颈椎病理疗疗效评定的探讨

为了寻求颈椎病理疗疗效的客观指标,本文观察了164例颈椎病患者理疗前、后脑血流图、甲皱微循环、热象图、电诊断各参数的变化。结果表明:理疗后由于临床症状和体征的改善,血流图的波幅增高,流入时间指数缩短(P<0.05)。甲皱毛细血管管袢数增加,血流速度加快。热象图上见到脊柱两侧皮肤温度曲线由不对称趋于对称。尺、挠神经的时值患侧大于健侧,但治疗前后无明显改变。通过观察初步认为:脑血流图、甲皱微循环、热象图检查可以做为评定颈椎病疗效的客观指标。而电诊断的时值测定可做为判断颈椎病患者有无神经肌肉兴奋性改变的指标。     

神经根型颈椎病患者与正常人握力测量的对照研究

目的 探讨电子握力计在神经根型颈椎病患者与正常人中握力测试的重复信度,比较正常人与颈椎病患者最大握力及10 s持续握力耐力的差异.方法 对26例神经根型颈椎病患者及20名正常人分别进行2次最大握力测试和单次10 s持续握力测试.结果 正常人2次重复的最大握力的组内相关系数(ICC)为0.947～0.989,神经根型颈椎病患者ICC为0.903～0.960.正常人最大握力值大于颈椎病患者(P<0.05).神经根型颈椎病患者患侧为非利手时,非利手握力递减速度小于正常人(P<0.05).结论 电子握力计是评价正常人及神经根型颈椎病患者握力的可信工具.神经根型颈椎病患者最大握力较正常人有所减退;当患侧为非利手时,握力耐力要好于正常人的非利手.     

神经根型颈椎病神经肌电图结果140例分析

颈椎病以颈痛伴单侧上肢或双侧上肢麻表现的神经根型居多，为进一步了解颈椎病导致颈神经根损伤的电诊断情况，对140例颈椎病患的神经肌电图结果进行分析。140例颈椎病患的手麻患肢肌电图除52例诊断颈椎病根性损害外，肌电图诊断腕管综合征17例，肘管综合征3例，颈椎病根性损害伴腕管综合征3例。肌电图能正确定位诊断及排除颈椎病以外的周围神经病变。     

常规肌电图及F波传导速度量化判断手法治疗神经根型颈椎病疗效的探讨

目的探求常规肌电图及F波传导速度量化判断手法治疗颈椎病的疗效.方法对69例神经根型颈椎病患者采用常规的摩、揉、滚、拿、点按及牵拉扳按法、低头扳按法、仰头扳按法等手法治疗,同时观察治疗前后常规肌电图和F波传导速度的改变.结果经两个疗程治疗,总有效率达94.2%,随着病情的好转,肌电图复查异常自发电位减少,运动单位电位数和波幅增加,F波传导速度增快,与治疗前比较差异有非常显著性(P<0.001).结论常规肌电图及F波传导速度可作为手法治疗神经根型颈椎病诊断,反映病变程度及量化判定疗效的客观依据之一.     

握力检查在神经根型颈椎病疗效评价中的应用

目的：探索一种用于评价神经根型颈椎病（慢性期）患者治疗前后肌力变化的可行方法。方法：采用DYNAMOMETER G100型握力器测量47例发病在6个月以上的神经根型颈椎病患者治疗前后握力的变化情况。以20例单纯腰椎间盘突出症患者为对照组。结果：将对照组按时间先后分别对每例患者左右手握力检查数据进行统计学分析，结果PM）．05，未见显著性差异。将治疗组第1次和第2次握力值进行比较，P〉0．05，未见显著性差异；第2次与第3次握力值比较，P〈0．05，具有显著性差异。结论：握力检查可客观、准确的评价神经根型颈椎病（慢性期）患者的治疗效果。     

神经根型颈椎病神经肌电图结果140例分析

颈椎病以颈痛伴单侧上肢或双侧上肢麻表现的神经根型者居多,为进一步了解颈椎病导致颈神经根损伤的电诊断情况,对140例颈椎病患者的神经肌电图结果进行分析。140例颈椎病患者的手麻患肢肌电图除52例诊断颈椎病根性损害外,肌电图诊断腕管综合征17例,肘管综合征3例,颈椎病根性损害伴腕管综合征3例。肌电图能正确定位诊断及排除颈椎病以外的周围神经病变。     

