先天性马蹄内翻足表面肌电信号研究

摘要 目的：探讨表面肌电（sEMG）检测技术在先天性马蹄内翻足患儿中的临床应用。 方法：采用十通道生物机能实验系统采集32例单侧先天性马蹄内翻足患儿的下肢表面肌电信号。患儿取仰卧位,在自然放松位、踝被动背伸至中立位、踝被动跖屈45度时检测双侧股直肌、胫前肌、腓肠肌的表面肌电信号,经信号处理得到股直肌、胫前肌、腓肠肌的平均均方根（RMS）值,并分析健侧与患侧相关肌肉平均RMS值的差异。 结果：患侧的小腿肌肉受累,健侧与患侧胫前肌、腓肠肌在背伸位、跖屈位平均RMS值差异有统计学意义（P＜0.05）,且患侧胫前肌、腓肠肌肌电信号均较健侧低。 结论：先天性马蹄内翻足患儿存在神经、肌肉功能异常,表面肌电图检测可以无创地了解患儿的神经及肌肉功能。     

田径运动员足肌闭合性损伤的成因

足肌力量的大小和柔韧性的优劣，在田径运动中起着至关重要的作用。如果不重视对足肌损伤的预防，足肌的损伤会时常发生，并将直接影响田径运动员水平的提高。     

改良胫后肌移位术治疗足下垂

1999年1月~2005年1月,我院对68例病因治疗效果不佳的足下垂患者采用胫后肌移位术治疗,效果满意,现报告如下。1临床资料1·1一般资料本组68例,男49例,女19例;年龄27~56岁,平均43·5岁。1·2足下垂原因单纯腓总神经损伤37例,坐骨神经损伤24例,腰椎间盘突出症5例,腓总神经纤维瘤2例。于损伤后14个月~6年来本院治疗。左足32例,右足36例。11例18个月前行腓总神经和坐骨神经修复,肌电图示功能无恢复,症状无缓解。1·3临床表现本组均有跛行及足下垂,踝关节背伸肌肌力0~1级,23例足背及小腿外侧感觉障碍。1·4手术方法采用腰麻或硬膜外麻醉。先取足内…     

痉挛肌治疗仪对脑卒中偏瘫患者足内翻的影响

目的探讨痉挛肌治疗仪对偏瘫患者足内翻的影响。方法60例足内翻患者分为对照组与观察组,每组30例,对照组进行常规治疗,观察组在常规治疗基础上增加痉挛肌治疗仪治疗。结果两组患者踝关节临床痉挛指数（CSI）治疗前后比较有显著性差异(P＜0.05),治疗后观察组CSI与对照组比较有显著性差异(P＜0.05)。结论KX-3型痉挛肌治疗仪对偏瘫患者足内翻的异常模式有改善作用。     

肌内效贴结合足下垂助行仪治疗脑卒中偏瘫患者足下垂步态的临床观察

目的:观察肌内效贴结合足下垂助行仪对脑卒中偏瘫患者足下垂步态的影响,以探索纠正偏瘫足下垂步态的科学方法。方法:60例脑卒中偏瘫患者随机分为实验组和对照组各30例。2组患者均接受常规康复训练,在此基础上,对照组接受常规步行训练,实验组接受肌内效贴结合足下垂助行仪辅助步行训练,以上治疗均每次30 min,每周5次,连续4周。用Gait Watch三维步态分析系统分析2组患者治疗前后步速、左右步长差,用Fugl-Meyer下肢运动功能评定量表(FMA)、步行功能分级(FAC)、改良Barthel指数(MBI)评价2组患者治疗前后下肢运动功能、步行功能和日常生活能力,比较2组疗效。结果:治疗4周后,2组步速、左右步长差及下肢FMA积分、FAC分级、MBI评分均较治疗前明显改善(P0.05),并且治疗后实验组较对照组明显改善(P0.01)。结论:肌内效贴结合足下垂助行仪能明显改善脑卒中偏瘫患者足下垂步态,治疗依从性好。     

