杜氏肌营养不良与贝氏肌营养不良常规MRI的对比研究

目的 探讨常规MRI鉴别诊断杜氏肌营养不良（DMD）和贝氏肌营养不良（BMD）的价值。方法 回顾性分析经临床确诊为抗肌萎缩蛋白病697例患者的臀部及大腿肌肉影像学资料,比较DMD与BMD影像学征象的异同。结果 DMD与BMD患者肌肉脂肪浸润的分布规律一致,DMD总体脂肪浸润程度高于BMD（P=0.034）,且以臀大肌、股直肌、缝匠肌为著;肌肉总体水肿程度差异无统计学意义（P=0.065）,但DMD大腿后群肌肉及缝匠肌的水肿明显高于BMD。DMD与BMD患者肌肉萎缩及肥大的选择性受累规律一致,BMD股外侧肌、股中间肌、股内侧肌、半膜肌及股二头肌长头萎缩频率明显高于DMD（P<0.05）;DMD与BMD患者肌肉的肥大改变差异无统计学意义（P>0.05）。结论 常规MRI可鉴别诊断DMD与BMD。     

脑梗死恢复期患者大腿前后肌群表面肌电特征的研究

目的探讨脑梗死偏瘫患者大腿前、后肌群收缩功能及协调性的变化,为针对性康复治疗提供客观依据。 方法选取18例脑梗死偏瘫患者作为病例组,另选18例年龄、性别与之相匹配的正常人作为正常对照组（对照组）。2组受试者均取俯卧位进行主动膝关节屈伸运动,采集股内侧肌、股直肌、股外侧肌、股二头肌及半腱半膜肌的表面肌电信号,病例组患者双大腿肌群均采集,对照组仅采集左侧大腿肌群。以标准化均方根值(stRMS)、协同收缩率(CR)作为观察指标进行比较分析。 结果伸膝时, 病例组患者偏瘫侧股直肌、股外侧肌、股内侧肌stRMS值明显大于健侧及对照组stRMS值（P<0.05）;屈膝时, 病例组患者健侧股二头肌、半腱半膜肌stRMS值明显大于偏瘫侧及对照组stRMS值（P<0.05）。屈膝时,病例组偏瘫侧CR值明显大于健侧及对照组CR值（P<0.05）, 结论脑梗死后偏瘫侧大腿前、后肌群功能均有受损,其中伸膝肌以股直股受损明显,屈膝肌群中半膜半腱肌及股二头肌受损程度相当,偏瘫侧膝伸屈肌群拮抗-收缩模式异常。康复治疗应加强偏瘫侧大腿前后肌群训练,改善异常收缩模式。     

短时翻转恢复序列在皮肌炎、多发性肌炎中的应用价值

目的探讨短时翻转恢复(short-tau inversion recovery,STIR)序列在皮肌炎、多发性肌炎中的应用价值。材料与方法回顾分析我院12例经临床确诊和(或)穿刺活检病理证实的皮肌炎/多发性肌炎患者资料。选择双侧大腿肌肉作为感兴趣区,采用常规T1WI、T2WI及STIR序列进行扫描,观察STIR序列与T1WI、T2WI在病变检出能力上的差异。结果 (1)本组12例患者于MRI上发现双侧大腿有不同程度异常信号表现,其中提示为肌炎11例、肌筋膜炎8例、皮下结缔组织炎9例、肌肉萎缩伴脂肪浸润1例。(2)在STIR序列上,12例患者均被发现双侧大腿有异常信号;T1WI仅发现5例皮下结缔组织炎,1例肌肉萎缩,未发现肌炎、肌筋膜炎;T2WI发现6例肌炎,1例肌肉萎缩及2例皮下结缔组织炎,未发现肌筋膜炎。(3)在STIR序列上,发现有7例患者的双侧大腿后、内侧肌群信号较其他受累肌群信号高,经病理证实该处肌肉损伤程度较重。结论 STIR序列具有高软组织分辨率和高灵敏性,可明显提高软组织炎性病变的检出率,其信号强度可主观反映肌肉的损伤程度,在临床上具有重要应用价值。     

