腓肠肌内外侧硬度与跟腱硬度的相关性研究

摘要目的：使用新型软组织弹性触诊仪（MyotonPRO）对健康受试者的跟腱硬度进行信度研究,探究腓肠肌内侧、外侧硬度与跟腱硬度相关性。方法：招募40例健康受试者,测试者A、B使用MyotonPRO对受试者跟腱硬度进行测量,测量点为根骨结节上方2cm（AT-2）和4cm（AT-4）,测试者A单独对腓肠肌硬度进行测量。分别计算了测试者之间及同一测试者前后测试指标的组内相关系数（ICC）、最小检测变化值（MDC）及肌肉硬度与肌腱硬度之间的相关系数。结果：测试者之间以及同一测试者前后所测指标信度良好（ICC=0.86—0.93）。踝关节中立位时,腓肠肌内、外侧与AT-4硬度的相关性分别为0.60和0.49（P＜0.05）,腓肠肌内侧与AT-2硬度的相关性为0.36（P＜0.05）,腓肠肌外侧与AT-4硬度无相关性（P＞0.05）。踝关节背屈10°位时,仅腓肠肌外侧与跟腱AT-4硬度存在相关性,相关系数为0.34（P＜0.05）。结论：MyotonPRO测量跟腱硬度的可信度较高,腓肠肌内、外侧肌肉硬度与跟腱硬度的相关性具有一定差异,并且受踝关节角度变化的影响。     

Effects of glenohumeral rotations and translations on supraspinatus tendon morphology

OBJECTIVE: The purpose of this study was to evaluate the effects of glenohumeral rotations and humeral head translations on supraspinatus tendon morphology. DESIGN: A convenience sample of cadaver shoulders was used to measure supraspinatus tendon shape and dimensions from MRI images. BACKGROUND: Epidemiological evidence has indicated that shoulder elevation and external rotation may be risk factors for rotator cuff tendon pathology, but little is known about how these postures affect tendon morphology. METHODS: Measurements of supraspinatus tendon morphology were made from three-dimensional reconstructions based on T2-weighted fast spin-echo magnetic resonance images. Seven cadaver arms were imaged at neutral, 45 degrees external and 45 degrees internal rotations at 0 degrees, 30 degrees, and 60 degrees of glenohumeral abduction. Measurements of the anterior, middle, and posterior portions of the tendon were made using ANALYZE software. RESULTS: The supraspinatus tendon was twisted at the muscle-tendon junction of the middle and posterior portions in 45 degrees external and 45 degrees internal axial rotations of the humerus, especially over 30 degrees of abduction. Abduction over 30 degrees shortened the entire supraspinatus tendon. External and internal rotation motions elongated the anterior and posterior portions, respectively. CONCLUSIONS: Arm posture affects morphology of the supraspinatus tendon. RELEVANCE: The results support the epidemiologic evidence linking external rotation and abduction to supraspinatus tendon disorders.     

关节镜下两种缝合方案在冈上肌腱损伤患者中的应用效果对比

目的比较关节镜下两种缝合方案在冈上肌腱损伤患者中的应用效果。方法选取2015年1月-2018年4月该院收治的136例冈上肌腱损伤患者为研究对象,将患者依据1∶1比例随机分为对照组(n=68)和观察组(n=68)。对照组患者采用关节镜下单排改良Mason-Allen缝合技术修复,观察组采用关节镜下改良缝合桥技术修复。比较两组患者肩关节活动度、视觉模拟评分(VAS)、美国肩肘外科协会评分(ASES)和Constant评分。结果治疗前两组患者肩关节内旋、外旋、前屈和外展情况、静息VAS、活动VAS评分、ASES评分和Constant评分比较均无明显差异(P0.05);治疗后两组患者的肩关节内旋、外旋、前屈和外展情况、静息VAS、活动VAS评分、ASES评分和Constant评分较治疗前均明显改善,且观察组优于对照组,差异有统计学意义(P 0.05)。结论冈上肌腱损伤患者经单排改良Mason-Allen缝合技术修复及改良缝合桥技术修复均能够有效缓解疼痛,改善肩关节活动度和功能,且改良缝合桥技术修复效果更佳。     

