训练性下腰痛躯干肌功能变化特点及防治干预

为探讨训练性下腰痛患者躯干肌功能变化 ,分别应用CYBEX 6 0 0 0型等速测试训练系统、彩超、肌电图、立位腰椎侧位X线片测试腰痛组(n=4 0 )和正常组 (n =4 0 )的躯干肌力指标、骶棘肌横截面积、腰背肌肌电指标及腰椎曲度。结果显示 ,在腰痛组与正常组 ,除躯干屈肌PT/BW、ER及骶棘肌横截面积差异无统计学意义 (P >0 0 5 )外 ,其他指标相比差异均有统计学意义(P <0 0 5 )。提示由于缺乏有效的腰背肌锻炼 ,训练性下腰痛患者存在明显的躯干肌肌力失衡 ,其主要由腰背肌肌力下降引起 ;同时腰背肌肌爆发力以及腰背肌静态耐力也明显下降 ,腰椎生理曲度变小 ,但不伴随有明显的椎旁肌萎缩 ;耐力比ER(动态耐力)与下腰痛关系并不密切。同时在此基础上设计了预防训练性下腰痛的现场干预实验 ,结果显示训练性下腰痛发生率明显降低 (锻炼组 8 93% ,对照组 17 0 1% ,P <0 0 1)。提示腰背肌锻炼可降低训练性下腰痛的发生率。     

耐力速度复合训练对新兵膝屈伸肌功能影响的等速测试研究

为探讨耐力速度复合训练对新兵膝屈伸肌功能的影响，对20名新兵进行为期4周的耐力速度复合训练，训练前后采用Cybex-6000型等速运动测试仪对新兵的膝屈伸肌肌力、肌爆发力及肌耐力进行等速测试并加以比较。结果发现，新兵训练后左膝屈肌的PT、TAE和ER值在快速测试中有明显的提高（P＜0．05）；左膝伸肌的PT和ER值在快速测试中有明显的提高（P＜0．05）；右膝屈伸肌除屈肌的PT、TAE值在快速测试中有明显的提高外余检测指标无改变。提示为期4周的耐力速度复合训练可使部分膝屈伸肌产生适应，但不能达到全面发展新兵膝屈伸肌肌力、肌爆发力和肌耐力的目的。     

4 h/d站立可防止4周尾部悬吊大鼠比目鱼肌的萎缩

目的依据比目鱼肌湿重、不同型肌纤维横截面积及比例与聚丙烯酰胺凝胶电泳分离肌球蛋白重链(mvosin heavy chain,MHC)异构体比例的变化,评价4h／d站立是否可防止模拟失重下比目鱼肌的萎缩。方法雄性SD大鼠18只,按体重配对原则随机分为3组,每组6只：即对照组(CON),尾部悬吊4周组(TS)及尾部悬吊 4h／d站立组(TS STD4)。4周后,取双侧肾上腺及比目鱼肌(soleus,SOL),称取湿重。左侧SOL行冰冻切片,ATP酶钙钴法染色以观察骨骼肌肌纤维种类及横截面积。右侧SOL行组织匀浆,在70V、40C下,于8％凝胶上电泳28h,考马斯亮蓝染色,用Scion image软件对MHC条带进行光密度容积的测量,得出不同MHC异构体的比例。结果4周模拟失重导致双侧后肢骨骼肌SOL的湿重、Ⅰ型与Ⅱ型肌纤维横截面积、Ⅰ型肌纤维比例及MHCI的比例均显著降低(P＜0、01或P＜0．05)。4h／d间断性站立可完全防止比目鱼肌上述指标的变化,与CON组相比无显著差异(P＞0．05)。结论每日4h站立可完全防止模拟失重大鼠SOL萎缩。     

