半月板损伤患者膝周肌肉的表面肌电图分析
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摘要
目的探讨半月板损伤对膝周肌肉功能的影响。方法 2017年2月至2018年2月,单侧半月板损伤患者22例,记录下蹲、站起和屈膝70°最大等长收缩时,健、患侧股外侧肌、股直肌、股内侧肌和股二头肌的表面肌电图。结果下蹲和站起时,患侧股外侧肌和股二头肌的平均肌电值显著低于健侧(t> 3.945, Z> 3.847, P <0.001),腘绳肌共同活动比率明显高于健侧(t> 3.650, P <0.01)。在70°最大等长收缩时,患侧股外侧肌、股直肌、股内侧肌和股二头肌平均肌电值均明显小于健侧(t> 2.907, Z=4.107, P <0.01)。结论 sEMG能定量评价半月板损伤患者不同运动状态下膝屈伸肌功能。半月板损伤患者患肢膝周肌肉功能下降,协调性异常,应在康复治疗过程中加以纠正。
Objective To investigate the influence of meniscus injury on the function of muscles around knee in patients with meniscus injury.Methods From February, 2017 to February, 2018, the suface electromyography of vastus lateralis(VL), rectus femoris(RF), vastus medialis(VM) and biceps femoris(BF) were recorded and analyzed in 22 patiens with unilateral meniscus injury, during squatting down-standing up test and maximal isometric voluntary contraction at knee flexing 70°.Results During squatting down-standing up test, the average electromyography(AEMG) of VL and BF was less in affected knee than in unaffected knee(t > 3.945, Z > 3.847, P < 0.001), and the coactivity ratio of hamstrings in affected knee was higher(t > 3.650, P < 0.01). The AEMG of VL, RF, VM and BF was less in affected knee than in unaffected knee(t > 2.907, Z = 4.107, P < 0.01) during maximal isometric voluntary contraction at knee flexing70°.Conclusion sEMG can be used to quantitatively evaluate the muscle function around knee for patients with meniscus injury in different motion states. Patients with meniscus injury demonstrate impaired muscular function and altered muscle balance around knee, which need to be corrected during rehabilitation.
Objective To investigate the influence of meniscus injury on the function of muscles around knee in patients with meniscus injury.Methods From February, 2017 to February, 2018, the suface electromyography of vastus lateralis(VL), rectus femoris(RF), vastus medialis(VM) and biceps femoris(BF) were recorded and analyzed in 22 patiens with unilateral meniscus injury, during squatting down-standing up test and maximal isometric voluntary contraction at knee flexing 70°.Results During squatting down-standing up test, the average electromyography(AEMG) of VL and BF was less in affected knee than in unaffected knee(t > 3.945, Z > 3.847, P < 0.001), and the coactivity ratio of hamstrings in affected knee was higher(t > 3.650, P < 0.01). The AEMG of VL, RF, VM and BF was less in affected knee than in unaffected knee(t > 2.907, Z = 4.107, P < 0.01) during maximal isometric voluntary contraction at knee flexing70°.Conclusion sEMG can be used to quantitatively evaluate the muscle function around knee for patients with meniscus injury in different motion states. Patients with meniscus injury demonstrate impaired muscular function and altered muscle balance around knee, which need to be corrected during rehabilitation.
引文
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[10]缪芸,倪朝民,夏清,等.膝部损伤后膝关节功能障碍患者股四头肌的表面肌电信号研究[J].中国康复理论与实践,2009,15(11):1065-1067.
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[13]Fox A J,Wanivenhaus F,Burge A J,et al.The human meniscus:a review of anatomy,function,injury,and advances in treatment[J].Clin Anat,2015,28(2):269-287.
[14]Rice D A,Mcnair P J.Quadriceps arthrogenic muscle inhibition:neural mechanisms and treatment perspectives[J].Semin Arthritis Rheum,2011,40(3):250-266.
[15]Herzog W,Suter E.Muscle inhibition following knee injury and disease[J].Sportverletz Sportschaden,1997,11(3):74-78.
[16]Young A,Stokes M,Iles J F.Effects of joint pathology on muscle[J].Clin Orthop Relat Res,1987,219:21-27.
[17]Baumeister J,Weiss M.Non-typical measurements during a isokinetic training session after ACL-reconstruction[J].Sportverletz Sportschaden,2002,16(2):74-79.
[18]周谋望.人工全膝关节置换的术后康复[J].中国临床康复,2004,8(2):344-345.
[19]林颖,王芗斌,陈菁华,等.膝骨性关节炎患者坐-站活动时的表面肌电图研究[J].按摩与康复医学,2015,6(6):13-16.
[20]李放,张凯莉,朱艺,等.膝关节骨关节炎的屈伸膝肌存在脊髓水平的选择性抑制[J].中华物理医学与康复杂志,2001,23(2):43-45.
[21]Assimakopoulos A P,Katonis P G,Agapitos M V,et al.The innervation of the human meniscus[J].Clin Orthop Relat Res,1992(275):232-236.
