改良点式剥脱术治疗老年下肢浅静脉曲张的临床疗效观察

探讨改良点式剥脱术治疗老年下肢浅静脉曲张的临床疗效。以收治的36例老年下肢静脉曲张患者为研究对象，将患者随机分为试验组和对照组，对照组接受传统点式剥脱术治疗，试验组接受改良点式剥脱术治疗，对比分析两组患者的临床效果。经过治疗，两组患者的临床症状都有所缓解，试验组在治疗效果、切口愈合时间、术中出血量和手术时间等方面都显著优于对照组，两组对比，差异具有统计学（P＜0.05）。改良点式剥脱术治疗老年下肢浅静脉曲张，具有有效、快捷、安全的特点，与传统治疗方法相比，治疗效果更加显著，具有较高的临床应用价值。     

高位结扎联合点式剥脱术治疗单纯性下肢浅静脉曲张的研究

目的：探讨高位结扎联合点式剥脱术治疗单纯性下肢浅静脉曲张的效果。方法：选择2017年1月~2018年9月收治的单纯性下肢浅静脉曲张患者92例,根据随机数字表法分为对照组和观察组各46例。对照组采用高位结扎联合传统阶段式剥脱术治疗,观察组采用高位结扎联合点式剥脱术治疗,比较两组患者围术期指标及并发症发生情况。结果：观察组手术时间、术中出血量、下床时间及住院时间均低于对照组（P＜0.05）;观察组术后并发症发生率低于对照组（P＜0.05）。结论：高位结扎联合点式剥脱术治疗单纯性下肢浅静脉曲张效果较好,可缩短手术时间,减少术中出血量,预防并发症发生。     

腔内激光联合高位结扎及点式剥脱术治疗大隐静脉曲张23例临床分析

目的：评价腔内激光联合高位结扎及点式剥脱术治疗单纯性大隐静脉曲张的临床疗效。方法：采用腔内激光联合高位结扎或点式剥脱术治疗大隐静脉曲张23例，28条患肢。结果：所有患者术后均恢复良好，无下肢深静脉血栓形成。随访2～10个月，无一例复发。结论：腔内激光联合高位结扎及点式剥脱术治疗大隐静脉曲张，具有安全、有效、微创的优点，值得临床推广应用。     

高位结扎联合点式剥脱术治疗单纯性下肢浅静脉曲张观察

目的：观察高位结扎联合点式剥脱术治疗单纯性下肢浅静脉曲张的临床疗效。 方法：选取 2018 年 12 月 ~2019 年 12 月 收治的 100 例单纯性下肢浅静脉曲张患者为研究对象,根据治疗方式分为对照组和观察组,各 50 例。 对照组给予高位结扎联合传 统阶段式剥脱术治疗,观察组给予高位结扎联合点式剥脱术治疗,比较两组患者手术指标及术后恢复情况,观察术后并发症发生 情况。结果：观察组手术时间、下床时间及住院时间均短于对照组,术中出血量低于对照组,差异有统计学意义（ P ＜0.05 ）;观察组术 后并发症发生率低于对照组,差异有统计学意义（ P ＜0.05 ）。 结论：单纯性下肢浅静脉曲张给予高位结扎联合点式剥脱术治疗效果 显著,手术时间相对较短,患者术后恢复快,且并发症发生率低。     

驱血带下点式剥脱治疗大隐静脉曲张62例

目的：探讨驱血带下点式剥脱治疗大隐静脉曲张脉曲张的效果。方法：驱血带下点式剥脱治疗大隐静脉曲张62例103条肢体，观察其手术效果。结果：手术时间（每条腿）25分钟-65分钟，平均38分钟中出血量（每条腿）10～80ml,平均38ml。术后腿部美观，无复发。结论：驱血带下点式剥脱治疗大隐静脉曲张脉曲张创伤小，出血少，恢复快，术后腿部美观，复发率低，操作简单，值得推广。     

