慢性颈痛患者颈肩部肌肉性能差异及其与疼痛、体质量指数的相关性

doi:10.3969/j.issn.1006-9771.2023.12.006

《中国康复理论与实践》 ›› 2023, Vol. 29 ›› Issue (12): 1420-1428.doi: 10.3969/j.issn.1006-9771.2023.12.006

慢性颈痛患者颈肩部肌肉性能差异及其与疼痛、体质量指数的相关性

沈星星¹, 熊玉玲², 陈伟健¹, 李聪聪¹, 李俊毅¹, 王帅¹, 章家皓¹, 向瑞安¹, 陈佳浩¹, 刘文刚³, 许学猛³()

1.广州中医药大学第五临床医学院，广东广州市 510405
2.广州中医药大学惠州医院，广东惠州市 516000
3.广东省第二中医院，广东广州市 510095

收稿日期:2023-09-14 修回日期:2023-11-06 出版日期:2023-12-25 发布日期:2023-12-28
通讯作者: 许学猛，男，主任中医师，二级教授，主要研究方向：中医药防治退行性骨关节病。E-mail： xuxuemeng@163.com
作者简介:沈星星(1998-)，男，汉族，江西南昌市人，硕士研究生，主要研究方向：中医药防治退行性骨关节病。
基金资助:
1.广东省自然科学基金项目(2021A1515011545);2.广东省科技计划项目(2021B1111610007);广东省科技计划项目(2018B020207009);3.广州市科技计划项目(202206010048)

Difference of cervical and shoulder muscle performance and its correlation with pain and body mass index in patients with chronic neck pain

SHEN Xingxing¹, XIONG Yuling², CHEN Weijian¹, LI Congcong¹, LI Junyi¹, WANG Shuai¹, ZHANG Jiahao¹, XIANG Ruian¹, CHEN Jiahao¹, LIU Wengang³, XU Xuemeng³()

1. The Fifth Clinical Medical School, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510405, China
2. Huizhou Hospital of Guangzhou University of Chinese Medicine, Huizhou, Guangdong 516000, China
3. Guangdong Second Traditional Chinese Medicine Hospital, Guangzhou, Guangdong 510095, China

Received:2023-09-14 Revised:2023-11-06 Published:2023-12-25 Online:2023-12-28
Contact: XU Xuemeng, E-mail: xuxuemeng@163.com
Supported by:
Guangdong Natural Science Foundation(2021A1515011545);Guangdong R & D Plan(2021B1111610007);Guangdong R & D Plan(2018B020207009);Guangzhou R & D Plan(202206010048)

摘要/Abstract

摘要：

目的检验MyotonPRO评估单侧慢性颈痛患者颈肩部肌肉性能参数的测试者间信度和重测信度，观察慢性颈痛患者健、患两侧肌肉性能的差异，分析引起慢性颈痛患者肌肉性能失衡的因素。

方法 2023年1月至6月，广东省第二中医院单侧慢性颈痛患者32例，由2名测试者采用相同的MyotonPRO设备测量放松体位下胸锁乳突肌和上斜方肌健、患两侧的肌张力、肌肉硬度和肌肉弹性，测试者1间隔30 min后重复测量，测试者2在测试者1两次测量的时间间隔内进行测量。并同步计算组内相关系数(ICC)、标准误差(SEM)和最小可检测变化(MDC)，将测量结果绘制成Bland-Altman图并进行系统偏倚分析。比较患侧和健侧的肌肉性能差异，同时收集受试者疼痛视觉模拟量表(VAS)评分和体质量指数(BMI)进行相关性分析。

结果除患侧的胸锁乳突肌弹性系数(ICC = 0.697)外，所有参数的测试者间信度均表现为高至非常高(ICC = 0.719~0.952，SEM = 0.04~6.53，MDC = 0.12~18.11)；所有参数的重测信度均较高(ICC = 0.883~0.981)，SEM = 0.03~5.72，MDC = 0.09~15.84)。Bland-Altman图分析显示散点分布一致性良好。单侧慢性颈痛患者患侧胸锁乳突肌和上斜方肌张力、硬度和肌肉弹性高于健侧(t > 2.846, P < 0.05)。上斜方肌和胸锁乳突肌肌张力、硬度、弹性系数的不对称指数与VAS评分和BMI均呈正相关(r > 0.385, P < 0.05)。

