慢性踝关节不稳步态支撑期踝周神经肌肉控制特征研究  

Study on neuromuscular control characteristics of ankle in patients with chronic ankle instability in stance phase of gait

作　　者：高丕明 罗小兵[1] 虞亚明[1] 何栩[1] 虞多多 GAO Piming;LUO Xiaobing;YU Yaming(Sichuan Province Orthopedic Hospital,Chengdu,Sichuan,610041)

机构地区：[1]四川省骨科医院运动医学科、治未病中心,四川省成都市610041

出　　处：《中国康复医学杂志》2025年第4期555-560,共6页Chinese Journal of Rehabilitation Medicine

基　　金：四川省科技厅重点研发项目(2021YFS0241);虞亚明全国名老中医药专家传承工作室建设项目;四川省骨科医院科技支撑项目(2019MS01)。

摘　　要：目的:研究慢性踝关节不稳(chronic ankle instability,CAI)患者步态支撑期各时相踝周肌肉的神经肌肉控制特征,以期为CAI功能评估和康复干预提供参考。方法:按纳入排除标准收集CAI患者,并依据年龄、身高、体重、性别匹配健康人。采用表面肌电测试仪检测所有受试者裸足自然行走时胫骨前肌、腓骨长肌、腓肠肌内侧头及外侧头肌电。结果:较之对照组,CAI患者步行时腓骨长肌在支撑中期至足跟离地期标化均方根值(root mean square,RMS)均值以及协同收缩指数显著减小(P<0.05),腓肠肌内侧头在足跟离地期至足趾离地期标化均值RMS明显增大(P<0.05),胫骨前肌(P<0.01)和腓肠肌外侧头(P<0.05)在足跟着地期至足平期协同收缩指数明显降低。结论:CAI患者步行时,腓骨长肌于支撑中期至足跟离地期神经肌肉控制能力降低,腓肠肌内侧头于足跟离地期至足趾离地期神经肌肉激活增加,而胫骨前肌和腓肠肌外侧头在足跟着地期至足平期的肌肉协同收缩能力不足,这些异常将影响相应时相足踝姿势和运动模式,增加踝关节扭伤风险。Objective:To study the neuromuscular control characteristics of ankle muscles of patients with chronic ankle instability(CAI)in different phases of stance,in order to provide reference for function evaluation and intervention of CAI.Method:CAI patients were collected according to the inclusion and exclusion criteria and matched with healthy individuals based on age,height,weight and sex.Surface electromyography was used to detect the electromyographic activity of the tibialis anterior,peroneus longus,gastrocnemius medialis and lateralis in all subjects during barefoot walking at a self-selected speed.Result:Compare with the control group,the mean normalized root mean square(RMS)value and co-contraction index of peroneus longus in CAI patients were significantly reduced from middle-stance to heel-off(P<0.05).The normalized RMS of gastrocnemius medialis was significantly increased from heel-off to toe-off(P<0.05).The co-contraction indexes of tibialis anterior(P<0.01)and gastrocnemius lateralis(P<0.05)was significantly decreased from heel-strike to foot flat.Conclusion:In CAI patients during walking,the neuromuscular control of the peroneus longus is reduced from middle-stance to heel-off,and the neuromuscular activation of the gastrocnemius medialis was increased from heel-off to toe-off,while the neuromuscular control of tibialis anterior and gastrocnemius lateralis is sufficient from heel-strike to foot-flat.These abnormalities will affect the posture and movement of foot-ankle at the corresponding gait phase and increase the risk of ankle sprain.

关 键 词：表面肌电 慢性踝关节不稳 步态 踝关节 神经肌肉控制 

分 类 号：R493[医药卫生—康复医学] R684.7[医药卫生—临床医学]