实时剪切波超声弹性成像技术评估肌肉减少症患者骨骼肌弹性模量的研究

摘 要 目的 研究肌肉减少症患者股四头肌、腘绳肌和肱二头肌长轴剪切波速度（SWV）值特征,探讨实时剪切波超声弹性成像技术（SWE）评估肌肉减少症患者肌肉状态的应用价值。方法 选择22例肌肉减少症患者（病变组）和21例同期年龄、性别匹配的健康体检者（对照组）,应用剪切波超声弹性成像技术,获取病变组和对照组优势侧的股四头肌4块肌肉［股外侧肌（VL）,股直肌（RF）,股内侧肌（VM）和股中间肌（VI）］,腘绳肌3块肌肉［股二头肌（BF）,半腱肌（ST）和半膜肌（SM）］和肱二头肌（BB）松弛状态下长轴SWV值,并进行对比分析。结果 松弛状态下病变组与对照组的VL、RF、VM、VI、BF、ST、SM和BB肌肉的SWV数值差异有显著统计学意义(均P＜0.001)。松弛状态下病变组与对照组比较,VL、RF、VM、VI、BF、ST、SM和BB肌肉的SWV数值分别降低7.8%、7.0%、7.3%、7.3%、7.1%、7.3%、6.5%和6.7%。与对照组比较,病变组SM长轴的SWV值降低最小,VL长轴的SWV值降低最为显著。年龄和BMI指数均为老年人骨骼肌弹性模量的影响因素。结论 实时剪切波超声弹性成像技术可检测肌肉减少症患者较大骨骼肌弹性差异,为评估肌肉减少症患者肌肉状态提供了一种新的检测方法。     

贝氏肌营养不良症与杜氏肌营养不良症患者骨骼肌脂肪浸润程度的对比研究

目的分析贝氏肌营养不良症（BMD）患者大腿骨骼肌在磁共振成像（MRI）上所显示的骨骼肌脂肪浸润规律,探讨其与杜氏肌营养不良症（DMD）患者之间的差异,为针对性康复治疗提供指导依据。 方法纳入23例BMD患者和47例DMD患者,所有患者均未经糖皮质激素治疗,均行双侧大腿骨骼肌MRI检查,并通过T1加权成像和应用改良的Mercuri分级评分法,对骨骼肌脂肪浸润程度进行0～5分的6级评分。采用描述性统计分析BMD的骨骼肌脂肪浸润进展程度,采用秩合检验分析BMD和DMD的组间差异。 结果BMD患者大收肌的重度脂肪浸润所占百分比最高,而后受累的依次为股二头肌、股四头肌、半膜肌和半腱肌,缝匠肌、股薄肌和长收肌的重度脂肪浸润所占百分比最低。BMD患者的大收肌、股二头肌和股四头肌在8～9岁可见中到重度脂肪浸润,半膜肌和半腱肌在10～11岁可见中到重度脂肪浸润,缝匠肌、股薄肌和长收肌在15岁以后可见轻到中度脂肪浸润。BMD组骨骼肌脂肪浸润程度评分总和的中位数在8、9、10和11岁依次为10、22、28和25分,DMD组依次为29、34、34和30分。BMD与DMD相比,8岁患者的脂肪浸润程度评分在大收肌（P=0.017）、股二头肌（P=0.013）、股外侧肌（P=0.021）、股直肌（P=0.007）、股内侧肌（P=0.008）、股中间肌（P=0.009）及评分总和（P=0.011）之间的差异均有统计学意义;9岁患者的脂肪浸润程度评分在大收肌（P=0.007）、股直肌（P=0.013）、股内侧肌（P=0.028）、股中间肌（P=0.028）及评分总和（P=0.020）之间的差异具有统计学意义。 结论BMD患者的大腿骨骼肌脂肪浸润存在一个特定受累模式,相同年龄的BMD与DMD患者骨骼肌脂肪浸润程度存在差异,可以协助指导BMD及DMD患者的康复治疗。     

