今后将陆续推出在读战友和临床感兴趣的战友利用业余时间创作的spine等杂志的中英文对照稿供大家参阅鉴赏。
战友的成长离不开您辛勤的汗水
向无私奉献的战友致敬！！
期待更多的战友参与活动
1、 愿意参与翻译工作的战友，请以回帖形式申请具体翻译的部分 ，为避免重复翻译，以每个主题加予序号（1、2、3....）为单位的形式认领
a、（每位战友每月限领1－2个专题，以减轻工作量，也给其他战友积极参与的机会）
b、重复翻译者（未跟贴认领，导致其他战友重复翻译）未跟贴者无积分奖励。
c、
已经认领的显示为 红色
尚未认领的显示为 黑色
认领翻译文献请到这里：>
3、翻译小组成员：感兴趣言而有信者即可参与
4、日常事物处理：shamo5、daihatsu、心愿、小骨头
注：各组员如有特殊情况无法及时完成工作，请提前pm版主，以便作出相应安排。
1、摘要一篇，奖励1分；全文一篇奖励3分
2、校验工作，摘要每1贴次1分，全文每1贴次3分。
Systematic Review of Randomized Trials Comparing Lumbar Fusion Surgery to Nonoperative Care for Treatment of Chronic Back Pain.
对比较腰椎融合术与非手术方法治疗慢性腰背痛的随机试验进行的系统性评价
Literature Review
文献综述
Abstract:
Study Design. Systematic review of randomized trials comparing surgical to nonsurgical treatment of discogenic back pain.
研究设计：对于比较手术和非手术方法治疗椎间盘源性腰痛的随机试验，进行系统性评价。
Objective. Compare research methods and results.
目的：对研究方法和结果进行比较。
Summary of Background Data. Recent reports have increased debate about the role of surgery in the treatment of chronic back pain associated with lumbar disc degeneration. We conducted a systematic review of randomized trials comparing lumbar fusion surgery to nonsurgical treatment of chronic back pain associated with lumbar disc degeneration.
背景资料概述：有关手术疗法在腰椎间盘退变相关的慢性腰背痛的治疗中的作用，近来的报道中争议越来越大。对于比较腰椎融合术和非手术疗法治疗腰椎间盘退变相关的慢性腰痛的随机试验，我们进行了一项系统性的评价。
Methods. A literature search identified 5 randomized trials that compared fusion to nonoperative treatment for chronic low back pain. Excluding 1 trial for spondylolisthesis, we compared study participants, interventions, analyses, and outcomes in 4 trials that focused on nonspecific chronic back.
方法：通过文献检索，我们找出了对融合于非手术疗法治疗慢性下腰痛进行比较的随机试验共5项。排除了1项有关脊椎滑脱的试验。我们对4个有关非特异性慢性腰痛的试验中研究的参与者（受试者）、干预措施、检验方法和结果进行了比较。
Results. All trials enrolled similar subjects. One study suggested greater improvement in back-specific disability for fusion compared to unstructured nonoperative care at 2 years, but the trial did not report data according to intent-to-treat principles. Three trials suggested no substantial difference in disability scores at 1-year and 2-years when fusion was compared to a 3-week cognitive-behavior treatment addressing fears about back injury. However, 2 of these trials were underpowered to identify clinically important differences. The third trial had high rates of cross-over (>20% for each treatment) and loss to follow-up (20%); it is unclear how these affected results.
结果：所有试验纳入了类似的受试者。有1项研究显示，2年时，融合与非系统性的非手术疗法相比，能大大改善腰背部特异性的功能障碍，但是这一试验没有报告按照治疗目的原则收集的数据。而另3项试验显示，融合与3个星期的针对有关腰背部损伤的恐惧心理而进行的认知-行为治疗相比，1年和2年时功能障碍的评分没有实质性的差异。然而，这些试验中有2项在处理重要的临床差异方面存在不足。第三个试验研究“cross-over”（？）的比率(每一种治疗都>20%) 和失访率(20%)都较高；尚不清楚这些因素对结果存在怎样的影响。
Conclusions. Surgery may be more efficacious than unstructured nonsurgical care for chronic back pain but may not be more efficacious than structured cognitive-behavior therapy. Methodological limitations of the randomized trials prevent firm conclusions. 结论：与非系统性的非手术疗法相比，手术治疗慢性腰痛可能效果更好，但与系统的认知-行为治疗相比，可能不会更有效。这些随机试验由于方法上的局限而无法得出确切的结论。
Anterior Cervical Discectomy and Fusion Without Instrumentation.
颈椎前路椎间盘切除融合不固定
Cervical Spine
Abstract:
Study Design. Review of clinical file information and postoperative imaging, collected prospectively over a period of 14 years, in anticipation of study.
研究设计：在一项预期性的研究中，复习有计划地收集的超过14年的临床文件信息和手术后的影像。
Objectives. 1) Assessment of technical success in achieving anterior cervical fusion without internal fixation; 2) assessment of postoperative neck pain relevant to technical success or failure of fusion; and 3) assessment of morbidity arising from iliac crest bone graft donor site.
目的：1）评价完成颈椎前路融合而不做内固定技术上的成功性；2）评价手术后颈部疼痛与融合技术上成败的相关性；3）对髂嵴作为骨移植物供体部位发病率上升作一评价。
Summary of Background Data. After anterior cervical discectomy and bone grafting for cervical radiculopathy or the intractable pain of cervical spondylosis, common clinical practice varies widely between the extremes of internal fixation in all cases, and never applying fixation. The clinical information and relevant imaging of 97 consecutive patients, 46 male, was reviewed at 12 months after surgery.
背景资料概述：对于神经根型或有顽固性疼痛的颈椎病，行颈椎前路椎间盘切除植骨后，常规的临床操作在这样两个极端之间存在很大的差异，那就是对所有患者均作内固定和从不应用内固定。我们对97例连续的患者（男性46例）手术后12个月时的临床资料和相关的影像进行了复习。
Methods. All surgery was performed at no more than 2 contiguous levels, by one surgeon (S.M.E.). After anterior discectomy alone, or combined with posterior vertebral body margin osteophytectomy, anterior bone grafting (Smith-Robinson) was performed at each level using a tricortical autogenous iliac crest bone block inserted under compression. In the interests of maximizing resource allocation and minimizing potential complications, all surgery was completed without internal fixation. A postoperative semirigid cervical collar was prescribed for 2 months.
方法：所有的手术都由同一位外科医生（S.M.E）完成，并且都不超过两个节段。单纯的前路椎间盘切除或者联合椎体后缘骨赘切除术后，用一块包括3侧皮质的髂嵴骨块在一定加压下插入进行前路植骨(Smith-Robinson)。为了最优化地分配资源，并将潜在的并发症最小化，完成所有的手术均没有进行内固定。手术后嘱患者2个月内戴半刚性的颈托。
Results. In 54 patients having 1-level fusion, there were 6 pseudarthroses (11%). In 43 patients having 2-level fusion, 12 patients demonstrated pseudarthroses (28% of patients) at a total of 18 levels (21% of levels). Only 2 of the 97 patients had pain related to the donor site.
结果：54例患者进行了单节段的融合，其中有6例（11%）存在假关节。43例患者进行了双节段的融合，12例患者（28%的患者）总共18个节段（21%的节段）显示存在假关节。97例患者中仅有2例供体部位存在相关的疼痛。
Conclusions. These results tend to confirm published reports of high pseudarthrosis rates in anterior cervical fusions carried out at 2 or more levels without fixation, as against improved fusion rates when internal fixation is applied. The authors are inclined to change their practice to include internal fixation in the form of anterior plating for fusions carried out at more than one level. Patients with technically successful fusions were less likely to have postoperative neck pain. Donor site pain was not a significant postoperative complication.
结论：这些结果趋向于证实以前发表过的报道：在2个或更多节段进行颈椎前路融合而不固定容易发生高比率的假关节，而为了提高融合率则应该进行内固定。本文的作者倾向于改变他们的这一常规，包括前路钢板等内固定形式对超过1个节段者进行融合。患者在技术上成功地融合很少会导致手术后颈部疼痛。而供体部位的疼痛也不是一个严重的手术后并发症。
Heterotopic Ossification Following Traumatic and Combat-Related Amputations. Prevalence, Risk Factors, and Preliminary Results of Excision
[color=blue]创伤及战伤截肢术后的异位骨化。患病率，危险因素，以及切除异位骨治疗的初期结果[/color]Background: Although infrequently reported in amputees previously, heterotopic ossification has proven to be a common and problematic clinical entity in our recent experience in the treatment of traumatic and combat-related amputations related to Operation Enduring Freedom and Operation Iraqi Freedom. The purpose of the present study was to report the prevalence of and risk factors for heterotopic ossification following trauma-related amputation as well as the preliminary results of operative excision.
