Muscle architecture adaptations to knee extensor eccentric training: Rectus femoris vs. vastus lateralis

Introduction: Changes in muscle architecture induced by eccentric knee extensor training remain unclear, as well the adaptive responses of synergistic knee extensor muscles with different geometrical designs. Methods: Ultrasonography images were taken from rectus femoris (RF) and vastus lateralis (VL) of 20 male volunteers before and after a non‐training control period of 4 weeks, and additional evaluations were performed after 4, 8, and 12 weeks of isokinetic eccentric training. Results: RF and VL had significant changes in muscle architecture within the first 4 training weeks, and the adaptive response throughout the intervention was similar. Muscle thickness increased by around 7–10%, fascicle length increased 17–19%, and pennation angle was unchanged. Conclusions: Increased muscle thickness due to eccentric training was related to increased fascicle length and not to pennation angle changes. Although RF and VL have a different fascicular geometry, they had similar morphological adaptations to eccentric training. Muscle Nerve 48 : 498–506, 2013     

左股直肌韧带样型纤维瘤病1例

正患者,男,16岁。1个多月前无意中发现左大腿中上段包块,触之轻压痛,行走过多或者劳累后疼痛加重,活动部分受限,休息后疼痛缓解,未做特殊诊治。近日发现左大腿包块较前略有增大,肿胀伴疼痛,来我院就诊。查体:左大腿中上段轻度肿胀,局部皮肤完整,皮温正常,未见明显皮下出血点、蜘蛛痣及静脉曲张。左大腿中上段前外侧可触及一大小约11 cm×4 cm×2 cm的包块,质韧、     

双侧腹横肌平面阻滞复合双侧腹直肌鞘阻滞在腹腔镜胆囊切除术中的应用

目的观察双侧腹横肌平面复合双侧腹直肌鞘阻滞在腹腔镜胆囊切除术患者中的镇痛效果及安全性。方法选择2015年5~9月拟在全麻下行腹腔镜胆囊切除术的患者90例,男35例,女55例,年龄19~79岁,BMI 18~30kg/m~2,ASAⅠ或Ⅱ级。将患者随机分为双侧腹横肌平面阻滞复合双侧腹直肌鞘阻滞组(TR组)、腹横肌平面阻滞组(T组)和静脉镇痛泵镇痛组(P组),每组30例。麻醉诱导前,TR组在超声引导下双侧腹横肌平面分别注射0.22%甲磺酸罗哌卡因20ml,双侧腹直肌后鞘分别注射0.22%甲磺酸罗哌卡因10ml;T组在超声引导下双侧腹横肌平面分别注射0.22%甲磺酸罗哌卡因20ml,双侧腹直肌后鞘分别注射生理盐水10 ml;P组在超声引导下双侧腹横肌平面分别注射生理盐水20ml,双侧腹直肌后鞘分别注射生理盐水10 ml,P组术后使用PCIA(配方:舒芬太尼50μg+生理盐水50ml)。记录三组患者入室后5min(T_1)、腹腔穿刺导入器置入前2min(T_2)和和置入后2min(T_3)的SBP、DBP、HR、SpO_2,术中瑞芬太尼及丙泊酚的用量,术后2、6、12、24h患者腹腔穿刺孔静态和动态视觉模拟疼痛(VAS)评分,同时评价术后镇痛满意度,记录不良反应的发生情况。结果与T组和P组比较,TR组患者在腹腔穿刺导入器穿刺前后血压波动较小(P0.05);术后2、6、12hTR组剑突下穿刺孔的静态和动态VAS评分明显低于T组和P组(P0.05);术后2、6hTR组脐穿刺孔的静态VAS评分和术后2、6、12hTR组脐穿刺孔的动态VAS评分明显低于T组和P组,术后12hTR组脐穿刺孔的静态VAS评分明显低于P组(P0.05);术后2、6、12hTR组右侧肋缘下穿刺孔的静态和动态VAS评分明显低于P组(P0.05),术后24h三组患者的VAS评分差异无统计学意义,TR组术后镇痛满意度明显高于T组和P组(P0.05)。结论双侧腹横肌平面复合双侧腹直肌鞘阻滞应用于腹腔镜胆囊切除术患者有助于术中循环稳定,术后镇痛效果好,具有安全性。     

On the anisotropy of skeletal muscle tissue under compression

This paper deals with the role of the muscle fibres and extracellular matrix (ECM) components when muscle tissue is subjected to compressive loads. To this end, dissected tissue samples were tested in compression modes which induced states of fibres in compression (I), in tension (II) or at constant length (III), respectively. A comparison of the stress responses indicated that the tissue behaviour is significantly different for these modes, including differences between the modes (I) and (III). This contradicts the paradigm of many constitutive models that the stress response can be decomposed into an isotropic part relating to the ECM and an anisotropic fibre part the contribution of which can be neglected under compression. Conversely, the results provide experimental evidence that there is an anisotropic contribution of the fibre direction to the compressive stress. Interpreting these results in terms of recent microscopical studies, potential connections between the observed behaviour and the structure of muscle ECM are established.     

