胸锁乳突肌表面肌电图的研究

目的：记录胸锁乳突肌不同体位姿势时的表面肌电图以评估其疲劳的发生及临床意义。方法：采用表面肌电图仪,用双电极引导法对8名健康受试者的胸锁乳突肌进行等长收缩和屈伸疲劳状态下的检测。观察指标为中位频率（MF）和平均功率频率（MPF）。在头平视、头前屈、头后伸、深吸气、头旋转、头强力前屈等姿势下记录右侧胸锁乳突肌的表面肌电图。结果：头平视位60s时MF为33.00±2.12,MPF为51.00±4.33; 头前屈位60s时MF为28.50±1.51,MPF为58.00±3.13;头后伸位60s时MF为23.00     

胸锁乳突肌三维有限元的建立

目的：采用三维有限元重建技术,建立出胸锁乳突肌的三维有限元模型。研究和分析颈部体位姿势对本模型各组成部分应力变化和分布特点的影响。方法：取材来自中国数字人I号头颈部断面切片图片,层距0.2mm,图片序号7800-8400,包含数字人胸锁乳突肌全长。对图片序号每间隔10张抽取1张,层厚2mm(0.2mm×10)。图片保存为BMP灰度图。采用Ansys8.0软件,分别以双侧轴向向上载荷100N,作用于乳突部,模拟头后仰时拉伸力;给一侧乳突部水平向前拉力100N,另一侧乳突部水平向后拉力100N,模拟头旋转时作     

胸锁乳突肌淋巴瘤超声表现并穿刺活检一例

患者因发现颈部包块1月就诊,超声示右侧胸锁乳突肌增厚,肌肉纹理弥漫性增粗,肌束间隙回声减低,可见较丰富血流信号,于超声引导下右侧胸锁乳突肌穿刺活检,提示淋巴瘤,检索相关超声文献较少,予以报道,了解肌肉淋巴瘤超声表现能对平时诊断有帮助。     

胸锁乳突肌瓣转位修复晚期面瘫的解剖与临床

目的：为应用胸锁乳突肌瓣转位修复晚期面瘫提供解剖依据。方法：利用新鲜尸体和活体头颈部共计26侧,解剖观测胸锁乳突肌的起止、长度、血供及其神经的分支类型和入肌部位。结果：胸锁乳突肌全长为17．0～19．0cm,枕动脉与副神经伴行支于乳突尖部下方4．0～5．0cm入肌肉上段;勖神经分叉点至胸锁乳突肌胸骨端起点的长度为14．0～15．7cm,大于分叉点至口轮匝肌外上缘的距离11．0～14．3cm。结论：胸锁乳突肌瓣转位修复面瘫的长度足以满足治疗需要,并且不论肌外、肌内分叉均可以顺利转位,肌肉血供也没有影响。     

胸锁乳突肌肌瓣修复腮腺肿瘤切除术后组织缺损

目的探讨腮腺肿瘤手术中即刻修复面部凹陷畸形,以降低术后味觉出汗综合征（Frey’s综合征）的一种手术术式。方法选择2006年1月至2009年1月我院腮腺肿瘤住院手术患者68例,随机分为实验组48例,对照组20例．实验组病人按常规“S”切口施行腮腺肿瘤加腮腺浅叶或全叶切除术,同期行胸锁乳突肌肌瓣转移修复术;对照组则不行同期肌瓣修复,经随访对比观察6个月～3年。结果对照组局部凹陷畸形发生率为90％（18／20）,Frey综合征发生率为55％（11／20）;实验组局部凹陷畸形发生率为16．67％（8／48）,Frey’s综合征发生率为8．33％（4／48）,经统计学处理差异有统计学意义（P〈0．01）。结论胸锁乳突肌肌瓣转移修复术是一种即刻修复腮腺肿瘤术后面部凹陷畸形和降低Frey综合征的较好术式。     