[22]Moran C J,Poynton A R,Moran R,et al.Analysis of meniscofemoral ligament tension during knee motion[J].Arthroscopy,2006,22(4):362-366.
[23]Lee J H,Heo J W,Lee D H.Comparative postural stability in patients with lateral meniscus versus medial meniscus tears[J].Knee,2018,25(2):256-261.
[24]Lewek M D,Scholz J,Rudolph K S,et al.Stride-to-stride variability of knee motion in patients with knee osteoarthritis[J].Gait Posture,2006,23(4):505-511.
[25]Childs J D,Sparto P J,Fitzgerald G K,et al.Alterations in lower extremity movement and muscle activation patterns in individuals with knee osteoarthritis[J].Clin Biomech(Bristol,Avon),2004,19(1):44-49.
[2]Blake M H,Johnson D L.Knee meniscus injuries:common problems and solutions[J].Clin Sports Med,2018,37(2):293-306.
[3]Walker P S,Arno S,Bell C,et al.Function of the medial meniscus in force transmission and stability[J].J Biomech,2015,48(8):1383-1388.
[4]Nyland J,Bealle D P,Kaufer H,et al.Long-term quadriceps femoris functional deficits following intramedullary nailing of isolated tibial fractures[J].Int Orthop,2001,24(6):342-346.
[5]O'Connor B L,Brandt K D.Neurogenic factors in the etiopathogenesis of osteoarthritis[J].Rheum Dis Clin North Am,1993,19(3):581-605.
[6]俞晓杰,吴毅,胡永善,等.膝关节骨关节炎患者膝屈伸肌的表面肌电信号研究[J].中华物理医学与康复杂志,2006,28(6):402-405.
[7]Duchene J,Hogrel J Y.A model of EMG generation[J].IEEETrans Biomed Eng,2000,47(2):192-201.
[8]胥少汀,葛宝丰,徐印坎.实用骨科学[M].4版.北京:人民军医出版社,2012.
[9]李建华,王健.表面肌电图诊断技术临床应用[M].杭州:浙江大学出版社,2015.
[10]缪芸,倪朝民,夏清,等.膝部损伤后膝关节功能障碍患者股四头肌的表面肌电信号研究[J].中国康复理论与实践,2009,15(11):1065-1067.
[11]Karsten K,Martin E.Impact of cartilage damage on arthrogenic muscle inhibition in patients with meniscus injuries[J].JMusculoskelet Res,2016,19(1):1650001.
[12]Keller K,Engelhardt M.Arthrogenic muscle inhibition after trauma-is there an age dependency of the intensity of arthrogenic muscle inhibition?[J].Sportverletz Sportschaden,2014,28(4):199-203.
[13]Fox A J,Wanivenhaus F,Burge A J,et al.The human meniscus:a review of anatomy,function,injury,and advances in treatment[J].Clin Anat,2015,28(2):269-287.
[14]Rice D A,Mcnair P J.Quadriceps arthrogenic muscle inhibition:neural mechanisms and treatment perspectives[J].Semin Arthritis Rheum,2011,40(3):250-266.
[15]Herzog W,Suter E.Muscle inhibition following knee injury and disease[J].Sportverletz Sportschaden,1997,11(3):74-78.
[16]Young A,Stokes M,Iles J F.Effects of joint pathology on muscle[J].Clin Orthop Relat Res,1987,219:21-27.
[17]Baumeister J,Weiss M.Non-typical measurements during a isokinetic training session after ACL-reconstruction[J].Sportverletz Sportschaden,2002,16(2):74-79.
[18]周谋望.人工全膝关节置换的术后康复[J].中国临床康复,2004,8(2):344-345.
[19]林颖,王芗斌,陈菁华,等.膝骨性关节炎患者坐-站活动时的表面肌电图研究[J].按摩与康复医学,2015,6(6):13-16.
[20]李放,张凯莉,朱艺,等.膝关节骨关节炎的屈伸膝肌存在脊髓水平的选择性抑制[J].中华物理医学与康复杂志,2001,23(2):43-45.
[21]Assimakopoulos A P,Katonis P G,Agapitos M V,et al.The innervation of the human meniscus[J].Clin Orthop Relat Res,1992(275):232-236.
[22]Moran C J,Poynton A R,Moran R,et al.Analysis of meniscofemoral ligament tension during knee motion[J].Arthroscopy,2006,22(4):362-366.
[23]Lee J H,Heo J W,Lee D H.Comparative postural stability in patients with lateral meniscus versus medial meniscus tears[J].Knee,2018,25(2):256-261.
[24]Lewek M D,Scholz J,Rudolph K S,et al.Stride-to-stride variability of knee motion in patients with knee osteoarthritis[J].Gait Posture,2006,23(4):505-511.
[25]Childs J D,Sparto P J,Fitzgerald G K,et al.Alterations in lower extremity movement and muscle activation patterns in individuals with knee osteoarthritis[J].Clin Biomech(Bristol,Avon),2004,19(1):44-49.