等动屈伸运动诱发下肢膝关节肌肉疲劳过程中表面肌电信号的特征分析

目的：了解健康成年人下肢膝关节等动屈伸运动至疲劳过程中下肢股内侧肌表面肌电信号（sEMG）的特征,为sEMG在动力性运动中的广泛应用提供依据。方法：选择在校男性大学生10人,使用艾力尔（Ariel）等动训练仪在60°s-1运动速度下诱发下肢股内外侧肌疲劳,同时使用ME6000表面肌电仪记录2块肌肉的sEMG,对其时域指标均方根振幅（RMS）和积分肌电（iEMG）以及频域指标中位频率（MF）和平均功率频率(MPF)进行分析。结果：在膝关节等速屈伸运动至疲劳过程中股内侧肌的时域指标RMS和iEMG显著上升（P<0.05）,疲劳对iEMG影响的效应尺度大于RMS;频域指标MF和MPF显著下降（P<0.05）,疲劳对MPF影响的效应尺度大于MF;肌肉疲劳过程中iEMG增加率显著高于RMS(P<0.05),MPF下降率显著大于MF(P<0.05)。结论：时域指标iEMG以及频域指标MPF可以作为评价动力性肌肉疲劳的敏感指标。     

脉冲治疗联合SET对神经根型颈椎病患者颈椎生物力学及颈部肌疲劳度的影响

目的 探讨脉冲治疗联合悬吊训练技术(sling exercise therapy, SET)治疗神经根型颈椎病的效果及其对颈椎生物力学及颈部肌疲劳度的影响。方法 选择神经根型颈椎病患者162例,按随机数字表法将患者分为对照组和观察组,每组81例。对照组采用SET治疗4周,观察组采用脉冲治疗联合SET治疗4周。比较2组治疗前后颈椎功能、疼痛程度、颈椎生物力学、颈部肌疲劳度和并发症发生情况。结果 治疗后,2组日本骨科协会颈髓功能(Japanese orthopedic association, JOA)评分、颈椎前屈角度、后伸角度、左侧屈角度、右侧屈角度、左侧旋角度、右侧旋角度、颈部后伸肌群肌电积分值(integrated electromyography, IEMG)、平均功率频率(mean power frequency, MPF)、中位频率(median frequency, MF)均高于治疗前(P<0.05),颈椎功能残障指数(neck disability index, NDI)、视觉模拟评分法(visual analogue scale, VAS)评分较低于治疗前(P&l...     

人尺侧腕屈肌亚部化研究

目的 拟用Sihler‘s肌内神经染色法证实人尺侧腕屈肌的肌亚部分。方法 用改良Sihler’s染色法对10侧人尺侧腕屈肌进行肌内神经染色，以观察肌内神经分支分布。结果 尺神经干发出2支神经分别进入尺侧腕屈肌尺侧半和桡侧半，尺侧半神经和桡侧半神经在各自半侧肌内发出数级神经分支，各级神经分支间有丰富的吻合。结论 尺侧腕屈肌可分为尺侧亚部和桡侧亚部，两亚部各有一独立神经支配。     

人尺侧腕屈肌肌亚部肌梭分布研究

目的：查滞尺侧腕屈肌尺侧亚部和桡侧亚部的肌梭分布情况，进一步揭示该肌的形态学特征。方法：取10侧人尺侧腕屈肌尺侧亚部和桡侧亚部的各部位肌组织做石蜡切片。经HE染色后采用体视学方法检测肌内肌梭的分布。结果：尺侧腕屈肌肌梭密度尺侧亚部大于桡侧亚部。结论：尺侧腕屈肌尺侧亚部的肌梭密度高于桡侧亚部，推测尺侧亚部对牵张的敏感度应高于桡侧亚部。     

健康男性伏案4小时表面肌电的变化观察研究

目的:研究观察长时间伏案工作下颈肩腰腿部位表面肌电改变,了解长时间静力负荷诱发疲劳过程中sEMG信号的变化规律,根据规律针对性地提出预防慢性疲劳形成的相关措施。方法:通过观察健康青年男性40名4h伏案工作中的两侧胸锁乳突肌、三角肌、斜方肌、背阔肌、冈上肌、竖脊肌、股四头肌和股二头肌持续收缩过程中的sEMG信号进行分析。结果:所测16块肌肉的中位频率(MF)、平均功率频率(MPF)和均方根值(RMS)在静坐3h内会达到变化的极限,终止值高于初始值。其中,右股二头肌的MF、左胸锁乳突肌RMS、左背阔肌RMS的回归系数具有显著性差异(P<0.05),右股二头肌的MPF具有极其显著性差异(P<0.01)。结论:提示长时间伏案工作会导致颈肩腰腿部位肌肉不适、酸痛,右利手实验对象左胸锁乳突肌、左背阔肌、右股二头肌疲劳程度与伏案时间呈正相关,是由于长时间维持身体平衡所造成的。     

