右上肢肌肉肥厚变异畸形1例

患者男性，7岁，主诉右上肢肥厚并手腕手指畸形入住我科。该患儿为第2胎足月顺产，出生后即被发现右上肢较左上肢明显肥厚，为均匀性肥大，以三角肌、前臂、手掌犹为明显(图1)。右手各指指间隙显著增宽，腕关节及各掌指、指间关节明显肥大，拇指位置接近腕关节。肘关节活动度基本正常，腕关节活动度差。夹持物体用示指及其余三指对掌完成，拇指对掌功能     

太极拳转体动作中下肢关节活动顺序性和肌肉力表现及肌肉激活特征

目的 分析太极拳转体与弓步动作中下肢关节活动顺序性、肌肉力表现和肌肉激活程度的差异,揭示太极拳转体动作的特征。 方法 募集 20 名练习时长超过 3 年的健康太极拳练习者,采用三维运动捕捉系统、测力台和表面肌电同步采集转体与弓步两种动作运动学、动力学和肌肉激活信息,并通过 OpenSim 仿真软件获取下肢肌力。结果 与弓步相比,转体动作髋、踝关节外旋幅度显著增大;膝关节外展和外旋力矩显著增大,股二头肌、半腱肌和内外侧腓肠肌峰值肌力显著增强,股二头肌、内外侧腓肠肌峰值肌力时刻显著提前,而股内外侧肌和胫骨前肌峰值肌力显著减小,胫骨前肌肌力最早达到峰值;股二头肌、股内外侧肌和内侧腓肠肌的平均激活水平和激活时间显著增加。 结论 太极拳转体动作由踝、髋关节依次转动组成,肌肉力表现的独特性在于重心两次转移致使支撑腿内外侧肌力曲线呈双峰型,因为全足着地延迟方式引发了腓肠肌与股四头肌激活顺序和肌肉平均激活水平改变。研究结果提示全足着地延迟方式具有调节肌肉激活顺序的作用,合理利用有助于提升临床康复效果。     

俯卧撑中前臂旋转对上肢肌肉电活动的影响

目的 分析俯卧撑中前臂旋转对上肢肌肉电活动的影响。方法 采集十个对象在前臂内旋90°（IR90）,中立位（NEU）和外旋90°（ER90）三个支撑位下肱三头肌长头和侧头、三角肌前部和中部、胸大肌和肱二头肌的肌电信号,计算肌电信号的均方根值,并作归一化处理,运用单因素方差分析法比较不同支撑位下肌电信号的差异。同时对一个周期内肌电信号进行包络线分析。结果 从IR90到ER90,肱三头肌长头信号无显著变化,肱三头肌侧头和三角肌中部信号逐渐减小,而三角肌前部、胸大肌和肱二头肌则逐渐增大。另外,包络分析结果显示了三种不同类型的肌电信号曲线。结论 不同前臂转动支撑位对肌肉活性产生影响,而对各肌肉的影响程度和方式并不相同。     

血流限制训练对上肢肌肉适能效益的影响

背景：血流限制训练在提高肢体肌肉力量方面有广阔的应用前景,其中上肢应用血流限制训练的效果较为理想,且具体应用方案具有较高的研究价值。目的：阐述血流限制训练对上肢肌肉适能效益的影响,总结上肢应用血流限制训练的具体方案,试图依据现有研究给出应用方案的建议。方法：检索中国知网(CNKI)、万方、维普、CBM、PubMed、 Embase、EBSCO、Cochrane Library及Web of Science数据库中发表的上肢应用血流限制训练的相关文献,中文检索词为“血流限制,血流限制训练,加压训练,上肢,上臂,前臂,手臂,小臂”,英文检索词为“Blood Flow Restriction Training,Blood Flow Restriction Exercise,Blood Flow Restriction Therapy,BFR Therapy,Occlusion training,KAATSU training,BFRT,Upper Extremity,Upper Limb,Arm,Forearm”。选择各数据库建库至2022年12月收录的上肢应用血流限制训练的相关文章,并根据...     