脑瘫儿童肌性足畸形无创伤性康复治疗

脑瘫患儿 14例 ,均智力发育正常 ,男 6例 ,女 8例 ;年龄3～ 6岁 8例 ,7～ 9岁 6例 ;均伴有癫痫或言语不清 ,不能站立行走 ,足跖屈、内翻内收及外翻等畸形 ;痉挛型 9例 ,松弛型 5例 ,其中 3例伴有剪刀步态。 14例患儿均采用综合康复治疗。①电针 :松弛型针刺松弛肌肉群远近两端相关穴位 ,2个穴位为 1组 ,如 :足踝跖屈在胫腓骨前、足背部踝横纹中央和股四头肌处选穴 ;内收内翻选外展肌群中解溪、绝骨、风市等穴 ;外翻可在内收肌群两端选穴进行针刺 ,深度至肌肉中部 ,功能开关置于疏密状态 ,电流强度适当放大到患肢有动感为宜。痉挛型功能开关…     

股直肌的超声解剖学特点与撕裂的声像图关系

目的探讨股商肌的超声解剖结构及其与不同部位股直肌外伤撕裂问的关系。方法应用高频超声对10例健康志愿者的股直肌（20条）进行超声扫查,采用系列长轴和短轴切面依次获得股直肌的纵断面与横断面声像图,并将声像图与解剖描述及图谱相对照分析,识别股直肌的超声解剖结构。回顾性分析2006年4月至2009年1月14例超声诊断股直肌撕裂患者的声像图资料,结合声像图解剖进行分型诊断,并经随访和临床证实。结果正常股直肌近端由直头肌腱和反折头肌腱起源。连续超声扫查显示直头肌腱参与形成浅层腱膜,反折头肌腱在近端肌腹内形成中央腱膜,中央腱膜于横断面显示清晰,呈“逗号样”高回声结构位于肌肉中央。股直肌远端肌腱参与形成股四头肌腱浅层。以此为基础,14例股直肌撕裂可分为3类,发生在远端肌肉肌腱连接处1例,肌纤维与外周腱膜连接处5例,肌纤维与中央腱膜连接处8例。结论超声检查能够显示股直肌存在特殊的解剖结构,识别其声像斟特点有助于对外伤撕裂的准确定位诊断。     

运动疗法结合肌电生物反馈对脑卒中足下垂的疗效观察

目的：观察运动疗法结合肌电生物反馈对脑卒中足下垂患者康复的临床效果。方法：脑卒中伴有足下垂的偏瘫患者56例随机分为观察组和对照组各28例。2组患者均接受神经科常规药物治疗和常规康复治疗,观察组在此基础上增加肌电生物反馈治疗。治疗前后给予步行能力评定量表评定、关节活动度（ROM）评定踝背屈主动活动度及下肢运动功能评分（FMA）评定。结果：治疗2个疗程后,2组患者步行能力、踝关节背屈角度、下肢FMA评分均较治疗前明显提高（P<0.05）,且观察组更高于对照组（P<0.05）。结论：运动疗法结合肌电生物反馈对改善脑卒中足下垂有明显的效果,值得推广应用。     

Prevalence of denervation in paraspinal and foot intrinsic musculature.

OBJECTIVE: The primary purpose of this investigation was to determine the prevalence of abnormal spontaneous activity (positive sharp waves (PSWs) and fibrillation potentials (FPs)) in selected lumbosacral paraspinal and foot intrinsic muscles in an asymptomatic healthy population. DESIGN: This was a prospective assessment of 50 individuals without history or physical findings suggestive of peripheral neuromuscular disease whereby a monopolar needle electrode was located in the unilateral L4 and L5 paraspinal as well as abductor hallucis and extensor digitorum brevis muscles. These muscles were extensively evaluated for the presence of PSWs, FPs, and fasciculation potentials. RESULTS: Ten subjects per decade from 20-59 yr and ten subjects from 60-80 yr comprised the 50 participants (28 women), resulting in a mean age of 45+/-15.9 (range, 20-76) yr. A single individual (prevalence, 2%) demonstrated fibrillation potentials in the extensor digitorum brevis, and FPs and PSWs were detected in two subjects' (4% prevalence) L4/L5 paraspinal muscles. Ninety-four percent of the subjects had fasciculation potentials in the abductor hallucis, whereas 60% had these waveforms in the extensor digitorum brevis. Only 6% of subjects had fasciculation potentials in the L4 but not L5 paraspinal muscles. All subjects demonstrated both prototypical and "atypical" appearing endplate spikes in all of the muscles examined. CONCLUSIONS: We failed to confirm the previously reported prevalence of FPs and PSWs in both the paraspinal and foot intrinsic musculature. Atypical appearing endplate spikes, however, display configurations similar to FPs and PSWs and were present in all subjects. Failure to pay close attention to the discharge rate and rhythm of endplate spikes can lead to misinterpreting these waveforms as FPs and PSWs. It is likely that the previously reported high prevalence of spontaneous activity in healthy persons resulted from not fully appreciating the similarity between innervated and denervated spontaneous single muscle fiber discharge configurations.     

