颈椎病患者MRI T2WI髓内有高信号与无高信号的比较研究

目的 探讨颈椎病患者MRI T2WI（T2加权像）髓内高信号产生的原因及共临床意义。方法 颈椎病患者MRI检查中，随机抽取T2WI髓内高信号和无高信号的各50例，对其主诉，症状，体征，MRI的表现进行比较。结果 MRI T2WI颈脊髓内高信号的患者以老年人居多，其主诉，症状和体征多符合脊髓现的诊断。结论 MRI T2WI髓内高信号的产生可能与脊髓前动脉受压有关，此类患者临床症状重，必须引起高度重视。     

颈椎前路单纯椎间融合器与钢板并用恢复颈椎生理曲度

目的探讨单纯应用椎间融合器(CAGE)及CAGE与ORIEN钢板联合应用对椎间高度变化率、颈椎前弯变化率的影响。方法采用CAGE或与ORIEN钢板联合应用治疗颈椎损伤、脊髓型颈椎病、颈椎退变78例,随访6～15个月,观察椎间高度变化率、颈椎前弯变化率、融合率及并发症。结果术后两组的颈椎生理曲线、椎间高度的改变无显著差别,但CAGE与ORIEN钢板联合应用组的融合率明显高于单纯CAGE组。结论CAGE与ORIEN钢板联合应用弥补了单独应用CAGE时稳定上的欠缺,组合后对椎间高度变化、颈椎前弯变化及植骨融合率均较单独应用有明显优势。     

脊髓型颈椎病髓内MRI对称性T2延长病变的研究

目的　探讨脊髓型颈椎病 MRI颈髓内 2个对称性 T2 高信号影像特点。方法　临床明确诊断为脊髓型颈椎病者 17例 ,对其颈髓内两个眼样 T2 高信号 snake eye sign MRI表现进行回顾性分析。结果　位置以椎体 4 /5、5 /6各5例为最多 ,颈髓腹侧者 6例中 4例有肌力下降 ,无法判定者 5例 ,腹背均涉及者 4例。发病 6个月以内 5例。 13例以上肢症状为主诉 ,snake eye sign位置与临床神经病理检查反映的病变节段一致。结论　MRI对显示脊髓型颈椎病髓内snake eye sign有价值。     

Influence of prior knowledge on automatic and voluntary postural adjustments in healthy and hemiplegic subjects

The purpose of this study was to analyze the effects of prior instruction on automatic postural responses and voluntary postural sways measured about the ankle joint. Ten subjects with right hemiplegia resulting from a cerebrovascular accident (mean age = 56 +/- 14 years) and 5 healthy subjects (mean age = 47 +/- 6 years) stood symmetrically on a movable force platform. During platform-induced sway, the support surface was translated horizontally to induce antero-posterior body sway about the ankle joints. Surface electromyographs were obtained from the tibialis anterior, quadriceps femoris, gastrocnemius, and hamstring muscles bilaterally. Prior knowledge appeared to have no significant influence on healthy subjects' ability to execute postural adjustments more rapidly during AP displacements. Hemiplegic subjects exhibited longer and more variable latencies in the paretic limb than in the nonparetic limb during voluntary AP weight shifts. When hemiplegic subjects had prior knowledge of the platform's movement (time and direction), latencies were significantly shorter in the paretic limb and could be as brief as those seen in the nonparetic limb. The results showed that prior knowledge may be an important treatment consideration for patients with muscle timing disorders.     

Electromyography Study of Forward-stepping Motion

[Purpose] The purpose of this study was to investigate and evaluate the timing and amount of muscle activity during forward-stepping motion. [Subjects and Methods] Seven healthy subjects participated in this study. The task was to step forward from a static standing position. Timing and amount of muscle activity were measured during the task. Muscle activities of the stance leg and the swing leg were measured using surface electromyography (EMG). [Results] A high negative correlation was found between the rate of change in the amount of tibialis anterior muscle activity of the stance leg and the reaction time. High positive correlations were found between the rates of change in the gastrocnemius and soleus muscles and the reaction time of the swing leg. [Discussion] Forward-stepping motion can be accomplished using two strategies. One is to swing the leg out taking a step forward using the gastrocnemius and soleus muscles of the swing leg. The other is to take a step forward using the tibialis anterior muscle of the stance leg. Increasing the activity of the tibialis anterior muscle of the stance leg may lead to taking a step forward rapidly.Key words: Forward-stepping motion, Tibialis anterior muscle, Electromyography     