运动所致血浆K+和血pH值的变化对肌肉疲劳和表面肌电图的影响

目的探讨血K+、H+与肌肉疲劳和肌电变化的关系.方法对同一批受试者在200 W和120 W蹬功率车之前和运动至疲劳后即刻、5 min、10 min、20 min时,测定血浆K+、血pH值以及活动肌和非活动肌定量负荷等长收缩10 s的肌电图(EMG).结果两次运动后血浆K+和活动肌平均功率频率(AM-MPF)均明显改变(P<0.01),二者高度负相关,并在20 min时基本恢复.200 W运动后20 min内血pH值一直明显低于安静值(P<0.01),但在120 W运动后无变化,并与肌电无相关关系.120 W运动后20 min内的非活动肌积分肌电图值(IM-IEMG)明显低于安静值(P<0.05).结论细胞外高K+是肌肉疲劳和AM-MPF下降的主要因素之一,并可能也是IM-IEMG下降的原因之一.H+不是疲劳形成的主因,并对肌电无直接影响.     

运动所致血浆K+和血pH值的变化对肌肉疲劳和表面肌电图的影响

目的探讨血K^ 、H^ 与肌肉疲劳和肌电变化的关系。方法对同一批受试者在200W和120w蹬功率车之前和运动至疲劳后即刻、5min、10min、20min时,测定血浆K^ 、血pH值以及活动肌和非活动肌定量负荷等长收缩10s的肌电图(EMG)。结果两次运动后血浆K^ 和活动肌平均功率频率(AM—MPF)均明显改变(P＜0．01),二者高度负相关,并在20min时基本恢复。200W运动后20min内血pH值一直明显低于安静值(P＜0.01),但在120w运动后无变化,并与肌电无相关关系。120W运动后20min内的非活动肌积分肌电图值(IM—IEMG)明显低于安静值(P＜0．05)。结论细胞外高K^ 是肌肉疲劳和AM—MPF下降的主要因素之一,并可能也是IM—IEMG下降的原因之一。H^ 不是疲劳形成的主因,并对肌电无直接影响。     

桡骨远端骨折畸形愈合合并远尺桡关节脱位的治疗

目的：探讨桡骨远端截骨矫形、尺侧腕屈肌腱移位、腕背侧关节囊及伸肌支持带紧缩重建远尺桡关节治疗桡骨远端骨折畸形愈合合并远尺桡关节脱位的临床疗效。方法：21例桡骨远端骨折畸形愈合合并远尺桡关节脱位。骨折类型按AO桡骨远端骨折分类皆为A型,未合并远尺桡关节炎。行桡骨远端截骨后,在＂C＂形臂下,桡骨高、掌倾角、尺偏角、远尺桡关节面对位恢复正常解剖位置,重建钢板固定,自体髂骨植骨。尺侧腕屈肌腱移位,腕背侧关节囊及伸肌支持带紧缩重建远尺桡关节。部分患者行旋前方肌松解。前臂旋后位克氏针固定。结果：21例患者均获随访,时间15～24个月,平均19.3个月。术前前臂旋转活动度为（41.6±8.9）°,术后为（138.1±14.3）°; 腕关节背伸术前为（9.2±4.2）°,术后为（33.2±11.8）°; 腕关节尺偏活动度术前为（10.5±6.3）°,术后为（31.3±4.4）°。Mayo评分结果：优10例,良7例,可4例。结论：应用桡骨远端截骨矫形术治疗尺侧腕屈肌腱移位,腕背侧关节囊及伸肌支持带紧缩重建远尺桡关节治疗桡骨远端骨折畸形愈合合并远尺桡关节脱位,手术效果良好,安全可靠。前臂旋转功能及腕关节各项运动功能得到有效恢复。     