膝关节骨性关节炎软骨损伤的分布特征及MRI定量成像对比研究

目的探讨关节镜下不同级别软骨损伤的分布差异,以及3.0 T MRI检查序列T_1 mapping、T_2 mapping及T_2~*mapping对膝关节骨性关节炎软骨不同级别病损的诊断价值和定量值变化差异。方法选择有完整关节镜检查结果及MRI软骨定量检查资料(包括T_1 mapping、T_2 mapping、T_2~*mapping)的患者共73个关节、213个病损部位。以关节镜结果作为标准,比较不同级别软骨损伤的分布部位,统计不同级别软骨损伤的T_1 mapping、T_2 mapping、T_2~*mapping测量值之间的差异及变化规律。结果Ⅰ、Ⅱ级软骨损伤发生在髌股关节面最多,内侧关节面次之,外侧关节面较少,三者间均有统计学差异(P0.05)。同一关节面的两个软骨亚区不同级别损伤的分布均没有差别(P0.05)。T_2 mapping和T_2~*mapping序列对Ⅰ～Ⅲ级损伤的分级正确率明显高于T_1 mapping (P0.05),T_2 mapping和T_2~*mapping序列无明显统计学差异(P0.05);对Ⅳ级软骨损伤分级符合率,三者之间无明显统计学差异(P0.05)。MRI检查序列对软骨损伤诊断符合率与关节镜结果一致性检验T_2~*mapping序列最高,Kappa值为0.663。关节软骨损伤时T_1 mapping、T_2 mapping及T_2~*mapping值增加,在Ⅰ、Ⅱ级软骨损伤时升高明显,而在Ⅲ级损伤时升高程度下降,T_2~*mapping值的变化较T_2 mapping更为明显。不同级别损伤时,T_1mapping值变化无明显差异(P0.05),T_2 mapping及T_2~*mapping值变化有统计学差异(P0.05)。结论膝关节OA软骨损伤分布具有一定特征性,MRI定量成像技术对区分膝关节OA不同级别损伤有很好的诊断价值。     

抗SRP抗体阳性和抗PM/Scl抗体阳性多发性肌炎 1例并文献复习

正多发性肌炎(polymyositis,PM)是以四肢近端肌肉受累为主要临床表现的获得性肌肉疾病,与皮肌炎、散发性包涵体肌炎及免疫介导坏死性肌病合称为特发性炎性肌病[1,2]。大多数特发性炎性肌病患者血清中可存在肌炎抗体,包括抗信号识别颗粒抗体(抗SRP抗体),有学者提出抗SRP抗体为特异     

MRI诊断皮肌炎与多发性肌炎的探讨

目的探讨磁共振成像(MRI)在诊断皮肌炎(DM)、多发性肌炎(PM)中的价值。方法使用GE公司的SignaMR/i对2001年11月～2002年8月我科收治的26例确有肌炎的患者(包括活动期DM/PM10例,稳定期DM/PM14例,SLE伴活动性肌炎2例)及15例无肌炎的结缔组织病、关节病或临床有肌肉酸痛的患者大腿肌群进行MRI扫描,对比其MRI表现,并结合活动期患者的肌酶(肌酸磷酸激酶CPK)、肌电图(EMG)、肌肉活检结果,比较4种检查的敏感性。结果①12例处于活动期肌炎(其中10例初发,2例复发)患者双大腿肌群的MRI上均有异常表现,占100%(灵敏度);在14例稳定期肌炎患者的MRI中也发现10例异常,占71.4%;15例无肌炎的患者(阴性对照组)MRI上均正常;②12例活动期肌炎患者中9例CPK升高,占75%(灵敏度);③12例活动期肌炎患者中9例行EMG检查,8例有肌源性肌电损害,占88.9%(灵敏度);④12例活动期肌炎患者中10例行肌肉活检,7例有肌炎改变,占70%(灵敏度)。得出,在活动期肌炎的辅助检查中,MRI的灵敏度高于CPK、肌肉活检,有统计学意义(P<0.01),而与肌电图的灵敏度差异不明显;且非活动期肌炎,71.4%患者的MRI也发现异常表现。结论①根据肌炎在MRI上有异常表现且灵敏度较高的特点,MRI有可能作为诊断DM/PM的另一有效手段;其与肌酶、肌电图和肌肉活检相比有无创、灵     