胸锁乳突肌下端切除术治疗肌性斜颈的疗效

目的：评价胸锁突肌下端切除术治疗肌性斜颈（muscular torticollis,MT)的疗效。方法：1992年以来应用胸锁乳突肌下端切断术治疗MT126例，经6个月－8年随访60例，年龄2－17例，平均8．5岁，从功能和美容两方面进行了术前和术后评估。结果：优良率达90％，其中2－7岁组优良率达100％，结论：胸锁乳突肌下端切断术治疗MT仍是简单，方便，并发症少，疗效高的传统方法。     

胸锁乳突肌锁骨瓣修复气管壁缺损的护理

气管狭窄及离断伤的修复是一个棘手的难题,目前常用的修复方法有断端吻合、肌骨膜瓣修复等,在治疗上虽然方法很多,但常由于手术后肉芽组织增生、瘢痕反复形成、新建气管壁塌陷等原因导致治疗效果不理想[1]。1993年11月~2004年5月我科对9例气管离断或狭窄患者采用胸锁乳突肌锁骨瓣进行一期气管重建术,取得了较满意效果,现将有关护理体会报告如下。1临床资料1993年11月~2004年5月我科采用胸锁乳突肌锁骨瓣治疗的气管离断或狭窄共9例,男性8例,女性1例,年龄21~59岁,平均年龄41岁。其中气管完全离断4例(车祸伤3例,机器绞榨伤1例),气管完全离断均…     

先天性肌性斜颈胸锁乳突肌抽除术后的护理

儿童先天性肌性斜颈传统采用胸锁乳突肌松解术,术后患侧颈部往往出现包块,影响美观而且复发率较高。我院2006年7月-2008年7月对29例7岁以上先天性肌性斜颈患儿采取胸锁乳突肌抽除术,治疗效果较好,现将手术方法及术后护理对策报告如下。     

小儿胸锁乳突肌假性肿瘤的超声诊断

小儿胸锁乳突肌假性肿瘤，又称肌性斜颈，是由于一侧胸锁乳突肌挛缩所致头部向患侧偏斜，并随患者年龄增长而逐渐引起面部及头颅畸形的一种常见病。该病以儿童为主，在婴幼儿发病率为0．4％-1．3％。其临床表面为患侧颈部有突起的肿块，质硬，随胸锁乳突肌被动移动，肿块表面不红，温度正常，无压痛，若早期得不到合理治疗，随年龄增长畸形将逐渐加重，将对病人各个方面带来很大的影响。因此对该病早期诊断、早期治疗有着重大意义。本文通过对我院前几年就诊的36例小儿胸锁乳突肌假性肿瘤的声像图进行回顾性总结分析，以提高超声对该病的诊断符合率。     

肌筋膜触发点与脊柱相关病症关系临床研究

目的探讨肌筋膜触发点与脊柱相关病症的关系。方法给予针对触发点治疗1周,1周后加用脊柱病治疗,并评价56例患者治疗后3次不同时间的疗效。结果触发点首次治疗后即时疗效评价全部有效,1周评价疗效保持欠佳,有效率为83.93%,两周评价（加整脊等治疗后）疗效显著,有效率为91.07%。结论肌筋膜触发点痛与脊柱相关病症互为因果,触发点与脊柱病在治疗时有相互促进的协同作用。     

Sonographic appearance of pyomyositis of the sternocleidomastoid muscle: A case report

Pyomyositis in the neck has rarely been described. We present the sonographic findings in a case of pyomyositis of the sternocleidomastoid muscle. A 62‐year‐old man with poorly controlled diabetes presented with an induration of the neck and fever. On gray‐scale sonography, a part of the sternocleidomastoid muscle appeared swollen and contained irregularly shaped hypoechoic areas. Power Doppler imaging showed increased vascularity in the muscle. Sonographic‐guided aspiration confirmed abscesses in the sternocleidomastoid muscle. Surgical drainage was successfully performed along with antibiotic treatment. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 45 :520–523, 2017     

The reliability of assessing sternocleidomastoid muscle length and strength in adults with and without mild neck pain