基于肌音信号的握力运动时桡侧腕屈肌动态疲劳分析

采集了10名受试者在做手部握力动作时桡侧腕屈肌的肌音信号,通过对信号进行滤波、动作分割和特征提取来分析肌肉动态疲劳程度与肌音信号特征值的关系。在信号滤波中,采用了小波包（WP）分解重构和经验模态分解（EMD）两种方法。在动作信号的分割中,提出了基于移动窗内信号方差阈值的自适应不等长分割算法。在特征提取时,提出了利用包含多个动作信号的移动窗对分割好的信号进行再重构,并选用平均功率频率（MPF）和中值频率（MDF）作为窗内信号提取的特征,再分别利用指数函数、二次函数和线性函数对特征值进行拟合。结果表明：去噪方法选用小波包分解重构、特征值选用MPF值、拟合方式选用指数函数进行逼近的分析方法,可以更好地反映肌肉疲劳的变化趋势。     

Extraarticular pigmented villonodular synovitis of the distal forearm: a case report

Extraarticular pigmented villonodular synovitis (PVNS) is very rare in the distal forearm. There has only been one previous case report of this disease in the extensor tendons of a child. We report a case of PVNS of the distal forearm that presented as two nodules over the radial aspect and a separate nodule on the ulnar aspect beneath the flexor carpi ulnaris tendon. Surgical exploration revealed an extensive extraarticular PVNS over the first and second dorsal compartment extensor tendons. On the anterior aspect it extended in the deep plane between the flexor tendons and the pronator quadratus and encased the radial artery completely. Complete excision of the tumour with the radial artery was done.     

乙型肝炎肝硬化患者疲劳与负性情绪的关系研究

[目的] 探讨负性情绪对乙型肝炎肝硬化患者疲劳状况的影响。[方法] 将纳入的乙型肝炎肝硬化患者分为有负性情绪组和无负性情绪组,采用疲劳自评量表（FSAS）对两组患者的疲劳状况进行量化评定,并运用统计软件对该量表中的躯体疲劳、精神疲劳、总体疲劳、疲劳后果、疲劳的情境性、睡眠/休息不能缓解疲劳6个因子分值进行组间的比较及分析。[结果] 除疲劳的情境性、睡眠/休息不能缓解疲劳2个因子以外,有负性情绪组患者的躯体疲劳、精神疲劳、疲劳后果、总体疲劳的得分均高于无负性情绪组患者,且差异有统计学意义（P<0.05）.[结论] 乙型肝炎肝硬化患者的负性情绪对患者的疲劳状况有一定的影响。     

Prevalence of palmaris longus absence – a study in the Yoruba population

Background

Palmaris longus (PL) has received a growing interest for its role in constructive surgery. Since the agenesis of PL shows a strong racial variation, it is conceivable that its prevalence on the Yoruba ethnic population in Nigeria will further confirm this phenomenon.

Methods

A total of 600 subjects comprising 335 males and 265 females aged 8-60years were used to assess the prevalence of agenesis of the PL in Yoruba tribe.

Results

The overall prevalence of absence both unilaterally and bilaterally in the two sexes was 6.7%. In males, unilateral absence was 5.4%. The distribution on the right and left were 2.4% and 3.0% respectively. The bilateral absence was 1.5%. In females, unilateral absence was 6.0%. The distribution on the right and left were 2.6% and 3.4% respectively. Bilaterally, it was 0.4%. In one subject unilaterally, PL was observed to have differentiated from flexor carpi radialis.

Conclusion

Results of this finding suggested that the prevalence of PL agenesis as reported in standard anatomy texts is significantly different from our observation in this Yoruba population. The differentiation of PL tendon from flexor carpi radialis is indicative that both muscles may develop from the same muscle group as previously suggested.     

应用扩展的桡侧腕屈肌入路治疗复杂的桡骨远端关节内骨折

目的：探讨应用扩展的桡侧腕屈肌入路治疗复杂的桡骨远端关节内骨折的手术方法和效果。方法： 回顾性分析自2012年10月至2015年3月北京积水潭医院应用扩展的桡侧腕屈肌入路治疗的38例新鲜桡骨远端关节内骨折患者,其中男性25例,女性13例,平均年龄（52.76±8.62）岁（32~64岁）。患者受伤至手术时间平均（5.42±1.91） d（3~10 d）,左侧17例,右侧21例。根据X线片、CT影像进行分型,所有患者均为国际内固定研究学会（Association for the Study of Internal Fixation,AO/ASIF）C3型桡骨远端骨折。分别在术后1、2、3、6、12个月对患者进行随访,随访内容包括正、侧位X线片,腕关节背伸、掌屈、桡偏、尺偏活动度,前臂旋转活动度,握力,并且在术后6、12个月随访时采用改良的Garland Werley评分法和PRWE（patient rated wrist evaluation）评分法评定疗效。结果： 所有患者骨折愈合良好,随访时间均超过12个月,术后平均随访时间（16.37±2.85）个月（12~22个月）。术后6个月改良的Garland-Werley评分5.37±2.82,优良率84.21%,术后12个月改良的Garland-Werley评分 5.03±2.60,优良率86.84%。术后6个月PRWE评分15.82±8.38,术后12个月PRWE评分12.17±7.58。结论： 应用扩展的桡侧腕屈肌入路能够有效地治疗复杂的桡骨远端关节内骨折,并且可以避免掌背侧联合入路的缺点。     

