Springer Barbara A, Gill Norman W
Physical Therapy Service, Department of Orthopaedics and Rehabilitation, Walter Reed Army Medical Center, Washington, DC, USA.
J Orthop Sports Phys Ther. 2007 Oct;37(10):635-43. doi: 10.2519/jospt.2007.2532.
Retrospective review.
To describe bilateral thickness of the lateral abdominal muscles at baseline and during an abdominal drawing-in maneuver (ADIM) in individuals with unilateral transtibial (TTA) or transfemoral (TFA) amputations.
Although side-to-side symmetry of lateral abdominal muscle thickness has been established in healthy individuals, the degree of symmetry in those with unilateral lower extremity amputations remains unknown. Differences in lateral abdominal muscle thickness may exist based on prior findings of asymmetry and differences measured based on level of amputation in both the size and function of the iliopsoas and back extensor muscles.
Seventy patients (69 males, 1 female) with traumatic unilateral lower extremity amputations (TTA, n = 39; TFA, n = 31) received a rehabilitative ultrasound imaging examination. Absolute thickness of the transversus abdominis (TrA) and the external and internal oblique muscles combined (EO+IO) were assessed bilaterally at baseline and during the ADIM. Symmetry was assessed using relative muscle thickness values at baseline. Percent increase in muscle thickness during the ADIM was used to investigate muscle function. Separate 2-by-2 mixed-model ANOVAs were used to compare both within-group (side of amputation versus nonamputated side) and between-group (TTA versus TFA) differences for thickness and function of the TrA and the EO+IO muscles.
On the side of the amputation, the relative baseline thickness of the EO+IO measurement was greater (P < .05), while the relative baseline thickness of the TrA muscle was smaller (P < .05). But the mean differences side to side were small (1.3%) and unlikely to be clinically significant. Further, there were no differences in baseline muscle thickness between groups for the TrA (P = .95) or the EO+IO (P = .94) muscles. For thickness measurements during the ADIM, the TrA showed no side-to-side (P = .74) or group (P = .07) differences. Similarly, no side-to-side (P = .60) or group (P = .09) differences were found in the EO+IO thickness during the ADIM.
Despite the limitations of retrospective review, these findings provide an initial reference data set for future studies. Bilateral symmetry of the lateral abdominal wall muscle thicknesses at baseline and during the ADIM for those with unilateral lower extremity amputations is comparable to healthy individuals. Future studies should consider the potential influences of low back pain and gait training on symmetry of muscle thickness and muscle function based on level of amputation.
回顾性研究。
描述单侧经胫骨截肢(TTA)或经股骨截肢(TFA)患者在基线状态及进行收腹动作(ADIM)时双侧腹外侧肌肉的厚度。
虽然已证实健康个体腹外侧肌肉厚度存在左右对称性,但单侧下肢截肢患者的对称程度仍不清楚。根据先前关于不对称性的研究结果以及基于截肢水平测量的髂腰肌和背部伸肌在大小和功能上的差异,腹外侧肌肉厚度可能存在差异。
70例创伤性单侧下肢截肢患者(69例男性,1例女性)(TTA,n = 39;TFA,n = 31)接受了康复超声成像检查。在基线状态及ADIM期间,双侧评估腹横肌(TrA)以及腹外斜肌和腹内斜肌联合(EO + IO)的绝对厚度。使用基线时的相对肌肉厚度值评估对称性。ADIM期间肌肉厚度的增加百分比用于研究肌肉功能。采用单独的2×2混合模型方差分析比较TrA和EO + IO肌肉厚度及功能的组内差异(截肢侧与非截肢侧)和组间差异(TTA与TFA)。
在截肢侧,EO + IO测量的相对基线厚度更大(P <.05),而TrA肌肉的相对基线厚度更小(P <.05)。但左右平均差异较小(1.3%),不太可能具有临床意义。此外,TrA(P =.95)或EO + IO(P =.94)肌肉在组间基线肌肉厚度上没有差异。对于ADIM期间的厚度测量,TrA未显示出左右差异(P =.74)或组间差异(P =.07)。同样,在ADIM期间,EO + IO厚度也未发现左右差异(P =.60)或组间差异(P =.09)。
尽管回顾性研究存在局限性,但这些发现为未来研究提供了初始参考数据集。单侧下肢截肢患者在基线状态及ADIM期间腹外侧壁肌肉厚度的双侧对称性与健康个体相当。未来研究应考虑基于截肢水平的腰痛和步态训练对肌肉厚度对称性和肌肉功能的潜在影响。