最大握力检查用于颈椎病手术后疗效评定

目的：最大握力检查用于颈椎病手术后疗效评定的可行方法。方法：实验组38例颈椎病患者手术前及手术后12 h、72 h、1周、2周、1个月、3个月、0.5 a、1 a的最大握力变化情况。对照组35例正常人。结果：对照组最大握力进行统计学分析,未见统计学差异（〉0.05）。治疗组手术前、手术后均有统计学差异（P〈0.05）。结论：最大握力检查对颈椎病手术后疗效确定具有重要意义,能比较客观精确,量化和动态判断其疗效。     

综合康复疗法治疗神经根型颈椎病的疗效观察

目的观察综合康复疗法治疗神经根型颈椎病患者的临床效果。方法将确诊为神经根型颈椎病的患者随机分为综合康复组和对照组。对照组采用常规训练程序治疗,综合康复组在此基础上加用颈椎牵引、中频电疗法加按摩综合理疗等综合疗法治疗。治疗前及治疗后4周采用目测类比法（VAS）评定疼痛程度,颈椎病临床评价量表（clinicalassessmentscaleforcervicalspondylosis,CASCS）分析两组临床疗效。结果综合康复组VAS评分下降程度及CASCS评分增加程度均明显高于对照组（P〈0．05）,治疗有效率明显高于对照组（P〈0．05）。结论综合性康复治疗能显著提高神经根型颈椎病患者的治疗效果。     

神经根型颈椎病的定量感觉测定

目的:运用定量感觉检查技术对神经根型颈椎病患者的温度觉进行定量分析,以了解神经根型颈椎病患者小纤维神经的功能状态。方法:神经根型颈椎病组为2005-01/04于卫生部北京医院疼痛诊疗中心就诊,并被明确诊断为神经根型颈椎病的患者20例,其中男8例,女12例;年龄33～70(49.8±11.5)岁。所选病例均为单侧上肢出现症状(左侧10例,右侧10例),且检查前1周未进行理疗或神经阻滞治疗。对照组选择同期在疼痛诊疗中心就诊的非颈椎病患者及志愿者20例,其中男8例,女12例;年龄23～75(49.7±14.7)岁。应用神经感觉定量分析仪界限法检查双上肢大鱼际掌侧冷感觉、热感觉、冷痛觉、热痛觉阈值。结果:20例神经根型颈椎病患者和20例对照者,均进入结果分析。①神经根型颈椎病组患侧冷感觉阈值低于健侧,热感觉阈值高于健侧[(29.00±1.26)℃,(30.00±1.06)℃;(35.04±0.87)℃,(34.14±0.99)℃,P<0.05]。冷痛觉和热痛觉阈值患侧与健侧比较,差异无显著性(P>0.05)。②神经根型颈椎病组患侧与健侧阈值之差和对照组双侧阈值之差进行比较可见:冷感觉、热感觉、冷痛觉和热痛觉差异均有显著性[(-1.01±0.57)℃,(0.04±0.28)℃;(0.89±0.39)℃,(0.05±0.26)℃;(2.49±1.10)℃,(0.28±1.79)℃;(-1.62±0.86)℃,(0.17±1.10)℃,P<0.01]。颈椎病组患侧冷感觉和热痛觉阈值比健侧低,热感觉和冷痛觉阈值比健侧高。结论:神经根型颈椎病患者感觉障碍发生率显著增高。主要形式为温度觉减退和痛觉过敏,提示C类和Aδ类神经纤维出现功能障碍。     

腹针治疗神经根型颈椎病观察及护理

颈椎病是临床常见病,其发病率有逐年增高趋势,其中以神经根型颈椎病发病率最高,占60％～70％,主要是压迫和刺激单侧或双侧神经根而产生的症状与体征,I临床表现为颈痛并向肩部和同侧上肢放射,颈部僵硬,活动受限,积久累及上肢麻木、手部肌肉萎缩。我院2004年10月～2006年8月共收治95例神经根型颈椎病患者,经腹针治疗后疗效满意,现总结如下。     

Outcome of surgery for cervical radiculopathy evaluated by determination of trapezius muscle microcirculation and electromyography.

