基于H反射通路探究大鼠慢性肌筋膜疼痛触发点的发病机制

目的:基于H反射探究大鼠慢性肌筋膜疼痛触发点(myofascial trigger points,MTrPs)的发病机制。方法:16只7周龄雄性SD大鼠随机分为实验组和对照组,实验组采取对腓肠肌定点钝性打击结合离心运动的模式进行连续8周造模。造模结束后两组均正常饲养4周。12周结束后,检测MTrPs造模成功指标(即紧张带、局部抽搐反应和自发肌电活动),并在此基础上进行H反射的诱发实验,采集引发H波的阈值、Mmax、Hmax、M波和H波潜伏期、Hmax/Mmax等。结果:与非MTrPs相比,MTrPs处诱发的H反射Mmax(4.28±1.27 mV)较低,Hmax(1.01±0.34 mV)较高,H波潜伏期(4.60±0.89 ms)较短,Hmax/Mmax比值(0.21±0.19)较大(P<0.05)。结论:H反射与慢性MTrPs形成的病理生理机制有关,MTrPs大鼠脊髓中枢可能存在高度致敏,Iα类传入神经兴奋性较高,肌梭敏感性可能也较高。     

PGF2α对大鼠肌筋膜疼痛触发点自发肌电活动的影响

目的:观察肌筋膜疼痛触发点(MTrPs)模型大鼠外周血中前列腺素F2α(PGF2α)浓度变化情况,并通过体外注射PGF2α观察其对触发点肌电活动的影响,探究PGF2α与触发点的关系。方法:40只雌性SD大鼠随机分为对照组(CG组)、造模组(MG组)、生理盐水组(SG组)和PGF2α组(PG组),每组10只。除CG组外,其余三组采取打击结合离心运动进行干预8周,恢复4周,检测受累肌结节、紧绷带、局部抽搐反应和自发性电位;CG组正常饲养12周。12周后ELISA法测量各组大鼠血清PGF2α浓度。之后分别对SG组局部肌肉注射生理盐水,PG组局部肌肉注射PGF2α,CG组和MG组分别作为空白对照和模型对照不注射任何物质。干预后即刻记录各组静息状态下的自发性电活动。结果:与CG组相比,其余三组大鼠血清PGF2α浓度均显著性增加(P0.05)。给药后即刻,MG组、SG组和PG组大鼠均能记录到异常的自发电位,对照组大鼠基本无电活动,肌电波形形似一条直线。与CG组相比,MG组、SG组和PG组的肌电波频、波幅以及波长均有显著性差异(P0.05);PG组显著高于MG组和SG组(P0.05)。MG组和SG组之间相比各指标均无显著性差异。结论:PGF2α能增加触发点肌纤维的肌电活动,促使触发点活性增加。     

体外冲击波对肌筋膜疼痛综合征大鼠疼痛及五羟色胺和去甲肾上腺素的影响研究

目的 观察体外冲击波对肌筋膜疼痛综合征大鼠疼痛以及血清和触发点局部组织五羟色胺、去甲肾上腺素的影响.方法 将30只大鼠随机分为空白组、模型组和冲击波组,每组10只.采用打击结合离心运动法建立肌筋膜疼痛综合征大鼠模型,造模8周.空白组接受常规喂养不参与造模;模型组在造模后无需干预,仅接受常规喂养;冲击波组进行体外冲击波干...     

基于电刺激的大鼠肌筋膜疼痛触发点的发生机制

目的:探究电刺激下肌筋膜疼痛触发点肌纤维的兴奋性和耐疲劳表现。方法:将48只雄性SD大鼠随机分为对照组(CG1、CG2、CG3)和触发点组(TG1、TG2、TG3)。CG1和TG1测试刺激阈值强度和最大收缩力量(MCF)以及其最适刺激强度;CG2和TG2测试不同刺激强度下MCF的变化;CG3和TG3测试不同刺激频率下MCF的变化。钝性打击结合离心运动造模8周,恢复4周后将大鼠接入生物机能测试系统,给予肌纤维一系列电刺激,测量比较各组引起肌肉收缩的阈值强度、MCF、刺激强度和频率诱导的肌肉疲劳等指标。结果:TG1组引起肌肉开始收缩的阈值强度和最大收缩力量(MCF)的最适刺激强度比CG1组低,具有显著性差异(P0.05);TG1组与CG1组的MCF无显著性差异(P0.05)。TG2组电刺激引起的MCF第15、20次增量电刺激低于第1、5、10次增量,具有高度显著性差异(P0.01);TG2组电刺激引起的MCF第10、15、20次增量CG2组,具有高度显著性差异(P0.01);TG2组电刺激引起的MCF第1、5、10次增量无显著性差异(P0.05);TG2组电刺激引起的MCF第1、5次增量与CG2组相比无显著性差异(P0.05)。TG3组电刺激引起MCF所需的刺激频率比CG3组低,呈高度显著性差异(P0.01);TG3组电刺激引起的MCF比CG3组低,具有显著性差异(P0.05)。结论:与正常肌纤维相比,触发点肌纤维对电刺激反应更敏感,受到连续电刺激时更易疲劳。     