超声评价老年高血压病左室收缩及舒张功能参数的研究

目的：应用定量组织速度成像技术（QTVI）评价老年高血压病患者的左室收缩及舒张功能。材料和方法：应用定量组织速度成像技术测定20例健康老年人及50例老年高血压患者左室各节段收缩期峰值速度（Vs）、达峰时间（Ts）、快速充盈期、心房收缩期的心肌运动速度Ve、Va和Ve／Va比值。比较两组间的差异并进行显著性检验。结果：高血压组基底段前间隔、前壁及中间段左室前壁、后壁的心肌收缩期峰值速度较正常组低（P〈0．05），高血压组基底段后间隔、侧壁、后壁的心肌达峰时间较正常组慢（P〈0．05）。高血压组其底段左室前壁、后壁及下壁Ve低于正常组（P〈0．01，P〈0．05），基底段后间隔、后壁及下壁Va低于正常组（P〈0．05），中间段后间隔、后壁Ve及Va均低于正常组（P〈0．05），Ve／Va比值与正常组比较，差异无显著性意义（P〉0．05）。结论：QTVI可于同一时相对不同的节段心肌进行多点取样，获得局域性心肌运动速度曲线，为评价左室整体和局域性收缩及舒张功能提供了新手段，但对于老年高血压患者根据Ve／Va比值无法评判局域性舒张功能。     

高压氧对荷S-180瘤细胞小鼠血液某些指标的影响(论著)

目的：探讨高压氧（HBO）暴露对荷瘤小鼠血液指标的影响。方法：用雄性Balb／C／小鼠20只，随机分成4组，每组5只。A组为正常对照；B组只行HBO暴露；C组只做肿瘤接种；D组行HBO暴露并接种肿瘤。B、D组经压力0．2MPa、氧浓度87％、氧分压0．174MPa的HBO暴露20次后，所有鼠摘眼球取血对其血红蛋白、白细胞总数、中性白细胞数、淋巴细胞数、中性白细胞百分比、淋巴细胞百分比作了观察。结果：（1）血红蛋白在HBO肿瘤组比单纯HBO组高（P＜0．01）；（2）白细胞总数在HBO肿瘤组分别高于对照组（P＜0．05）、单纯HBO组（P＜0．01）和单纯肿瘤组（P＜0．05）；（3）中性白细胞数在HBO肿瘤组和单纯肿瘤组，均比对照组高（P＜0．01，P＜0．05），而HBO肿瘤组分别比单纯HBO组和单纯肿瘤组高（P＜0．01，P＜0．05）；（4）淋巴细胞数各组之间均无明显差异；（5）中性白细胞百分比在HBO肿瘤组和单纯肿瘤组，均比对照组高（P＜0．01，P＜0．05），而HBO肿瘤组比单纯HBO组高（P＜0．01）；（6）淋巴细胞百分比在对照组分别比HBO肿瘤组和单纯肿瘤组高（P＜0．01，P＜0．05），而单纯HBO组比HBO肿瘤组高（P＜0．01）。结论：（1）HBO（氧分压＝0．174MPa）可使荷瘤小鼠的白细胞总数和中性白细胞数量提高，但未能改变正常     

高原慢性肺心病患者吸气肌功能失调与高碳酸血症的关系

探讨高原肺心病患者吸气肌功能失调与高碳酸血症的关系。对48例高原（海拔2260～3200m）慢性肺心病缓解期患者测定了肺功能、血气、口腔最大吸气压（PImax）、最大跨膈压（Pdimax）和漏肌张力—时间指数（TTdi），并与42例当地同龄健康人对比。结果：①肺心病组PLmax、Pdimax明显低于健康组（P均＜0.01），TTdi较健康组明显延长（P＜0.01）；②将肺心病分为正常碳酸血症（A组）、轻度高碳酸血症（B组）和重度高碳酸血症（C组）。三组均有低氧血症，以C组最低，三组比较P均＜0.01。一秒种用力呼气容积（PEV1）、PImax、Pdimax均明显降低，以C组最低．三组比较P＜0．01或＜0．05。TTdi均延长，以C组最明显，三组比较P，0.01；③PaCO2与VD／VT比率和TTdi明显正相关，r值分别为0.57、0．52，P均＜0．01；与FEV1、PIamx、Pdimax明显负相关，r值分别为-0．61、－0．51、－0．58，P均＜0．01。结论：高原肺心病患者吸气肌疲劳和膈肌储备力下降在其高碳酸血症形成中起重要作用。     

