Akashi Paula M H, Sacco Isabel C N, Watari Ricky, Hennig Ewald
Department of Physical Therapy, Speech and Occupational Therapy, Laboratory of Human Movement and Posture, School of Medicine, University of Sao Paulo, Brazil.
Clin Biomech (Bristol). 2008 Jun;23(5):584-92. doi: 10.1016/j.clinbiomech.2007.11.015. Epub 2008 Feb 21.
We aimed at investigating the influence of diabetic neuropathy and previous history of plantar ulcers on electromyography (EMG) of the thigh and calf and on vertical ground reaction forces during gait.
This study involved 45 adults divided into three groups: a control group (n=16), diabetic neuropathic group (n=19) and diabetic neuropathic group with previous history of plantar ulceration (n=10). EMG of the right vastus lateralis, lateral gastrocnemius and tibialis anterior were studied during the stance phase. The peaks and time of peak occurrence were determined and a co-activation index between tibialis anterior and lateral gastrocnemius. In order to represent the effect of the changes in EMG, the first and second peaks and the minimum value of the vertical ground reaction force were also determined. Inter-group comparisons of the electromyographical and ground reaction forces variables were made using three MANCOVA (peaks and times of EMG and peaks of force) and one ANCOVA (co-activation index).
The ulcerated group presented a delayed in the time of the lateral gastrocnemius and vastus lateralis peak occurrence in comparison to control's. The lateral gastrocnemius delay may be related to the lower second vertical peak in diabetic subjects. However, the delay of the vastus lateralis did not cause any significant change on the first vertical peak.
The vastus lateralis and lateral gastrocnemius delay demonstrate that ulcerated diabetic neuropathic patients have a motor deficit that could compromise their ability to walk, which was partially confirmed by changes on ground reaction forces during the push-off phase.
我们旨在研究糖尿病神经病变和既往足底溃疡病史对大腿和小腿肌电图（EMG）以及步态期间垂直地面反作用力的影响。
本研究纳入45名成年人，分为三组：对照组（n = 16）、糖尿病神经病变组（n = 19）和有既往足底溃疡病史的糖尿病神经病变组（n = 10）。在站立期研究右侧股外侧肌、腓肠外侧肌和胫前肌的肌电图。确定峰值和峰值出现时间，并计算胫前肌和腓肠外侧肌之间的共同激活指数。为了体现肌电图变化的影响，还确定了垂直地面反作用力的第一和第二峰值以及最小值。使用三个多变量协方差分析（肌电图的峰值和时间以及力的峰值）和一个协方差分析（共同激活指数）对肌电图和地面反作用力变量进行组间比较。
与对照组相比，溃疡组腓肠外侧肌和股外侧肌峰值出现时间延迟。腓肠外侧肌延迟可能与糖尿病患者较低的第二垂直峰值有关。然而，股外侧肌延迟并未导致第一垂直峰值出现任何显著变化。
股外侧肌和腓肠外侧肌延迟表明，有溃疡的糖尿病神经病变患者存在运动功能障碍，这可能会损害他们的行走能力，在蹬离期地面反作用力的变化部分证实了这一点。
