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中华物理医学与康复杂志
中华物理医学与康复杂志

黄晓琳

月刊

0254-1424

cjpmr@tjh.tjmu.edu.cn

027-83662874

430030

湖北省武汉市解放大道1095号同济医院内

中华物理医学与康复杂志/Journal Chinese Journal of Physical Medicine and RehabilitationCSCD北大核心CSTPCD
查看更多>>中华医学会主办。本刊主要内容包括：贯彻党和国家的卫生工作方针政策，理论与实践相结合，提高与普及相结合，积极倡导百花齐放、百家争鸣；全面介绍物理治疗、物理医学与康复领域内领先的科研成果和新理论、新技术、新方法、新经验以及对物理因子治疗、康复临床、疗养等有指导作用，且与康复医学密切相关的基础理论研究，同时密切关注国际康复医学发展的新动向。主要栏目包括论著、综述、研究报告、经验交流、继续教育、讲座、病例报告、会议纪要、书评、国内外学术动态、学术活动预告等。
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    脉冲电磁场对椎间盘退行性病变大鼠A2A腺苷受体及p38 MAPK信号通路的影响

    黎清波蔡磊王正坤方为志...
    769-775页
    查看更多>>摘要：目的 观察脉冲电磁场(PEMF)对椎间盘退行性病变(IDD)大鼠A2A腺苷受体(A2AR)及p38 MAPK信号通路的影响。 方法 采用随机数字表法将40只SD大鼠分为对照组、IDD模型组(简称模型组)、PEMF组和PEMF联合CGS-21680治疗组(简称观察组)。将模型组、PEMF组及观察组大鼠制成IDD动物模型，PEMF组于制模后给予PEMF干预，观察组则给予PEMF干预并注射A2AR激动剂CGS-21680。于造模8周后采用番红O-快绿染色评估各组大鼠椎间盘病理改变，同时检测各组大鼠椎间盘A2AR、环磷酸腺苷(cAMP)、蛋白激酶A(PKA)、半胱氨酸天冬氨酸蛋白水解酶-3(Caspase-3)、Ⅱ型胶原(Col-Ⅱ)、基质金属蛋白酶-3(MMP3)表达水平。 结果 模型组大鼠髓核组织皱缩，纤维成分及软骨细胞增多，观察组大鼠髓核形态基本趋于正常，纤维环完整无破裂。模型组椎间盘组织A2AR蛋白表达及mRNA水平均高于对照组，观察组A2AR蛋白表达及mRNA水平均显著高于其他各组(P<0.05)。PEMF组和观察组椎间盘cAMP含量及PKA mRNA表达均较模型组增高，且观察组与模型组间差异具有统计学意义(P<0.05)。模型组大鼠椎间盘p38 MAPK、p-p38 MAPK含量及p-p38 MAPK/p38 MAPK比值均显著高于对照组(P<0.05)，PEMF组和观察组p38 MAPK、p-p38 MAPK蛋白含量及p-p38 MAPK/p38 MAPK比值均有不同程度降低，且观察组上述指标数值均显著低于模型组(P<0.05)，p-p38 MAPK蛋白含量及p-p38 MAPK/p38 MAPK比值亦显著低于PEMF组(P<0.05)。模型组大鼠Caspase-3蛋白含量及mRNA表达均显著高于对照组，PEMF组及观察组上述指标含量均较模型组明显降低(P<0.05)。模型组大鼠MMP3含量较对照组显著升高，Col-Ⅱ含量则明显下降；PEMF组、观察组MMP3含量均较模型组降低，Col-Ⅱ表达均较模型组增高，并且观察组上述指标含量与模型组间差异均具有统计学意义(P<0.05)。 结论 炎性因子刺激能活化p38 MAPK信号通路并诱导细胞凋亡，这也是促进IDD大鼠病变的重要原因之一。PEMF联合A2AR激动剂干预能激活A2AR/cAMP/PKA信号通路，进而抑制p38 MAPK磷酸化，减少髓核细胞凋亡，缓解IDD损伤。 Objective To explore any effect of pulsed electromagnetic field (PEMF) stimulation on intervertebral disc degeneration (IDD). Methods Forty Sprague-Dawley rats were randomly divided into a control group, an IDD model group, a PEMF group and an observation group. An IDD model was induced in all except those in the control group. Both the PEMF and observation groups were given PEMF stimulation, while the latter was additionally injected with the A2AR agonist CGS-21680. Eight weeks after the modelling any pathological changes in the morphology of the rats′ intervertebral disc tissues were evaluated using saffron solid green staining. The expression of A2AR, cyclic adenosine phosphate (cAMP), protein kinase A (PKA), cysteine aspartate proteolytic enzyme-3 (Caspase-3), type II collagen (COL-II) and matrix metalloproteinase-3 (MMP3) in the intervertebral discs were evaluated. Results The nucleus pulposus had shrunk, while fibrous tissues and chondrocytes had increased in the IDD model group. In the observation group the nucleus pulposus was intact and of basically normal shape. A2AR mRNA and protein levels were higher in the intervertebral disc tissue of the model group than among the control group, on average, while the levels in the observation group were significantly higher than in the other groups. In the PEMF and observation groups cAMP and PKA mRNA were significantly higher than in the IDD model group. The p38 MAPK and P-P38 MAPK levels of the IDD model group and its average P-P38 MAPK/p38 MAPK ratio were significantly higher than in the control group. In the PEMF and observation groups those indices had decreased to varying degrees, with those of the observation group significantly lower than among the model and PEMF groups on average, except for the p38 MAPK values. Caspase-3 and its mRNA were significantly higher in the model group than in the control group, on average, and those values were significantly lower in the PEMF and observation groups than in the IDD model group. The average MMP3 contents of the IDD model group had increased significantly compared with the control group, while the Col-Ⅱ level had decreased significantly. Compared with the IDD model group, the MMP3 level had decreased but Col-Ⅱ expression had increased in both the PEMF and observation groups, with significant differences between the IDD model and observation groups. Conclusions The activation of the p38 MAPK signaling pathway by inflammatory factors to induce apoptosis is one of the important reasons for the aggravation of IDD lesions. PEMF combined with A2AR agonists can activate the A2AR/cAMP/PKA signaling pathway, inhibit p38 MAPK phosphorylation, reduce apoptosis of nucleus pulposus cells, and relieve IDD damage.