牛磺酸对长期大强度运动训练后大鼠自由基代谢、膜流动性及钙转运的影响

70只雄性Wistar大鼠（80-100g）,随机分为3组：对照组（G1）、游泳训练组（G2）和游泳训练＋牛磺酸组（G3）。牛磺酸补充方式为每日灌服1次（500mg／Kg）。递增负荷训练6周,观察牛磺酸对长期大强度运动训练后大鼠自由基代谢、膜流动性及钙转运的影响。结果显示：运动后即刻,G3组血NH3、BLA、BUN明显低于G2组（P＜0．05）;运动后24小时,G3组血NH3、BLA与对照组比较已无显著性差异（P＞0．05）,而G3组BUN明显低于G2组（P＜0．05）。运动后即刻及24小时,G3组RBC、血浆及心肌线粒体MDA含量明显低于G2组（P＜0．05）;G3组RBC及心肌线粒体GPX活力明显高于G1和G2组（P＜0．05）;G3组心肌线粒体膜荧光偏振度P明显低于G2组（P＜0．05）;G3组心肌线粒体Ca2+浓度明显低于G2组（P＜0．05）;G3组SRCa2+－Atpase活性和摄钙率明显高于G2组（P＜0．05）。以上结果表明,牛磺酸的抗自由基损伤,稳定生物膜和调节钙转运作用可能是其对抗运动性疲劳的重要机制。     

MEBO对实验性电光性眼炎角膜超氧化物歧化酶和过氧化脂质的影响及临床观察

观察了MEBO对实验性电光性眼炎角膜中超氧化物歧化酶（SOD）和过氧化脂质（LPO）的影响，并与1％地长因组对照。结果：在电焊弧光照射后应用MEBO治疗，SOD及LPO与正常无明显差异（P均＞0．05），照射前用MEBO预防眼SOD低于正常，LPO高于正常（P均wto．OS），但两项指标均明显优于对照组及地长因组（P均＜0．05），提示MEBO有防治电光性眼炎（PEO）与保护角膜中的SOD清除自由基的活性有关。临床观察表明，MEBO联合地长因治疗PEO，疗效明显优于单纯地长因治疗（P＜0．05）。MEBO对实验性电光性眼炎角膜超氧化物歧化酶…     

体质指数与退变性腰椎管狭窄症的关系

目的 探讨体质指数与退变性腰椎管狭窄症的关系。方法 研究对象为慢性下腰痛的患者,共1638例。术前记录患者身高、体重,并计算体质指数（BMI）。根据BMI将患者分为3组：正常组BMI〈24,超重组BMI为24～28,肥胖组BMI〉28。以CT对腰椎管横截面扫描,通过计算机图像测算技术,测量L3～L4、L4～L5、L5～S1硬膜囊横截面积（CSADS）和侧隐窝前后径,并以硬膜囊横截面积（CSADS）≤100mm^2或侧隐窝前后径（骨性标志）≤3mm为标准,诊断腰椎管狭窄症162例。结果 BMI正常组与超重组、肥胖组腰椎管狭窄症患病率比较有显著性差异（P〈0．05）,超重组、肥胖组腰椎管狭窄症患病率高于BMI正常组（P〈0．05）。结论 BMI过高,即体重超重、肥胖是退变性腰椎管狭窄症的危险因素之一。     

子宫内膜癌68例预后因素临床分析

探讨子宫内膜癌的预后相关因素，分析：68例子宫内膜癌患者的临床病理资料。结果发现40岁以上患者的5年存活率略低于年轻发病者，绝经与否对5年存活率无影响，5年存活率足月产≥2次者为92．7％（P＜0．05），行以手术为主的综合治疗者可达94．7％，临床I期者为98．0％（P＜0．05），腺癌略高于其他类型癌（P＞0．05），子宫肌层浸润深度＜1／2者达94．0％（P＜0．05），提示手术方式，临床分期，子宫肌层浸润深度和足月产次是影响子宫内膜癌预后的重要因素。     