The influence of lipid-extraction method on the stiffness of articular cartilage

BACKGROUND: One of the known characteristics of osteoarthritis is the loss of articular cartilage lipids. Therefore, it is important to study how lipids influence the functions of the tissue. This can only be done successfully by indirect analysis involving the extraction of lipids and subsequent assessment of the delipidized matrix. Therefore, for accuracy, the procedure for lipid extraction must not induce any other modification in the samples to be assessed. Hence, we compare three rinsing agents and methods in this study. METHODS: Normal and delipidized articular cartilage samples were tested under compressive loading at 4 loading velocities to obtain and compare their stiffness values. FINDINGS: Chloroform rinsing resulted in a 45% decrease in the stiffness of cartilage at low strain-rates (10(-2)/s and 10(-1)/s) on average with a corresponding increase of 55% at higher strain-rate of 10/s relative to the normal. Ethanol rinsed cartilage exhibited a corresponding decrease of 40% at the low strain-rates while exhibiting an increase of about 20% at the highest loading rates. Propylene glycol rinsing resulted in a decrease of approximately 20% in stiffness, while an increase of up to 5% at high rates of loading. INTERPRETATION: The loss of lipids modifies the stiffness of articular cartilage at all loading rates. The relatively larger deviation of the stiffness of chloroform-rinsed samples relative to the normal is probably a consequence of the drying process involved in rinsing protocol. It is probable that the results of milder rinsing agents, used without vacuum drying, are more reflective of physiological delipidization effects on the tissue. Consequently, we recommend propylene glycol and its associated protocol for extracting lipids from articular cartilage.     

实时超声检查与磁共振成像诊断冈上肌腱撕裂的对比研究

目的评价实时超声检查与磁共振成像(MRI)对冈上肌腱撕裂病变的诊断价值。方法回顾性分析2003年1月至2008年1月间经手术证实冈上肌腱撕裂且临床资料完整的70例患者的实时超声检查及MRI检查资料,以开放手术或肩关节镜术中结果作为金标准,比较两种检查方法的有效性。结果 70例冈上肌腱撕裂,术前实时超声检查诊断65例,MRI诊断67例。实时超声检查诊断冈上肌腱撕裂的敏感性、特异性、阳性预测值、阴性预测值及准确性分别为92.8%、82.1%、92.8%、82.1%及89.8%。MRI诊断冈上肌腱撕裂的敏感性、特异性、阳性预测值、阴性预测值及准确性分别为95.7%、85.7%、94.4%、88.9%及92.9%。经χ2检验,冈上肌腱撕裂实时超声检查的有效性与MRI检查的有效性无统计学差异(χ2=0.09,P0.05)。结论实时超声检查与MRI同样能够准确地诊断冈上肌腱撕裂,可作为冈上肌腱检查的首选影像学方法 。     

Elasticity of the supraspinatus tendon-muscle unit is preserved after acute tendon tearing in the rabbit

Supraspinatus tendon tearing is one of the most common causes of the shoulder pain and dysfunction, which often requires a surgical repair. In this situation, proximal tendon stump is usually retracted medially from its original insertion. For successful reduction of the retracted tendon stump to its original insertion, the elasticity of the tendon-muscle unit should be preserved by the time of surgery. The purpose of the present study was to clarify the chronological changes in the elasticity of the supraspinatus tendon-muscle unit after acute tendon tearing to determine the optimal timing for the surgery. Right supraspinatus tendon was detached (detached side) in 40 male Japanese white rabbits, with left shoulders served as controls (control side). Eight animals were euthanized at 3 days and 1, 2, 4, or 8 weeks after surgery. Tissue sound speed that closely correlates to its elasticity was measured with a scanning acoustic microscope. In the supraspinatus tendon, tissue sound speed at 3 days after surgery was 1691.1 m/s, compared to 1714.3 m/s at the control side, but the difference was not statistically significant at any postoperative time period up to 8 weeks. In the supraspinatus muscle, tissue sound speed was not affected at all by the detachment of the tendon. The present study indicated that the elasticity of the supraspinatus tendon-muscle unit was well preserved for 8 weeks after the detachment. In the clinical practice, the retracted supraspinatus tendon stump could be repaired without excessive tension by 8 weeks from the acute tendon tearing.     

