关节角度测量器测量结果准确性及可重复使用性评价

背景：设计了一种使用简便的医用关节角度测量器,并申请获得了专利。目的：以国际标准测量器Cybex NormTM测量系统为标准,验证关节角度测量器测量结果的准确性;并将各关节病理及功能状态下的测量结果与主观量表评估结果进行相关性分析,以证实关节角度测量器的可重复使用性和实用价值。设计、时间及地点：分层随机对照试验,于2004-10/2005-03在北京协和医院骨科进行。参试者：121例患者中,肩周炎43例,股骨头缺血性坏死31例,膝关节骨关节炎47例。将患者随机分成OTMA组60例和Cybex组61例,保证被测试关节数量相同。方法：在治疗前、治疗后3个月和1年随访时,分别应用关节角度测量器和Cybex NORMTM型等速测量系统对两组患者进行关节活动度测量。将关节活动度测量结果分别在肩关节Karlsson疗效标准、膝关节HSS量表和髋关节Harris量表中应用,并填写目测类比疼痛评估量表及SF-36生活质量评估量表。主要观察指标：两组不同时间点关节活动度值的符合率;各量表得分及关节活动度间的相关性。结果：121例患者的评估完成率为100%。关节角度测量器的测量结果与Cybex NORMTM测量结果之间的符合率为98.3%。两组中HSS量表,Karlsson疗效标准,Harris量表评分值随关节活动度增加而升高（P〈0.01）,相关分析结果显示关节活动度与以上3个量表结果高度相关,符合患者的临床表现。结论：关节角度测量器测量结果准确,能被患者所接受,并可进行重复测量使用。其结果能反映患者的临床症状,实现测量辅助临床诊断的目的。     

依据三维空间测量原理设计的关节角度测量器

背景：Cybex NORM^TM型等速测试仪测量结果精确度较高，但其操作方法复杂，检查费用昂贵，不适用于常规临床检查。 目的：比较OTMA和Cybex NORM^TM型等速测试仪测量肩、髋、膝关节疾病治疗前后关节活动度，验证科技专利成果关节角度测量器（Orthopedics Tool Measurement Apparatus，OTMA）的科学性和实用价值。 设计、时间及地点：临床随机对照试验，2004—10／2005—03北京协和医院骨科人工关节中心。 对象：将121例患者随机分成①OTMA组：肩周炎患者22例22肩；股骨头缺血性坏死患者15例21髋；膝关节骨关节炎患者24例33膝。②Cybex组：肩周炎患者21例21肩；股骨头缺血性坏死患者16例21髋；膝关节骨关节炎患者23例33膝。 方法：分别应用OTMA和Cybex NORM^TM型等速测试仪对两组患者进行治疗前、治疗后3个月和1年随访时关节活动度测量；将测量数据分别在（膝关节）HSS评估量表，（肩关节）Karlsson疗效标准评估量表和（髋关节）Harris疗效标准评估量表中应用，填写VAS疼痛量表和SF-36等评估量表。 主要观察指标：肩、髋和膝关节的活动度值；Karlsson、Harris和HSS评分；VAS和SF-36评分。结果：OTMA的测量结果与Cybex NORM^TM测量结果之间的符合率为98-3％;测量过程能够被所有患者接受，测量操作方法的完成率100％。关节活动度与HSS、Kaflsson、Harris的评分值有相关性（P=0．002）。 结论：在三维空间测量原理指导下设计的数字化OTMA，获取结果与Cybex NORM^TM型等速测试仪相近，在测量过程中能够获得更接近于真实角度的测量值。     

四肢关节功能牵引法—附器械介绍及临床应用1424例分析

本文介绍了适用于改善四肢关节活动度的关节功能牵引方法及一套专用的简易器械,从而为关节活动度的恢复提出了一项新的方法。作者通过此法的1424例临床应用,观察了对各种体创伤的疗效。在拇外展牵引病例的自身对比中证明其疗效明显地高于传统的由主动、被动运动和按摩构成的锻炼方法。从纤维组织的力学特性出发探讨了关节功能牵引作用特点,从实际疗效总结中分析了影响疗效的因素,指出关节功能牵引有疗效较好,不易引起新的损伤,痛苦少及操作方便等优点。     

