非特异性下腰痛患者腰肌表面肌电特征的研究

目的分析非特异性下腰痛患者与正常者腰肌表面肌电信号的差异。方法对非特异性下腰痛患者和正常对照者进行半桥动作、单侧足支撑半桥动作时腰肌的活动进行肌电信号的分析比较。结果非特异性下腰痛患者组双侧多裂肌在实施实验动作时的表面肌电时阈指标存在统计学差异,而对照组双侧多裂肌在实施实验动作时的表面肌电时阈指标不存在统计学差异。结论非特异性下腰痛患者双侧多裂肌收缩失平衡。     

不同角速度下等速躯干屈伸训练对腰痛患者核心肌群的影响

目的观察不同角速度等速肌力训练对腰痛患者的腰背部核心肌群的训练效果,探讨改善慢性腰痛的更优角速度。方法 2016年1月至2018年6月,本院男性慢性腰痛患者60例,随机分为A、B、C三组,每组20例。A组行常规康复治疗手段;B组、C组分别在常规康复治疗基础上,选取角速度为30°/s和90°/s的等速肌力训练,每周3次,共训练4周。训练前后进行等速肌力测试,记录峰力矩和平均功率。结果训练后,B组和C组屈、伸肌峰力矩及功率均大于A组(P 0.05),C组屈、伸肌峰力矩小于B组(P 0.05),屈、伸肌功率与B组无显著性差异(P 0.05)。训练后,B组、C组VAS评分均明显降低(t 4.098,P 0.01),且均低于A组(P 0.05),C组和B组间无显著性差异(P 0.05)。结论等速肌力训练可提高腰痛患者的躯干屈、伸肌群的峰力矩和功率,低角速度(30°/s)等速训练效果更佳。     

腰椎稳定性训练结合肌内效贴治疗慢性非特异性腰背痛的临床疗效观察

目的:观察腰椎稳定性训练结合肌内效贴治疗慢性非特异性腰背痛的临床疗效。方法:将38例慢性非特异性腰背痛患者随机分为对照组和观察组各19例。对照组患者接受常规康复治疗,观察组患者在常规康复治疗的同时接受家庭腰椎稳定性训练和肌内效贴治疗。在康复治疗前、后用目测类比评分法(VAS),腰痛障碍指数(ODI)对患者进行评定。结果:经过4周的治疗,2组VAS及ODI评分均较治疗前明显下降(均P0.05);且观察组患者VAS及ODI评分均明显低于对照组(均P0.05)。结论:慢性非特异性腰背痛患者在接受常规康复治疗的同时,进行家庭腰椎稳定性训练联合肌内效贴治疗能有效地缓解腰痛,改善功能,值得临床上应用、推广。     

非特异性下腰痛患者不同桥式运动时腰肌表面肌电信号的变化

目的了解非特异性下腰痛患者在行不同桥式运动时腰肌表面肌电活动的变化。方法选取正常对照与非特异性下腰痛患者各18 例,记录两组受试者行桥式运动、单足支撑桥式运动时的腰肌表面肌电信号均方根值。结果对照组行不同桥式运动时,双侧竖脊肌、多裂肌表面肌电配对比较均无显著性差异(P>0.05);各时段组间同侧同名肌肉表面肌电比较无显著性差异(P>0.05)。患者组行桥式运动时,双侧腰肌表面肌电配对比较无显著性差异(P>0.05);行单足支撑桥式运动时,支撑足侧竖脊肌肌电值较对侧大(P<0.05),前、中、后时段腰肌肌电值无显著性差异(P>0.05)。结论非特异性下腰痛患者行非对称性桥式运动时,双侧竖脊肌收缩力不平衡。     