背景：尽管以前罕有关于截肢者的报道，但我们近年来治疗的“永久自由手术”和“伊拉克自由手术”（可能是指伊拉克战争）中创伤和战伤而被截肢者的经验认为，异位骨化已被证实是常见的、令人困惑的临床现象。目前研究的目的为了报道战伤截肢后异位骨化的发病率和风险因素以及手术切除后的初步结果。[/color][color=black]Methods: We identified 330 patients with a total of 373 traumatic and combat-related amputations who had been managed at our centers between September 11, 2001 and November 30, 2005. We reviewed the medical records and radiographs of 187 patients with 213 amputations who had adequate radiographic follow-up. Additional analysis was performed for twenty-four patients with twenty-five limbs that required excision of symptomatic lesions. The mechanism and zone of injury, amputation level, timing of excision, use of prophylaxis against recurrence, and other confounding variables were examined. Outcomes were assessed by determining clinical and radiographic recurrence rates, perioperative complications, preoperative and follow-up pain medication requirements, and the ability to be fit with a functional prosthesis.
方法：[color=red]2001年9月11日至2005年11月30日我们中心处理的战伤和战伤后截肢的病人共计373名，我们确定了其中330名。在213名有足够的X线片随访的截肢者中我们回顾了187名患者的医疗文件和X线片。另外对24名病人共25个肢体需要切除异位骨才能缓解症状作了分析。损伤机理和损伤区域、切断平面、切除时间。复发预防和其它混合变量都被检测。结果用以下因素评价：是否决定临床和影像学上的复发率、手术并发症的多少、术前、术后的使用止痛药物的剂量，以及对功能假肢的适应能力。[/color]Results: Heterotopic ossification was present in 134 (63%) of 213 residual limbs, with twenty-five lesions requiring excision. A final amputation level within the zone of injury was a risk factor for both the development and the grade of heterotopic ossification (p < 0.05). A blast mechanism was predictive of occurrence (p < 0.05) but did not correlate with grade. All patients who had been managed with excision were tolerating the prosthetic limb at an average of twelve months of follow-up. Twenty-three limbs demonstrated no evidence of recurrence, and two limbs had development of clinically asymptomatic, radiographically minimal recurrences. Six patients experienced wound-related complications that required reoperation, and two patients required subsequent minor revision surgery. There was a
significant decrease in the use of pain medication following surgery (p < 0.05).
结果：213例截肢中有134例（63％）出现异位骨化，其中25例需要手术切除异化骨。截肢术中最后切断平面即是异位骨化发生也是其严重程度的危险因素（P<0.05）。爆破性损伤机理可以预示着异位骨化的发生（P<0.05）,但不能预示其发生的程度。所有进行了异位骨化切除的病人在术后随访的十二个月中都能耐受假肢。25例中23例证实无复发征象，另外2例的复发无临床症状，影像学只有轻度改变。有6个病人体验了与伤口有关的并发症并需要重新手术，其中有2个病人要求再进行小的修补手术。在外科手术后使用疼痛药物治疗使异位骨化发生明显下降(p < 0.05).Conclusions: Heterotopic ossification following trauma-related amputation is more common than the literature would suggest, particularly following amputations that are performed within the initial zone of injury and those that are due to blast injuries. Many patients are asymptomatic or can be successfully managed with modification of the prosthesis. For patients with refractory symptoms, surgical excision is associated with low recurrence rates and decreased medication requirements, with acceptable complication rates. Level of Evidence: Prognostic Level II. See Instructions to Authors for a complete description of levels of evidence.
结论：与创伤有关的截肢术后异位骨化比文献报道更为常见，尤其因为在最初的损伤区内进行截肢后和由于爆破性损害造成的情况。许多病人没有症状或者能够很好地适应假肢。出现不耐受症状的病人，手术切除异化骨使复发率低，且能减少止痛药物治疗剂量，并且使手术并发症的发生率在可接受范围。
Isolated Arthroscopic Biceps Tenotomy or Tenodesis Improves Symptoms in Patients with Massive Irreparable Rotator Cuff Tears
关节镜二头肌肌腱切除术或腱固定术改善重度难以挽回的肩袖撕裂症患者的症状
Background: Lesions of the long head of the biceps tendon are often associated with
massive rotator cuff tears and may be responsible for shoulder pain and dysfunction. The purpose of this study was to evaluate the clinical and radiographic outcomes of isolated arthroscopic biceps tenotomy or tenodesis as treatment for persistent shoulder pain and dysfunction due to an irreparable rotator cuff tear associated with a biceps lesion.
背景：肱二头肌肌腱长头的病变通常与肩袖撕裂有关，而且可以导致肩关节的疼痛和功能丧失。本研究的目的是评价关节镜下二头肌肌腱切除术或者腱固定术来治疗由于肩袖撕裂及其二头肌肌腱病变导致的肩部疼痛或者功能丧失。
Methods: We conducted a retrospective study of sixty-eight consecutive patients (mean age [and standard deviation], 68 ± 6 years) in whom a total of seventy-two irreparable rotator cuff tears had been treated arthroscopically with biceps tenotomy or tenodesis. A simple tenotomy was performed in thirty-nine cases, and a tenodesis was performed in thirty-three. No associated acromioplasty was performed. All patients were evaluated clinically and radiographically by an independent observer at a mean of thirty-five months postoperatively.
方法：我们回顾性的研究了68例连续的患者，平均年龄68 ± 6 岁，其中72例不可自身修复的肩袖撕裂使用关节镜行二头肌肌腱切除术或者腱固定术进行修复。其中39例患者行简单的肌腱切除术；33例行肌腱固定术，未行相关的肩峰成形术。所有的患者临床和放射学上由一个独立的观察者进行随访35个月的评估。
Results: Fifty-three patients (78%) were satisfied with the result. The mean Constant score improved from 46.3 ± 11.9 points preoperatively to 66.5 ± 16.3 points postoperatively (p < 0.001). A healthy-appearing teres minor on preoperative imaging was associated with significantly increased postoperative external rotation (40.4° ± 19.8° compared with 18.1° ± 18.4°) and a significantly higher Constant score (p < 0.05 for both) compared with the values for the patients with an absent or atrophic teres minor preoperatively. Three patients with pseudoparalysis of the shoulder did not benefit from the procedure and did not regain active elevation above the horizontal level. In contrast, the fifteen patients with painful loss of active elevation recovered active elevation. The acromiohumeral distance decreased 1.1 ± 1.9 mm on the average, and glenohumeral osteoarthritis developed in only one patient. The results did not differ between the tenotomy and tenodesis groups (mean Constant score, 61.2 ± 18 points and 72.8 ± 12 points, respectively). The "Popeye" sign was clinically apparent in twenty-four (62%) of the shoulders that had been treated with a tenotomy; of the sixteen patients who noticed it, none were bothered by it.
结果： 53例患者（78%）临床结果满意。平均常数分值从术前的46.3± 11.9 分提高到术后的66.5 ± 16.3分 (p < 0.001)。外观健康的小圆肌术后旋转功能明显增加了(术后的40.4° ± 19.8° 和术前的18.1° ± 18.4°) 明显的常数分值(两者与术前出现小圆肌萎缩或者缺乏的患者相比p < 0.05 ) 。3例患者出现了肩关节假性瘫痪，没有从手术中受益，没有在水平位上重获平衡。相比之下，15例患者由于疼痛导致活动的功能降低。肩峰肱骨距平均降低了1.1 ± 1.9 mm ，盂肱关节炎出现在了一个患者中，结果提示在肌腱切除组和腱固定组之间没有显著的差异（平均常数分别为61.2 ± 18 分和 72.8 ± 12 分）“波沛”征出现在肌腱切除术的24例患者（62%）中，16例患者注意到了，但是没有1例出现临床症状。
Conclusions: Both arthroscopic biceps tenotomy and arthroscopic biceps tenodesis can effectively treat severe pain or dysfunction caused by an irreparable rotator cuff tear associated with a biceps lesion. Shoulder function is significantly inferior if the teres minor is atrophic or absent. Pseudoparalysis of the shoulder and severe rotator cuff arthropathy are contraindications to this procedure.
结论：关节镜下肱二头肌肌腱切除术和关节镜下肱二头肌肌腱固顶术可以有效的治疗重度疼痛或者功能丧失，由于不可环节的肩袖撕裂，及其相关的肱二头肌病变。如果小圆肌存在肩功能可能保留很好，相比之下，如果其萎缩或者缺如，则效果欠佳。肩关节假性瘫痪和严重的旋转撕裂是这个方法的禁忌症。
Level of Evidence: Therapeutic Level III. See Instructions to Authors for a complete
description of levels of evidence.
循证医学证据水平：治疗水平III。
The Anatomy of the Posterior Aspect of the Knee
An Anatomic Study
膝关节后方的解剖
一个解剖学研究
Background: The orthopaedic literature contains relatively little quantitative information regarding the anatomy of the posterior aspect of the knee. The purpose of the present study was to provide a detailed description of, and to propose a standard nomenclature for, the anatomy of the posterior aspect of the knee.
背景：骨科文献包括相当少的定量信息，尤其是膝关节后方的解剖结构等，本研究的主要目的是提供细节的描述和提出一个标准的术语。
Methods: Detailed dissection of twenty nonpaired, fresh-frozen knees was performed. Posterior knee structures were measured according to length, width, and/or distance to reproducible osseous landmarks.