不同年龄与不同位置下进行远端指间关节活动度的测量研究

摘要 目的：使用通用量角器测量远端指间关节活动度,探讨不同年龄和不同姿势对测量结果的影响。 方法：选取40名健康志愿者（20名年轻人和20名老年人）,对其在四个姿势下（即姿势1近端指间关节屈曲并主动屈曲远端指间关节、姿势2近端指间关节屈曲并被动屈曲远端指间关节,姿势3近端指间关节伸直并主动屈曲远端指间关节,姿势4近端指间关节伸直并被动屈曲远端指间关节）分别进行远端指间关节活动度的测量。 结果：在同一年龄组,近端指间关节屈曲和伸直位可对远端指间关节的活动度产生明显的影响。即使保持近端指间关节在同一姿势,远端指间关节主动活动度和被动活动度值间差异具有显著性。另外,近端指间关节伸直位时远端指间关节主动屈曲的活动度明显小于近端指间关节屈曲位时远端指间关节被动屈曲的活动度。在同一姿势下,年轻人与老年人的远端指间关节活动度也存在显著性差异。 结论：不同年龄和不同姿势可明显影响远端指间关节活动度的测量结果。     

正常肩锁关节角度与盂肱关节活动的相关性

背景:应用钩钢板固定治疗肩关节损伤或合并锁骨远端骨折时,钩钢板钩部的角度固定不变,而人体肩锁关节正常角度或在上臂运动时会发生相关变化.目的:探讨正常肩锁关节倾斜角度与肩关节活动相关性,及其临床意义.方法:纳入包含肩部CT检查的TOP图像资料97例,其中男57例,女40例,选择CT时TOP图像,在CT上用机器进行角度测量.肩锁关节角度:为肩峰长轴沿线与锁骨远端长轴沿线的夹角,盂肱关节的角度为肱骨外展与垂线的角度.结果及结论:在上肢下垂时平均肩锁角为(162.04±10.53)°.下垂平均肱骨角为(16.06±11.87)°,R=0.010(P＜0.01),说明肩关节与肩锁关节两个角度相关.在上肢上举时肩锁角(174.34±10.14)°,上举肱骨角(137.65±14.48)°,R=0.053(P＜0.01)两个角度也是相关的.提示,肩锁关节角度在肱骨上举运动时发生变化.肩关节活动时肩锁关节相关活动,既盂肱关节活动时,肩锁关节角度也随之变化.     

屈光不正矫正前后拇指法、Worth四点灯法与卡洞法测量主导眼的比较

目的研究屈光不正矫正前后拇指法、Worth四点灯法与卡洞法测量主导眼的差异。方法屈光不正患者矫正前后分别用拇指法、Worth四点灯法和卡洞法测量主导眼,比较3种方法的差异。结果在屈光不正矫正前后拇指法和卡洞法对主导眼的测量结果比较差异均无统计学意义（P〉0.05）;Worth四点灯法与卡洞法﹑拇指法的测量结果比较差异均有统计学意义（P〈0.05）。结论拇指法与卡洞法2种方法一致性好,可以联合作为临床上确定主导眼的检查方法;而Worth四点灯法因受影响的因素较多,不适合作为主导眼的测量方法。     

两种工具在四肢关节ROM测量中的比较

由11名医科大学学生和1名进修医师用两种工具分别测定11名健康青年的上、下肢各关节25个方向的关节ROM。结果发现,两种工具的测量结果存在显著相关性;不同测量者用方盘量角器在相同人身上测得的数据的标准差明显小于通用量角器.说明方盘量角器可代替通用量角器,而且其测量结果较通用量角器更为精确.     

