中风后比目鱼肌和腓肠肌肌束及跟腱的并发缺陷

Concurrent deficits of soleus and gastrocnemius muscle fascicles and Achilles tendon post stroke.

作者信息

Zhao Heng, Ren Yupeng, Roth Elliot J, Harvey Richard L, Zhang Li-Qun

机构信息

Rehabilitation Institute of Chicago, Illinois; Northwestern University, Chicago, Illinois; and Mayo Clinic, Rochester, Minnesota.

Rehabilitation Institute of Chicago, Illinois; Northwestern University, Chicago, Illinois; and.

出版信息

J Appl Physiol (1985). 2015 Apr 1;118(7):863-71. doi: 10.1152/japplphysiol.00226.2014. Epub 2015 Feb 5.

Abstract

Calf muscles and Achilles tendon play important roles in functional activities. However, it is not clear how biomechanical properties of the uniarticular soleus (SOL) and biarticular gastrocnemius muscle and Achilles tendon, including the fascicle length, pennation angle, and stiffness, change concurrently post stroke. Biomechanical properties of the medial gastrocnemius (GM) and soleus muscles were evaluated bilaterally in 10 hemiparetic stroke survivors using combined ultrasonography-biomechanical measurements. Biomechanical properties of the Achilles tendon including the length, cross-sectional area (CSA), stiffness, and Young's modulus were evaluated, together with calf muscle biomechanical properties. Gastrocnemius and SOL contributions were separated using flexed and extended knee positions. The impaired side showed decreased fascicle length (GM: 6%, P = 0.002 and SOL: 9%, P = 0.03, at full knee extension and 0° ankle dorsiflexion) and increased fascicular stiffness (GM: 64%, P = 0.005 and SOL: 19%, P = 0.012, at a common 50 N force level). In contrast, Achilles tendon on the impaired side showed changes in the opposite direction as the muscle fascicles with increased tendon length (5%, P < 0.001), decreased tendon CSA (5%, P = 0.04), decreased tendon stiffness (42%, P < 0.001) and Young's modulus (30%, P < 0.001) compared with the unimpaired side. The fascicle and tendon stiffness changes were correlated negatively to the corresponding fascicle and tendon length changes, and decrease in Achilles tendon stiffness was correlated to the increases of SOL and GM fascicular stiffness (P < 0.05). Characterizations of calf muscle fascicles and Achilles tendon biomechanical properties help us better understand concurrent changes of fascicles and tendon as part of the calf muscle-tendon unit and facilitate development of more effective treatments.

摘要

小腿肌肉和跟腱在功能活动中发挥着重要作用。然而,目前尚不清楚单关节比目鱼肌(SOL)、双关节腓肠肌以及跟腱的生物力学特性,包括肌束长度、羽状角和刚度,在中风后是如何同时发生变化的。使用超声-生物力学联合测量方法,对10名偏瘫中风幸存者双侧的内侧腓肠肌(GM)和比目鱼肌的生物力学特性进行了评估。同时评估了跟腱的生物力学特性,包括长度、横截面积(CSA)、刚度和杨氏模量,以及小腿肌肉的生物力学特性。通过膝关节屈曲和伸展位置来区分腓肠肌和比目鱼肌的贡献。患侧在膝关节完全伸展和踝关节背屈0°时,肌束长度缩短(GM:6%,P = 0.002;SOL:9%,P = 0.03),肌束刚度增加(在50 N的共同力水平下,GM:64%,P = 0.005;SOL:19%,P = 0.012)。相比之下,患侧跟腱的变化方向与肌肉肌束相反,与健侧相比,跟腱长度增加(5%,P < 0.001),跟腱CSA减小(5%,P = 0.04),跟腱刚度降低(42%,P < 0.001),杨氏模量降低(30%,P < 0.001)。肌束和肌腱刚度的变化与相应的肌束和肌腱长度变化呈负相关,跟腱刚度的降低与比目鱼肌和腓肠肌肌束刚度的增加相关(P < 0.05)。对小腿肌肉肌束和跟腱生物力学特性的表征有助于我们更好地理解作为小腿肌肉-肌腱单元一部分的肌束和肌腱的同时变化,并促进更有效治疗方法的开发。

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