胸锁乳突肌表面肌电图的研究

目的：记录胸锁乳突肌不同体位姿势时的表面肌电图以评估其疲劳的发生及临床意义。方法：采用表面肌电图仪,用双电极引导法对8名健康受试者的胸锁乳突肌进行等长收缩和屈伸疲劳状态下的检测。观察指标为中位频率（MF）和平均功率频率（MPF）。在头平视、头前屈、头后伸、深吸气、头旋转、头强力前屈等姿势下记录右侧胸锁乳突肌的表面肌电图。结果：头平视位60s时MF为33.00±2.12,MPF为51.00±4.33; 头前屈位60s时MF为28.50±1.51,MPF为58.00±3.13;头后伸位60s时MF为23.00     

悬吊运动训练对慢性颈痛患者胸锁乳突肌表面肌电的影响

目的:利用表面肌电评估慢性颈痛患者在悬吊运动疗法(sling exercise therapy,SET)与传统姿势性训练治疗前后胸锁乳突肌的肌电变化,间接反映颈深屈肌的功能,来客观的评价SET的治疗效果。方法:本研究选取2013年1月—2013年6月我院门诊收治的14例入组慢性颈痛患者作为研究对象。将其随机分为两组,其中SET组8例,对照组6例。分别在治疗前和治疗4周后对受试者在头颈屈试验(craniocervical flexion test,CCFT)下进行双侧胸锁乳突肌表面肌电测量,取均方根值,标准化后进行统计学比较。其他的评估方法包括颈椎功能障碍指数(neck disability index,NDI)、视觉模拟评分法(visual analogue scale,VAS)。评估过程采用盲法。结果:两组数据在年龄、身高、体重、病程、VAS、NDI上差异均无显著性意义(P0.05),具有可比性。结果发现试验前SET组与对照组之间CCFT的各阶段胸锁乳突肌标准化均方根值(root mean square,RMS)均无显著性差异(P0.05)。而两组治疗后在22mm Hg时SET组RMS值为3.78±3.12,对照组为3.73±2.63;24mm Hg时SET组RMS值为6.77±6.02,对照组为12.31±7.74;26mm Hg时SET组RMS值为8.90±7.19,对照组为22.26±10.57;28mm Hg时SET组RMS值为13.67±10.18,对照组为24.59±10.39;30mm Hg时SET组RMS值为15.58±8.75,对照组为33.14±11.18,除22mm Hg外,各阶段P值均小于0.05,具有显著性差异。结论:SET对于慢性颈痛患者的治疗要明显优于姿势运动训练,SET可以使胸锁乳突肌在CCFT试验中的异常兴奋性减低,从而间接说明了颈深肌群被激活。     

颈髓损伤患者颈肩部残存肌力与呼吸功能恢复的关系北大核心CSCD

目的观察颈髓损伤患者颈肩部残存肌力与呼吸功能的相关性。方法 2015年1月至2016年6月,30例创伤性颈髓损伤患者于损伤后5周、24周检查患者胸锁乳突肌、斜方肌、三角肌肌力,进行感觉、运动功能评分,检测肺功能。结果间断脱机患者三角肌肌力与肺活量在伤后5周、24周呈正相关(r>0.806,P<0.05),感觉评分在伤后5周存在相关性(r=0.914,P<0.01),运动评分(r=0.979,P<0.001)、斜方肌肌力(r=0.894,P<0.01)在伤后24周存在相关性。结论颈肩部残存肌力,特别是三角肌肌力对颈髓损伤患者呼吸功能有一定影响。     

SET与传统姿势性训练治疗前后慢性颈痛患者胸锁乳突肌的肌电变化情况观察

选取2015年1月~2016年5月于我院收治的46例慢性颈痛患者,随机分为观察组和对照组各23例。对照组患者单纯行传统姿势性训练,观察组患者在对照组的基础上给予SET疗法,并于治疗前后行表面肌电图测定。治疗前,两组患者五个阶段胸锁乳突肌的均方根值比较无明显差异(P0.05),治疗后,观察组各阶段均方根值均下降(P0.05),与对照组比较,差异明显(P0.05);两组患者疼痛评分于治疗前比较无明显差异(P0.05),治疗后,观察组评分明显低于对照组(P0.05)。SET疗法在治疗慢性颈痛的疗效优于传统姿势性训练。     

