脑瘫患儿髋关节敏感指标及痉挛型双瘫患儿髋关节发育情况分析

目的探讨评价脑瘫患儿髋关节发育的敏感指标,研究不能独立行走的痉挛型双瘫患儿髋关节发育状况及其影响因素。 方法比较57例脑瘫患儿（脑瘫组）及30例正常儿童（对照组）的髋关节X线片,测量髋臼指数（AI）、股骨头偏移百分比（MP）、中心边缘角（CE角）、颈干角（NSA）,并进行统计学分析。计算各年龄组不能独立行走的痉挛型双瘫患儿的髋关节半脱位患病率,并进行比较。 结果脑瘫组MP、NSA与对照组比较,差异有统计学意义（P<0.01）。不能独立行走的痉挛型双瘫患儿的髋关节半脱位患病率为20.45%,其中3~5岁年龄组髋关节半脱位患病率高于<3岁年龄组,差异有统计学意义（P<0.05）。 结论MP可作为评价髋关节发育的敏感观察指标,5岁以内不能独立行走的痉挛型双瘫患儿的髋关节半脱位患病率为20.45%,年龄是影响其髋关节发育的重要因素。     

改良儿童重锤式髋关节训练器对痉挛型脑瘫双瘫的疗效

痉挛型双瘫是脑性瘫痪较常见的类型 ,主要表现为运动年龄落后、双下肢肌张力增高、股角小及交叉尖足、蹶臀、膝反张等姿势异常。现通过我院康复科住院患儿应用改良儿童重锤式髋关节训练器的疗效 ,探讨该训练器对脑瘫痉挛型双瘫的康复治疗作用。1资料和方法1.1临床资料　观察对象为 2 0 0 0年 6月— 2 0 0 1年 1月在我院康复科住院的脑瘫痉挛型双瘫患儿 4 0例 ,随机分成两组。治疗组 2 0例 ,其中 :男性 11例 ,女性 9例 ;6月— 1岁 5例 ,1— 2岁 10例 ,2— 3岁 5例 ;合并脑积水 1例 ,先心室缺 1例。对照组 2 0例 ,其中 :男性12例 ,女性 8例 ;4…     

重锤式髋关节分离器改良法在痉挛型脑性瘫痪中的应用

痉挛型脑性瘫痪（简称脑瘫）患儿由于锥体系损害，通过对脑瘫患儿进行髋关节分离后，患儿的内收肌角、角、足背屈角都有明显的好转，对应的髋关节外展和踝关节背屈功能得到改善。自１９９９年购进重锤式髋关节分离器后，治疗痉挛型脑瘫患儿５０例，现报道如下。１对象与方法１．１对象脑瘫分型以“全国小儿脑瘫座谈会纪要”为准，以痉挛型四肢瘫和痉挛型双瘫为主要治疗对象。其中，痉挛型四肢瘫１２例，痉挛型双瘫３８例。５０例患儿中，０．５～１岁２１例，１～１．５岁１５例，１．６～２岁１４例。男３８例，女１２例。１．２治疗方法将…     

痉挛型脑瘫患儿平衡障碍程度的测定及特点

目的:评定12—48个月龄痉挛型脑瘫患儿的平衡障碍程度及特点,为患儿制订合理的康复计划及提供有效的训练方案。方法:正常组为97例年龄在12—48个月的健康儿童,均能够无辅助装置维持静态站立位至少持续1min。脑瘫组为110例具有站立能力的年龄在12—48个月的脑瘫患儿。其中双瘫82例,偏瘫28例。利用JB-PHY-Ⅱ型平衡测试仪测试其静态立位平衡功能。结果:痉挛型双瘫与正常儿童各月龄组的平衡数据比较(左右偏移除外)有显著差异(P<0.01)。痉挛型偏瘫各月龄组左右偏移与正常儿童比较有显著性意义(P<0.05),痉挛型偏瘫12—24个月龄组和24—36个月龄组的外周面积和单位面积轨迹长与正常儿童比较均有显著性意义(P<0.05),而轨迹长和矩形面积无显著性意义(P>0.05);36—48个月龄组各平衡参数与正常儿童比较都具有显著性意义(P<0.05);正常儿童重心轨迹图大多呈球心型,双瘫患儿重心轨迹图大部分介于球心型和弥散型之间,少部分呈弥散型和球心型。偏瘫患儿以前后型为主,少部分呈弥散型和球心型。结论:痉挛型双瘫患儿平衡功能与正常儿童有较大差异,但重心不存在明显左右差异。痉挛型偏瘫患儿重心存在明显的左右差异,随着年龄的增大平衡功能与正常儿童比较差异变大。     