脊髓压迫症患者早期静态平衡功能的定量测评及分析

目的了解脊髓压迫症(Compressivemyelopathy)患者早期的平衡功能,验证平衡功能定量检测指标的敏感性。方法采用日本产人体摆动平衡测试仪定量测试34例早期脊髓压迫症患者和30例正常人患者的静态平衡功能,并对所获定量检测指标进行分析比较。结果脊髓压迫症患者总轨迹长(LNG)、包络面积(Envarea)等平衡功能检测参数与正常人相比有显著性差异,早期脊髓压迫症患者平衡能力明显降低。结论人体动摇平衡测试仪作为一种定量分析平衡功能障碍的检测手段,可以为临床了解脊髓压迫症患者病情的轻重程度,以及判定治疗效果提供帮助。     

骨质疏松症合并颈椎病的颈椎椎体形态改变:病例-对照

背景:有学者发现,老年骨质疏松患者的颈椎椎体骨小梁减少、变细、甚至穿孔,那么这种改变是否会导致颈椎椎体变形,又与颈椎病发病有哪些关系呢?目的:通过测量、比较骨质疏松症合并颈椎病后的颈椎形态学改变来探讨二者的关系.方法:以40例腰椎骨密度正常、无颈椎病的体检者为对照组,平均32.5岁;30例确诊的颈椎病为颈椎病组,平均43 6岁;46例颈椎病合并骨质疏松症组为合并骨质疏松症组,平均58.6岁.116例受试者拍摄X射线片.测量椎体高度、椎体矢状径和椎体高度/矢状径比、椎管/椎体矢状径比.结果与结论:与对照组比较,骨质疏松合并颈椎病组的椎体高度下降、矢状径变长(P＜0.05),椎管/椎体矢状径比变小(P＜0.05),椎体变形以椎体高度下降与矢状径延长而变得扁平为主要特点.提示骨质疏松导致颈椎椎体变形,骨质疏松与颈椎病存在相关性,并可能是颈椎病进展的因素.     

The potential influence of stochastic resonance vibrations on neuromuscular strategies and center of pressure sway during single-leg stance

BackgroundStochastic resonance vibrations are known to enhance balance in the elderly and patients with impaired plantar sensation. However, the underlying mechanisms of plantar vibrations on balance capacity are not well resolved. This study investigated the impact of stochastic resonance vibrations on activities of major extrinsic foot muscles and center of pressure sway in tactile inhibited subjects.MethodsUsing a customized vibration insole, single-leg stance tests were performed in fourteen healthy subjects at control, ice-intervention-only (inhibited foot sensation) and ice-intervention plus vibration conditions. The sway parameters and the root mean square of electromyography of medial gastrocnemius, tibialis anterior, peroneus longus, and extensor digitorum longus were examined.FindingsThe sway area in the ice-intervention-only condition was significantly increased compared with the control (P < .001). Following vibrations, the sway area, however, was significantly decreased. Regression analysis showed the activity levels of all extrinsic foot muscles were positively correlated with sway area when foot sensation was inhibited. In contrast, following vibrations, only that of the tibialis anterior muscle was positively correlated with sway area, indicative of a muscle control strategy similar to the control condition.InterpretationThe study showed that stochastic resonance vibrations could effectively reduce body sway in the healthy subjects with inhibited foot sensation. The effects seemed to be associated with improved muscle activities in particular to the tibialis anterior muscle. It suggested that vibration insole may be used as a means to affect neuromuscular strategies to enhance balance control in people with diminished plantar sensations.     

The effect of walking aids on balance and weight-bearing patterns of patients with hemiparesis in various stance positions

BACKGROUND AND PURPOSE: Standard and quad canes are often prescribed to patients with hemiparesis, yet their effect on postural control remains unclear. Thus, the objective of this study was to examine the effects of standard and quad canes on postural sway and on weight-bearing patterns in patients with hemiparesis. SUBJECTS: Thirty subjects with a diagnosis of unilateral hemiparesis following a stroke (patient group; mean age=71.2 years, SD=7.0) and 20 age-matched, community-dwelling volunteers without hemiparesis (comparison group; mean age=72.1 years, SD=5.2) participated in the study. METHODS: Postural sway and percentage of body weight (%BW) borne by each extremity were measured in 3 positions: with the heels aligned with each other (aligned position) and in staggered foot positions with either the affected or unaffected extremity placed forward (affected FW and unaffected FW positions). All subjects were tested in each position with no cane, a standard cane, and a quad cane. The order of tests was randomized, and analysis of data included use of an analysis of variance and adjusted Tukey-Kramer tests. RESULTS: In both the aligned and unaffected FW positions, postural sway was reduced only with the quad cane. Both types of canes reduced postural sway in the affected FW position; however, the quad cane had a greater effect. An asymmetrical weight distribution between the lower extremities did not change in the patient group across positions, even with walking aids. DISCUSSION AND CONCLUSION: A quad cane appears to be more effective than a standard cane in decreasing postural sway in patients with moderate impairment secondary to hemiparesis during stance. The greatest effect on postural sway occurred when the assistive device was contralateral to the foot placed forward. The use of a cane does not appear to adversely affect the asymmetrical weight-bearing pattern during stance that is characteristic of patients with hemiparesis, even when balance is challenged by decreasing the base of support.     

