CAJ | 학술논문

以临床疾病创伤性肩关节前方不稳（Traumatic Anterior Shoulder Instability,TASI）者为研究对象,通过研究患肩周围肌肉表面肌电活动与正常肩关节在不同功能性动作中比较来探寻TASI肩周肌肉活动募集的大致特征,为TASI患者选择治疗方案提供理论依据。方法：选取东方医院运动医学科就诊的TASI运动员患者和正常运动员肩关节（CON）对照。肌肉活动采用德国Biovision 16导联肌电图仪进行表面肌电信号采集,执行肩胛平面外展、前屈、后伸,0°和45°外展时内外旋,评价肌肉活动特征。结果：TASI和CON相比,TASI肩周肌肉具有以下特征,胸大肌在中立位内旋活动下降明显,三角肌前束在肩胛平面外展的后半部分范围和前屈的前半部分范围中明显下降,三角肌中束活动在前屈的中间范围活动下降,冈上肌活动在外展起始范围有增加的趋势,其余大多数运动范围均呈现下降趋势。肱二头肌活动在前屈和外旋运动中增加。冈下肌活动性在外旋时下降。前锯肌活动在前屈的后范围活动、内外旋运动中是下降的。结论：（1）增加了TASI发病机制的理解,补充了TASI康复训练和治疗选择依据的基本数据库。（2）TASI肩外展肌群、外旋肌群的工作能力下降,内外旋肌群存在失衡现象,外旋肌群的工作能力下降较明显。（3）TASI肩非手术治疗时可适当考虑前方动力性稳定结构,应加强冈上肌、前锯肌以及外旋肌肉的活动性训练,适当加强三角肌前、中束和内旋肌群的训练。
이림상질병창상성견관절전방불은（Traumatic Anterior Shoulder Instability,TASI）자위연구대상,통과연구환견주위기육표면기전활동여정상견관절재불동공능성동작중비교래탐심TASI견주기육활동모집적대치특정,위TASI환자선택치료방안제공이론의거。방법：선취동방의원운동의학과취진적TASI운동원환자화정상운동원견관절（CON）대조。기육활동채용덕국Biovision 16도련기전도의진행표면기전신호채집,집행견갑평면외전、전굴、후신,0°화45°외전시내외선,평개기육활동특정。결과：TASI화CON상비,TASI견주기육구유이하특정,흉대기재중립위내선활동하강명현,삼각기전속재견갑평면외전적후반부분범위화전굴적전반부분범위중명현하강,삼각기중속활동재전굴적중간범위활동하강,강상기활동재외전기시범위유증가적추세,기여대다수운동범위균정현하강추세。굉이두기활동재전굴화외선운동중증가。강하기활동성재외선시하강。전거기활동재전굴적후범위활동、내외선운동중시하강적。결론：（1）증가료TASI발병궤제적리해,보충료TASI강복훈련화치료선택의거적기본수거고。（2）TASI견외전기군、외선기군적공작능력하강,내외선기군존재실형현상,외선기군적공작능력하강교명현。（3）TASI견비수술치료시가괄당고필전방동력성은정결구,응가강강상기、전거기이급외선기육적활동성훈련,괄당가강삼각기전、중속화내선기군적훈련。
Objective With the clinical problem of traumatic anterior shoulder instability（TASI） as the subject,the authors compared the SEMG activities of the patient＇s shoulder muscles with normal shoulder joints in different functional movements so as to find out the approximate characteristics of TASI shoulder muscle movements and provide theoretical basis for selecting treatment options for TASI patients.Method A comparison was made between the TASI athletes and the normal athletes＇ shoulder joints（CON）.Biovision 16 EMG made in Germany was used to collect the signals of SEMG activities so as to evaluate the muscle movement characteristics of shoulder extension,forward bend,back extension and inward and outward spins in 0°and 45°extension.Result Compared to CON,TASI shoulder muscles have the following characteristics： Pectoralis major muscle movement obviously decreases in inward spin.Deltoid toe movement decreases distinctly in the second half of shoulder extension and the first half of forward bend.The movement of deltoid in the beam decreases in the middle of forward bend.Supraspinatus movement increases at the initial part of the extension,but decreases in the rest movements.Biceps movement increases in forward bend and outward spin.Infraspinatus movement decreases in outward spin.Serratus anterior movements decrease in the second half of forward bend and inward and outward spins.Conclusion 1.The understanding of TASI pathogenesis has been improved.The basic data base for TASI rehabilitation training and treatment choice has been supplemented.2.The working ability of TASI shoulder extension muscles and outward spin muscles decreases.Imbalance exists in inward and outward spin muscles.The working ability of outward spin muscles decreases significantly.3.In non-operative treatment of TASI,anterior dynamic stability structure may be taken into consideration.Movement training of supraspinatus,serratus anterior and outward spin muscles should be increased.And the training of deltoid toe,deltoid in the beam and inward spin muscles should also be strengthened to an appropriate extent.