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1.
Achilles tendon mechanics influence plantar flexion force steadiness (FS) and balance. In the upper limb, elbow flexor FS is greater in supinated and neutral forearm orientations compared to pronated, with contributions of tendon mechanics remaining unknown in position-dependent FS. This study investigated whether distal biceps brachii (BB) tendon mechanics across supinated, neutral and pronated forearm orientations influence position-dependent FS of the elbow flexors. Eleven males (23 ± 3 years) performed submaximal isometric elbow flexion tasks at low (5, 10% maximal voluntary contraction (MVC)) and high (25, 50, 75% MVC) force levels in supinated, neutral and pronated forearm orientations. Distal BB tendon elongation and CSA were recorded on ultrasound to calculate mechanics of tendon stress, strain and stiffness. Relationships between FS, calculated as coefficient of variation (CV) of force, and tendon mechanics were evaluated with multiple regressions. Supinated and neutral were ∼50% stronger and ∼60% steadier than pronated (p < 0.05). Tendon stress was ∼52% greater in supinated and neutral compared to pronated, tendon strain was ∼36% greater in neutral than pronated (p < 0.05), while tendon stiffness (267.4 ± 78.9 N/mm) did not differ across orientations (p > 0.05). At low forces, CV of force was predicted by MVC (r2: 0.52) in supinated, and MVC and stress in neutral and pronated (r2: 0.65–0.81). At high force levels, CV of force was predicted by MVC and stress in supinated (r2: 0.49), and MVC in neutral (r2: 0.53). Absolute strength and tendon mechanics influence the ability of the BB tendon to distribute forces, and thus are key factors in position-dependent FS.  相似文献   

2.
The purposes of this study were to compare the elasticity of tendon and aponeurosis in human knee extensors and ankle plantar flexors in vivo and to examine whether the maximal strain of tendon was correlated to that of aponeurosis. The elongation of tendon and aponeurosis during isometric knee extension (n = 23) and ankle plantar flexion (n = 22), respectively, were determined using a real-time ultrasonic apparatus, while the participants performed ramp isometric contractions up to voluntary maximum. To calculate the strain values from the measured elongation, we measured the respective length of tendon and aponeurosis. For the knee extensors, the maximal strain of aponeurosis (12.1 +/- 2.8 %) was significantly greater than that of the patella tendon (8.3 +/- 2.4 %), p < 0.001. On the contrary, the maximal strain of Achilles tendon (5.9 +/- 1.4 %) was significantly greater than that of aponeurosis in ankle plantar flexors (2.7 +/- 1.4 %), p < 0.001. Furthermore, for both knee extensors and ankle plantar flexors there was no significant correlation between maximal strain of tendon and aponeurosis. These results would be important for understanding the different roles of tendon and aponeurosis during human movements and for more accurate muscle modeling.  相似文献   

3.
The in vivo strain properties of human skeletal muscle-tendon complexes are poorly understood, particularly following chronic periods of reduced load bearing. We studied eight healthy volunteers who underwent 4 wk of unilateral lower limb suspension (ULLS) to induce chronic unloading. Before and after the ULLS, maximum isometric ankle plantar flexion torque was determined by using a magnetic resonance (MR)-compatible dynamometry. Volumes of the triceps surae muscles and strain distribution of the soleus aponeurosis and the Achilles tendon at a constant submaximal plantar flexion (20% pre-maximal voluntary contraction) were measured by using MRI and velocity-encoded, phase-contrast MRI techniques. Following ULLS, volumes of the soleus and the medial gastrocnemius and the maximum isometric ankle plantar flexion (maximum voluntary contraction) decreased by 5.5+/-1.9, 7.5+/-2.7, and 48.1+/-6.1%, respectively. The strain of the aponeurosis along the length of the muscle before the ULLS was 0.3+/-0.3%, ranging from -1.5 to 2.7% in different locations of the aponeurosis. Following ULLS, the mean strain was -6.4+/-0.3%, ranging from -1.6 to 1.3%. The strain distribution of the midregion of the aponeurosis was significantly influenced by the ULLS, whereas the more distal component showed no consistent changes. Achilles tendon strain was not affected by the ULLS. These results raise the issue as to whether these changes in strain distribution affect the functional properties of the triceps surae and whether the probability of strain injuries within the triceps surae increases following chronic unloading in those regions of this muscle complex in which unusual strains occur.  相似文献   