核心肌群训练联合平衡罐疗法在慢性非特异性下腰痛患者中的应用

目的探讨核心肌群训练联合平衡罐疗法在慢性非特异性下腰痛患者中的应用效果。方法采用便利抽样法,于2017年1月—2019年12月选择广东省佛山市中医院的130例慢性非特异性下腰痛患者,依据随机数字表法分为核心肌群组和联合治疗组,每组各65例。核心肌群组予以瑞士球按端坐、双桥、屈膝双桥、反桥和俯卧撑的顺序进行核心肌群训练,联合治疗组在核心肌群训练基础上予以平衡罐按照闪罐、走罐、坐罐进行治疗。干预4周后,比较两组患者的腰痛视觉模拟量表(VAS)评分、Roland-Morris功能障碍问卷调查表(RMDQ)评分、指地距离(FFD)、静态及动态肌耐力时间、治疗总有效率。结果干预后,联合治疗组的VAS评分、RMDQ评分及FFD低于核心肌群组,差异有统计学意义(P<0.01);联合治疗组的静态肌、动态肌耐力时间均高于核心肌群组,差异有统计学意义(P<0.01)。联合治疗组的总有效率为90.77%(59/65),高于核心肌群组的76.92%(50/65),差异有统计学意义(P<0.05)。结论核心肌群训练联合平衡罐疗法能减轻慢性非特异性下腰痛患者的腰痛程度,改善腰部功能障碍,提高腰部柔韧性及肌耐力,临床疗效较好。     

骨肌超声在慢性腰痛患者多裂肌厚度和横截面积测量中的应用

目的:应用骨肌超声测量慢性腰痛患者多裂肌厚度和横截面积.方法:应用骨肌超声对22例慢性腰痛患者和20例健康人群分别进行多裂肌形态学研究,由一位有经验的超声医生在不同时间对多裂肌厚度和横截面积进行测量,其中测量2次,时间间隔为2-3天.结果:应用骨肌超声测量多裂肌厚度和横截面积重复性测量信度为0.89-0.96,对比腰痛组与健康组的多裂肌厚度和横截面积有显著性差异(P＜0.05),健康组明显高于腰痛组.结论:骨肌超声可以用于有效而客观地评估多裂肌厚度和横截面积.     

电针结合核心肌群训练治疗非特异性下腰痛的疗效观察

目的:探讨电针结合核心肌群训练治疗非特异性下腰痛的临床疗效。方法:选取符合诊断标准的非特异性下腰痛患者60例,随机把患者分为观察组和对照组各30例,2组均进行电针治疗,观察组加用核心肌群训练,共治疗2周。在治疗前、治疗第2周结束时及治疗结束后3个月随访时分别使用疼痛视觉类比评分法(VAS)评估疼痛强度,使用改良日本骨科协会(JOA)腰痛疗效问卷评分观察腰痛改善情况。结果:治疗2周后,2组患者改良JOA腰痛疗效评分及VAS评分均较治疗前有显著改善(P0.05),且观察组更优于对照组(P0.05);治疗3个月后随访,观察组的复发率明显低于对照组(10.0%、30.0%,P0.05)。结论:电针治疗结合腰部核心肌群训练治疗非特异性下腰痛2周的临床疗效优于单纯电针治疗,不易复发。     

慢性非特异性腰痛髋部肌群肌力及腰部功能特征研究

目的:观察慢性非特异性腰痛(CNLBP)的髋部肌群肌力特征,并探讨其与腰部疼痛及功能的相关性。方法:选取CNLBP患者(CNLBP组)30例,30例正常健康人为对照组。评估CNLBP组疼痛侧、非疼痛侧与对照组右侧髋部肌群肌力。应用等速肌力测试系统(60°/s)测定2组髋屈曲、髋后伸、髋内收、髋外展、髋内旋和髋外旋肌群的峰力矩。采用视觉模拟评分(VAS)评估腰部疼痛,采用日本骨科协会(JOA)评分评估腰部功能。以峰力矩/体重评估髋部肌群肌力,并进行CNLBP组疼痛侧与非疼痛侧对比、两侧分别与对照组右侧对比。对CNLBP组髋部肌群肌力和腰部疼痛、功能进行相关性分析。结果:CNLBP组疼痛侧髋屈曲、髋外展、髋外旋肌群峰力矩/体重比值均低于非疼痛侧且低于对照组(P<0.05)。髋屈曲、髋外展肌群肌力与腰部疼痛程度具有中等程度相关性(P<0.05)。髋屈曲、髋外展、髋外旋肌群肌力与腰部功能评分有中等程度相关性(P<0.05)。结论:CNLBP患者存在疼痛侧髋屈曲、髋外展及髋外旋肌群肌力下降。以纠正髋部肌群肌力失衡为目标的康复训练对改善腰部疼痛及功能可能有积极作用。     