    脉冲电磁场A2A腺苷受体p38MAPK椎间盘退行性病变

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    低频共振训练对脑卒中后偏瘫患者平衡及步行功能的影响

    马飞翔李万浪朱颖玲刘婷婷...
    776-780页
    查看更多>>摘要：目的 观察低频共振训练对脑卒中偏瘫患者平衡及步行能力的影响。 方法 按随机数字表法将符合纳入标准的66例脑卒中后偏瘫患者分为低频共振训练组、高频振动训练组和对照组，每组22例。研究全程共有4例病例脱落，最终62例纳入统计分析，即低频共振训练组22例、高频振动训练组20例、对照组20例。所有患者均接受常规运动训练，训练强度遵循个性化原则；采用德国SVG公司的Wellengang振动治疗仪(型号Excellence)进行全身振动训练。低频共振训练组、高频振动训练组和对照组(常规运动训练组)治疗频率分别为7、15和1 Hz，每次训练1 min，坐位休息1 min，5个循环，每日2次，每周治疗5 d，共治疗40次。分别于训练前(治疗前)和训练40次后(治疗后)，采用Berg平衡量表(BBS)、起立-行走测试(TUGT)、10 m步行测试(10MWT)、步长、步频、步速等参数指标对患者平衡及步行能力进行评估和分析。 结果 训练前，3组患者BBS、TUGT、10MWT、步长、步频、步速组间比较，差异均无统计学意义(P>0.05)。不同频率训练后，上述参数均不同程度改善，组内差异均有统计学意义(P<0.05)；组间比较，低频共振训练组各参数指标改善均优于其余二组(P<0.05)，高频振动训练组亦明显优于对照组(P<0.05)。 结论 7 Hz低频共振训练能更有效地改善脑卒中偏瘫患者平衡及步行能力。 Objective To observe any effect of low-frequency whole body resonant stimulation on the ba-lance and walking ability of hemiplegic stroke survivors. Methods Sixty-six stroke survivors with hemiplegia were randomly divided into a low-frequency resonance training group, a high-frequency vibration training group and a control group, each of 22. All received routine exercise training at individualized intensities. All three groups underwent five 1-minute cycles of 7Hz, 15Hz or 1Hz stimulation twice a day, five days a week for eight weeks. Before and after the intervention, balance and walking ability were evaluated using the Berg Balance Scale, the timed up and go test and a 10m walking test. Step length, step frequency and step speed were also measured. Results There were no significant differences among the three groups before the training. Afterward, significant improvement was observed in all of the groups in terms of all of the measurements. The average results of the low-frequency resonance training group were at that point significantly better than the other two groups′ averages, while the high-frequency vibration training group′s results were superior to those of the control group. Conclusion Resonance training at 7Hz is the most effective in improving the balance and walking ability of stroke survivors with hemiplegia.

