Physiko- und Rheumatherapie, St. Poelten, Austria.
Institute for Biomedical and Neural Engineering/Biomedical Technology Centre, Reykjavik University and Landspitali, Reykjavik, Iceland.
Adv Exp Med Biol. 2018;1088:585-591. doi: 10.1007/978-981-13-1435-3_27.
After spinal cord injury (SCI), patients spend daily several hours in wheelchairs, sitting on their hamstring muscles. SCI causes muscle atrophy and wasting, which is especially severe after complete and permanent damage to lower motor neurons. A European Union (EU)-supported work demonstrates that electrical fields produced by large electrodes and purpose-developed electrical stimulators recover both quadriceps and hamstring muscles, producing a cushioning effect capable of benefitting SCI patients, even in the worst case of complete and long-term lower motor neuron denervation of leg muscles. We reported that 20 out of 25 patients completed a 2-year h-bFES program, which resulted in (1) a 35% increase in cross-sectional area of the quadriceps muscles (P < 0.001), (2) a 75% increase in mean diameter of quadriceps muscle fibers (P < 0.001), and (3) improvement of the ultrastructural organization of contractile machinery and of the Ca2+-handling system. Though not expected, after 2 years during which the 20 subjects performed 5 days per week h-bFES of the atrophic quadriceps muscles, the CT cross-sectional area of the hamstring muscles also augmented, increasing from 26.9+/-8.4 (cm) to 30.7+/-9.8 (cm), representing a significant (p ≤ 0.05) 15% increase. Here we show by quantitative muscle color computed tomography (QMC-CT) that h-bFES-induced tissue improvements are present also in the hamstring muscles: a once supposed drawback (lack of specificity of muscle activation by large surface electrodes) is responsible for a major positive clinical effect. Interestingly, 2 years of home-based FES by large surface electrodes reversed also the denervation-induced skin atrophy, increasing epidermis thickness. Finally, we would like to attract attention of the readers to quantitative muscle color computed tomography (QMC-CT), a sensitive quantitative imaging analysis of anatomically defined skeletal muscles introduced by our group to monitor atrophy/degeneration of skeletal muscle tissue. Worldwide acceptance of QMC-CT will provide physicians an improved tool to quantitate skeletal muscle atrophy/degeneration before and during rehabilitation strategies so that therapy for mobility-impaired persons can be better prescribed, evaluated, and altered where needed.
脊髓损伤（SCI）后，患者每天要在轮椅上坐上几个小时，坐骨神经肌肉承受压力。SCI 会导致肌肉萎缩和消耗，尤其是在下运动神经元完全和永久性损伤后更为严重。欧盟（EU）支持的一项工作表明，大型电极和专门开发的电刺激器产生的电场可恢复四头肌和坐骨神经肌肉，产生缓冲效应，有益于 SCI 患者，即使在腿部肌肉的下运动神经元完全和长期去神经支配的最坏情况下也是如此。我们报告说，25 名患者中有 20 名完成了为期 2 年的 h-bFES 计划，该计划导致：（1）股四头肌横截面积增加 35%（P < 0.001）；（2）股四头肌纤维平均直径增加 75%（P < 0.001）；（3）收缩机制和 Ca2+处理系统的超微结构组织得到改善。尽管出乎意料，但在 20 名受试者每周 5 天进行萎缩性股四头肌 h-bFES 治疗的 2 年后，腘绳肌的 CT 横截面积也增加了，从 26.9+/-8.4（cm）增加到 30.7+/-9.8（cm），代表着显著（p ≤ 0.05）的 15%增长。在这里，我们通过定量肌肉彩色计算机断层扫描（QMC-CT）显示，h-bFES 诱导的组织改善也存在于腘绳肌中：以前认为的缺点（大型表面电极对肌肉激活的特异性缺乏）是造成主要积极临床效果的原因。有趣的是，2 年的家庭基于大型表面电极的 FES 也逆转了去神经诱导的皮肤萎缩，增加了表皮厚度。最后，我们希望引起读者对定量肌肉彩色计算机断层扫描（QMC-CT）的关注，这是我们小组引入的一种用于监测骨骼肌肉组织萎缩/退化的敏感定量成像分析。QMC-CT 的全球接受度将为医生提供一种更好的工具，用于在康复策略之前和期间量化骨骼肌肉萎缩/退化，从而可以更好地规定、评估和改变行动不便者的治疗方法。
