诊断<em>家鼠腓肠肌</em>密封性 - 关键因素临床考试
Summary
隔离家鼠腓肠肌密封性是足踝部病变的常见原因。目前国内还没有规范的检测程序存在。这份手稿表明，20度屈膝消除了M的制约作用对踝关节背屈和腓肠肌提出了统一考试协议的视频描述。
Abstract
常见的脚和踝关节病症已与孤立家鼠腓肠肌密封性（MGT）。各种检查技术已经描述评估MGT。尽管如此，标准化的审批程序缺失。文学主张负重检查，但需要膝关节屈曲度，以消除M的制约作用对踝关节背屈（ADF） 腓肠肌是未知的。该原稿调查屈膝上踝关节背屈的影响，并提供了标准化检查协议的详细描述。关于20名健康个体检查发现，即20°屈膝足以充分消除M的影响腓肠肌上ADF。这建立了一个标准化考试MGT的前提。 ADF的非负重和负重检查具有进行与膝盖完全伸展和至少20°弯曲。两名调查员应在仰卧位进行主题非负重测试。为了获得可靠的结果，腓骨的轴线应标明。一个考官可以在弓步立场主题进行负重检查。如果ADF与膝盖在显著上升ADF完全伸展和屈膝结果受损的隔离MGT存在。本文中所提出的统一考试是为今后的研究旨在建立正常值的前提。
Introduction
有限公司踝关节背屈（ADF）改变步态运动学，并负责常见的足部病变，包括跟腱炎，应力性骨折，跖骨和足底足跟痛1-5。有限ADF的最常见的原因是孤立的家鼠腓肠肌密封性（MGT）3,6。
脚踝的关节运动由屈膝作为分枝的影响腓肠肌桥梁双侧颞下颌关节。肌肉是在张力下时膝盖完全伸展，作为肌肉的起源然后最远近端。这M.腓肠肌然后抑制ADF。屈膝近似于肌肉的原点，从而降低了分枝腓肠肌的张力，并因此增加了ADF中。踝关节背屈然后通过踝关节的其他解剖结构的限制， 图1示出了这一原理。在MGT的情况下，ADF是有限的膝盖完全离倾向于而是由膝关节4的屈曲大大增加。
对于MGT临床检查取上述原则的优势，首先是由Silfverskiöld，瑞典骨科医生7于1923年发表。从那时起，许多检查技术已被描述的，所有这些比较在ADF用膝盖延伸并弯曲。发表的临床试验可分为非负重5,8，负重9,10和仪表11,12。如今，非负重检查是最常见的进行13。病人被置于仰卧在检查床上和ADF进行评估与膝盖完全伸展并一般为90°弯曲（ 图2A）。与此相反，负重ADF测量与弓步姿态直立受试者进行。后排膝盖伸展或弯曲，询问受试者只是脚跟发射前向前倾（ 图2B）。对于这两种测试MGT诊断，如果用膝盖延长了ADF自动进稿器中的一个显著上升受损和膝关节屈曲结果。
虽然非负重测试频繁地进行，负重测试有几个优点。首先，需要一种用于负重检查只有一个调查，而两位考官需要实现可靠的非负重测量。二，负重检查更加紧密地反映步态期间的负荷。第三，施加到踝的力独立于检查者。四，负重检查具有更高的内部和跨信度9,10,13-15。
为MGT所有测试的主要限制是，膝屈曲的最小程度需要消除分枝的抑制作用在ADF 腓肠肌不明8,15。而90°膝关节屈曲通常应用在非负重检测5,8,16撒谎，这是不适合的负重检查可行的。广大人民不能没有抬起脚跟离地执行与膝关节屈曲90°弓步。因此，大多数的研究进行负重考试没有控制膝关节屈曲8,15。为了进行可靠的负重检查它必须查明最小程度所需的膝盖屈曲消除M的抑制作用腓肠肌上ADF。
总体而言，文学主张负重测试MGT的诊断。为了提供有效的负重检查过程，膝屈曲，以消除M的ADF抑制效果所需的最低限度腓肠肌必须已知。本研究的目的是调查屈膝ADF的非负重的影响和负重检测，并提供一个步骤bŸ一步的指导，进行非负重和负重考试MGT。
Protocol
Representative Results
Discussion
20健康人检查发现，这20度屈膝已经消除了M的影响腓肠肌上ADF。另外膝关节屈曲造成了不显著ADF增加。对于MGT标准化非负重和负重检查的此呈现视频说明构建未来研究建立生理正常值的前提。
这项研究有局限性。第一，没有定制测量装置被用来评估ADF，这可能有助于测量误差。这是为研究者依靠在非负重检测，使用测角仪和相邻关节运动的施加力。此外，本文?…
Disclosures
The authors have nothing to disclose.
Acknowledgements
We would like to thank Jakob Binder for his help in subject acquisition and organization of the examinations, Mrs. Hella Thun for designing Figure 1 and 2 and finally Mr. Dipl.-Ing. (FH), M.Sc. M. Saller for his statistical support.
Materials
| Examination couch | |||
| Standard goniometer | MDF Instruments USA, Inc. Malibu, CA, USA | 2° increments | |
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