Surgery for cervical radiculopathy was evaluated in 27 patients after anterior Cloward procedure (19 patients) or posterior decompression (eight patients). In addition, we examined 10 conservatively treated patients. Each patient was studied prospectively with regards to the effects on microcirculation in the local trapezius muscle during a fatiguing series of stepwise increased contractions. The right and left muscles were simultaneously examined pre-operatively and postoperatively after 9 months using laser-Doppler flowmetry and simultaneous surface electromyography (EMG). Preoperatively, a reduced microcirculation was found in the most painful side compared with the opposite side. This is in accordance with earlier reports on patients with chronic neurogenic neck pain, who also show reduced muscle tension on EMG. Postoperatively, the muscle blood flow became increased, but only in patients operated on via a posterior approach. A tendency at increased EMG-amplitude and reduced mean power frequency of the EMG was noted. These EMG signs of muscle fatigue suggest increased ability to exhaust the trapezius muscle postoperatively. The observed postoperative changes were consistently more frequent in the less painful side. We conclude from these objective measurements showing only a tendency at increased microcirculation and muscle tension postoperatively, that the effect on the trapezius muscle is limited.     

Effects of electromyographic processing methods on computer-averaged surface electromyographic profiles for the gluteus medius muscle

The objective of this study was to demonstrate how two different linear envelope detectors, as used in the quantification of surface electromyographic (EMG) signals, can lead to differences in the properties of observed computer-averaged EMG profiles. Eight healthy male subjects, aged 24 to 32 years, participated in the study. Computer-averaged EMG profiles for the gluteus medius muscle were recorded at a free-walking cadence and at stepping frequencies of 78 and 120 steps/min, using detectors with 3- and 25-Hz cutoff frequencies simultaneously. The 3-Hz filtered EMG profiles proved to be smoother, to exhibit a significantly lower cycle-to-cycle variability, and to have a greater time lag with respect to the original unprocessed EMG signal than the 25-Hz filtered EMG profiles. The observed intersubject variability also was lower for the 3-Hz filtered EMG profiles than for the 25-Hz filtered EMG profiles. The results indicate that comparison of EMG profiles recorded with different detectors is difficult. A standard detector may solve this difficulty.     

表面肌电图用于腰椎间盘突出症疗效评定的研究

目的　采用表面肌电图检测技术对腰椎间盘突出症疗效评定的作用进行初步探讨。方法　腰椎间盘突出症 3 7例 ,其中男性 2 1例 ,女性 16例 ,年龄 2 0～ 61岁 ,平均 3 9.46± 11.5岁 ,接受腰骶部透热治疗、腰牵、推拿及经络导平等综合物理治疗。在入院时及住院治疗一月后 ,受试者分别接受腰背肌等长收缩测试 ,取俯卧位 ,下半身固定 ,嘱受试者用力保持上半身与下半身在同一水平面 ,此测试持续至受试者不能耐受为止 (以上半身开始向下偏离水平面为标准 ) ,同时用芬兰ME3 0 0 0P型表面肌电图仪记录肌电图 ,测试患侧与健侧骶棘肌和多裂肌等腰脊旁肌的表面肌电图中位频率的斜率 (MFslope ,MFs) ,平均肌电图波幅。结果　治疗后 ,2 9例症状缓解 ,患侧MFs的衰减降低 ,与治疗前比较差异显著 (P <0 .0 5 ) ,健侧MFs的衰减无显著改变 ;治疗后 ,平均EMG波幅健侧无显著改变 ,患侧波幅有增高趋势 ,但差异无显著性。 8例症状未缓解患者 ,健、患侧差异显著 ,治疗前后MFs及平均EMG波幅差异无显著。本组 13例病人 ,治疗后作CT检查 ,无 1例显示腰椎间盘回纳。结论　表面肌电图可用作腰椎间盘突出症临床疗效评定的客观指标之一 ,具有较好的临床应用价值。     

肌电图评价腰椎间盘突出症的临床价值

背景：肌电图对腰椎间盘突出症患者的诊断、治疗方法选择及治疗效果有客观的评价作用,并且在神经病变恢复的评定中具有客观、准确、定量等的作用。目的：总结近年来肌电图在腰椎间盘突出患者诊断、治疗方法效果评定中所起的作用。方法：以LDH,Lumbar disc herniation,sEMG,EMG为检索词,检索Pubmed数据库（1990-01,2010-10）,以腰椎间盘突出症,肌电图为检索词,检索中国期刊全文数据库（1998-01／2010-10）,文献检索语种限制为英文和中文。纳入肌电图及腰椎间盘突出症相关的内容。排除重复性研究。结果与结论：通过34篇文献对肌电图在腰椎间盘突出症患者诊断以及疗效评估上的作用进行分析。不仅常规肌电图在腰椎间盘突出患者的诊断、疗效评价、治疗方法的选择具有客观的作用,表面肌电图也具有同样的作用,但是表面肌电图的干扰因素较多,所以把表面肌电图大规模应用在临床上还有很长的路要走,需进行进一步的研究。     