MRI在多发性肌炎、皮肌炎诊疗中的应用

目的探讨多发性肌炎（PM）、皮肌炎（DM）患行肌肉MRI农现,计价MRI在PM、DM诊断和疗效评估中的价值。材料与方法对临床资料完整的15例PM和21例DM患者的肌肉MR图像进行回顾分忻,所有病例均行治疗前双侧大腿肌肉MRI检查,8例患者进行了治疗后MRI复查。MRI检查序列包括快速门旋回波（TSE）T1WI、T2WI、短时反转恢复序列（STIR）。结果36例PM、DM中31例大腿肌肉MRI上存在异常,异常表现包括肌肉炎性水肿30例、肌筋膜炎7例、皮下软组织水肿14例、肌肉萎缩伴脂肪浸润5例。8例治疗后复AMRI均显示炎性水肿较治疗前明显好转、吸收。结论MRI枪查是一种敏感、无创的检查手段,其在PM、DM诊断、疗效评估中有重要应用价值：肌肉和皮下组织炎性水肿是PM、DM患者最常见的肌肉MRI表现。     

日常生活活动中人体下肢肌肉的表面肌电特性

目的探讨个体完成日常生活活动时下肢主要肌肉群肌电信号特征。方法30 名正常成年人完成7 个基本动作,同步检测双侧股直肌、股内侧肌、股外侧肌、腓肠肌外侧、胫前肌和比目鱼肌的表面肌电平均肌电值(AEMG)。结果和结论在日常生活活动中,左右下肢肌肉的发力有显著性差异,下肢各肌肉发力有显著性差异,男、女性在完成日常生活活动时下肢发力方式不同     

A Study on the Differences of Quadriceps Femoris Activities by Knee Alignment during Isometric Contraction

[Purpose] This study attempted to identify how genu varum or valgum affects the electromyographic activities of the vastus medialis, vastus lateralis, and rectus femoris during knee isometric contraction. [Subjects] Fifty-two healthy young adults were enrolled in this study. They were enrolled and classified into three groups by knee alignment conditions: the genu varum, genu valgum, and control groups. [Methods] The electromyographic activity ratio of the vastus medialis to the vastus lateralis and rectus femoris were calculated using the percentage of maximum voluntary contraction. The participants contracted their quadriceps during isometric contraction at 30 and 60° of knee flexion. [Results] The genu varum group had more activity in the vastus medialis than in the vastus lateralis and rectus femoris, whereas the genu valgum group had more activity in the vastus lateralis and rectus femoris than in the vastus medialis. There was a significant difference in the muscle activity ratio between the vastus medialis and vastus lateralis by angle of knee flexion degree only in the genu valgum. There were no significant differences in any of the three groups in terms of the muscle activity ratio of the vastus medialis to the rectus femoris by angle of knee flexion. [Conclusion] The quadriceps femoris was used for different strategies according to knee alignment during isometric contraction at 30 and 60°. This study suggests that rehabilitation training programs used to strengthen the quadriceps should consider the knee alignment conditions of the target subjects.Key words: Electromyography, Quadriceps muscle, Isometric contraction     

Quantity and Quality of the Lower Extremity Muscles in Women with Knee Osteoarthritis

The objective of the study described here was to compare lower extremity muscle quantity and quality between individuals with and those without knee osteoarthritis (OA). Twenty-one women with knee OA (mild, n = 8; severe, n = 13) and 23 healthy patients participated. Ultrasonography was used to measure muscle thickness (MT) and echo intensity (EI) of the rectus femoris, vastus intermedius, vastus lateralis, vastus medialis, biceps femoris, gluteus maximus, gluteus medius, gastrocnemius, soleus and tibialis anterior. MTs of the vastus medialis and vastus intermedius were smaller, and EIs of the vastus medialis, vastus intermedius, gluteus medius and tibialis anterior were larger, in the severe OA group compared than in the healthy group. Compared with the healthy group, the mild OA group had decreased MT and enhanced EI. Changes in quality and quantity occurring with knee OA progression differed among muscles. In the vastus medialis, change was observed from an earlier stage.     

