“X” plastic operation and postoperative rehabilitative treatment of hand proximal interphalangeal joint flexion contraction deformity

Background:The contraction deformity of hand proximal interphalangeal joint flexion often occurs after different injury of palmar digital skin,which has effections on hand functions in different extent (varying degrees) and brings many difficults to patients in their life and work.And marked effect are achieved when “X” plastic operation and postoperative recovery therapy are put into use.Objective:To investigate “X” plastic operation and curative effect of postoperative rehabilitative treatment of contraction deformity of hand proximal interphalangeal joint flexion.Unit:First Clinical Medical College of Harbin Medical Universkty.Subjects:4 patients,3 males and 1 females,all the deformity of six fingers were caused by deep trauma of hand skin,timely ranged from 0.5 to 8 years.Intervention:In the location of finger flexion contraction “X” incision was done across the joint,which reached deeply the surface of flexor aponeurosis and fully slacked contraction.After X-shaped incision,two side triangular flaps were formed,which should not be separated in order to prevent necrosis of tips.Two triangular flaps crisscrossed and were connected to finger flexion joint.One or two new surface of wound left over by proximal and distal ends of flaps can be done with free skin grafting of thick graft of thick faint graft.After operation the affected fingers were bandaged and fixed.The patients should be told passive flexion and extension of finger joint in early postoperative period and active floxion and extension in later period.The mobility should be refined to the range of joint sour and endurance.The child can be fixed for three months with plaster model or small splint according to the conditions and assigned with floxion and extension.Results: Flaps growed well after operation and all survived.Following up three cases half one year and founding that no one case recurred up to now ad the flaps were extending and the function of flexion and extension were good.Conclusion: Two side flaps caused by this operation can easily acrossly connect to the joint of flexion surface and can gradually extend with the flexion and extension of joint.It achieve marked effect that other operations cannot achieve.Early rehabilitative training after operation can not only add patients‘ confidence,make them fully realize the importance of practices,but also improve the early recovery of joint function.     

脑卒中简明ICF核心要素信和效度检验的Rasch模型分析

目的 运用多层面Rasch模型检验中国版脑卒中国际功能、残疾与健康分类(ICF)核心要素的信度和效度.方法 由2名评定员对38例脑卒中患者采用中国版简明ICF核心要素的"身体功能"成分包含的20个类目分别进行评分,运用FACETS统计软件计算个人分离指数和信度、拟合分析等检验ICF核心要素的信度和效度.结果 中国版简明ICF核心要素量表中"身体功能"成分类目内部一致性信度好(个人分离指数为6.02,分离信度为0.94,χ2=2158.3,P＜0.01),评定者内信度好(未加权的均方拟合统计量为0.92～1.12),但2位评定员评分时的严格程度有显著差异(χ2=1042.5,P=0.01).该部分量表的结构效度较好(分离指数为1050,分离信度为0.80,χ2=467.3,P=0.01).但是拟合分析表明,b117智力功能处于非拟合状态,而b152情感功能和b755不随意运动反应功能处于过度拟合状态.结论 中国版脑卒中简明ICF核心要素的身体功能成分具有良好的信度和结构效度.多层面 Rasch模型对于检验简明ICF核心要素的信度和效度能够提供更全面的信息,具有良好应用前景.

Abstract：

Objective To test the reliability and validity of the brief International Classification of Functioning, Disability and Health (ICF) core sets for Chinese stroke patients using Rasch model analysis. Methods The body functions of 38 Chinese stroke patients were measured using the brief ICF core sets. The qualifiers of the 20items were measured by two raters and analyzed using FACETS statistical software. The intra-rater reliability and validity were tested by using the separation index and separation reliability and fit analysis. Results The brief ICF core sets had good internal consistency and reliability (person separation index = 6.02, person separation reliability = 0.94 ) with these Chinese patients. The raters showed significantly different strictness in rating, but their ratings had good internal self-consistency. The construct validity was good for the body functions of the ICF component ( separation index = 10.50, separation reliability = 0.80) , but misfitting and overfitting were found in items b117, b152and b755. Conclusion The body function of the brief ICF core sets has good reliability and validity for Chinese stroke patients. A many-facet Rasch measurement model can provide comprehensive information and has good application prospects for testing the reliability and validity of ICF core sets.     