    全身振动训练共振训练偏瘫平衡功能步态

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    重复经颅磁刺激联合改良强制性运动疗法对脑卒中患者步行功能的影响

    朱冬燕卢红建黄志东王梁...
    781-785页
    查看更多>>摘要：目的 探讨重复经颅磁刺激(rTMS)联合改良强制性运动疗法(mCIMT)对脑卒中患者步行功能的影响。 方法 将纳入的75例脑卒中患者按随机数字表法分为rTMS组、假刺激组和联合治疗组，每组25例。3组患者均接受常规康复训练，主要包括平衡训练、转移训练、肌力训练、本体感觉训练等，治疗时间1次/日，每次40 min，每周5 d，共治疗4周。在此基础上，rTMS组增加rTMS治疗，假刺激组增加rTMS假刺激治疗，联合治疗组增加rTMS治疗20 min再间隔30 min后行mCIMT治疗。每日1次，每周5 d，共治疗4周。分别于治疗前和治疗4周后(治疗后)，采用Fugl-Meyer运动量表下肢部分(FMA-LE)、Berg平衡量表(BBS)、10 m步行时间(10MWT)和改良Barthel指数(MBI)对3组患者的步行功能和日常生活活动能力进行评定。 结果 治疗后，3组患者的FMA-LE、BBS、10MWT和MBI等各项指标均较组内治疗前明显改善(P<0.05)，且联合治疗组治疗后的FMA-LE评分[(27.88±4.04)分]、BBS评分[(47.80±5.16)分]、10MWT[(22.39±6.10)s]和MBI评分[(71.48±9.41)分]的改善程度均优于假刺激组和rTMS组，且组间差异有统计学意义(P<0.05)。 结论 rTMS联合mCIMT能更加有效改善脑卒中患者的步行功能，提高患者日常生活自理能力。 Objective To seek any differential effect of combining repeated transcranial magnetic stimulation (rTMS) with a modified version of constraint-induced movement therapy (mCIMT) on the walking ability of stroke survivors. Methods Seventy-five stroke survivors were randomly divided into a sham rTMS group, an rTMS group and a combined group, each of 25. In addition to 40 minutes of routine rehabilitation daily, including balance training, transfer training, muscle strength training, and proprioceptive training five times a week for 4 weeks, the sham rTMS group and rTMS group received sham or genuine rTMS. The combined group received 20 minutes of rTMS followed by mCIMT training 30 minutes later. The treatment was performed once a day, 5 days a week for 4 weeks. Before and after the treatment, all groups were evaluated using the Fugl-Meyer lower extremity assessment, the Berg balance scale, a 10-metre walk test and the modified Barthel index. Results Significant improvement was observed in the average scores of all three groups in all of the assessments. The combined group′s averages were, however, significantly better than those of the other two groups. Conclusion Supplementing mCIMT with rTMS can better improve the walking and other abilities in the activities of daily living of stroke survivors.

