前交叉韧带重建术后6—8周步行时下肢肌肉的表面肌电特征

关键词：前交叉韧带重建术  表面肌电  三维动作捕捉系统  均方根值  积分肌电值  步态周期  协同收缩

Keywords:anterior cruciate ligament  surface electromyography  3D motion capture system  root mean square  integral electromyography  gait cycle  synergetic contraction

摘要：

      摘要 目的：探究前交叉韧带重建术（ACLR）患者早期步行时下肢肌肉表面肌电特征变化情况，分析其与创伤性膝骨关节炎疾病的关系，为术后康复治疗方案的制定提供理论依据和指导意见。 方法：2022年3—11月，招募滨州医学院烟台附属医院单侧前交叉韧带重建术患者32例，三维动作捕捉系统协同表面肌电采集步行时下肢双侧股外侧肌、股内侧肌、股直肌、股二头肌、半腱肌、腓肠肌内侧头、臀大肌和臀中肌表面肌电，计算均方根（RMS）、积分肌电值（iEMG）和协同收缩比值，对比分析双侧下肢肌肉的差异。 结果：ACLR患者在初始双支撑期时，患侧股二头肌、半腱肌、臀中肌和臀大肌运动RMS和iEMG均大于健侧，腓肠肌内侧小于健侧（P＜0.05）；单支撑期，患侧股外侧肌、股直肌、腓肠肌内侧RMS和iEMG均小于健侧，半腱肌RMS大于健侧，股二头肌、半腱肌和臀大肌iEMG小于健侧（P＜0.05）；双支撑期时，患侧股外侧肌、股内侧肌、股直肌、股二头肌、半腱肌、腓肠肌内侧、臀大肌和臀中肌iEMG均小于健侧（P＜0.05），股外侧肌和腓肠肌内侧RMS小于健侧（P＜0.05）；摆动期时，患侧股内侧肌、股二头肌、半腱肌、臀大肌和臀中肌RMS和iEMG均大于健侧，患侧腓肠肌内侧RMS和iEMG小于健侧，股内侧肌iEMG大于健侧（P＜0.05）；ACLR患者在初始双支撑期、双支撑期和摆动期阶段，患侧BF/VL和VM/VL的均方根比值均大于健侧（P＜0.05）。 结论：ACLR患者术后6—8周时，在不同的步行时相中，患侧下肢肌肉的激活情况与健侧相比均存在一定差异。患侧股二头肌、半腱肌、臀大肌和臀中肌在大部分步态时相中激活程度较健侧高，股四头肌激活情况变化较大，且膝关节内外侧肌肉协同收缩增加，改变了原有的肌肉激活策略，对关节软骨及关节负荷产生影响。

Abstract:

      Abstract Objective：To explore the changes of EMG characteristics of lower limb muscle surface in patients with anterior cruciate ligament reconstruction (ACLR) during early walking，analyze the relationship with traumatic knee osteoarthritis，and to provide the theoretical basis and guidance for the formulation of postoperative rehabilitation treatment. Method：Thirty-two patients undergoing unilateral anterior cruciate ligament reconstruction in Yantai Affiliated Hospital of Binzhou Medical University from March to November in 2022 were recruited. Three-dimensional motion capture system combined with surface electromyography （sEMG） was used to collect the lateral vastus muscle， medial vastus muscle， rectus femoris， biceps femoris， semitendinosus muscle， medial gastrocnemius muscle， gluteus maximus muscle and gluteus medius muscle during walking， and calculate the root mean square （RMS）， integral EMG （iEMG） and synergistic contraction ratio, to compare and analyze the differences in bilateral lower limb muscles. Result：During the initial double support phase， the RMS and iEMG of biceps femoris， semitendinosus， gluteus medius and gluteus maximus in the affected side were higher than those in the healthy side， while the medial gastrocnemius muscle was smaller than that in the healthy side （P<0.05）. During the single support period， the RMS and iEMG of lateral vastus muscle， rectus femoris and medial gastrocnemius muscle of the affected side were lower than those of the healthy side， the RMS of the semitendinosus muscle was larger than that of the healthy side， and the iEMG of biceps femoris， semitendinosus muscle and gluteus maximus muscle was lower than that of the healthy side （P<0.05）. During the double support phase， the iEMG of lateral vastus muscle， medial vastus muscle， rectus femoris， biceps femoris， semitendinosus muscle， medial gastrocnemius muscle， gluteus maximus and middle gluteus muscle of the affected side was lower than that of the healthy side （P<0.05）， and the RMS of lateral vastus muscle and gastrocnemius muscle of the affected side was lower than that of the healthy side （P<0.05）. During the swing period， the RMS and iEMG of medial vastus muscle， biceps femoris， semitendinosus muscle， gluteus maximus and gluteus medius muscle of the affected side were higher than those of the healthy side， while the RMS and iEMG of medial gastrocnemius muscle of the affected side were lower than those of the healthy side， and the iEMG of medial vastus muscle was larger than that of the healthy side （P<0.05）； In patients with ACLR， the root mean square ratio of BF/VL and VM/VL in the affected side was higher than that in the healthy side in the initial double support phase， double support phase and swing period. Conclusion：Six to eight weeks after ACLR, the activation of the lower limb muscles of the affected side is different from that of the healthy side in different walking phases. The activation degree of biceps femoris， semitendinosus muscle， gluteus maximus and gluteus medius muscle of the affected side was higher than that of the healthy side in most gait phases， the activation of quadriceps femoris changed greatly， and the coordinated contraction of medial and lateral muscles of knee joint increased， which changed the original muscle activation strategy and affected articular cartilage and joint loading.