康复指导训练配合CPM锻炼护理对膝部骨折患者术后膝关节功能的影响

目的 探讨康复指导训练配合持续性被动运动(CPM)锻炼护理对膝部骨折患者术后膝关节功能的影响,以期改善患者预后,促进膝关节功能恢复。方法 选取2017年10月～2019年9月我院收治的手术治疗的60例膝部骨折患者,采用随机数字表法分为对照组和观察组各30例。对照组给予CPM CPM锻炼护理,均干预1个月。比较两组干预前及干预1个月时美国特种外科医院膝关节评分(HSS)、美国膝关节协会评分(KSS)评分及膝关节屈曲活动度。结果 干预1个月,两组HSS评分、KSS评分高于护理前,且观察组HSS、KSS评分高于对照组,差异有统计学意义(P0.05);干预1个月,两组膝关节屈曲活动度均大于干预前,且观察组膝关节屈曲活动度大于对照组,差异有统计学意义(P0.05)。结论 膝部骨折术后应用康复指导训练配合CPM锻炼的干预效果较好,可有效改善膝关节功能及膝关节活动范围,促进其术后康复。     

CPM锻炼结合护理康复对膝部骨折术后膝关节功能的影响

[目的]观察持续性被动运动(CPM)锻炼结合护理康复对膝部骨折术后膝关节功能的疗效.[方法]将84例符合纳入标准的患者按照时间先后分为对照组和观察组各42例,对照组进行CPM锻炼,观察组在对照组基础上配合护理康复指导训练,观察治疗3周后两组患者膝关节活动度情况及疗效.[结果]两组患者治疗后膝关节活动度较本组治疗前均有显著性差异(P＜0.05,P＜0.01),且观察组治疗后较对照组改善明显(P＜0.05).观察组疗效显著优于对照组(P＜0.01).[结论]CPM锻炼结合护理康复可有效改善膝部骨折术后膝关节活动范围,疗效较好.     

CPM机在膝关节周围骨折术后早期康复中的应用

目的:探讨膝关节周围骨折术后早期应用CPM机的临床疗效。方法:回顾性分析2013年1月~2014年6月我院骨科诊治的53例膝关节周围骨折患者,并随机分为CPM组26例和对照组27例。CPM组患者每日锻炼2次,每次2 h,起始角度为30°,至术后2周,逐渐增加至90°,同时自术后第1天起进行主动功能锻炼;对照组患者进行同CPM组相同的主动功能锻炼。出院后两组患者行相同的功能训练,分别比较两组患者在术后1,2,6周及3,6个月的膝关节屈曲角度及术后3,6个月膝关节AKS评分。结果:术后第1,2,6周及3个月患者的膝关节屈曲角度CPM组优于对照组(P0.05),而术后6个月时膝关节屈曲度两组比较差异无统计学意义(P0.05)。AKS膝关节评分比较,术后3个月CPM组优于对照组(P0.05);术后6个月,组间比较差异无统计学意义(P0.05)。结论:术后早期应用CPM机,有效防止关节僵硬,加快恢复膝关节活动度,改善了关节功能。     

悬吊训练在膝关节置换术后康复中的作用

目的观察悬吊训练在膝关节置换术后康复中的作用。方法 46例膝关节置换术后患者,随机分为悬吊训练(SET)组(n=23)和持续被动运动训练(CPM)组(n=23)。CPM组给予持续被动运动训练,SET组给予悬吊训练。术前、术后15 d、术后3个月采用膝关节活动度(ROM)、膝关节功能量表(HSS)和姿势控制能力进行评估。结果术后15 d,SET组患者的膝关节最大被动屈曲角度比CPM组增加6.0°(95%CI=0.9°~11.2°;P0.01),膝关节最大主动屈曲角度比CPM组增加5.7°(95%CI=0.4°~9.1°;P0.01);但两组最大主动伸展角度、最大被动伸展角度、HSS评分(除活动度外)、姿势控制能力均无显著性差异(P0.05)。术后3个月,两组间所有评估项目均无显著性差异(P0.05)。结论 SET在短期内增加膝关节ROM比CPM更有效,可以用于膝关节置换术后的早期康复。     

加味海桐皮汤熏蒸联合CPM机在膝关节镜术后功能康复中的应用

目的:探讨加味海桐皮汤熏蒸联合CPM机在膝关节镜术后功能康复中的应用效果。方法:将48例膝关节镜术后患者随机分为对照组和观察组各24例,两组均于术后第3天拆除弹力绷带,对照组拆除弹力绷带后常规接受CPM锻炼,观察组加用自制加味海桐皮汤熏蒸,并常规接受CPM锻炼。术后1个月比较两组患者膝关节评分(HSS)情况。结果:术后1个月观察组膝关节疼痛、活动度、稳定度、功能评分及优良率均明显优于对照组(P0.05)。结论:加味海桐皮汤联合CPM机锻炼膝关节比单纯使用CPM机锻炼在改善膝关节活动度、关节功能及减轻疼痛等方面更有效。     

股内侧肌入路全膝关节置换术后主动功能锻炼的临床研究

目的:研究股内侧肌入路全膝关节置换术后的患者主动功能锻炼的临床疗效.方法:将2010年2-10月在我院行股内侧肌入路全膝关节置换术的50例患者随机分为两组,研究组25例,术后行主动功能锻炼,对照组25例,术后应用CPM机按常规行膝关节功能锻炼.记录术后第1、3、7天的疼痛视觉模拟评分(VAS)及关节屈伸活动度,记录术前、术后1周和术后1、3个月的膝关节功能评分(HSS评分).结果:所有患者均获得3～9个月的随访.术后第1天,两组VAS疼痛评分及关节屈伸活动度比较差异无统计学意义(P＞0.05),术后第3、7天,两组VAS疼痛评分及关节屈伸活动度比较差异有统计学意义(P＜0.05).术前、术后1周,两组膝关节HSS评分比较差异无统计学意义(P＞0.05),术后1、3个月,两组膝关节HSS评分比较差异有统计学意义(P＜0.05).结论:股内侧肌入路全膝关节置换术后的主动功能锻炼为患者的康复创造了有利条件,使患者的关节功能最大限度地得到了恢复.     

