单侧前交叉韧带重建患者步行双侧下肢肌肉协同模式差异

Difference in bilateral lower limb muscle synergy mode for gait in patients after unilateral anterior cruciate ligament reconstruction

目的探究单侧前交叉韧带重建患者步态活动时双侧下肢肌肉协同模式差异。方法2023年4月至6月,于武汉体育学院附属医院招募单侧前交叉韧带重建患者男性12例、女性8例,采集步行时双侧下肢肌肉的肌电,采用非负矩阵分解算法提取健、患侧腿肌肉协同元参与数量、肌肉协同元峰值激活用时、肌肉相对权重。结果男性健侧腿解析出6类肌肉协同元,患侧腿解析出5类肌肉协同元,缺乏以胫骨前肌为主要参与肌肉的协同元2;女性健、患侧腿则均解析出6类肌肉协同元。相比于健侧腿,男性参与患侧腿活动的各类肌肉协同元的峰值激活用时均无显著变化(P>0.05);女性的协同元3、协同元5的峰值激活用时增加(P<0.05)。男性患侧腿协同元1的股直肌相对权重降低(P<0.05);女性患侧腿协同元2的股外侧肌相对权重升高(P<0.05),股二头肌相对权重降低(P<0.05),协同元3的股直肌的相对权重降低(P<0.05),协同元6的股二头肌相对权重降低(P<0.05)。结论步行期间,男性患侧腿冻结主导踝关节背屈功能的肌肉协同元参与以增强踝关节稳定性,降低承重反应期股直肌的相对权重以弱化膝关节落地缓冲功能;女性主导患侧腿承重反应期、支撑相中期动作的协同元激活延迟,增强承重反应期股外侧肌的相对权重,降低承重反应期股直肌、股二头肌与支撑相中期股二头肌的相对权重,以限制膝关节屈曲活动。

Objective To investigate the difference in bilateral lower limb muscle synergy mode during gait in patients after unilateral anterior cruciate ligament reconstruction.Methods Electromyography from bilateral lower limb muscles during gait were collected from twelve male and eight female patients after unilateral anterior cruciate ligament reconstruction in Affiliated Hospital of Wuhan Sports University,from April to June,2023.The data were analyzed using non-negative matrix decomposition algorithm to extract the number of muscle synergies in the affected and unaffected legs,the time to peak activation of muscle synergies and the relative weights of the muscles.Results Six types of muscle synergy were identified in the unaffected leg of males during gait,while five types were identified in the affected leg,lacking synergy 2 that mainly from the tibialis anterior muscle.Six types of muscle synergy were identified in both legs in females during gait.There was no significant difference in the time to peak activation of muscle synergies between both legs in males(P>0.05).However,the time to peak activation of muscle synergies increased in females in the affected leg for synergy 3 and synergy 5(P<0.05).The relative weight of the rectus femoris was lower in synergy 1 in the affected leg in males(P<0.05).For female,the relative weight of the vastus lateralis was higher and the relative weight of the biceps femoris was lower in synergy 2 in the affected leg in females(P<0.05);while the relative weight of the rectus femoris was lower in synergy 3(P<0.05),and the relative weight of the biceps femoris was lower in synergy 6(P<0.05).Conclusion Males would freeze the muscle synergy dominating ankle dorsiflexion in affected leg to enhance ankle stability,and reduce the relative weight of rectus femoris during the loading response phase to weaken the knee landing cushioning.However,females would delay the activation of synergies dominating in loading response phase and the mid-stance phase,enhance the relative weight of vastus lateralis during the loading response phase,and reduce the relative weights of rectus femoris in the loading response phase and the relative weight of biceps femoris in the mid-stance phase,to limit knee flexion.