4.
王晓军  刘劲松  张洪彬  沈勇伟 《生物磁学》2009,(20):3897-3899,3881
目的:研究短跑训练对运动员跟腱的影响。方法:选择从事运动训练4-6年的健康男、女短跑运动员为实验组(n=12),同时选同龄健康非运动员男、女为对照组(n=12),采用高频超声检测平静状态跟腱长度、横截面积,以及小腿三头肌等长收缩最大力量跖屈跟腱长度的变化。结果:跟腱长度:对照组男子168.5±9.2mm,女子162.4±9.8mm,实验组男子170.9±10.7mm,女子164.0±7.0mm。实验组和对照组组内、组间差别均无统计学意义。跟腱横截面积:对照组男子62.2±6.2mm2,女子47.1±4.5mm2,实验组男子65.6±2.9mm2,女子49.6±1.9mm2。同组内男子比女子跟腱横截面积大,差别有统计学意义(P&lt;0.05),但实验组和对照组组间差别无统计学意义。小腿三头肌等长收缩最大力跖屈时跟腱拉长值:对照组男子7.6±3.6mm,女子4.9±2.8mm,实验组男子11.1±2.9mm,女子7.9±3.1mm。男子比女子跟腱拉长值大、实验组比对照组拉长值大,差别均有统计学意义(P&lt;0.05)。结论:短跑训练可增加跟腱可拉伸长度,跟腱的长度和横截面积未发生明显变化。高频超声可作为重要的测量手段用于...  相似文献   

5.
Following active muscle lengthening, steady-state isometric force is elevated compared with an isometric contraction without prior lengthening for the same muscle length and activation level. This property of muscle contraction is known as residual force enhancement (RFE). Here, we aimed to determine whether neural factors may mask some of the mechanical benefits of RFE on plantar flexion torque production. Inherent to lengthening contractions is an increase in cortical and spinal-mediated inhibition, while knee flexion places the medial gastrocnemius at a neuromechanical disadvantage. Neuromuscular properties of the plantar flexors were investigated with a Humac Norm dynamometer in 10 males (∼27 years) with a flexed (90°) and extended (180°) knee and with or without calcaneal tendon vibration (frequency range: 80–110 Hz). There was no effect for vibration (p > 0.05), but there was an effect for knee angle (p < 0.05) such that there was a 2 fold increase in RFE with the knee flexed compared with extended. During submaximal torque matching, following active lengthening there was an activation reduction (electromyography; EMG) of 7.2 and 4.7% with the knee flexed and extended, respectively for soleus as compared with the reference isometric contraction, but no difference for the medial gastrocnemius. Despite attempting to excite Ia input onto the plantar flexor motor neuron pool, vibration had no influence on RFE. Surprisingly, RFE was elevated more for the knee flexed than extended, which was possibly owing to the activation differences across the disparate muscles of the triceps surae during the plantar flexion task.  相似文献   

6.
The purposes of this study were to examine (a) whether the morphological properties of the muscle gastrocnemius medialis (GM) contribute to the known enhanced muscle fatigue resistance during submaximal sustained isometric plantar flexion contraction of old compared to young adults and (b) whether a submaximal fatiguing contraction differently affects the mechanical properties of the GM tendon and aponeurosis of old and young adults. Fourteen old and 12 young male subjects performed maximal voluntary isometric plantar flexions (MVC) on a dynamometer before and after a submaximal fatiguing task (40% MVC). Moments and EMG signals from the gastrocnemius medialis and lateralis, soleus and tibialis anterior muscles were measured. The elongation of the GM tendon and aponeurosis and the morphological properties of its contractile element were examined by means of ultrasonography. The old adults showed lower maximal ankle joint moment, stiffness and fascicle length in both tested conditions. The submaximal fatiguing contraction did not affect the force-strain relationship of the GM tendon and aponeurosis of either young or old adults. The time to task failure was longer for the old adults and was strongly correlated with the fascicle length (r(2)=0.50, P<0.001). This provides evidence on that the lower ratio of the active muscle volume to muscle force for the old adults might be an additional mechanism contributing to the known age related increase in muscle fatigue resistance.  相似文献   

