# 【白读03】正在读

**URL:** <https://forum.beginner.center/t/topic/475>\
**Category:** 🗣️闲聊\
**Tags:** 白读\
**Created:** [2023 年10 月 26 日 05:35 UTC](https://forum.beginner.center/t/topic/475 "2023-10-26T05:35:20Z")\
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作者： ![王白水](https://forum.beginner.center/user_avatar/forum.beginner.center/%E7%8E%8B%E7%99%BD%E6%B0%B4/32/192_2.png) [@王白水](https://forum.beginner.center/u/%E7%8E%8B%E7%99%BD%E6%B0%B4)\
发布日期： [2023 年10 月 26 日 05:35 UTC](https://forum.beginner.center/t/topic/475/1 "2023-10-26T05:35:21Z")

</div>

# 推荐词

# 原文链接

> **[Characteristics of Stabilizer Muscles: A Systematic Review](https://pmc.ncbi.nlm.nih.gov/articles/PMC4403366/)**
>
> Purpose: To identify the main characteristics, based on available evidence, of stabilizer muscles to inform the development of a definition of stabilizer muscles. Methods: Electronic databases were systematically searched for relevant literature ...

# 正文

## 关联数据

补充材料

**在线表格。** [ptc-66-348-OnlineTable.pdf](https://forum.beginner.center/pmc/articles/PMC4403366/bin/ptc-66-348-OnlineTable.pdf)（405 KB）GUID：238B108A-87F0-4453-B15E-999337FAE935

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## 摘要

**_目的：_** 确定稳定肌（stabilizer muscles）的主要特征，以基于现有证据构建稳定肌的定义。 **_方法：_** 我们在多个电子数据库中系统检索了自建库起至2013年6月的相关文献，检索关键词涵盖稳定性、肌肉及稳定肌特征等主题。凡至少报告一项稳定肌特征的研究均被纳入。为评估研究质量，所有纳入文献被归类为实验性研究或观点性论述。我们采用定制化的核查清单评估其方法学质量，并通过内容分析法进行叙事性综合。某项肌肉特征对稳定肌的重要性等级，取决于支持该特征与关节稳定性之间存在直接关联的文献数量，或间接证据（即被公认属于稳定肌的肌肉具备该特征）的数量。 **_结果：_** 共有77项研究符合纳入标准。其中，支持特定肌肉特征具有稳定作用的文献数量最多者依次为生物力学特征（27篇）、神经学特征（22篇）以及解剖学/生理学特征（4篇）。 **_结论：_** 综合现有文献证据，可将稳定肌定义为：通过共收缩（co-contraction）增强关节刚度，并能借助前馈（feed-forward）与反馈（feedback）控制机制快速响应扰动的肌肉。这些结果有助于研究人员识别具备上述特征的肌肉，从而判断其在正常功能活动中是否主要发挥稳定作用而非原动作用（motive function）。

**关键词：** 关节；肌肉；关节不稳

稳定性是物理治疗与康复领域中常被讨论的概念。稳定性缺失被认为是肩关节脱位等疾病的主要临床主诉；关节复位后的干预措施往往聚焦于通过肌肉活动维持关节稳定性的训练方案。更广义的稳定性概念——如“运动控制”（motor control）和“核心稳定性”（core stability）——已发展成为众多康复及预防性项目的基本原理。[1](#B1)–[3](#B3) 尽管已有多种关于稳定性的定义尝试，但目前尚无单一、被普遍接受的定义。

关节稳定性曾被定义为“关节内骨与骨之间连接的牢固程度”。[4](#B4)（第105页）文献中提出了若干有关稳定性的理论，包括主动—被动—神经子系统模型；[5](#B5), [6](#B6) 局部与整体稳定性系统；[2](#B2), [7](#B7), [8](#B8) 核心控制；[3](#B3), [7](#B7) 跨关节肌肉力；[9](#B9) 动态稳定；[10](#B10) 以及感觉—运动控制。[2](#B2), [8](#B8)

所有上述概念与理论均强烈提示：肌肉与运动控制在关节稳定性中扮演着重要角色。例如，多项研究报道肩袖肌群在盂肱关节处发挥动态稳定作用；[11](#B11), [12](#B12) 类似地，腰椎的稳定系统亦包含调控运动的肌肉，这些肌肉对脊柱的正常功能至关重要。[13](#B13), [14](#B14) 基于此，许多康复方案旨在改善这些稳定肌的功能与运动控制能力，以提供关节稳定性并预防损伤。[1](#B1)–[3](#B3)