    脑卒中重复经颅磁刺激改良强制性运动疗法步行功能

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    口面肌功能治疗改善Pierre-Robin序列征术后吞咽功能及语言障碍的疗效观察

    朱洪漫朱敏徐怡赵晓科...
    786-790页
    查看更多>>摘要：目的 探讨口面肌功能治疗(OMT)对Pierre-Robin序列征(PRS)术后患儿吞咽功能及言语语言障碍的影响。 方法 采用随机数字表法将52例PRS术后(经下颌骨牵引成骨术治疗)吞咽障碍患儿分为观察组及对照组，每组26例。对照组患儿术后给予常规营养支持，观察组在此基础上给予OMT治疗。于干预前、干预6个月后比较2组患儿吞咽障碍程度、营养风险筛查结果、营养相关实验室指标及体质量指数等差异，并通过随访对比2组患儿3岁时其口面肌功能水平及言语语言障碍发生率。 结果 干预6个月后发现观察组患儿藤岛一郎吞咽障碍评分[(8.12±1.30)分]较治疗前及同期对照组均显著提高，营养风险筛查结果、营养相关指标等均较对照组明显改善，随访至3岁时发现观察组患儿口面肌功能分级水平[(70.40±6.34)分]明显优于对照组[(61.8±7.31)分]，言语语言障碍(构音障碍/语言发育迟缓)发生率(52.0%)较对照组(68.0%)显著降低，组间差异均具有统计学意义(P<0.05)。 结论 OMT治疗能显著改善PRS术后患儿吞咽功能及营养状况，促进患儿身体发育，同时还能降低其言语语言障碍发生率，该疗法值得临床推广、应用。 Objective To explore any effect of orofacial myofunction therapy (OMT) on the swallowing and speech of children with Pierre-Robin malformation (PRS) after a corrective operation. Methods Fifty-two children with dysphagia caused by PRS mandibular distraction osteogenesis were randomly divided into an observation group and a control group, each of 26. All were given routine nutrition support, but the observation group was additionally provided with OMT. Swallowing disorders, nutritional risk and body mass index were compared between the two groups after 6 months of the intervention. Orofacial muscle functioning and speech and language disorders were also compared between the two groups at the age of 3. Results After the 6-month intervention the average Ichiro Fujishima dysphagia score in the observation group had improved significantly compared with before treatment and with the control group. The observation group′s nutritional status was also significantly better. At age three the orofacial myofunction classification of the observation group remained significantly better, on average, than that in the control group, and dysarthria or language retardation was significantly less prevalent. Conclusion OMT can significantly improve the swallowing function, speech and nutritional status of children after surgery to correct PRS. This therapy is worthy of promotion and clinical application.

    口面肌功能治疗Pierre-Robin序列征术后吞咽障碍营养状况言语语言障碍

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    语音训练对 125Ⅰ放射性粒子植入术后的青年舌癌患者语音清晰度的影响