胫腓骨骨折术后分期康复治疗效果分析

Background: Joint movement disorder and even stiff joint often occurs after external fixation for fracture of tibia and fibula, the reason of which is usually the intra joint adherence and the adherence and atrophy of the extra joint muscles. Objective: To discuss the treatment effects of post- operational staged rehabilitation for fracture of tibia and fibula. Unit: Second People Hospital of Ningxia. Subject: There were 65 cases including 45 male and 20 female ones. They were from 16～ 70 years with the average of 43 years. The fractures were all unstable, fragmental and open. Intervention: Three- staged rehabilitation was applied after external fixation: (1) Early rehabilitation treatment (3～ 6 weeks after operation): ① The fractured limb was elevated to diminish the swelling; ② To exercise the joints at the end of the limbs, as to exercise the toes for multiple times every day; ③ Fix the muscles of the limbs and contract them isometricly, do it for 15～ 20 minutes each time and for multiple times every day. (2) Middle rehabilitation treatment(8～ 10 weeks after operation ) muscle force exercises were increased gradually, the anti resistance exercises were added gradually after the muscle force got over degree III, the joint movement ranges were added gradually with the muscle under control. (3) Late rehabilitation treatment ( the fracture had healed).① Muscle force exercises: Anti resistance exercises such as sandbag kicking and pedaling. ② Joint movement exercises including active and passive exercises, such as extension and flexion of knee joint, dorsiextension and planter flexion of ankle joint, the exercises should be increased gradually to form some rhythm and speed. Also electric treatment, heat treatment, ultrasonic treatment and massage etc may be added in this period. Result: The follow up periods for the 65 cases were 3～ 12 months and the time for the fractures to heal completely was 8～ 16 weeks ( the average was 12 weeks). The function condition of the ankle and knee joints was as follows: knee flexion 150° , knee extension 0° ; ankle dorsiflexion 20° , ankle planter flexion 40° , ankle inversion 30° , ankle extroversion 20° . Conclusion: Manipulative reduction combined with rehabilitation exercises may have excellent effects on facture of tibia and fibula.     

The application of acellular dermal matrix allograft in functional position of patients with post-burns plastic operation

AIM：To investigate the effect of allogeneic acellular dermal matrix(ADM) on cograft in joint functional positions of patients with post-burn plastic operation.METHODS:9 patients with hypertrophic acar and joint dysfunction after severe burns were used.After pre-treating with trypsin and TritonX-100,13 reticulated ADM were overlapped with autogenous ultrathin split-thickness skin grafts(USTS),and were transplanted to the acar excision wounds in the joints of four limbs at the same time.The neighbouring autogenous thin split-thickness skin grafts(TSTS) were used as control.RESULTS:The composite skin grafts as well as the controls were all survived.The rejection and hypertrophic scars were not found during (1-5) years follow-up studies.The apearance,fiber and function of composite skin grafts were near to normal skins.CONCLUSION;The ADM could be used to joint functional positions of patients with post-burn hypertrophicscare and could produce satisfactory plastic results as dermal substitute.     

The application of acellular dermal matrix allograft in functional position of patients with post-barns plastic operation

AIM: To investigate the effect of allogeneic acellular dermal matrix(ADM) on cograft in joint functional positions of patients with post-burn plastic operation. METHODS: 9 patients vrith hypertrophic scar and joint dysfunction after severe burns were used After pre-treating with trypsin and TritonX-100, 13 reticulated ADM were overlapped with autogenous ultrathin split-thickness skin grafts (USTS), and were transplanted to the scar excision wounds in the joints of four limbs at the same time. The neighbouring autogenous thin split-thickness skin grafts(TSTS) were used as control RESULTS: The composite skin grafts as well as the controls were all survived The rejection and hypertrophic scars were not found during (1-5) years follow-up studies. The appearance, fiber and function of composite skin grafts were near to normal skins. CONCLUSION: The ADM could be used to joint functional positions of patients with post-burn hypertrophic scan and could produce satisfactory plastic results as dermal substitute.     

育龄妇女生殖道健康相关信念量表的研制

目的 研制适用于测量育龄妇女的生殖道健康相关信念的评价工具,并进行信度和效度检验.方法 收集500例育龄妇女相关数据,以健康信念模式为框架编制量表,分析量表信度和效度.结果 量表由2个分量表组成,内容效度均为1.0.生殖道感染相关健康信念分量表提取出4个因子,累计解释变异量为75.91%;生殖道健康相关自我效能分量表提取出4个因子,累计解释变异量为68.19%,量表数据统计结构与设计结构相符.各维度Cronbach'sα系数、重测信度、折半信度均＞0.70.结论 本量表具有较好的信效度,可用于育龄妇女生殖道感染相关健康信念评估.