肌内效贴对离心收缩诱发的踝关节肌肉疲劳后的肌力和平衡能力的影响

目的:探讨肌内效贴贴扎对离心运动诱发的踝关节周围肌群疲劳后肌肉力量以及静态平衡能力的即刻影响。方法:受试对象为45名健康男性大学生,将受试者随机分成3组各15例进行不同测试(正常组、肌肉疲劳组以及肌内效贴组)。其中,正常组直接进行肌力与平衡测试;肌肉疲劳组在BIODEX等速训练仪的离心/离心的训练方式下进行连续的踝背伸及跖屈进而诱导肌肉疲劳,当疲劳出现时立即进行肌力与平衡测试;肌内效贴组采用与肌肉疲劳组相同的训练方法,在疲劳后即刻接受肌内效贴贴扎随后进行肌力与平衡测试,包括：向心模式60°/s和180°/s速度下的等速肌力和睁眼/闭眼状态下的静态平衡测试。结果:在等速肌力方面,肌肉疲劳组60°/s与180°/s跖屈、背伸各项肌力指标均较正常组降低(均P<0.05);肌内效贴组60°/s跖屈峰力矩与平均功率、60°/s背伸峰力矩、平均峰力矩、平均功率均较肌肉疲劳组增加(均P<0.05)。180°/s跖屈平均峰力矩、背伸平均峰力矩、平均功率均较肌肉疲劳组增加(均P<0.05),肌内效贴组背伸峰力矩较正常组降低(P<0.05)。在静态平衡方面,在睁眼状态下肌肉疲劳组Y...     

等速运动在膝关节创伤康复中的临床效果

目的:观察等速运动在膝关节创伤康复中的临床效果。方法:选取2017年1~12月我院收治的患有单侧膝关节创伤的20例患者作为观察组,20例正常人作为对照组,观察组给予膝关节屈曲范围和屈伸肌肌力等速训练,对照组只进行常规训练,不采取其他任何干预措施,观察两组训练前后膝关节屈肌峰力矩与伸肌峰力矩在60°/s、120°/s、180°/s测试速度下存在的差异。结果:训练前观察组患侧膝关节屈肌峰力矩与伸肌峰力矩在60°/s、120°/s、180°/s的测试速度下与本组健侧和对照组比较存在明显差异,具有统计学意义(P0.05);训练后观察组患侧膝关节屈肌峰力矩与伸肌峰力矩在60°/s、120°/s、180°/s的测试速度下与健侧及对照组比较无明显差异,不具有统计学意义(P0.05)。结论:采用等速运动治疗患有膝关节创伤的患者,提高了康复治疗的效果,改善患者患侧膝关节的屈肌峰力矩与伸肌峰力矩,取得了理想的临床效果。     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Modified micro-superior percutaneously-assisted total hip: early experiences & case reports

Because of the extensile nature and familiarity of the standard posterior-lateral approach to the hip, a family of "micro-posterior" approaches has been developed. This family includes the Percutaneously-Assisted Total Hip (PATH) approach, the Supercapsular (SuperCap) approach and a newer hybrid approach, the Supercapsular Percutaneously-Assisted Total Hip (SuperPATH) approach. Such approaches should ideally provide a continuum for the surgeon: from a "micro" (external rotator sparing) posterior approach, to a "mini" (external rotator sacrificing) posterior approach, to a standard posterior approach. This could keep a surgeon within his comfort zone during the learning curve of the procedure, while leaving options for complicated reconstructions for the more practiced micro-posterior surgeons. This paper details one author's experiences utilizing this combined approach, as well as permutations of this entire micro-posterior family of approaches as applied to more complex hip reconstructions.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.