US appearance of partial-thickness supraspinatus tendon tears: Application of the string theory. Pictorial essay

The supraspinatus tendon is composed of 5 different layers consisting of intertwining bundles. On a front portion of the tendon, the layers become coated bundles which insert on the trochanter. At the insertion, the superficial or bursal surface of the tendon corresponding to the tendon fibers in contact with the subacromial bursa can be distinguished from the deep surface corresponding to the fibers in contact with the glenohumeral joint. A tendon tear may involve partial or total disruption of the tendon fibers and is called full-thickness tear if it affects the entire tendon, and partial-thickness tear if it involves only part of the tendon. Partial-thickness tears of the supraspinatus tendon include lesions of the superficial, deep and central surface or tendon delamination.A contrast enhanced examination requires injection of contrast agent into the joint (arthrography followed by computed tomography (CT) or magnetic resonance imaging (MRI)) to study the deep surface, and injection into the subacromial bursa (bursography followed by CT) to study the superficial surface. MRI and ultrasound (US) examination allow the study of these different tendon layers without the use of contrast agent (which is not possible at CT).     

髋臼骨折合并髋臼关节面压缩缺损的治疗策略

目的探讨治疗髋臼骨折合并髋臼关节面压缩缺损的手术方法与措施。方法1997年7月至2005年2月，收治复杂性髋臼骨折合并髋臼关节面压缩缺损43例，其中复杂骨折与缺损34例，简单骨折与缺损9例。缺损体积3～9cm^3．平均4．5cm^3。采用改良髋臼入路，通过髋臼碎骨关节面整复法，自体髂骨髋臼后壁解剖性重建法重建髋臼关节面，应用髋臼三维记忆内固定系统（ATMFS）固定碎骨块，自体骨＋人工骨填塞骨缺损，骨腊隔离法预防异位骨化等相关措施。术后随访5～86个月，平均15．7个月。结果髋臼骨折关节面粉碎填补压缩体积至头臼解剖复位31例，自体髂骨后壁解剖性重建头臼解剖复位12例；40例平均5．3月伤侧髋关节功能达到健侧水平；1例股骨头缺血性坏死；2例异位骨化合并股骨头缺血性坏死导致髋关节骨性融合。结论该方法与措施有效地提高了股骨头与髋臼解剖对应率，为髋关节功能的恢复提供了新的思路。     

Strain on the repaired supraspinatus tendon during manual traction and translational glide mobilization on the glenohumeral joint: a cadaveric biomechanics study

There has been no report on the mechanical effects of joint mobilization on rotator cuffs. The purpose of this study was to determine whether it is safe to use grade 3 joint mobilization techniques after rotator cuff repair. Nine fresh frozen cadaveric shoulders were used in this study. The strains on the artificially repaired supraspinatus tendon during joint mobilization were measured at 0 degrees and 30 degrees of shoulder abduction and were compared with those at the maximal stretching position and relaxing position. Additionally, gap distances were measured during this experiment. The strain at 30 degrees of abduction of the repaired tendon during each joint mobilization was significantly smaller than that at 0 degrees abduction (P<0.05). At 30 degrees of abduction, the strain during joint mobilization was not statistically different from that of the shoulder in the relaxing position, except during the inferior glide technique. Gap distances were 0mm at 30 degrees , while the distances were 1.06-1.46 mm at 0 degrees. Our findings suggest that joint mobilization techniques, except inferior glide, can be performed safely without significantly straining the repaired tendon at 30 degrees of abduction, if rotator cuff repair is performed at 0 degrees of abduction.     

不同运动方式引起关节软骨改变的病理研究

目的研究不同方式的运动训练对骨性关节炎关节软骨改变的影响。方法以新西兰白兔 60只为研究对象,管型石膏固定的方法建立 OA动物模型,随机分为制动 4周组（ A组）,制动 8周组（ B组）。从组织形态学方面观察不同运动方式对不同 OA病理分期的作用效果。结果制动 4周时,软骨表面不平滑,部分软骨细胞退变坏死,制动 8周时病变加重,软骨表面纤维化,软骨细胞明显退变并减少。制动可引起软骨退变,但退变关节软骨在运动中有重塑的能力。结论适宜的运动可使 OA关节软骨早期病变逆转,对晚期关节软骨退变只起减轻和延缓作用。     

Evaluation of supraspinatus muscle changes in the shoulder joint of stroke patients with hemiplegic and shoulder subluxation using ultrasonography: comparison between affected and unaffected sides