Inter‐ and intramuscular differences in training‐induced hypertrophy of the quadriceps femoris: association with muscle activation during the first training session

The purpose of this study was to examine whether inter‐ and intramuscular differences in hypertrophy induced by resistance training correspond to differences in muscle activation during the first training session. Eleven young men completed 12 weeks of training intervention for knee extension. Before and after the intervention, T1‐weighted magnetic resonance (MR) images were recorded to determine the volume and anatomical cross‐sectional area (CSA) along the length of the individual muscles of the quadriceps femoris. The T2‐weighted MR images were also acquired before and immediately after the first training session. The T2 was calculated for each pixel within the quadriceps femoris, from which the muscle activation was evaluated as %activated volume and area. The results showed that the %activated volume after the first training session was significantly higher in the vastus intermedius than the vastus medialis. However, the relative change in muscle volume after the training intervention was significantly greater in the rectus femoris than the vasti muscles (vastus lateralis, intermedius and medialis). Within the rectus femoris, both the %activated area and relative increase in CSA were significantly greater in the distal region than the proximal region. In contrast, the %activated area and relative increase in CSA of the vasti were nearly uniform along each muscle. These results suggest that the muscle activation during the first training session is associated with the intramuscular difference in hypertrophy induced by training intervention, but not with the intermuscular difference.     

The influence of weakness in the vastus medialis oblique muscle on the patellofemoral joint: an in vitro biomechanical study

OBJECTIVE: Investigation of the influence of weakness in the vastus medialis oblique muscle on patellar tracking. DESIGN: In vitro biomechanical study. BACKGROUND: Currently, the influence of weakness in the vastus medialis oblique muscle on patellar tracking has not been well understood. METHODS: Seven human cadaveric knees were used. The direction of loading forces in the rectus femoris/vastus intermedius, vastus medialis oblique, and the vastus lateralis muscles was decided by the muscle alignment of each cadaver knee measured at the time of dissection. The loads used were 60 N in the rectus femoris, 50 N in the vastus lateralis, and 40 N in the vastus medialis oblique, according to the ratio calculated from the cross-sectional study. The weakness of vastus medialis oblique was simulated at 30 N (75%), 20 N (50%), 10 N (25%), and 0 N (0%), and the patellar position was measured for each condition using a magnetic 3 Space Tracker System. The influence of weakness in the vastus medialis oblique muscle on patellar position was investigated with seven cadaver knees using a magnetic 3 Space Tracker System. RESULTS: At 0 degrees and 15 degrees of knee flexion, 75%, 50%, 25% and 0% of the normal vastus medialis oblique muscle led to a significant difference in lateral patellar shift compared to the normal (P<0.05). CONCLUSIONS: Weakness of the vastus medialis caused the patellar lateral shift at 0 degrees and 15 degrees of knee flexion. RELEVANCE: Weakness of the vastus medialis is thought to be an important factor causing patellar subluxation and dislocation. Understanding the relationship between the vastus medialis weakness and patellar tracking will be useful in diagnosis, treatment and prevention of patellar subluxation and dislocation.     

Differences of quadriceps activity during inline lunge by using FMS assessment

[Purpose] This study assessed the exercise capacity of healthy adults while performing the inline lunge exercise by using Functional Movement Screen (FMS). Compared the difference in muscle activity of the quadriceps according to the exercise capacity. [Participants and Methods] Thirty two healthy participants (12 males, 20 females) participated in this study. The surface electromyography (sEMG) was used to measure the electrical activities for the vastus medialis (VM), rectus femoris (RF), vastus lateralis (VL) of quadriceps. [Results] Both groups had significant difference when sitting up and getting up during the inline lunge. In scores 3 group, vastus medialis showed higher muscle activity than vastus lateralis. On contrary, in scores 2 group, vastus lateralis had higher muscle activity than vastus medialis. [Conclusion] Therefore, this study suggests that inline lunge can help to strengthen the quadriceps effectively by showing the difference of quadriceps activity according to exercise capacity.Key words: Inline lunge, Muscle activity, Functional movement screen     

Changes in muscle activity during fast, alternating flexion-extension movements of the knee

The effects of high frequency alternating knee flexion-extension on muscle activity of the quadriceps and hamstring muscle groups has been investigated. Standard loads were used for each subject. The muscle activity in vastus medialis, vastus lateralis, rectus femoris and the lateral hamstrings were recorded by electromyography during increasing velocities. Rectus femoris and hamstrings were found to increase their activities significantly with increasing speed while vastus medialis and vastus lateralis showed no such change. The individual thigh muscles thus differ in function in relation to the velocity of movement.     

