义（P<0.05）。 结论身体运动功能训练能显著促进患髌腱末端病患者身体运动功能和平衡能力的恢复。     

Reliability of concentric and eccentric torque during isokinetic knee extension in post-stroke hemiparesis

BACKGROUND: Emerging evidence on the velocity-dependent nature of force impairment in post-stroke hemiparesis has emphasized the complexity of strength and motor performance assessments in this clinical population. The need to establish reliability and responsiveness of muscle performance measures across a broad range of concentric and eccentric movement speeds is therefore clear, as these metrics will provide benchmarks both for making clinical inference and evaluating meaningful clinical change following interventions. METHODS: Isokinetic knee extensor strength was tested at 14 angular velocities in 17 adults with chronic post-stroke hemiparesis (>18 months), and 13 non-disabled controls. Identical tests were conducted on two occasions separated by two days. Test-retest reliability of maximal isokinetic torque was evaluated using intraclass correlation. Absolute reliability was assessed using standard error of measurement from which smallest real differences were derived. FINDINGS: Overall, intraclass correlation coefficients were excellent for both hemiparetic (0.891) and control (0.937) groups. Intraclass correlation coefficients for each criterion speed were also high for both groups (>0.86). Measurement error relative to the mean torque varied between 14.1% and 26.3% for hemiparetic subjects and 6.0-18.1% for controls. The smallest real difference relative to mean torque was 39.0-72.7% and 16.6-50.2% for hemiparetic and control subjects, respectively. INTERPRETATION: Isokinetic knee extension torque can be measured reliably in persons with chronic post-stroke hemiparesis and in non-disabled controls across a full functional range of concentric and eccentric speeds. Established measurement error and smallest real differences will aid interpretation of longitudinal observations of muscle performance in this clinical population.     

Tibiofemoral joint forces during maximal isokinetic eccentric and concentric efforts of the knee flexors

OBJECTIVE: The examination of muscular and tibiofemoral joint forces during maximal efforts of the knee flexors. DESIGN: The muscular and tibiofemoral joint knee forces during eccentric and concentric isokinetic efforts of the knee flexors were determined using a two-dimensional mathematical model. BACKGROUND: The examination of joint and muscle loading during isokinetic movements is important for the determination of safety of this exercise. METHODS: Ten healthy males performed three maximal isokinetic concentric and eccentric efforts of the knee flexors at angular velocities of 30 degrees s(-1), 90 degrees s(-1), 120 degrees s(-1) and 150 degrees s(-1). The muscular, tibiofemoral shear and compressive joint forces were determined using a two-dimensional model. RESULTS: The maximum muscular force ranged from 3.44 (Standard deviation, 1.32) times body weight to 6.19 (1.78) times body weight. The tibiofemoral compressive force ranged from 2.62 (1.17) times body weight to 5.89 (1.99) times body weight occurring at angles ranging from 0 degrees to 40 degrees of knee flexion. The posterior shear force ranged from 2.61 (1.33) times body weight to 3.89 (1.62) times body weight and was observed at angles ranging from 50 degrees to 80 degrees of knee flexion. Two-way analysis of variance designs indicated significant effects of type of muscle action and angular velocity on muscle and compressive forces (P<0.05). In contrast, the shear force was not affected by the type of muscle action or the angular velocity (P>0.05). CONCLUSIONS: Isokinetic efforts of the knee flexors induce high tibiofemoral joint forces, especially during high-speed eccentric tests.     