7.
Effects of three different fatiguing local muscular exercises upon plantar flexion reaction time and achilles tendon reflex time have been studied in 24 normal males. The Exercise Conditions, each involving a series of 30 maximal voluntary isometric contractions (MVC) of the plantar flexors, differed by allowing either 5, 10 or 20 sec rest interval between each MVC. Decrements in strength ranged from 15% to 34% MVC. Trend analysis of the fatigue patterns revealed that a cubic orthogonal polynomial equation was sufficient to describe the profile of MVC decrement for all conditions. Following the fatiguing exercise, simple visual reaction time (plantar flexion), and its two components, premotor and motor time, failed to demonstrate any change from Pre Exercise Conditions. Achilles Tendon Reflex Times, however, demonstrated a marked augmentation, as manifest in reduced total reflex times, contraction times and half relaxation times. These results may suggest the differential fatigue of motor units employed in the three motor tasks, viz. MVC, voluntary reaction and achilles tendon reflex. A plausible explanation for the augmentation of the reflex contraction resides in the known potentiating effect of elevated intramuscular temperature. Alternatively, one might postulate a neurally mediated increase in gain of the stretch servomechanism. The possibility of both mechanisms being operative is not excluded.  相似文献   

8.
Load-strain characteristics of tendinous tissues (Achilles tendon and aponeurosis) were determined in vivo for human medial gastrocnemius (MG) muscle. Seven male subjects exerted isometric plantar flexion torque while the elongation of tendinous tissues of MG was determined from the tendinous movements by using ultrasonography. The maximal strain of the Achilles tendon and aponeurosis, estimated separately from the elongation data, was 5.1 +/- 1.1 and 5.9 +/- 1.6%, respectively. There was no significant difference in strain between the Achilles tendon and aponeurosis. In addition, no significant difference in strain was observed between the proximal and distal regions of the aponeurosis. The results indicate that tendinous tissues of the MG are homogeneously stretched along their lengths by muscle contraction, which has functional implications for the operation of the human MG muscle-tendon unit in vivo.  相似文献   

9.
10.
Although muscle–tendon slack length is a crucial parameter used in muscle models, this is one of the most difficult measures to estimate in vivo. The aim of this study was to determine the onset of the rise in tension (i.e., slack length) during passive stretching in both Achilles tendon and gastrocnemius medialis. Muscle and tendon shear elastic modulus was measured by elastography (supersonic shear imaging) during passive plantarflexion (0° and 90° of knee angle, 0° representing knee fully extended, in a random order) in 9 participants. The within-session repeatability of the determined slack length was good at 90° of knee flexion (SEM=3.3° and 2.2° for Achilles tendon and gastrocnemius medialis, respectively) and very good at 0° of knee flexion (SEM=1.9° and 1.9° for Achilles tendon and gastrocnemius medialis, respectively). The slack length of gastrocnemius medialis was obtained at a significantly lower plantarflexed angle than for Achilles tendon at both 0° (P<0.0001; mean difference=19.4±3.8°) and 90° of knee flexion (P<0.0001; mean difference=25.5±7.6°). In conclusion, this study showed that the joint angle at which the tendon falls slack can be experimentally determined using supersonic shear imaging. The slack length of gastrocnemius medialis and Achilles tendon occurred at different joint angles. Although reporting this result is crucial to a better understanding of muscle–tendon interactions, further experimental investigations are required to explain this result.  相似文献   

11.
The purpose of this study was to investigate whether the mechanical properties of the Achilles tendon were correlated to muscle strength in the triceps surae in humans. Twenty-four men and twelve women exerted maximal voluntary isometric plantar flexion (MVIP) torque. The elongation (DeltaX) and strain of the Achilles tendon (epsilon), the proximal part of which is the composite of the gastrocnemius tendon and the soleus aponeurosis, at MVIP were determined from the displacement of the distal myotendinous junction of the medial gastrocnemius using ultrasonography. The Achilles tendon force at MVIP (F) was calculated from the MVIP torque and the Achilles tendon moment arm. There were no significant differences in either the F-DeltaX or F-epsilon relationships between men and women. DeltaX and epsilon were 9.8 +/- 2.6 mm and 5.3 +/- 1.6%, respectively, and were positively correlated to F (r = 0.39, P < 0.05; r = 0.39, P < 0.05), which meant that subjects with greater muscle strength could store more elastic energy in the tendon. The regression y-intercepts for the F-DeltaX (P < 0.01) and F-epsilon (P < 0.05) relationship were significantly positive. These results might indicate that the Achilles tendon was stiffer in subjects with greater muscle strength, which may play a role in reducing the probability of tendon strain injuries. It was suggested that the Achilles tendon of subjects with greater muscle strength did not impair the potential for storing elastic energy in tendons and may be able to deliver the greater force supplied from a stronger muscle more efficiently. Furthermore, the difference in the Achilles tendon mechanical properties between men and women seemed to be correlated to the difference in muscle strength rather than gender.  相似文献   

