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目的 分析血友病患者髂腰肌出血的临床特征和康复治疗临床效果.方法 对2006年1月-2010年12月收治的血友病髂腰肌出血患者的症状、体征、并发症及康复治疗进行回颐性分析.结果 41例血友病髂腰肌出血患者均为男性.左侧髂腰肌出血20例、右侧18例,治疗期间先后双侧出血3例.中位年龄18(6-61)岁.初次髂腰肌出血中位年龄17(6-20)岁.34例(82.90%)患者合并股神经损伤,其中19例合并同侧膝关节出血.20例(48.8%)伴有股四头肌萎缩,2例有骨盆假性肿瘤形成,2例伴有永久性姿势异常.超声影像学表现主要为腰大肌区或腹股沟Ⅸ低回声或低回声为主的混合回声区.34例患者在凝血冈子替代保护治疗下完成8~12周康复治疗,其中33例患者血肿完全消失,患侧髋关节活动度恢复至出血前范围,合并股神经损伤的32例患者中27例(84.4%)股四头肌肌力恢复达到≥4级,20例(62.5%)患者遗留股神经分布区域感觉减低.结论 本组血友病髂腰肌出血患者主要为青少年,股神经损伤和继发性膝关节出血的发生率较高,凝血因子保护下的康复治疗对于血肿的吸收及神经功能的恢复具有良好的疗效. 相似文献
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Antoun Nader MD Khalid Malik MD Mark C. Kendall MD Hubert Benzon MD Robert J. McCarthy PharmD 《Journal of ultrasound in medicine》2009,28(3):345-350
Objective. Nerve stimulator–assisted localization of the femoral nerve is well described; however, direct ultrasound imaging of the femoral nerve branches may be challenging. The purpose of this study was to correlate the evoked motor responses obtained by femoral nerve stimulation and the topographic orientation of the femoral nerve branches during ultrasound examinations of the infrainguinal region. Methods. Eighty‐two patients undergoing total knee replacement were enrolled in this study. A 25‐mm, 5‐ to 10‐MHz broadband linear array transducer was used to identify the femoral nerve at the inguinal crease. The medial and lateral aspects of the femoral nerve were stimulated under ultrasound imaging. Twenty cadavers were dissected to support our clinical findings. Results. A quadriceps contraction was elicited in 1.2% and 96% of the patients when stimulating the medial and lateral aspects of the femoral nerve, respectively. In contrast, a sartorius muscle contraction was elicited in 94% and 0% when stimulating the medial and lateral aspects of the femoral nerve. Our findings during anatomic dissection revealed that the femoral nerve branch to the quadriceps muscle, when compared with the branch to the sartorius muscle, originated laterally in 95% and medially in 5% of the specimens. Conclusions. When using out‐of‐plane ultrasound imaging at the inguinal crease, directing the stimulating needle to the lateral half of the femoral nerve may be associated with a higher probability of encountering the motor branch to the quadriceps muscle. 相似文献
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Paralysis of the femoral nerve secondary to compression from a hematoma of the iliopsoas muscle in the lesser pelvis is a well-known complication of anticoagulants and certain surgical procedures, but is a rare post-traumatic event. A 16-year-old teenage boy presented with a painful, swollen knee with an active extension deficit of the leg following a fall. Seven weeks before he had also received a blunt trauma to the greater trochanter of the homolateral hip. The diagnosis of a patellar tendon tear was first suggested, but this was eliminated on MRI. A close clinical evaluation showed complete paralysis of the quadriceps with a sensory deficit of the anterior side of the thigh. MRI of the lesser pelvis showed a massive iliopsoas hematoma compressing the femoral nerve. Surgical evacuation was performed 9 weeks after the original trauma. At 6 months of follow-up, recovery of the muscle was complete and the electromyogram was normal. 相似文献
