膝关节置换术后早期引入临床康复护理路径的效果评价

目的探讨临床康复路径管理在膝关节置换术后患者早期康复中的应用效果。方法选取2014年1月-2015年12月收治的膝关节置换术病人246例,随机分为两组,各123例。对照组按入院、术前、术后、出院分阶段实施常规护理,观察组在术后实施临床康复护理路径管理,比较两组患者术后不同时间膝关节KSS评分、膝关节ROM评分、日常生活能力(ADL)评分、疼痛评分及并发症的发生率。结果两组患者术后不同时间膝关节KSS评分、膝关节ROM评分比较差异有统计学意义(P0.05)。两组患者术后日常生活能力评分、疼痛评分及病发症比较差异有统计学意义(P0.05)。结论对膝关节置换术后患者实施临床康复护理路径管理可有效改善膝关节功能,提高日常生活自理能力,降低术后疼痛程度及并发症的发生率。     

人工全膝关节置换术后的早期康复

目的人工全膝关节置换术后进行康复活动,在于防止粘连,增加关节活动度和肌力,减少畸形,提高日常生活能力。方法我们制订了一整套的人工全膝关节置换术后的康复常规。自１９９６年在我院试用于２４例人工全膝关节置换术后患者（３５膝）,获得良好的早期临床效果。结果术后２０天,患者安静及行走时疼痛、行走距离、转移能力、肌力及屈曲畸形较术前明显改善,差异有显著性;拐杖的使用率及内外翻畸形较术前明显下降,差异有显著性;关节的稳定性较术前无明显差异;但关节的活动度较术前下降,差异有显著性;使用楼梯能力较术前无明显改善。结论全膝关节置换术后患者出院后仍须继续进行正确的肌力、关节活动度及日常生活能力的康复训练。     

乳腺癌患者术后患肢功能状况的纵向研究

目的探讨乳腺癌患者术后患肢功能的状况及变化规律。方法采用便利抽样法,抽取在本院住院的80例乳腺癌术后患者,采用上臂和肩关节功能自我评定量表分别于术前、术后3个月、术后6个月、术后1年对患者进行测评,并同时测评其肩关节活动度。结果术前、术后3个月、术后6个月、术后1年不同时间点患者肩关节活动度水平及上臂和肩关节功能自我评定得分比较,差异有统计学意义(P<0.001),两两比较结果显示,术后3个月分别与术前、术后6个月、术后1年比较,差异有统计学意义(P<0.0083);术后6个月分别与术前、术后3个月、术后1年比较,差异有统计学意义(P<0.0083);术后1年分别与术后3个月、术后6个月比较,差异有统计学意义(P<0.0083);术前与术后1年比较,除肩关节后伸度外,其余差异有统计学意义(P<0.0083)。患者的肩关节活动度及上臂和肩关节功能自我评定得分均于术后3个月最低。结论乳腺癌患者术后患肢功能康复水平是动态变化的,术后3个月为最低水平,随着术后时间延长,之后逐渐上升,但至术后1年仍未恢复至术前水平。需加强乳腺癌患者术后患肢功能的管理,延长随访时间,以提升患者患肢功能水平,进而提高康复效果。     

体外冲击波对于肩袖修补术后患者功能恢复的疗效观察

目的：观察行肩关节镜下肩袖修补术的患者在术后康复训练的基础上配合使用体外冲击波治疗（ESWT）的临床效果。方法：此项研究选取肩袖损伤诊断明确且保守治疗无效的患者共计68例，随机分为观察组和对照组，每组34例。2组患者术后0～12周分3个阶段行制动康复训练、保护康复训练、增强康复训练。2组患者均采用被动功能训练，观察组同时增加体外冲击波辅助治疗。分别于患者术前、术后3周、6周及12周采用UCLASS评分、Constant评分、VAS评分和ROM评分评估患肩功能恢复情况。结果：术后3周、6周及12周，2组分别与组内术前比较，UCLASS、constant及ROM评分均有显著提高（P＜0.05），VAS评分显著降低（P＜0.05），术后3周、6周及12周，2组各评分行组间比较差异均有统计学意义（P＜0.05）。结论：对于肩关节镜下行肩袖修补术的患者在术后康复训练的基础上早期提供规律的体外冲击波治疗能够显著改善患者的患侧肩关节功能恢复情况，另外在缓解疼痛方面疗效显著。     