银质针导热治疗对MPS大鼠脊髓中枢神经递质的影响

目的:观察银质针导热疗法对肌筋膜疼痛综合征大鼠脊髓水平神经递质的影响。方法:24只健康SD大鼠随机分为3组(n=8):正常组,不给予任何刺激;模型组,采用打击结合运动疲劳建立慢性肌筋膜疼痛综合征模型;银质针组,MPS模型成功后,行银质针导热治疗。各组大鼠在治疗2周后测定热痛阈值、右股内侧肌自发电活动。麻醉后处死大鼠,取右股内侧肌及脊髓L4~6节段,HE染色切片观察局部肌肉形态学变化,免疫组化法检测脊髓神经元型一氧化氮合酶(n NOS)、P物质(SP)及5-羟色胺(5-HT)。结果:与正常组相比模型组大鼠热痛阈降低,局部肌肉自发电活动增加(P<0.01);脊髓n NOS、SP表达升高(P<0.01)。与模型组相比,银质针组热痛阈明显升高,自发电活动明显降低(P<0.01);脊髓n NOS及SP表达明显降低,5-HT表达明显升高(P<0.01)。结论:银质针导热治疗可能通过降低肌筋膜疼痛综合征大鼠脊髓n NOS及SP表达,增高5-HT表达产生镇痛作用。     

正常翼外肌与翼外肌痉挛的肌电变化

目的:对正常翼外肌、翼外肌痉挛患者进行研究,探讨正常翼外肌、翼外肌痉挛的肌电特征。方法:以35例单侧翼外肌痉挛成人患者为实验组,35例正常人为对照组。采用ZEP-500型诱发电位仪(中科电器高技术公司)测试翼外肌上下头在最大牙尖交错位(intercuspalposition,ICP)紧咬及张口1.0,2.5cm的肌电变化情况。结果:对照组翼外肌上、下头在ICP及开口运动中均有肌电活动;张口1.0cm时,翼外肌上头肌电变化较ICP时低,张口2.5cm时较张口1.0cm时升高,有显著性差异(P<0.05)。实验组ICP,翼外肌上、下头的肌电电位经统计学检验t值分别为0.60,0.74,无显著性差异(P>0.05);张口2.5cm时,低于对照组,翼外肌上、下头的肌电电位经统计学检验t值分别0.49,0.24,无显著性差异(P>0.05);张口1.0cm时,实验组肌电电位明显高于对照组,翼外肌上、下头的肌电电位经统计学检验t值分别2.15,2.31,有显著性差异(P<0.05)。结论:支持翼外肌上下头是协同肌肉,均表现为开口时收缩的观点;翼外肌痉挛时,张口1.0cm的电位明显高于正常翼外肌电位,可为临床诊断提供参考指标。     

盆底康复锻炼对产妇盆底肌肉肌电活动及盆底功能的影响

目的:探讨产后盆底康复锻炼对盆底肌肉肌电活动、盆底功能的影响。方法:选取140例产妇,根据是否于产后6周接受盆底康复锻炼分为康复组83例(给予生物电刺激+生物反馈治疗)、对照组57例(患者不愿意接受产后盆底功能康复治疗),对比2组产妇产后6周及3个月时的盆底肌电生理指标、盆腔器官脱垂定量(POP-Q)分度。结果:产后6周时,康复组盆底Ⅰ类、Ⅱ类肌纤维的肌电位均值与对照组比较差异无统计学意义;产后3个月,康复组盆底Ⅰ类、Ⅱ类肌纤维的肌电位均值均显著高于对照组(均P0.05),康复组的盆底Ⅰ类、Ⅱ类肌纤维的疲劳值均显著小于对照组(均P0.05);产后3个月,康复组的C点距离、D点距离均显著大于对照组(均P0.05);产后3个月,康复组的PFIQ-7、PISQ-12评分均显著高于对照组(均P0.05)。结论:产后盆底康复锻炼对盆底肌肉肌电活动、盆底功能恢复具有积极作用。     