Recruitment of the plantar intrinsic foot muscles with increasing postural demand

Background

The aim of this study was to determine the difference in activation patterns of the plantar intrinsic foot muscles during two quiet standing tasks with increasing postural difficulty. We hypothesised that activation of these muscles would increase with increasing postural demand and be correlated with postural sway.

Methods

Intra-muscular electromyographic (EMG) activity was recorded from abductor hallucis, flexor digitorum brevis and quadratus plantae in 10 healthy participants while performing two balance tasks of graded difficulty (double leg stance and single leg stance). These two standing postures were used to appraise any relationship between postural sway and intrinsic foot muscle activity.

Findings

Single leg stance compared to double leg stance resulted in greater mean centre of pressure speed (0.24 m s^− 1 versus 0.06 m s^− 1, respectively, P ≤ 0.05) and greater mean EMG amplitude for abductor hallucis (P ≥ 0.001, ES = 0.83), flexor digitorum brevis (P ≤ 0.001, ES = 0.79) and quadratus plantae (P ≤ 0.05, ES = 0.4). EMG amplitude waveforms for all muscles were moderate to strongly correlated to centre of pressure (CoP) medio-lateral waveforms (all r ≥ 0.4), with muscle activity amplitude increasing with medial deviations of the CoP. Intra-muscular EMG waveforms were all strongly correlated with each other (all r ≥ 0.85).

Interpretations

Activation of the plantar intrinsic foot muscles increases with increasing postural demand. These muscles are clearly important in postural control and are recruited in a highly co-ordinated manner to stabilise the foot and maintain balance in the medio-lateral direction, particularly during single leg stance.     

Effect of alterations in the thyroid state on the intrinsic contractile properties of isolated rat skeletal muscle

Contractile properties of soleus muscles isolated from 31 euthyroid (EU), 20 hyperthyroid (HT), and 18 myxedematous (MY) rats were studied in a myograph. At 100 stimuli/sec maximum isometric tension was essentially identical in EU (17.2 +/-0.5 g/mm(2)) and HT (17.7 +/-0.5 g/mm(2)) muscles, but was significantly depressed in MY muscles (11.5 +/-0.7 g/mm(2)). The rate of tension development was increased in HT (103 +/-4.5 g/sec per mm(2)) as compared to both EU (86.2 +/-4.6 g/sec per mm(2)) and MY (38.4 +/-2.2 g/sec per mm(2)) muscles, while the duration of the active state was shortened in HT (77.1 +/-2.3 msec) as compared to EU (105.1 +/-1.1 msec) muscles and was prolonged in MY muscles (153.3 +/-6.0 msec). The mean rate of isometric relaxation was 26.5 +/-4.9 g/mm(2) per sec in EU muscles, more rapid in HT muscles (33.1 +/-1.3 g/sec per mm(2)), and slower in MY muscles (16.0 +/- g/mm(2) per sec). The fusion frequency was greater in HT muscles, averaging 68.5 +/-3.6 stimuli/sec compared to EU muscles (38.1 +/-1.2 stimuli/sec) and to MY muscles (33.3 +/-4.0 stimuli/sec). At 40 stimuli/sec tension averaged 16.4 +/-0.8 g/mm(2) in EU muscles while at the same frequency tension was reduced in HT muscle, averaging 14.2 +/-0.5 g/mm(2). All differences were significant (P < 0.01). In conclusion, HT and MY result in profound alterations in the intrinsic contractile properties of skeletal muscle. While tension in HT muscles is maintained in vitro at a stimulus frequency of 100 stimuli/sec, the reduction in duration of active state may lower tension in vivo by preventing complete fusion of contractile events. In MY tension is reduced as a consequence of the lowered intensity of the active state. These changes explain, at least in part, the weakness of muscle activity in both HT and MY.     