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目的:了解神经肌肉电刺激股四头肌对全膝关节置换术(TKR)后运动功能康复的影响。方法:TKR术后患者104例,按分层随机法分为两组,治疗组52例,用神经肌肉电刺激股四头肌,要求患者随电流刺激同时进行主动伸膝;对照组52例,用经皮神经电刺激模式,两组电极分别置于膝部痛点。同时所有患者参与常规康复治疗,平均治疗(14.89±3.65)d出院。出院前行视觉模拟评分法(VAS)、膝关节活动度和膝关节损伤和骨关节炎评分量表(KOOS)评定。出院后随访平均间隔9.5月,随访时行美国膝关节协会评分(KSS)和KOOS量表评定。结果:出院时治疗组和对照组VAS评分分别为(18.11±9.66)和(16.13±4.25)、膝关节主动活动范围(AROM)分别为(103.21°±15.44°)和(99.21°±15.19°),两组的差异均无显著性(P>0.05);治疗组主动伸膝受限为(1.93°±3.47°),明显小于对照组(6.26°±4.28°),差异非常显著(P<0.01);治疗组KOOS评分为(71.52±10.97),明显高于对照组(65.02±10.26),两组差异显著(P<0.01)。随访时,两组KSS评分均达优水平,差异无显著性(P>0.05);治疗组KOOS评分(96.16±2.96)高于对照组(94.04±4.80),两组差异非常显著(P<0.01)。结论:TKR术后早期配合神经肌肉电刺激股四头肌的康复治疗,有助于早期提高伸膝装置的功能和加速功能康复。 相似文献
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Junya Sakamoto Yosuke Morimoto Shun Ishii Jiro Nakano Yoshitaka Manabe Minoru Okita Toshiyuki Tsurumoto 《Journal of Physical Therapy Science》2014,26(2):203-208
[Purpose] The aim of this study was to examine the incidence and patterns of referred
pain in patients with hip disease, as well as the nerve distribution in the hip and knee
joints of 2 cadavers. [Subjects and Methods] A total of 113 patients with hip joint
disease were included in the investigation. The incidence of regional pain and referred
pain patterns were evaluated before and after arthroplasty. Two cadavers were
macroscopically observed to verify the nerve innervation of the hip and knee joints.
[Results] Anterior knee pain was observed preoperatively in 13.3% (in resting) and 33.6%
(in motion) of the patients, which was comparable with the incidence of greater trochanter
pain. In addition, the preoperative incidence rates of knee pain in resting and motion
markedly decreased postoperatively. Of note is the remarkable incidence of pain radiating
to the ventral lower limb. An anteromedial innervation was determined in the cadavers by
the articular branches of the obturator and femoral nerve, which supply small branches to
the knee joints. [Conclusion] Our results suggest that the distribution of the incidence
of pain among the patients with hip disease is diverse owing to the sensory distribution
of the femoral and obturator nerves.Key words: Hip joint disease, Referred pain, Macroscopic anatomy 相似文献
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Wojna D Anwajler J Mladzka I Ostrowska B Skolimowski T 《Ortopedia, traumatologia, rehabilitacja》2006,8(3):315-322
Background. The objective of our research was to assess the impact of physiotherapy on the frequency of intraarticular and intramuscular hemorrhages and on elbow and knee joint function, in hemophilic patients. Material and methods. We examined 22 boys, 6-14 years of age, suffering from hemophilia A. The research program included patient history in respect to intraarticular hemorrhages in elbows and knees before therapy, observation of intra-articular bleeding during physiotherapy, goniometric measurements of the range of movement in the elbow and knee, measurement of the circumference of the arm, forearm, thigh and calf, and momentum dynamometric measurements of the relative and absolute force of the flexors and extensors of the lower leg at the knee joints and of the forearm at the elbow joints, in static conditions. The treatment program included deficit coagulant agent replacement therapy, physiotherapy, and kinesitherapy. Results. The physiotherapy program we applied resulted in a considerable improvement in mobility, as well as increased muscle strength and mass. Conclusions. Our research showed that, due to the application of the appropriate replacement treatment, there was a decrease in the frequency and size of intraarticular hemorrhages, despite intense rehabilitation and physical activity. 相似文献