12.
The present study aimed to clarify the effects of knee joint angle on the behavior of the medial gastrocnemius muscle (MG) fascicles during eccentric plantar flexions. Eight male subjects performed maximal eccentric plantar flexions at two knee positions [fully extended (K0) and 90° flexed (K90)]. The eccentric actions were preceded by static plantar flexion at a 30° plantar flexed position and then the ankle joint was forcibly dorsiflexed to 15° of dorsiflexion with an isokinetic dynamometer at 30°/s and 150°/s. Tendon force was calculated by dividing the plantar flexion torque by the estimated moment arm of the Achilles tendon. The MG fascicle length was determined with ultrasonography. The tendon forces during eccentric plantar flexions were influenced by the knee joint angle, but not by the angular velocity. The MG fascicle lengths were elongated as the ankle was dorsiflexed in K0, but in K90 they were almost constant despite the identical range of ankle joint motion. These results suggested that MG fascicle behavior during eccentric actions was markedly affected by the knee joint angle. The difference in the fascicle behavior between K0 and K90 could be attributed to the non-linear force–length relations and/or to the slackness of tendinous tissues.  相似文献   

13.
It has been suggested that a suppression of maximal voluntary contraction (MVC) induced by prolonged vibration is due to an attenuation of Ia afferent activity. The purpose of the present study was to test the hypothesis that aftereffects following prolonged vibration on muscle activity during MVC differ among plantar flexor synergists owing to a supposed difference in muscle fiber composition. The plantar flexion MVC torque and surface electromyogram (EMG) of the medial head of gastrocnemius (MG), the lateral head of gastrocnemius (LG), and the soleus (Sol) were recorded in 13 subjects before and after prolonged vibration applied to the Achilles tendon at 100 Hz for 30 min. The maximal H reflexes and M waves were also determined from the three muscles, and the ratio between H reflexes and M waves (H/Mmax) was calculated before and after the vibration. The MVC torque was decreased by 16.6 +/- 3.7% after the vibration (P < 0.05; ANOVA). The H/Mmax also decreased for all three muscles, indicating that Ia afferent activity was successfully attenuated by the vibration in all plantar flexors. However, a reduction of EMG during MVC was observed only in MG (12.7 +/- 4.0%) and LG (11.4 +/- 3.9%) (P < 0.05; ANOVA), not in Sol (3.4 +/- 3.0%). These results demonstrated that prolonged vibration-induced MVC suppression was attributable mainly to the reduction of muscle activity in MG and LG, both of which have a larger proportion of fast-twitch muscle fibers than Sol. This finding suggests that Ia-afferent activity that reinforces the recruitment of high-threshold motor units is necessary to enhance force exertion during MVC.  相似文献   

14.
This study investigated the influence of tendon elongation (TE) on postcontraction doublet (PCD) torque in the assessment of activation in the plantar flexors of nine elderly men (EM, age 73.7 +/- 3.6 yr) and nine young men (YM, age 24.7 +/- 4.7 yr). Plantar flexion maximal voluntary contractions (MVC) and activation were assessed at ankle joint angles of -20 degrees (dorsiflexion), 0 degrees , and 20 degrees (plantar flexion). Across the ankle joint angles tested, compared with YM, the EM had a 36-49% lower plantar flexion MVC (P < 0.01), TE was greater by 25-31% (P < 0.01), and electromechanical delay was 65-108% greater (P < 0.01). Activation (PCD torque to interpolated doublet torque) was 15% lower in EM compared with YM at -20 degrees (P < 0.05), but no different at 0 and 20 degrees . In the EM, PCD torque relative to MVC torque was significantly lower at 20 degrees compared with 0 degrees (P < 0.05). Electromechanical delay was positively correlated with TE (R(2) = 0.489, P < 0.01). In conclusion, this investigation demonstrates that, although a negative association exists between TE and PCD torque, the consequence of a greater TE on the estimation of activation in EM is negligible. This is due to a greater influence of ankle joint angle on the occlusion of a superimposed doublet, which counteracts the lesser influence of joint angle on TE and PCD torque. However, a greater TE in EM was found to significantly increase electromechanical delay, which is expected to influence the time needed for postural readjustments.  相似文献   

