Arangio G A, Chen C, Kalady M, Reed J F
Hershey Medical College, Penn State University, USA.
J Orthop Sports Phys Ther. 1997 Nov;26(5):238-43. doi: 10.2519/jospt.1997.26.5.238.
It is the hypothesis of the senior author (GAA) that high circumference measurements are not an accurate reflection of thigh muscle cross-sectional area or muscle strength after standard rehabilitation following anterior cruciate ligament reconstruction. Likewise, normal quadriceps femoris strength is not achieved in these patients despite aggressive rehabilitation. The purpose of our study was to quantify thigh muscle size and strength and correlate thigh circumference, muscle cross-sectional area by magnetic resonance imaging (MRI), and isokinetic strength in our patients. Thirty-three patients with anterior cruciate ligament repair utilizing autografts of iliotibial band (N = 28), semitendinosus autograft (N = 3), and bone-patellar tendon-bone autograft (N = 2) were retrospectively evaluated 48.7 +/- 6.91 months after surgery. We compared involved operated extremities with uninjured, uninvolved contralateral extremities, measuring thigh circumference, isokinetic peak torque, and cross-sectional area by MRI. We found a significant 1.8% decrease in thigh circumference, a 10% decrease in average quadriceps torque, and a 8.6% decrease in quadriceps cross-sectional area by MRI in the involved extremities compared with the uninvolved extremities. A positive correlation between MRI cross-sectional area, quadriceps, and hamstring peak torque was recorded in involved and uninvolved extremities. A positive correlation between thigh circumference, quadriceps, and hamstring peak torque was found in uninvolved extremities but not in operated extremities. The authors concluded that thigh circumference underestimates atrophy and is not correlated with cross-sectional thigh muscle area by MRI or strength in operated extremities. Persistent quadriceps weakness and decreased cross-sectional area at 49 months postsurgery and rehabilitation continue to challenge our efforts. The pathophysiology of the decrease in thigh muscle size and quadriceps femoris strength is discussed.
资深作者（GAA）的假设是，在前交叉韧带重建术后进行标准康复后，大腿围度测量并不能准确反映大腿肌肉的横截面积或肌肉力量。同样，尽管进行了积极的康复治疗，这些患者的股四头肌力量仍未恢复正常。我们研究的目的是量化大腿肌肉的大小和力量，并将大腿围度、通过磁共振成像（MRI）测量的肌肉横截面积以及我们患者的等速肌力进行关联。对33例行前交叉韧带修复术的患者进行了回顾性评估，这些患者分别使用了髂胫束自体移植物（N = 28）、半腱肌自体移植物（N = 3）和骨-髌腱-骨自体移植物（N = 2），评估时间为术后48.7±6.91个月。我们将患侧手术肢体与未受伤的对侧未受累肢体进行比较，测量大腿围度、等速峰值扭矩以及通过MRI测量的横截面积。我们发现，与未受累肢体相比，患侧肢体的大腿围度显著下降了1.8%，股四头肌平均扭矩下降了10%，股四头肌横截面积通过MRI测量下降了8.6%。在患侧和未受累肢体中，MRI横截面积、股四头肌和腘绳肌峰值扭矩之间均记录到正相关。在未受累肢体中发现大腿围度、股四头肌和腘绳肌峰值扭矩之间存在正相关，但在手术肢体中未发现。作者得出结论，大腿围度低估了萎缩情况，并且与手术肢体中通过MRI测量的大腿肌肉横截面积或力量无关。术后49个月，经过康复治疗后，股四头肌持续无力和横截面积减小仍然是我们面临的挑战。本文还讨论了大腿肌肉大小和股四头肌力量下降的病理生理学机制。