超声诊断右颈部淋巴管瘤1例

患者,男性,26岁,因发现右颈部无痛性肿块2年来院就诊。体检:右颈上部下颌角下缘可扪及一30mm× 40mm肿块,质中偏软,界欠清,无压痛,活动度差,位置较深,位于胸锁乳突肌深面。右侧咽壁(-)。     

非手术脊柱减压系统牵引与普通牵引对颈棘旁肌表面肌电信号的影响

目的观察非手术脊柱减压系统（SDS）牵引及普通牵引对颈棘旁肌表面肌电信号的影响。 方法随机选取健康青年志愿者22例,采用SDS和普通牵引对受试者进行测试,不同测试间需相隔24h以上,测试时利用表面肌电图仪对受试者双侧颈棘旁肌肌电活动的波幅均值及波幅峰值进行记录,观察受试者在坐立位和平卧位时不同牵引阶段的表面肌电信号变化。 结果与左侧颈棘旁肌比较,右侧颈棘旁肌的波幅均值及波幅峰值均有不同程度变化,但差异无统计学意义（P&rt;0.05）。普通牵引时,坐立位牵引中及牵引后的波幅均值及波幅峰值均低于牵引前（P<0.05）,左侧颈棘旁肌坐立位牵引后的波幅均值［（17.91±4.06）μV］及波幅峰值［（21.00±4.74）μV］高于坐立位牵引中的波幅均值［（12.91±2.89）μV］及波幅峰值［（16.45±4.19）μV］（P<0.05）,右侧颈棘旁肌坐立位牵引后的波幅均值［（17.55±3.22）μV］及波幅峰值［（21.73±4.17）μV］亦高于坐立位牵引中的波幅均值［（14.00±2.86）μV］及波幅峰值［（16.09±3.13）μV］（P<0.05）。SDS牵引下,与同侧颈棘旁肌坐立位牵引前比较,受试者平卧位牵引前、平卧位牵引中、平卧位牵引后及坐立位牵引后的波幅均值、波幅峰值均降低,差异有统计学意义（P<0.05）。平卧位牵引中、平卧位牵引后的波幅均值、波幅峰值均较同侧颈棘旁肌平卧位牵引前低（P<0.05）,坐立位牵引后的波幅均值、波幅峰值较平卧位牵引前高（P<0.05）。与平卧位牵引中比较,同侧颈棘旁肌平卧位牵引后、坐立位牵引后的波幅均值及波幅峰值较高（P<0.05）。坐立位牵引后的波幅均值、波幅峰值较同侧颈棘旁肌平卧位牵引后高,差异有统计学意义（P<0.05）。 结论SDS牵引及普通牵引均能较好地放松颈部肌肉,但SDS的效果更为优异,值得临床应用、推广。     

三叉神经-颈反射检测方法的建立和正常值及在神经损伤时的评估作用

目的建立三叉神经-颈反射的肌电检测方法,测量国人正常值,探讨其临床应用。方法70例志愿者,取仰卧位,轻度收缩胸锁乳突肌,于眶下孔附近刺激,胸锁乳突肌记录。结果刺激正常受试者一侧的眶下神经,可引起双侧的正/负波。结论三叉神经-颈反射能够可靠测定,在下位脑干损伤的定位诊断中有一定作用。     

脑卒中偏瘫患者在坐位躯干旋转时躯干肌群表面肌电信号特征研究

目的:比较正常人及脑卒中偏瘫患者在躯干向左(瘫痪侧)及向右(非瘫痪侧)旋转过程中躯干浅表肌群的表面肌电信号特征。方法:选取17例脑卒中偏瘫患者及16例健康志愿者,采集2组受试者在躯干左旋(向瘫痪侧旋转)45°、右旋(向非瘫痪侧旋转)45°时腹直肌、腹外斜肌、胸段竖脊肌、腰段竖脊肌、背阔肌的表面肌电图均方根振幅(RMS)。结果:正常人在躯干向一侧旋转时对侧腹外斜肌RMS值大于转向侧(P0.01),转向侧胸段竖脊肌、背阔肌的RMS值大于对侧(P0.01);向左(瘫痪侧)旋转时脑卒中患者偏瘫侧腹外斜肌、胸段竖脊肌和背阔肌的RMS值低于正常组左侧(P0.01),非瘫痪侧腹外斜肌的RMS值低于正常组右侧(P0.01);向右(非瘫痪侧)旋转时脑卒中患者偏瘫侧腹外斜肌、胸段竖脊肌的RMS值小于正常组左侧(P0.01),偏瘫侧腰段竖脊肌的RMS值小于正常组左侧(P0.05),非瘫痪侧腹外斜肌、腰段竖脊肌和胸段竖脊肌的RMS值小于正常组右侧(P0.01)。结论:正常人在躯干旋转时胸段竖脊肌、背阔肌、腹外斜肌呈现明显的交叉性,转向侧的胸段竖脊肌、背阔肌的肌电活动明显增加,对侧的腹外斜肌肌电活动明显增加;而脑卒中患者则没有这种交叉性。     