骨髓间充质干细胞成肌诱导后移植对延缓失神经肌肉萎缩的作用

目的:实验将化学和应力协同诱导后的大鼠骨髓间充质干细胞移植到失神经骨骼肌内,观察体内的成肌效应,以达到延缓失神经骨骼肌萎缩的目的.方法:实验于2007-04/10在上海交通大学医学院附属新华医院动物实验中心和中心实验室完成.①实验材料:SD大鼠由上海西普尔-必凯实验动物有限公司提供,实验过程中对动物处置符合动物伦理学标准.②实验方法:采用密度梯度离心法分离培养雄性SD大鼠股骨、胫骨中骨髓间充质干细胞.取第3代细胞进行化学诱导后,再进行应力诱导,于移植前1d以DAPI标记.取8周龄SD大鼠36只,随机分为对照组与实验组,18只,组.两组均切断大鼠左侧后肢坐骨神经,并造成1 cm神经缺损,形成失神经支配腓肠肌动物模型.实验组大鼠腓肠肌的内、外侧头经皮注入骨髓间充质干细胞,对照组大鼠以同样方法注入无细胞、不含胎牛血清低糖DMEM培养液.⑨实验评估:术后第4,8,12周检测大鼠双侧腓肠肌运动单位电位及纤颤电位,取双侧腓肠肌测定肌湿重,然后行苏木精-伊红染色,并作图象分析,测定肌纤维横截面积,采用BCA法测双侧腓肠肌蛋白总量.结果:①切断坐骨神经后2周大鼠腓肠肌均发生不同程度的萎缩.左侧腓肠肌运动单位电位波形逐渐变单一,时限逐渐延长,电压逐渐变小,纤颤电位的正向波逐渐增多.4、8周时实验组与对照组有差异,12周时两组无差异.②实验组骨髓间充质干细胞移植处可观察到带荧光的细胞核及肌纤维,对照组未见此现象.实验组第4,8周失神经支配腓肠肌湿重残存率、腓肠肌纤维横截面积残存率、蛋白总量残存率均明显低于对照组(P<0.01),12周时两组差异无统计学意义.结论:骨髓间充质干细胞移植到失神经骨骼肌内可明显延缓失神经支配骨骼肌的萎缩,并且这一作用只在细胞移植8周以内比较明显.     

肌电触发神经肌肉刺激对改善脑卒中早期患者腕背伸功能的疗效观察

目的:探讨肌电触发神经肌肉刺激在改善脑卒中早期患者的腕背伸功能中的作用。方法:将60例脑卒中早期患者随机分为早期肌电触发神经肌肉刺激训练组(治疗组)和对照组各30例,对照组给予常规康复训练,治疗组在常规训练的基础上,应用AM800型神经功能重建仪对患侧上肢腕背伸肌群进行20min/d肌电触发的神经肌肉电刺激。在入院24h内和治疗后12周分别对两组的最大肌电幅度、腕背伸活动度、上肢运动功能Fugl-Meyer(FMA)评定法及改良Barthel(MBI)评分进行评定。结果:治疗后,治疗组患者的患侧上肢运动功能、手部功能及腕背伸活动度、日常生活活动能力较对照组明显提高(P<0.01)。结论:肌电触发神经肌肉刺激的早期介入可明显提高脑卒中偏瘫患者的上肢运动功能和日常生活活动能力。     