尽管肌肉对关节稳定的重要性已被广泛认可，但稳定肌的确切定义及其特征仍不够清晰，且缺乏充分的循证支持。[7](#B7), [8](#B8) 鉴于稳定肌对关节正常功能的重要意义，深入理解其特征——尤其是探索支撑这些特征的科学证据——将有助于在肌肉骨骼系统疾病的诊断过程中识别此类肌肉，并指导成功康复方案的设计。

因此，本系统综述的目标是：基于现有证据，确定稳定肌的关键特征，从而为构建稳定肌的明确定义提供依据。

跳转至：

## 方法

### 数据来源与检索策略

我们系统检索了四个电子数据库（AMED、CINAHL、Medline 和 SPORT Discus），时间跨度为各数据库建库起至2013年6月。检索采用三个主题概念组合，各概念间用 AND 连接，而每个概念内部的关键词则用 OR 连接（关键词详见[在线表格](#SM1)）。第一个概念使用术语 _muscl\*_（含 muscle, muscles, muscular 等变体）；第二个概念涵盖与稳定性相关的术语，如 _stabiliz\*_（含 stabilize, stabilization 等）、_control_ 或 _stiffness_；第三个概念涉及“特征”，其关键词来源于文献中常见描述，例如 _feed-forward_（前馈）与 _feedback_（反馈）、_muscle recruitment_（肌肉募集）以及 _muscle architectural characteristics_（肌肉建筑学特征）。

### 研究筛选

初始在线检索后，我们首先剔除全部重复文献。随后，两位独立评审员依据筛选标准（见[方框1](#BX1)）对文献标题与摘要进行初筛。所有可能符合纳入条件的研究均进入全文阅读阶段，并由两位评审员再次独立应用纳入标准进行评估。最终是否纳入综述，由双方协商一致决定。纳入标准为：研究需至少描述一项稳定肌的特征，且该特征须归属于 Ng 等学者提出的分类框架——即解剖学/生理学特征、神经学特征或生物力学特征。[13](#B13)

### 方框1

#### 筛选标准

| 纳入标准 | 排除标准 |
| --- | --- |
| • 提供隐含的稳定肌定义，且至少包含一项特征： | • 干预性研究，但未提供任何关于稳定肌特征的信息 |
| – 解剖学/生理学特征 | • 主要关注其他肌肉特征的研究，  
例如延迟性肌肉酸痛（DOMS） |
| ○ 例如：肌纤维类型 |
| – 神经学特征 | • 动物实验研究 |
| ○ 例如：激活起始时间 | • 仅含摘要的文献 |
| – 生物力学特征 | • 学位论文 |
| ○ 例如：拉力角度 | |
| • 仅限英文文献 | |

[在新窗口中打开](/pmc/articles/PMC4403366/table/d35e325/?report=objectonly)
### 质量评估

我们将所纳入的文章分为观点性研究或实验性研究两类。由于现有质量评价工具不适用于本综述类型，我们专门设计了一份定制化核查清单（见[表1](https://forum.beginner.center/pmc/articles/PMC4403366/table/T1/)），以涵盖关键的偏倚来源[15](#B15)。若观点性研究采用了系统性检索策略，则被认为偏倚风险较低；而实验性研究若提供了支持性证据，则被认为偏倚风险较低。支持性证据可分为两类：直接证据（即直接支持某特征与关节稳定性之间关联的证据）和间接证据（即表明被视作稳定肌的肌肉具备该特征的证据）（[表1](https://forum.beginner.center/pmc/articles/PMC4403366/table/T1/)）。质量评估结果未导致任何研究被排除。

### 表1

当前文献中描述的稳定肌特征及所纳入研究的质量评估

aria-expanded=“false” aria-haspopup=“true”\>38\<\<td align=“left” rowspan=“1” colspan="“1”\>威廉姆斯（2001）[28](#B28)\</t