    徐丽娜李峰贾志阳杨延飞...
    791-796页
    查看更多>>摘要：目的 观察语音训练对125Ⅰ放射性粒子植入术后的青年舌癌患者语音清晰度的影响。 方法 选取行125Ⅰ放射性粒子植入术的青年舌癌患者50例，所有患者均于术后第二日开始康复训练，包括舌功能训练、异常语音矫正、网络平台辅助家庭训练和CSL生物反馈辅助训练。舌功能训练和异常语音矫正在住院期间完成，每日训练1次，每次共0~40 min，连续训练1周后出院；网络平台辅助家庭训练和CSL生物反馈辅助训练均待患者出院后在家中完成，每日训练1次，每次各20~30 min。于语音训练前和语音训练1周后采集50例患者的时域波形图、语音频谱图和能量瀑布图，并于粒子植入术前、语音训练前和出院1、2、4、6个月后对50例患者进行语音清晰度(PI)评估。 结果 与语音训练前比较，患者语音训练1周后时域波形图中的异常波形消失，语音频谱图中的擦音乱纹区域明显改善，能量瀑布图特征中能量分布均匀，呈现正常语音规则起伏趋势。50例患者行125Ⅰ粒子植入术前的PI值为(39.92±8.46)，语音训练前为(40.32±8.79)，出院1、2、4、6个月后分别为(42.78±8.24)、(54.68±7.18)、(72.32±5.55)、(88.04±2.42)，重复测量方差分析结果显示，出院2、4、6个月后的PI值与语音训练前为比较，差异均有统计学意义(P<0.01)。 结论 语音训练可显著改善125Ⅰ放射性粒子植入术后青年舌癌患者的语音清晰度。 Objective To explore the benefits of speech training for young persons with tongue cancer after 125Ⅰ radioactive seed implantation. Methods Fifty young persons bearing a 125Ⅰ radioactive seed implanted to treat tongue cancer were given up to 40min of daily tongue function training beginning on the second day after the operation. Abnormal sounds were corrected in the seven days before their discharge. An online platform assisted further training in the family combined with biofeedback. Daily 20-30 minute sessions were prescribed. Time domain waveforms, speech spectra and energy waterfalls were recorded from the 50 subjects before the experiment and after 1 week of the speech training. Intelligibility (PI) was quantified before the operation and the speech training, and then 1, 2, 4 and 6 months after discharge. Results After 1 week of speech training abnormal waveforms had disappeared from the time domain waveform diagram. Fricative disturbance areas in the speech spectrum diagram had improved significantly, and the energy distribution in the energy waterfall diagram was balanced, showing a trend typical of normal speech fluctuation. The average PI before the operation (39.92±8.46) increased to (40.32±8.79) before the speech training and to (42.78±8.24) one month after discharge. It then continued to improve to (72.32±5.55) 6 months after discharge. Conclusion Speech training can significantly improve the speech intelligibility of patients with tongue cancer after 125Ⅰ radioactive seed implantation.

    舌癌语音训练语音清晰度125Ⅰ放射性粒子植入青年患者

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    语音分析技术在社区中筛查吞咽障碍高风险人群的应用研究

    蔡娟汤颖鑫樊永梅石丸雅司...
    796-800页
    查看更多>>摘要：目的 观察语音分析技术筛查社区中老年人群中的吞咽障碍高风险人群(年龄相关的吞咽功能减退)的可行性。 方法 招募50~80岁社区中老年人215例，用特定语音任务和进食评估工具-10(EAT-10)收集受试者的语音数据和吞咽功能情况，并根据吞咽功能的状况进一步分为吞咽功能正常组和吞咽障碍高风险组。从语音文件中提取162个语音特征。依据性别进行语音特征与吞咽障碍发生风险的关联分析，确定差异语音特征量，用多元回归构建男性与女性受试者基于语音特征的吞咽障碍发生风险预测模型，使用灵敏度、特异度与准确度评价模型的分类能力。 结果 吞咽障碍高风险组的反映下颌、舌部运动与舌部力量的23个语音特征量与正常组有统计学差异(P<0.05)。基于性别的单相关分析结果表明，反映舌部运动、舌部力量的语音特征量与吞咽功能显著相关。经多元回归预测，吞咽障碍高风险人群中，男性组的灵敏度、特异度和准确度分别为0.33、0.86和0.81，女性组分别为0、1、0.97。 结论 吞咽功能障碍高风险受试者的舌部运动与舌部力量发生了显著改变。语音分析技术有助于在社区中早期筛查出合并视力、手部功能、理解障碍中老年人吞咽障碍的罹患风险。

    吞咽障碍年龄相关的吞咽功能减退语音分析进食评估工具-10

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    超声引导下多点药物注射联合肩关节腔液压扩张治疗冻结肩的疗效观察