胸锁乳突肌内侧路径行颈神经丛阻滞

颈神经丛阻滞麻醉是颈部手术的主要方法。因其止痛满意，患者清醒，易管理，安全系数大，在临床广泛应用。我院2001年3月～2007年3月对60例颈部手术患者实施二种不同路径颈浅神经丛阻滞麻醉，并进行比较，报告如下。     

头颈部弹力带渐进抗阻训练治疗慢性颈痛患者的疗效观察

目的 观察头颈部弹力带渐进抗阻训练治疗慢性颈痛患者的疗效及对患者胸锁乳突肌表面肌电（sEMG）的影响。 方法 采用随机数字表法将40例慢性颈痛患者分为观察组及对照组,每组20例。2组患者均给予传统物理治疗及药物治疗,在此基础上对照组辅以颈椎姿势训练,观察组则辅以头颈部弹力带渐进抗阻训练。于治疗前、治疗4周后分别采用疼痛视觉模拟评分法（VAS）及颈椎功能障碍指数（NDI）对2组患者进行疗效评定,同时采集患者坐位时胸锁乳突肌sEMG信号,并对其频域指标中位频率（MF）及时域指标振幅均方根值（RMS）进行比较。 结果 治疗4周后观察组患者疼痛VAS评分［（1.8±0.2）分］、NDI评分［（13.4±0.8）%］及对照组疼痛VAS评分［（2.6±0.3）分］、NDI评分［（17.4±1.2）%］均较治疗前明显改善（P＜0.05）;并且观察组疼痛VAS评分、NDI评分亦显著优于对照组水平（P＜0.05）;治疗后观察组患者颈部放松时RMS［（12.3±1.4）μＶ］、MF［（57.3±5.1）Ｈｚ］及颈部后伸时RMS［（23.3±1.7）μＶ］、MF［（49.2±4.3）Ｈｚ］均较治疗前及对照组明显改善（P＜0.05）,对照组上述肌电指标较治疗前均无明显变化（P>0.05）。 结论 头颈部弹力带渐进抗阻训练能有效减轻慢性颈痛患者疼痛,改善颈椎功能,其治疗机制可能与提高患者胸锁乳突肌抗疲劳能力及增强肌肉收缩功能有关。     

颈肩痛患者颈肩部肌肉的表面肌电图特征

背景：颈肩痛是由颈肩部软组织（主要是肌肉）的慢性劳损所引起的常见临床症状.表面肌电图是一种新型、无创的肌肉活动检查手段,能测量肌肉的活动和功能.目的：评价颈肩疼痛患者颈肩部肌肉功能,为表面肌电图的应用和颈肩疼痛患者合理防治与康复提供理论依据.方法：应用表面肌电图对32例单侧颈肩疼痛的办公室工作人员在站立下,进行低头、头后伸、双手上举时颈竖脊肌、斜方肌上支的表面肌电测试.在测试前,对患者的颈肩疼痛进行目测类比评分.然后根据收集的数据,比较受试者颈肩部疼痛侧与非疼痛侧测试肌肉的肌电活动.结果与结论：测试前,受试者颈肩疼痛目测类比评分（平均分）为5.03分;受试者在低头、头后伸、双手上举过程中,其疼痛侧的颈竖脊肌、斜方肌上支的肌电原始信号较非疼痛侧的颈竖脊肌、斜方肌上支的肌电原始信号弱;疼痛侧颈竖脊肌、斜方肌上支肌电的平均振幅值与非疼痛侧相比差异有显著性意义（P＜0.05）;疼痛侧颈竖脊肌、斜方肌上支肌电的平均频率斜率值与非疼痛侧相比差异无显著性意义（P＞0.05）.提示颈肩疼痛患者疼痛侧的颈肩肌肉的活动能力下降,长期坐位作业的办公室人员要定时进行颈肩部肌肉锻炼.     

