肩胛下肌撕裂和胸大肌移位对肌肉活动影响的计算分析
Computational Analysis of Subscapularis Tears and Pectoralis Major Transfers on Muscular Activity
摘要：
肌肉转移通常用于恢复肌肉撕裂后的关节功能。然而，肌肉转移的生物力学研究并不多，现有的研究往往局限于解剖平面上的被动运动。使用数据从三个日常生活活动（ADL）和一个可用的计算肌肉骨骼模型的肩膀，我们分析了肩胛下肌撕裂的影响和治疗胸大肌（PMA）转移锁骨，胸骨，或两个部分。肩关节模型根据实验数据进行了验证：运动捕捉模型运动学、EMG测量肌肉活动和器械假体体内数据模型关节反作用力。我们的研究结果表明，肩胛下肌撕裂需要冈上肌的代偿性激活，并伴随着减少共同收缩的冈下肌，这两者都可以部分恢复后PMA转移。此外，虽然PMA的动作异步的肩胛下肌转移前，其激活模式的变化显着转移后。总的来说，这项研究表明，肌肉转移在主动运动过程中对关节的神经肌肉系统有显着的影响，不仅仅是运动学。转移的肌肉段激活类似于完整的肩胛下肌的能力被认为是依赖于所考虑的运动。完整的肩胛下肌和PMA节段之间的激活模式的差异可以解释一些患者在康复期间难以适应他们的心理运动模式。因此，康复计划可以受益于针对特定运动模式和生物反馈计划的有针对性的训练。最后，在锁骨部分转移之前，应考虑前三角肌的情况，以避免增加对关节功能的限制。
英文摘要：
Muscle transfers are commonly performed to restore joint function after muscle tears. However, there are not many biomechanical studies of muscle transfers, with the available ones often limited to passive movements in anatomical planes. Using data from three activities of daily living (ADL) and an available computational musculoskeletal model of the shoulder, we analyse the impact of a subscapularis tear and its treatment by a pectoralis major (PMA) transfer of the clavicular, sternal, or both segments. The shoulder model is validated against experimental data: the model kinematics with motion capture, muscle activity with EMG measurements, and model joint reaction force with in-vivo data from an instrumented prosthesis. Our results indicate that subscapularis tear requires a compensatory activation of the supraspinatus and is accompanied by a reduced co-contraction of the infraspinatus, both of which can be partially recovered after PMA transfer. Furthermore, although the PMA acts asynchronously to the subscapularis before the transfer, its patterns of activation change significantly after the transfer. Overall, this study demonstrates that muscle transfers have a significant impact on the neuromuscular system of the joint during active motion, beyond mere kinematics. Capability of a transferred muscle segment to activate similarly to intact subscapularis is found to be dependent on a considered motion. Differences in the activation patterns between intact subscapularis and segments of PMA may explain the difficulty of some patients in adapting their psycho-motor patterns during the rehabilitation period. Thereby, rehabilitation programs could benefit from targeted training on specific motion patterns and biofeedback programs. Finally, the condition of the anterior deltoid should be considered to avoid adding limitations to the joint function before a transfer of the clavicular part.
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