髓芯减压多孔钽棒植入术与带蒂股方肌肌骨瓣移植术治疗Ficat II期成人股骨头坏死的疗效比较

目的   探讨髓芯减压多孔钽棒植入术与带蒂股方肌肌骨瓣移植术治疗Ficat II期成人股骨头缺血坏死的临床疗效。 方法    选择2006年7月至2009年4月我院收治的非创伤性成人股骨头缺血坏死早期患者36例（46髋）,男29例,女7例,26～59岁,平均39.2岁。其中12例（16髋）采用髓芯减压多孔钽棒植入术治疗。24例（30髋）采用减压加带蒂股方肌肌骨瓣移植术治疗。记录两种手术方法的患者术前、术后一般状况、X线平片、Harris评分。并对36例病例进行回顾性分析。结果    所有病例均获得术后随访8～32个月。X线平片显示,髓芯减压多孔钽棒植入术组患者有1例发生股骨头塌陷,术后Harris评分平均为91.4分。带蒂股方肌肌骨瓣移植术组有11例发生股骨头塌陷,术后Harris评分平均为80.7分。结论    髓芯减压多孔钽棒植入术在治疗Ficat II期成人股骨头缺血坏死中的临床疗效明显优于带蒂股方肌肌骨瓣移植术。     

淫羊藿对激素性股骨头坏死兔模型血钙血磷的影响

目的：观察淫羊藿提取液对激素性股骨头坏死兔模型血钙、血磷变化及骨密度的影响,探讨淫羊藿提取液的作用机理。方法：所选用动物随机分为空白组10只,造模组20只。所有参加造模组动物第一次应用马血清10 mL·kg-1,经兔耳缘静脉注射;间隔3周后,再次经兔耳缘静脉注射马血清6 mL·kg-1;间隔2周后,按45 mg·kg-1的剂量给予甲基强的松龙腹腔注射,连续3 d,每天注射1次。注射激素期间,为了预防感染,每只动物每天腹腔注射青霉素10×104 U,连续7 d。预防感染。空白组动物常规饲养。造模完成后随机选取空白组、造模组动物各一只解剖出股骨头做病理观察,证实造模成功（空气栓塞法处死）。随后空气栓塞法处死造模动物3只及空白组动物1只（总共4只）,至最后一次注射激素后将所剩造模组16只动物随机分为两组即模型组和实验组。空白组和模型组动物每天给予10 mL生理盐水灌胃,实验组动物每天给予10 mL淫羊藿提取液灌胃,共连续灌胃8周,8周后检测各组动物血钙、血磷及骨密度变化情况。结果：给药8周后空白组（2.478±0.117） mmol·L-1与实验组（2.330±0.135）mmol·L-1血磷比较,差异有统计学意义（ P>0.05）;空白组、实验组和模型组（1.301±0.186）mmol · L-1血磷比较,有统计学意义（ P <0.05）。空白组（1.081±0.333）mmol · L-1与实验组（1.201±0.281）mmol·L-1血钙相比较,差异无统计学意义（P>0.05）;空白组、实验组和模型组（1.336±0.359）mmol·L-1血钙比较,差异有统计学意义（P<0.05）。给药8周后空白组骨密度为（0.2035±0.0148）g·cm-2,高于模型组（0.1689±0.0119） g·cm-2,二者比较差异,差异有统计学意义（P<0.05）;空白组与实验组（0.1923±0.0082）g·cm-2比较,二者比较差异有统计学意义（P<0.05）;实验组、空白组和模型组骨密度比较,二者比较,差异有统计学意义（P<0.05）。结论：糖皮质激素能够降低血磷水平而升高血钙水平,淫羊藿提取液能够降低糖皮质激素引起的高血钙水平及升高糖皮质激素引起的低血磷水平。     

Laparoscopic extraperitoneal inguinal hernia repair

We have devised a reproducible approach to the preperitoneal space for laparoscopic repair of inguinal hernias that is based on an understanding of the abdominal wall anatomy. Laparoscopic totally extraperitoneal herniorrhaphy was performed on 99 hernias in 90 patients at the Los Angeles County–University of Southern California Medical Center, using a standardized approach to the preperitoneal space. Operative times, morbidity, and recurrence rates were recorded prospectively. The median operative time was 37 min (range, 28–60) for unilateral hernias and 46 min (range, 35–73) for bilateral hernias. There were no conversions to open repair, and there was only one conversion to a laparoscopic transabdominal approach. Complications were limited to urinary retention in two patients, pneumoscrotum in one patient, and postoperative pain requiring a large dose of analgesics in one patient. All patients were discharged within 23 h. There were no recurrences or neuralgias on follow-up at 2 years. A standardized approach to the preperitoneal space based on a thorough understanding of the abdominal wall anatomy is essential to a satisfactory outcome in hernia repair. Received: 18 November 1998/Accepted: 19 March 1999