高频超声观察不同训练动作对产后腹直肌分离间距的即时影响

背景：产后腹直肌分离具有较高的发病率,对产妇的身心健康造成了一定的不良影响。运动疗法是其主要的治疗方法之一,但何种运动方式能更有效地促进其修复,目前尚缺乏共识。目的：通过高频超声检查,观察卷腹运动、腹部中空运动、盆底肌收缩和联合运动4个训练动作对产后腹直肌分离间距的即时影响。方法：招募39例符合条件的腹直肌分离产妇,产后时间2-6个月。在静息状态、卷腹运动、腹式呼吸、盆底收缩、联合运动5个动作模式下,利用高频超声分别在受试者脐上4.5 cm、脐水平和脐下4.5 cm处对腹直肌分离间距进行测量。结果与结论：(1)脐上4.5 cm处,4个训练动作与静息状态相比,对腹直肌分离间距的影响差异均无显著性意义(均P> 0.05);脐水平处,卷腹运动与静息状态相比腹直肌分离间距显著减少(P <0.01),而联合运动与静息状态相比腹直肌分离间距增加(P <0.05);脐下4.5 cm处,卷腹运动与静息状态相比腹直肌分离间距减少(P <0.05),其他3个动作与静息状态相比,腹直肌分离间距虽有增加的趋势,但差异无显著性意义(均P> 0.05);(2)顺产组和剖腹产组相比,静...     

四点跪位和手足位训练中躯干肌肉激活和共收缩模式比较

目的 分析四点跪位和手足位训练在躯干肌肉活动和共收缩模式上的异同,探究手足位训练作为核心稳定性训练的可能性,并为实际训练提供建议。方法 19名健康受试者参与研究,随机执行四点跪位（4个）和手足位（3个）动作,同时测量两侧腹直肌、腹外斜肌、竖脊肌、多裂肌的表面肌电信号。分析并比较基于表面肌电信号,得到肌电平均振幅值和肌肉共收缩指数。结果 四点跪位和手足位训练的组内和组间比较中,单一肌肉激活程度和共收缩指数都表现出统计学差异。四点跪位右手左腿抬起时,所有肌肉激活程度都高于起始位。四点跪位左腿抬起时同侧多裂肌明显高于手足位。手足位右手抬时腹外斜肌和腹直肌激活度较高。对8条肌肉两两匹配对共得到28种肌肉配对方式,四点跪位起始姿势波动最小,说明脊椎最为稳定,而其他动作指数波动范围较大。结论 从肌肉激活程度和共收缩两方面,证明了手足位训练作为核心稳定性训练的可能性。手足位训练和四点跪位训练可分别用于腹部肌肉和背部肌肉锻炼,而对侧上下肢抬起时,腹肌和背肌都能得到很好的锻炼,但需注意避免运动损伤。     

腹肌局部解剖自制模型在实验教学中的应用

腹肌、腹股沟管和腹直肌鞘的局部结构一直是教学中的难点,又有重要的临床意义,比如腹股沟疝修补术,要求手术医生必须清楚腹肌的局部解剖[1].为了解决这一问题,笔者在实验课堂上现场制作模型,来讲解腹股沟管和腹直肌鞘的局部解剖结构,取得了较好的教学效果.     

腹直肌形态与肌内神经分布研究及其临床意义

目的:通过对腹直肌形态学、神经入肌点和肌内神经分支分布的研究,为腹直肌的临床肌移植提供形态学资料.方法:大体解剖法和改良Sihler's肌内神经染色法.结果:(1)腹直肌肌重(47.80±12.89)g,肌长(33.18±3.38)cm,肌宽(4.55±1.87)cm,肌厚(0.55±0.24)cm,腱划长(1.06±0.32)cm.(2)腹白:肌神经入肌点在肌深面肌宽的中、外1/3交界处,自上而下呈线形排列.(3)腹直肌受第7～12胸神终前支和第1腰神经前支支配,呈节段性、重替性分布.神经主干和分支在肌内走行不受腱划分隔的影响.结论:腹直肌由多神经节段性重叠性支配,神经在肌内的行程不受腱划影响.腹直肌的神经入肌点在肌深面肌宽的中、外1/3交界处.     

双侧二腹肌前腹双肌腹1例

双侧二腹肌前腹双肌腹１例李朗①彭华山①二腹肌的变异及畸形较少见，在解剖１具壮年男性尸体过程中，见其双侧二腹肌前腹为双肌腹，查阅文献尚未见报道，现报道如下：变异为一人字形完整肌，位于双侧二腹肌前腹中央，下颌舌骨肌的表面（见附图）。肌腹以一共同的短腱起于...     