Surface diaphragmatic electromyogram changes after laparotomy

The aim of this human study was to objective cliaphragmatic electromyogram (EMG) changes after supraombilical laparotomy. The surface diapbragmatic FMG was recorded in patients (before and after laparotomy), and in healthy volunteers, during standardized inspiratory efforts sustained at -30 cmH2O (Muller manoeuvres). The quantitative EMG analysis showed significant postoperative modifications: the root mean square (RMS) increased and the median frequency (ME) decreased. These modifications are compatible with an altered diaphragmatic excitability and/or a reduced central drive to the diaphragm.     

Surface electromyography apparatus as a measurement device for biofield research: results from a single case study

OBJECTIVES: The objective of this preliminary investigation was to determine if surface electromyography (EMG) equipment is capable of detecting electrical signals that can be used as a measure in biofield research. DESIGN: These preliminary data were collected from one subject (a member of the research team), using the subject as his own control. Resting state data are compared to data collected during a specific Healing Touch (HT) intervention. SETTINGS/LOCATION: The setting was in an electromagnetically shielded room (a modular enclosure utilizing two separate conductive electromagnetic barriers, which were electrically isolated, attached by a single-point ground connection) at the University of Wisconsin-Milwaukee, Milwaukee, WI. INTERVENTION: Data were collected during a resting state, and subsequently during a partial "HT back sequence." The back sequence is a standard HT procedure consisting of "Connecting the Lower Body," "Open Spinal Energy Flow," a "Vertebral Spiral Technique," and other techniques taught in HT level 2. MEASURES: Electrodes were attached to the back of the subject at eight acupoints. The Model 544 EMG System (amplifier and electrode assembly) (Therapeutics Unlimited, Inc. Iowa City, IA) was used to acquire data. The raw data were divided into discrete time segments and converted from the time domain into the frequency domain by performing a fast Fourier transform. Integer frequency averaging was conducted to allow for ease of interpretation. Using the voltages at each frequency, the signal strength was calculated in decibels. RESULTS: A 0-65 Hz frequency spectrum was obtained from the surface EMG apparatus. An averaged baseline, "resting state" frequency spectrum was definable for the subject that was stable with time for signal strengths >0 dB. When the HT practitioner attuned with the subject, higher frequency components of the spectrum increased in amplitude, peaked, then decreased throughout the intervention. CONCLUSIONS: The conclusions drawn from these results is that the surface EMG apparatus has potential as a measurement device for biofield research. Further experimentation using this device for biofield measurement is encouraged.     

Relationship between wire EMG activity,muscle length,and torque of the hamstrings

OBJECTIVE: To determine the effect of change of muscle length on the torque and wire electromyographic activity of six knee flexor muscles. DESIGN: Maximum isometric knee flexion torque and wire EMG data were collected at nine different positions. BACKGROUND: In vivo EMG-length-tension relationship is difficult to determine because of the interaction between muscle length and moment arm. The study of two-joint muscles allows the change of muscle length at one joint while preserving stable mechanical relationships at the other. This model facilitates understanding of length-tension and EMG-length relationship in vivo. METHODS: Nineteen subjects performed maximum isometric knee flexion contraction at nine positions of varying hip and knee angles. Wire EMG activity was recorded from semitendionsus, semimembranosus, long and short head of the biceps femoris, gracilis and sartorious muscles. RESULTS: As the two-joint hamstrings were lengthened, torque was significantly increased. Maximum isometric torque ranged from 257 to 716 kg cm. The ratio of the torque values to EMG activity of all muscles was increased at longer muscle lengths. A change in the muscle length of the two-joint hamstrings did not produce a consistent change of EMG activity. The short head of the biceps femoris and sartorius muscles increased their activity as the angle of knee flexion increased. CONCLUSIONS: Maximum torque of knee flexion occurs at the most lengthened position of the hamstrings. EMG activity did not consistently change with the change in muscle length. RELEVANCE: Understanding in vivo length-tension relationship and associated EMG activity is important for designing rehabilitation protocols, tendon lengthening and transfer and interpretation of EMG data.     