关节松动术治疗肩周炎的综合评定

为探讨关节松动术对肩周炎的疗效,采用肩关节松动术治疗肩周炎３２例,同时用肩关节功能评价量表在治疗前后对肩关节疼痛、ＲＯＭ、ＡＤＬ、肌力及局部形态进行综合评定。结果：治愈８例,显效１３例,好转９例,无效２例,有效率９３．７５％;治疗后肩关节功能评定得分显著增加（Ｐ〈０．００１）;以治疗后肩关节功能分值、治疗前后得分增加值为标准评定疗效并与临床疗效评定结果比较,差异无显著性（Ｐ〉０．９）。提示：关节松     

康复治疗结合盐酸氨基葡萄糖治疗肩关节周围炎的疗效观察

目的探讨康复治疗结合盐酸氨基葡萄糖治疗肩关节周围炎的临床疗效。方法将2009年3月-2011年11月在成都军区总医院康复医学科门诊和住院的90例肩关节周围炎患者随机分为两组,治疗组45例,采用运动疗法结合口服盐酸氨基葡萄糖治疗90d;对照组45例,仅采用运动疗法治疗90d。结果治疗90d后,在临床疗效方面,治疗组总有效率86．7％;对照组总有效率66．7％,差异有统计学意义（P〈O．05）。在康复疗效方面,两组患者肩关节疾患治疗成绩判定标准中疼痛、肌力、关节活动度（ROM）、日常生活能力（ADL）和关节稳定性5个方面均有明显改善（P〈0．01）;和对照组相比,治疗组在疼痛、ROM、ADL3个方面改善更明显（P〈0．05）。结论康复治疗结合盐酸氨基葡萄糖治疗肩关节周围炎疗效比单独采用康复治疗要好。     

100例肩关节镜下治疗肩袖损伤术后的护理

目的 对肩关节镜手术治疗肩袖损伤术前及术后护理与康复经验进行探讨.方法 对10例肩袖损伤患者进行肩关节镜手术治疗,分别行术前护理、术后护理、术后康复训练、并发症的观察.比较术前后患者肩关节功能情况.结果 术后患者肩关节功能的优良率优于术前,术前后比较,x2=7.81,P＜0.01,差异具有统计学意义.结论 肩关节镜手术的护理和康复指导是肩关节镜手术后肩关节功能恢复的有力保证.系统的整体护理是肩关节镜手术取得良好效果的重要保障.     

棍棒操预防脑卒中后肩—手综合征的临床疗效

目的探讨自编的棍棒操防治脑卒中后肩-手综合征的临床疗效。方法将100 例脑卒中早期上肢处于Brunnstrom Ⅰ～Ⅲ级,同时未出现肩痛、手肿患者,随机分为观察组(n=50)和对照组(n=50),两组均进行常规康复治疗,观察组在此基础上结合棍棒操,30 d 为1 个疗程。比较两组治疗前、治疗2 个疗程后肩痛的发生率、肩关节主动活动范围、上肢运动功能以及日常生活活动能力(ADL)。结果治疗前两组各项指标均无显著性差异(P>0.05),治疗2 个疗程后观察组肩关节的主动活动范围、上肢运动功能评分、ADL 均显著高于对照组(P<0.001),肩痛的发生率明显低于对照组(P<0.01)。结论自编的棍棒操能降低脑卒中后患者肩痛的发生,改善肩关节活动度,提高上肢功能,最终提高患者ADL,有效地预防脑卒中后肩-手综合征的发生。     