腹直肌肌皮瓣的应用解剖及其肌内神经分布

目的:研究腹直肌肌皮瓣的血管、神经支配及其肌内神经分布与走行,为临床应用腹直肌肌皮瓣修复重建功能提供详尽的解剖学资料。方法:在新鲜成人尸体标本,完整取下腹直肌,观察测量肌外神经及血管支配,并采用改良Sihler肌内神经染色法观察肌内神经的分支分布。结果:腹直肌血液供应来自腹壁上、下动脉;神经支配来源于第8～12肋间神经,节段性支配腹直肌各个肌腹。结论:应以腹直肌内侧作为切取腹直肌肌皮瓣的手术入路,避免神经损伤;第9～12肋间神经是理想的供肌神经蒂;在利用腹直肌进行亚部游离移植时,宜选择腹直肌的上半部、下半部或者第3、第4肌腹。     

副二腹肌

作者在一例成年男尸上发现了副二腹,现将解剖结果记录如下: 两侧二腹肌后腹以及与其相邻的茎突舌骨肌无异常所见。左、右二腹肌前腹均起自下颌骨的二腹肌窝,都各自移行为中间腱,左侧二腹肌前腹最大横径为14毫米,长径为28毫米;右侧二腹肌前腹最大横径为12毫米,长径为31毫米。在左、右二腹肌前腹的内侧均有一块副肌腹存在,也都起自同侧的下颌骨二腹肌窝内,两侧副肌腹起始部之间的距离为6毫米。左     

新式屈髋肌力训练机在轻重阻力下对下肢肌电与运动范围的影响

目的探讨新式屈髋肌力训练机在轻、重阻力情况下对下肢肌肉兴奋程度与运动范围的影响。方法 6位志愿者在屈髋肌力训练机台上,随机在轻或重阻力条件下进行连续30次的上提与下摆动作,并同时采集运动过程中的肌肉兴奋程度与下肢运动范围。结果肌肉兴奋程度方面,在连续30次动作过程中,重阻力在腹直肌、屈髋肌、臀大肌、股直肌和股二头肌的兴奋程度皆显著高于轻阻力(P<0.05);重阻力在腹直肌、屈髋肌和股直肌后3次的兴奋程度皆显著高于前3次(P<0.05);轻阻力情况下,只有竖脊肌以及股直肌最后3次的兴奋程度显著高于前3次(P<0.05)。运动范围方面,重阻力情况下的动作范围与下摆角度显著小于轻阻力(P<0.05)。结论新式屈髋肌力训练机无论是在轻或重阻力条件下,都能在髋关节合理的活动范围内刺激屈与伸髋主动肌群以及周边协同肌群来完成动作,特别是相对较重阻力的条件下。     

对称性二腹肌双前腹一例

<正> 两侧二腹肌为双前腹的报导较少见,本人在制作标本时遇见一例,记录如下: 男性,10岁,身高120厘米。两侧二腹肌后腹如常,起自乳突切迹,向前下移行为中间腱。两侧二腹肌前腹都有双肌腹,且可分为内侧和外侧。两侧的外侧前腹(即常人的二腹肌前腹)由中间腱行向     

腹式与胸式呼吸训练在蛛网膜下腔出血患者肺功能康复中的应用对比

目的:探讨对蛛网膜下腔出血(Subarachnoid hemorrhage,SAH)患者应用腹式与胸式呼吸训练后肺功能的康复效果差异.方法:选取我科2019年4月至2021年4月期间95例SAH患者作为研究对象,采用随机数字表法分成两组,均给予常规治疗.其中胸式呼吸组(n=47)进行胸式呼吸训练,腹式呼吸组(n=48)进行腹式呼吸训练,3 m后分别采用肺功能仪、双水平医用呼吸机、B型线性超声探头测定患者肺功能、呼吸力学指标以及膈肌肌电水平.结果:腹式呼吸组肺功能改善幅度高于胸式呼吸组(P<0.05);腹式呼吸组呼吸力学指标低于胸式呼吸组(P<0.05);腹式呼吸组膈肌肌电水平高于胸式呼吸组P<0.05).结论:呼吸训练干预SAH患者,可改善患者肺功能,降低呼吸力学指标,提高膈肌肌电水平,且腹式呼吸训练相比胸式呼吸训练干预效果更显著.     