    赵佳芬黄敏曾艳刘青...
    801-805页
    查看更多>>摘要：目的 观察超声引导下肩峰下滑囊、喙突下滑囊和肩关节腔药物注射联合生理盐水液压扩张法治疗冻结肩(FS)的临床疗效。 方法 选取FS患者116例，按随机数字表法随机分为注射治疗组和联合治疗组，每组患者58例。注射治疗组第1天行超声引导下的肩峰下滑囊、喙突下滑囊和肩关节腔类固醇混合药物注射，联合治疗组在注射治疗组治疗方案的基础上增加肩关节腔30 ml生理盐水注入行液压扩张治疗，然后2组患者再行居家肩关节功能训练15 d。2组患者均于治疗前、注射结束后和居家肩关节功能训练结束后(治疗结束后)进行肩痛评估[疼痛视觉模拟评分(VAS)]、肩关节功能评估[肩关节被动活动度(PROM)]，并于治疗过程中进行安全性评价。 结果 注射结束后和治疗结束后，2组患者的VAS评分和PROM评分较组内治疗前，差异均有统计学意义(P<0.05)；且联合治疗组注射结束后和治疗结束后的VAS评分和PROM评分均显著优于注射治疗组同时间点，差异均有统计学意义(P<0.05)。 结论 超声引导下肩峰下滑囊、喙突下滑囊和肩关节腔药物注射联合液压扩张治疗可显著改善FS患者的肩痛和肩关节活动度，且疗效优于单纯的药物注射。 Objective To observe any effect of combining ultrasound-guided drug injection into the subacromial bursa, coracoid bursa and shoulder joint cavity with hydraulic dilation of the glenohumeral joint in the treatment of frozen shoulder (FS). Methods A total of 116 persons diagnosed with FS were randomly divided into an injection treatment group and a combined treatment group, each of 58. On the first day, both groups received ultrasound-guided steroid injections into the subacromial bursa, coracoid bursa and shoulder joint cavity. The combined treatment group was also injected with 30ml of normal saline into the glenohumeral joint for hydraulic dilation. All then followed a family-based program of shoulder function training for 15 days. Shoulder pain assessment (VAS) and shoulder function assessment (PROM) were performed for both groups before the treatment, after the injections and after the shoulder function training. Results The average VAS and PROM scores of both groups were significantly different after the treatment, with those of the combined treatment group significantly better than the injection group′s averages at each time point. Conclusion Combining ultrasound-guided drug injection with hydraulic dilation of the subacromial bursa, the coracoid bursa and the shoulder joint cavity can significantly relieve pain of FS and improve shoulder mobility. It is more effective than drug injection alone.

    冻结肩液压扩张超声引导

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    体外冲击波联合超声引导肩峰下滑囊注射治疗非钙化性冈上肌腱炎的疗效观察