15.
Comprehensive characterization of stress relaxation in musculotendinous structures is needed to create robust models of viscoelastic behavior. The commonly used quasi-linear viscoelastic (QLV) theory requires that the relaxation response be independent of tissue strain (length). This study aims to characterize stress relaxation in the musculotendinous and ligamentous structures crossing the human ankle (ankle-only structures and the gastrocnemius muscle–tendon unit, which crosses the ankle and knee), and to determine whether stress relaxation is independent of the length of these structures. Two experiments were conducted on 8 healthy subjects. The first experiment compared stress relaxation over 10 min at different gastrocnemius muscle–tendon unit lengths keeping the length of ankle-joint only structures fixed. The second experiment compared stress relaxation at different lengths of ankle-joint only structures keeping gastrocnemius muscle–tendon unit length fixed. Stress relaxation data were fitted with a two-term exponential function (T=G0+G1e?λ1t+G2e?λ2t). The first experiment demonstrated a significant effect of gastrocnemius muscle–tendon unit length on G1, and the second experiment demonstrated an effect of the length of ankle-joint only structures on G2, λ1 and λ2 (p<0.05). Nonetheless, the size of effects on stress relaxation was small (ΔG/G<10%), similar to experimental variability. We conclude that stress relaxation in the relaxed human ankle is minimally affected by changing gastrocnemius muscle–tendon unit length or by changing the lengths of ankle-joint only structures. Consequently quasi-linear viscoelastic models of the relaxed human ankle can use a common stress relaxation modulus at different knee and ankle angles with minimal error.  相似文献   

16.
It is well known that during maximal plantar flexion contractions the ankle joint rotation overestimates the actual elongation of the tendon and aponeurosis. The aim of this study was to examine the influence of the curve length changes of the Achilles tendon on the joint rotation corrected elongation and strain of the gastrocnemius medialis (GM) tendon and aponeurosis. Nine subjects (age: 29.4 ± 5.7 years, body mass: 78.8 ± 6.8 kg, body height: 178 ± 4 cm) participated in the study. The subjects performed maximal voluntary isometric plantarflexion contractions in the prone position on a Biodex-dynamometer. Ultrasonography (Aloka SSD 4000) was used to visualize the muscle belly of the GM muscle-tendon unit. To calculate the curve length changes of the Achilles tendon its surface contour was reconstructed using a series of small reflective skin markers having a diameter of 2.5 mm. The elongation of the GM tendon and aponeurosis was calculated (a) as the difference of the measured and the passive (due to joint rotation) displacement of the tendon and aponeurosis and (b) as the difference of the measured displacement and the length changes of the reconstructed Achilles tendon surface contour. The absolute difference between the elongation obtained by both methods were 1.2 ± 0.4 mm. These differences were due to the higher changes in length obtained by the reconstruction of the tendon curved surface contour as compared to the changes observed in the passive displacement of the digitised point at the aponeurosis. Without correcting for angle joint rotation, the measured elongation clearly overestimates the actual elongation of the GM tendon and aponeurosis. After the passive displacement correction the calculated elongation still overestimates the actual elongation of the GM tendon and aponeurosis. However, this overestimation has a negligible effect on the examined in vivo strain (0.3%) of the tendon and aponeurosis.  相似文献   

