无痛下持续被动活动在膝关节术后康复中的应用

目的探讨无痛下持续被动活动(continuouspassivemo-tion,CPM)在膝关节术后康复过程中的效果。方法将锦州市中心医院就诊的膝关节术后患者132例随机分为CPM组(n=68)和对照组(n=4)。CPM组于术后12～24h使用CPM治疗,平均治疗16天,间歇期进行肌肉的主动舒缩功能锻炼。对照组不使用CPM,鼓励患者主动进行关节功能和肌肉舒缩的练习。对术后随访病例按照关节活动时的疼痛程度、关节的活动范围、切口的愈合情况、肌肉的萎缩程度以及步态等进行综合评价。结果CPM组膝关节活动度改善程度优于对照组,CPM组术后6个月复查全部达到优良程度,修复效果明显优于对照组。结论膝关节术后在止痛泵下早期应用CPM对于促进关节功能的恢复、减轻局部并发症有显著效果。     

膝关节挤压术对膝交叉韧带损伤的康复作用

膝关节交叉韧带损伤大多采取切开关节进行修复重建，交叉韧带重建后如本体感受功能恢复不佳，对患肢的正常功能影响很大。采用本体感觉神经肌肉促进技术，骑车练习及上下楼梯练习，均能有效地增加本体感觉输入，恢复患膝的本体感受功能，可改善运动控制、肌力、协调和耐力，最终改善关节功能，提高日常生活和步行的能力。对膝关节、距小腿关节的反复挤压不但可强化本体感觉刺激，还能改善关节软骨的营养，有利于预防退行性膝关节炎。     

无痛下持续被动活动在膝关节术后康复中的应用

目的探讨无痛下持续被动活动(continuous Dassivemotion，CPM)在膝关节术后康复过程中的效果。方法 将锦州市中心医院就诊的膝关节术后患者132例随机分为CPM组(n=68)和对照组(n=4)。CPM组于术后12～24h使用CPM治疗，平均治疗16天，间歇期进行肌肉的主动舒缩功能锻炼。对照组不使用CPM，鼓励患者主动进行关节功能和肌肉舒缩的练习。对术后随访病例按照关节活动时的疼痛程度、关节的活动范围、切口的愈合情况、肌肉的萎缩程度以及步态等进行综合评价。结果 CPM组膝关节活动度改善程度优于对照组，CM组术后6个月复查全部达到优良程度，修复效果明显优于对照组。结论膝关节术后在止痛泵下早期应用CPM对于促进关节功能的恢复、减轻局部并发症有显著效果。     

膝关节挤压术对膝交叉韧带损伤的康复作用

膝关节交叉韧带损伤大多采取切开关节进行修复重建,交叉韧带重建后如本体感受功能恢复不佳,对患肢的正常功能影响很大。采用本体感觉神经肌肉促进技术,骑车练习及上下楼梯练习,均能有效地增加本体感觉输入,恢复患膝的本体感受功能,可改善运动控制、肌力、协调和耐力,最终改善关节功能,提高日常生活和步行的能力。对膝关节、距小腿关节的反复挤压不但可强化本体感觉刺激,还能改善关节软骨的营养,有利于预防退行性膝关节炎。     

膝关节骨性关节炎经关节镜手术后的等速肌力评价

目的：评价单侧膝关节骨性关节炎患经关节镜手术前后膝屈伸肌群的肌肉功能。方法：用LKSS量表及CYBEX－6000型等速肌力测试系统对24例单侧漆关节骨性关节炎患膝关节镜手术的疗效及肌肉功能进行测试。结果：膝关节镜术后1年关节疼痛及关节活动度有明显改善，患膝股四头肌峰力矩、总作功量和爆发力有明显提高，而Guo绳肌与股四头肌峰力矩的比值较术前有所降低。结论：膝关节镜手术术后应加强屈膝肌力的训练以改善膝关节的稳定性。     

