全膝关节置换术围手术期康复管理及其疗效评定

目的:探讨围手术期康复管理对人工全膝关节置换术(TKR)后患者关节功能恢复的影响。方法:170例膝TKR患者分为康复组和对照组各85例,均接受TKR手术及常规的治疗与护理,术后CPM机功能训练。康复组患者在围手术期制定管理程度:术前健康教育;术后分期康复治疗,主要为呼吸、肌力及关节活动度(ROM)训练,平衡功能、本体感觉、步态和独立转移能力训练。2组治疗前后均采用美国HSS膝关节功能评分和ROM测定。结果:术后7及14d时,2组HSS膝关节功能评分和ROM测评均明显高于治疗前(P0.05,0.01)康复组均明显高于对照组(均P0.05,0.01)。结论:TKR围手术期康复管理对患者的功能恢复有十分重要的意义。     

早期阶梯式康复锻炼在全膝关节表面置换术后中的应用

目的:探讨全膝关节表面置换术后(TKR)早期行阶梯式康复锻炼方案与常规康复锻炼对膝关节功能评分(HSS)与膝关节活动度(ROM)的影响。方法:将44例骨性关节炎(OA)患者按手术顺序随机分为康复组和对照组各22例,两组患者均行TKR手术,术后进行常规治疗与护理,治疗组患者严格按制定的阶梯式康复锻炼方案进行训练。两组在治疗前后均采用HSS评分和ROM测定。结果:两组患者术后第4天、第1、2、6、12、24周HSS评分和ROM测定比较差异有统计学意义(P<0.05)。结论:TKR术后患者早期进行阶梯式康复锻炼可有效改善膝关节的功能和关节活动度,减少卧床时间,对患者整体功能恢复有非常重要的临床意义。     

早期阶段性康复干预对老年膝关节骨性关节炎患者全关节置换术后下肢疼痛及功能的影响

目的:测试阶段性康复干预方案在缓解TKR术后膝关节疼痛和改善膝关节主体功能方面的安全性和可行性,并评估测量身体功能的变化。方法:本研究共纳入了46例受试者,被随机分进对照组和康复干预组。对照组(n=22)接受关节置换术后临床常规治疗和康复指导;康复干预组(n=24)在接受临床常规治疗同时,将在术后第一天开始接受每天1次(第1阶段)或每周3次(第2、3阶段),为期12周的"全膝关节置换术后康复干预方案"。所有患者在术前、术后4周、术后12周接受全身状态、疼痛及膝关节相关功能评估。结果:在干预组,患者在术后第4—12周,下肢功能逐步得到显著改善,减轻疼痛表现为WOMAC、VAS、肌力、主被动ROM、患肢维度、BBS、FAC、FIM评分与术前存在显著性差异(P0.05)。与对照组相比,干预组患者的疼痛和功能恢复速度更快、幅度更大。术前、术后VAS疼痛评分与病程、BMI、WOMAC呈显著正相关(P0.05),与伸膝肌力、主动ROM、BBS、FIM、FAC呈显著负相关(P0.05)。结论:持续12周的分阶段TKR术后康复方案,对改善TKR术后患者的疼痛缓解和功能恢复有明显效果,其训练计划是安全可行的。疼痛控制是康复干预关键因素。     

股骨髁上骨折术后早期康复治疗对患膝关节功能恢复的影响

目的:观察股骨髁上骨折术后早期康复治疗对膝关节功能的影响。方法:股骨髁上骨折术后患者65例,随机分为康复组32例与对照组33例,2组均行膝关节逆行交锁髓内钉术,术后常规抗感染、消肿止痛、促进骨折愈合等药物治疗。对照组以卧床休息为主,康复组术前后均进行关节功能训练、肌力训练;并于术后配合物理因子等治疗。结果:治疗3个月后,康复组Lysholm膝关节评分和关节活动范围(ROM)均明显高于对照组(P0.01)。结论:股骨髁上骨折术后早期的综合康复治疗对膝关节功能恢复有显著促进作用。     