肌筋膜触发点针刺和牵伸运动对原发性痛经的即刻镇痛效果比较

摘要 目的：探究一次腹部肌筋膜触发点针刺治疗和一次牵伸运动练习对原发性痛经女性在经期时的即刻镇痛效果。 方法：共54例原发性痛经女性参与试验,将所有受试者随机分为肌筋膜触发点组（20例）、运动组（18例）和空白对照组（16例）,肌筋膜触发点组在经期第一天痛感最强时接受一次腹部触发点针刺治疗,运动组在经期第一天痛感最强时接受一次时长为30—45min的牵伸运动练习,对照组不接受任何干预。在干预前后采集压痛阈值、McGill疼痛评分和痛经症状评分。 结果：即刻治疗后,组内比较时,肌筋膜触发点组在各个部位的压痛阈值显著升高（P＜0.05）、McGill疼痛评分和痛经症状积分均显著降低（P＜0.05）,运动组在腹部远端区域见压痛阈值显著提高（P＜0.05）,在部分腹部近端区域（腰椎左侧、上腹直肌处）见压痛阈值显著降低（P＜0.05）、McGill疼痛评分显著降低（P＜0.05）,但痛经症状积分仅有下降趋势（P＞0.05）;组间比较时,肌筋膜触发点组与对照组之间仅在腕背部右侧、斜方肌右侧、下腹直肌左侧不存在显著性差异（P＞0.05）。 结论：经期时,肌筋膜触发点针刺治疗可以立即降低机体的疼痛敏感性和疼痛强度,以及缓解痛经相关症状,而即刻的牵伸运动可能提高机体的疼痛敏感性。     

表面肌电仪对髌股疼痛综合征患者膝关节肌电活动的分析

目的利用表面肌电仪分析髌股疼痛综合征患者康复训练前后股内侧斜肌（VMO）和股外侧肌（VL）肌电活动的变化。方法26例髌股疼痛综合征患者随机分为神经肌电生物反馈训练组（A组）和单纯训练组（B组）各13例，均接受相同的家庭训练，但A组患者在神经肌电生物反馈仪配合下进行训练。所有患者在开始训练前和训练8周后，利用表面肌电仪对VMO和VL的神经肌肉电活动进行连续6h评定，同时对膝关节疼痛程度进行评定。结果治疗后，B组患者的VMO／VL神经肌电比率与治疗前比较差异无显著性意义（P〉0．05），而A组患者的VMO／VL神经肌电比率与治疗前比较差异有显著性意义（P〈0．05）。结论采用神经肌电生物反馈仪配合髌股疼痛综合征患者的康复训练可促进股内侧斜肌的募集。     

Patellar kinematics, part I: the influence of vastus muscle activity in subjects with and without patellofemoral pain

BACKGROUND AND PURPOSE: Reduced motor unit activity of the vastus medialis muscle relative to the vastus lateralis muscle has been implicated as a cause of lateral patellar subluxation. The purpose of this study was to assess the influence of vastus muscle motor unit activity on patellar kinematics. SUBJECTS: Twenty-three women (mean age=26.8 years, SD=8.5, range=14-46) with a diagnosis of patellofemoral pain and 12 women (mean age=29.1 years, SD=5.0, range=24-38) without patellofemoral pain participated. Only female subjects were studied because of potential biomechanical differences between sexes. METHODS: Patellar kinematics (kinematic magnetic resonance imaging) and vastus muscle electromyographic (EMG) activity using indwelling electrodes were measured during resisted knee extension. Measurements of medial and lateral patellar displacement and tilt obtained from magnetic resonance images were correlated with normalized vastus lateralis:vastus medialis oblique muscle and vastus lateralis:vastus medialis longus muscle EMG ratios at 45, 36, 27, 18, 9, and 0 degrees of knee flexion using a stepwise regression procedure. RESULTS: The vastus lateralis:vastus medialis longus muscle EMG ratio contributed to the prediction of lateral patellar glide at 27 degrees of knee flexion (r=-.48), with increased vastus medialis longus muscle activity being associated with greater lateral patellar displacement. A similar inverse relationship was evident with lateral patellar tilt at 36, 27, 18, and 9 degrees of knee flexion. CONCLUSION AND DISCUSSION: These results suggest that increased motor unit activity of the vastus medialis muscle appears to be associated with abnormal patellar kinematics in women, but it is not necessarily a cause of abnormal patellar kinematics.     