疼痛的综合护理干预对乳腺癌术后康复的影响

目的 探讨针对性疼痛护理干预对根治性乳腺癌切除术后功能康复的影响.方法 80例行乳腺癌根治性切除术的患者随机分为实验组和对照组,每组各40例.在围手术期,实验组除了接受常规护理以外,还接受缓解疼痛的综合护理干预,而对照组则仅接受常规护理.术后5 d内每天应用疼痛数字评估量表（NRS）和Athens失眠量表（AIS）对80例患者进行疼痛评分和睡眠质量评估;在术后1个月内,对患者的拔管时间、住院时间、患侧肩关节活动起始时间、患肢水肿情况、上肢功能恢复情况等康复指标进行评估.结果术后5 d每天实验组的平均NRS评分和平均MS评分均低于实验组的相关指标;实验组与对照组相比,术后疼痛强度显示了较快的下降趋势;在康复指标方面,实验组除了拔管时间外,其余指标均优于对照组.结论 疼痛护理干预可明显减轻乳腺癌根治性切除术患者术后切口的疼痛,促使患者早日恢复患肢功能锻炼,进而改善术后康复的整体效果.     

综合康复在汶川地震截肢伤员功能障碍的临床疗效分析

目的观察综合康复治疗对汶川地震截肢伤员功能障碍的临床疗效。方法对5·12汶川大地震22例挤压伤截肢患者的24条截肢残端实施护理、摆放良肢位、运动治疗、残端塑形、紫外线疗法、红外线疗法、石蜡疗法、音频电疗法、经皮电刺激神经疗法、关节松动、按摩和拍打、超短波治疗、作业疗法和心理治疗等综合康复治疗,直至截肢伤员出院为止。视觉模拟评分法量表评定幻肢痛疼痛强度、测定膝关节和髋关节活动范围、Barthel指数评定日常活动。结果治疗前幻肢痛疼痛强度为2.95±1.33,治疗后为0.50±0.96;治疗前肘关节活动范围为（90.0±28.3）°,治疗后为（135.0±7.1）°;治疗前肩关节屈伸活动范围为（68.8±27.8°）,治疗后为（137.5±9.6）°;治疗前肩关节收展活动范围为（53.8±7.5）°,治疗后为（96.3±4.8）°;治疗前膝关节活动范围为（91.0±23.0）°,治疗后为（123.0±6.7）°;治疗前髋关节屈伸活动范围为（86.9±25.9）°,治疗后为（132.3±13.8）°;治疗前髋关节收展活动范围为（46.9±10.9）°,治疗后为（64.6±8.7）°;治疗前Barthel指数为57.05±18.69,治疗后为78.18±13.85,康复治疗前后均有统计学意义（P〈0.05）。结论地震后截肢不良残肢发生率高,综合康复治疗能促进截肢残端伤口愈合和消除残肢疼痛,可明显改善残肢条件,有利于地震截肢患者功能恢复和日常生活能力的提高,为后期的假肢安装及步态训练创造了条件。     

人工全肩关节置换术患者无痛化管理的临床研究

目的：探讨人工全肩关节置换术患者疼痛控制的效果，为控制患者疼痛提供治疗和护理依据。方法选取20例行人工全肩关节置换术患者，按住院号的单双分为对照组9例和研究组11例，对照组进行传统疼痛控制，研究组采用无痛病房规范化的疼痛管理，比较两组患者术后疼痛控制效果。结果研究组患者术后疼痛评分低于对照组，术后夜间睡眠时间比对照组长，术后肩关节功能Mallet评分高于对照组，差异均有统计学意义（P＜0．05）。结论无痛病房规范化的疼痛管理能降低TSA患者术后疼痛，有助于患者术后肩关节功能恢复，提高患者住院满意度和舒适度。     

Comparison of Rehabilitation Training at Different Timepoints to Restore Shoulder Function in Patients With Breast Cancer After Lymph Node Dissection: A Randomized Controlled Trial