胸膜纤维板剥脱术治疗慢性脓胸23例分析

目的 探讨如何选择胸膜纤维板剥脱术及其改良术式治疗慢性脓胸,并观察疗效.方法 回顾性分析2000至2007年我院采用胸膜纤维板剥脱术治疗23例慢性脓胸患者的疗效.结果 全组采用传统胸膜纤维板剥脱术1例;仅行脏层胸膜12例,脏层胸膜纤维板剥除加壁层纤维网状切开术10例,加作肺叶切除1例.术后脓腔全部消灭,脓胸全部治疗愈,全组无死亡病例.结论 胸膜纤维板剥脱术是治疗慢性脓胸的有效方法.纤维板形成初期由于质地疏松,容易剥脱,宜选传统的胸膜纤维板剥除术将脏、壁层胸膜及脓腔整块切除;病史长者,粘连致密,剥离困难,可选用改良术式,仅作脏层纤维板剥除,壁层胸膜纤维板不作处理或网状切开,亦可达到满意疗效.     

胸膜纤维板剥脱术治疗慢性脓胸临床分析

目的 探讨如何选择胸膜纤维板剥脱术及其改良术式治疗慢性脓胸,并观察疗效.方法 回顾性分析2000年1月至2010年4月本院采用胸膜纤维板剥脱术治疗36例慢性脓胸患者的疗效.结果 全组采用传统胸膜纤维板剥脱术2例;仅行脏层胸膜12例,脏层胸膜纤维板剥除加壁层纤维部分剥除及网状切开术22例,加作肺叶切除2例.术后脓腔全部消灭,脓胸全部治愈,全组无死亡病例.结论 胸膜纤维板剥脱术是治疗慢性脓胸的有效方法.纤维板形成初期由于质地疏松,容易剥脱,宜选传统的胸膜纤维板剥除术将脏、壁层胸膜及脓腔整块切除;病史长者,粘连致密,剥离困难,可选用改良术式,仅作脏层纤维板剥除,部分壁层胸膜纤维板不作处理或网状切开,亦可达到满意疗效.     

微创曲张静脉刨吸术的疗效观察及手术配合

目的探讨静脉曲张微创刨吸术的疗效及手术配合要点。方法选择23例(36条肢体)静脉曲张患者,行微创刨吸曲张静脉切除术;同期选择手术前条件相似的25例(36条肢体),采用点式剥脱法,记录两种手术方法的手术时间、术中出血量、切口数、切口大小及住院天数等资料进行统计学分析。结果23例行刨吸术者无1例复发,25例点式剥脱法者有3例(4条肢体)复发;与点式剥脱法比较,微创刨吸术的手术时间、住院天数,术中出血量、切口数、切口情况比较,经统计学分析,均P<0.01,差异有统计学意义。结论微创刨吸术治疗下肢静脉曲张手术创伤小,复发率低。     

微创大隐静脉剥脱术

目的：介绍一种微创手术方法,以改进传统大隐静脉剥脱术之不足。方法：采用大隐静脉高位结扎顺行微创剥脱术治疗下肢静脉曲线。结果：272例中随访247例,结果显示本手术方法创伤小、并发症少、复发率低（1.21%)。结论：该术式操作简单合理,易于掌握,具疗效理想。     

点式剥脱治疗大隐静脉曲张临床效果分析

62例大隐静脉曲张患者随机分为治疗组及对照组,治疗组采用点式剥脱技术进行小腿曲张静脉剥脱,对照组采用切开剥脱进行小腿曲张静脉剥脱,比较两组患者术中及术后恢复情况。治疗组手术时间短于对照组,术中出血量少于对照组,治疗组术后住院时间短于对照组,术后并发症发生率低于对照组。点式剥脱治疗大隐静脉曲张能够减少手术创伤,降低术后并发症的发生机率,改善临床治疗效果。     

An identification technique for evaluating body segment parameters in the upper extremity from manipulator-hand contact forces and arm kinematics