方法：仔细分离20例非配对的新鲜冷冻的膝关节。后方的膝关节结构分别被用来进行测量长度、宽度和/或重塑骨性标志的距离。
Results: The semimembranosus tendon had eight attachments distal to the main common tendon. The main components were a lateral expansion to the oblique popliteal ligament; a direct arm, which attached to the tibia; and an anterior arm. The oblique popliteal ligament, the largest posterior knee structure, formed a broad fascial sheath over the posterior aspect of the knee and measured 48.0 mm in length and 9.5 mm wide at its medial origin and 16.4 mm wide at its lateral attachment. It had two lateral attachments, one to the meniscofemoral portion of the posterolateral joint capsule and one to the tibia, along the lateral border of the posterior cruciate ligament facet. The semimembranosus also had a distal tibial expansion, which formed a posterior fascial layer over the popliteus muscle. A thickening of the posterior joint capsule, the proximal popliteus capsular expansion, which in this study averaged 40.5 mm in length, connected the posteromedial knee capsule at its attachment at the intercondylar notch to the medial border of the popliteus musculotendinous junction. The plantaris muscle, popliteofibular ligament, fabellofibular ligament, and semimembranosus bursa were present in all specimens.
结果：半膜肌肌腱在主要附着点的远侧有8个附着点。主要的部分是一个可以侧方扩展的腘斜韧带，最大的膝关节后方的组织结构，形成了一个较大的筋膜外皮位于膝关节的后方，测量结果显示长度为48mm，边缘宽度为9.5mm，侧方附件的宽度为16.4mm，它具有两个方面的附件，一个位于半月板股骨间部分的后外侧关节囊和一个在胫骨端的后叉韧带边缘，半膜肌同时也存在一个远处的胫骨扩展，形成了一个后方的筋膜附着腘肌。后方的关节囊增厚，在此研究中大约是40.5mm左右长，连接后正中的膝关节囊于其髁结节处，髁间窝连接到腘肌肉和肌腱的交接处。跖肌腘胫韧带，腓肠豆腓侧韧带和半膜肌都在标本中保留。
Conclusions: The anatomy of the posterior aspect of the knee is quite complex. This study provides information that can lead to further biomechanical, radiographic imaging, and clinical studies of the importance of these posterior knee structures.
结论：膝关节后方的解剖是很复杂的。本研究提供的信息可以为进一步的生物力学，放射影像学和临床中对这些结构重要性的研究提供足够的信息。
The Influence of Fracture Mechanism and Morphology on the Reliability and Validity of
Two Novel Thoracolumbar Injury Classification Systems.
骨折的机制和形态学改变在两种心的胸腰椎损伤分类系统的可靠性和有效性比较
Clinical Case Series
临床病例研究
Abstract:
摘要：
Study Design. The Thoracolumbar Injury Severity Score (TLISS) and the Thoracolumbar Injury Classification and Severity Score (TLICS) were prospectively evaluated.
研究设计.胸腰椎损伤严重度评分（TLISS）和胸腰椎损伤分类和严重度评分（TLICS）分别进行评估。
Objectives. To compare the reliability and validity of the TLISS and TLICS schemes to determine the importance of injury mechanism and morphology to the identification and treatment of thoracolumbar fractures.
目的.比较TLISS和TLICS在决定损伤机制和形态学变化上的有效性和真实性中的作用来确定和治疗胸腰椎骨折。
Summary of Background Data. Two novel algorithms have been developed for the categorization and management of thoracolumbar injuries: the TLISS system emphasizing
injury mechanism and the TLICS scheme involving injury morphology.
研究背景. 两个新的算法用来分类和管理胸腰椎损伤的患者：TLISS系统强调损伤的机制，TLICS包括损伤的形态学。
Methods. The clinical and radiographic findings of 25 patients with thoracolumbar fractures were prospectively presented to 5 groups of surgeons with disparate levels of training and experience with spinal trauma. These injuries were consecutively scored, first using the TLISS and then 3 months later with the TLICS. The recommended treatments proposed by the 2 schemes were compared with the actual management of each patient.
方法.胸腰椎损伤的25例患者的临床和放射学结果分别经5组不同经历的医生进行评估。这些损伤分别被评分，首先使用TLISS系统，3个月以后使用TLICS系统。推荐的治疗方法在每一个患者中进行比较。
Results. For both algorithms, the interrater kappa statistics of all subgroups (mechanism/morphology, status of the posterior ligaments, total score, predicted management) were within the range of moderate to substantial reproducibility (0.45-0.74), and there were no statistically significant differences noted between the respective kappa values. Interrater correlation was higher for the TLISS paradigm on mechanism/morphology, integrity of the posterior ligaments, and proposed management (P <= 0.01). The TLISS and TLICS schemes both exhibited excellent overall validity.
结果.两个算法中，每个小组的统计学差异K值（机制/形态学，后方韧带的状态，总分，预期的管理）都在中到低度的可重复性（0.45-0.74），两足间无统计学差异。组间评价的相关性TLISS指数要明显高于机制/形态学，后方韧带的完整性，预期的管理（P<= 0.01). TLISS和TLICS等都展现出整体的有效性。
Conclusions. Although both schemes were noted to have substantial reproducibility and validity, our results indicate the TLISS is more reliable than the TLICS, suggesting that the mechanism of trauma may be a more valuable parameter than fracture morphology for the classification and treatment thoracolumbar injuries. Since these injury characteristics are interrelated and are critical to the maintenance of spinal stability, we think that both concepts should be considered during the assessment and management of these patients.
结论.尽管两者都提示可重复性和有效性较高，我们的结果提示TLISS较TLICS更加可靠，提示创伤的机制可能是一个更加有价值的指标，与骨折的形态学相比，因为这些损伤的特征在维持脊柱的稳定性上很重要，我们认为所有的概念都应该被考虑到，在评估和管理这些病人的时候。
Total Lumbar Disc Replacement: Different Results for Different Levels.
腰椎人工椎间盘置换：不同的节段不同的结果
Clinical Case Series
临床病例研究
Abstract:
摘要：
Study Design. Prospective study analyzing midterm clinical results of total lumbar disc
replacement (TDR) with ProDisc II performed at different lumbar motion segments.
研究设计.前瞻性的研究分析中期腰椎人工椎间盘置换技术（ProDisc II)在不同节段的临床效果.
Objectives. To assess the influence of the disc level and number of discs replaced following TDR on postoperative outcome.
目的.评价椎间盘节段和椎间盘置换的数目对腰椎人工椎间盘置换术后的临床效果。
Summary of Background Data. Multisegmental disc replacement procedures belong to the so-called "off- label" indications for disc replacement, which still lack evidence of
noninferiority when compared with fusion procedures. Results from uncontrolled clinical trials regarding monosegmental versus multisegmental disc replacements are
contradictory.
背景.多节段的腰椎人工椎间盘置换手术属于所谓的“无标签”的椎间盘置换指征，目前依然缺乏明显的优势，和腰椎融合技术相比。来自非对照的临床实验研究结果关于单阶段和多节段的椎间盘置换的结果目前依然存在争议。
Methods. The influence of the level and the number of lumbar discs replaced on postoperative outcome was analyzed prospectively according to Visual Analogue Scale (VAS), Oswestry Disability Index (ODI), and numerous clinical parameters. Post-TDR pain
patterns were analyzed with fluoroscopically guided spine infiltrations.
方法.腰椎人工椎间盘置换技术的水平和数目的影响在术前后分别使用VAS，Oswestry残障指数（ODI)，和其他临床参数进行比较。术后腰椎人工椎间盘置换的疼痛方法使用荧光探针技术进行分析。
Results. A total of 99 patients from 3 treatment groups with a mean follow-up of 25.8
months (range, 12.1-57.5 months) achieved significant improvement of preoperative VAS and ODI levels (P < 0.05). Best results and highest patient satisfaction rates (90.9%) were achieved in patients with monosegmental TDR at L4-L5 (n = 22). Results deteriorated when monosegmental TDR was performed at the lumbosacral junction (n = 57) with a tendency toward statistical significance at 24-month follow-up (P = 0.07). Postoperative outcome was significantly inferior following bisegmental disc replacements at L4-L5 + L5-S1 (n = 20) with a considerably higher complication rate when compared with monosegmental TDR procedures. Fluoroscopically guided spine infiltrations confirmed that the incidence of postoperative pain from posterior joint structures was 9.1% (n = 2) for L4-L5 TDR, 28.1% (n = 16) following L5-S1, and 60.0% (n = 12) for bisegmental-TDR at L4-L5 + L5-S1, respectively.
结果.本研究中包括来自3个研究组的99例患者，平均随访25.8个月（12.1-57.5个月）达到了明显的术前VAS和ODI水平改善（P<0.05），单节段腰椎人工椎间盘置换L4-5的22例患者获得了最好的满意率。腰骶结合区域的57例单节段结果，统计学上在术后24月的随访期内有明显的差异(P = 0.07)。术后的结果L4-5明显优于L5-S1双侧的椎间盘置换的结果。荧光屏介导的探针技术证实术后源自后方关节结构的疼痛的发生率是分别9.1%(n = 2) L4-L5 椎间盘置换, 28.1% (n = 16) L5-S1椎间盘置换,和 60.0% (n = 12)双节段 L4-L5 和 L5-S1。
Conclusion. The level and the number of lumbar disc replacements influence postoperative outcome significantly. Satisfactory outcome was achieved for monosegmental L4-L5 and L5-S1 disc replacement procedures with best results achieved following TDR at L4-L5. For bisegmental TDR, complication rates are significantly higher and inferior postoperative results are to be expected. The incidence of postoperative pain originating from facet and/or iliosacral joints is currently underestimated and will require further investigation.