基于颈部软组织张力探讨悬吊循经弹拨结合麦肯基疗法对颈型颈椎病的疗效及机制

目的比较悬吊循经弹拨结合麦肯基疗法与两者分别单一治疗颈型颈椎病的临床疗效差异并探讨其疗效机制。方法将88例符合标准的患者按照随机数字表法分为综合组(29例)、对照1组(30例)、对照2组(29例)。对照1组采用悬吊循经弹拨法,对照2组采用麦肯基疗法,综合组将对照组的治疗方法相结合,5 d为1疗程,共观察2个疗程。应用颈椎病临床评价量表(clinical assessment scale for cervical spondylosis,CASCS)、利用表面肌电图比较2个疗程治疗前后颈椎功能情况以及胸锁乳突肌、斜方肌上部纤维平均功率频率(mean power frequency,MPF)和中位频率(median frequency,MF)数值变化(对应肌肉的疲劳度改变)。结果治疗结束后,综合组总有效率96.55%,优于对照1组总有效率80.00%和对照2组75.86%(P<0.05或P<0.01),且综合组颈椎功能情况及胸锁乳突肌、斜方肌上部纤维MPF、MF值的治疗效果均优于对照1组和对照2组,组间差异有统计学意义(P<0.05或P<0.01)。结论悬吊循经弹拨法结合麦肯基疗法能有效治疗颈型颈椎病,其效果优于单纯悬吊循经弹拨法和单纯麦肯基疗法,能更好地修复颈部软组织张力,实现生物力学平衡,恢复颈椎运动功能,因此临床上可推广此法治疗颈型颈椎病。     

Muscle maintenance by volitional contraction against applied electrical stimulation

Muscle training exercises are needed for muscular endurance during spaceflight. This study was designed to investigate effects of volitional contraction against applied electrical stimulation on the muscular endurance of the proximal upper extremity. Thirteen healthy sedentary men were allocated into two groups. One group participated in a hybrid (HYB) exercise regimen in which the biceps brachii was stimulated as he volitionally extended his elbow, and the triceps brachii was stimulated as the volitionally flexed his elbow. The second group underwent a similar regimen in which the electrical stimulation (ELS) was alternatively delivered to the biceps brachii and then to the triceps brachii with the limb fixed. Forty-second surface electromyography (EMG) recordings at 50% maximum voluntary contraction (MVC) were made as baseline data at just before starting the training regimen, and again conclusion. The median frequency (MF) and mean power frequency (MPF) slopes with time were determined using power spectrum analysis. There were statistical significance only for the triceps in which the MF and MPF slopes in the HYB Group became less negative over the period of study (from -45.7+/-14.7 and -47.0+/-8.6%/min at baseline to -36.9+/-10.7 and -36.8+/-7.0%/min at the end of training, respectively). The corresponding values for these slopes in the ELS Group showed opposite tends with less marked changes of borderline significance for MF and of statistical significance for MPF. These results suggested that the HYB exercise regimen was capable of producing an improvement in triceps but not biceps brachii.     

前臂缺血性肌挛缩的手术治疗

目的探讨减压松解治疗缺血性肌挛缩的手术时机并评价治疗效果.方法对24例前臂缺血性肌挛缩的患者行减压松解神经、肌肉术,为纠正畸形,其中12例同时行屈肌腱延长术,4例同时行屈肌起点滑移术.结果伤后3d～3个月手术者12例中,优4例,良4例,中1例,差3例;伤后3～12个月手术者12例中,优2例,中5例,差5例.结论伤后1年内做神经、肌肉减压松解治疗缺血性肌挛缩有一定的效果,早期(伤后3个月内)做神经、肌肉减压松解治疗缺血性肌挛缩是必要和有效的.     

咬合板治疗肌筋膜痛效果评估－随机双盲对照实验

Background Occlusal splints have been the preferred modalities in the management of myofascial temporomandibular disorders (TMDs),but now controversy exists in reporting whether they are successful for...     