Anterior ankle-foot orthosis effects on postural stability in hemiplegic patients

OBJECTIVES: To evaluate the effects of an anterior ankle-foot orthosis (AFO) on static and dynamic postural stability in hemiplegic patients. DESIGN: A cross-sectional assessment of hemiplegic subjects with and without an AFO. SETTING: Outpatient department of a rehabilitation hospital. PATIENTS: A convenience sample of 24 subjects who had been prescribed an anterior AFO. OUTCOME MEASURES: Postural sway index and postural symmetry (body weight distribution through the affected leg) when standing were measured as static postural stability. Maximal balance range in anterior-posterior and lateral directions and the affected leg's weight bearing after weight shift to affected side were measured as dynamic postural stability. RESULTS: When wearing the anterior AFO, there was no significant difference and small effect size (r<0.3) in postural sway index (p = .35), postural symmetry (p = .21), and maximal balance range in anterior-posterior direction (p = .46). There was a significant improvement and large effect size (r>0.5) in lateral weight shifting (p<.01) and weight bearing through the affected leg after weight shifted to the affected side (p<.01). CONCLUSIONS: The significant effects of the anterior AFO in long-term hemiplegic patients were on lateral weight shifting and weight bearing through affected leg after weight shifted to the affected side. Postural sway, postural symmetry, and anterior-posterior weight shifting were not significantly affected.     

前路"杂交式"减压治疗多节段颈椎病:可有效改善颈椎生理弯曲度及椎间高度

背景:单节段或双节段颈椎病患者通常采用颈椎前路减压内固定,但对于多节段颈椎病手术方式的选择一直存在争议.目的:探讨前路"杂交式"减压即单椎体次全切联合椎间盘切除治疗多节段颈椎病的方法及临床效果.方法:回顾性分析30例多节段颈椎病患者资料,均选择前路"杂交式"减压、自体髂骨植骨及ZEPHIR钢板内固定.观察治疗后患者神经功能评分、植骨融合率、颈椎生理曲度和椎间高度变化及并发症情况.结果与结论:随访12~72个月,平均36个月.颈椎生理曲度及椎间高度较治疗前明显改善,受压节段脊髓膨隆良好.钢板及螺钉无松动、断裂或移位.治疗后6个月植骨均融合,12个月JOA评分明显提高,改善率优10例,良16例,可4例,优良率86.7%.说明采用前路"杂交式"减压治疗多节段颈椎病,减压直接彻底并能尽量保留颈椎结构,增加植骨融合率,有效改善颈椎生理曲度和椎间高度.     

Effect of Muscle Vibration on Postural Balance of Parkinson’s Diseases Patients in Bipedal Quiet Standing

[Purpose] The purpose of this study was to investigate the effect of muscle vibration applied to the lower extremities on static postural balance of patients with Parkinson’s disease (PD). [Subjects] Seven subjects with Parkinson’s disease participated in this study. [Methods] The oscillators of vibration were attached to the muscle bellies of the tibialis anterior, gastrocnemius, biceps femoris, and rectus femoris on both sides of the lower extremities with adhesive tape. A vibration frequency of 60 Hz was used to induce static postural reactions. Subjects’ center of pressure (COP) sway and peak ground reaction force (GRF) were measured with their eyes open with and without vibration. COP sway and peak GRF (Fx, Fy, Fz) were measured using a force plate (AMTI, Newton, USA), which provides x, y and z coordinates of body movement. [Results] The area of COP sway with vibration was significantly smaller than that with no vibration, but the length of COP sway showed no difference between two conditions. Peak medial-lateral maximum force (Fy) with vibration was significantly higher than that with no vibration, but peak anterior-posterior force (Fx) and peak vertical force (Fz) showed no differences. [Conclusion] These results suggest that vibration applied to the lower extremities can help PD patients control postural balance during quiet standing.Key words: Vibration, Postural balance, Parkinson’s disease     