[Purpose] The shoulder joint has a very unstable structure yet a significantly wide range of motion. Weakness of the muscles around the shoulder joint may cause shoulder joint subluxation. This study aimed to determine changes in supraspinatus muscle thickness between different shoulder abduction angles using ultrasonography and to compare differences in supraspinatus muscle thickness changes between the affected and unaffected sides depending on shoulder joint subluxation. [Participants and Methods] Forty hemiplegic patients with stroke were recruited (20 patients with and 20 without shoulder subluxation). Using ultrasonography, we measured supraspinatus muscle thickness at three shoulder joint abduction angles and calculated the differences in supraspinatus muscle thickness. Depending on subluxation, we separately analyzed the thickness and variations in the supraspinatus muscle on both the affected and unaffected sides. [Results] In stroke patients with shoulder subluxation, the difference in supraspinatus muscle thickness was significantly less in the affected side than in the unaffected side. [Conclusion] The thickness and rate of supraspinatus muscle thickness change was significantly less in the affected side than in the unaffected side in stroke patients with shoulder subluxation.     

Concurrent validity and intrarater reliability of two ultrasound-based methods for assessing patellar tendon stiffness

IntroductionAssessment of tendon stiffness in vivo traditionally involves maximal muscle contractions, which can be challenging in pain populations. Alternative methods are suggested, although the clinimetric properties are sparse. This study investigated the concurrent validity and the intrarater reliability of two ultrasound-based methods for assessing patellar tendon stiffness.MethodsPatellar tendon stiffness was assessed in 17 healthy adults with (a) the dynamometer and B-mode ultrasonography method (DBUS) and (b) the strain elastography method. Correlations between the two methods were analysed using Kendall’s Tau-b. The relative reliability of both methods was evaluated using intraclass correlation coefficient (ICC). The absolute reliability was presented by Bland–Altman plots, standard error of measurement (SEM) and minimum detectable change (MDC).ResultsNo correlation was found between the two methods, irrespective of reference tissue in strain elastography (Kendall’s Tau-b Hoffa = –0.01 (p = 1.00), Kendall’s Tau-b subcutis = 0.04 (p = 0.87)). Tracking of the tendon elongation in the DBUS method had good to excellent relative reliability (ICC = 0.95 (95% confidence interval – CI: 0.85–0.98)) and high absolute reliability (SEM = 0.04 mm (1%), MDC = 0.11 mm (3%)). The strain elastography method had good to excellent relative reliability, regardless of reference tissue (ICC Hoffa = 0.95 (95% CI: 0.86–0.98), ICC subcutis = 0.94 (95% CI: 0.82–0.98)), but low absolute reliability (SEM Hoffa = 0.06 (20%), MDC Hoffa = 0.18 (60%), SEM subcutis = 0.12 (41%), MDC subcutis = 0.32 (110%)).ConclusionsNo concurrent validity existed for DBUS and strain elastography, suggesting that the two methods measure different tendon properties. The overall reliability for the DBUS method was high, but the absolute reliability was low for strain elastography stiffness ratios. Therefore, the strain elastography method may not be recommended for tracking differences in patellar tendon stiffness in healthy adults.     

脑卒中患者瘫痪侧别对功能恢复预后影响的分析

目的:探讨脑卒中患者不同瘫痪侧别对功能预后的影响,为临床康复策略的制订提供理论基础。方法:脑卒中患者278例,分为两组:利手侧瘫痪组和非利手侧瘫痪组;两组都予以规范的三级康复治疗,分别于入选时、第1个月末、第3个月末和第6个月末进行瘫痪侧肢体功能评定(Brunnstrom分期、Fugl-Meyer评定)和生活功能评定(生存质量评定、日常生活活动能力评定和综合功能评定)。结果:利手侧瘫痪组和非利手侧瘫痪组患者在各次随访时的瘫痪侧肢体功能无明显差异(P0.05);利手侧瘫痪组和非利手侧瘫痪组的患者在各次随访时的生活功能有明显差异(P0.05),其中非利手侧瘫痪组的患者生活功能更好。结论:非利手侧瘫痪组的脑卒中患者生活功能的恢复进程和预后要优于利手侧瘫痪组的患者;而非利手侧瘫痪组与利手侧瘫痪组对脑卒中患者瘫痪侧肢体功能的恢复速度和预后无影响。     

The rise and fall of cot sides

Some researchers have questioned the use of cot sides, citing evidence that the incorrect use of them might be considered dangerous and even unethical. This article looks at some of the literature on the subject and discusses the results of an audit which was carried out in a large district general hospital last year.