CPM机康复护理对胫骨平台骨折患者术后膝关节功能的影响

目的探讨CPM机康复护理对胫骨平台骨折患者术后膝关节功能的影响。方法选取2018年1月至2019年1月我院收治的胫骨平台骨折患者60例为研究对象,采用随机数字表法等分为对照组和研究组,对照组实施常规术后护理,研究组在对照组基础上采用CPM机康复护理,持续6个月。比较两组患者术后疼痛程度、肌力水平、膝关节功能及日常生活能力。结果研究组护理3,6个月后疼痛评分均低于对照组(P 0. 05);研究组术后肌力水平优良率高于对照组(P 0. 05);研究组护理3,6个月后Lysholm膝关节评分均高于对照组(P 0. 05);研究组护理3,6个月后日常生活能力评分均高于对照组(P 0. 05)。结论 CPM机康复护理能够缓解胫骨平台骨折患者术后疼痛,改善肌力水平,增强膝关节功能,提高日常生活能力。     

本体感觉训练结合CPM机对膝关节周围骨折术后患者疗效分析

目的探究本体感觉训练结合持续性被动运动(CPM)机对膝关节周围骨折术后患者膝关节功能及生活质量的影响。方法选取某科97例膝关节周围骨折术后患者采用随机数字表分组。对照组48例给予CPM机训练,观察组49例增加本体感觉训练,对比疗效。结果训练后观察组疼痛视觉模拟评分(VAS)(3.45±1.12)分低于对照组(5.96±1.03)分、骨折愈合时间低于对照组,膝关节活动度(116.29±20.67)°高于对照组(90.22±15.12)°,膝关节功能评分(HSS)(87.35±10.27)分高于对照组(60.36±10.21)分,世界卫生组织生活质量测量表(WHOQOL-BREF)各项评分、优良率高于对照组,差异有统计学意义(P0.05)。结论本体感觉训练结合CPM机对膝关节周围骨折术后患者干预,可降低机体疼痛程度,缩短骨折愈合时间,提高膝关节功能、生活质量,提升临床疗效。     

膝关节置换术后基于动机行为转化的渐进性康复护理效果

目的:研究膝关节置换术后基于动机行为转化的渐进性康复护理效果,为患者术后护理提供参考依据。方法:选择2019年1月至2020年4月亳州市人民医院接诊的60例需要膝关节置换的患者进行研究。将所有患者按照随机数表法,随机均分为研究组和对照组各30例。对照组患者给予常规护理,观察组在对照组护理方式的基础上给予基于动机行为转化的渐进性康复护理。对2组患者干预前后的自我效能、护理前后的不良情绪、护理前后膝关节功能、术后并发症发生率与护理满意度进行比较。结果:护理前,2组康复自我效能感量表(self-efficacy rehabilitation scale, SERS)、抑郁自评量表(self-rating depression scale,SDS)、焦虑自评量表(self-rating anxiety scale,SAS)、视觉模拟评分法(VAS)、膝关节评分系统(hospitalforspecialsurger y,HSS)评分相比,差异无统计学意义(P0.05);护理后,2组患者SER、HSS评分结果均明显升高,且研究组SER、HSS评分(87.52±10.61,73.61±9.39)明显高于对照组评分(71.35±9.41,62.80±9.62),差异有统计学意义(P0.05);护理后,2组患者SDS、SA S、VA S评分结果均明显降低,且研究组患者SDS、SA S、VA S(评分18.13±4.32、22.38±4.21,2.83±0.59)明显低于对照组评分(26.92±6.13、35.21±5.91、4.71±0.32),差异有统计学意义(P0.05)。研究组患者的直腿抬高试验、股四头肌锻炼和(肢体智能运动训练治疗护理器)连续被动运动(continuous passive motion,CPM)机锻炼的功能锻炼正确率明显高于对照组患者,运动功能达标率明显高于对照组,差异有统计学意义(P0.05)。研究组的术后并发症发生率明显低于对照组患者,差异有统计学意义(P0.05)。研究组的护理满意度明显高于对照组,差异有统计学意义(P0.05)。结论:膝关节置换术后基于动机行为转化的渐进性康复护理效果理想,值得临床推广应用。     

功能锻炼计划表在微创全膝关节置换术后患者中的应用

目的:探讨功能锻炼计划表在微创全膝关节置换术(MIS-TKA)后患者中的应用效果。方法:将80例MIS-TKA患者按照病区分为观察组和对照组各40例,对照组采用常规功能锻炼方法,观察组根据功能锻炼计划表进行训练,比较两组患者关节功能康复效果。结果:观察组患者首次屈曲达110°时间早于对照组(P0.01)。方差分析表明,两组患者不同时间点HSS评分的时间主效应、处理主效应及交互效应均具有统计学意义(P0.01)。进一步两两比较,观察组患者在出院时、术后1个月、3个月HSS评分均高于对照组(P0.01),但在术后6个月时两组患者HSS评分无统计学差异(P0.05)。结论:功能锻炼计划表有利于促进MIS-TKA术后患者膝关节功能恢复,提高康复锻炼的有效性。     

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.     

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.     

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.     

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.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.