Postural sway characteristics in women with lower extremity arthritis before and after an aquatic exercise intervention

OBJECTIVE: To examine the reliability of postural sway assessment in women with lower extremity arthritis and to ascertain the effects of an aquatic exercise intervention program on these measures. DESIGN: The reliability of postural sway measures was analyzed by within-subjects (Subject times Trial) analysis of variance (ANOVA). The effects of aquatic exercise were analyzed by repeated measures ANOVA using a planned comparison approach with an independent 2 x 2 (Group times Test) design. SETTING: Testing in a motor control research laboratory; aquatic exercise in a warm water pool at an area YMCA. PARTICIPANTS: Volunteer sample, 24 women with lower extremity arthritis (rheumatoid [RA] n = 11, osteo [OA] n = 13) randomly assigned into an aquatic exercise group (n = 14) or control group (n = 10). INTERVENTION: Postural sway measures under a two-legged stance test on two separate test days: day 1, pretest; day 2, posttest, administered after a 6-week aquatic exercise program. RESULTS: Reliability correlation coefficients for postural sway measures ranged from .64 to .94 for both subject groups. Aquatic exercise subjects significantly reduced lateral sway and total sway area scores (by 18% to 30%) under both visual conditions after the 6-week intervention. Postural sway scores were significantly higher under the no-vision condition than under the vision condition in each group for both test sessions. Both OA and RA groups had normal sagittal/lateral ratio scores. CONCLUSION: Women with lower extremity arthritis can be reliably assessed on postural sway measures on a stable two-legged stance test. Although they had normal sagittal/lateral sway ratio scores (ie, scores typical for nonarthritic peers), vision played an important role in their postural stability for this balance task. Aquatic exercise reduced postural sway in women with lower extremity arthritis, as demonstrated by a two-legged stance test, and this exercise program appears to be a viable treatment for increasing postural stability in this population.     

Standing balance in persistent whiplash: a comparison between subjects with and without dizziness.

OBJECTIVE: Dizziness and unsteadiness, associated with altered balance, are frequent complaints in subjects suffering persistent whiplash associated disorders. Research has been inconclusive with respect to possible aetiology. This study assessed balance responses in subjects with whiplash associated disorders, taking into account several possible causes. DESIGN: A prospective, 3 group, observational design.Subjects: 100 subjects with persistent whiplash associated disorders, 50 complaining of dizziness, 50 not complaining of dizziness and 50 healthy controls. METHODS: The Clinical Test for Sensory Interaction in Balance was performed in both comfortable and tandem stance. The sway trace was analysed using wavelet analysis. CONCLUSION: The results indicated that the energy of the sway signal for comfortable stance tests was significantly greater in the group with dizziness compared with the group without dizziness. In the group without dizziness the energy was greater than controls for all tests, but significantly different on selected tests. In selected tandem stance tests, subjects with dizziness were significantly less able to complete the test than subjects without dizziness and controls. These deficits could not be attributed to medications, compensation, anxiety or age and are likely to be due to disturbances to the postural control system possibly originating from abnormal cervical afferent input.     

Contribution of vision and tactile sensation on body sway during quiet stance

[Purpose] This study examines the contribution of vision and tactile sensation on body sway during quiet stance. [Participants and Methods] Sixteen healthy participants maintained quiet stance. The mean distance between the neutral center of pressure (COP) and that at the peak deviated position, indicating how quickly humans initiate the swaying of the body back to the neutral position, was calculated (COPpeak). [Results] The displacement of the COP in both the anterior–posterior and medial–lateral axes was greater when vision was occluded. The anterior or posterior COPpeak was also greater when vision was occluded. The leftward COPpeak was greater when the tactile sensation of the sole was masked. Visual occlusion decreased the tactile perception threshold of the sole. There was no significant interaction between the effect of vision and that of tactile sensation on body sway during quiet stance. [Conclusion] Vision plays a role in returning the body to the neutral position, particularly in the anterior–posterior axis. Tactile sensation contributes particularly to recovery from the leftward body sway during quiet stance. Tactile sensitivity is enhanced by visual occlusion through inter-modal reweighting. However, inter-modal reweighting between vision and tactile sensation is not specifically for postural control during quiet stance.     