    师帅于秉伦孟欣苏虹...
    806-810页
    查看更多>>摘要：目的 观察体外冲击波联合超声引导肩峰下滑囊注射治疗非钙化性冈上肌腱炎的疗效。 方法 采用随机数字表法将60例非钙化性冈上肌腱炎患者分为对照组和观察组，每组30例。两组患者均给予常规药物治疗和健康宣教，对照组在此基础上增加聚焦式体外冲击波治疗，观察组在对照组基础上应用超声引导肩峰下滑囊药物注射。治疗前和治疗7 d、14 d后，采用视觉模拟评分法(VAS)、美国加州大学肩关节评分系统(UCLA)对两组患者进行疗效评定；治疗7 d、14 d后，采用超声图像评价两组患者肩峰下滑囊积液的吸收情况。 结果 与组内治疗前比较，两组患者治疗7 d、14 d后的VAS评分下降，UCLA评分增加(P<0.05)。观察组治疗7 d后的VAS评分[(3.06±0.86)分]和UCLA评分[(24.83±1.74)分]、14 d后的VAS评分[(2.03±0.80)分]和UCLA评分[(30.93±1.46)分]均较对照组改善优异(P<0.05)。观察组治疗14 d后肩峰下滑囊积液吸收总有效率(80.0%)较对照组高(P<0.05)。 结论 体外冲击波联合超声引导肩峰下滑囊注射治疗能有效缓解非钙化性冈上肌腱炎患者的疼痛，改善肩关节运动功能，促进滑囊积液吸收。 Objective To observe any differential clinical effect of supplementing ultrasound-guided injection of the subacromial bursa with extracorporeal shock wave stimulation in the treatment of non-calcific tendinitis of the supraspinatus tendon. Methods Sixty individuals with non-calcific tendinitis of the supraspinatus tendon were randomly divided into an observation group and a control group, each of 30. Both groups received routine medication, health education and extracorporeal shock wave treatment, but the observation group additionally received ultrasound-guided injection of compound betamethasone injection plus 2% lidocaine intothe subacromial bursa. The treatment′s effect was evaluated using a visual analogue scale (VAS) and the UCLA shoulder rating scale (UCLA). Absorption of hydrops in the subacromial bursa was assessed using ultrasound imaging after 7 and 14 days of the treatment. Results After 7 and after 14 days the average VAS scores had decreased significantly, while the average UCLA score had increased significantly. At both time points the observation group′s average results were significantly better than those of the control group. The total effective absorption rate of hydrops in the subacromial bursa in the observation group (80.0%) was significantly higher than in the control group after 14 days of treatment. Conclusion Extracorporeal shock wave stimulation combined with injection of the subacromial bursa can effectively alleviate the pain of non-calcific tendinitis of the supraspinatus tendon, improve joint function, and promote the absorption of hydrops.

    非钙化性冈上肌腱炎体外冲击波超声引导肩峰下滑囊注射

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    肌内效贴贴扎对先天性肌性斜颈患儿头颈部活动度的影响

    陆晶晶张玮涛杨美霞李辉...
    811-814页
    查看更多>>摘要：目的 探讨肌内效贴贴扎对先天性肌性斜颈患儿头颈部活动度的影响。 方法 选取先天性肌性斜颈患儿52例，采用随机数字表法将其分为治疗组和对照组，每组26例。两组患儿均接受常规康复训练，每日1次，每次20 min，每周5 d，5 d为1个疗程，共4个疗程。治疗组在此基础上运用肌内效贴贴扎技术进行斜颈的治疗，间隔2 d进行1次，单次贴扎时间≤48 h，共4周。治疗前、治疗4周后(治疗后)，测量两组患儿头部倾斜、颈部侧屈角度及颈部左右旋转角度差值，并评估临床疗效。 结果 治疗后，两组患儿头部倾斜角度、颈部侧屈角度、颈部左右旋转角度差值均较组内治疗前改善(P<0.05)，且治疗组治疗后患儿头部倾斜角度[(4.46±3.00)°]、颈部侧屈角度[(62.92±7.68)°]、颈部左右旋转角度差值[(4.92±3.06)°]较对照组改善优异(P<0.05)。治疗后，治疗组患儿治愈率(46.15%)、好转率(50.00%)均高于对照组，无效率(3.85%)低于对照组(P<0.05)。 结论 在常规康复训练基础上增加肌内效贴贴扎，能更好地改善先天性肌性斜颈患儿的头颈部活动度。 Objective To explore any effect of kinesio taping on the head and neck mobility of children with congenital muscular torticollis. Methods A total of 52 children with congenital muscular torticollis were randomly divided into a treatment group and a control group, each of 26. All were given 20 minutes of routine rehabilitation training daily, 5 days a week for 4 weeks. The treatment group was additionally taped up with kinesio tape for no more than 48 hours once every 3 days for 4 weeks. Before and after the treatment the angles of head tilt and neck lateral flexion and the gaps in left and right neck rotation were measured for both groups. Results Significant improvement was observed in both groups but there was significantly more improvement among the treatment group. The treatment had a cure rate (46.15%) and an improvement rate (50.00%) significantly superior to those of the control group and a significantly lower rate of ineffectiveness. Conclusion Kinesio taping along with routine rehabilitation training can better improve the head and neck mobility of children with congenital muscular torticollis.

