Current perspectives and clinical practice of physiotherapists on assessment,rehabilitation, and return to sport criteria after anterior cruciate ligament injury and reconstruction. An online survey of 538 physiotherapists

ObjectivesTo evaluate the perspectives and clinical practice of physiotherapists regarding rehabilitation after anterior cruciate ligament reconstruction (ACLR).DesignOnline survey.SettingSurvey platform.ParticipantsGreek physiotherapists.Outcome measuresThe survey consisted of 7 sections: participant demographics, importance of ACLR rehabilitation, clinical measurements, practice, criteria to progress rehabilitation, return to running and return to sport.ResultsSignificant variability in measures and criteria used for clinical decision-making were found including: limb symmetry in strength and function, knee range of motion and effusion, progression, and return to sport criteria. The majority of the practitioners (28.3%) extrapolate knee strength from hop capacity. Return to running ranged from 3 to 5 months post-operatively reflecting that this was tied to physical capacities, not time from surgery. 70.0% of the Greek physiotherapists would allow return to sport ≤9 months after ACLR. Agreement was found in using: physical measures, function, and dynamic stability in ACLR rehabilitation, but the mode and interpretation varied substantially. Less than 29.0% of the physiotherapists reported using patient-reported outcome measures in their decision-making.ConclusionCurrent ACLR rehabilitation practices in Greece are largely not aligned with the contemporary scientific evidence and guidelines.     

应用纤连蛋白片段建立椎间盘退变动物模型

目的:探讨应用N端30kDa纤连蛋白片段(Fn-f)建立模拟人类椎间盘退变规律的椎间盘退变动物模型的可行性,为椎间盘退变的防治提供实验模型及实验依据.方法:选取雄性6月龄新西兰大白兔28只,麻醉后使用30G微量注射针和微量注射器,在透视引导下经皮将25μl 1.5μmol/L Fn-f(Fn-f组)或25μl磷酸缓冲液(PBS,0.01mol/L,pH值7.2;PBS组)随机分别注射入不同节段的腰椎间盘中心区.分别于注射4、8、12、16周后获取椎间盘,对椎间盘进行组织学检测(HE、Masson三色及番红O染色),并以RT-PCR法对椎间盘聚集蛋白聚糖和Ⅱ型胶原的基因表达水平进行分析.结果:与注射PBS椎间盘相比,注射Fn-f椎间盘造模后4周时椎间盘的髓核、纤维环结构以及胞外基质蛋白聚糖等无明显差别;8周时髓核细胞数量减少、细胞簇状分布,被胞外基质分隔开来,纤维环层状结构排列部分出现紊乱,蛋白聚糖染色变浅;12和16周时髓核细胞数量明显减少,细胞变圆,呈明显的成簇聚集分布,纤维环排列明显不规整,各层间出现裂隙,甚至断裂,蛋白聚糖染色明显变浅,甚至部分未见染色.Fn-f组椎间盘聚集蛋白聚糖mRNA表达水平在8、12和16周3个时间点均明显低于PBS组(P＜0.05);Ⅱ型胶原mRNA表达水平在12和16周时明显低于PBS对照组(P＜0.05).结论:透视引导下兔椎间盘内注射N端30kDa Fn-f可诱导椎间盘产生渐进性退行性病变,该法建立的动物模型可作为研究椎间盘退变的发病机制及防治的实验模板.     

Reconstruction of a neurocutaneous defect of the proximal phalanx with a heterodigital arterialised nerve pedicle flap