Activity of masticatory muscles in subjects with different orofacial pain conditions

The existence of a pathophysiological link between tonic muscle activity and chronic muscle pain is still being debated. The purpose of this retrospective, controlled study was to evaluate the electromyographic (EMG) activity of masticatory muscles in subjects with different orofacial pain conditions. The temporal and masseter EMG activity at rest and the masseteric reflex were recorded in two groups of patients with either myofascial pain (n=33) or neuropathic pain (n=20), one group of non-pain patients with disc derangement disorders (n=27) and one control group of healthy, asymptomatic subjects (n=32). The EMG activities of both muscles at rest were significantly higher in the pain patient groups compared to the asymptomatic control group. There was no significant difference between the disc derangement disorder group and the control group. The masseteric reflex amplitude was reduced in all patient groups when compared with the control group. In pain patient groups, the increased EMG activity at rest and the reduction of the masseteric reflex amplitude were equally distributed in the pain and non-pain sides. In addition, subjects presenting with bilateral pain showed higher EMG activity at rest than those with unilateral pain. These results suggested that the modulation of muscle activity was not the direct consequence of a peripheral nociceptive mechanism and seemed to indicate that a central mechanism was at work. The contrast between the increased EMG activity at rest and the reduction of the masseteric reflex amplitude may reflect modulations of motoneurones that differed in tonic versus phasic conditions in chronic pain patients.     

Correlation between electromyographic spectral changes and subjective assessment of lumbar muscle fatigue in subjects without pain from the lower back

OBJECTIVE: The purpose of this study was to correlate objective measurements of muscle fatigue in the lower back to the subject's own assessment of fatigue. DESIGN: Muscle fatigue in the lower back was assessed in healthy subjects using electromyography (EMG), endurance time and the Borg scale. BACKGROUND: Muscle fatigue, measured with EMG and endurance time, in the lower back, is significant for patients with pain in the lower back. METHODS: Fifty healthy subjects participated. EMG was detected from the lumbar extensor muscles during a modified S?rensen's test, an isometric contraction for the back extensors until exhaustion. During the test, subjects rated their subjective fatigue on a Borg CR-10 scale. RESULTS: Borg scale ratings correlated with endurance time (0.68) and EMG median- and mean power frequency slopes (0.41-0.50). At a Borg rating of 3, median- and mean power frequency and endurance time were reduced by 30%. At a Borg rating of 5, median- and mean power frequency and endurance time were reduced by 50%. At a Borg rating of 7, median- and mean power frequency and endurance time were reduced by 60-70%. CONCLUSIONS: Significant correlation between the Borg scale, EMG and endurance time suggests a close relationship between subjective and objective assessment of muscle fatigue.     

Associations between pain and neuromuscular activity in the human jaw and neck muscles

The aim of this study was to test the effects of glutamate-evoked jaw or neck muscle pain on electromyographic (EMG) activity of jaw and neck muscles in humans. EMG recordings were made from left (MAL) and right (MAR) masseter muscles, and right sternocleidomastoid (SCM) and splenius (SP) muscles in three different head positions (head rest, head back, head right) or during maximal jaw clenching in 19 men. Glutamate (1 M) or isotonic saline was injected into MAR or SP, and induced pain was recorded on visual analogue scales. EMG activity in MAL and MAR was increased in the head back position compared to head rest and head right positions, whereas EMG activity in SCM and SP was progressively increased as the head was moved from rest position to head back to head right positions. Glutamate-evoked MAR pain was associated with increases in EMG activity in MAR, SCM and SP at rest but not in the head back or head right positions. Glutamate-evoked SP pain was associated with an increase in SP EMG activity at rest and a decrease in SCM EMG activity in the head right position. Decreases in jaw clench-related EMG activity were observed in MAL, MAR and SCM muscles only during glutamate-evoked MAR pain. Isotonic saline injections induced no pain or EMG changes. In conclusion, experimental neck pain is not associated with tonic increases in jaw EMG activity although jaw muscle pain can be linked to increases in neck EMG activity with the head and jaw at rest.