| | 研究  
类型 | 生物力学  
特征
* * *
 | 神经学  
特征
* * *
 | 解剖学/  
生理学  
特征 | 质量评估
* * *
 |
| --- | --- | --- | --- | --- | --- |
| 参考文献 | | 关节  
压缩 | 肌肉  
力学 | 神经肌肉  
控制 | 募集 | O1 | O2 | O3 | E1 |
| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |
| Arbanas (2009)[29](#B29) | E | | | | | ✓ | | | | N |
| Bergmark (1989)[7](#B7) | O | | ✓ | | | | N | Y | N | |
| Boettcher (2010)[12](#B12) | E | ✓ | | | ✓ | | | | | N |
| Bogduk (1992)[30](#B30) | E | | ✓ | | | | | | | N |
| Borghuis (2008)[1](#B1) | O | ✓ | ✓ | ✓ | | ✓ | N | Y | N | |
| Brown (2005)[82](#B82) | E | ✓✓✓ | | | ✓✓ | | | | | Y |
| Brown (2005)[31](#B31) | E | ✓ | ✓✓✓ | | | | | | | Y |
| Lin (2011)[33](#B33) | E | ✓✓✓ | | ✓ | | | | | | Y |
| Cheng (2008)[34](#B34) | E | ✓✓ | | | | | | | | Y |
| Cholewicki (2002)[37](#B37) | E | | ✓✓✓ | | ✓✓ | | | | | Y |
| Cholewicki (1996)[35](#B35) | E | ✓ | ✓✓✓ | | | | | | | Y |
| Cholewicki (1997)[36](#B36) | E | ✓✓✓ | | | | | | | | Y |
| Comerford (2001)[2](#B2) | O | | ✓ | | | | N | Y | N | |
| Comerford (2001)[8](#B8) | O | | ✓ | | ✓ | | N | Y | N | |
| Cowan (2002)[38](#B38) | E | ✓✓ | | | | | | | | Y |
| E | | | ✓ | ✓ | | | | | N |
| Crisco（1991）[39](#B39) | E | ✓ | | ✓ | | | | | | N |
| Danneels（2001）[40](#B40) | E | ✓✓ | ✓✓ | | ✓✓ | | | | | N |
| Davarani（2007）[41](#B41) | E | ✓✓✓ | | ✓✓✓ | | | | | | N |
| Day（2012）[11](#B11) | E | | | ✓✓ | ✓✓ | | | | | N |
| Delahunt（2006）[42](#B42) | E | | | ✓✓✓ | | | | | | N |
| Franklin（2007）[43](#B43) | E | ✓✓✓ | | ✓✓✓ | | | | | | N |
| Gardner-Morse（1995）[44](#B44) | E | ✓ | ✓✓✓ | | | | | | | N |
| Gardner-Morse（1998）[45](#B45) | E | ✓✓✓ | | ✓✓✓ | | | | | | N |
| Gibson（2004）[81](#B81) | E | | ✓✓ | ✓✓ | | | | | | N |
| Granata（2001）[46](#B46) | E | ✓ | | ✓✓ | | | | | | N |
| Granata（2001）[48](#B48) | E | ✓✓✓ | ✓ | ✓✓✓ | | | | | | Y |
| Granata（2004）[47](#B47) | E | | | ✓ | | | | | | N |
| Granata（2007）[49](#B49) | E | ✓✓ | | ✓✓ | | | | | | Y |
| Guieterrez（2009）[19](#B19) | O | | | n=“1”\>✓ | | | 否 | 是 | 否 | |
| Hides（2008）[50](#B50) | E | | | | ✓ | | | | | 否 |
| Hodges（1999）[20](#B20) | O | ✓ | | ✓ | ✓ | ✓ | 否 | 是 | 否 | |
| Hodges（1998）[52](#B52) | E | ✓ | | ✓✓✓ | ✓✓✓ | | | | | 是 |
| Hodges（1996）[51](#B51) | E | ✓ | | ✓✓✓ | ✓✓✓ | | | | | 是 |
| Holmes（2009）[21](#B21) | O | ✓ | | ✓ | | | 否 | 是 | 否 | |
| Hossain（2005）[22](#B22) | O | | | | ✓ | | 否 | CT | 否 | |
| Hungerford（2003）[53](#B53) | E | ✓ | | | ✓ | | | | | 否 |