X线胃肠机改良颞颌关节摄片法的临床应用

目的 探讨X线胃肠机透视定位及带摇控、自动换片、胶片自动分隔等优点在改良颢颌关节许勒氏位中的临床应用。方法 采用日本岛津500 mA X线胃肠机，自制角度板，透视下定位摄片，并与传统摄片方法照片进行比较。结果 96例颞颌关节病患者，有94例通过该方法摄片，与传统摄片方法相比，结果新的摄片法具有定位精确，成像标准，摄片成功率高达98％等优点。结论 应用X线胃肠机对许勒氏位改良摄片改进传统方法存在的缺点，为X线胃肠机在口腔X线影像学方面的应用开拓了新的应用范围。     

关节松动术治疗腰椎间盘突出症临床疗效分析

目的观察关节松动术治疗腰椎间盘突出症的临床疗效.方法63例患者用关节松动术为治疗组,对照组74例用牵引治疗法.结果治疗组腰部活动范围,治疗后前屈增加(17.27±16.31)度(P＜0.01),后伸增加(4.08±13.02)度(P＜0.01),侧屈增加(3.72±11.39)度(P＜0.01),差异性非常显著;治疗组疗效优于对照组,(γ=9.596,P＜0.01),差异显著.结论关节松动术治疗腰椎同盘突出症疗效较好,无副作用,病程越短疗效越好,值得推广应用.     

不同速度下正常老年人下肢关节的角度参数

背景：目前国内主要采用步态分析仪测量患者步行时的关节角度,但是在每一个康复治疗时期进行这些测量非常耗费时间。利用Lokomat步态康复机器人则可以在患者训练过程中对患者的关节角度、肌力等参数进行实时记录,省时省力。目的：采用步态康复机器人Lokomat测定正常老年人不同速度下的下肢关节角度参数。方法：选取健康老年人30名,男15名,女15名,年龄60~64（62.40±1.58）岁。利用步态康复机器人评估工具,在减重40%,引导力60%,速度1.6,1.8,2.0km/h状态下对正常老年人的下肢关节角度参数进行记录。结果与结论：老年人关节角度参数动态指标测试结果显示,在速度1.6km/h状态下左髋关节最大伸展角度,在速度2.0km/h状态下左、右髋关节最大屈曲角度,男女组间差异有显著性意义（P〈0.05）。老年人不同速度下髋膝关节角度测试结果显示,老年人左右膝关节最大伸展角度在步行速度1.6km/h与1.8km/h,1.6km/h与2.0km/h,1.8km/h与2.0km/h相比差异有显著性意义（P〈0.05）。结果可见不同速度下髋关节最大屈曲角度男性大于女性,治疗师在进行Lokomat步态康复训练时应根据患者的性别差异,调整髋膝关节角度和训练模式。随着步行速度的增加老年人髋膝关节屈曲角度增加,伸展角度减小,治疗师应根据步速的增减适当调节髋膝关节活动度,增强患者腿部运动与机器人外骨骼式机械腿的配合,提高患者的训练效果。     

Rapid quantitative method using spin columns to measure porphobilinogen in urine

BACKGROUND: Large increases of urinary porphobilinogen (PBG) indicate acute porphyria, which may be due to acute intermittent porphyria, variegate porphyria, or hereditary coproporphyria. These conditions are relatively rare but share symptoms with more common conditions, such as acute surgical abdomen, and often must be ruled out rapidly. Reported quantitative methods for PBG measurement are time-consuming and inconvenient. We developed a rapid quantitative method that uses resin-packed spin columns to measure PBG in urine. Method: We applied urine to anion exchange resin in a spin column, then performed centrifugal separation and washing. PBG was eluted in 1 mol/L acetic acid and reacted with Ehrlich's reagent. After 5 min, we measured absorbance at 525, 555, and 585 nm. PBG concentration (mg/L) was calculated as 88 (A(555) - (1/2)(A(525) + A(585))). RESULTS: The reportable PBG concentration range was 0.2-15 mg/L. Between-day (total) imprecision (CV) was 8.4% at 1.2 mg/L and 3.5% at 4.4 mg/L. Comparison with our established method (x) yielded a Deming regression equation: y = 1.04x - 0.01 mg/L (R(2) = 0.98; S(y,x) = 0.87 mg/L). No interference was noted from urobilinogen or highly colored urine specimens. CONCLUSIONS: This method for PBG measurement is more rapid and precise than other methods. This test can serve as a quick screening test and facilitates batch analysis for routine quantitative testing.     