前路槽式减压植骨钢板内固定治疗脊髓型颈椎病

目的：探讨前路槽式减压植骨钢板内固定手术在治疗脊髓型颈椎病中的应用价值。方法：对19例脊髓型颈椎病行前路槽式减压自体髂骨移植加钢板内固定术，其中单节段2例、2节段15例、3节段2例。并对术后临床症状及X线表现进行分析。结果：19例平均随访8．9个月,18 四肢麻木于术后3d-22周消失，17例行走困难于后2－24周消失或明显好转，11 例深反射亢进于术后3－16周基本恢复正常，椎间隙于术后8－12周骨性融合，1例钢板螺钉动，无神经症状加重，颈椎反曲畸形及钢板螺钉断裂等并发症发生。结论：前路槽式减压植骨钢板内固定治疗脊髓型颈椎病疗效肯定，但远期并发症有待进一步观察。     

颈椎病伴颈源性眩晕的临床分析

目的探讨伴颈源性眩晕的颈椎病发病机制和颈前路手术疗效。方法对2008年3月-2012年11月收治的293例颈椎病患者中83例伴有颈源性眩晕者进行手术治疗,其中神经根型颈椎病23例,脊髓型颈椎病60例。病变涉及单节段29例,2个节段50例,3个节段4例。对全部病变节段均行前路减压固定融合术。观察比较术前、术后3 d、及末次随访时眩晕缓解情况,采用颈性眩晕症状与功能评估量表30分法评定眩晕及主观满意情况,日本骨科学会评估治疗分数法评定神经脊髓功能改善情况。结果随访12～30个月,平均21个月。两种评分在术后3 d、末次随访与术前比较差异有统计学意义（P〈0.05）,末次随访与术后3 d比较差异无统计学意义（P〉0.05）。结论颈源性眩晕手术效果往往伴随脊髓和神经根症状改善而缓解,颈椎病伴颈源性眩晕采取手术治疗是一种有效的方法。     

Electromyographic analysis of postural adjustments in two methods of balance testing

The primary purpose of this study was to compare postural responses during two methods of balance testing: 1) a platform perturbation test (PP), with destabilizing forces of uniform magnitude given at the base of support, and 2) a postural stress test (PST), with destabilizing forces of increasing magnitude given at the waist. A secondary purpose was to examine the relationship between balance strategy scores and the patterns of muscle responses as determined by electromyographic analysis on the PST. Postural responses to backward sway of 17 healthy subjects, aged 60 to 79 years (means = 69.0, s = 5.3), were characterized bilaterally by EMG recording of the tibialis anterior, quadriceps femoris, gastrocnemius, and hamstring muscles. We examined three measures of bilateral postural responses: 1) latency to first muscle response (FR) among the four lower extremity muscle groups, 2) tibialis anterior muscle latency (TA), and 3) patterns of muscle responses. Our results demonstrated significantly shorter (p less than .001) TAs and FRs (in milliseconds) on the PST than on the PP (PST TA: = means = 80.3, s = 12.4; PP TA: = means = 142.6, s = 13.4; PST FR: means = 75.9, s = 10.4; PP FR: = means = 140.4, s = 13.6). The ankle strategy was the most frequently used pattern of muscle response during both the PP and the PST, but it occurred less frequently on the PST than on the PP (PP = 72.5%, PST = 50.9%) (p less than .05). No consistent relationship was observed between the balance strategy scores as determined by videotape analysis of the PST and the patterns of muscle responses as determined by EMG analysis.     

Bilateral compensatory postural adjustments to a unilateral perturbation in subjects with chronic ankle instability

BackgroundTo evaluate the magnitude of bilateral compensatory postural adjustments in response to a unilateral sudden inversion perturbation in subjects with chronic ankle instability.Methods24 athletes with chronic ankle instability (14 with functional ankle instability, 10 with mechanical ankle instability) and twenty controls participated in this study. The bilateral electromyography of ankle muscles was collected during a unilateral sudden ankle inversion to assess the magnitude of subcortical and voluntary compensatory postural adjustments in both the perturbed and the contralateral limb (support limb).FindingsIn the support position, compared to the control group, the group with functional ankle instability presented decreased compensatory postural adjustments of the tibialis anterior in both the injured and the uninjured limbs in the support position and of the soleus in the uninjured limb. In the side of the perturbation, participants with functional ankle instability presented decreased soleus compensatory postural adjustments in the uninjured limb when compared to the control group. Increased values of soleus and peroneal brevis compensatory postural adjustments were observed in the group with mechanical instability when compared to the control group and to the group with functional ankle instability.InterpretationSubjects with functional ankle instability present bilateral impairment of compensatory postural adjustments of the tibialis anterior in a support position and of the soleus of the uninjured limb regardless of the position. Subjects with mechanical instability present bilateral increase of these adjustments in the peroneal brevis regardless of the position and in the soleus muscle in the side of the perturbation.