ObjectiveTo investigate whether advancing the initiation of rehabilitation training compared with the time recommended by the guidelines after breast cancer (BC) surgery is beneficial to the recovery of shoulder function and quality of life.DesignProspective, observational, single center, randomized controlled trial.SettingThe study was conducted between September 2018 and December 2019, with a 12-week supervised intervention and 6-week home-exercise period concluding in May 2020.ParticipantsTwo hundred BC patients received axillary lymph node dissection (N=200).InterventionsParticipants were recruited and randomly allocated into 4 groups (A, B, C, and D). Group A started range of motion (ROM) training at 7 days postoperative and progressive resistance training (PRT) at 4 weeks postoperative; group B started ROM training at 7 days postoperative and PRT at 3 weeks postoperative; group C started ROM training at 3 days postoperative and PRT at 4 weeks postoperative; and group D started ROM training at 3 days postoperative and PRT at 3 weeks postoperative.Main Outcome MeasuresThe primary outcome measure was Constant-Murley Score. Secondary outcome measures included ROM, shoulder strength, grip, European Organization Research and Treatment of Cancer breast cancer-specific quality-of-life questionnaire module (EORTC QLQ-BR23), and SF-36. Incidence of adverse reactions (drainage and pain) and complications (ecchymosis, subcutaneous hematoma, lymphedema) were also assessed.ResultsParticipants who started ROM training at 3 days postoperative obtained more benefits in mobility, shoulder function, and EORTC QLQ-BR23 score, while patients who started PRT at 3 weeks postoperative saw improvements in shoulder strength and SF-36. Incidence of adverse reactions and complications were low in all 4 groups, with no significant differences among the 4 groups.ConclusionsAdvancing ROM training initiation to 3 days postoperative or PRT to 3 weeks postoperative can better restore shoulder function after BC surgery and lead to faster quality of life improvement.     

微创手术与药物治疗对早期原发性冻结肩患者近期和远期效果的比较

目的比较微创手术与药物治疗对早期原发性冻结肩(PFS)患者的近期和远期效果。方法选取2014年6月-2015年9月该科收治入院的82例PFS患者为研究对象,随机分为药物组与手术组两组,各41例。对照组患者行关节腔内固醇激素注射治疗,观察组患者行关节镜下盂肱关节与肩峰下间隙的清理松解术。比较两组的基线资料、治疗前后的视觉模拟评分(VAS)、Constant肩关节评分、内旋、外旋、外展、前屈的主动关节活动度(ROM)。结果两组的基线资料、治疗前的VAS评分、Constant肩关节评分、主动ROM比较,差异无统计学意义(P0.05),具有可比性。与治疗前相比,两组患者治疗后的VAS评分均明显降低,Constant肩关节评分、主动ROM均明显升高,差异有统计学意义(P0.05)。在治疗后4周,手术组患者的VAS评分明显高于药物组,Constant肩关节评分、主动ROM明显低于药物组,差异有统计学意义(P0.05)。在治疗后12周、半年和1年,手术组患者的VAS评分明显低于药物组,Constant肩关节评分、主动ROM明显高于药物组,差异有统计学意义(P0.05)。结论肩关节镜下微创手术与药物注射都是早期PFS患者的有效治疗方法,药物注射的近期疗效显著,但远期疗效较差,而微创手术的远期效果更加突出,配合术后的药物口服和康复锻炼能显著改善其肩关节功能和生活质量,值得临床推广应用。     

股神经和硬膜外自控镇痛在全膝关节置换后的作用

背景：全膝关节置换后疼痛是阻碍早期锻炼的主要问题,置换后镇痛有多种方法可供选择,每种镇痛方法均有自身的优缺点,越来越多的学者趋向于神经阻滞和自控镇痛。目的：比较经股神经自控镇痛和硬膜外自控镇痛在单侧全膝关节置换后镇痛及促进功能恢复效果的差异。方法：选择ASAⅠ～Ⅲ级单侧膝关节置换患者42例,随机分为股神经自控镇痛组和硬膜外自控镇痛组,每组21例,均在连续硬膜外麻醉下实施置换,置换后连接镇痛泵。置换后4,8,12,24和48h,采用目测类比法进行疼痛评分,采用Bromage评分法进行运动阻滞评分;分别记录患者在置换后1,2,3d、1周、1个月患膝关节主动活动的关节活动度以及不良反应发生情况等。结果与结论：全膝关节置换后两组目测类比评分差异无显著性意义,运动阻滞Bromage评分股神经自控镇痛组低于硬膜外自控镇痛组,而且股神经自控镇痛组不良反应明显低于硬膜外自控镇痛组,早期关节活动度也好于硬膜外自控镇痛组。提示股神经自控镇痛在全膝关节置换后的镇痛效果是安全有效的,有利于置换后功能恢复。     