Abstract：

Objective To develop a suitable instrument for measuring health beliefs related to reproductive tract infections (RTIs) and testing its reliability and validity. Methods Within the framework of the Health Belief Model, 500 questionnaires of health beliefs related to RTIs were collected, its reliability and validity was analyzed. Results The instrument contained two subscales, all content validity index(CVI)were 1.0. RTIs-related health belief subscale extracted four factors, the cumulative variance was 75.91%;RTIs-related self-efficacy subscale extracted four factors,the cumulative variance was 68.19%. Scale statistics consisted with the structure and design structure. The dimensions Cronbach's α coefficient, test-retest reliability, split half reliability were greater than 0.70. Conclusions This scale has good reliability and validity and can be used for measuring health beliefs related to reproductive tract infections in women of childbearing age.     

内侧副韧带加强重建后桡骨小头切除治疗青年肘关节恐怖三联征患者疗效观察

Objective To observe the results of medial collateral ligament reconstruction plus radial head resection in the treatment of terrible triad of the elbow for young patients. Methods From November 2005 to October 2009,3 cases of terrible triad of the elbow were treated in our hospital. The radial head fractures were classified in type Ⅲ according to Mason classification. All patients underwent coronoid fixation, collateral ligament and joint capsule repair, medial collateral ligament reconstruction and radial head resection. Postoperatively Kirschner wire and the plaster was applied for elbow stabilization for 3 weeks after operation, in position with elbow flexion in 90 degrees and forearm rotation in neutral, and then removal of Kirschner wire and the plaster. Then physical exercise and rehabilitation program were carried out. Results 3 patients were followed up for more than 1 year with fracture healing. The functional outcome in 3 cases was excellent in 2 and good in 1 according to Broberg and Morrey Elbow Score. Conclusion It is exceptionally important of the reconstruction of collateral ligaments and joint capsule in the treatment of elbow terrible triad associated with radial head comminuted fracture for young patients. Radial head replacement should be cautious. Radial head resection under the premise of satisfactory ligament reconstruction does not cause significant elbow dysfunction.     

内侧副韧带加强重建后桡骨小头切除治疗青年肘关节恐怖三联征患者疗效观察

Objective To observe the results of medial collateral ligament reconstruction plus radial head resection in the treatment of terrible triad of the elbow for young patients. Methods From November 2005 to October 2009,3 cases of terrible triad of the elbow were treated in our hospital. The radial head fractures were classified in type Ⅲ according to Mason classification. All patients underwent coronoid fixation, collateral ligament and joint capsule repair, medial collateral ligament reconstruction and radial head resection. Postoperatively Kirschner wire and the plaster was applied for elbow stabilization for 3 weeks after operation, in position with elbow flexion in 90 degrees and forearm rotation in neutral, and then removal of Kirschner wire and the plaster. Then physical exercise and rehabilitation program were carried out. Results 3 patients were followed up for more than 1 year with fracture healing. The functional outcome in 3 cases was excellent in 2 and good in 1 according to Broberg and Morrey Elbow Score. Conclusion It is exceptionally important of the reconstruction of collateral ligaments and joint capsule in the treatment of elbow terrible triad associated with radial head comminuted fracture for young patients. Radial head replacement should be cautious. Radial head resection under the premise of satisfactory ligament reconstruction does not cause significant elbow dysfunction.     

中文版糖尿病自护行为量表的信度和效度研究

目的 考察中文版糖尿病自护行为量表(SDSCA)的信度和效度,为我国2型糖尿病患者,自护行为评估提供有效、简便的工具.方法 翻译国外的糖尿病自护行为量表(SDSCA),形成中文版SDSCA,采用随机抽样方法,从内分泌门诊中选取20例2型糖尿病患者,进行中文版糖尿病自护行为量表的重测信度、量表内部一致性和结构效度研究.结果 中文版SDSCA各维度重测信度在0.763～1.000;量表各维度条目间相关系数,具体饮食最低(0.104),其余各维度条目间呈中度至高度相关0.555～0.933;主成分分析共抽取4个因子,解释变异量的67.483%.结论 中文版SDSCA的信效度理想,适合于2型糖尿病患者自护行为评价.

Abstract：

Objective To test the reliability and validity of the Chinese version Diabetea Self-Care Behavior(SDSCA)Questionnaire,and thus to provide an effective and convenient way of self-care behavior assessment for patients with type 2 diabetes.Methods The questionnaire based on the translation of SDSCA wag used in 20 cases of type 2 diabetes patients,in order to analyze the retest rehability,internal consistency and scale construct validity. Results The retest reliability of each dimension wag between 0.763 to 1.000;the scale correlation coeflicients between items in specific diet dimension Wag lowest(0.104),and the others were moderate to high degree of correlation between 0.555～0.933;exploratory factor analysis extracted 4 components,and the percentage of variance explained was 67.483% .Conclusions Chinese version SDSCA has a good reliability and validity,and is good for evaluating the self-care activities in type 2 diabetes patients.