BackgroundComplex digital injuries involving soft-tissue loss and digital nerve defect pose a challenging problem for hand surgeons. The purpose of this study was to evaluate the efficacy of transferring the heterodigital arterialised nerve pedicle flap for reconstructing the digital neurocutaneous defects and to compare the results with those of transferring the cross-finger flap and secondary nerve grafting.MethodsFrom March 2008 to September 2011, the nerve pedicle flap was used in 12 patients who had a combination of soft-tissue and digital nerve defects. The injured fingers included four index, four long, three ring and one little finger. The mean size of the soft-tissue losses was 2.4 × 1.9 cm (range, 2.3 × 1.3 to 3.2 × 2.0 cm). The mean flap size was 2.6 × 2.1 cm (range, 2.5 × 1.5 to 3.4 × 2.2 cm). The length of the nerve defects ranged from 1.5 to 3.8 cm (mean, 2.8 cm). The nerve defect was reconstructed with transfer of the digital nerve dorsal branch. For comparison, we collected a series of 24 patients with similar defects treated with the cross-finger flap and secondary free nerve grafting.ResultsSignificant differences were found between the two groups in static two-point discrimination (p < .01) and pain (p = .03) in the reconstructed finger. In comparison, the study group presented better discriminatory sensation on the finger pulp and lower incidence of pain sensibility in the injured finger. There was no significant difference in cold intolerance and Semmes–Weinstein monofilament. In the study group, the total active motion of the donor fingers was similar to that of the opposite hands.ConclusionsThe heterodigital arterialised nerve pedicle flap is useful and reliable for reconstructing the neurocutaneous defects in the proximal phalanx. Comparable sensory recovery and lower pain incidence can be achieved using our nerve pedicle flap instead of conventional nerve grafting.Type of study/level of evidenceTherapeutic II.     

健康国人颈椎和腰椎体积骨密度的定量CT研究

目的 探讨国人健康成人颈椎和腰椎体积骨密度值(vBMD)分布情况。方法 采用横断面研究方法。2014年12月—2016年1月北京积水潭医院招募770名健康志愿者,其中男329名,女441名,年龄21～59岁。志愿者按年龄分为4组:A组(21～30岁)142人,B组(31～40岁)262人,C组(41～50岁)263人,D组(51～60岁)103人。采用日本TOSHIBA 128排CT机对志愿者行颈椎和腰椎定量CT扫描,并使用Mindways骨密度测量软件测量C₂～C₇、L₂～L₄椎体的vBMD值。采用单因素方差分析分别比较颈、腰椎中vBMD在不同性别、年龄组、节段的分布情况,男性、女性颈腰椎间各椎体vBMD的相关性采用Pearson相关分析。结果 男性志愿者C₂～C₇和L₂～L₄椎体vBMD分别为(288.40±60.63)、(275.71±56.33)、(283.91±59.62)、(278.95±53.76)、(253.38±49.99)、(217.94±44.96)和(151.64±31.74)、(145.22±31.77)、(147.16±35.81)mg/cm³,女性志愿者分别为(329.24±74.34)、(313.88±67.86)、(328.54±73.40)、(323.22±72.53)、(286.44±66.36)、(251.53±58.63)和(168.50±37.10)、(160.78±37.00)、(162.81±37.10)mg/cm³。无论男性还是女性,颈椎及腰椎的体积骨密度值均随着年龄增长而逐渐下降,差异均有统计学意义(P值均＜0.05)。男性志愿者同一年龄组内比较:C₂～C₇不同椎体的vBMD均呈下降趋势,差异均有统计学意义(P值均＜0.05);而L₂～L₄不同椎体的vBMD差异均无统计学意义(P值均＞0.05)。女性志愿者同一年龄组内比较:C₂～C₇不同椎体的vBMD均呈下降趋势,差异均有统计学意义(P值均＜0.05);D组L₂～L₄各椎体的vBMD均呈下降趋势,差异有统计学意义(P＜0.05),其他年龄组vBMD差异均无统计学意义(P值均＞0.05)。无论是男性或女性志愿者,在任何年龄组,颈椎vBMD均＞200 mg/cm³,腰椎vBMD值均＜200 mg/cm³,颈椎vBMD值均高于腰椎(P值均＜0.01)。男性、女性颈腰椎不同椎体间vBMD值均具有显著的相关性(r_男性=0.509～0.968, r_女性=0.658～0.976, P值均＜0.01);男性中,r_颈椎间=0.667～0.928,r_腰椎间=0.850～0.968,r_{颈椎与腰椎间}=0.509～0.675;女性中,r_颈椎间=0.754～0.933,r_腰椎间=0.956～0.973,r_{颈椎与腰椎间}=0.658～0.752;颈椎间或腰椎间vBMD相关系数均高于颈腰椎之间相关系数。结论 颈椎和腰椎vBMD在不同性别、年龄、节段分布存在差异,但各椎体vBMD均存在中-强相关性。本研究结果可为临床监测骨质疏松、评估骨折风险提供参考数据。     

Candida infection in severe burns

Candida infection has become an important cause of morbidity and death in burned or immunosuppressed patients. Two patients with extensive burn complicated with Candida infection are presented, along with the risk factors, diagnostic procedures, and current methods of treatment.     