神经肌肉控制训练治疗粘连性肩关节囊炎的效果北大核心CSCD

目的探讨神经肌肉控制训练对粘连性肩关节囊炎患者的治疗效果。方法2021年2月至8月,北京同仁医院康复科门诊首次发病的原发性粘连性肩关节囊炎患者34例随机分为对照组(n=17)和观察组(n=17)。两组均接受常规康复,观察组在此基础上进行神经肌肉控制训练,每天1次,每周5 d,共6周。训练前后,采用日本骨科协会(JOA)肩关节评分进行评定。结果治疗后,两组JOA各项评分及总分均提高(|t|>14.835,|Z|>2.070,P<0.05),观察组JOA的疼痛、ADL、ROM及总分均高于对照组(Z=-2.191,t>2.060,P<0.05)。结论神经肌肉控制训练能有效改善粘连性肩关节囊炎患者的肩关节功能。     

综合康复治疗骨折后腕手关节功能障碍14例分析

目的探讨综合康复疗法对骨折后腕手关节功能障碍的疗效。方法对 14例骨折后腕手关节功能障碍患者采用综合康复疗法 ,包括恢复关节活动度、功能训练、作业治疗、物理治疗等方法 ,以关节总活动度 (TAM )和日常生活活动能力 (ADL)评定评价疗效。结果治疗后 ,患者的关节活动范围 (ROM )和ADL均好于治疗前 (P <0 .0 5 )。结论综合康复治疗对骨折后腕手关节功能障碍的恢复有确切疗效。     

分阶段康复训练联合发散式冲击波促进巨大肩袖撕裂术后康复的疗效研究

目的：观察分阶段康复训练联合发散式冲击波促进巨大肩袖撕裂术后康复的疗效。方法：38例肩关节镜下修复术的巨大肩袖损伤患者分为对照组18例和观察组20例。2组患者进行术后为期12周的康复治疗,对照组患者采用分阶段康复训练,观察组患者在此基础上增加体外发散式冲击波辅助治疗。并在治疗前、治疗4周、8周、12周及末次随访时应用视觉模拟评分（VAS）、加州大学肩关节评分系统(UCLASS)、Constant肩关节功能评分、关节外展活动度（ROM）对患者进行评定。结果：治疗后4周、8周、12周及末次随访时,2组VAS评分较治疗前均明显降低（均P<0.05）,UCLASS及Constant评分较治疗前均明显提高（均P<0.05）,且ROM较治疗前均明显增加（均P<0.05）;治疗后4周、8周,观察组VAS评分与对照组同时间点比较均明显降低（均P<0.05）,UCLASS、Constant评分与对照组同时间点比较均明显提高（均P<0.05）,且ROM较对照组均明显增加（均P<0.05）;治疗后12周,观察组VAS评分与对照组同时间点比较明显降低（P<0.05）,其余指标2组间比较差异无统计学意义;末次随访时,2组间各指标比较差异均无统计学意义。结论：分阶段康复训练联合发散式冲击波可明显缓解巨大肩袖撕裂修复术后早期患者疼痛,促进患者早期活动度和功能的恢复,这对于患者早期康复和快速康复具有重要意义,值得临床推广。     

Is discharge knee range of motion a useful and relevant clinical indicator after total knee replacement? Part 2

Objective Knee range of motion (ROM) at discharge from acute care is used as a clinical indicator following total knee replacement (TKR) surgery. This study aimed to assess the clinical relevance of this indicator by determining whether discharge knee ROM predicts longer‐term knee ROM and patient‐reported knee pain and function. Methods A total of 176 TKR recipients were prospectively followed after discharge from acute care. Outcomes assessed included knee ROM and Oxford knee score post rehabilitation and 1 year post surgery. Discharge ROM and other patient factors were identified a priori as potential predictors in multiple linear regression modelling. Results A total of 133 (76%) and 141 (80%) patients were available for follow‐up post rehabilitation [mean postoperative week 8.1 (SD 2.7)] and at 1 year [mean postoperative month 12.1 (SD 1.4)], respectively. Greater discharge knee flexion was a significant (P < 0.001) predictor of greater post‐rehabilitation flexion but not 1‐year knee flexion (P < 0.083). Better discharge knee extension was a significant predictor of better post‐rehabilitation (P = 0.001) and 1‐year knee extension (P = 0.013). Preoperative Oxford score and post‐rehabilitation knee flexion independently predicted post‐rehabilitation Oxford score, and gender predicted 1‐year Oxford score. Discharge ROM did not significantly predict Oxford score in either model. Conclusion The finding that early knee range predicts longer‐term range provides clinical evidence favouring the relevance of discharge knee ROM as a clinical indicator. Although longer‐term patient‐reported knee pain and function were not directly associated with discharge knee ROM, they were associated with ROM when measured concurrently in the sub‐acute phase. No causal effect has been demonstrated, but the findings suggest it may be important for physiotherapists to maximize range in the early and sub‐acute periods.     