The trunk muscles of elite oarsmen

OBJECTIVES: To investigate the trunk strength of elite rowers and the impact of low back pain on these measures in order to determine if asymmetries or weakness were present. METHODS: Twenty two elite rowers were recruited: 13 reported previous low back pain, five current low back pain, and the remainder had no history of low back pain. All subjects were scanned during simulated rowing in an interventional open magnetic resonance imaging scanner. In each simulated rowing position, axial scans were obtained at the level of the L4-5 and L5-S1 disc interspace to determine the cross sectional area of the posterior trunk muscles. RESULTS: Considerable differences were observed between the three groups of rowers. In contrast with expectations and previous literature, the trunk muscles of rowers with low back pain had significantly larger cross sectional areas (p<0.001). No left/right asymmetries were observed and no differences between oarside and non-oarside in terms of muscle cross sectional area. CONCLUSION: These findings suggest that low back pain in rowers does not arise as a result of muscle weakness.     

躯干屈伸肌群等速肌力和耐力的初步研究

采用Ｃｙｂｅｘ－ＴＥＦ系统对４０例年轻人躯干屈伸肌群的肌力和耐力进行等速测试。结果表明：随着测试速度的增加,女性屈伸肌群和男性伸肌群的ＰＦ值逐渐降低,而男性屈肌群ＰＴ值随速度的变化不大。两性伸肌群的ＥＲ和女性的ＲＲ均低于屈肌群。本研究提供了一组正常年人的数据,对了解其躯干肌肉功能特点、指导运动训练及预防下腰痛和运动伤病具有参考意义。     

原发性骨质疏松或骨量低下患者下肢肌力与平衡功能相关性研究

目的:研究原发性骨质疏松和骨量低下患者下肢肌肉力量与平衡功能的相关性。方法:入组患者为57名通过GE Express超声波跟骨骨密度仪检测诊断为原发性骨质疏松或骨量低下的绝经期女性患者;采用美国Biodex Medical Systems公司生产的Biodex System 4多关节等速测试系统测试下肢肌力;采用单腿站立平衡检测(single leg balance test,SLBT)结果反映患者平衡功能,所得数据应用spss15.0软件进行Pearson线性相关分析,得出线性回归方程。结果:原发性骨质疏松患者优势腿单腿站立时间与慢速屈肌群相对峰力矩的相关系数r=0.540(P=0.000),与中速屈肌群相对峰力矩的相关系数r=0.523(P=0.000),与慢速伸肌群相对峰力矩相关系数r=0.378(P=0.004),与中速伸肌群相对峰力矩的相关系数r=0.282(P=0.034)。结论:原发性骨质疏松患者优势腿伸肌肌力和屈肌肌力与平衡功能均呈正相关,其中屈肌肌力对平衡功能的影响大于伸肌肌力。     

Flexed lumbar spine postures are associated with greater strength and efficiency than lordotic postures during a maximal lift in pain-free individuals

BackgroundInspite of common lifting advice to maintain a lordotic posture, there is debate regarding optimal lumbar spine posture during lifting. To date, the influence of lumbar posture on trunk muscle recruitment, strength and efficiency during high intensity lifting has not been fully explored.Research questionHow do differences in lumbar posture influence trunk extensor strength (moment), trunk muscle activity, and neuromuscular efficiency during maximal lifting?MethodsTwenty-six healthy participants adopted three lumbar postures (maximal extension (lordotic), mid-range (flat-back), and fully flexed) in a free lifting position. Motion analysis and force measurements were used to determine the back extensor, hip and knee moments. Surface electromyography (EMG) of three trunk extensors and the internal obliques were recorded. Neuromuscular efficiency (NME) was expressed as a ratio of normalised extensor moment to normalised EMG.ResultsSignificantly higher back extensor moments were exerted when moving from an extended to mid-range, and from a mid-range to fully flexed lumbar posture. This was accompanied by a decrease in activity across all three back extensor muscles (P < 0.001) resulting in a higher NME of these muscles in more flexed postures. Change in lumbar posture did not influence hip or knee moments or internal oblique activation.SignificanceA flexed-back posture is associated with increased strength and efficiency of the back muscles compared to a lordotic posture. These findings further question the manual handling advice to lift with a lordotic lumbar spine.     