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目的:研究人工髋关节置换术后下肢深静脉血栓形成的易发因素及常见治疗方法间的疗效对比。材料与方法:通过对髋关节疾患行全髋置换术治疗的267例病例,进行前瞻性随机对照研究。根据患者并发下肢深静脉血栓的风险程度不同,按随机分组设计将其随机分为4个研究组。甲组(对照组):无预防措施。乙组(预防组):(1)组:使用低分子肝素(LMWH)预防;(2)组:使用下肢间歇性气囊加压(IPC)预防;(3)组:使用中药川穹、当归等活血药物预防。应用彩色多普勒超声分别于术前一天、术后第二天对患者双下肢静脉血管进行扫查,如有血栓形成,则继续动态观察,应用统计学方法,进行组间及组内对照分析。结果:预防组比对照组下肢深静脉血栓发生率显著下降(p=0.006),预防组组间下肢深静脉血栓发生率无显著差异(p=0.067)。四组中LDVT最常见部位为股浅静脉,占57.1%(16/28),其次为小腿肌间静脉,占42.8%(12/28)。甲组中发现下肢深静脉血栓数于术后4天最多,第3-5天发现比例为76.8%。高危因素是引起LDVT的重要因素,其中甲组高危患者中发生血栓的患者比例为19/33=57.6%,中危患者中发生血栓的患者比例为3/28=10.7%,低危患者中发生血栓的患者比例为1/23=4.3%。高危患者发生率较后三者有显著差异(p0.05)。结论:彩色多普勒超声对人工髋关节置换术后LDVT检查有重要价值。高年龄、术后患肢制动、血液高凝状态等高危因素是形成LDVT的重要原因。LDVT最常见的部位为股浅静脉及肌间静脉。人工髋关节置换术后第3-5天是LDVT的易发期。术后采取积极的预防措施具有重要临床意义。 相似文献
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PD Dr. O. Rommel L. Finger E. Bös A. Eichbaum G. Jäger 《Schmerz (Berlin, Germany)》2009,23(4):355-359
We report on two patients with neuropathic knee pain following lesions of the infrapatellar branch of the femoral nerve due to knee joint replacement. In one patient, the neuropathic pain syndrome was complicated by the development of complex regional pain syndrome (CPRS II, causalgia). Patients exhibit a sharp, burning pain, often induced by exercise, and sensory impairment in the skin area supplied by the infrapatellar nerve. This nerve is a branch of the femoral nerve medial to the fascia lata and is responsible for the skin sensation of the anterior and medial part of the knee. Clinical features, anatomy, diagnostic methods and therapeutic options are reviewed. 相似文献
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目的通过分析1例获得性血友病A(AHA)合并静脉血栓形成患者的临床资料并复习相关文献,提高对该病的认识。方法结合1例胃印戒细胞癌患者相关的AHA合并下肢深静脉血栓形成的临床资料及文献报道,对本病的病因学、发病机制、临床表现、诊断和治疗进行讨论。结果 AHA是由针对凝血因子Ⅷ的自身抗体导致的罕见出血性疾病,多见于老年人;与其相关的常见疾病是自身免疫性疾病、恶性肿瘤,约50%的AHA患者既往身体健康。出血最常累及软组织。AHA患者存在的各种促血栓形成因素(先天性、获得性)均有助于静脉血栓形成。AHA患者的治疗包括凝血因子替代止血治疗和抗体清除治疗,静脉血栓的抗凝治疗则有可能加重患者出血倾向。本例患者为一66岁男性胃癌患者,术前APTT延长,术后软组织血肿,血浆凝血因子Ⅷ活性(FⅧ:C)下降,FⅧ抗体滴度128BU,予糖皮质激素、丙种球蛋白、环磷酰胺(CTX)抑制抗体生成、输注FⅧ、凝血酶原复合物(PCC)止血;此后,出现右下肢静脉血栓形成;停用PCC,并予胃癌联合化疗,出血和血栓症状消失,凝血功能恢复正常。结论 AHA合并静脉血栓形成临床罕见,治疗相互矛盾。及时识别这两种疾病同时存在并采取综合性、个体化治疗措施是成功治疗的关键。 相似文献
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Elena Donoso-Úbeda Javier Meroño-Gallut José Antonio López-Pina 《Physiotherapy theory and practice》2018,34(10):757-764
Background: The primary clinical manifestations of hemophilia are muscle and joint bleeding. Recurrent bleeding leads to a degenerative process known as hemophilic arthropathy. Fascial therapy is one of the most used physiotherapy techniques today to improve joint dysfunctions and chronic pain. Objective: To assess the safety and efficacy of fascial therapy treatment in patients with hemophilic arthropathy of ankle and knee. Design: Non-randomized, controlled clinical trial. Intervention: Sixteen patients with hemophilia were allocated to an experimental group or to a control group. The physiotherapy intervention was performed