仰卧位等长收缩时体格检查评估股四头肌关节抑制的可行性：一项横断面研究。

Assessment of arthrogenic quadriceps muscle inhibition by physical examination in the supine position during isometric contraction is feasible as demonstrated by electromyography: a cross-sectional study.

机构信息

Department of Physical Therapy, College of Health Science, Eulji University, Seongnam, Republic of Korea.

Department of Orthopaedic Surgery, Eulji University Medical Centre, Eulji University College of Medicine, Daejeon, Republic of Korea.

出版信息

J Orthop Surg Res. 2024 Aug 2;19(1):458. doi: 10.1186/s13018-024-04949-9.

DOI:10.1186/s13018-024-04949-9

PMID:39095797

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11297743/

Abstract

BACKGROUND

Preventing severe arthrogenic muscle inhibition (AMI) after knee injury is critical for better prognosis. The novel Sonnery-Cottet classification of AMI enables the evaluation of AMI severity but requires validation. This study aimed to investigate the electromyography (EMG) patterns of leg muscles in the examination position from the classification during isometric contraction to confirm its validity. We hypothesised that the AMI pattern, which is characterised by quadriceps inhibition and hamstring hypercontraction, would be detectable in the supine position during isometric contraction.

METHODS

Patients with meniscal or knee ligament injuries were enrolled between August 2023 and May 2024. Surface EMG was assessed during submaximal voluntary isometric contractions (sMVIC) at 0° extension in the supine position for the vastus medialis (VM) and vastus lateralis (VL) muscles and at 20° flexion in the prone position for the semitendinosus (ST) and biceps femoris (BF) muscles. Reference values for normalisation were obtained from the EMG activity during the gait of the uninjured leg. The Kruskal-Wallis test was used to compare the activation patterns of the muscle groups within the same leg, and the post-hoc tests were conducted using the Mann-Whitney U test and Bonferroni correction.

RESULTS

Electromyographic data of 40 patients with knee injuries were analyzed. During sMVIC, the extensor and flexor muscles of the injured leg showed distinct behaviours (P < 0.001), whereas the uninjured side did not (P = 0.144). In the injured leg, the VM differed significantly from the ST (P = 0.018), and the VL differed significantly from the ST and BF (P = 0.001 and P = 0.026, respectively). However, there were no statistically significant differences within the extensor muscle groups (VM and VL, P = 0.487) or flexor muscle groups (ST and BF, P = 0.377).

CONCLUSION

AMI was detectable in the examination position suggested by the Sonnery-Cottet classification. The flexor and extensor muscles of the injured leg exhibited distinct activation behaviours, with inhibition predominantly occurring in the quadriceps muscles, whereas the hamstrings showed excitation.

摘要

背景

预防膝关节损伤后的严重关节源性肌肉抑制（AMI）对于更好的预后至关重要。新型的 Sonnery-Cottet AMI 分类法可用于评估 AMI 的严重程度，但需要验证。本研究旨在通过等长收缩时的检查体位来调查该分类法中的肌电图（EMG）模式，以确认其有效性。我们假设，在等长收缩时仰卧位下可检测到以股四头肌抑制和腘绳肌过度收缩为特征的 AMI 模式。

方法

2023 年 8 月至 2024 年 5 月期间，招募了半月板或膝关节韧带损伤的患者。在仰卧位下进行最大自主等长收缩（sMVIC）时，评估股直肌（VM）和股外侧肌（VL）在 0°伸展位和俯卧位下半腱肌（ST）和股二头肌（BF）在 20°屈曲位的表面 EMG。通过对未受伤腿步态期间的 EMG 活动进行归一化获得参考值。使用 Kruskal-Wallis 检验比较同一腿内肌肉群的激活模式，使用曼-惠特尼 U 检验和 Bonferroni 校正进行事后检验。

结果

对 40 例膝关节损伤患者的肌电图数据进行了分析。在 sMVIC 时，受伤腿的伸肌和屈肌表现出明显不同的行为（P<0.001），而未受伤侧则没有（P=0.144）。在受伤腿中，VM 与 ST 明显不同（P=0.018），VL 与 ST 和 BF 明显不同（P=0.001 和 P=0.026）。然而，在伸肌肌群（VM 和 VL，P=0.487）或屈肌肌群（ST 和 BF，P=0.377）内没有统计学上的显著差异。