OBJECTIVE: To show that it is possible to determine segment masses and segment centers of mass by measuring manipulator-hand contact forces and joint angles during upper extremity movement. BACKGROUND: The method serves as a quick subject specific body segment parameter evaluation technique. Clinically we see this method as an alternative upper extremity body segment parameter evaluation study especially useful in rehabilitation treatment activities. METHODS: The experiment is based on coupling the human arm with a robotic manipulator which is then used for imposing a specified sagittal plane trajectory. Joint angles and forces in the contact point serve as input to the identification procedure. For verification purposes the proposed identification procedure was first performed on a mechanical arm. Afterwards a low velocity trajectory was imposed into all joints of the human upper extremity, with very small angular deviations. Within this small angular region the arm was assumed to be represented as a linear system. FINDINGS: The outcome of the identification procedure is an estimate of masses and center of mass coordinates for the lower arm and palm segments, their products for the upper arm and the passive moments around the measured angle of all joints in the sagittal plane. The results obtained for three particular human arms are eventually compared to the average population based literature. CONCLUSION: From the clinical point of view the study can become useful for biomechanical evaluation and for evaluating biomechanical properties of lower extremities or other body segments. This method may also provide a foundation to measuring body segment moments of inertia and joint viscoelastic parameters.     

偏瘫后强化上肢本体感觉刺激的价值

目的：观察偏瘫患者接受本体感觉强化刺激的治疗及疗效。方法：６０例偏瘫患者随机分为治疗组和对照组各３０例，二组患者均接受一般的康复治疗，治疗组还接受上肢各关节本体感觉强化刺激疗法。上肢综合功能评定采用ＦｕｇｌＭｅｙｅｒ积分法和Ｂａｒｔｈｅｌ指数法。结果：治疗组患者上肢综合功能与日常生活活动能力均明显提高，上肢合并症的发生明显减少，与对照组比较差异有非常显著性（Ｐ＜０．０１），治疗组疗效明显优于对照组。结论：在偏瘫患者进行康复治疗中，应对上肢本体感觉进行强化刺激，以提高上肢综合性运动功能并减少合并症的发生     

Modifying center of mass trajectory during sit-to-stand tasks redistributes the mechanical demand across the lower extremity joints

OBJECTIVE: Sit-to-stand tasks are commonly facilitated by modifying the initial position of the center of mass relative to the feet. It was hypothesized that modifications in the center of mass trajectory during sit-to-stand tasks altered the total body momentum at seat departure and redistributed the lower extremity net joint moments. DESIGN: Between-task within-subject comparison was employed using a robust statistical method to accommodate for small sample size. METHODS: Six individuals performed four sit-to-stand tasks with systematic modifications in the initial center of mass position by varying the orientation of the lower extremity segments. The momentum of the center of mass and lower extremity net joint moments were quantified and compared. RESULTS: Reducing the horizontal center of mass displacement significantly reduced horizontal total body momentum required at seat departure. Sit-to-stand tasks initiated with more horizontal shank and thigh positions required significantly greater knee and hip extensor net joint moments than those with more vertical shank and thigh positions. Sit-to-stand tasks initiated with vertical shank positions also required significantly greater hip extensor net joint moments as compared to those with more horizontal shank orientations. INTERPRETATION: When changes in initial center of mass position are made, alteration in center of mass horizontal momentum and the orientation of the lower extremity segments relative to the reaction force are observed. Consequently, mechanical demand imposed on the ankle, knee, and hip joint is redistributed. The magnitude of the net joint moments is dependent on the segment orientation, the reaction force, and the adjacent net joint moment.     