Development of a noninvasive measure of pelvic and hip angles in seated posture

OBJECTIVE: To develop a valid noninvasive means to measure pelvic tilt and hip angle in seated posture. DESIGN: Validation cohort study using radiographs as a criterion standard for pelvic posture. SETTING: Rehabilitation hospital. PARTICIPANTS: Volunteer sample of 10 adult men with no known physical disability. INTERVENTIONS: Radiographs were taken as subjects sat in erect, anterior, and posterior postures. An electromagnetic tracking device was as a pointer to digitize the anterior superior and posterior superior iliac spines and as a 6 degrees of freedom (df) sensor mounted on the thigh and sacrum. MAIN OUTCOME MEASURES: Variables included pelvic tilt and hip flexion angle. Intra- and interrater reliability of radiographic measures was determined by using intraclass correlation coefficient comparison of the results from 2 investigators. Validity was determined by comparing noninvasive measures of pelvic and hip angles to radiographic measures by using correlation, analysis of variance (ANOVA), and regression. RESULTS: Reliability of radiographic measures of pelvic tilt and hip angles were >/=.98. Pelvic tilt comparison: pointer: r=.89, R(2)=.80; 6-df sensor: r=.91, R(2)=.83; hip angle comparison using 6-df sensor: r=.78 with average difference of 4.25 degrees. ANOVA showed that differences between all invasive and noninvasive measures did not differ significantly (P>.05). CONCLUSION: Results indicated excellent reliability of radiographic analysis techniques and represented an improvement over previously published techniques. Noninvasive measures of pelvic tilt and hip angle were shown to be valid.     

Development of a clinical instrument to measure heel pad indentation

OBJECTIVE: To provide an accurate, reliable, non-invasive, portable instrument to measure heel pad indentation in a clinical setting. DESIGN: A novel instrument was applied to assess heel pad indentation. BACKGROUND: For the lack of quantitative biomechanical tools for in vivo assessment, palpation is used to evaluate heel pad stiffness subjectively in everyday clinical practice. Furthermore, previous studies have evaluated heel pad stiffness using non-portable instrumentation. METHODS: Cylindrical probe was attached to an electronic force gauge unit that passed through a Perspex plate for placement on heel pad. Displacement of the plate was connected to a linear variable differential transformer. A laptop PC allowed for portability and storage of data. An exponential curve described the force-displacement data. Ten healthy subjects (mean 21. 7; SD, 1.7 years) were assessed on ten separate occasions. The procedure was standardised for subject position and placement. RESULTS: Accuracy and reliability of each device component was established. An intraclass correlation (2,1) of 0.90 and 0.88 demonstrated curve coefficients b1 and b0 respectively. A paired t-test demonstrated no significant difference between the left and right foot coefficients. CONCLUSION: The results demonstrated that each system component could be measured accurately and reliable. Reproducible results were obtained over separate occasions. The study has described a method to analyse the force-displacement curve. RelevanceThe development of a hand-held device may help the clinician to assess heel pad stiffness in the clinical setting. Heel pad stiffness may be associated in the development of plantar heel pain in athletes.     