Surface electromyography activity of trunk muscles during wheelchair propulsion

BACKGROUND: Trunk instability due to paralysis can have adverse effects on posture and function in a wheelchair. The purpose of this study was to record trunk muscle recruitment patterns using surface electromyography from unimpaired individuals during wheelchair propulsion under various propulsion speed conditions to be able to design trunk muscle stimulation patterns for actual wheelchair users with spinal cord injury. METHODS: Fourteen unimpaired subjects propelled a test wheelchair on a dynamometer system at two steady state speeds of 0.9 m/s and 1.8 m/s and acceleration from rest to their maximum speed. Lower back/abdominal surface electromyography and upper body movements were recorded for each trial. Based on the hand movement during propulsion, the propulsive cycle was further divided into five stages to describe the activation patterns. FINDINGS: Both abdominal and back muscle groups revealed significantly higher activation at early push and pre-push stages when compared to the other three stages of the propulsion phase. With increasing propulsive speed, trunk muscles showed increased activation (P<0.0001). Back muscle activity was significantly higher than abdominal muscle activity across the three speed conditions (P<0.0005), with lower back muscles predominating. INTERPRETATION: Abdominal and back muscle groups cocontracted at late recovery phase and early push phase to provide sufficient trunk stability to meet the demands of propulsion. This study provides an indication of the amount and duration of stimulation needed for a future application of electrical stimulation of the trunk musculature for persons with spinal cord injury.     

侧卧位肺功能在内科胸腔镜术中的应用价值

目的：研究侧卧位肺功能在内科胸腔镜术中的应用价值。方法：在局麻下开放性胸腔镜术。监测15例接受开放式胸腔镜术患者术前、术中、术后的呼吸、血压、心率、ECG、动脉血气、肺功能指标。结果：患者术前、术中、术后呼吸、脉搏、心率、血压、血气指标（pH值、PaO2、SaO2、PaCO2）皆无明显变化，无显著统计学差异（P〉0．05）。术中侧卧位肺功能低于术前坐位、术前侧卧位肺功能，差异均有显著统计学意义（P〈0．05）。三者相应指标均有高度相关性（校正R2〉0．90，P〈0．05）；术前侧卧位肺活量（VC）与术中肺活量（VC）、1s用力呼气容积（FEV1）和用力肺活量（FVC）高度相关。10例患者术中发生一过性ECG变化（S—T段较术前升高或降低≥0．1mV和／或出现室性早搏≥5次／min），与术中VC〈1．0L、FEV1〈0．5L高度相关（P〈0.05）。结论：开放式胸腔镜术是相对安全的，大多患者可以耐受。术前侧卧位肺功能指标与术中侧卧位肺功能高度相关，完全可以通过术前侧卧位肺功能检查来评估和预测患者术中的肺功能。术中VC〈1．0L、FEV1〈0．5L，心脏并发症可能性增加。内科胸腔镜术前应行侧卧位肺功能检查评估患者术中肺功能。     

正常青年人自然步态下肢肌的表面肌电图分析

背景:肌肉的生物电活动是人体的能动部分,可反映人体运动的功能。目的:观察和分析正常青年人在自然步态中下肢肌肉的表面肌电活动。方法:采用美国NORAXON公司生产的TELEMYO2400RG2表面肌电图仪对30例正常青年人在平地自然行走时,其双下肢股直肌、胫前肌、股二头肌和腓肠肌内侧进行测试,分析在正常步态中受试肌群表面肌电信号的变化规律。结果与结论:正常青年人平地自然步行中,其双下肢股直肌、胫前肌、股二头肌和腓肠肌内侧的肌电随步态周期呈活动与静止周期性变化,左右侧同名肌肉交替活动;平均肌电振幅、平均肌电积分、平均频率、中位频率值最大的是腓肠肌内侧,其余由大到小依次是胫前肌,股二头肌,股直肌,右左腿分布规律一致;右侧腓肠肌内侧平均肌电振幅、平均频率、中位频率值均明显低于左侧(P<0.05);受试肌的时域、频域值波动在一定范围。提示正常青年人自然步态中下肢肌群肌电活动呈节律性和右左侧交替活动;在受试肌中腓肠肌内侧的肌电活动最强;腓肠肌内侧的肌电活动存在着优势侧与非优势侧的轻度差别;下肢肌肌电活动的时域、频域值在一定范围波动。     