结论.腰椎间盘置换的水平和数目影响手术后的效果。单节段的L4-5和L5S1的腰椎间盘置换可以获得很好的临床效果。双节端的腰椎人工椎间盘置换并发症的发生率明显增高。术后源自关节突和或者骶髂关节的疼痛被低估，需要进一步的调查研究。
Effectiveness of a Back Pain Prevention Program: A Cluster Randomized Controlled Trial in an Occupational Setting.
腰背痛预防系统有效性：一个专业设置群体随机对照试验
Randomized Trial
随机试验
Abstract:
摘要：
Study Design. A cluster randomized controlled trial and economic evaluation with a 12-month follow-up and with work department as the unit of randomization.
研究设计：这是一个随机对照试验，并且我们同劳动部门一起，对随机的单位进行了随访12个月的经济效益评估。
Objective. To evaluate the effectiveness of a prevention program for low back pain (LBP) in an occupational setting with an economic evaluation.
目的：在一个专业设置中评估腰背痛预防系统的有效性，同时还进行了经济效益的评估。
Summary of Background Data. LBP acco unts for high economic costs in Western societies. Little is known on the effectiveness and related costs and savings of prevention programs for LBP.
背景概述：在西方社会中，腰背痛就意味着很高的经济负担。对于腰背痛预防系统的有效性以及相关的患者经济收支情况我们知之甚少。
Methods. The study population consisted of workers in physically demanding jobs from 9 large companies located throughout The Netherlands. In each company, 2 comparable work units were randomly allocated, resulting in 18 clusters with 258 workers assigned to the intervention group and 231 workers to the control group.
方法：研究的群体由荷兰的9家大劳力公司中从事体力劳动的工人组成。在每个公司中，随机组成了2人单位，总共有18个群体，其中258人为介入组，另外231人为对照组。
Results. Results in our study did not show significant differences in effects or costs savings of the program. Indirect costs related to work absence and productivity losses accounted for the majority (84%) of total costs due to LBP.
结果：研究结果显示这个系统中的研究对象的收支情况并没有明显的统计学差异。由于缺工以及生产力下降所造成的间接损失是腰背痛所致经济损失的主要部分（84％）。
Conclusions. This study provides no evidence for the adoption of this worksite prevention program for LBP.
结论：研究显示，没有证据支持在这些劳动点采用腰背痛预防系统是必要的。
我是不是没有机会了。怎样可以申请到翻译的机会啊。本人急切想知道。
修改：Conclusions: The anatomy of the posterior aspect of the knee is quite complex. This study provides information that can lead to further biomechanical, radiographic imaging, and clinical studies of the importance of these posterior knee structures.
结论：膝关节后方的解剖是相当复杂的。本研究提供的信息可以对膝关节后方的解剖结构进行更深入的生物力学、放射影像学和临床方面的研究。
如何参与翻译的队伍？
认领关于颈椎方面的文献！
Intradiscal Pressure, Shear Strain, and Fiber Strain in the Intervertebral Disc Under Combined Loading.
在承载负荷时的椎间盘盘内压、切应力与纤维强度
Biomechanics
生物力学
Abstract:
摘要：
Study Design. Finite element study.
研究设计：有限元素法
Objective. To investigate intradiscal pressure, shear strain between anulus and adjacent endplates, and fiber strain in the anulus under pure and combined moments.
目标：调查在环与相邻终板之间的盘内压和切应力，以及单纯和联合运动时的纤维强度。
Summary of Background Data. Concerning anulus failures such as fissures and disc prolapses, the mechanical response of the intervertebral disc during combined load situations is still not well understood.
背景概述：关于像脑裂和椎间盘突出时的环纤维，椎间盘在联合负荷状态下的反应机制目前尚不清楚。
Methods. A 3-dimensional, nonlinear finite element model of a lumbar spinal segment L4-L5 was used. Pure unconstraint moments of 7.5 Nm in all anatomic planes with and without an axial preload of 500 N were applied to the upper vertebral body. The load direction was incrementally changed with an angle of 15[degrees] between the 3 anatomic planes to realize not only moments in the principle motion planes but also moment combinations.
方法：我们使用了一个关于L4－L5腰椎的3维非线性有限元素法的模型。实验中我们在所有解剖学平面给予7.5N的单纯非强迫运动的同时，同时伴或不伴在上一个椎体的给予了一个500N的轴向前负荷。负荷的方向在3个解剖平面呈15度的增量性改变，从而实现了平面的理论上的运动和联合运动。
Results. Intradiscal pressure was highest in flexion and lowest in lateral bending. Load combinations did not increase the pressure. A combination of lateral bending plus flexion or lateral bending plus extension strongly increased the maximum shear strains. Lateral bending plus axial rotation yielded the highest increase in fiber strains, followed by axial rotation plus flexion or axial rotation plus extension. The highest shear and fiber strains were both located posterolaterally. An additional axial preload tended to increase the pressure, the shear, and fiber strains essentially for all load scenarios.
结果：椎间盘内压在屈曲的时候最高，在侧弯的时候最低。联合负荷并没有增加压力的程度。合并有侧弯加屈曲或侧弯加伸展的运动很明显地增加了最大切应力。在轴向旋转加屈曲或轴向旋转加伸展时，侧弯加轴向旋转是纤维强度增强的最大。最大的切应力和纤维强度都定位在后侧方。特别在负荷方案中，一个附加的轴向前负荷可以趋向于增加压力、切应力和纤维强度。
Conclusions. Combined moments seem to lead to higher stresses in the disc, especially posterolaterally. This region might be more susceptible to disc failure and prolapses. These results may help clinicians better understand the mechanical causes of disc prolapses and may also be valuable in developing preventive clinical strategies and postoperative treatments.
结论：联合运动可以增加椎间盘的盘内压，特别在后外侧。这个部位对椎间盘退化和突出的更加敏感。这些结果可以帮助临床医生更好地理解椎间盘突出的产生机制，同时在发展临床预防体系以及术后处理方面具有意义。
Cervical Electromyogram PCervical Electromyogram Profile Differences Between
Patients of Neck Pain and Control
颈痛患者和正常人颈部肌电图表现的区别
Study Design. A comparative analysis of electromyogram(EMG) signals of patients of cervical pain and normal controls.
研究设计：对比研究颈痛患者和正常对照组之间的肌电图表图。
Objectives. To determine the differences between frequency and time domain parameters of EMG signals of patients of cervical pain and normal controls.
目的：为了研究颈痛患者和正常人之间肌电图的频率和时域的区别。
Summary of Background Data. No diagnostic technique has emerged as a satisfactory tool for identification of spinal pain.
研究背景：目前，在脊柱疼痛方面还没有一种鉴别诊断技术令人满意。
Method. Seventeen male and 17 female chronic neck pain patients without cervical radiculopathy were recruited through neurology EMG clinic. The controls consisted of 30 male and 33 female subjects with no history of neck pain in the past 12 months. All subjects performed flexion, left anterolateral flexion, left lateral flexion, left posterolateral extension, and extension to pain threshold/20% maximum voluntary contraction and pain tolerance/maximum voluntary contraction in random order. The descriptive statistics for body weight normalized strength, normalized peak EMG, time to onset, time to peak, median frequency, mean power frequency, and frequency bands were calculated. These variables were subjected to analysis of variance and logistic egression to distinguish between patients and controls.
研究方法： 17名男性患者和17名女性进行肌电图检查，患者均无神经根症状。正常人包括30名男性和33名女性，这些正常人在过去12月中无颈痛史。所有的受试者均进行前屈，左侧前屈，左侧屈，左侧后伸和后伸运动。这些运动需达到痛域/或是20%的最大肌肉收缩力并且能够忍受的疼痛/随意最大随意收缩。对于力量与体重、肌电图的峰值、起始时间、峰值时间、中位频率、平均功率、和频段均进行标准化描述后进行统计计算。患者和正常人的数据变量均进行方差分析和logistc回归分析，以观察正常人和患者的区别。
Results. The normalized peak EMG of patients was significantly greater than those of controls in both maximal and submaximal exertions (P < 0.01). Whereas there was no consistent pattern in time to peak EMG, the time to onset of EMG revealed that the left sternocleidomastoid was always recruited before the onset of torque. A lack of significant difference in the median frequency of the 2 samples indicates that the pain did not disturb the muscle conduction velocity. Using discriminant logistic regression on frequency domain and time domain parameters, up to 97% of patients and controls were correctly
classified with the resubstitution method.
结果：在最大力量和次最大力量的情况下，患者肌电图的峰值显著大于正常人（p<0.01）。然而，在肌电图的峰值处没有一个固定的形式，肌电图的开始位置显示，左侧胸锁乳突肌通常在转头开始前就已经达到峰值。在2组中，中位频率没有显著区别，这说明疼痛并没有影响肌肉的传导速度。在恢复方法治疗下，应用logistc回归分析频域和时域参数，将近有97%的患者和正常人能够区分。
Conclusion. Surface EMG can be used successfully in distinguishing chronic pain patients and controls, and efficacy of treatment regimes.