下肢静脉倒流性疾病的造影诊断（附123例分析）

目的：探讨下肢静脉倒流性疾病的最佳造影检查方法。材料与方法：分别对123例下肢静脉病变行顺行造影、经皮穿刺Go静脉插管造影及改良法下肢静脉造影,比较分析不同检查方法显示下肢深静脉瓣膜功能、浅－深静脉交通支及浅静脉病变的价值。方法：顺行造影显示,42例下肢原发生下肢下深静脉瓣功能不全（PDVI）、13例单纯性浅静脉曲张,Go穿造影显示PDVI39条、单纯性浅静脉曲张4条;改良法显示PDVI36条,单纯性浅静脉曲线1条,此外,GO穿造影及改良法还分别显示了不同程度的血液倒流及瓣膜功能损害。结论：改良法较单纯顺行及GO穿造影能更好地显示下肢浅静脉及深静脉瓣膜功能异常。     

脊髓损伤病人对深静脉血栓认知评价要素的质性研究

[目的]探讨和分析脊髓损伤治疗专家及护理专家对下肢静脉血栓的理解和认知,确定评价病人对下肢血栓认知的基本要素。[方法]以质性研究的方法为指导,对10名专家进行深入访谈并收集资料。[结果]共提炼出4个基本内容,包括下肢静脉血栓的概念及机制、对下肢静脉血栓危害性认识、脊髓损伤病人患下肢静脉血栓的危险因素、脊髓损伤病人对下肢静脉血栓的预防方法(运动、饮食、治疗)。[结论]构建了脊髓损伤病人对下肢血栓认知的基本框架,为以后开展量性研究提供依据。     

Testing apparatus and experimental procedure for position specific normalization of electromyographic measurements of distal upper extremity musculature.

OBJECTIVE: An apparatus and procedure are described to determine position specific normalization coefficients for surface EMG of upper extremity musculature. STUDY DESIGN: Thirty-nine subjects were tested three times. Repeatability of EMG measurements across test sessions was determined by computing intraclass correlation coefficients. Two-way analysis of variance was used to test upper extremity position dependent differences in EMG measurements. BACKGROUND: EMG measurements are susceptible to error from skin movement and muscle length changes, both of which may occur when upper extremity positions vary. Normalization of the EMG signal without consideration for such positional influences may lead to erroneous conclusions regarding muscle activation during functional tasks. METHOD: An apparatus was designed that allowed subjects to perform three repetitions of maximum elbow flexion, forearm pronation, wrist extension, and wrist flexion with the forearm in neutral and pronated positions. Surface EMG was sampled from eight muscles. Mean EMG on maximum voluntary contraction was computed, and resting EMG was subtracted to obtain EMG normalization coefficients. RESULTS: Upper extremity position affected the EMG normalization coefficient for biceps brachii, which was lower in the pronated position, and extensor carpi radialis, which was higher in the pronated position (P<0.00625). CONCLUSIONS: The apparatus accommodates various combined positions of the elbow, forearm and wrist. The normalization procedure is efficient for testing subjects who are being observed during functional tasks. Only two muscles were affected by upper extremity position, but group trends were not always consistent with individual behavior. This method would ensure the use of appropriate EMG normalization coefficients regardless of individual variation. RELEVANCE: This method is effective for normalizing EMG signals using task specific upper extremity positions. It may be used to test isometric exertions of distal upper extremity musculature for clinical and research purposes.     

Strength assessment in postpolio syndrome: validity of a hand-held dynamometer in detecting change.

OBJECTIVES: To investigate the validity, the intraexaminer and interexaminer reproducibility, and the ability to detect change of a hand-held dynamometer (HHD) in strength measurements in former polio subjects. DESIGN: HHD measurement of knee extensor strength was compared with the criterion standard of a chair dynamometer measurement in 49 subjects. The "break" method was used for HHD measurements. Reproducibility was studied for six lower extremity muscle groups in 28 subjects. The measurements were performed by one experienced and one inexperienced examiner on two separate occasions, with an interval of 1 week. The examiners were blinded to each other's and to previous results. SETTING: University hospital. SUBJECTS: Volunteer sample of former polio subjects. RESULTS: For knee extension, the forces that could be measured with the HHD were limited to approximately 200N. Although the intraclass correlation coefficients were high (.75 to .98), the 95% limits of agreement between measurements showed large intervals for differences between two measurements (ratio intervals ranging from .76-1.52 to .52-2.77). The intraexaminer reproducibility for the experienced examiner was superior to that of the inexperienced examiner. The reproducibility of the inexperienced examiner showed systematic bias, with significantly higher strength values for the second session measurement of three muscle groups. CONCLUSION: The device has good validity in the lower force range. However, because the agreement between measurements was poor, it has limited ability to detect a change in muscle strength. Therefore, this method is unable to detect small changes in lower extremity muscle strength in former polio patients.     