人体肌肉短时间工作能力的遗传学特点*

背景：近年来,研究者们从人类遗传学的角度论证人体肌肉短时工作能力很大程度上受控于基因,且人体肌肉力量、无氧耐力均有较高的遗传度。 目的：就近年来人体肌肉短时间工作能力研究进展进行综述,为今后短时工作能力的遗传学研究打下基础。  方法：应用计算机检索中国期刊全文数据库、PubMed数据库和Medline database数据库1990/2011相关文献,纳入以短时肌肉工作能力分子遗传学评价的文献报道,选取35篇文献进行分析归纳。 结果与结论：文章归纳了前期动物实验与近期人体试验。在为数不多的与人有关的肌肉短时间工作能力的遗传学研究中,结果取得了惊人的一致性,而且阳性率较高。由此可见,存在于人类肌肉短时间工作能力的个体差异在很大程度上反映了DNA序列及其表达调控差异。伴随着分子生物学的技术的发展,为进一步开展与基因相关的肌肉短时工作能力遗传学研究提供了强有力的理论依据。 关键词：肌肉;短时工作能力;肌肉生长抑制素;力量训练;遗传 doi:10.3969/j.issn.1673-8225.2012.11.035     

太极拳上步弓步动作足前进角对膝关节载荷的影响及肌肉协调收缩策略

目的考察太极拳运动姿势对膝关节载荷的影响及肌肉协调收缩策略。方法募集20名具有3年以上健康太极拳习练者,借助红外高速运动捕捉系统和三维测力台,采集太极拳上步弓步动作支撑腿内收角、胫骨角、关节力、关节力矩等参数,通过仿真方法获取股四头肌和腓肠肌肌肉力。比较惯用步、外展步和内收步肌肉力表现、募集模式和激活方式特征。结果外展步胫骨角和内收力增大,而内收步不变;外展步股内肌、半膜半腱肌及外侧腓肠肌力增大;内收步股外肌和内侧腓肠肌力增强,腓肠肌比股四头肌被优先激活,肌群募集方式发生改变。结论太极拳运动姿势改变肌肉力募集方式,影响膝关节功能,规范动作可作为骨性关节炎运动疗法借鉴,具有临床应用意义。     

功能性游离肌肉移植重建部分上肢功能的临床应用

目的　探讨应用3种功能性游离肌肉移植重建部分上肢功能手术的疗效,结合相关解剖基础分享临床经验。 方法　2010年1月至2018年12月,应用功能性游离股薄肌、背阔肌、胸小肌移植重建上肢功能手术治疗患者39例,包括重建屈肘和屈指功能6例,屈指功能11例,拇对掌功能22例。根据肢体情况选择不同的动力神经和供血血管,术中调节移植肌肉于最佳肌张力水平,重建移植肌肉的神经和血运。 结果　功能性游离肌肉完全成活37例,重建的上肢功能恢复良好,优、良率达94.8%;重建功能未恢复者2例,其中1例出现移植肌肉和皮瓣部分坏死。 结论　应用功能性游离股薄肌、背阔肌和胸小肌移植重建上肢功能手术效果满意,是治疗各种原因导致的上肢肌肉缺损及严重肢体障碍的有效方法。     

基于光学运动捕捉的上肢康复机器人可用性测试研究

目的对一款上肢康复机器人进行可用性测试研究,验证其安全性、有效性和舒适性,并提出改进设计的意见。方法运用光学式运动捕捉系统采集受试者进行康复训练时的角度数据,再对受试者进行主观问卷调查。结果快速上肢评估量表结果显示上肢康复机器人配置相对合适,但需要进一步深入研究。角度数据在肩关节内收外展运动和肘关节屈伸运动上表现出显著相关性,而在腕关节数据的统计结果上表现出无相关性。主观问卷调查总得分表明上肢康复机器人舒适性总体上是令人满意的,但在手臂固定装置的舒适性、训练过程中肌肉拉伸程度和座位高度设置的问题上存在设计不合理。结论运用光学式运动捕捉系统可以定量评价上肢康复机器人的性能,对康复机器人的设计及改进具有重要意义。     