结论：表面肌电图可以成功的鉴别慢性疼痛和正常人，可以有效的用来评估治疗结果。
Key words: cervical pain, classification, identification, chronic pain, electromyogram.
关键词：颈痛，分类，鉴别，慢性疼痛，肌电图
请各位战友指正！谢谢！
请教各位战友：axial symptoms 当如何翻译？
原句如下：Objectives. To compare the relative impact of radicular and axial symptoms associated with disease of the cervical spine on general health as measured by the SF-36 Health Survey,
Sterilization and strength of 70/30 Polylactide Cages
70/30聚乳酸椎间融合器的消毒方式和强度
Study Design. In vitro and in vivo studies on the degradation of 70/30 poly(L,DL-lactide) (PLDLLA) cages.
实验设计：对70/30PLDLIA椎间融合器降解的体内和体外研究Objective. To evaluate the effect of e-beam and ethylene oxide sterilization on degradation and strength.
目的： 评价电子束和环氧乙烯消毒法对该椎间融合器降解和强度的影响。
Summary of Background Data. e-beam-sterilized PLDLLA cages were shown to maintain mechanical strength for at least 6 months during degradation studies in vitro. Yet failure of the cages was observed after only 3 months in vivo.
We hypothesized that degradation characteristics and mechanical strength could be improved by sterilizing the cages through ethylene oxide (EtO) instead of e-beam.
背景资料总结：体内降解实验显示，电子束消毒的PLDILA椎间融合器能维持至少6个月的力学强度。然而，该椎间融合器在体内仅3个月就观察到失败。我们假设：通过环氧乙烯消毒法而不是电子束消毒法能改善椎间融合器的降解特性和力学强度。Methods. PLDLLA cages were sterilized either by ebeam or EtO, and degraded in phosphate-buffered saline. Each month, cages were compressed until failure. Inherent viscosity was determined as a measure of degradation. For the in vivo evaluation, e-beam- or EtO-sterilized cages were implanted at L3–L4 in a standardized goat model. After 3 or 6 months, retrieved segments were scanned by high-resolution magnetic resonance imaging. Also, inherent viscosity of the polymer was measured.
方法：PLDLIA椎间融合器通过电子束或环氧乙烯消毒，在磷酸盐缓冲盐水中降解。每个月，椎间融合器都受压直至出现变形。检测标志降解程度的固有粘度。在体内评价中，电子束或环氧乙烯消毒的椎间融合器被植入标准化的山羊模型的L3-L4节段。3或6月后，取出的节段用高分辨率的磁共振扫描。同时，检测椎间融合器的固有粘度。
Results. e-beam sterilization strongly decreased inherent viscosity of PLDLLA compared with EtO sterilization, but initial strength was only affected marginally. After 6 months, the strength of the e-beam-sterilized cages dropped, while that of EtO-sterilized cages was maintained. Degradation in vivo was slightly faster than in vitro. In both groups, however, mechanical failure occurred at 3 months after implantation.
结果：和环氧乙烯消毒法相比较，电子束消毒法明显的降低了PLDLIA椎间融合器的固有粘度，但初始强度仅仅在融合器的边缘处发生变化。6月后，电子束消毒的椎间融合器的强度下降，而环氧乙烯消毒的椎间融合器的强度不发生改变。体内降解比体外略快。但是，2组中力学的融合失败发生在植入后3月。Conclusions. Inherent viscosity decreases with degradation time, but strength only decreases when inherent viscosity is below a certain threshold. Above this threshold, mechanical strength is a property of the polymer and independent of inherent viscosity. e-beam sterilization strongly decreases inherent viscosity and thus advances mechanical degradation. EtO sterilization delays degradation but does not increase initial strength. Early failure of PLDLLA cages in the goat model thus is unrelated to sterilization method and requires further study.
结论：固有粘度随着降解时间的延长而下降，但是只有当固有粘度降低到小于一定的域值时才出现强度的改变。在域值以上，力学强度是该聚合物的固有特性和固有粘度无关。电子束消毒明显的降低了固有粘度，因此也增加了力学的降解。环氧乙烯延迟了降解但是并未增加初始强度。山羊模型中PLDLIA椎间融合器的早期失败和消毒模式并无联系，此方面的原因需要进一步研究。Key words: resorbable cage, sterilization, e-beam, ethylene oxide, mechanical strength, polylactide.
关键词：可吸收性椎间融合器，消毒，电子束，环氧乙烯，力学强度，聚乳酸
axial symptoms 轴性症状
Cervical Electromyogram Profile Differences Between
Patients of Neck Pain and Control
颈痛患者和正常人颈部肌电图表现的区别
Study Design. A comparative analysis of electromyogram(EMG) signals of patients of cervical pain and normal controls.
研究设计：对比研究颈痛患者和正常对照组之间的肌电图表现。
Objectives. To determine the differences between frequency and time domain parameters of EMG signals of patients of cervical pain and normal controls.
目的：为了研究颈痛患者和正常人之间肌电图的频率和时域的区别。
Summary of Background Data. No diagnostic technique has emerged as a satisfactory tool for identification of spinal pain.
研究背景：目前，在脊柱疼痛方面还没有一种鉴别诊断技术令人满意。
Method. Seventeen male and 17 female chronic neck pain patients without cervical radiculopathy were recruited through neurology EMG clinic. The controls consisted of 30 male and 33 female subjects with no history of neck pain in the past 12 months. All subjects performed flexion, left anterolateral flexion, left lateral flexion, left posterolateral extension, and extension to pain threshold/20% maximum voluntary contraction and pain tolerance/maximum voluntary contraction in random order. The descriptive statistics for body weight normalized strength, normalized peak EMG, time to onset, time to peak, median frequency, mean power frequency, and frequency bands were calculated. These variables were subjected to analysis of variance and logistic egression to distinguish between patients and controls.
研究方法： 17名男性患者和17名女性进行肌电图检查，患者均无神经根症状。正常人包括30名男性和33名女性，这些正常人在过去12月中无颈痛史。所有的受试者均进行前屈，左侧前屈，左侧屈，左侧后伸和后伸运动。这些运动需达到痛域/或是20%的最大肌肉收缩力并且能够忍受的疼痛/随意最大随意收缩。对于力量与体重、肌电图的峰值、起始时间、峰值时间、中位频率、平均功率、和频段均进行标准化描述后进行统计计算。患者和正常人的数据变量均进行方差分析和logistc回归分析，以观察正常人和患者的区别。
Results. The normalized peak EMG of patients was significantly greater than
those of controls in both maximal and submaximal exertions (P < 0.01). Whereas there was no consistent pattern in time to peak EMG, the time to onset of EMG revealed that the left sternocleidomastoid was always recruited before the onset of torque. A lack of significant difference in the median frequency of the 2 samples indicates that the pain did not disturb the muscle conduction velocity. Using discriminant logistic regression on frequency domain and time domain parameters, up to 97% of patients and controls were correctly
classified with the resubstitution method.
结果：在最大力量和次最大力量的情况下，患者肌电图的峰值显著大于正常人（p<0.01）。然而，在肌电图的峰值处没有一个固定的形式，肌电图的开始位置显示，左侧胸锁乳突肌通常在转头开始前就已经达到峰值。在2组中，中位频率没有显著区别，这说明疼痛并没有影响肌肉的传导速度。在恢复方法治疗下，应用logistc回归分析频域和时域参数，将近有97%的患者和正常人能够区分。Conclusion. Surface EMG can be used successfully in distinguishing chronic pain patients and controls, and efficacy of treatment regimes.
结论：表面肌电图可以成功的鉴别慢性疼痛和正常人，可以有效的用来评估治疗结果。
Key words: cervical pain, classification, identification, chronic pain, electromyogram.
关键词：颈痛，分类，鉴别，慢性疼痛，肌电图Neck pain is a common occurrence in our society and constitutes significant social and economic burden. From the epidemiological data of population survey as well as accounting for the insurance claims, it would appear that it is the minor accidents and events that are responsible for the large majority of these cases. Given the nature of biomechanical loading, the injuries are surmised to have occurred according to the “Overexertion theories” of musculoskeletal injury causation.1 The injuries are most likely to be located in the musculoligamentous structure of the neck. The evidence is forthcoming from the findings of Kumar et al.2,3 Kumar et al3 demonstrated that a speed change or 5 kph or less in a rear-end impact could cause 179% of maximal voluntary contraction in the sternocleidomastoid muscle. This rate of progression of muscle stress is clearly likely to cause disruption of these tissues, resulting in pain. Thus, this project was designed to investigate and establish muscle pathophysiology in a large majority of these cases.
在当今社会，颈痛的发生普遍存在并对社会造成及其严重的经济负担。流行病学调查和保险索赔的数据说明，造成大量颈痛病人的原因是轻微的意外伤害和事故。除了正常的生物力学的负担，这些伤害还认为是由于肌肉受伤引起的“过度负荷”所造成[1]。这些损伤绝大多数位于颈部的肌肉韧带系统。这些将被Kumar等人的研究所证实。[2,3] Kumar等人[3]证实，速度的改变或是以５千米每小时或更低的速度在后部撞击会对胸锁乳突肌造成最大179%的收缩。这样的肌肉的应激过程会对这些肌肉组织造成伤害并导致疼痛。因此，本课题研究是建立在大量的病例基础上，研究肌肉的病理生理表现，建立评估体系。Glaros and Burton4 have demonstrated that parafunctional clenching increases the pain and can lead to temporomandibular disorder in otherwise pain-free individuals.
