【作者】 张秋霞；

【导师】 张林；

【作者基本信息】 苏州大学 ， 体育教育训练学， 2010， 博士

【摘要】 目的:踝关节是体育运动中最容易受伤的关节,而导致功能性不稳踝关节反复扭伤的原因还不确定。本研究从功能性不稳踝关节矢状面内的本体感觉、等速向心以及离心状态下的肌力特征、局部肌肉疲劳对本体感觉和生物力学特性的影响等不同研究角度和层次,系统探讨功能性不稳踝关节的神经肌肉控制机制,为踝关节损伤防治和康复训练提供基础理论和实验依据。方法:本研究选取有单侧功能性踝关节不稳的受试者14名(FAI组),根据FAI组受试者的年龄、身高、体重、训练项目、下肢形态学指标等匹配14名无功能性踝关节不稳的健康受试者作为对照组。对FAI组的患侧和健侧、对照组的匹配侧和对侧踝关节运用CON-TREX等速力量测试系统和biovision多导运动生物电记录分析系统进行踝关节矢状面内(跖屈和背屈)运动过程中的角度、力矩、速度和表面信号的同步采集。本体感觉的位置觉采用受试者对踝关节跖屈5°的被动定位被动复位能力进行测试,肌肉力觉采用受试者对踝关节跖屈肌群25%最大等长峰值力矩值的复制能力进行测试。对于FAI组和对照组的踝关节的本体感觉及局部肌肉疲劳对其影响,不同测试踝、不同速度(60和180°? s?1)下最大等速向心和离心运动的峰值力矩以及背屈与跖屈肌群的峰值力矩比,跖屈、背屈肌群的峰值力矩、SEMG特征随着时间变化情况差异的比较,均采用混合多元方差分析;采用t检验分析FAI组和对照组等速向心运动至肌肉疲劳的重复测试次数的差异;对于踝关节的肌力特征与本体感觉之间的关系采用典型相关分析法进行。结果:(1)用来衡量关节位置觉和肌肉力觉的可变误差和绝对误差的组内相关系数均大于0.75,而且测量的标准误相对较小;但常数误差的组内相关系数均小于0.75,而且测量的标准误相对较大。(2)踝关节位置觉、背屈肌群相对峰值力矩、跖屈及背屈离心/向心峰值力矩比在FAI组和对照组之间的差异无统计学意义(P>0.05),而踝关节肌肉的力觉、跖屈肌群相对峰值力矩、跖屈及背屈动态控制率在FAI组和对照组之间的差异有统计学意义(P<0.05)。(3)不同速度下,踝关节肌群等速离心峰值力矩差异无统计学意义(P>0.05);踝关节肌群离心/向心峰值力矩比随着速度的增加而增加(P<0.05)。(4)踝关节肌力特征和本体感觉的典型相关分析得出的两个典型相关系数均无统计学意义(P>0.05),踝关节肌力特征与位置觉各指标之间不存在线性相关(P>0.05),肌力特征与力觉的部分指标之间存在中低度相关(P<0.05)。(5)不论是FAI组还是对照组的踝关节在局部肌肉疲劳后,本体感觉(关节位置觉和肌肉力觉)均较疲劳前差(P<0.05),疲劳前,踝关节位置觉和肌肉力觉在不同疲劳方式之间的差异无统计学意义(P>0.05),在等速向心运动至肌肉疲劳后,用来衡量位置觉的可变误差、绝对误差和用来衡量力觉的绝对误差,大于在等速离心运动至肌肉疲劳后的相应值(P<0.05)。(6)基于小波变换的时频分析计算出SEMG的瞬时中值频率的变异系数,小于基于傅立叶变换计算出的中位频率和平均功率频率的变异系数。(7)FAI组的患侧踝最大随意向心运动至局部肌肉疲劳过程中,胫骨前肌和腓肠肌内侧头的平均功率频率和瞬时中值频率在不同运动时段出现统计学上的差异(P<0.05),而比目鱼肌和腓肠肌外侧头的平均功率频率和和瞬时中值频率在不同运动时段上的差异没有统计学意义(P >0.05),而对照组的匹配踝在此过程中,所有肌肉的SEMG指标均会随时间发生变化(P<0.05)。结论:(1)用来衡量位置觉和力觉的可变误差和绝对误差重测信度较好,而常数误差信度较差,因此本研究选用可变误差和绝对误差作为本体感觉的评定。(2)FAI组与对照组的踝关节相比,力觉较差,跖屈肌力有不足,最大等速向心收缩至肌肉疲劳过程中,比目鱼肌和腓肠肌外侧头处于相对抑制状态。(3)FAI组和对照组踝关节在位置觉、背屈肌群向心或离心峰值力矩上无差异。(4)踝关节的肌力特征和位置觉各指标之间不存在线性相关,肌力特征与肌肉力觉的部分指标之间存在中低度相关。(5)踝关节肌群的动态控制率可作为踝关节稳定性的功能评定指标之一。(6)局部肌肉疲劳后,踝关节的本体感觉(位置觉和肌肉力觉)均较疲劳前差;而且等速向心运动导致的局部肌肉疲劳对踝关节本体感觉的影响大于等速离心运动对其影响。更多还原