Differences in onset time between the vastus medialis and lateralis during stair stepping in individuals with genu varum or valgum

[Purpose] We investigated the difference in onset time between the vastus medialis and lateralis according to knee alignment during stair ascent and descent to examine the effects of knee alignment on the quadriceps during stair stepping. [Subjects] Fifty-two adults (20 with genu varum, 12 with genu valgum, and 20 controls) were enrolled. Subjects with > 4 cm between the medial epicondyles of the knees were placed in the genu varum group, whereas subjects with > 4 cm between the medial malleolus of the ankle were placed in the genu valgum group. [Methods] Surface electromyography was used to measure the onset times of the vastus medialis and vastus lateralis during stair ascent and descent. [Results] The vastus lateralis showed more delayed firing than the vastus medialis in the genu varum group, whereas vastus medialis firing was more delayed than vastus lateralis firing in the genu valgum group. Significant differences in onset time were detected between stair ascent and descent in the genu varum and valgum groups. [Conclusion] Genu varum and valgum affect quadriceps firing during stair stepping. Therefore, selective rehabilitation training of the quadriceps femoris should be considered to prevent pain or knee malalignment deformities.Key words: Quadriceps muscle, Genu varum, Genu valgum     

运动疗法对膝关节骨关节炎患者肌发电量的影响

目的：研究肌发电量在膝关节骨关节炎患者股四头肌肌力训练中的变化情况及股四头肌的详细变化情况。方法：采用股四头肌的等长收缩运动训练方法和其他疗法进行比较,用肌电图进行股直肌、股内侧肌、股外侧肌的肌发电量测定,同时用“膝关节功能评定表”进行功能的辅助评定。结果：两种方法治疗后,股直肌、股内侧肌的肌发电量都有显著的变化,尤其以股内侧肌的变化极显著,股外侧的肌发电量无显著变化。两种方法中肌力训练较其他治疗方法在提高肌发电量方面更为有效。结论：股内侧肌在膝关节肌力锻炼中的变化最大,说明股内侧肌比股直肌和股外侧肌在稳定膝关节方面更重要。股外侧肌在训练中的变化最小,在维护膝关节的稳定性方面起的作用比股内侧肌和股直肌小;肌力训练比其他方法在增加肌发电量方面更有效,更能提高膝关节的稳定性。     

Differences in onset timing between the vastus medialis and lateralis during concentric knee contraction in individuals with genu varum or valgum

[Purpose] The purpose of this study was to investigate the difference in onset timing between the vastus medialis and lateralis among the different knee alignments, as well as the best isokinetic angular velocity for an isokinetic concentric contraction. [Subjects] Fifty-two adults (20 with genu varum, 12 genu valgum, and 20 controls) were enrolled in this study. Subjects with > 4 cm between the medial epicondyles of the knee were placed in the genu varum group, whereas subjects with > 4 cm between the medial malleolus of the ankle were placed in the genu valgum group. [Methods] Surface electromyography was used to measure the onset times of the vastus medialis and vastus lateralis during concentric contractions at 30, 60, and 90°/sec. [Results] The vastus lateralis showed more delayed firing than the vastus medialis in the genu varum group, whereas vastus medialis firing was delayed more than that of the vastus lateralis in the genu valgum group. No differences in onset timing were observed between the vastus medialis and lateralis according the different angular velocities during concentric contractions in all three groups. [Conclusion] Genu varum and valgum affect quadriceps firing. Therefore, selective rehabilitation training of the quadriceps femoris should be considered to prevent pain or knee malalignment deformities.Key words: Quadriceps muscle, Genu varum, Genu valgum