Glaros and Burton[4]已经证实患有磨牙症的患者会加重疼痛并导致颞下颌关节紊乱，如果没有患磨牙症，将不会导致疼痛。
This will indicate that strong muscle activity, as has been shown in low-velocity impacts, could very well result in precipitation of pain. Mork and Westgaard5 have shown a similar finding for trapezius muscle.
这表明强烈的肌肉收缩，尽管是缓慢的过程，也会导致疼痛的积累。Mork and Westgaard[5]在斜方肌观察到了同样的表现。
In a voluntary cervical motion, the neuromotor control exercised by the central nervous system determines the time, intensity, and a nature of excitation of agonists and antagonist muscles. The neuromotor control is responsible for carrying out 2 functions: (1) produce torque about a given spinal joint to carry out the task at hand, and (2) develop appropriate forces required to stabilize the spine. In symptomatic subjects, due to pain, the pattern of the neuromotor control may be disrupted, altering the relationship between the muscle excitation, regional muscle balance, and resultant mechanical output.
在颈椎主动运动的过程中，由中枢神经所支配的神经运动取决于主动肌和拮抗肌刺激反应的时间和紧张程度。中枢神经的控制主要表现在两个方面：（１）产生扭转力矩以便支持颈椎和实现手的功能；（２）提供适当的力量以便支持脊柱的稳定。在有颈椎病的患中，由于疼痛的原因，神经控制的方式就会改变，这将会改变肌肉之间兴奋的关系，打破肌肉力量的平衡，最终导致力学失衡。
Therefore, the global objective of this study was to develop an electromyogram (EMG) signature of muscles in patients of neck pain in comparison to those of normal controls. The working hypothesis of the study was that the composite pattern, magnitude, and power spectrum profile of the EMG of cervical muscles will deviate in pain patients from those of the normal subjects.
因此，本研究的目的是发现一种能够区分颈痛患者和正常人的肌电信号。本研究的假设条件是正常人颈部肌肉的肌电图的图形，强度，和频率与颈痛患者有区别。
Materials and Methods
Sample. Seventeen male and 17 female patients of chronic neck pain were recruited from the neurology EMG clinic. The exclusion criterion was cervical radiculopathy demonstrated by EMG and imaging studies. Thus, any patient with chronic pain lasting 3 months or more was recruited into the study. The mean age, height, and weight of male patients were 56 years(12), 174 cm , and 90 kg (18), respectively. The females on the other hand had a mean age of 48 years (10), height of 161cm (7), and mean weight of 67 kg (12). There were 30 male controls with an age, height, and weight of 30 years (13), 175cm (9), and 74 kg (11), respectively. In addition, there were 33female control subjects with a mean age of 33 years (17), height of 162 cm (7), and mean weight of 59 kg (10).
材料和方法
样本：门诊纳入17名男性和17名女性慢性颈痛患者，进行肌电图测试。将经过肌电图测试和影像学检查有神经根表现的患者排除。将慢性疼痛的时间等于或大于三个月的患者纳入研究对象。男性患者的平均年龄，身高和体重分别是：56岁(12),174cm,90kg(18),女性患者的平均年龄，身高和体重分别是：48岁(10),161cm(7),67kg(12)。男性对照组30个，其平均年龄，身高和体重分别是：30岁(13),175cm(9),74kg(11)。女性对照组33人，平均年龄33岁(17)，身高162cm,体重(7),平均体重59kg(10)。Subject Preparation. After suitable skin preparation, Delsys bipolar active, knife edge, fixed interelectrode distance (10mm) surface electrodes were applied to the upper trapezius (level with C4), splenius capitis, and sternocleidomastoids bilaterally to both patients and control subjects. These electrodes were connected to an on-site preamplifier with a gain of 10 times that fed into an amplifier where the signals were amplified by another 1000. These subjects were required to exert individual muscle specific activities to discern crosstalk; if any crosstalk was present, the electrodes were moved to an ideal location to minimize it. Such prepared subjects were seated in the experimental setup for a cervical testing.
受检者的准备：将受试组和对照组收拾对象皮肤准备好，激活Delsys电极，小刀的边缘，将电极以10mm 间距，分别粘贴于颈夹肌，斜方肌上部（C4水平）和胸锁乳突肌。这些电极一端连接一个放大10倍的前置放大器，然后将信号输入放大器，后者可以将信号放大1000倍。这些受试着要求尽力活动以来区分波形，如果在没有测试之前出现波形，那么电极将被移动以来减小误差。这些受试着测试时坐于专用的仪器上。Testing Device. The testing device consisted of an adjustable chair, sliding platform, and floor-mounted strength measuring device (Figure 1). A full description of the testing device is published elsewhere.6
测试装置：测试装置包括一个可调节的椅子，滑动平台，和在地面上固定的测试力量的装置（图１）。整套测试装置的具体描述已发表[6]。
Tasks. The subjects were informed about the objectives and procedure of the
experiment. After signing the informed consent form, subjects were measured and weighed. Their age was also recorded. Finally, they were seated and stabilized in an
erect and upright posture. Previously prepared subjects were seated in the experimental setup for cervical testing. The subjects were asked to exert in isometric flexion, extension, left lateral flexion, left anterolateral flexion, and left posterolateral extension (Figure 2). The sequence of these exertions was fully randomized. Subsequently, the chair was rotated in the desired position. Using the adjustability, the pivot point of the resistance of arm was set at the same height as the horizontal upholstered bar. Before the start of a trial, the subjects were informed to exert their appropriate effort concentrating on using their neck only. The subjects where instructed to bring their contraction to the desired level in the first 2 seconds and hold it there are for another 3. At this time, the trial was terminated. The force was measured in N. Kumar et al6 established the reliability and accuracy of this equipment and procedure. The patients were asked to exert to their pain threshold and pain tolerance levels. The control subjects were asked to exert to their 20% maximum voluntary contraction (MVC) and MVC. All exertions were required to be 5 seconds long. While the subjects exerted force, the strength of exertion, and EMG of all 6 muscles were sampled at 2 kHz.
测试程序：预先告知受试者所要测试的项目和程序。签订知情同意书后，纪录受试者的身高、体重和年龄。受试者准备好后坐于测试设备上准备颈椎测试。最后，将受试者以坐姿解剖中立位固定于测试装置上。受试者被告知尽力以等长状态前伸、后屈、左侧屈、左前侧伸、左后侧伸（图２）。受试者需尽力这些动作。随后，椅子将被转至需要测试的位置。使用调节装置，水平阻力臂的支点与头部接触的点保持在同一水平位置。在测试之前，告知受试者仅仅用颈部的力量尽力而为。告知受试者在初始的２秒钟尽力完成规定的用力方向，并保持３秒钟。随后，次测试终止，测试的力量以Ｎ为单位衡量。Kumar等人评估了这套测试设备的信度与效度，认为可行。告知患者在疼痛允许的范围内活动并以疼痛可以忍受的力量进行测试。告知对照组的受试对象以最大随意肌收缩力和２０％的随意肌收缩力进行测试。所用的测试时间均为５秒。当受试者竭尽全力，６块肌肉的最大力量和肌电图均显示为２ＨＺ。
图１颈椎力量测试系统
图２头部活动方向
Data Analysis
Force. The force recorded in cervical isometric flexion, extension left lateral flexion, left anterolateral flexion, and left posterolateral extension was normalized against the individuals’ body weight. These percentage data were quantitatively compared between the patients and normal control with pain threshold for patients and 20% MVC for controls, and pain tolerance for patients versus maximal voluntary contraction for controls.
数据分析
力量：收集颈椎等长运动时、左侧屈运动、左前侧伸展运动、和左后侧屈运动的力量信号，然后与受试着的体重相比较。这些百分率数据是患者和的痛域值与正常对照组的20%的最大随意收缩值的比较和最大能忍受的疼痛和正常人最大随意收缩力量的比较。
EMG. The raw EMG signals were bandpass filtered with a low cutoff frequency of 20 Hz and high cutoff frequency of 450Hz. The signals in this frequency band were preamplified at the site by a factor of 10 and differentially amplified again with a gain of 1000. The time constant used was 25 milliseconds, and the amplification system had a common mode rejection ratio of 92 dB. The pattern of EMG was observed by plotting the normalized EMG in time with 1 standard deviation confidence interval (CI).
肌电图：
肌电图信号经过最大450HZ，最小20HZ的频率过滤。在这个波段的信号被一个装置放大10倍，然后又被另一个装置在放大1000倍。信号的时间常数为25毫秒，共模抑制比率为92dB。在标准肌电图模式下，一个标准的可信区间观察肌电图信号的图形。
In order to determine the timing of EMG events, the linear envelope detected EMG of right and left sternocleidomastoids, splenius capitis, and trapezii were stack plotted along with the force trace. At the point of departure of the force trace from the baseline (1% of maximal force), the trace was electronically marked to represent initiation of the activity. The time to onset of EMG channels was measured against this force onset time. Similarly, time to peak EMG of all channels in each activity was also marked for both patients and normal control subjects.