The reliability and validity of visual rating of dynamic alignment during lower extremity functional screening tests: a review of the literature

Abstract

Background:

Musculoskeletal assessment of lower extremity dynamic alignment during functional screening tests is important. Clinicians must consider the reliability and validity of visual assessment and the reliability of kinematics during the tests.

Aim:

To review studies reporting on the reliability and validity of visual and kinematic assessments of dynamic alignment during lower extremity functional screening tests.

Methods:

One relevant book and 39 journal articles were reviewed after searches of electronic databases.

Findings:

Reliability of lower extremity joint kinematics during functional tests ranged from fair to excellent [intraclass correlation coefficient (ICC)?=?0.46–1.0]. The best evidence of reliable kinematics from 3D motion analysis exists for the single leg squat, small knee bend and drop jump/land. Intra-rater and inter-rater agreement with visual rating of functional tests ranged from slight to excellent (AC1?=?0.01–0.96; κ?=?0.00–0.92). Visual assessment can differentiate groups with kinematics and hip muscle function that may place them at increased risk of injury. Clinician's visual ratings agreed sufficiently with those of an expert consensus panel. Reliability and validity of visual assessment may improve with clinical experience, training, simple dichotomous rating methods and slower velocity tests.

Conclusion:

The most valid clinical assessment of lower extremity dynamic alignment will be achieved with the use of a single leg squat, single or double leg small knee bend or drop jump, rating knee position relative to the foot on a dichotomous scale. If using more complex rating methods, example ratings and/or additional rater training are needed to gain acceptable agreement.     

两种血压计袖带测量下肢血压对比研究

目的研究两种不同血压计袖带的气囊长度、宽度对下肢血压测量值的影响,探讨下肢血压准确的测量方法。方法对69名患者分别采用普通血压计袖带气囊、新型下肢袖带气囊测量下肢血压,普通血压计袖带气囊测量肱动脉血压,进行自身对照研究。结果普通血压计袖带气囊与新型下肢袖带气囊测量下肢血压相比,收缩压经t检验,t=4.44,P<0.001,舒张压经t检验,t=3.01,P<0.01,具有统计学意义;新型袖带气囊测量体表下肢与普通袖带气囊测量上肢血压相比,收缩压经t检验,t=-7.09,P<0.001,舒张压经t检验,t=-7.24,P<0.001,也具有统计学意义。结论普通血压计袖带气囊测量下肢血压比新型袖带气囊测量的下肢血压偏高,而新型下肢袖带气囊测量较准确。新型袖带气囊测量的下肢血压高于普通袖带气囊测量的上肢血压,符合生理特点,与测量工具无关。     

Volumetric evaluation of upper extremities in 250 healthy persons

BACKGROUND AND PURPOSE: Upper extremity oedema frequently occurs as a complication of several diseases. The aim of this study was to establish normative data for upper extremity volumes with a modified water displacement method. These data were used to develop predictive formulas helpful in detecting abnormal swelling. SUBJECTS AND METHODS: Upper extremities of 250 healthy subjects (138 men and 112 women) were measured by water displacement. RESULTS: A mean difference of 3.0% (3.2%) between right and left arm (forearm) was found. Intra-class correlation coefficients were 0.99 for intra-rater and inter-rater reliabilities. Coefficient of variation was 0.23%. To predict the premorbid volume of an oedematous arm, prediction formulas were constructed. DISCUSSION AND CONCLUSION: Water displacement as used in this study is a highly reliable technique for volume measurement of upper extremities. This technique was applied to gather normative data for upper extremity volumes. We suggest that this technique can be used in daily clinical practice for the evaluation of upper extremity oedema or atrophy caused by various diseases as well as for volume monitoring. Prediction formulas can be used to define abnormal swelling.