5种结核杆菌检测方法的临床应用价值

目的比较和分析免疫磁珠捕获联合双内标聚合酶链反应-酶联免疫吸附试验定量检测结核杆菌技术(IMC-PCR-ELISA)与其他几种结核杆菌检测法在结核病诊断中的临床应用价值。方法以102例结核分枝杆菌痰培养阳性的患者作为阳性对照,以48例结核分枝杆菌培养阴性的非结核普通住院患者作为阴性对照。比较抗酸染色涂片法(AFS)、免疫磁珠-抗酸染色涂片法(IMC-AFS)、金标抗结核抗体检测法(DICA)、普通PCR及IMCPCR-ELISA的敏感性及特异性。结果 IMC-PCR-ELISA定量检测结核分枝杆菌全过程约4.5h,最低检测限为5copy/μL,本法的特异性和敏感性均为100.00%,其他4种(AFS、IMC-AFS、DICA、普通PCR)检测方法的敏感性分别为35.29%、43.14%、60.78%、93.14%,特异性分别为95.83%、95.83%、75.00%、91.67%。结论 IMC-PCRELISA与AFS、IMC-AFS、DICA及普通PCR相比,具有快速、灵敏、特异、可定量的特点,是临床快速诊断结核病的有效检测方法。     

Novel method to measure active myofascial trigger point stiffness using ultrasound imaging

Introduction

Myofascial trigger points (MTrPs) are one of the most common and important causes of musculoskeletal pain. Ultrasound is a useful modality in examining musculoskeletal disorders. By applying compressive stress and observing changes in ultrasound images, the elastic modulus (Young's modulus) can be calculated. Our objective was to develop a novel method to distinguish MTrPs from normal tissues.

A new technique for determining 3-D joint angles: the tilt/twist method

OBJECTIVE: To develop a new method of representing 3-D joint angles that is both physically meaningful and mathematically stable. DESIGN: The two halves of a joint are modeled as overlapping cylinders. This simple physical model is easily understood and yields mathematically stable angle equations. BACKGROUND: Two currently-used methods are the Euler/Cardan (joint coordinate system) method and the projection angle method. Both of these methods approach a singularity at 90 degrees that limits their use. The helical angle (attitude vector) method is mathematically stable but has limited physical meaning and is difficult to communicate. METHODS: Calculation of the tilt/twist angles is described. Tilt/twist angles are compared to Euler/Cardan, projection, and helical angles in terms of behavior and stability. RESULTS: Through a small range of angulation, tilt/twist angles match the specific projection and Euler/Cardan angles previously found to be appropriate for describing spinal motion. Through larger ranges, tilt/twist angles do not match the other angles studied. Although not as stable as helical angles, tilt/twist angles are twice as stable as Euler/Cardan and projection angles, reaching a singularity only at 180 degrees. CONCLUSIONS: Because of their mathematical stability and simple physical interpretation, tilt/twist angles are recommended as a standard in describing angular joint motion.     

Speed-dependent variations of lower-limb joint angles during walking. A graphic computerized method showing individual patterns

A method for obtaining a synthetic representation of the joint angle time-courses at different walking velocities is presented, based on a computerized procedure. Hip, knee and ankle joint angles are measured by electrogoniometric devices and checked on line for their reliability. One stride only for each walking speed is selected as representative of the adopted cadence. For each joint a tridimensional representation of angle time-course versus stride frequency or versus gait speed is performed so that speed-dependent variations can be analyzed. Ten normal (seven males and three females) and three prosthetized subjects have been tested by this method. In normal as well as in pathological subjects individual features could be easily detected and the method proved to be useful for a functional gait evaluation.     

阴道炎五联检试剂盒的临床应用

目的 通过和白带常规镜检结果进行对比分析,考察阴道炎五联检试剂盒方法的临床符合率及临床应用价值.方法 收集232例白带标本,分别采用常规镜检方法和五联检试剂盒方法进行检测,并对结果进行对比分析.结果 232例白带标本用五联检试剂盒和常规镜检法其清洁度检测结果的符合率为84.5%,差异无统计学意义(χ2=0.69<3.8...     

A tool to measure nurse efficiency and value

Home care nurses who have multiple roles can increase their value by validating their contributions and work efficiency. This article presents a method for tracking nurse efficiency for those who are paid on an hourly basis, and provides a mechanism to document their contributions to the home care agency.