【Abstract】 Objectives: Ankle sprain can lead to a chronic condition called functional ankle instability(FAI). The reason of ankle sprain recurrently was unknown. The purpose of this study was to investigate the proprioception, biomechanics of the maximal concentric and eccentric contraction, and the effects of repeated maximal concentric exercise on the proprioception and biomechanics of the ankle joint with functional ankle instability(FAI), in order to explore the neuromuscular control of the ankle joint and the effects of fatigue on them ,and to provide theoretical and experimental reference for the solid understanding of FAI group in the the clinic and rehabilitation training.Methods: The ankles of 28 college-aged males were tested in this study. Fourteen of the subjects had unilateral FAI, while the other 14 subjects were matched-paired and served as controls. The CON-TREX isokinetic dynamometer and the biovision system were synchronously used to collect peak torque, SEMG of the muscles and the angle of the joint. The target angle of the ankle passively reposition was 5°of plantar flexion to measure joint position sense(JPS). The target force of the muscle was 25% maximal voluntary isometric contraction to measure the muscle force sense(MFS). A multivariate repeated measures ANOVA was used to determine time-dependent differences, and the differences before and after fatigue in neuromuscular control between the two groups with FI and without FI, between different velocities(60 and 180°? s?1). Dependent variables were the characters of proprioception and biomechanics. T test was used to determine the cycles’differences until maximal concentric fatigue between the two groups with FI and without FI. Product-moment correlation analysis was used to determine the relationship between proprioception and biomechanics of ankles. Results : (1)Interclass correlation coefficients(ICC) of variable errors(VE) and absolute errors(AE) in JPS and MFS were more than 0.75, and standard errors of measurement(SEM) of them were less. ICCs of constant error(CE) of them are less than 0.75, and SEMs of them are greater. (2)There were significant differences between the two groups with and without FI, and the difference was not in JPS and relative peak torque of dorsal flexion(P >0.05)but in MFS, relative peak torque of plantar flexion, and dynamic control rate(DCR)(P <0.05). (3) There is no significant difference under the different velocity (P >0.05). The higher the velocity was, the higher the rate of eccentric peak torque to concentric peak torque. (4)No significant correlation was found between JPS and the biomechanical characters(P >0.05). Significant, but low and medium correlation was found between the two groups for MFS and some of the torque characters. (5) For either group, there was a significant main effect for JPS and MFS across both fatigue method(P >0.05), but the effect of concentric exercise was greater than that of eccentric exercise. (6) Coefficient of variation(CV),of the instantaneous median frequency based on wavelet time-frequency analysis for SEMG,was lower than that of median frequency(MF) and mean power frequency(MPF) based on FFT. (7) Tibialis anterior for the group with FI was easier to get fatigue than that for the group without FI. (8) MPF and IMDF, of TA and medial head of gastrocnemius muscle for the group with FI, are time-dependent. But for the group without FI,the indexes of SEMG were time-independent.Conclusions:(1) The test-retest reliability for VE and AE of JPS and MFS was better than CE of them. (2) Compared to group without FI, MFS and muscular strength were impaired in plantar flexion of the ankle for the group with FI. During the maximal isokinetic concentric fatigue, Tibialis anterior muscle was easier to get fatigue. Soleus and the lateral head of gastrocnemius may exist in arthrogenous muscle inhibition. The plantarflexor may have been destroyed after ankle sprain, thus, the recruitment of motor unit of muscle is changed. (3)There was no difference, for JPS, and the concentric and eccentric peak torque of the dorsiflexor, between the two groups with and without FI. (4)There was no linear correlation between JPS and the biomechanical characters of the ankle, and the correlation was low and medium between MFS and the biomechanical characters of the ankle joint. (5) Dynamic control rate (DCR)of muscle may be one of the evaluation indexes of ankle functional stability. (6)Proprioception after local muscle fatigue was worse than before for either fatigue method, and the influence from maximal isokinetic concentric fatigue was greater than that from maximal isokinetic eccentric fatigue.更多还原