腹前外侧群肌的肌内神经分布模式

目的 揭示腹前外侧群肌的肌内神经分布模式,探讨其临床意义。 方法 取经甲醛固定的12具24侧中国成年尸体的腹前外侧群肌,行改良的Sihler染色。 结果 腹前外侧群肌的神经绝大多数源于节段性分布的胸神经。腹外斜肌各肌齿有独立的神经支配,在髂前上棘和髂结节之间的髂嵴上方有一纵向神经密集带。腹内斜肌腹股沟韧带中点上方有一纵向神经密集带,髂嵴上方有一横向神经密集带。腹横肌髂前上棘与第8、9肋软骨连结处之间有一弧形的神经密集带。腹直肌各肌腹中部有一横向神经密集带,上3个肌腹有独立神经支配。 结论 腹外斜肌和腹直肌可分出神经肌肉亚部;各肌内的神经密集带应被考虑为肉毒毒素A注射和局部麻醉的最佳靶点部位,不宜设为腹壁手术的切口部位。     

Abdominal muscle size and symmetry at rest and during abdominal hollowing exercises in healthy control subjects

The symmetry of, and physical characteristics influencing, the thickness of the lateral abdominal muscles at rest and during abdominal exercises were examined in 57 healthy subjects (20 men, 37 women; aged 22–62 years). M-mode ultrasound images were recorded from the abdominal muscles at rest and during abdominal hollowing exercises in hook-lying. The fascial lines bordering the transvs. abdominis, obliquus internus and obliquus externus were digitized and the absolute thickness, relative thickness (% of total lateral thickness) and contraction ratio (thickness during hollowing/thickness at rest), as well as the asymmetry (difference between sides expressed as a percent of the smallest value for the two sides) for each of these parameters were determined for each muscle. Both at rest and during hollowing, obliquus internus was the thickest and transvs. abdominis the thinnest muscle. There were no significant differences between left and right sides for group mean thicknesses of any muscle; however, individual asymmetries were evident, with mean values for the different muscles ranging from 11% to 26%; asymmetry was much less for the contraction ratios (mean % side differences, 5–14% depending on muscle). Body mass was the most significant positive predictor of absolute muscle thickness, for all muscles at rest and during hollowing, accounting for 30–44% variance. Body mass index explained 20–30% variance in transvs. abdominis contraction ratio (negative relationship). The influence of these confounders must be considered in comparative studies of healthy controls and back pain patients, unless groups are very carefully matched. Asymmetries observed in patients should be interpreted with caution, as they are also common in healthy subjects.     

男性单侧腹直肌罕见缺失变异1例

目的 报道1例罕见的右侧腹直肌完全缺失并不伴有其他器官系统变异尸体的腹部解剖过程,腹壁肌群及其供血情况。 方法 解剖并观察尸体腹壁肌、血供、神经支配,对比两侧腹直肌发育和形态差异。 结果 该尸体右侧腹直肌缺失,腹直肌鞘完好,腹壁上动脉和腹壁下动脉仍在腹直肌鞘内走行并相吻合,肋间神经及肋下神经（T7～T12）由鞘内穿出达皮下。左侧腹直肌发育正常并有代偿性增生。男尸腹壁未见疤痕和手术切痕,腹内器官无缺失,腹膜除肝区外无黏连。 结论 该尸体右侧腹直肌缺失可能是胚胎发育第6周之前出现异常所导致。目前腹直肌肌皮瓣常用于多项外科重建手术,全面了解腹直肌的相关变异,对于扩展重建手术的应用范围和作好术前准备,确保手术成功均具有指导意义。     

Stabilization of lumbo-pelvic region and electromyography of the abdominal muscles

It is usual to find athletes that can perform de curl up test easily, but are unable to maintain the stabilization of the low back during the double straight leg lowering (DSLL). In spite of having strong abdominal muscles, its stabilization role seems not to be effective. Thus, the purpose of this study was to verify the relation among individuals with strong abdominal muscles and: the ability in perform posterior pelvic tilt (PPT); the ability to stabilize the low back during the DSLL and the eletromyographic activity of the abdominal muscles. Eighteen male subjects (aged 19.27 +/- 3.5), without history of muscle skeletal dysfunction, performed both the PPT and DSLL tests. During these tests electromyographic signals of the rectus abdominis (RA), obliquus internus abdominis (OI) and obliquus externus abdominis (OE) were recorded, the angle of the hip and the pressure under the low back were measured. The results of analyses of variance (ANOVA) show that most volunteers accomplished the PPT test, actively flattening the low back with regular or good quality. However, none of them was able to stabilize the low back during the DSLL test. During the PPT test all abdominal muscle portions analysed were activated without significant differences. In an attempt of maintaining the lumbo-pelvic region stabilized during the DSLL, it was observed a tendency of higher bilateral activation of OE when compared to RA and OI muscle portions between 70 and 20 degrees of hip flexion.     

