功能性踝关节不稳的神经肌肉控制机制及PNF干预效果研究
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摘要
目的：功能性踝关节不稳是与踝关节反复扭伤相关的一种功能障碍,其原因尚不明确,治疗方法的有效性存在质疑。本研究对功能性踝关节不稳患者在起跳落地活动中的运动学和动力学进行综合性研究,从肌肉预准备及反应性活动入手,分析下肢关键肌群的肌肉激活模式,各关节在三维平面的运动学特征及本体感觉特征,并应用本体感觉神经肌肉促进技术(PNF)进行干预,探讨功能性踝关节不稳的神经肌肉控制机制及PNF应用的有效性。
方法：本研究选取28名单侧功能性踝关节不稳的男性受试者为实验组(FAI组),28名无下肢伤病的男性受试者为对照组。利用BTS SMART-D综合动作分析系统同步收集起跳落地试验过程中下肢三维平面的关节角度及五块靶肌肉的表而肌电信号,并评定受试者主动闭链运动的本体感觉差异。应用PNF多种技术组合的治疗方案,对FAI组进行持续4周治疗并再次测试上述指标。
结果：①FAI组落地前胫骨前肌及腓肠肌外侧头的激活时间提前,股二头肌的激活时间延迟且启动激活达峰值的时间延长(P<0.05)；②FAI组落地前胫骨前肌和腓肠肌外侧头的肌肉动员率(%MVC)增加(P<0.05),而落地即刻和落地后的激活无差异(P>0.05)：③FAI组在起跳落地前膝屈曲增加、踝跖屈减少(P<0.05),而其它方向的关节角度无差异(P>0.05)；④PNF治疗后,FAI组胫骨前肌在落地前后的肌肉动员率增加(P<0.05),腓肠肌外侧头的肌肉动员率恢复到对照组水平(P>0.05),股二头肌的激活时间明显提前(P<0.01),但落地前下肢屈伸的关节角度仍有差异(P<0.05)；⑤主动闭链式本体感觉测试中,FAI组左右方向及多轴轨迹追踪误差高于对照组(P<0.05),治疗后所有方向的轨迹追踪误差恢复至对照组水平(P>0.05)；⑥PNF治疗后,FAI组的踝关节功能分值提高,踝关节失稳次数减少(P<0.01)。
结论：①功能性踝关节不稳患者在起跳落地活动的运动学、动力学及肌肉激活均改变,神经肌肉控制前馈及反馈机制发生了改变；②腓肠肌外侧头和胫骨前肌是影响前馈控制的关键肌；③PNF之D2模式组合技术调节了落地前肌肉的激活方式和落地后肌肉的反应性活动,改变了近端关节神经肌肉控制机制,恢复本体感觉,提高了踝关节的稳定性。
Objectives:Functional Ankle Instability (FAI) was a disability condition related with repeat ankle sprain. The underlying reason was unknown and the effective of treatment was doubted. The purpose of this study was to investigate the kinematics and kinetics of single-leg jumping test with FAI. Muscle activation pattern, which involved pre-programme activity and reactional activity, proprioception and the range of motion in three dimensional plane were analyzed. The application of Proprioception Neuromuscular Facilitation to FAI was in progress. In order to explore the neuromuscular control mechanism of FAI and effectiveness of PNF.
Methods:28 unilateral FAI males and 28 males without low limb injury experience were tested. With single-leg jumping test, the range of motion in three dimensional plane and sEMG of 5 key muscles was collected by BTS SMART-D Integrate Motion Analysis System. Proprioception of active closed-chain was assessed. Testing was repeated after 4 weeks PNF application.
Result:①Muscle activation time pre-contact was significant difference in FAI group(P<0.05), biceps femoris delaied(P<0.05), tibial anterior and gastronimus lateralis advanced (P<0.05).②Muscle activation rate of tibial anterior and gastronimus lateralis pre-contact were significant difference(P<0.05), there was no difference post-contact (P>0.05).③There was significant difference in sagittal plane momvent, knee flexion increased and ankle plantar flexion decreased. (P<0.05), no difference in coronal plane and horizontal plane (P>0.05);④After PNF training, muscle activation time of biceps femoris was significant improved(P<0.05), and gastronimus lateralis activation pattern improved to control group level(P< 0.05). There were significant difference in tibial anterior activation pattern and angles of sigittal plane after training. (P<0.05);⑤There were significant difference in active close-chain proprioception assessment. The average length error of medial-lateral direction and average of trace error of multidiretion increased in FAI group (P<0.05), both of them decreased to control group level after PNF training (P>0.05);⑥After PNF training, ankle joint functional assessment score increased and the frenqucy of giving way decreased (P<0.05)。
Conclusions:①During single leg jumping test, kinesiology, kinematic and muscle activation changed with functional ankle instability. Feedfoward and feedback of neuromuscular control changed.②Gastronimus lateral is and tibial anterior were the key muscles of feedfoward neuromusclar control of functional ankle instability.③D2 pattern of PNF training modified muscle activation pattern both pre-and post-contact, changed neuromuscular control of proximal joint, improved proprioception. PNF was effective to improve ankle stability and function of FAI.