Effect of prior experience and task stability on the intrinsic muscle activity of the thumb

Manual techniques involving the use of the thumb are commonly employed by physical therapists for treating patients with vertebral disorders. The demands on the intrinsic muscles of the thumb in these manual tasks are very different from those of the pinch tasks. The aim of this study was to investigate the influence of clinical experience and different mobilization techniques on the electromyographic activity (EMG) of thumb intrinsic muscles. Fifteen participants without exposure to manual techniques (the Novice Group) and fifteen physical therapists with at least 3 years of orthopaedic experience (the Experienced Group) participated. Each participant exerted thumb tip forces with 3 different posterioanterior (PA) glide techniques including unsupported, with digital support and with thumb interphalangeal joint supported by the index finger. The exerted force was increased from 25% to 100% maximum force at 25% increments on a 6 component load cell. The thumb tip force and EMG activity of four intrinsic muscles (flexor pollicis brevis, adductor pollicis, abductor pollicis brevis, first dorsal interosseus) were recorded with surface electrodes. Both experience and technique influenced intrinsic muscle activity of the thumb. While participants of both groups generated the same magnitude of force, experienced participants generated less intrinsic muscle activity while performing PA glide through practice. However, novice participants increased activity of the intrinsic muscles in accordance with the stability status of the technique. PA glide with thumb interphalangeal joint supported by the index finger was a more stable technique as evidenced by smallest relative errors of thumb tip force.     

头静脉营养血管远端蒂复合瓣的解剖学研究

背景：前臂皮神经营养血管远端蒂皮瓣，特别适宜手部远端的组织缺损修复，但由于皮瓣旋转轴点较高，时常难以满足修复手部远侧创伤缺损的需要，还会对供区造成较大的损害。目的：观察前臂桡侧缘远端动脉穿支的解剖走行，为前臂桡侧缘头静脉营养血管远端蒂复合瓣的设计提出解剖学理论。设计：单一样本实验。单位：解放军南京军区福州总医院军区骨科研究所临床解剖学研究中心。材料：实验于2004-08／12在解放军南京军区福州总医院军区骨科研究所临床解剖学研究中心实验室完成。30侧动脉内灌注红色乳胶成人上肢标本（由解放军南京军区福州总医院军区骨科研究所临床解剖学研究中心提供）。方法：以桡骨茎突为观测标志点，采用游标卡尺、直尺测量血管外径、距离。主要观察指标：①前臂桡侧缘远端的动脉穿支。②多头静脉的营养血管。③营养血管与邻近骨、皮和前臂外侧皮神经的血供关系。④多头静脉的浅深交通支。结果：前臂桡侧缘远端的动脉穿支来自：桡动脉的皮支6-11支．外径（0．7&;#177;0．3）mm；掌浅支的皮支2-6支，外径（0．5&;#177;0．3）mm；桡骨茎突返支的皮支1-2支，外径（0．5&;#177;0．1）mm；鼻烟壶支的皮支1-2支，外径（0．6&;#177;0．2）mm。在桡骨茎突上方8．0-15．0cm，桡动脉肌间隙骨皮穿支1-3支，外径（1．1&;#177;0．2）mm，分布桡骨体部中下段的裸露区及相应区域的皮肤。上述动脉穿支均发皮支、筋膜支、骨膜支、头静脉和皮神经远端营养血管支，形成头静脉旁血管链和皮神经干血管链以及深、浅筋膜和骨膜血管网。结论：前臂桡侧缘远端的动脉穿支是头静脉营养血管的来源，营养血管又与邻近的骨、皮和前臂外侧皮神经的营养血管同源，是设计头静脉营养血管远端蒂复合瓣的解剖学基础。以桡骨茎突返支（或鼻烟壶支）为蒂的远端蒂复合瓣，旋转轴点可达腕关节平面，用于转位修复手部远处的组织缺损。     

