表面肌电在肘关节骨折术后患者运动功能评估中的应用

doi:10.3969/j.issn.1006-9771.2022.12.014

摘要/Abstract

摘要：

目的探讨肘关节术后患者在肘关节最大等长收缩和肘关节屈伸运动中肩肘肌群表面肌电(sEMG)信号的特征。

方法选择北京积水潭医院康复科2021年8月至2022年4月肘关节术后恢复期患者15例(患者组)和与之匹配的健康人11例(对照组)。分别在肘关节做最大等长收缩和肘关节屈伸活动时，记录肱二头肌、肱三头肌、肱桡肌、斜方肌上束、三角肌前束、三角肌中束以及三角肌后束的sEMG信号，计算相应肌肉的均方根值(RMS)、协同收缩率(CSR)、共激活率(CR)和屈伸活动中目标肌肉的激活百分比。

结果屈、伸肘最大等长收缩时，患者组肱二头肌和肱三头肌的最大肌力均明显小于对照组(|t| > 4.109, P < 0.01)；伸肘最大等长收缩时，患者组肱三头肌的RMS显著小于对照组(t = -7.695, P < 0.001)。伸肘最大等长收缩时，患者组肱二头肌、肱桡肌的CR均大于对照组(t > 2.326, P < 0.05)；屈肘最大等长收缩时，患者组斜方肌上束CSR大于对照组(t = 2.232, P < 0.05)。屈肘活动时，患者组肱三头肌的激活水平大于对照组(t = 3.336, P < 0.05)；伸肘活动时，患者组肱二头肌、肱三头肌激活水平均大于对照组(t > 2.339, P < 0.05)。

结论肘关节骨折术后患者肩肘肌群存在异常收缩模式，其中屈肘肌群共收缩模式明显，肘伸肌激活不足，肩周肌群存在代偿收缩模式。表面肌电技术在肘关节骨折术后患者运动功能定量评估方面具有较大潜力。

关键词: 肘关节骨折, 创伤后肘关节僵硬, 表面肌电, 均方根值, 共收缩率

Abstract:

Objective To investigate the features of surface electromyography (sEMG) signals of elbow and shoulder muscle groups during maximal isometric contraction of elbow joint, and flexion and extension exercises of elbow joint after elbow fracture surgery.

Methods From August, 2021 to April, 2022, 15 convalescent patients after elbow fracture surgery (patient group) and 11 healthy controls (control group) were collected. sEMG signals of biceps brachii, triceps brachii, brachioradialis brachii, upper trapezius, anterior deltoid, middle deltoid and posterior deltoid were recorded during maximal isometric contraction, and flexion and extension exercises of the elbow joint. Root mean square (RMS) value, co-synergy contraction ratio (CSR), co-activation radio (CR), and target muscle activation percentage during flexion and extension were calculated.

Results In flexion and extension of elbow joint during maximal isometric contraction, the maximum strength of biceps brachii and triceps brachii were lower in the patient group than in the control group (|t| > 4.109, P < 0.01), and the RMS value of triceps brachii was lower in the patient group than in the control group (t = -7.695, P < 0.001). During maximal isometric extension of elbow joint, the CR of biceps brachii and brachioradialis brachii were more in the the patient group than in the control group (t> 2.326, P < 0.05); during maximal isometric flexion of elbow joint, the CSR of upper trapezius was more in the patient group than in the control group (t = 2.232, P< 0.05). During the extension exercise, the activation level of triceps brachii was more in the patient group than in the control group (t = 3.336, P < 0.05); during flexion exercise, the activation level of biceps brachii and triceps brachii was more in the patient group than in the control group (t >2.339, P < 0.05).

Conclusion There is abnormal contraction pattern of elbow and shoulder muscle groups in patients with elbow fracture after operation, which includes obvious co-contraction pattern of elbow flexor muscle group, insufficient activation of elbow extensor muscle and the compensatory contraction pattern of perishoulder muscle group. sEMG has great potential in quantitative evaluation of motor function after elbow fracture.

Key words: elbow fracture, post-traumatic elbow stiffness, surface electromyography, root mean square, co-contraction ratio

中图分类号:

R658.2

职文倩,黄强,李蔷,李艳超,王宇章,杨明,刘晓华. 表面肌电在肘关节骨折术后患者运动功能评估中的应用[J]. 《中国康复理论与实践》, 2022, 28(12): 1478-1483.

ZHI Wenqian,HUANG Qiang,LI Qiang,LI Yanchao,WANG Yuzhang,YANG Ming,LIU Xiaohua. Application of surface electromyography in motor function evaluation of patients after elbow fracture surgery[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2022, 28(12): 1478-1483.

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组别	n	性别（男/女）/n	年龄/岁	身高/cm	体质量/kg	体质量指数/kg·m^-2
对照组	11	3/8	38.091±13.487	165.273±5.877	65.636±10.604	23.903±2.526
患者组	15	8/7	39.933±10.640	171.133±9.319	77.133±20.553	25.950±4.418
χ²/t值		1.766	0.390	1.962	1.691	1.376
P值		0.184	0.700	0.062	0.104	0.182

组别	n	屈肘		伸肘
组别	n	最大肌力/磅力	肱二头肌RMS/10^-5	最大肌力/磅力	肱三头肌RMS/10^-5
对照组	11	32.056±11.381	136.016±84.054	24.369±8.529	99.714±9.582
患者组	15	19.603±6.348	193.140±400.912	12.194±5.084	32.243±3.822
t值		-4.109	0.832	-6.256	-7.695
P值		0.001	0.410	< 0.001	< 0.001

组别	n	屈肘	伸肘
组别	n	肱三头肌	肱二头肌	肱桡肌
对照组	11	0.086±0.043	0.163±0.045	0.148±0.045
患者组	15	0.123±0.090	0.246±0.090	0.272±0.199
t值		1.382	2.812	2.326
P值		0.181	0.010	0.034

组别	n	屈肘				伸肘
组别	n	三角肌前束	三角肌中束	三角肌后束	斜方肌上束	三角肌前束	三角肌中束	三角肌后束	斜方肌上束
对照组	11	0.256±0.103	0.158±0.081	0.096±0.052	0.285±0.106	0.155±0.078	0.243±0.127	0.376±0.074	0.160±0.178
患者组	15	0.335±0.183	0.214±0.164	0.132±0.102	0.417±0.173	0.207±0.094	0.344±0.199	0.407±0.144	0.316±0.222
t值		1.395	1.148	1.083	2.232	1.498	1.465	0.724	1.918
P值		0.176	0.264	0.290	0.035	0.147	0.156	0.477	0.067

组别	n	屈肘			伸肘
组别	n	肱二头肌	肱桡肌	肱三头肌	肱二头肌	肱桡肌	肱三头肌
对照组	11	10.451±12.348	17.525±14.126	2.552±1.461	2.715±2.086	5.175±4.160	3.091±2.320
患者组	15	10.877±5.843	19.592±11.900	12.296±11.182	6.154±4.520	7.590±4.210	13.124±8.714
t值		0.117	0.405	3.336	2.339	1.452	4.258
P值		0.908	0.668	0.047	0.028	0.159	0.001