痉挛型脑瘫患儿髋关节半脱位的相关因素分析

目的:观察痉挛型脑瘫患儿髋关节半脱位的发生情况,探讨相关因素对半脱位的影响。方法:对我院康复治疗的脑瘫患儿248名采用拍摄骨盆正位片的方式,测量髋关节股骨头外移百分比(MP)。并采用MP分级、粗大运动功能分级、改良Ashworth量表对患儿进行评定。结果:髋关节半脱位发生率为32.7%,不同分型患儿的发生率差异有统计学意义(χ^2=23.626,P=0.001),相关性分析发现粗大运动功能分级(GMFCS)、内收肌改良Ashworth量表(MAS)评分与MP值具有相关性(P<0.01)。结论:痉挛型脑瘫患儿的髋关节半脱位的相关因素是分型、粗大运动功能、内收肌肌张力。     

痉挛型双瘫的脑瘫患儿矫形外科术后综合康复治疗的疗效分析

目的:探讨痉挛型双瘫的脑瘫患儿矫形术后进行长期系统的综合康复训练对患儿下肢功能的影响.方法:对36例(年龄5-16岁)患儿行矫形术后分为治疗组(18例)及对照组(18例).治疗组采用综合康复治疗方法,对照组仅进行家庭康复训练.在治疗前、治疗第3个月进行双下肢痉挛评分(改良Ashworth量化分值)、踝关节关节活动度(ROM)以及粗大运动功能量表(GMFM)评定.结果:两组患儿治疗3个月后,改良Ashworth量化分值下降,GMFM站立走跑跳两大功能评分提高,踝关节ROM比治疗前改善明显,差异有显著性意义(P＜0.01).治疗3个月后,治疗组Ashworth、踝关节ROM及GMFM等指标均优于对照组.结论:痉挛型双瘫矫形术后进行长期系统的综合康复训练可有效治疗改善痉挛型双瘫患儿下肢功能.     

脑性瘫痪儿童家庭康复指导

脑性瘫痪 (脑瘫 )儿童不可能每天都得到治疗师的训练,这就决定了家庭日常生活护理及家庭康复的重要性及必要性。 1脑瘫患儿日常生活指导 大多数脑瘫患儿就诊时已出现异常姿势,如挛缩、非对称姿势等,因此治疗同时应配合日常生活护理。 1.1脑瘫儿童抱法痉挛型患儿可采用骑跨式抱法,使患儿双臂前伸,髋关节及双膝弯曲,扶住头,面对面抱起靠近家长身体,双臂围住家长颈部,把患儿双腿分开,骑跨于腰部两侧。这种抱法有利于缓解双下肢的痉挛。徐动型患儿适合端坐位抱法：让患儿双上肢及双下肢靠拢屈曲,呈四肢对称屈曲状,家长再把患儿面部…     

双侧痉挛型脑瘫患儿的步态特征分析

目的 研究双侧痉挛型腩瘫患儿的步态特征.方法 对26例痉挛型脑瘫患儿进行步态分析.结果 和结论脑瘫患儿步态时空参数(跨步周期、跨步长、站立相时间、步频、步速)和运动学参数(髋关节、膝关节、踝关节首次着地屈曲角度,站立相最大伸展角度,足尖离地时关节角度,迈步相最大屈曲角度,矢状面关节角度范围)与正常儿童存在显著差异.     

家庭姿势管理在改善痉挛型脑瘫患儿运动功能中的应用效果

目的 对痉挛型脑瘫患儿采用家庭姿势管理的效果评价。 方法 选取2015年1月-2017年1月某妇幼保健院儿童康复科收治的痉挛型脑瘫住院患儿60例作为研究对象,随机将60例患儿分为观察组和对照组各30例,对照组实施综合康复训练,观察组在对照组基础上给予家庭姿势管理。分别在治疗前和治疗6个月后采用粗大运动功能评估量表(gross motor function measure, GMFM-88)评价2组粗大运动功能。 结果 治疗后观察组GMFM-88评分总百分比高于对照组(t=-5.284, P=0.016) 。 结论 痉挛型脑瘫应用家庭姿势管理可显著提高患儿运动能力,值得推广使用。     

脑干听觉诱发电位在痉挛型脑性瘫痪患儿中的应用探讨

目的　探讨脑干听觉诱发电位在痉挛型脑瘫患儿中的应用价值。方法　依据脑瘫诊断标准 ,将 58例痉挛型脑瘫患儿分为双瘫组、双重性偏瘫组及四肢瘫组 ,同时选取 2 8例正常儿童作为对照组 ,并比较各组间脑干听觉诱发电位 (BAEP)的差异。结果　痉挛型脑瘫患儿中 ,双重性偏瘫及四肢瘫患儿的BAEP异常率明显高于双瘫组 (P均 <0 .0 1 )。结论　脑干听觉诱发电位有助于早期发现脑瘫患儿存在的听力障碍 ,同时也可为脑瘫患儿的预后提供客观依据     

Cemented versus uncemented hip replacement for fracture of the hip

Purpose: Review cemented versus uncemented hemi-arthroplasty hip replacement regarding morbidity and long term results.