Computer-assisted auto-frame navigation system for distal locking of tibial intramedullary nails： a preliminary report on clinical application

Objective: To evaluate the clinical feasibility and effect of the computer-assisted auto-frame navigation system for distal locking of tibial intramedullary nails. Methods: The hardware components of the system included a PC computer with a monitor, auto mechanical stereotactical locating cubic frame, foot holder and localization operative apparatus. Special navigation software can be used for registration of X-ray fluoroscopic images and real-tune controlling navigation of tools. Twenty-one cases of close tibial and fibular fractures were treated with closed intramedullary nailing, 6 of which involved in middle third, 12 in middle and lower third, 3 in lower third. C-arm alignment and registration time, fluoroscopic time and drilling time involved in the locking procedure were recorded. The size of unreamed or reamed tibial nails ranged from 8/300-11/330. Results: All distal holes except 1 were locked successfuUy. In 9 of 41 locked holes (21.95%), the drill bit touched the canal of locking hole without damage of the nail and clinical consequences. The fluoroscopy time per pair of screws was 2.23 s±0.31 s . Conclusions: The computer-assisted auto-frame navigation system for distal locking is well designed, easy to operate and do not need additional instruments during the procedure. The developed system enables the physician to precisely navigate surgical instruments throughout the anatomy using just a few computer-calibrated radiographic images. The total time of x-ray exposure per procedure can be significantly reduced.     

Chromic acid burns and acute chromium poisoning

The problems encountered during the treatment of a patient with burns covering 40 per cent of the body surface caused by hot chromic acid and the resulting chromium poisoning are described. Anuria developed on the second day after injury and the patient died on the sixth day.     

Efficacy of denosumab in joint preservation for patients with giant cell tumour of the bone

BackgroundGiant cell tumour of the bone (GCTB) is an aggressive osteolytic primary tumour. GCTB is rich in osteoclast-like giant cells and contains mononuclear cells that express RANK ligand (RANKL), a key mediator of osteoclast activation. The potential therapeutic effect of denosumab was investigated with special reference to its role in joint preservation.MethodsIn this prospective non-randomised study patients with GCTB received denosumab for 6–11 months preoperatively. Serial radiographs and biopsy and resection tumour specimens were used to monitor response to denosumab.ResultsAll 20 patients experienced pain relief in the first month of treatment. All patients demonstrated a positive radiographic response with improved subchondral and cortical bone which allowed intralesional tumour resection and preservation of the joint and articular surface in 18 cases. Histological examination following denosumab revealed rarely detectable osteoclast-like giant cells. There was an obvious increase in osteoid matrix and woven bone which showed rare RANK staining amongst the mononuclear cells and only focal RANKL positivity. At median 30 months follow-up after resection, local tumour recurrence occurred in three patients.ConclusionDenosumab provides favourable and consistent clinical, radiographic and pathologic responses which facilitates less aggressive surgical treatment, especially joint preservation. However, the local recurrence rate for GCTB following resection does not seem to be affected by denosumab and remains a concern.     

正常足与外翻足的足底压力研究

目的　对正常足与外翻足的足底压力进行测量。方法　运用自行研制的足底生物力学测试系统对30 名健康人60 足,45 例外翻患者89 足进行了行走时足底压力的测试。结果　重度外翻组31 足和正常组相比,第一跖骨头下压力明显减低( P< 0.001),第二跖骨头下压力明显增加(P< 0 .05),第三、五跖骨头下压力有增高的趋势。结论　正常人前足第一跖骨头下压力最高,并向外侧递减。重度外翻足前足第一跖骨头下压力明显减低,第二跖骨头下压力明显增高