为了描述肌电图的周期性，肌电图的线性包迹和肌电图的电极分别粘贴在双侧胸锁乳突肌的双侧斜方肌以及双侧头夹肌上。如果力线上的点离开基线（最大力量的1%）的话，这些表现意味着活动的开始。肌电图通道标记信号的开始一位着力量作用的开始。同样的，当肌电图所有通路的图像到达顶峰的时候，也意味着受试着力量的最大值。For the frequency domain characteristics, the raw EMG signals were subjected to DC removal. Subsequently, the sections of data, which are presented in a stable force, and EMG activities were marked and selected for fast Fourier transform analysis. Those activities were isometric, and the data segments were stationary when chosen for such analysis. However, a test of the stationarity of the data was carried out before proceeding with the rest of the analysis. The spectral data analysis of each muscle in each of the 10 activities was done separately for patients of neck pain and control subjects. From the spectral analysis, the lower and upper 3 dB frequencies and the bandwidths were extracted for patients and controls. All these 3 parameters were calculated for both threshold/20% MVC and tolerance/MVC contractions. The median frequency of each of the cervical muscle in each of the 10 activities of both patients and controls was also extracted. Similarly, mean power frequency, total power, and peak power were also calculated for the aforementioned muscles from the spectral analysis.
对于频域的特点，初始时肌电图的信号要经过转换器转换。然后，数据片断，这些数据片断表现为一种稳定的力量，并且肌电图经过打标激活，最后进行快速频谱转换分析。这些活动是等长活动，并且供选择的数据是固定的。然而，在进行其它分析之前，要有一个数据稳定性的测试。在颈痛患者和正常人之间，在10次运动中每一次运动都进行光谱分析。我们从正常人和患者的所有这些3组数据的参数中抽出最高和最低的3dB频率和带宽的参数进行光谱分析。 所有的这3组参数进行域值与最大随意收缩的20%比值，和可忍受的力量和最大随意收缩比值。同样，提取正常人和患者每人的颈椎肌肉力量测试的众位频率。同样的，平均功率、总功、和峰值功率也从上述肌肉中提取进行光谱分析。
Descriptive statistics of the variables of force, EMG magnitude, peak normalized EMG, median frequency, total power, peak power, frequency at peak power, time to onset, and time to peak EMG were calculated. Each of these variables was also subjected to a 1-way analysis of variance (ANOVA). This ANOVA and logistic regression was carried out to determine any significant difference between patients and controls.
对于力量数据变量、表面肌电图强度、标准化肌电图的峰值、中位频率、总功、峰力矩、峰力矩频率、到达峰力矩的时间、和到达肌电图峰值的时间数据进行统计分析。所有的这些数据进行单因素方差分析（ANOVA）。这些数据和回归分析的数据结果来决定患者和正常人那组数据有差异。Statistical Analysis for Classification. In this analysis, EMG signals on 6 muscles (SCM, SPL, TRP, bilaterally) in 5 directions (extension, flexion, lateral flexion, anterolateral flexion, and posterolateral extension) were observed at 2 exertion levels (MVC/pain tolerance and 20%MVC/pain threshold). These EMG signals were subjected to wavelet analysis to obtain 8 levels of decomposition of signals, for each subject under each condition and for each channel. Daubechies wavelet transformation was used for this purpose. The 8 levels or scales, of the raw signal decomposition, were confined to the following frequency bands:
统计分析的分类：在结果数据的分析中，6块肌肉的肌电图（双侧的颈夹肌，斜方肌和胸锁乳突肌）在5个方向（后伸、前屈、侧屈、前外侧屈、后外侧屈）在2种用力水平（最大肌肉收缩/疼痛忍受值或20%的最大肌肉收缩/痛预值）。这写肌电图的信号被8分类，分为8种子信号，对于每一个通道每一种信号每一种状态进行分析。应用Daubechies信号转换。初始信号按频率分为如下8种类别：1. 0–7.8125 Hz
2. 7.8125–15.625 Hz
3. 15.625–31.25 Hz
4. 31.25–62.5 Hz
5. 62.5–125 Hz
6. 125–250 Hz
7. 250–500 Hz
8. 500–1000 Hz
At each of the aforementioned 8 scales, the following measures were computed as frequency features:
对于前面提到的8种分类，下面的计算基于如下的频率特征：
● Eight RMS values (RMS1, RMS2, . . ., RMS8)
8种RMS值（RMS1, RMS2, . . ., RMS8)
● Mean , dispersion , skewness , and kurtosis
● 均值（m），离散度（d），偏度（s）和峰值（k）
For time domain features, the EMG signals were subjected to fourth-order autoregressive analysis using the “arfit.m” in Matlab. From this fourth-order autoregressive model, autocorrelations (rxx1, rxx2, rxx3, rxx4) and autoregression coefficients up (phi1, phi2, phi3, phi4) to order 4 were extracted to describe time domain features of the signals.
对于时域特征，肌电图信号趋向于第四阶段自主退化阶段的分析使用Matlab的“arfit.m”。对于4个自主退变的模型，采用自主相关性分析和回归性分析描述时域信号特征的4个方面。All these signals were subjected to both wavelet analysis to obtain frequency domain features and time series analysis to obtain time domain features on all 78 subjects.
全部78位受试者的信号通过子波分析采集频率特征并通过时间序列分析采集时域特征信号。
Logistic regression analysis was applied to identify the best time domain and frequency domain features in classifying subjects to “control” and “Cervical Pain Group” by treating group as a binary response variable (0 for “Cervical Pain Group” and 1 for the “Control Group”) and all aforementioned time domain and frequency domain measures as predictors. Separate logistic models were fitted for 2 exertion levels.After identifying the “best model” with a minimum number of predictors, the classification procedure was formed based on the “best model” by classifying a subject to the “Cervical Pain Group” if predicted probability from the model is>=0.5, otherwise the subject will be classified to the “Control Group.” Based 1-fold (delete 1) cross-validation approach misclassification errors were computed to evaluate the performance of the proposed classification scheme. Also, to examine sensitivity and specificity of each of the selected time domain and frequency domain features under the “best-fitted” model, receiver operating characteristic (ROC) curves were computed. The following is the brief description of logistic model classification in general.
应用Logistic回归分析来鉴别正常对照组和颈痛患者组之间在最佳时域和最佳频率域之间的特征。将患者和正常对照组设为二项反应变量（0为“颈痛组”1为“正常对照组”）同样的将前面提到的时域特征和频率域特征也设为二项反应变量。单独的logistic模型应用于2次努力水平。将预计的最小量的“最佳模型”区别开以后，这个分类的过程是基于“最佳模型”可以将患者和正常对照组区别开来P>=0.05，否则，受试者均被归于“对照组”。基于1交叉（删除1）进行交叉效度分析以得出误分类误差值，计算出误分类误差值用来评价我们所采用的分类法的效能。同样的，为了检测在“最佳”模型中每一个所选择时域指标和频率域指标的敏感性和特异性，计算出特异性指标（operating characteristic，ROC）曲线。下面将来简要描述一下logistic分类模型的一般特征。
Logistic Regression Discrimination Model. Subject type was used as the response binary variable (Y), while time domain and frequency domain features were used as predictors (X1, X2,) in fitting a logistic linear regression model:
Logistic回归分类模型。受试者通常被定义为二项变量的反应者（Y），然而时域特性和频率域特性被认为是估计因子（x1，x2），以适合logistic直线回归，模型：
where the binary response variable Y was assigned the value 1 if the subject type was a “patient” and 0 if the subject type was a “control.”
这里的二项变量Y如果是患者组将被定义为“1”，如果是对照组将被定义为“0”The regression coefficients, b1,b2,. . . in the aforementioned model were the odds ratios corresponding to the frequency and time domain measures X1, X2,. . . . (i.e., a negative value for the regression coefficient implied that a larger value for the corresponding predictor for a subject will increase the chance of classifying the subject to the “Cervical Pain Group” compared to the “Control Group”).
回归系数，b1,b2,……On the other hand, if a regression coefficient corresponding to a predictor was positive, then a large value for the predictor for a subject will increase the chance of classifying the subject to the “Control Group” compared to the “Cervical Pain Group.” To identify the “best” predictors for discriminating subject type, the forward likelihood method is adopted in SPSS 13 (SPSS, Inc., Chicago, IL). To examine the performance of the fitted logistic regression model and to discriminate subjects’ type misclassification, errors were calculated. Also, estimates for the “best” predictors are given along with their associated statistical significance values. After identifying the statistically significant
predictors (time and frequency domain measures), estimates for regression coefficients were computed for the final model. Let __ 0, __ 1, __ 2, . . . be the estimates obtained for the model with significant predictors.
Discussion
Both rehabilitation and primary prevention of neck pain epidemic can be better managed with the knowledge of functional capacity as well as the physiologic behavior of the cervical muscles. With pain, the force generating capacity of the cervical region may be compromised. It has been shown that the cervical strength in the chronic neck patients was significantly lower than that of age-matched controls for both flexion and extension.8 In the current study, the cervical strength at both levels of contractions (pain threshold/20% MVC and pain tolerance/MVC) were significantly different between patients and controls (P< 0.003).