Background: The sternocleidomastoid (SCM) is an important cervical spine muscle. Weakness of the SCM muscle has been implicated with cervical problems. No studies have examined the reliability of assessing the SCM muscle length or strength. Also no studies exist that have looked to see if imbalances in SCM muscle length or strength exists between the left and right sides in those with and without neck pain. Objective: To determine the reliability of assessing the SCM muscle for length and strength and to see if SCM length could predict SCM strength in those with and without neck pain. Design: Cross-sectional study. Methods: Fifty-one subjects with and without mild neck pain. Analysis: Intratester reliability was assessed for SCM muscle length and SCM muscle strength. Differences in SCM length and strength were examined in those with and without neck pain. Results: Intratester reliability was shown to be excellent (ICC (2,2) > 0.90) for the left and right SCM when assessing muscle length and muscle strength for those with and without neck pain. No differences were noted when comparing left to right SCM between those with and without neck pain regarding muscle length or muscle strength. Neither regression models were able to predict SCM muscle strength from SCM muscle length. Conclusion: SCM muscle length and SCM strength can be reliably assessed using a bubble goniometer and HHD. No differences were found when comparing left to right SCM muscle length or strength in those with or without mild neck pain.     

Myofascial trigger points and their relationship to headache clinical parameters in chronic tension-type headache

OBJECTIVE: To assess the presence of trigger points (TrPs) in several head and neck muscles in subjects with chronic tension-type headache (CTTH) and in healthy subjects; and to evaluate the relationship of these TrPs with forward head posture (FHP), headache intensity, duration, and frequency. BACKGROUND: Tension-type headache (TTH) is a headache in which myofascial TrPs in head and neck muscles might play an important etiologic role. DESIGN: A blinded, controlled, pilot study. METHODS: Twenty-five CTTH subjects and 25 matched controls without headache were studied. TrPs in bilateral upper trapezius, sternocleidomastoids, and temporalis muscles were identified according to Simons et al's diagnostic criteria: tenderness in a hyperirritable spot within a palpable taut band, local twitch response elicited by snapping palpation, and elicited referred pain with palpation. A TrP was considered active if the subject recognized the evoked referred pain as familiar headache. If the evoked referred pain was not recognized as familiar headache, the TrP was considered as latent. Side-view pictures of each subject were taken in both sitting and standing positions in order to assess FHP by measuring the cranio-vertebral angle. Both measurements were made by a blinded assessor. A headache diary was kept for 4 weeks in order to assess headache intensity, frequency, and duration. RESULTS: The mean number of TrPs on each CTTH subject was 3.9 (SD: 1.2), of which 1.9 (SD: 1.2) were active TrPs and 1.9 (SD: 0.8) were latent TrPs. Control subjects only exhibited latent TrPs (mean: 1.4; SD: 0.8). There was a significant difference between the CTTH group and the controls for active TrPs (P < .001), but not for latent TrPs (P > .05). Differences in the distribution of active and latent TrPs within each muscle were also significant for all the analyzed muscles (P < .01). CTTH subjects with active TrPs in the right upper trapezius muscle or left sternocleidomastoid muscle showed a greater headache intensity and duration, but not headache frequency, compared to those with latent TrPs (P < .05). Active TrPs in the right temporalis muscle were associated with longer headache duration (P < .01), whereas active TrPs in the left temporalis muscle were associated with greater headache intensity (P < .05). CTTH subjects with active TrPs in the analyzed muscles had a greater FHP than those with latent TrPs in both sitting and standing positions. Differences were only significant for TrPs in the left sternocleidomastoid and FHP in the sitting position (P < .01). CONCLUSIONS: Active TrPs in upper trapezius, sternocleidomastoid, and temporalis muscles were associated with CTTH. CTTH subjects with active TrPs usually reported a greater headache intensity and longer headache duration than those with latent TrPs. CTTH subjects with active TrPs tended to have a greater FHP than CTTH subjects with latent TrPs.     