神经肌肉电刺激结合康复疗法治疗膝关节骨性关节炎的疗效观察

摘要 目的:探讨神经肌肉电刺激结合康复疗法治疗膝关节骨性关节炎的临床疗效。 方法:选择我科门诊70例膝关节骨性关节炎患者,随机将患者分成单纯康复组（35例）、联合康复组（35例）。单纯康复组分别采用中药薰蒸、关节松动术、功能练习三种康复疗法,联合康复组除采用单纯康复组方法外应用神经肌肉电刺激(NMES)作用于患者膝关节周围肌肉组织治疗。 结果:两组患者经治疗24d后,分别采用视觉模拟评分法(联合康复组2.57±0.44,单纯康复组4.46±0.38)和Lysholm膝关节量表评分(联合康复组82.11±4.02,单纯康复组61.29±3.98)比较,总分级间差异具有显著性意义,联合康复组VAS评分低于单纯康复组（P<0.05）,患膝关节功能改善更明显,联合康复组疗效优于单纯康复组（P<0.01）。 结论:神经肌肉电刺激能增强患侧肢体肌肉组织的耐力和肌力,结合康复疗法治疗膝关节骨性关节炎具有显著疗效。     

神经肌肉关节促进法改善膝关节骨性关节炎患者的关节功能及疼痛的效果分析

目的:分析神经肌肉关节促进法改善膝关节骨性关节炎患者的关节功能及疼痛的效果。方法:采用随机平行对照法将105例膝关节骨性关节炎患者进行分组,对照组52例给予常规治疗,包括超短波治疗及电针治疗,观察组53例在常规治疗的基础上联合神经肌肉关节促进法治疗,观察2组患者治疗后膝关节功能及疼痛改善效果。结果:观察组治疗后优良率86.79%高于对照组67.31%,P0.05;观察组Lysholm评分(91.34±8.83)分高于对照组(70.09±10.91)分,VAS评分(3.01±0.84)分低于对照组(4.68±1.45)分,P0.05。结论:在针灸治疗的基础上给予神经肌肉关节促进法,通过调和营卫,疏通经络气血,增强肌力,治疗膝关节骨性关节炎改善膝关节功能,减轻疼痛,效果确切,值得临床的推广及应用。     

四肢关节功能障碍的康复治疗

四肢于创伤及长时间外固定后均有不同程度关节功能障碍。我们采用手法治疗、中频电治疗、直流电离子导入、关节活动训练器等康复疗法，治疗肩、肘、膝关节功能障碍患者５４例，取得了增强相关肌肉肌力，减轻关节皮肤瘢痕挛缩，松解粘连的肌肉和韧带，使患肢关节活动度（ROM）得到良好恢复。１对象与方法１．１对象肩、肘、膝关节功能障碍者５４例，男３０例，女２４例，年龄１９～５９岁，其中肩关节功能障碍３１例，肘关节功能障碍５例，膝关节功能障碍１８例，病程１～１０个月。又分为关节内骨折１４例，关节软组织损伤１２例，皮肤瘢…     

PNF技术对膝关节损伤术后功能障碍的作用

膝关节损伤并手术后功能障碍患者80例随机分为对照组和观察组各40例。两组均行常规康复治疗,包括关节活动度训练、肌肉力量训练、平衡训练等。观察组另外结合PNF治疗。治疗前后对患者本体感觉、关节活动度、肌肉力量、疼痛进行测试和评估,并分析其功能改善效果。结果在治疗8w后,两组患者与治疗前比较,膝部本体感觉偏差评分与疼痛评分明显降低,关节活动度及肌肉力量均明显增加,且观察组优于对照组（P＜0.01）。 PNF技术能够更好的提升膝关节损伤以及手术治疗后患者的膝关节总和功能。     

腘绳肌练习对脑卒中后膝稳定性及日常生活活动能力的影响

目的：观察腘绳肌练习对改善脑卒中患者膝关节过伸及日常生活活动能力(ADL)的疗效。方法：38例患者随机分为治疗组(20例)和对照组(18例)。治疗组除了给予常规康复治疗(中级偏瘫医疗体操；神经肌肉促进技术；步态分解练习；ADL训练)，还给予针对性腘绳肌练习(腘绳肌最大向心性等张一膝关节末端等长抗阻练习；腘绳肌肌电生物反馈治疗)；对照组只给予常规康复治疗。治疗时间60d。比较治疗前后LKSS膝关节功能评定、上田敏12级评定、Barthel指数等各项指标的变化。结果：治疗组各项指数的改变均明显优于对照组(P&;lt;0．01)。结论：腘绳肌练习对脑卒中偏瘫患者的膝关节不稳有明显疗效，并能改善患者的日常生活活动能力。     

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.     

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.     

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.     

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.     