康复和颈痛的流行病预防都可以受益于颈椎的功能状态和颈椎肌肉的生理功能状态。由于疼痛，颈椎的活动范围和肌肉力量将受限。结果显示，颈痛患者组的颈肌力量在屈伸方面均显著低于正常对照组。目前的研究显示，在肌肉收缩的两个水平（疼痛域值/20%的最大肌肉收缩和疼痛最大可忍受的情况下/最大肌肉收缩）在患者和正常人之间有显著差异（P<0.03）。
Cervical spine is a mechanical structure that has both strength and flexibility. It has been suggested that the biomechanics of the spinal movement is affected by abnormal patterns of muscle activity that could result in mechanically induced pain. Abnormal patterns of muscle activity during spinal movement may also predispose the spine to an unstable state and, therefore, result in abnormal loading, causing neuromuscular dysfunction resulting in pain.9,10 Asymmetry of muscle activity has also been assigned as a cause of pain development. Asymmetry of muscle activity can occur, and, thereby, it may decrease or increase activity compared to normal symmetrical response. The decreased activity is attributed to the reflex inhibition, and the increased activity has been attributed to muscle spasm, which would prevent painful movement.11
颈椎是具有强度和柔韧度的力学结构。颈椎肌肉的异常活动模式导致椎体的机械性异常位移从而导致颈椎的机械行疼痛。肌肉的异常活动方式同样会导致椎体的失稳，从而，导致椎体的异常负荷。最终导致神经肌肉功能的功能异常而导致疼痛[9,10]。肌肉活动的不均衡性还是疼痛进一步加剧的原因。因此，肌肉活动的不均衡的发生可以导致正常肌肉反应的增加或较少。活动的减少是由于反射抑制所造成的，活动的增加归因于肌肉的痉挛，痉挛可以减轻活动时的疼痛[11]。
Figure 6. Two sigma error bars to compare effects of first-order autoregression coefficient (for LSCM in lateral flexion) between the “Cervical Pain Group” and “Control Group” at 20% MVC exertion.
The EMG of the 6 cervical muscles for flexion and extension clearly demonstrated a significantly different pattern and magnitude of activity between patients and controls.
6块肌肉在屈伸时候肌电图的改变，明确的显示了正常人和患者肌肉活动的形式和方式显著区别。
Significant differences in normalized peak EMG were reported both in pain threshold/20% MVC and pain tolerance/MVC contractions. However, there were more muscles that were showing significant differences in the pain threshold/20% MVC contraction. In these, the left and right sternocleidomastoids in both males and females were significantly different in patients as compared to controls for all 5 contractions (P<0.01) (flexion, left anterolateral flexion, left lateral flexion, left posterolateral extension, and extension). The splenius capitis muscle was found to be significantly different for flexion, left anterolateral flexion, and left lateral flexion. It would clearly appear that the role of the sternocleidomastoids is a dominant one. In all flexion activities, symmetrical or asymmetrical sternocleidomastoids were the major flexor muscles, and they had to balance the mechanics of the neck as agonists, synergists, or antagonists.
在痛域/20%最大肌肉力量收缩和最大痛域/最大肌肉力量收缩的比较中，在肌电图的峰值可以看到显著差别。然而，其它肌肉和20%最大肌肉力量收缩比较时依然有显著性差异。在这些肌肉中，患者组中男女患者的胸锁乳突肌域对照组的胸锁乳突肌在5个方向（前屈、左前侧屈、左侧屈、左后侧屈、和后伸）的肌力相比均有显著性差异 (p<0.01) 。头颈夹肌在前屈、左前侧屈、左侧屈时具有显著的差异。这写清晰的显示胸锁乳突肌在这些活动中占有主导地位的因素之一。在所有的前屈肌中，对称性的和不对称的胸锁乳突肌是主要的前屈肌，并且，他们在颈椎的运动中，承担着主动肌、平衡肌和拮抗肌的作用。
In extensor activities, as one would expect, the trapezius muscle was significantly different in patients as compared to the controls (P < 0.01). It would, therefore, appear that when pain threshold contractions are compared with the submaximal 20% MVC contraction of normal controls, there is a significant difference and can be used as a useful classifier.
在后伸活动中，正如所预期的那样，患者的斜方肌域正常人相比有显著的区别(p<0.01)。因此，正常人的痛域的收缩值和20%的次最大肌肉力量收缩值域患者具有显著性意义，可以用来作为一个鉴别指标。
This observation is also supported by the findings of Sohn et al,12 who reported a significant increase in the twitch amplitude as a result of experimental pain induced by injection of 0.2 mL capsaicin (P <0.001) without changes to half relaxation time and contraction time. They also reported no significant changes to single motor unit twitch properties. Lundblad et al13 demonstrated that in repeated contractions of shoulder muscles there was a shift in the mean frequency of the surface EMG, which was greater in patients than in controls. However, no repetitive contractions were studied in the current study. The fact that there were no consistent significant differences between patient and control subjects for time-to-peak EMG indicates that the overall motor output had not changed between patients and controls. However, an earlier recruitment of the left sternocleidomastoids in patients may suggest a protective strategy. Similarly, no significant difference between the median frequency of the cervical muscles between patients and controls indicated that they had similar spectral characteristics and insignificant changes in the conduction velocity of the muscles, if any. However, when Levene’s test for equality of variances was conducted for the spectral power at 10% of bandwidth of the muscles, the sternocleidomastoids had significantly different power in left and right sternocleidomastoids for flexion and left anterolateral flexion (P<0.01) between patients and controls. The left trapezius muscle had significantly different power between patients and controls for left posterolateral extension and extension (P<0.05).
这些观察结果同样被Sohn 等人[12]所证实,他们报道称，通过给肌肉注射0.2ml的辣椒碱所致的疼痛可以显著的增加肌肉的抽搐(p<0.01) 但其收缩时间和舒张的时间并没有显著改变。他们同时也观察到没有单个神经单元的抽搐现象。Lundblad等人[13]观察到在患者组和正常人组重复收缩肩部肌肉的过程中，患者组表面肌电图的中卫频率明显偏移。然而，目前这种说法尚无人验证。患者和正常受试着到达峰力矩的肌电图没有显著差别说明，两者之间的所有的神经输出没有显著性异常。但是，患者组的左侧胸锁乳突肌早期的募集反应意味着这是一种保护机制在发挥作用。同样的，患者合组正常人群颈肌的中位频率无差别意味着它们在光谱分析和肌肉的传导方面没有区别。但是，当对右侧的胸锁乳突肌在前屈和左侧后伸的10%的波段进行光谱分析的时候发现，患者组和对照组有显著性差异（p<0.01）。患者和正常人左侧的斜方肌在后伸和左侧后伸时的功率有显著性区别（p<0.05）.
The results of this study dealing with the frequency and time domain parameters show significant promise. A 97% overall correct classification using the resubstitution method and 93% using the cross resubstitution -validation method is significant. This high level of success was achievable by using the pain threshold exertion, where the effect of pain is most likely to be manifested. Exceeding the pain threshold value is likely to obscure the distinguishing features by recruiting a large number of motor units, diluting the effect. Other researchers14 also used the power spectrum analysis coupled with principal component analysis without success and suggested a greater sophistication of technique was needed. Others15 have compared identical activities between patients and controls finding similar temporal patterns of EMG.
频率和时域的处理结果显示有显著的意义。应用resubstitution方法有97%的区分率，应用the cross resubstitution –validation方法有93%的可信区间。这样高的成功结果是通过应用疼痛域值量表的描述来取得的，这写量表已经经过证明过的。极度的疼痛可能是由于不像不清楚地募集大量的神经元而区别，冲淡疗效。其它研究人员[14]也曾经应用光谱分析和主成分分析但是没有成功，可能是由于参杂的因素太多所致，需要更加优良的技术处理参杂因素。然而，其它的研究者 [15] ，对患者和正常人采用同样的研究方法得出相似的肌电图图形。This study has some limitations. The results do not provide diagnostic tests for different pathologies beyond establishing pain. However, it is suggested that changes in muscle physiology due to underlying pain may be similar regardless of pathology. Also, the pain and no-pain samples were not age matched. Again, there is no evidence to indicate that age has any effect on muscle physiology. Despite foregoing limitations, such an objective measure of underlying pain can be useful in determination of treatment efficacy. Additionally, in our society, establishing the presence/absence of pain has been a contentious issue in many sectors. It has been at the root of numerous conflicts with socioeconomic consequences. This objective methodology can assist in resolution of many such problems.
本研究尚有一定的缺陷。这些结果出了疼痛以外没有其它的病理学诊断。然而，肌肉的生理改变所导致的疼痛可以不必考虑其它的病理变化。同样的，疼痛和没有疼痛的受试对象没有进行年龄的匹配。另一方面，没有任何证据表明年龄域肌肉的生理改变有关。尽管有上述的缺陷，这样的一种对疼痛的客观测量可以较好的评价治疗的效果。另外，在我们这样的社会的许多部门对疼痛的有无依然存在争论。这些争论导致了大量的社会经济的浪费，这样的一种方法学可以解决大量的类似问题。
（h）未完，待续！因本人正在准备论文答辩，尚有部分节段未能完成！等译完后在上传！文中多有翻译不当之处，望各位大侠指正！