through three sessions (one per week), for 60 min per session. Patients received a physiotherapy treatment using a fascial therapy protocol for patients with hemophilia. Main Outcome Measures: The joint status was evaluated using the Hemophilia Joint Health Score; pain was assessed with the Visual Analogue Scale; the range of movement was evaluated using a universal goniometer; the flexibility of the hamstring muscles was assessed with the fingertip-to-floor, and the lumbar mobility through the Schöber test. Results: We observed significant differences in the experimental group for both quality of life and illness behavior. There was no significant improvement in the joint status; however, an improvement was noted in terms of perception of pain in the ankle. Conclusions: A physiotherapy program based on fascial therapy is safe in patients with hemophilia. Fascial therapy may improve joint status, pain, and mobility in patients with hemophiliac arthropathy of the knee and ankle. 相似文献
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Yoshida Y Mizner RL Ramsey DK Snyder-Mackler L 《Clinical biomechanics (Bristol, Avon)》2008,23(3):320-328
BACKGROUND: Temporal-spatial gait parameters improve following total knee arthroplasty (TKA) but lower limb kinematics and moments fail to match those of age-matched healthy individuals. The aim of this study was to determine whether quadriceps strength, clinical measures of knee function, lower limb kinematics, and joint moments improve following arthroplasty and normalize over time. METHODS: Twelve patients underwent total knee arthroplasty were tested at 3 and 12 months following surgery. Twelve matched controls were also tested. All underwent quadriceps strength testing and gait analysis to calculate knee joint kinematics and kinetics. Function was assessed using clinical tests and self-report. FINDINGS: All clinical measures except for quadriceps strength significantly improved from 3 to 12 months. Gait asymmetry was observed at 3 months (lower stance times, peak knee flexion angle, range of motion and vertical ground reaction force), but ankle, knee and hip moments contributing to the total limb support moment were equivalent between legs. At 12 months, gait speed remained significantly slower than controls. Inter-limb differences in peak knee flexion angle and range of motion persisted. Greater hip and lower knee moments were evident in the operated limb, compared to the non-operated limb and controls. Quadriceps strength was positively correlated with faster times on the Time Up and Go and Stair Climbing Test and greater distances during the 6 Minute Walk test. INTERPRETATION: Patients who have undergone TKA demonstrate improvements in function as measured by self-report and functional performance measures. Gait becomes more symmetric and quadriceps strength becomes stronger. Some approached the values of healthy control subjects. Important differences still remain however. The larger hip extensor contribution to the total support moment may be to compensate for the diminished knee extensor contribution during level walking. Since instrumented gait analysis and functional performance measures appear to reflect different aspects of recovery following total knee replacement, both should be considered when evaluating gait and function. 相似文献