方法：本研究选取28名单侧功能性踝关节不稳的男性受试者为实验组(FAI组),28名无下肢伤病的男性受试者为对照组。利用BTS SMART-D综合动作分析系统同步收集起跳落地试验过程中下肢三维平面的关节角度及五块靶肌肉的表而肌电信号,并评定受试者主动闭链运动的本体感觉差异。应用PNF多种技术组合的治疗方案,对FAI组进行持续4周治疗并再次测试上述指标。
结果：①FAI组落地前胫骨前肌及腓肠肌外侧头的激活时间提前,股二头肌的激活时间延迟且启动激活达峰值的时间延长(P<0.05)；②FAI组落地前胫骨前肌和腓肠肌外侧头的肌肉动员率(%MVC)增加(P<0.05),而落地即刻和落地后的激活无差异(P>0.05)：③FAI组在起跳落地前膝屈曲增加、踝跖屈减少(P<0.05),而其它方向的关节角度无差异(P>0.05)；④PNF治疗后,FAI组胫骨前肌在落地前后的肌肉动员率增加(P<0.05),腓肠肌外侧头的肌肉动员率恢复到对照组水平(P>0.05),股二头肌的激活时间明显提前(P<0.01),但落地前下肢屈伸的关节角度仍有差异(P<0.05)；⑤主动闭链式本体感觉测试中,FAI组左右方向及多轴轨迹追踪误差高于对照组(P<0.05),治疗后所有方向的轨迹追踪误差恢复至对照组水平(P>0.05)；⑥PNF治疗后,FAI组的踝关节功能分值提高,踝关节失稳次数减少(P<0.01)。
结论：①功能性踝关节不稳患者在起跳落地活动的运动学、动力学及肌肉激活均改变,神经肌肉控制前馈及反馈机制发生了改变；②腓肠肌外侧头和胫骨前肌是影响前馈控制的关键肌；③PNF之D2模式组合技术调节了落地前肌肉的激活方式和落地后肌肉的反应性活动,改变了近端关节神经肌肉控制机制,恢复本体感觉,提高了踝关节的稳定性。
Objectives:Functional Ankle Instability (FAI) was a disability condition related with repeat ankle sprain. The underlying reason was unknown and the effective of treatment was doubted. The purpose of this study was to investigate the kinematics and kinetics of single-leg jumping test with FAI. Muscle activation pattern, which involved pre-programme activity and reactional activity, proprioception and the range of motion in three dimensional plane were analyzed. The application of Proprioception Neuromuscular Facilitation to FAI was in progress. In order to explore the neuromuscular control mechanism of FAI and effectiveness of PNF.
Methods:28 unilateral FAI males and 28 males without low limb injury experience were tested. With single-leg jumping test, the range of motion in three dimensional plane and sEMG of 5 key muscles was collected by BTS SMART-D Integrate Motion Analysis System. Proprioception of active closed-chain was assessed. Testing was repeated after 4 weeks PNF application.
Result:①Muscle activation time pre-contact was significant difference in FAI group(P<0.05), biceps femoris delaied(P<0.05), tibial anterior and gastronimus lateralis advanced (P<0.05).②Muscle activation rate of tibial anterior and gastronimus lateralis pre-contact were significant difference(P<0.05), there was no difference post-contact (P>0.05).③There was significant difference in sagittal plane momvent, knee flexion increased and ankle plantar flexion decreased. (P<0.05), no difference in coronal plane and horizontal plane (P>0.05);④After PNF training, muscle activation time of biceps femoris was significant improved(P<0.05), and gastronimus lateralis activation pattern improved to control group level(P< 0.05). There were significant difference in tibial anterior activation pattern and angles of sigittal plane after training. (P<0.05);⑤There were significant difference in active close-chain proprioception assessment. The average length error of medial-lateral direction and average of trace error of multidiretion increased in FAI group (P<0.05), both of them decreased to control group level after PNF training (P>0.05);⑥After PNF training, ankle joint functional assessment score increased and the frenqucy of giving way decreased (P<0.05)。
Conclusions:①During single leg jumping test, kinesiology, kinematic and muscle activation changed with functional ankle instability. Feedfoward and feedback of neuromuscular control changed.②Gastronimus lateral is and tibial anterior were the key muscles of feedfoward neuromusclar control of functional ankle instability.③D2 pattern of PNF training modified muscle activation pattern both pre-and post-contact, changed neuromuscular control of proximal joint, improved proprioception. PNF was effective to improve ankle stability and function of FAI.
引文
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