The relationship between gluteus medius latent trigger point and muscle strength in healthy subjects

IntroductionWe hypothesized that latent MTrPs might decrease gluteus medius muscle strength in healthy individuals. This study aimed to investigate the relationship between latent MTrPs and gluteus medius muscle strength in a group of healthy adults.MethodsForty-eight healthy men were included in the study. Trigger point examination for the gluteus medius was performed bilaterally. Subjects with one or more trigger points on the dominant side and those without any trigger point were assigned to two groups. Muscle strength for the gluteus medius was assessed with a manual muscle tester using the “break test” technique on both sides. For statistical analysis, the independent sample t-test was used to compare the intergroup differences.ResultsThe latent MTrP group demonstrated lower abduction muscle strength in the dominant gluteus medius. Moreover, the latent MTrP group showed higher abduction muscle strength in the non-dominant gluteus medius (p < 0.05). Intergroup comparison revealed that gluteus medius abduction muscle strength on the dominant side was higher in the non-latent MTrP group (p < 0.05).ConclusionLatent MTrP may cause joint movement limitation, overload by affecting motor activation patterns and reciprocal inhibition mechanisms. Outcomes of the current study revealed that gluteus medius abduction strength values below 9.7 kg could be associated with latent MTrP with high sensitivity and low specificity. It is imperative to note that the latent MTrP of gluteus medius muscle, which has a critical role in the lumbopelvic junction, should not be ignored in clinical practice, and treatment should be applied when detected.     

Referred pain from the trochlear region in tension-type headache: a myofascial trigger point from the superior oblique muscle

BACKGROUND: Tension-type headache (TTH) is a prototypical headache in which myofascial trigger points (MTrPs) can play an important role. To our knowledge, MTrPs in the muscle tissues of the trochlear region, ie, the superior oblique muscle (SOM), have not been previously mentioned, and a referred pain pattern from this region has never been reported. OBJECTIVE: To describe the referred pain from the trochlear area based on the examination of MTrPs in the SOM in patients with episodic and chronic TTH (CTTH). DESIGN: A blinded, controlled study. METHODS: The trochlear region was examined in 15 patients with CTTH, 15 patients with episodic TTH (ETTH), and 15 control subjects. Referred pain elicited by different maneuvers performed during manual palpation, ie, maintained pressure, active muscle contraction, and stretching of the muscle, was assessed with a visual analogue scale. Patients with ETTH were examined on days when they were headache-free, whereas CTTH patients were examined on days in which headache intensity was less than 4 points on a 10-cm horizontal visual analogue scale. RESULTS: Eighty-six percent of patients with CTTH and 60% with ETTH had referred pain that originated from MTrPs in the SOM, while only 27% of the controls reported referred pain. This pain was perceived as a deep ache located at the retro-orbital region, sometimes extending to the supra-orbital region or the homo-lateral forehead. Pain intensity was greater in CTTH patients than in ETTH patients or control subjects (P < .001). CONCLUSIONS: MTrPs in the SOM may evoke a typical referred pain pattern in patients with TTH. The presence of a myofascial disorder in the trochlear region might contribute to the pathogenesis of TTH.     

A self-determination theory-based self-myofascial release program in older adults with myofascial trigger points in the neck and back: A pilot study

Purpose: To examine the effectiveness and adherence to a self-determination theory (SDT)-based self-myofascial release (SMR) program in older adults with myofascial trigger points (MTrPs), and to investigate the factors that influence participant behavioral change while conducting the program in a home setting. Methods: An explanatory mixed-method design was used to evaluate a 12-week SDT-based SMR program, including a 4-week group-based education and practice (EP) phase and an 8-week home-based self-management (SM) phase. Pain intensity on palpation and sensitivity to pain were assessed at baseline and the post EP and post SM phase. Focus group interviews were conducted at the post SM phase. Findings: Fifteen participants completed the study. Pain intensity and sensitivity to pain significantly improved at the post SM phase compared with the baseline. Adherence increased during the SM phase compared with that during the EP phase. Four main themes emerged as factors that influenced participant behavioral change: 1) “awareness of the effectiveness”; 2) “a sense of duty to perform the exercise”; 3) “obedience to expert instruction”; and 4) “lack of friendship.” Conclusions: These results support the effectiveness of an SDT-based SMR program for the treatment of MTrPs and in motivating older adults to participate in the program.