Effects of the slow speed-targeting squat exercise on the vastus medialis oblique/vastus lateralis muscle ratio

[Purpose] This study investigated the effects of the slow speed-targeting squat exercise on the vastus medialis oblique/vastus lateralis ratio. [Subjects] Ten asymptomatic men were recruited. [Methods] The EMG activities of the vastus medialis oblique and vastus lateralis muscles were recorded using surface electrodes. The subject performed the squat exercise under 3 different conditions. [Results] The vastus medialis oblique/vastus lateralis ratio in condition 2 (1.5 ± 0.7) was significantly higher than that in conditions 1 and 3 (1.0 ± 0.5, 1.1 ± 0.8, respectively) [Conclusion] Therefore, an effectively slow movement speed is recommended for selective strengthening of vastus medialis oblique using a slow speed-targeting device that provides biofeedback.Key words: Slow movement speed, Squat exercise, VMO     

Contribution of components of the quadriceps femoris muscle for producing external torque in patients with patellofemoral pain syndrome

IntroductionDifferent muscular activities of the quadriceps components for producing necessary torque may change in patients with patellofemoral pain syndrome (PFPS). The aim of the current study, therefore, was to assess the contribution of each component of the quadriceps femoris muscle for producing external torque in patients with PFPS.MethodTwelve females with PFPS (24.7 ± 2.3 years) and twelve healthy matched females (25.4 ± 2.4 years) performed three consecutive knee flexion and extension movements with maximum effort at 45°/s and 300°/s using a Biodex system 3 dynamometer. Simultaneously, electromyographic (EMG) activities of the vastus medialis oblique (VMO), RF (rectus femoris) and vastus lateralis (VL) muscles were recorded using a DataLog instrument. Standard multiple regressions were used to assess the ability of EMG activities of the VMO, RF and VL muscles to predict normalized quadriceps femoris isokinetic concentric and eccentric torques at 45°/s and 300°/s in the normal and patient groups.ResultsIn the normal group, the VL and the VMO were the good predictors of quadriceps concentric torque at 45°/s and 300°/s, respectively. The VL and the RF were the good predictors of quadriceps eccentric torque at 300°/s in the patient group. No other conditions showed a considerable prediction for quadriceps torque in the normal or patient group.ConclusionFemales with PFPS differ with normal females in terms of the contribution of each component of the quadriceps femoris for producing external torque. Training the VMO for concentric contraction at both high and low velocities should be included in the management of the patients with PFPS.     

Diagnostic value of five clinical tests in patellofemoral pain syndrome

The current study is aimed at examining the validity of five clinical patellofemoral tests used in the diagnosis of patellofemoral pain syndrome (PFPS). Forty-five knee patients were divided into either the PFPS or the non-PFPS group, based on the fulfilment of the diagnostic criteria for PFPS. An investigator, blinded to the group assignment, performed the vastus medialis coordination test, patellar apprehension test, Waldron's test, Clarke's test, and the eccentric step test. The positive likelihood ratio was 2.26 for both the vastus medialis coordination test and the patellar apprehension test. For the eccentric step test, the positive likelihood ratio was 2.34. A positive outcome on either the vastus medialis coordination test, the patellar apprehension test, or the eccentric step test increases the probability of PFPS to a small, but sometimes important, degree. For the remaining tests, the positive likelihood ratios were below the threshold value of 2, indicating that given a positive test result, the probability that the patient has PFPS is altered to a small, and rarely important degree. The negative likelihood ratios for all tests exceeded the threshold value of 0.5, suggestive of clinically irrelevant information. These data question the validity of clinical tests for the diagnosis of PFPS.     

Quantified electromyography of lower-limb muscles during level walking

The electromyography (EMG) of eleven different lower limb muscles of ten healthy subjects was quantified during normal level walking. The surface EMGs obtained were normalized, in percentage, to the activity obtained during an isometric maximum voluntary test contraction of each subject. The mean peak activities of the gluteus maximus, gluteus medius, rectus femoris, vastus medialis, vastus lateralis, biceps femoris and medial hamstring muscles occurred at heel-strike and were between 5 and 15% of max isometric EMG. The magnitudes of tibialis anterior and triceps surae muscular activity were higher than those of the other muscles investigated. Mean peak activity in tibialis anterior was 27%, in gastrocnemius medialis 42%, in gastrocnemius lateralis 19% and in soleus 40%. The important role of the triceps surae during walking was reflected in comparatively high muscular activity at push-off.     