Methods: A literature review searching PubMed and Medline was done. Publications applicable to hip fractures treated by hip replacement or hemi-arthroplasty replacement were reviewed.

Results: Several articles compared cemented femoral stems to fracture fixation. There were few articles comparing cemented and uncemented stems. Some noted increased problems with uncemented stems but did consider design factors. Unreamed tapered stems may have may have fewer problems

Conclusions: Prospective studies comparing cemented and uncemented femoral stems are needed to determine the best form of fixation for patients having hip surgery following hip fracture. Tapered uncemented stems may offer as good a result as cemented stems, with less morbidity.     

Cemented versus uncemented hip replacement for fracture of the hip

Purpose: Review cemented versus uncemented hemi-arthroplasty hip replacement regarding morbidity and long term results.

Methods: A literature review searching PubMed and Medline was done. Publications applicable to hip fractures treated by hip replacement or hemi-arthroplasty replacement were reviewed.

Results: Several articles compared cemented femoral stems to fracture fixation. There were few articles comparing cemented and uncemented stems. Some noted increased problems with uncemented stems but did consider design factors. Unreamed tapered stems may have may have fewer problems

Conclusions: Prospective studies comparing cemented and uncemented femoral stems are needed to determine the best form of fixation for patients having hip surgery following hip fracture. Tapered uncemented stems may offer as good a result as cemented stems, with less morbidity.     

Common sonographic findings in the painful hip after hip arthroplasty

Diagnosing the cause of hip pain in patients with hip arthroplasty can be challenging because of the numerous possible causes of pain and artifacts caused by the prosthetic components on computed tomography and magnetic resonance imaging. Sonography plays an important role in the diagnosis and management of these patients because the soft tissues surrounding the prosthetic joint are not obscured by artifacts and because sonography enables hands-on examination of the painful site, dynamic evaluation of moving structures, and comparison with the opposite side. Another advantage of sonography is the ability to perform sonographically guided diagnostic and therapeutic procedures. In this pictorial essay, we highlight commonly encountered sonographic findings in patients with hip pain after hip arthroplasty.     

Joint moment-angle properties of the hip abductors and hip extensors

Purpose: Strengthening of hip joint musculature is common in the rehabilitation of the lower extremity. However, strength curves for hip abduction and extension have not been assessed when varying the position of the knee. The force-length properties of the biarticular muscles can be affected when altering the position of the knee during the production of hip moments. Methods: Maximum isometric joint moments were measured at four different angles of hip abduction and hip extension, at the two knee positions (0° and 90°). Results: The hip abduction and extension moments decreased as the hip moved from an adducted position and flexed position to an abducted position and extended position, respectively, resulting in a descending joint moment angle curve for each. Conclusion: The results indicate that position of the knee does not significantly change the normalized peak hip abduction joint moment, but the position of the knee does significantly change the normalized peak hip extension joint moment. This provides a baseline reference of hip joint moment production and can be utilized when assessing a population with a pathology or prescribing rehabilitative exercises.     

老年髋部骨折后对侧髋部的再骨折

背景:老年髋部骨折后发生对侧髋部再骨折数目在逐年增加。目的:阐述老年髋部骨折后对侧髋部再骨折的临床特征,提高对再次对侧髋部骨折的认识。方法:于2001-01/2011-07对老年单侧髋部骨折患者567例和老年再发对侧髋部骨折患者30例,分析再发对侧骨折病例的发生率、骨折类型、年龄、性别、骨密度、骨质疏松、再骨折时间间隔和合并症。结果与结论:单侧髋部骨折与再发对侧髋部骨折患者年龄、性别比例和骨密度值接近。老年髋部骨折患者中,对侧髋部再骨折发生率为5.0%。转子间骨折再发对侧髋部骨折率高于股骨颈骨折再发对侧髋部骨折率(P=0.018)。再发对侧骨折组骨质疏松发生率高于单侧骨折组(P=0.032)。初次骨折后发生对侧骨折的间隔时间平均2.4年,其中1年发生的最多,占40.1%。提示老年髋部骨折患者对侧髋部再骨折发生率较高,对于伴有骨质疏松和合并症的转子间骨折患者在术后1年内应加强预防,防止对侧髋部骨折的再次发生。