结论 MyotonPRO评估慢性颈痛人群健、患两侧肌肉性能具有良好的测试者间信度和重测信度。慢性颈痛患者患侧胸锁乳突肌和上斜方肌的肌张力、肌肉硬度和肌肉弹性高于健侧，且这种肌肉性能的差异与疼痛和BMI呈正相关。

关键词: 上斜方肌, 胸锁乳突肌, MyotonPRO, 肌张力, 肌肉硬度, 肌肉弹性, 信度

Abstract:

Objective To test the inter-tester reliability and test-retest reliability of MyotonPRO for evaluating neck and shoulder muscle performance parameters in patients with unilateral chronic neck pain, observe the difference of muscle performance between the healthy and affected sides of patients with chronic neck pain, and analyze the factors that cause the imbalance of muscle performance in patients with chronic neck pain.

Methods From January to June, 2023, 32 patients with unilateral chronic neck pain in Guangdong Second Traditional Chinese Medicine Hospital were selected. Two testers used the same MyotonPRO equipment to measure the muscle tone, muscle hardness and muscle elasticity on both sides of the sternocleidomastoid muscle and the upper trapezius muscle in the relaxed position. Tester 1 repeated the measurement after an interval of 30 minutes, and Tester 2 was measured within the time interval between the two measurements of Tester 1. The intraclass correlation coefficient (ICC), standard error of mean (SEM) and minimum detectable change (MDC) were calculated simultaneously. The measurement results were plotted into Bland-Altman diagram and systematic bias analysis was performed. The difference in muscle characteristics between the affected side and the healthy side was compared. At the same time, the Visual Analogue Scale (VAS) score and body mass index (BMI) of the subjects were collected for correlation analysis.

Results Except the sternocleidomastoid muscle elasticity of the affected side (ICC = 0.697), the inter-tester reliability of all other parameters was high to very high (ICC = 0.719 to 0.952, SEM = 0.04 to 6.53, MDC = 0.12 to 18.11). The test-retest reliability of all parameters was high (ICC = 0.883 to 0.981, SEM = 0.03 to 5.72, MDC = 0.09 to 15.84). Bland-Altman plot analysis showed that the scatter distribution was consistent. The muscle tone, muscle hardness and muscle elasticity of sternocleidomastoid muscle and upper trapezius muscle were higher on the affected side than on the healthy side (t > 2.846, P< 0.05). The asymmetry index of tension, hardness and elasticity of upper trapezius muscle and sternocleidomastoid muscle was significantly positively correlated with VAS score and BMI (r> 0.385, P< 0.05).

Conclusion MyotonPRO has good inter-tester reliability and retest reliability in evaluating the muscle performance of both sides of patients with chronic neck pain. The muscle tone, muscle hardness and muscle elasticity of sternocleidomastoid muscle and upper trapezius muscle on the affected side were higher than on the healthy side, and the difference of muscle performance was positively correlated with pain and BMI.

Key words: upper trapezius muscle, sternocleidomastoid muscle, MyotonPRO, muscle tone, muscle hardness, muscle elasticity, reliability

中图分类号:

R681.5

沈星星, 熊玉玲, 陈伟健, 李聪聪, 李俊毅, 王帅, 章家皓, 向瑞安, 陈佳浩, 刘文刚, 许学猛. 慢性颈痛患者颈肩部肌肉性能差异及其与疼痛、体质量指数的相关性[J]. 《中国康复理论与实践》, 2023, 29(12): 1420-1428.

SHEN Xingxing, XIONG Yuling, CHEN Weijian, LI Congcong, LI Junyi, WANG Shuai, ZHANG Jiahao, XIANG Ruian, CHEN Jiahao, LIU Wengang, XU Xuemeng. Difference of cervical and shoulder muscle performance and its correlation with pain and body mass index in patients with chronic neck pain[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(12): 1420-1428.

