CAI运动生理学运动生理学.pdf

疾病概述 流行病学研究 •踝关节扭伤是运动中最常见的运动损伤疾病[1] •40% 的急性踝关节扭伤可以发展为慢性踝关节不稳[2] 社会经济成本 直接医疗成本：低 间接社会成本：高 体力活动减退 创伤性骨性关节炎 [1]DOHERTY C, DELAHUNT E, CAULFIELD B, et al. The incidence and prevalence of ankle sprain injury: a systematic review and meta-analysis of prospective epidemiological studies[J]. Sports Med, 2014, 44(1): 123-140. [2]MIKLOVIC T M, DONOVAN L, PROTZUK O A, et al. Acute lateral ankle sprain to chronic ankle instability: a pathway of dysfunction[J]. Physician and Sports medicine, 2018, 46(1): 116-122. 发病机制 外周机制 中枢机制 韧带松弛或断裂： 本体感觉减退 前距腓韧带 运动皮层[4] 跟腓韧带 兴奋性减弱 肌力减弱和失衡 支配面积减少 下肢肌力：踝、膝、髋 感觉信息权重 腓骨肌离心/ 向心收缩肌力比值[3] 视觉-前庭觉-本体感觉 MI:mechanical instability; PI:perceived instability; RS: recurrent sprain 慢性踝关节不稳分类模型（a.Hertel 模型； b.Hillier 改良模型） [3]HARTSELL H D, SPAULDING S J. Eccentric/concentric ratios at selected velocities for the invertor and evertor muscles of the chronically unstable ankle[J]. British Journal of Sports Medicine, 1999, 33(4): 255-258. [4]KOSIK K B, TERADA M, DRINKARD C P, et al. Potential Corticomotor Plasticity in Those with and without Chronic Ankle Instability[J]. Medicine Science in Sports Exercise, 2017, 49(1): 141-149. 临床表现 反复崴脚或踝关节扭伤恶性循环 踝关节活动度减退 下肢运动控制能力下降 运动模式变化 运动学习效率降低[5] 单侧损伤，往往累及对侧 [5]WITCHALLS J B, WADDINGTON G, ADAMS R, et al. Chronic ankle instability affects learning rate during repeated proprioception