CLINICAL EFFECTIVENESS OF KINESIOLOGICAL TAPING ON PAIN AND PAIN‐FREE SHOULDER RANGE OF MOTION IN PATIENTS WITH SHOULDER IMPINGEMENT SYNDROME: A RANDOMIZED,DOUBLE BLINDED,PLACEBO‐CONTROLLED TRIAL

Background:

Kinesiological taping (KT) is commonly used to improve symptoms associated with musculoskeletal disorders. However, review of the literature revealed minimal evidence to support the use of KT in treatment of shoulder disorders and controversy exists regarding the effect of KT in patients with shoulder impingement syndrome (SIS).

Objective:

The purpose of this study was to investigate the effect of KT on pain intensity during movement, pain experienced during the night (nocturnal pain), and pain‐free shoulder range of motion (ROM) immediately after taping, after three days and after one week, in patients with SIS.

Design:

Randomized, Double blinded, Placebo‐controlled design.

Participants:

A total of 30 patients with SIS participated in this study. Patients were assigned randomly to a control (N = 15) and an experimental group (N = 15).

Methods:

The patients in the experimental group received a standardized therapeutic KT. The standardized, placebo neutral KT was applied for control group. KT was applied two times with a three day interval, remaining on during the 3 day interval. Both groups followed the same procedures. Pain‐free active ROM during shoulder abduction, flexion, and elevation in the scapular plane was measured. Visual analogue scale (VAS) for pain intensity during movement or nocturnal pain and was assessed at baseline, immediately after KT, after three days, and one week after KT.

Results:

The result of repeated measures ANOVA showed a significant change in pain level during movement, nocturnal pain, and pain‐free ROM (p = 0.000) after KT in the experimental group. In the ANCOVA, controlling for pre‐test scores, change in pain level at movement (p = 0.009) and nocturnal pain (p = 0.04) immediately after KT was significantly greater in the experimental group than in control group. There was no significant difference in ROM measures (p > 0.05) between groups immediately after KT. No significant differences were found between the two groups in the after one week measurements of pain intensity and shoulder ROM.

Conclusion:

The KT produces an immediate improvement in the pain intensity at movement and nocturnal pain in patients with SIS.

Level of Evidence:

1     

Shoulder and elbow range of motion for the performance of activities of daily living: A systematic review

The loss of range of motion (ROM) in the upper extremities can interfere with activities of daily living (ADL) and, therefore, many interventions focus on improving impaired ROM. The question, however, is what joint angles are needed to naturally perform ADL. The present review aimed to compile and synthesize data from literature on shoulder and elbow angles that unimpaired participants used when performing ADL tasks. A search was conducted in PubMed, Cochrane, Scopus, CINAHL, and PEDro. Studies were eligible when shoulder (flexion, extension, abduction, adduction) and/or elbow (flexion, extension) angles were measured in unimpaired participants who were naturally performing ADL tasks, and angles were provided per task. Thirty-six studies involving a total of 66 ADL tasks were included. Results demonstrated that unimpaired participants used up to full elbow flexion (150°) in personal care, eating, and drinking tasks. For shoulder flexion and abduction approximately 130° was necessary. Specific ADL tasks were measured often, however, almost never for tasks such as dressing. The synthesized information can be used to interpret impairments on the individual level and to establish rehabilitation goals in terms of function and prevention of secondary conditions due to excessive use of compensatory movements.