太极拳运动下肢生物力学研究进展

太极拳的保健和康复功能已经在全球得到认可,国内外的专家学者利用运动生物力学方法对太极拳保健作用的机制进行研究,其中大部分是针对人体下肢的研究。检索2007~2015年太极拳运动的下肢生物力学研究文献20篇(15篇英文和5篇中文),根据研究目的和评价指标,从太极拳本身的运动学和动力学特点及其对下肢的影响、太极拳对下肢肌肉活动的影响、太极拳运动对人体下肢生物力学参数与其他系统参数相互作用的影响三个方面进行综述,并对太极拳运动下肢生物力学研究的展望和不足之处进行总结。     

老年人参加太极拳运动的健康意义

目的调查老年人参加太极拳运动后的心理、生理和社会效果。方法采用CMI量表对133名老年人进行评定,分别将其分为自由运动组、太极拳训练组、非运动对照组。测量运动0月、2个月、6个月时的心身变化情况。结果2个月时抑郁、焦虑、紧张等心理症状分值降低;6个月时身体项目分值降低幅度为太极拳组>自由运动组>非运动组;社会参与活动较运动前好转。结论太极拳运动能够改善心身功能,继而激发社会功能的改善。     

肘关节运动肌的构筑学研究

对12侧人肘关节运动肌的构筑进行了研究。结果表明，肱三头肌的生理横切面积是屈肘肌的1．9倍（41．56与21．69cm2），表明它比屈肘肌具有更大肌力。根据肌纤维长度的差异，肘屈肌的收缩速度应比肱三头肌快60％左右。由于肱三头肌的快缩纤维比例较大（60％），再加肘关节的杠杆装置，肱三头肌的伸肘速度应可与屈肌相匹配。旋前和旋后运动的肌力大致相等、旋前圆肌、旋后肌、肘肌和肱桡肌的生理横切面积合计达22．10cm2，比屈肘肌的肌力还大，我们认为它们对稳定肘关节有重要作用。本文对人类肘关节运动肌的进化特征进行了讨论。     

A Model of the Upper Extremity for Simulating Musculoskeletal Surgery and Analyzing Neuromuscular Control

Biomechanical models of the musculoskeletal system are frequently used to study neuromuscular control and simulate surgical procedures. To be broadly applicable, a model must be accessible to users, provide accurate representations of muscles and joints, and capture important interactions between joints. We have developed a model of the upper extremity that includes 15 degrees of freedom representing the shoulder, elbow, forearm, wrist, thumb, and index finger, and 50 muscle compartments crossing these joints. The kinematics of each joint and the force-generating parameters for each muscle were derived from experimental data. The model estimates the muscle–tendon lengths and moment arms for each of the muscles over a wide range of postures. Given a pattern of muscle activations, the model also estimates muscle forces and joint moments. The moment arms and maximum moment-generating capacity of each muscle group (e.g., elbow flexors) were compared to experimental data to assess the accuracy of the model. These comparisons showed that moment arms and joint moments estimated using the model captured important features of upper extremity geometry and mechanics. The model also revealed coupling between joints, such as increased passive finger flexion moment with wrist extension. The computer model is available to researchers at .     

Reliability and Validity of the Upper Limb Physician's Rating Scale in Children with Cerebral Palsy

Purpose

The Upper Limb Physician''s Rating Scale (ULPRS) is a tool that assesses movement quality of the upper limbs. It is used as an outcome measure after botulinum toxin type A injection in children with cerebral palsy (CP). This study aimed to investigate the reliability and validity of the ULPRS in children with spastic CP.

Materials and Methods

Thirty children with spastic CP (M:F=17:13) aged 5 to 13 years old were recruited. The ULPRS was scored based on recorded videotapes by four physicians on two separate occasions. The Melbourne Assessment of Unilateral Upper Limb Function (MUUL) was scored by an occupational therapist. Intraclass correlation coefficients (ICCs), 95% confidence intervals and weighted kappa statistics were calculated for the scores of ULPRS to obtain interrater and intrarater reliability. The relationship between ULPRS and MUUL was assessed using Pearson correlation coefficients.

Results

The ICCs for the total ULPRS scores were 0.94 between raters and 0.99 to 1.00 within raters. The weighted kappa statistics for subitem scores for the ULPRS ranged from 0.67 to 1.00 within raters and from 0.46 to 0.86 between raters. The relationship between ULPRS and MUUL was strong (Pearson correlation coefficient=0.751; p<0.05).