多模态运动干预对脑卒中患者下肢肢体功能、心理状态和疲劳状态的影响

目的 探讨多模态运动干预对脑卒中患者下肢肢体功能、心理状态和疲劳状态的影响。方法 选择2020年3月—2022年3月苏州大学附属第一医院康复科收治的98例脑卒中患者,按随机数表法分为对照组和研究组,每组49例。对照组采用常规康复治疗,研究组在常规康复治疗的基础上采用多模态运动干预。采用简易精神状态检查量表（MMSE）评估认知功能,采用Fugl-Meyer评定量表（FMA）评估肢体功能,采用日常生活能力评定量表-巴氏指数（BI）评定表评估日常生活能力;采用状态-特质焦虑问卷（STAI）评估心理状态,采用一般自我效能感量表（GSES）评估自我效能;采用足印法进行步态分析;采用多维度疲乏量表（MFI-20）评估两组患者疲劳程度。比较两组认知功能、肢体功能、日常生活能力、心理状态和自我效能、步态参数、疲劳程度。结果 两组干预后MMSE、FMA、BI、GSES评分均比干预前高,步速、步频均比干预前快,步幅较干预前大,S-AI、T-AI、精神疲乏、活动减少、身体疲乏、活动下降、总体疲乏评分均比干预前低（P <0.05）;研究组干预后MMSE、FMA、BI、GSES评分均比对照组高,步速、步频均比对照组快,步幅较对照组大,S-AI、T-AI、精神疲乏、活动减少、身体疲乏、活动下降、总体疲乏评分均比对照组低（P <0.05）。结论 多模态运动干预应用于脑卒中患者的效果明显,不仅可有效缓解不良情绪和疲劳状态,提高自我效能,还可改善患者下肢运动功能,提高行走能力和日常生活能力。     

Ligament reconstruction with tendon interposition arthroplasty for first carpometacarpal joint osteoarthritis

Background Ligament reconstruction tendon interposition （LRTI） is the most commonly performed surgical procedure for first carpometacarpal joint osteoarthdtis.The purpose of this study was to examine the radiographic and clinical outcomes of LRTI arthroplasty and document the clinical results based on metacarpal subsidence.Methods From January 2008 to January 2011,19 patients （21 thumbs） underwent surgery for thumb carpometacarpal arthritis using ligament reconstruction tendon interposition arthroplasty with flexor carpi radialis （FCR） in Kleinert Kutz Hand Care Center of Louisville University,USA.The follow-up period was an average of 13.9 months.Pain,grip strength,tip pinch strength,range of motion,and radiographic measurements were recorded.Based on first metacarpal subsidence,the cases were classified in to mild,moderate,and severe.Clinical outcomes of the groups were evaluated and compared.Results Grip strength improved from 18.6 kg to 20.5 kg,and tip pinch strength increased from 4.4 kg to 4.5 kg after the surgery.Radial abduction and palmar abduction improved after surgery.Radial abduction increased from 55.7° to 60.6° and palmar abduction improved from 56.7° to 63.5° after the procedure.Visual analogue scores （VAS） were significantly reduced,from 6.6 to 0.5.Compared with the preoperative radiographs the first metacarpal had subsided about 54.6％ of the arthroplasty space.The height of arthroplasty space and index of the arthroplasty space significantly decreased from 12.4 mm to 5.6 mm and from 0.27 to 0.12 respectively.Between the various groups （mild,moderate and severe metacarpal subsidence）,there was no difference in grip strength,tip pinch strength,thumb range of motion,and VAS.Conclusions Ligament reconstruction tendon interposition arthroplasty resulted in excellent relief of pain and increase in range of motion.However,LRTI cannot maintain the arthroplasty space.Compared with the preoperative radiographs,the metacarpal subsided more than 50％.The amount of first metacarpal     

尺神经手背支的解剖学研究

在３０侧成人上肢标本上解剖观测了尺神经手背支。该支由尺神经内侧面发出，分支处距豌豆骨上缘６．４±１．３ｃｍ，起点处横径为２．５±０．５ｍｍ，它经尺侧腕屈肌穿过深筋膜转向背侧，在距豌豆骨上缘３．８±１．７ｃｍ处移行为皮支。该神经平均有５个分支，横径在０．５～２ｍｍ间．对该神经的详细观测为临床医生修复创伤，腕部手术以及局部神经阻滞麻醉时定位提供了参考依据。