存在功能性踝关节不稳的受试者腿部肌肉中的关节源性肌肉抑制

Arthrogenic muscle inhibition in the leg muscles of subjects exhibiting functional ankle instability.

作者信息

McVey Eric D, Palmieri Riann M, Docherty Carrie L, Zinder Steven M, Ingersoll Christopher D

机构信息

University of Virginia, Department of Human Services, P.O. Box 400407, 210 Emmet Street South, Charlottesville, VA 22904, USA.

出版信息

Foot Ankle Int. 2005 Dec;26(12):1055-61. doi: 10.1177/107110070502601210.

DOI:10.1177/107110070502601210

PMID:16390639

Abstract

BACKGROUND

Functional ankle instability or a subjective report of ;;giving way'' at the ankle may be present in up to 40% of patients after a lateral ankle sprain. Damage to mechanoreceptors within the lateral ankle ligaments after injury is hypothesized to interrupt neurologic feedback mechanisms resulting in functional ankle instability. The altered input can lead to weakness of muscles surrounding a joint, or arthrogenic muscle inhibition. Arthrogenic muscle inhibition may be the underlying cause of functional ankle instability. Establishing the involvement of arthrogenic muscle inhibition in functional ankle instability is critical to understanding the underlying mechanisms or chronic ankle instability. The purpose of this investigation was to determine if arthrogenic muscle inhibition is present in the ankle joint musculature of patients exhibiting unilateral functional ankle instability.

METHODS

Twenty-nine subjects, 15 with unilateral functional ankle instability and 14 healthy control subjects, consented to participate. Bilateral soleus, peroneal, and tibialis anterior H-reflex and M-wave recruitment curves were obtained. Maximal H-reflex and maximal M-wave values were identified and the H:M ratios were calculated for data analysis. Separate 1 x 2 ANOVA were done for both the functional ankle instability and control groups to evaluate differences between limbs on the H:M ratios. Bonferroni multiple comparison procedures were used for post hoc comparisons (p < or = 0.05).

RESULTS

The soleus and peroneal H:M ratios for subjects with functional ankle instability were smaller in the injured limb when compared with the uninjured limb (p < 0.05). No limb difference was detected for the tibialis anterior H:M ratio in the functional ankle instability group (p = 0.904). No side-to-side differences were detected for the H:M ratios in patients reporting no history of ankle injury (p > 0.05).

CONCLUSIONS

Depressed H:M ratios in the injured limb suggest that arthrogenic muscle inhibition is present in the ankle musculature of patients exhibiting functional ankle instability. Establishing and using therapeutic techniques to reverse arthrogenic muscle inhibition may reduce the incidence of functional ankle instability.

摘要

背景

功能性踝关节不稳或踝关节出现“打软”的主观报告，在外侧踝关节扭伤后的患者中发生率可达40%。损伤后外侧踝关节韧带内的机械感受器受损，据推测会中断神经反馈机制，导致功能性踝关节不稳。输入的改变会导致关节周围肌肉无力，即关节源性肌肉抑制。关节源性肌肉抑制可能是功能性踝关节不稳的根本原因。确定关节源性肌肉抑制与功能性踝关节不稳的关联，对于理解慢性踝关节不稳的潜在机制至关重要。本研究的目的是确定在表现为单侧功能性踝关节不稳的患者的踝关节肌肉组织中是否存在关节源性肌肉抑制。

方法

29名受试者，15名患有单侧功能性踝关节不稳，14名是健康对照受试者，同意参与研究。获取双侧比目鱼肌、腓骨肌和胫前肌的Hoffmann反射（H反射）和M波募集曲线。确定最大H反射和最大M波值，并计算H:M比值用于数据分析。对功能性踝关节不稳组和对照组分别进行单独的1×2方差分析，以评估肢体间H:M比值的差异。采用Bonferroni多重比较程序进行事后比较（p≤0.05）。