Observations on intra-abdominal pressure and patterns of abdominal intra-muscular activity in man.

The aim was to investigate possible relationships between activities of the individual muscles of the ventrolateral abdominal wall and the development of pressure within the abdominal cavity. Intra-muscular activity was recorded bilaterally from transversus abdominis, obliquus internus, obliquus externus and rectus abdominis with fine-wire electrodes guided into place using real-time ultrasound. Intra-abdominal pressure was measured intragastrically using a micro tip pressure transducer. Six males were studied during loading and movement tasks with varied levels of intra-abdominal pressure. During both maximal voluntary isometric trunk flexion and extension, transversus abdominis activity and intra-abdominal pressure remained constant, while all other abdominal muscles showed a marked reduction during extension. When maximal isometric trunk flexor or extensor torques were imposed upon a maximal Valsalva manoeuvre, transversus abdominis activity and intra-abdominal pressure remained comparable within and across conditions, whereas obliquus internus, obliquus externus and rectus abdominis activities either markedly increased (flexion) or decreased (extension). Trunk twisting movements showed reciprocal patterns of activity between the left and right sides of transversus abdominis, indicating an ability for torque development. During trunk flexion--extension, transversus abdominis showed less distinguished changes of activity possibly relating to a general stabilizing function. In varied pulsed Valsalva manoeuvres, changes in peak intra-abdominal pressure were correlated with mean amplitude electromyograms of all abdominal muscles, excluding rectus abdominis. It is concluded that the co-ordinative patterns shown between the muscles of the ventrolateral abdominal wall are task specific based upon demands of movement, torque and stabilization. It appears that transversus abdominis is the abdominal muscle whose activity is most consistently related to changes in intra-abdominal pressure.     

Observations on intra-abdominal pressure and patterns of abdominal intra-muscular activity in man

Cresswell , A. G., Grundström , H. & Thorstensson , A. 1992. Observations on intra-abdominal pressure and patterns of abdominal intra-muscular activity in man. Actri Physiol Scand 144 , 409418. Received 16 July 1 991 , accepted 11 October 1991. ISSN 0001–6772. Department of Physiology III, Karolinska Institute, and Department of Radiology, Danderyd Hospital, Stockholm, Sweden. The aim was to investigate possible relationships between activities of the individual muscles of the ventrolateral abdominal wall and the development of pressure within the abdominal cavity. Intra-muscular activity was recorded bilaterally from transversus abdominis, obliquus internus, obliquus externus and rectus abdominis with fine-wire electrodes guided into place using real-time ultrasound. Intra-abdominal pressure was measured intragastrically using a micro tip pressure transducer. Six males were studied during loading and movement tasks with varied levels of intra-abdominal pressure. During both maximal voluntary isometric trunk flexion and extension, transversus abdominis activity and intra-abdominal pressure remained constant, while all other abdominal muscles showed a marked reduction during extension. When maximal isometric trunk flexor or extensor torques were imposed upon a maximal Valsalva manoeuvre, transversus abdominis activity and intra-abdominal pressure remained comparable within and across conditions, whereas obliquus internus, obliquus externus and rectus abdominis activities either markedly increased (flexion) or decreased (extension). Trunk twisting movements showed reciprocal patterns of activity between the left and right sides of transversus abdominis, indicating an ability for torque development. During trunk flexion-extension, transversus abdominis showed less distinguished changes of activity possibly relating to a general stabilizing function. In varied pulsed Valsalva manoeuvres, changes in peak intra-abdominal pressure were correlated with mean amplitude electromyograms of all abdominal muscles, excluding rectus abdominis. It is concluded that the coordinative patterns shown between the muscles of the ventrolateral abdominal wall are task specific based upon demands of movement, torque and stabilization. It appears that transversus ahdominis is the abdominal muscle whose activity is most consistently related to changes in intra-abdominal pressure.     

