Crisóstomo R S S, Candeias M S, Armada-da-Siva P A S
Laboratório de Biomecânica e Morfologia Funcional (LBMF).
Phlebology. 2014 May;29(4):247-56. doi: 10.1177/0268355512471757. Epub 2013 May 6.
To evaluate popliteal vein blood flow during calf muscle contraction in chronic venous disease (CVD) patients and healthy controls using ultrasound imaging and to investigate the relationship between venous blood flow and gastrocnemius muscle (GM) morphology.
Thirty-one subjects participated in this study (mean age: 40.3 [11.8] years), 15 healthy controls and 16 with CVD (clinical classification: C₁₋₄). Popliteal vein cross-sectional area and venous blood flow velocity (FV) were evaluated by Doppler ultrasound at baseline and during three sets of 10 tip-toe movement repetitions. Muscle thickness, muscle fascicle length and pennation angle of both medial and lateral GM were measured by ultrasound. Measures were repeated a week later in 17 participants in order to assess reproducibility with intraclass correlation coefficient (ICC) and Bland-Altman analysis.
Peak FV was lower in CDV group compared with Control group for both first (40.6 [11.8] versus 62.4 (22.1) cm²/second; P = 0.021) and last (30.4 [9.1] versus 49.5 (22.7) cm²/second; P = 0.024) contraction. In CVD group, peak FV during first contraction increased with GM's muscle fascicle length (r = 0.63; P = 0.041). Popliteal FV also increased with rising range of muscle fascicles pennation change between ankle dorsiflexion and plantar flexion (r = 0.70; P = 0.025). No associations were found between haemodynamics and medial or lateral GM thickness. Calf muscular architecture was similar in both CVD and control participants. Test-retest reliability of FV measured in the same session was high (ICC≈0.70) for measures taken in the first contraction of the set but lowered when using the last contraction (ICC<0.50). Reproducibility of ultrasound evaluation of calf pump is acceptable within the same session but is unsatisfactory when testing in separate days.
Patients with moderate CVD have lower FV during calf muscles contraction but similar muscle anatomical characteristics compared with healthy controls. Changes in calf muscles flexibility and fatigue resistance may be investigated as possible causes of calf pump dysfunction.
使用超声成像评估慢性静脉疾病（CVD）患者和健康对照者在小腿肌肉收缩期间的腘静脉血流，并研究静脉血流与腓肠肌（GM）形态之间的关系。
31名受试者参与了本研究（平均年龄：40.3[11.8]岁），其中15名健康对照者和16名CVD患者（临床分级：C₁₋₄）。在基线时以及三组每组重复10次踮脚尖动作期间，通过多普勒超声评估腘静脉横截面积和静脉血流速度（FV）。通过超声测量内侧和外侧GM的肌肉厚度、肌束长度和羽状角。为了使用组内相关系数（ICC）和布兰德-奥特曼分析评估可重复性，17名参与者在一周后重复进行测量。
在第一次（40.6[11.8]对62.4(22.1)cm²/秒；P = 0.021）和最后一次（30.4[9.1]对49.5(22.7)cm²/秒；P = 0.024）收缩时，CVD组的峰值FV均低于对照组。在CVD组中，第一次收缩期间的峰值FV随GM的肌束长度增加而增加（r = 0.63；P = 0.041）。腘静脉FV也随着踝关节背屈和跖屈之间肌束羽状变化范围的增加而增加（r = 0.70；P = 0.025）。未发现血流动力学与内侧或外侧GM厚度之间存在关联。CVD患者和对照参与者的小腿肌肉结构相似。在同一组测量中，第一次收缩时测量的FV的重测信度较高（ICC≈0.70），但使用最后一次收缩时则降低（ICC<0.50）。在同一组内，小腿泵超声评估的可重复性是可以接受的，但在不同日期进行测试时则不令人满意。
与健康对照者相比，中度CVD患者在小腿肌肉收缩期间的FV较低，但肌肉解剖特征相似。小腿肌肉柔韧性和抗疲劳性的变化可能作为小腿泵功能障碍的可能原因进行研究。