| Huxel（2008）[54](#B54) | E | ✓ | ✓✓✓ | | ✓✓ | | | | | 是 |
| Jemmett（2004）[55](#B55) | E | | ✓✓ | | | | | | | 是 |
| An（2002）[18](#B18) | O | | ✓ | | | | 否 | CT | 否 | |
| Kalimo（1989）[23](#B23) | O | | | | | ✓ | N | CT | N | |
| Kibler（2006）[3](#B3) | O | | | | ✓ | | N | Y | N | |
| Lee（2000）[58](#B58) | E | | ✓✓✓ | | | | | | | Y |
| Lee（2002）[59](#B59) | E | ✓ | ✓✓✓ | | | | | | | Y |
| Lee（2006）[56](#B56) | E | ✓✓✓ | | ✓ | | | | | | Y |
| Lee（2007）[57](#B57) | E | ✓✓✓ | | | ✓ | | | | | Y |
| Lin（2011）[60](#B60) | E | ✓✓✓ | | ✓✓ | | | | | | Y |
| MacDonald（2006）[24](#B24) | O | ✓ | | ✓ | | | N | Y | N | |
| Macintosh（1986）[61](#B61) | E | ✓ | | | | | | | | N |
| 马泰伊卡（2006）[62](#B62) | E | | | | | ✓✓✓ | | | | Y |
| 麦吉尔（2003）[10](#B10) | O | ✓ | | | | | N | Y | N | |
| 莫里斯（2012）[63](#B63) | E | ✓ | | | | | | | | N |
| 吴（1998）[13](#B13) | O | | | | | ✓ | N | Y | N | |
| 诺里斯（1995）[14](#B14) | O | ✓ | | | | | N | CT | N | |
| 诺里斯（1995）[26](#B26) | O | ✓ | | | | ✓ | N | Y | N | |
| 诺里斯（1995）[25](#B25) | O | ✓ | | | | | 否 | 是 | 否 | |
| O’Sullivan（1997）[65](#B65) | E | | ✓ | | | | | | | 否 |
| O’Sullivan（1998）[64](#B64) | E | ✓ | | | | | | | | 否 |
| Panjabi（1989）[66](#B66) | E | | ✓ | ✓ | | | | | | 否 |
| Panjabi（1992）[5](#B5) | O | | ✓ | ✓ | | | 否 | 是 | 否 | |
| Panjabi（1992）[6](#B6) | O | | ✓ | | | | 否 | 是 | 否 | |
| 旁遮普语（1994）[27](#B27) | O | | ✓ | ✓ | | | 否 | 是 | 否 | |
| 拉德博尔德（2000）[67](#B67) | E | | | | ✓ | | | | | 否 |
| 雷格夫（2011）[68](#B68) | E | | | | | ✓✓✓ | | | | 是 |
| 罗多斯基（1994）[69](#B69) | lspan=“1”\>E | | ✓✓✓ | | | | | | | Y |
| 佐仓（1998）[70](#B70) | E | | ✓ | | | | | | | N |
| 西尔菲斯（2005）[72](#B72) | E | ✓ | | ✓ | | | | | | N |
| 西尔菲斯（2009）[71](#B71) | E | | | | ✓ | | | | | N |
| 辛克亚尔（1991）[73](#B73) | E | ✓ | ✓ | | ✓✓ | | | | | Y |
| 斯托克斯（2000）[74](#B74) | E | ✓ | ✓ | | | | | | | N |
| 斯托克斯（2011）[75](#B75) | E | ✓ | ✓ | | ✓ | | | | | N |
| 范迪恩（2003）[76](#B76) | E | | | | ✓✓✓ | | | | | Y |
| 维拉-加西亚（2006）[77](#B77) | E | ✓✓✓ | ✓ | | | | | | | Y |
| 沃德（2006）[78](#B78) | E | | ✓✓ | | | ✓✓✓ | | | | Y |
| 沃德（2009）[79](#B79) | E | | ✓✓ | | ✓ | ✓✓ | \</t | | | 是 |
| 瓦塔纳帕拉孔（2011）[80](#B80) | E | | | | ✓✓ | | | | | 是 |
| O | | | ✓ | | | N | Y | N | |
| 总计数量 | | 40 | 30 | 28 | 23 | 10 | | | | |
| 具有直接支持性证据的记录数 | | 11 | 8 | 7 | 3 | 3 | | | | |
| 具有间接支持性证据的记录数 | | 3 | 5 | 5 | 7 | 1 | | | | |
| 具有任何支持性证据的记录总数 | | 14 | 13 | 12 | 10 | 4 | | | | |