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肌肉	性能	测试者	患侧		健侧
肌肉	性能	测试者	第1次测量	第2次测量	第1次测量	第2次测量
上斜方肌	肌张力/Hz	1	19.88±1.02	19.78±0.96	18.61±0.75	18.49±0.76
		2	19.43±0.86		18.18±0.90
	肌肉硬度/(N•m^-1)	1	389.66±25.97	393.38±25.00	361.03±24.64	364.19±22.22
		2	381.69±23.82		355.34±23.07
	弹性系数	1	1.24±0.11	1.27±0.11	1.10±0.11	1.11±0.11
		2	1.17±0.12		1.04±0.11
胸锁乳突肌	肌张力/Hz	1	13.94±1.14	14.03±1.10	13.14±0.94	13.23±1.10
		2	13.49±1.24		12.72±1.22
	肌肉硬度/(N•m^-1)	1	251.03±13.24	255.09±13.18	237.19±11.82	240.34±12.73
		2	246.09±13.46
	弹性系数	1	1.52±0.12	1.54±0.13	1.61±0.13	1.62±0.13
		2	1.48±0.11		1.55±0.12

肌肉	性能	患侧			健侧
肌肉	性能	ICC (95% CI)	SEM	MDC	ICC (95% CI)	SEM	MDC
上斜方肌	肌张力	0.719(0.498, 0.852)	0.51	1.41	0.839(0.695, 0.918)	0.34	0.95
	肌肉硬度	0.932(0.865, 0.966)	6.53	18.11	0.952(0.905, 0.852)	5.23	14.48
	弹性系数	0.849(0.713, 0.923)	0.05	0.13	0.841(0.699, 0.919)	0.04	0.12
胸锁乳突肌	肌张力	0.890(0.787, 0.946)	0.40	1.10	0.757(0.559, 0.874)	0.55	1.52
	肌肉硬度	0.892(0.791, 0.946)	4.43	12.28	0.801(0.630, 0.897)	5.36	14.86
	弹性系数	0.697(0.464, 0.840)	0.07	0.20	0.742(0.535, 0.865)	0.06	0.17

肌肉	性能	患侧	健侧	t值	P值
上斜方肌	肌张力/Hz	19.70±0.96	18.43±0.82	17.353	< 0.001
	肌肉硬度/(N•m^-1)	388.24±25.16	360.19±23.37	27.639	< 0.001
	弹性系数	1.23±0.12	1.09±0.11	25.045	< 0.001
胸锁乳突肌	肌张力/Hz	13.82±1.17	13.03±1.11	2.846	0.013
	肌肉硬度/(N•m^-1)	250.74±13.67	236.49±12.49	20.210	< 0.001
	弹性系数	1.60±0.13	1.51±0.12	3.495	0.004

肌肉	性能	不对称指数/%	VAS评分		BMI
肌肉	性能	不对称指数/%	r值	P值	r值	P值
上斜方肌	肌张力	6.38±2.89	0.620	< 0.001	0.527	0.002
	肌肉硬度	7.21±1.84	0.529	0.002	0.400	0.023
	弹性系数	11.62±3.08	0.531	0.002	0.504	0.003
胸锁乳突肌	肌张力	5.98±2.47	0.499	0.004	0.462	0.008
	肌肉硬度	5.75±2.05	0.455	0.009	0.470	0.007
	弹性系数	5.35±2.95	0.417	0.018	0.385	0.030

慢性颈痛患者颈肩部肌肉性能差异及其与疼痛、体质量指数的相关性

Difference of cervical and shoulder muscle performance and its correlation with pain and body mass index in patients with chronic neck pain

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肌肉	性能	患侧			健侧
肌肉	性能	ICC (95% CI)	SEM	MDC	ICC (95% CI)	SEM	MDC
上斜方肌	肌张力	0.981(0.961, 0.991)	0.14	0.37	0.977(0.952, 0.989)	0.11	0.32
	肌肉硬度	0.981(0.960, 0.991)	3.50	9.69	0.940(0.877, 0.971)	5.72	15.84
	弹性系数	0.921(0.838, 0.961)	0.03	0.09	0.909(0.814, 0.956)	0.03	0.09
胸锁乳突肌	肌张力	0.929(0.854, 0.965)	0.30	0.82	0.883(0.761, 0.943)	0.35	0.97
	肌肉硬度	0.963(0.924, 0.982)	2.55	7.08	0.898(0.790, 0.950)	3.93	10.88
	弹性系数	0.886(0.767, 0.945)	0.04	0.12	0.933(0.862, 0.967)	0.03	0.09