Inter-joint coordination and the flexion-relaxation phenomenon among adults with low back pain during bending

BackgroundAltered inter-joint coordination and reduced flexion-relaxation at end-range trunk flexion are common in people with low back pain. Inconsistencies in these behaviors, however, make assessment and treatment challenging for this population.Research questionThe study objective was to investigate patterns of regional lumbo-pelvic coordination and flexion-relaxation in adults with and without low back pain, during a bending task.MethodsAdults with low back pain (n = 16) and a healthy group (n = 21) performed three trials of a bending task. Motion capture and surface electromyography systems measured joint kinematics (hip, lower and upper lumbar spine) and muscle activity (erector spinae longissimus, iliocostalis, and multifidus). Continuous relative phase analysis determined inter-joint coordination of the hip/lower lumbar and lower lumbar/upper lumbar joint pairs, during flexion and extension periods. Flexion-relaxation ratios using normalized surface electromyography data determined the extent of flexion-relaxation for each muscle, during each period. For inter-joint coordination, two-way repeated measure mixed ANOVAs calculated the effects of group (healthy/low back pain), period, and their interactions. Separate hierarchical linear models were constructed and tested relationships between flexion-relaxation ratios and our independent variables, group and muscle, while controlling for patient characteristics.ResultsThe low back pain group had more out-of-phase coordination of the hip/lower lumbar joint pair compared to the healthy group (mean difference = 24.7°; 95 % confidence interval = 3.93–45.4), independent of movement period. No significant between group differences in lower lumbar/upper lumbar coordination were observed. The low back pain group demonstrated reduced flexion-relaxation of all muscles during full flexion (21.7 % reduction on average), with multifidus showing the least relaxation.SignificanceRegional differences in the lumbar spine and the possibility of subgroups with distinct movement pattern should be considered when analyzing coordination in people with low back pain. Multifidus showed the largest changes in flexion-relaxation and should be included when measuring this construct.     

Biological risk indicators for recurrent non-specific low back pain in adolescents

Objectives: A matched case-control study was carried out to evaluate biological risk indicators for recurrent non-specific low back pain in adolescents.

Methods: Adolescents with recurrent non-specific low back pain (symptomatic; n = 28; mean (SD) age 14.9 (0.7) years) and matched controls (asymptomatic; n = 28; age 14.9 (0.7) years) with no history of non-specific low back pain participated. Measures of stature, mass, sitting height, sexual maturity (Tanner self assessment), lateral flexion of the spine, lumbar sagittal plane mobility (modified Schöber), hip range of motion (Leighton flexometer), back and hamstring flexibility (sit and reach), and trunk muscle endurance (number of sit ups) were performed using standardised procedures with established reliability. Backward stepwise logistic regression analysis was performed, with the presence/absence of recurrent low back pain as the dependent variable and the biological measures as the independent variables.

Results: Hip range of motion, trunk muscle endurance, lumbar sagittal plane mobility, and lateral flexion of the spine were identified as significant risk indicators of recurrent low back pain (p<0.05). Follow up analysis indicated that symptomatic subjects had significantly reduced lateral flexion of the spine, lumbar sagittal plane mobility, and trunk muscle endurance (p<0.05).

Conclusions: Hip range of motion, abdominal muscle endurance, lumbar flexibility, and lateral flexion of the spine were risk indicators for recurrent non-specific low back pain in a group of adolescents. These risk indicators identify the potential for exercise as a primary or secondary prevention method.

