The effects of joint damage on muscle function, proprioception and rehabilitation.
The effects of joint damage on muscle function, proprioception and rehabilitation.
复制标题
关节损伤对肌肉功能、本体感觉和康复的影响。
作者：
Michael Hurley
摘要本文总结了一系列的研究调查减少股四头肌的激活及其对创伤和关节炎性膝关节损伤患者康复的影响。它结合了相关研究领域的发现，并推测了关节损伤后自愿激活减少的生理原因及其临床意义。关节性自主活动减少是指无法最大限度地激活穿过受损关节的肌肉。这种现象可能会通过阻止肌肉的完全激活而导致肌肉无力，如果延长，可能会导致肌纤维萎缩，并可能妨碍康复。在前交叉韧带（ACL）缺陷膝关节的患者中，股四头肌激活的减少与关节损伤的持续量相关，并导致股四头肌无力。孤立性ACL断裂的患者股四头肌活动略有减少，但不会妨碍保守康复。然而，ACL断裂和相关关节损伤的患者激活大大减少，对康复的反应很差。手术稳定ACL缺陷肢体可增加激活并提高康复疗效。轻度膝关节骨关节炎患者的股四头肌激活也减少，这些患者对康复反应良好。关节损伤后，异常的关节传入信息可能会降低α-运动神经元的兴奋性，减少随意股四头肌的激活。如果关节损伤是广泛的，则导致激活的大幅减少可能会阻止达到肌肉肥大的刺激阈值，这会阻碍康复。异常的关节传入信息也可能降低γ运动神经元的兴奋性，导致本体感受缺陷。增加α-运动神经元兴奋性的康复也可以增加γ-运动神经元兴奋性，从而改善本体感觉。版权所有1997年哈考特出版有限公司。
SUMMARY. The paper summarizes a series of studies investigating reduced quadriceps femoris activation and its effect on rehabilitation of patients with traumatic and arthritic knee damage. It incorporates findings from related research fields and speculates on the physiological causes of reduced voluntary activation following joint damage and its clinical implications. Arthrogenic reduction in voluntary activation is the inability to maximally activate muscles acting across damaged joints. This phenomenon may cause muscle weakness by preventing complete activation of the muscle and if prolonged may result in muscle fibre atrophy, and may possibly impede rehabilitation. In patients with anterior cruciate ligament (ACL) deficient knees the reduction in quadriceps femoris activation was related to the amount of joint damage sustained and caused some quadriceps femoris weakness. Patients with isolated ACL ruptures had a small reduction of quadriceps femoris activation that did not impede conservative rehabilitation. However, patients with ACL ruptures and associated joint damage had a large reduction in activation and responded poorly to rehabilitation. Operative stabilization of ACL-deficient limbs may increase activation and improve efficacy of rehabilitation. Quadriceps femoris activation was also reduced in patients with mild knee osteoarthritis, who responded well to rehabilitation. Following joint damage, abnormal articular afferent information may decrease alpha-motoneurone excitability, reducing voluntary quadriceps femoris activation. If joint damage is extensive the resulting large reduction in activation may prevent the threshold for stimulation of muscle hypertrophy from being reached, which impedes rehabilitation. Abnormal articular afferent information may also decrease gamma-motoneurone excitability causing proprioceptive deficits. Rehabilitation which increases alpha-motoneurone excitability may also increase gamma-motoneurone excitability, improving proprioception. Copyright 1997 Harcourt Publishers Ltd.