Conclusion

The results demonstrated the high reliability of the total ULPRS score within and between raters. A significant concurrent validity between ULPRS and MUUL also supports the clinical utility of the ULPRS as an outcome measure of spastic upper limb in children with CP.     

基于AnyBody仿真的太极拳不同步型特征

目的 对比太极拳初学者和专业者不同步型的下肢运动学、动力学、肌肉力参数差异,为太极拳科学化及制定运动处方提供依据.方法 以练习时长超过3年的30名太极拳练习者为专业组,30名无太极拳经历初学者作为对照组.用BTS红外捕捉系统、Kistler三维测力台采集太极拳动作数据,以AnyBody 7.0建模仿真系统计算运动学、动...     

Effects of endurance training on hyperammonaemia during a 45-min constant exercise intensity

Summary Eleven laboratory-pretrained subjects (initial =54 ml·kg⁻¹·min⁻¹) took part in a study to evaluate the effect of a short endurance training programme [8–12 sessions, 1 h per session, with an intensity varying from 60% to 90% maximal oxygen consumption ] on the responses of blood ammonia (b[NH ₄ ⁺ ]) and lactate (b[la]) concentrations during progressive and constant exercise intensities. After training, during which did not increase, significant decreases in b[NH ₄ ⁺ ], b[la] and muscle proton concentration were observed at the end of the 80% constant exercise intensity, although b[NH ₄ ⁺ ] and b[la] during progressive exercise were unchanged. On the other hand, no correlations were found between muscle fibre composition and b[NH ₄ ⁺ ] in any of the exercise procedures. This study demonstrated that a constant exercise intensity was necessary to reveal the effect of training on muscle metabolic changes inducing the decrease in b[NH ₄ ⁺ ] and b[la]. At a relative power of exercise of 80% , there was no effect of muscle fibre composition on b[NH ₄ ⁺ ] accumulation.     

Estimation of Musculotendon Properties in the Human Upper Limb

The purpose of this study was to develop and apply a general method for estimating the architectural properties of human muscles in vivo. The method consists of a two-phase, nested optimization procedure in which the values of peak isometric force, optimal muscle-fiber length, and tendon slack length are calculated for each musculotendon actuator, knowing muscle volume and the minimum and maximum physiological lengths of the actuator. In phase I, the positions of the bones and the activation levels of the muscles are found by maximizing the isometric torque developed for each degree of freedom at each joint. In phase II, the architectural properties of each musculotendon actuator are found by matching the strength profile of the model to that measured for subjects. The method is used to estimate the architectural properties of 26 major muscle groups crossing the shoulder, elbow, and wrist. Wherever possible, the model calculations are compared against measurements obtained from anatomical studies reported in the literature. Architectural data obtained from our work should be useful to researchers interested in developing musculoskeletal models of the upper limb. © 2003 Biomedical Engineering Society. PAC2003: 8719Rr, 8710+e, 8719Ff     

搂膝拗步膝踝关节预激活与共收缩的表面肌电分析

目的 分析长期太极拳练习者进行搂膝拗步和正常行走时下肢膝、踝关节肌群预激活与共收缩的表面肌电（surface electromyography, sEMG）特征,探讨太极预防跌倒的神经肌肉控制策略。方法 采用Vicon运动捕捉系统、Kistler测力板和Noraxon表面肌电图系统同步采集搂膝拗步和正常行走时股直肌、股二头肌、胫骨前肌、外侧腓肠肌的sEMG信号和体位信息。通过股直肌和股二头肌、胫骨前肌和外侧腓肠肌两对肌肉的积分肌电分别计算膝、踝关节预激活和共收缩。结果 与正常行走相比,搂膝拗步在4个阶段的平均用时显著增加;搂膝拗步在4个阶段内时间百分比存在显著性差异;搂膝拗步膝关节共收缩水平和预激活水平降低,踝关节共收缩水平和预激活水平升高。结论 长期的太极拳练习可能使膝关节周围肌肉的激活水平提高,增强肌肉群之间的协同作用,以帮助稳定关节。研究结果为神经肌肉控制障碍疾病的康复评估和训练提供参考。