运动疗法对膝关节骨关节炎患者肌发电量的影响

目的：研究肌发电量在膝关节骨关节炎患者股四头肌肌力训练中的变化情况及股四头肌的详细变化情况。方法：采用股四头肌的等长收缩运动训练方法和其他疗法进行比较,用肌电图进行股直肌、股内侧肌、股外侧肌的肌发电量测定,同时用“膝关节功能评定表”进行功能的辅助评定。结果：两种方法治疗后,股直肌、股内侧肌的肌发电量都有显著的变化,尤其以股内侧肌的变化极显著,股外侧的肌发电量无显著变化。两种方法中肌力训练较其他治疗方法在提高肌发电量方面更为有效。结论：股内侧肌在膝关节肌力锻炼中的变化最大,说明股内侧肌比股直肌和股外侧肌在稳定膝关节方面更重要。股外侧肌在训练中的变化最小,在维护膝关节的稳定性方面起的作用比股内侧肌和股直肌小;肌力训练比其他方法在增加肌发电量方面更有效,更能提高膝关节的稳定性。     

膝骨关节炎患者股内侧肌、股直肌和股外侧肌间的协调性

目的应用表面肌电图和等速肌力测定方法比较膝骨关节炎患者与正常人股内侧肌、股直肌和股外侧肌间的协调性改变。方法34例膝骨关节炎患者和34名膝关节健康者在膝关节屈曲10°、60°、100°等长伸膝和等速60°/s、180°/s伸膝运动测试模式下,进行股内侧肌(VM)、股直肌(RF)和股外侧肌(VL)的表面肌电图和股四头肌肌力的评测,包括肌肉激活启动顺序和VM/VL神经肌电比值。结果与正常人对比,膝骨关节炎患者在等速180°/s伸膝运动时VM相对于VL启动延迟（P＜0.05）;在膝屈10°等长伸膝运动时,VM/VL神经肌电比值降低（P＜0.05）。结论膝骨关节炎患者患侧股四头肌的协调性减退。     

Delayed onset of electromyographic activity of vastus medialis obliquus relative to vastus lateralis in subjects with patellofemoral pain syndrome

OBJECTIVE: To determine whether electromyographic (EMG) onsets of vastus medialis obliquus (VMO) and vastus lateralis (VL) are altered in the presence of patellofemoral pain syndrome (PFPS) during the functional task of stair stepping. DESIGN: Cross-sectional. SETTING: University laboratory. PATIENTS: Thirty-three subjects with PFPS and 33 asymptomatic controls. INTERVENTIONS: Subjects ascended and descended a set of stairs-2 steps, each 20-cm high-at usual stair-stepping pace. EMG readings of VMO and VL taken on middle stair during step up (concentric contraction) and step down (eccentric contraction). MAIN OUTCOME MEASURES: Relative difference in onset of surface EMG activity of VMO compared with VL during a stair-stepping task. EMG onsets were determined by using a computer algorithm and were verified visually. RESULTS: In the PFPS population, the EMG onset of VL occurred before that of VMO in both the step up and step down phases of the stair-stepping task (p <.05). In contrast, no such differences occurred in the onsets of EMG activity of VMO and VL in either phase of the task for the control subjects. CONCLUSION: This finding supports the hypothesized relationship between changes in the timing of activity of the vastimuscles and PFPS. This finding provides theoretical rationale to support physiotherapy treatment commonly used in the management of PFPS.     

小腿假肢对线对膝关节肌肉活动特性的影响

目的：研究小腿假肢对线对患者站立状态下膝关节肌肉活动特性的影响。探索最优对线的生物力学依据。方法：针对矢状面不同的对线角度，采用NoraxonTM TeleMYO 2400R表面肌电信号采集系统，测量健侧和残侧有关的10组肌肉的表面肌电信号。结果：为保持站立状态下膝关节稳定，残侧股二头肌和股内侧肌的等张收缩程度高于健侧：调整矢状面对线角度会改变健侧的腓肠内、外肌和残侧股内、外侧肌的收缩程度，当腿管相对于接受腔的屈伸角从一60增大＋60到时．以上肌肉的表面肌电绝对平均值变化幅度达一倍以上。而双侧股二头肌、健侧股四头肌肌群收缩程度几乎不变。结论：小腿假肢矢状面对线对患者站立状体下膝关节肌肉和健侧踝关节肌肉活动特性影响明显，以上结果为假肢的优化对线提供了直观定量的生物力学依据．可以结合残侧承重线、足底压力的分析，寻找指导对线的原则。