人工膝关节置换术早期康复的卫生经济学评价

目的:探讨早期康复治疗对人工膝关节置换术(TKA)的卫生经济学影响。方法:TKA患者64例,随机分为对照组与康复组各32例,对照组给予常规骨科治疗、骨科康复知识宣教与连续被动运动(CPM)机训练等;康复组此基础上加入早期康复介入治疗。术后第2天与出院前采用关节活动度(ROM)、肢体周径、日常生活活动能力(ADL)评分、美国特种外科医院评分系统(HSS)等指标评定2组患者功能恢复效果;采用平均住院日、住院各项费用等指标评估2组患者经济效果。结果:2组患者出院时与术后第2天比较,ROM、ADL、HSS均有显著改善(P0.05),且康复组以上指标均优于对照组(P0.05)。康复组平均住院日明显低于对照组(P0.05),2组住院费用差别无统计学意义。结论:早期康复治疗可有效改善TKA患者功能状态,缩短患者住院周期,增加床位周转率,是值得临床推广的有效、经济、合理的治疗方法。     

双侧全膝关节置换术后系统康复的临床研究

目的:前瞻性地进行双侧一次性全膝关节置换术(TKR)患者围手术期系统康复的临床研究。方法:选择2002年3月—2002年8月住院治疗TKR患者21例,所有入选病例均为膝关节骨性关节炎实施双侧一次性TKR的患者,入院后即开始实施系统个性化康复治疗方案,康复治疗分为3个阶段。第一阶段(手术前)、第二阶段(术后0—20天)、第三阶段(出院后),康复治疗内容包括:肌力训练、关节活动度训练、平衡功能、本体感觉及步态训练,术后康复治疗从术后第1天开始。结果:病例随访6—12个月,总共42个膝关节。膝关节活动度:出院时(术后10—20天):膝关节屈曲:100°—120°,平均101°±11.3°;伸直:10°—30°,平均10.4°±8.6°;膝关节周围肌力达到4级以上;术后半年复查,按照HSS膝关节评分标准:优:18例,良:3例,优良率100%,患者能够脱离拐杖行走及上下楼梯,生活完全自理。结论:双侧TKR患者术后早期系统康复治疗可直接影响手术的效果;早期系统的康复训练对于维持关节的稳定性、减少对人工关节的磨损、延长人工关节的使用寿命、提高患者生活质量是必需的,对双侧TKR患者更为重要。     

强化护理干预在人工全膝关节置换翻修术中的应用

目的:探讨强化护理干预对人工全膝关节置换术(TKR)患者中的应用效果,为促进TKR翻修术后关节功能康复患者提供有效护理依据。方法:将拟行TKR术的60例患者随机分为对照组和观察组各30例,对照组予常规护理治疗,观察组术前在对照组基础上予强化护理干预,术后3个月分别评估膝关节活动度(ROM)和膝关节评分标准(Hss)评分情况。结果:观察组ROM度数和Hss评分均高于对照组(P0.05)。结论:强化护理干预能有效促进TKR翻修患者术后关节功能恢复,值得进一步推广应用。     

早期大角度被动关节活动联合常规康复训练对全膝关节置换术后患者膝关节功能的影响

目的观察早期大角度被动关节活动训练对全膝关节置换术（TKR）后患者膝关节功能的影响。 方法TKR术后患者36例,按随机数字表法随机分成大角度被动关节活动训练组（观察组）和常规被动关节活动训练组（对照组）,每组患者18例。对照组患者采用常规活动角度的被动关节活动训练和常规康复训练进行治疗,其中康复医学科病房治疗2周,出院后采用同样的方法治疗10周,观察组采用大角度被动关节活动训练和常规康复训练进行治疗（仅被动关节活动训练的屈膝角度较对照组大20°,其他方法与对照组完全相同）。于康复治疗前和康复治疗1,2,4,6,12周后采用美国纽约特种外科医院（HSS）的膝关节功能评定量表、膝关节主动关节活动范围（ROM）和被动ROM评定2组患者膝关节功能的恢复情况。 结果康复治疗前,2组患者HSS评分和膝关节主动ROM和被动ROM差异均无统计学意义（P&rt;0.05）。康复治疗1,2,4,6,12周后,观察组的HSS评分均高于对照组,其中康复治疗1,2周后组间差异有统计学意义（P<0.05）。康复治疗1,2,4,6,12周后,观察组患者的膝关节主动和被动ROM较对照组均显著改善,差异有统计学意义（P<0.01）。 结论早期大角度被动关节活动可有效地改善TKR后患者膝关节的运动功能。     