Prospects for the control of neglected tropical diseases by mass drug administration

The prospects for the control of neglected tropical diseases, including soil-transmitted helminthiasis, shistosomiasis, lymphatic filariasis, onchocerciasis and trachoma, through mass drug administration, are exemplified by the elimination of the trachoma as a public-health problem in Morocco. In spite of this and other striking successes, mass drug administration programs are faced with major challenges resulting from suboptimal coverage and lack of efficacy. At current suboptimal coverage rates, programs may need prolongation for an extended period, increasing costs and undermining sustainability. Community participation through health education and information appears to be crucial to improve coverage and to achieve sustainability. Implementation of complementary measures, such as vector control, improved hygiene and environmental sanitation, are important to further control transmission and to prevent re-emergence of the infection and, again, may only be achieved effectively through community-based initiatives. To reduce costs and to relieve pressure on the health system, combining neglected tropical disease programs in areas where diseases coexist and integration with existing control programs for malaria, tuberculosis and HIV/AIDS is advocated. The risk of developing drug resistance is of particular concern in view of the lack of alternative drugs, and reduced treatment efficacy due to emerging resistance is evident for the soil-transmitted helminths and onchocerciasis. Given the risk for the development of drug resistance and the need for a high degree of participation, close attention should be paid to the monitoring of the coverage and efficacy of the different program components.     

Clinical Trial Updates and Hotline Sessions presented at the European Society of Cardiology Congress 2007

This article provides information and commentaries on trials which were presented at the Hotline and Clinical Trial Update Sessions at the European Society of Cardiology Congress 2007 in Vienna. The key presentations were performed by leading experts in the field with relevant positions in the trials or registries. It is important to note that unpublished reports should be considered as preliminary data, as the analysis may change in the final publications. The comprehensive summaries have been generated from the oral presentation and the webcasts of the European Society of Cardiology and should provide the readers with the most comprehensive information of relevant publications.     

Bacterial meningitis: an update of new treatment options

The outcome of bacterial meningitis critically depends on the rapid initiation of bactericidal antibiotic therapy and adequate management of septic shock. In community-acquired meningitis, the choice of an optimum initial empirical antibiotic regimen depends on the regional resistance patterns. Pathogens resistant to antibacterials prevail in nosocomial bacterial meningitis. Dexamethasone is recommended as adjunctive therapy for community-acquired meningitis in developed countries. In comatose patients, aggressive measures to lower intracranial pressure <20 mmHg (in particular, external ventriculostomy, osmotherapy and temporary hyperventilation) were effective in a case–control study. Although many experimental approaches were protective in animal models, none of them has been proven effective in patients. Antibiotics, which are bactericidal but do not lyse bacteria, and inhibitors of matrix metalloproteinases or complement factor C5 appear the most promising therapeutic options. At present, vaccination is the most efficient method to reduce disease burden. Palmitoylethanolamide appears promising to enhance the resistance of the brain to infections.     

Balance and Boundaries in Grief Counseling: An Intervention Framework for Volunteer Training

Volunteers or paraprofessional counselors are commonly used to provide supportive care to the bereaved. These counselors generally are trained in basic listening skills, providing a generic, nonspecific approach to intervention that remains to be proven effective. The present paper outlines a framework that provides paraprofessionals with a broader model for intervention with the bereaved. Attention to boundaries as a helper and balance in the grief recovery are central to the model. Interventions are described that provide the paraprofessional counselor with more options for tailoring their counseling strategy to the individual. These include techniques that are presumed to be more specific to the enhancement of grief recovery.     

Imaging choices in occult hip fracture

Background: Hip fracture is a common injury, with an incidence rate of > 250,000 per year in the United States. Diagnosis is particularly important due to the high dependence on the integrity of the hip in the daily life of most people. Objectives: In this article we review the literature focused on hip fracture detection and discuss advantages and limitations of each major imaging modality. Discussion: Plain radiographs are usually sufficient for diagnosis as they are at least 90% sensitive for hip fracture. However, in the 3–4% of Emergency Department (ED) patients having hip X-ray studies who harbor an occult hip fracture, the Emergency Physician must choose among several methods, each with intrinsic limitations, for further evaluation. These methods include computed tomography, scintigraphy, and magnetic resonance imaging. Conclusion: We present an evidence-based algorithm for the evaluation of a patient suspected to have an occult hip fracture in the ED. Also outlined are future directions for research to distinguish more effective techniques for identifying occult hip fractures.