Tensiomyography as method of evaluating muscles status

Sports results, as well as results of rehabilitation treatments are closely related to a detailed, strictly individualized programme of sports and rehabilitation training. It is vitally important to monitor and evaluate results constantly. Along with already standardized methods of evaluating neuromuscular system, such as electrodinamometry and isokinetic dinamometry on Cybex; tensiomyography (TMG) as method of assessing muscles status has been introduced. TMG is non-invasive, selective, objective method designed to measure time of activation, delay time as well as contraction time, relaxation time and intesity of muscle contraction in conditions of submaximum electrostimulation. The method is based on measuring the muscle belly enlargements by a superficialy placed precise electromagnetic sensor.TMG enables the examination of some otherwise inaccessible muscles like gluteus maximus muscle and also selective evaluation of single muscle head (for example m. vastus medialis, m. vastus lateralis and m. rectus femoris of m. quadriceps). Estimation of harmonisation between agonistic and antagonistic muscles, synergistic muscles and same muscles on left and right side of the body, is based on muscles biomechanical properties i.e. parameters, calculated from TMG response. Total harmonization (100%) is hardly ever the case, the lowest level sufficient muscle groups functionality is defined by 80% for lateral and 65% for agonistic/synergistic harmonisation. Harmonization below this level either reflects past injures, muscle adaptation or indicates increased exposure to injury.     

Spinal cord location of the motoneurons innervating the abdominal,cutaneous maximus,latissimus dorsi and longissimus dorsi muscles in the cat

Summary Horseradish peroxidase (HRP) injections were made in the rectus abdominis, obliquus externus, obliquus internus, transversus abdominis, cutaneous maximus, latissimus dorsi and the longissimus dorsi muscles in the cat. The results showed that motoneurons innervating the obliquus externus, obliquus internus and transversus abdominis muscles were located in greatly overlapping areas of midthoracic, caudal thoracic and upper lumbar spinal segments. These motoneuronal cell groups were present laterally in the ventral horn and at caudal thoracic and upper lumbar levels they bordered on the white matter. The location of the rectus motoneurons differed somewhat from the location of the other motoneuronal cell groups because they were also present at low cervical and upper thoracic levels and in the segments T12 to L3 they were found in the ventral horn medial to the other abdominal muscle motoneuronal cell group. At mid-thoracic levels rectus motoneurons were located in the same area as the other abdominal muscle motoneurons. Latissimus dorsi motoneurons were observed in a large cell group in the ventrolateral part of the ventral horn at the levels caudal C6 to rostral C8. Furthermore they were found in the segments T9 to L3 laterally in the ventral horn which is the same area in which the other abdominal muscle motoneurons except the rectus ones are located. Longissimus dorsi motoneurons were located in the most ventral portion of the ventral horn in all thoracic and upper 4 lumbar segments. The cutaneous maximus motoneurons were found in a cell group, located ventrolaterally in the ventral horn at the edge of the gray and white matter at the level caudal C8-rostral T1. This cell group corresponds to the caudal part of the ventral motor nucleus (VMN) of Matsushita and Ueyama (1973). Interestingly, labeled motoneurons were also present in the VMN after injecting HRP in the abdominal muscles as well as in the caudal (but not in the rostral) parts of the latissimus dorsi muscle but not in the longissimus dorsi injected cases. The possibility whether these motoneurons are labeled because of leakage of HRP to abdominal and caudal latissimus dorsi muscles is discussed. If leakage would not be the case, motoneurons in the VMN may be involved in specific functions of the abdominal muscles, such as the so-called steady state contractions.     

Immediate changes in feedforward postural adjustments following voluntary motor training

There is limited evidence that preprogrammed feedforward adjustments, which are modified in people with neurological and musculoskeletal conditions, can be trained and whether this depends on the type of training. As previous findings demonstrate consistent delays in feedforward activation of the deep abdominal muscle, transversus abdominis (TrA), in people with recurrent low back pain (LBP), we investigated whether training involving voluntary muscle activation can change feedforward mechanisms, and whether this depends on the manner in which the muscle is trained. Twenty-two volunteers with recurrent LBP were randomly assigned to undertake either training of isolated voluntary activation of TrA or sit-up training to activate TrA in a non-isolated manner to identical amplitude. Subjects performed a trunk perturbation task involving arm movement prior to and after training, and surface and fine-wire electromyography (EMG) recordings were made from trunk and arm muscles. Following a single session of training of isolated voluntary activation of TrA, onset of TrA EMG was earlier during rapid arm flexion and extension, to more closely resemble the responses in pain-free individuals. The magnitude of change in TrA EMG onset was correlated with the quality of isolated training. In contrast, all of the abdominal muscles were recruited earlier during arm flexion after sit-up training, while onset of TrA EMG was further delayed during arm extension. The results provide evidence that training of isolated muscle activation leads to changes in feedforward postural strategies, and the magnitude of the effect is dependent on the type and quality of motor training.