     

Center of pressure trajectories,trunk kinematics and trunk muscle activation during unstable sitting in low back pain patients

Trunk motor behavior has been reported to be altered in low-back pain. This may be associated with impaired lumbar proprioception, which could be compensated by trunk stiffening. We assessed trunk control by measuring center-of-pressure, lumbar kinematics and trunk muscle electromyography in 20 low-back pain patients and 11 healthy individuals during a seated balancing task, in conditions with and without disturbance of lumbar proprioception and occlusion of vision. We hypothesized that low-back pain patients show larger postural sway, but smaller thoraco-lumbar movements than healthy individuals. Repeated measures analyses of variance indicated that the effects of proprioception disturbance and vision occlusion were similar between groups. Interestingly, low-back pain patients grabbed the safety rail more often, while differences between groups in sway measures were rather subtle. This suggests that low-back pain patients were more cautious. Furthermore, low-back pain patients had an about 20 degrees less flexed lumbar posture than healthy individuals, and, in contrast to our hypothesis, made larger thoraco-lumbar movements in the sagittal plane, as indicated by higher SDs of thoraco-lumbar flexion and lower (more negative) correlations between pelvis and thorax movements. Activation of the intersegmental longissimus relative to the iliocostalis muscle, which spans all lumbar segments, was lower in low-back pain patients compared to healthy individuals. This difference in muscle activation may be causal for larger thoraco-lumbar movements, and may be causative of reduced control over segmental lumbar movement, but may also reflect the need for larger corrective movements to compensate balance impairments.     

Trunk muscle strength and disability level of low back pain in collegiate wrestlers

INTRODUCTION/PURPOSE: Low back pain (LBP) is a frequent injury in athletes. This study examined the relationship between isokinetic trunk muscle strength and the functional disability level of chronic LBP. We particularly focused on the existence of radiological abnormalities (RA) in the lumbar region. METHODS: Subjects were 53 collegiate wrestlers. Trunk extensor and flexor muscle strength was measured at three angular velocities (60, 90, and 120degrees x s(-1)). The examined parameters for trunk muscle strength were peak torque, work, average torque, and average power. The disability level of LBP was estimated by using two questionnaires. Based on the RA evaluation with x-ray and MRI, all 53 wrestlers were assigned to two groups as the RA group (N = 35, 66%) and the non-RA group (N = 18, 34%). Correlations between trunk muscle strength and the disability level of LBP in each group were analyzed with Spearman's rank test. RESULTS: Without considering the disability level, there were 14 subjects with LBP (40%) in the RA group and 8 (44%) in the non-RA. Significantly correlated parameters with the disability level of LBP could be observed only when the subjects were restricted to the non-RA group. The correlated parameters with the two questionnaires were peak torque at 120degrees x s(-1), work at 60degrees x s(-1) and 90degrees x s(-1), and average torque at 90degrees x s(-1) and 120degrees x s(-1). There were no significantly correlated parameters in the RA group. None of the trunk flexor parameters were significantly correlated with the disability level of LBP. CONCLUSION: The relatively low strength of trunk extensors may be one of the factors related to nonspecific chronic low back pain in collegiate wrestlers.     

Muscular performance after a 3 month progressive physical exercise program and 9 month follow-up in subjects with low back pain. A controlled study

The purpose of this study was to assess, in subjects with low back pain, the changes and their permanence in muscular performance after a 3 month progressive physical exercise program. Ninety subjects with chronic low back pain participated in the study. The study design was controlled and it was carried out in three groups: intensive training, home exercise, and control group. Isometric and dynamic muscle strength of the trunk and lower limb were measured, at the beginning of the study and after the 3 months exercise program, and then during each of the follow-up sessions. The Oswestry Index and back pain intensity were also determined. Both exercise groups received benefit from the progressive exercise program. Their muscular performance improved and their back pain intensity decreased significantly. Among the home exercise group, the Oswestry Index also changed positively. The results demonstrate that the home exercise program could be as effective as the intensive training program in increasing muscle strength, as well as decreasing back pain and functional disability among low back pain patients with mild functional limitations.