    先天性肌性斜颈贴扎本体感觉

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    慢性腰痛患者深层多裂肌非线性肌电信号的特征分析

    张珊珊张振发黄诗敏伍盈...
    815-819页
    查看更多>>摘要：目的 采用非线性动力学方法提取慢性腰痛(cLBP)患者与健康对照者深度多裂肌不同状态下肌电图(EMG)信号中所蕴含的非线性动力学信息，比较二者的非线性指标Lempel-Ziv(LZ)复杂度的变化特点。 方法 选取符合标准的cLBP患者25例设为cLBP组，另选取性别、年龄、教育程度等相匹配的正常受试者28例设为正常组。采用sEMG结合丝电极记录2组受试者腰部L4深层多裂肌EMG信号，分析静息状态、最大肌力、耐力收缩、持续收缩后放松等4种不同状态下多裂肌电非线性特征LZ复杂度的差异，并比较cLBP组腰部痛侧与非痛侧多裂肌LZ复杂度的差异性。采用Pearson相关分析cLBP组的疼痛持续时间、疼痛强度和功能障碍指数与LZ复杂度的相关性。 结果 cLBP组患者的VAS评分平均为(4.00±1.04)分，持续疼痛时间平均为(5.96±4.69)年，ODI指数平均为(17.12±10.49)。cLBP组患者肌电信号采集各时间点(进针时、退针后、肌肉收缩时和动作终止时)的VAS评分均显著高于正常组，差异均有统计学意义(P<0.01)。cLBP组在肌力测试、耐力测试和持续收缩后放松的深层多裂肌LZ复杂度与正常组比较，差异均有统计学意义(P<0.01)。2组受试者肌力测试、耐力测试和持续收缩后放松的深层多裂肌LZ复杂度与组内静息状态比较，差异均有统计学意义(P<0.01)；2组受试者持续收缩后放松的深层多裂肌LZ复杂度与组内肌力测试和耐力测试时比较，差异均有统计学意义(P<0.01)。cLBP组疼痛持续时间与其深层多裂肌最大等长收缩(肌力测试时和耐力测试时)的LZ复杂度呈显著负相关(P<0.01)。 结论 持续的疼痛刺激会影响大脑对深层多裂肌的协调控制，进而导致中枢对核心稳定肌肉的控制能力下降，提示中枢参与核心稳定肌调控障碍可能是cLBP病因机制的关键因素。 Objective To explore any changes in the electromyographic (EMG) signals from the deep lumbar multifidus (DM) of patients with chronic low back pain (cLBP). Methods Twenty-five cLBP patients formed the cLBP group, while twenty-eight healthy counterparts similar in sex, age and education background were chosen as the control group. EMG signals were recorded during maximum isometric voluntary contraction of the DM. Two-way repeated measures analysis of variance was applied to compare the two groups′ signals′ Lempel-Ziv (LZ) complexity values at rest and during the maximum strength, strength endurance and relaxation stages of contraction. Pearson correlation coefficients were computed relating the LZ complexity to pain duration and intensity, as well as to Oswestry disability index (ODI) values in the cLBP group. Results The cLBP patients reported a mean symptom duration of 5.96±4.69 years, with an average VAS score of 4.00±1.04 and ODI of 17.12±10.49. They reported greater pain intensity during needle insertions, needle removal, muscle contraction and relaxation than the healthy controls. There were significant differences in LZ complexity among the four stages of contraction with all of the subjects. The LZ complexity was significantly lower in the maximum strength and strength endurance states, but higher in the relaxation after contraction states in the cLBP group. Pain duration was negatively correlated with the nonlinear index of DM during contraction. Conclusion Continuous pain stimulation will affect the coordinated control of the deep multifidus muscle, leading to decreased control of core muscles via the central nervous system. That provides insight into the mechanisms underlying activation and coordinated control during chronic pain.

    腰痛深层多裂肌非线性肌电特征LZ复杂度

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