17.
The present study determined in vivo deformation of the entire Achilles tendon in the longitudinal and transverse directions during isometric plantar flexions. Twelve young women and men performed isometric plantar flexions at 0% (rest), 30%, and 60% of the maximal voluntary contraction (MVC) while a series of oblique longitudinal and cross-sectional magnetic resonance (MR) images of the Achilles tendon were taken. At the distal end of the soleus muscle belly, the Achilles tendon was divided into the aponeurotic (ATapo) and the tendinous (ATten) components. The length of each component was measured in the MR images. The widths of the Achilles tendon were determined at 10 regions along ATapo and at four regions along ATten. Longitudinal and transverse strains were calculated as changes in relative length and width compared with those at rest. The ATapo deformed in both longitudinal and transverse directions at 30%MVC and 60%MVC. There was no difference between the strains of the ATapo at 30%MVC and 60%MVC either in the longitudinal (1.1 and 1.6%) or transverse (5.0~11.4 and 5.0~13.9%) direction. The ATten was elongated longitudinally (3.3%) to a greater amount than ATapo, while narrowing transversely in the most distal region (-4.6%). The current results show that the magnitude and the direction of contraction-induced deformation of Achilles tendon are different for the proximal and distal components. This may be related to the different functions of Achilles tendon, i.e., force transmission or elastic energy storage during muscle contractions.  相似文献   

18.
The purpose of this study was to provide evidence on the fact that the observed decrease in EMG activity of the gastrocnemius medialis (GM) at pronounced knee flexed positions is not only due to GM insufficiency, by examining muscle fascicle lengths during maximal voluntary contractions at different positions. Twenty-two male long distance runners (body mass: 78.5+/-6.7 kg, height: 183+/-6 cm) participated in the study. The subjects performed isometric maximal voluntary plantar flexion contractions (MVC) of their left leg at six ankle-knee angle combinations. To examine the resultant ankle joint moments the kinematics of the left leg were recorded using a Vicon 624 system with 8 cameras operating at 120 Hz. The EMG activity of GM, gastrocnemius lateralis (GL), soleus (SOL) and tibialis anterior (TA) were measured using surface electromyography. Synchronously, fascicle length and pennation angle values of the GM were obtained at rest and at the plateau of the maximal plantar flexion using ultrasonography. The main findings were: (a) identifiable differences in fascicle length of the GM at rest do not necessarily imply that these differences would also exist during a maximal isometric plantar flexion contraction and (b) the EMG activity of the biarticular GM during the MVC decreased at a pronounced flexed knee-joint position (up to 110 degrees ) despite of no differences in GM fascicle length. It is suggested that the decrease in EMG activity of the GM at pronounced knee flexed positions is due to a critical force-length potential of all three muscles of the triceps surae.  相似文献   

19.
Individuals with spastic cerebral palsy (CP) typically experience muscle weakness. The mechanisms responsible for muscle weakness in spastic CP are complex and may be influenced by the intrinsic mechanical properties of the muscle and tendon. The purpose of this study was to investigate the medial gastrocnemius (MG) muscle fascicle active torque-length and Achilles tendon properties in young adults with spastic CP. Nine relatively high functioning young adults with spastic CP (GMFCS I, 17±2 years) and 10 typically developing individuals (18±2 years) participated in the study. Active MG torque-length and Achilles tendon properties were assessed under controlled conditions on a dynamometer. EMG was recorded from leg muscles and ultrasound was used to measure MG fascicle length and Achilles tendon length during maximal isometric contractions at five ankle angles throughout the available range of motion and during passive rotations imposed by the dynamometer. Compared to the typically developing group, the spastic CP group had 33% lower active ankle plantarflexion torque across the available range of ankle joint motion, partially explained by 37% smaller MG muscle and 4% greater antagonistic co-contraction. The Achilles tendon slack length was also 10% longer in the spastic CP group. This study confirms young adults with mild spastic CP have altered muscle–tendon mechanical properties. The adaptation of a longer Achilles tendon may facilitate a greater storage and recovery of elastic energy and partially compensate for decreased force and work production by the small muscles of the triceps surae during activities such as locomotion.  相似文献   

20.
The purpose of the study was to examine the effect of prolonged vibration on the force fluctuations during a force-matching task performed at low-force levels. Fourteen young healthy men performed a submaximal force-matching task of isometric plantar flexion before and after Achilles tendon vibration (n = 8, vibration subjects) or lying without vibration (n = 6, control subjects) for 30 min. The target forces were 2.5-10% of the previbration maximal voluntary contraction force. The standard deviation of force decreased by a mean of 29 +/- 20% across target forces after vibration, whereas it did not decrease significantly in control subjects (-5 +/- 12%). This change was significantly greater compared with control subjects (P < 0.01 for both). Power spectral density of the force was predominantly composed of signals of low-frequency bandwidth (相似文献   

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