不同姿势颈部抗阻训练对慢性非特异性颈痛的干预研究

目的：比较不同姿势颈部抗阻训练对慢性非特异性颈痛（chronic non-specific neck pain,CNSNP）的干预效果,为CNSNP探寻一种更高效的运动疗法。方法：51例CNSNP患者（年龄41.0±5.0岁）随机分为3组：俯卧姿颈部抗阻训练组（A组,n=17）、坐姿颈部抗阻训练组（B组,n=17）和俯卧姿对照组（C组,n=17）。测试指标包括视觉模拟评分（visual analog score,VAS）、颈椎功能障碍指数（neck disability index,NDI）、颅颈角（craniocervical angle,CVA）、颈椎活动度（range of motion,ROM）和均方根振幅（root mean square,RMS）。所有指标均在干预前和干预4周后进行测量。结果：A组的干预效果优于B组和C组。A组的颈部疼痛评分（VAS）、颈椎功能障碍指数（NDI）、颅颈角（CVA）、颈椎屈曲活动度（ROM）、颈椎伸展活动度（ROM）、RMS（斜方肌上束,屈曲;胸锁乳突肌,静息;胸锁乳突肌,伸展）较B组和C组均存在显著性差异（P<0.05）。A组的RMS（...     

Cervical spine position versus e.m.g. activity in neck muscles during maximum isometric neck extension

The aim of the study was to describe the relationships between cervical spine positions and neck muscle activity during maximum isometric neck extension. Ten healthy women participated (mean age 25·6 years). Maximum isometric neck extensions were performed in 12 different neck positions with resistance applied againstthe back of the head. Surface e.m.g. was recorded from posterior neck muscles at six locations. The e.m.g. signals were rectified, low-pass filtered and normalized. The position of the upper cervical spine did not influence the e.m.g. levels, whereas the lower cervical spine positions did. The e.m.g. levels, in the cervical erector spinae/trapezius were higher in the slightly flexed lower cervical spine position than in the neutral (despite an approximately similar magnitude of muscular moment developed), when the upper cervical spine was in the neutral position. However, when the lower cervical spine was much flexed the e.m.g. level was about the same as that of the neutral lower cervical spine position (with upper cervical spine neutral). The e.m.g. levels of the splenius and the thoracic erector spinae/rhomboids varied in a similar way, but less pronouncedly. These findings are of interest for the method of normalization of e.m.g,. e.g. in studies of work postures and/or movements.     

Surface electromyography of pelvic floor muscles in healthy children. Methodological study

Pelvic floor muscle activity was recorded in ten healthy children, aged six to ten years, by using surface electromyography and a polygraph writer. The electromyograms were recorded simultaneously from four electrode pairs on the perineum and three electrode pairs on adjacent muscle groups, i.e. hip and abdominis muscles. The children performed ten different manoeuvres. Necessary prerequisites for this investigatory method include good electrode application, adequate instruction of the child and the child's adjustment to the method. Using the described procedure, it was possible to record pelvic floor muscle activity without any appreciably detectable electrical influence from adjacent muscles. The method sometimes allows selective recording of electromyographic activity between the ventral urogenital and the dorsal anal regions. Therefore both anal and urethral electrode pairs should be used to achieve functional information about the pelvic floor muscles. The envisaged method should be useful as a tool for assessment of pelvic floor muscle exercises in children with voiding disorders.     

Surface electromyography of abdominal and back muscles in patients with active scars

Among the clinical symptoms caused by active scars in the abdominal region, back pain is very frequent. The muscles underneath such a scar appear to be less active on palpation than on the opposite side. To confirm this, 13 patients and 13 healthy controls were examined by surface electromyography (SEMG). We proceeded with SEMG of the straight abdominal muscles on both sides on lifting the head and the shoulders with the subject supine, and of the erector spinae with the patient prone. The patients with active scars were examined before and immediately after soft tissue treatment. SEMG examination showed increased muscle activity of the rectus abdominis in 6 cases on the side of the active scar and in 7 cases on the opposite side. This asymmetry decreased in 7 cases (p=0.045). Asymmetry was also found in the controls. This asymmetry was, however, significantly lesser than in the patients with an active scar (p=0.029). The discrepancy between palpatory and EMG findings is due to hypotony of the soft tissues on the side of the scar, giving the impression (illusion) that muscular activity is diminished on that side.     

不同头颈位对气管插管患者呼吸道各段长度的影响

气管插管广泛用于临床麻醉和重症加强治疗病房,对保护呼吸道通畅起着至关重要的作用.在麻醉过程和急危重症抢救过程中,气管插管患者存在气管内导管位置变化的问题,如果发生在头部位置变动的患者.