Effect of stabilization on maximal isokinetic torque of the quadriceps femoris muscle during concentric and eccentric contractions

The purpose of this study was to investigate the effect of stabilization on the maximal isokinetic torque generated by the quadriceps femoris muscle during concentric and eccentric contractions at different velocities using the KIN/COM isokinetic dynamometer. Fifteen female volunteers between the ages of 18 and 32 years were trained to perform maximal isokinetic concentric and eccentric contractions. Each subject participated in two testing sessions. In one testing session, subjects were stabilized maximally, and in the other testing session, subjects were stabilized minimally. Subjects were tested both concentrically and eccentrically at velocities of 30 degrees, 60 degrees, 90 degrees, 120 degrees, 150 degrees, 180 degrees, and 200 degrees/sec. The velocity sequence and stabilization procedure used were randomly assigned. Two nested model analyses of variance followed by post hoc comparisons were used to analyze the data. Results revealed no significant difference between the maximal stabilization procedure and the minimal stabilization procedure for concentric and eccentric contractions. The results of this study should aid rehabilitation specialists in the development of testing and rehabilitation procedures when using the KIN/COM.     

等速向心和离心肌力训练治疗膝关节骨性关节炎患者的有效性研究

目的：比较等速向心和等速离心肌力训练治疗膝关节骨性关节炎（OA）患者的有效性。方法：45例膝OA患者随机分为向心训练组、离心训练组和对照组。向心训练组患者（n=15）接受等速向心肌力训练．离心训练组（n=15）患者接受等速离心肌力训练，每周训练3次，共训练8周。用Biodex等速肌力测试训练系统评价膝OA患者训练前后的膝关节伸肌和屈肌的峰力矩改变。用目测类比评分法和Lequesne指数评价膝OA患者疼痛和功能障碍的改变。结果：两个训练组的膝OA患者的疼痛、功能障碍和肌肉峰力矩在训练后都有明显改善（P〈0．05）。而对照组8周后无明显改变。虽然不同的等速训练方法显示了一定的训练效果特异性．但在两个训练组之间各项参数无显著性差异。结论：等速向心和等速离心肌力训练方案在膝OA的治疗中都是有效的。在等速向心和等速离心训练之间未观察到显著性差异。     

等速离心训练对膝关节骨关节炎患者的影响

目的探讨等速离心肌力训练对膝关节骨关节炎患者的康复疗效。方法运用Cybex-6000型等速肌力测试及训练系统对40例膝关节骨关节炎患者(共70个患膝)进行为期4周、每周3次的等速离心肌力训练。分别于训练前、后测定患者在60°/s、120°/s及180°/s等速运动时的峰力矩、单次最大作功量、平均功率及力矩加速能量;并将训练前、后患膝疼痛程度及下肢功能评分进行比较。结果患者经训练后,其患膝屈、伸肌群各项功能参数均有显著改善,并以屈膝肌各项功能参数的改善尤为显著;患膝疼痛及功能性行为能力评分亦均较治疗前有显著改善。结论等速离心训练能有效改善膝关节骨关节炎患者屈、伸肌群的各项功能参数(其中以屈膝肌的改善尤为显著);同时还能缓解患者疼痛,显著提高其功能性行为能力。     

Muscular and tibiofemoral joint forces during isokinetic concentric knee extension

The purpose of this study was the examination of muscular and tibiofemoral forces during concentric isokinetic knee extension at angular velocities ranging from 30 to 210 deg s(-1), using a two-dimensional biomechanical model. Five males without knee joint injury history participated in the study. The maximum moment ranged from 226.2 Nm at 30 deg s(-1) to 166.4 Nm at 210 deg s(-1). The maximum muscular force ranged from 7.5 times body weight at 30 deg s(-1) to 5.7 at 210 deg s(-1). The compressive tibiofemoral force ranged from 7.5 times body weight at 30 deg s(-1) to 5.7 at 210 deg s(-1) and the shear tibiofemoral force ranged from 0.9 to 0.8 times body weight respectively. These results indicate that the forces developed during maximal isokinetic knee extension are significantly reduced relative to other powerful dynamic activities but are higher than joint forces during simple walking and cycling activities. Appropriate precautions and adjustment of the isokinetic protocol are required in the final phases of joint injury rehabilitation. RELEVANCE: Isokinetic dynamometry has widespread applications in rehabilitation and training of muscle function. It is therefore important to examine the joint and muscular forces under different conditions in order to alter rehabilitation and training programmes and prevent exercise-induced injuries.