头静脉营养血管远端蒂复合瓣的解剖学研究

背景:前臂皮神经营养血管远端蒂皮瓣,特别适宜手部远端的组织缺损修复,但由于皮瓣旋转轴点较高,时常难以满足修复手部远侧创伤缺损的需要,还会对供区造成较大的损害。目的:观察前臂桡侧缘远端动脉穿支的解剖走行,为前臂桡侧缘头静脉营养血管远端蒂复合瓣的设计提出解剖学理论。设计:单一样本实验。单位:解放军南京军区福州总医院军区骨科研究所临床解剖学研究中心。材料:实验于2004-08/12在解放军南京军区福州总医院军区骨科研究所临床解剖学研究中心实验室完成。30侧动脉内灌注红色乳胶成人上肢标本(由解放军南京军区福州总医院军区骨科研究所临床解剖学研究中心提供)。方法:以桡骨茎突为观测标志点,采用游标卡尺、直尺测量血管外径、距离。主要观察指标:①前臂桡侧缘远端的动脉穿支。②头静脉的营养血管。③营养血管与邻近骨、皮和前臂外侧皮神经的血供关系。④头静脉的浅深交通支。结果:前臂桡侧缘远端的动脉穿支来自:桡动脉的皮支6～11支,外径(0.7±0.3)mm;掌浅支的皮支2～6支,外径(0.5±0.3)mm;桡骨茎突返支的皮支1～2支,外径(0.5±0.1)mm;鼻烟壶支的皮支1～2支,外径(0.6±0.2)mm。在桡骨茎突上方8.0～15.0cm,桡动脉肌间隙骨皮穿支1～3支,外径(1.1±0.2)mm,分布桡骨体部中下段的裸露区及相应区域的皮肤。上述动脉穿支均发皮支、筋膜支、骨膜支、头静脉和皮神经远端营养血管支,形成头静脉旁血管链和皮神经干血管链以及深、浅筋膜和骨膜血管网。结论:前臂桡侧缘远端的动脉穿支是头静脉营养血管的来源,营养血管又与邻近的骨、皮和前臂外侧皮神经的营养血管同源,是设计头静脉营养血管远端蒂复合瓣的解剖学基础。以桡骨茎突返支(或鼻烟壶支)为蒂的远端蒂复合瓣,旋转轴点可达腕关节平面,用于转位修复手部远处的组织缺损。     

负压封闭引流技术治疗重度糖尿病足坏疽的临床观察

目的 探讨负压封闭引流技术(VSD)在重度糖尿病足坏疽(DFG)治疗中的临床疗效及适应证.方法 随机选取60例符合Wagner分级3～5级的DFG患者,使用VSD技术治疗创面,即VSD治疗组,采用回顾性对照研究的方法,对1年前采用创面常规引流方法治疗DFG的患者62例进行对照分析,即常规治疗组,观察创面愈合时间、换药次数、转归(治愈率)、平均住院时间及住院总费用等.结果 VSD组与常规治疗组比较创面愈合时间[(30.5±6.8)d与(53.8±5.5)d,t=2.636]、换药次数[(15.0±4.7)次与(29.5±6.1)次,t=2.374]、治愈率[96.7％ (58/60)与87.1％ (54/62),x2=9.93]、平均住院时间[(20.1±3.5)d与(36.5±4.6)d,t=2.564]、总住院费用[(20 155.6±153.8)元与(41465.5±146.6)元,t=2.873],差异均有统计学意义(P均＜0.05).结论 VSD治疗重度DFG疗效好,明显缩短创面愈合时间,提高治愈率,明显缩短住院时间,降低住院费用,是治疗DFG创面的有效方法.