早期系统康复治疗对股骨远端骨折术后效果的影响

目的评价早期系统康复治疗对股骨远端骨折患者术后效果的影响。方法选取58例手术治疗的股骨远端骨折患者,根据术后有无系统的康复治疗将其分为康复组(30例)和对照组(28例)。康复组术后采取早期系统康复治疗和训练,对照组进行常规术后康复治疗。比较2组术后1、3个月后膝关节活动度(ROM)。结果 2组在治疗1、3个月后膝关节ROM较治疗前均得到明显提高(P<0.01,P<0.05),且康复组高于对照组(P<0.01);康复组治疗3个月膝关节ROM较治疗1个月明显提高(P<0.05),而对照组差异无统计学意义(P>0.05)。结论膝关节ROM的恢复在早期1个月内是恢复的关键时期,早期系统康复治疗对恢复膝关节ROM,改善其功能有着重要作用。更多还原     

基于表面肌电评价术前康复治疗对单膝关节置换术后功能恢复的影响

目的:探讨术前康复治疗对单膝关节置换患者术后股四头肌肌力恢复、步行功能恢复所需治疗时间的影响。方法:40例准备进行单膝关节置换患者,按照随机数字表法分成术前康复组(A组,20例)与术后康复组(B组,20例)。A组术前7天开始股四头肌肌力强化训练与下肢有氧训练,术后2组均采取常规康复治疗,包括关节活动度训练、肌力训练、站立步行训练、空气波压力治疗、股四头肌低频电刺激。术后第3天与第7天分别采用表面肌电图评估患者股四头肌均方根植(RMS),比较患者手术开始至恢复正常步行功能(达到Holden步行功能Ⅴ级)所需治疗天数。结果:2组股直肌及股内侧肌表面RMS比较,术后第3天A组高于B组,肌肉收缩能力增强;术后第7天,2组RMS比较差异无统计学意义(P0.05)。2组股外侧肌表面RMS比较,术后第3天及第7天差异无统计学意义(P0.05)。A组术后达到Holden步行功能Ⅴ级所需平均治疗天数与B组比较,差异有统计学意义(P0.01)。结论:术前康复治疗能有效改善患者术后肌肉抑制现象,有效缩短术后功能恢复时间,减少患者术后住院时间。     

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.     

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.     

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.     

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.     

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.     

A new method for the simultaneous analysis of unmodified and modified urinary nucleosides and nucleobases by high performance liquid chromatography

Details are given of a new, rapid and simple pre-fractionation method and an isocratic high performance liquid chromatography system suitable for parallel analysis of nucleosides and nucleobases from urine and other biological fluids. The quantitative recovery and excellent reproducibility of the method is demonstrated by analysis of representative standard RNA catabolites. The advantage of this new method for application to biological samples is discussed.     

Adsorption of Charged Non-albumin Bound Drugs by Amorphous Silica

We investigated the in vitro drug adsorption of PQ 10150 sodium silicate gel (AIS, Santa Clara, CA) with particle size of 230 um and surface area of 400 nr/g. We observed 99% to 88% adsorption of gentamicin; a mean 91 % of disopyramide; a mean 89% of quinidine at low concentration, falling to 75% at higher concentration. Insulin was 88% adsorbed at low concentrations but less so (65%) at higher concentrations. We observed a mean 83 % adsorption of procainamide, a mean 84% of N-acetyl procainamide, 74% oflidocaine, 73% of amitriptyline; and 44% of desipramine. We found an average 14% reduction of total digoxin concentration when serum containing digoxin (2 to 33 ng/mL) was exposed to sodium silicate, while the reduction in free digoxin concentration was 16%. Five percent ethosuximide was also removed. The adsorption of theophylline, phenobarbital, acetaminophen, phenytoin, ethylene glycol, methotrexate, salicylate, thiocyanate and diazepam was minimal and not significant. We conclude that significant amounts of charged, non-albumin bound drugs can be removed by PQ 10150 sodium silicate gel.