[在新窗口中打开](https://forum.beginner.center/pmc/articles/PMC4403366/table/T1/?report=objectonly)

O1=是否描述了特定的检索策略？；O2=是否纳入了重要且相关的研究？；O3=作者是否评估了所纳入研究的质量？；E1=是否提供了与稳定性的任何支持性证据？；E=实验性研究；O=基于观点的研究；✓=报告了该特征；✓✓=以间接支持性证据报告该特征；✓✓✓=以直接支持性证据报告该特征；Y=是；N=否；CT=无法判断。

### 数据分析

我们采用内容分析法，从所选研究中收集有关稳定肌特征的数据。该方法包含内容分析的三个原则：（1）在数据中搜寻之前先建立分类体系；（2）选择待分类的样本；（3）统计或系统记录每一类出现的次数。[16](#B16)

我们首先依据Ng及其同事提出的分类法，建立了稳定肌特征的三类范畴——解剖学/生理学、神经学及生物力学。[13](#B13) 随后，在每篇文章中识别出与某一特征相关的单个句子、术语或段落。此后，我们采用轴心编码法（axial coding），通过子类别将这些选定的稳定肌特征与原始三大范畴关联起来。[17](#B17) 对于每项研究，我们遵循内容分析第三原则，记录稳定化特征出现的次数，并注明该研究是否发现支持性证据（直接或间接），用以建立该特征与稳定性的关联。某概念被多少篇文献提供支持性证据来关联其与稳定性的关系，决定了该概念在描述稳定肌特征时的重要程度。

跳转至：

## 结果

### 检索产出

初始检索共识别出2,079篇文献。经应用筛选标准后，共纳入77项研究进行综述（参见[图1](https://forum.beginner.center/pmc/articles/PMC4403366/figure/F1/)）。

[![](https://forum.beginner.center/images/transparent.png)](https://forum.beginner.center/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=%E7%82%B9%E5%87%BB%E5%9B%BE%E7%89%87%E6%94%BE%E5%A4%A7&p=PMC3&id=4403366_ptc-66-348-g001.jpg)[在新窗口中打开](https://forum.beginner.center/pmc/articles/PMC4403366/figure/F1/?report=objectonly)[图1](https://forum.beginner.center/pmc/articles/PMC4403366/figure/F1/)

纳入研究的选择流程图。

### 质量评估

在77项纳入研究中，21项为基于观点的研究，[2](#B2),[3](#B3),[5](#B5)–[8](#B8),[10](#B10),[13](#B13),[14](#B14),[18](#B18)–[28](#B28)，其余56项为实验性研究[11](#B11),[12](#B12),[28](#B28)–[81](#B81)（参见[表1](https://forum.beginner.center/pmc/articles/PMC4403366/table/T1/)）。我们的质量分析发现，所有基于观点的研究均未说明其检索策略或所纳入研究的质量评估情况；它们仅提供低等级证据，即仅引用其他研究中的实验性证据来阐述肌肉的稳定化特征。在56项实验性研究中，36项提供了支持性证据：其中26项提供了直接证据，证明该特征与关节稳定性之间存在关联；另外10项则提供了间接证据，表明被认定为稳定肌的肌肉具备该特征（参见[表1](https://forum.beginner.center/pmc/articles/PMC4403366/table/T1/)）。

### 稳定肌的特征

轴心编码共识别出11项特征，并按需将其归入原有三大范畴下的子类别中（参见[图2](https://forum.beginner.center/pmc/articles/PMC4403366/figure/F2/)）。关键特征的定义及其与关节稳定性的关系见[方框2](#BX2)。

[![](https://forum.beginner.center/images/transparent.png)](https://forum.beginner.center/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=%E7%82%B9%E5%87%BB%E5%9B%BE%E7%89%87%E6%94%BE%E5%A4%A7&p=PMC3&id=4403366_ptc-66-348-g002.jpg)[在新窗口中打开](https://forum.beginner.center/pmc/articles/PMC4403366/figure/F2/?report=objectonly)[图2](https://forum.beginner.center/pmc/articles/PMC4403366/figure/F2/)

稳定肌的特征。括号内数字（a, b）分别表示报告该特征的研究数量（a）及提供支持性证据的研究数量（b）。

PCSA = 生理横截面积（Physiological Cross Sectional Area）

### 方框2

#### 肌肉特征定义及其与关节稳定性的关系

#### 在线表格

[请点击此处查看。](https://forum.beginner.center/pmc/articles/PMC4403366/bin/ptc-66-348-OnlineTable.pdf)（405 KB，PDF格式）  
跳转至：

## 注释

《加拿大物理治疗》（_Physiotherapy Canada_）2014年；66(4): 348–358；doi:10.3138/ptc.2013-51

跳转至：

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