单纯性前臂屈肌挛缩的诊断与治疗

目的 探讨单纯性前臂屈肌挛缩的临床特点和治疗体会.方法 回顾性分析16例单纯性前臂屈肌挛缩的患者,平均年龄13.5岁,临床表现为中、环、小指屈曲畸形.早期患者采用理疗、体疗和支具牵引;晚期患者采用手术治疗,根据病情选择术式,术中发现主要病变为中、环、小指指深屈肌肌腹纤维化.术后进行康复训练.结果 术后2例失访,14例获得随访,其中优7例,良5例,中2例.受累手指屈伸功能明显改善.结论 单纯性前臂屈肌挛缩发生后,早期应进行康复治疗,晚期手术治疗结合后康复治疗,效果满意.     

Walking after Stroke: Does It Matter? Changes in Bone Mineral Density Within the First 12 Months after Stroke. A Longitudinal Study

Stroke patients have increased risk of hip fractures. Nearly all fractures occur on the hemiplegic side, and reduced bone mineral density (BMD) may be an important predisposing factor. The aim of this study was to investigate the degree of demineralization within the first year after stroke, and to elucidate a possible difference in patients with high versus low ambulatory levels. Forty acute stroke patients were followed (17 initially wheelchair-bound and 23 initially ambulatory). BMD was measured in the proximal femur bilaterally at a mean 6 days, 7 months and 1 year after stroke onset using dual-energy X-ray absorptiometry. Ambulatory status was independently associated with changes in BMD (p≤0.005) 1 year after stroke. The 17 initially wheelchair-bound patients had a significant 10% reduction in BMD at the paretic side and 5% reduction at the non-paretic side (p<0.001), while the 23 patients initially able to walk had a significant loss (3%) only at the paretic side (p = 0.01). The analysis also indicated that the major reduction in BMD took place within the first 7 months. Two months after stroke 12 of the wheelchair-bound patients had relearned to walk. At the paretic side the 1 year changes in BMD in the patients who stayed wheelchair-bound, the patients who relearned to walk within the first 2 months and the patients who were able to walk throughout the study were 13%, 8% and 3%, respectively, and a statistically significant trend with ambulatory level was found (p = 0.007). This study provides clear evidence that lack of mobility and weight-bearing early after stroke is an important factor for the greater bone loss in the paretic leg, but that relearning to walk within the first 2 months after stroke, even with the support of another person, may reduce the bone loss after immobilization. Received: 24 August 1999 / Accepted: 25 October 1999     

针刺配合康复训练对中风后肩手综合征疗效观察

目的观察针刺下康复训练对中风后肩手综合征的临床疗效。方法将60例中风后肩手综合征患者随机分为两组，各30例。对照组采用常规针刺后康复训练，治疗组采用针刺的同时进行康复训练，治疗4星期后观察两组的临床疗效。结果治疗后治疗组总有效率为90．0％，对照组总有效率为76．7％，两组比较差异具有统计学意义（P〈0．05），治疗组明显优于对照组。治疗后两组疼痛程度变化比较差异具有统计学意义（P〈0．01），治疗组明显优于对照组。结论针刺下康复训练对中风后肩手综合征的疗效优于常规针刺后康复训练。     

膝腱反射检查对前交叉韧带断裂和重建后本体感觉功能的评价

目的探讨膝腱反射检查对前交叉韧带断裂和重建后本体感觉功能的评价和意义。方法对20例单纯前交叉韧带断裂,采用关节镜下自体四股半腱肌-股薄肌肌腱重建。常规方法检查膝腱反射,双极表面电极电刺激髌韧带并记录股内侧肌肌电图。观察前交叉韧带断裂和重建后膝腱反射和肌电图的客观改变,结合临床"打软腿"的主观症状,研究主、客观相互关系。结果3项指标手术前后两样本率比较,差异有统计学意义(PKJ=0.004,PEMG=0.022,PS=0.000);3项指标手术前后改变率之间两两比较,差异无统计学意义(PKJ-EMG=0.495,PKJ-S=0.476,PEMG-S=0.163)。结论提出"前交叉韧带-膝腱反射弧"的观点,将膝腱反射检查作为前交叉韧带断裂和重建后的常规查体,借此评价膝关节本体感觉功能,以指导本体感觉的康复锻炼。     

Time use of stroke patients in an intensive rehabilitation unit: a comparison between a Belgian and a Swiss setting

Purpose : Functional improvement after stroke has been related to the intensity of treatment. The present study was set up to observe how stroke patients spend their time in a rehabilitation unit. Method : Behavioural mapping was performed throughout a full working day in a Belgian and Swiss stroke unit. Results : Patients were most frequently involved in therapeutic activities, 28% of the day in Belgium and 45% in Switzerland. Physiotherapy accounted for the majority of the therapy time. The Belgian patients spent 27% of the day in their own room and Swiss patients 49% of the day. The most striking finding was that the Swiss patients spent nearly 1.5 hours per day more in therapy. Conclusions : Differences between the two settings could only partially be explained by more favourable patient-staff ratios in the Swiss setting. Autonomous practice, group therapy sessions and family involvement have to also be considered.     

Disorders of Consciousness and Disordered Care: Families,Caregivers, and Narratives of Necessity

By their nature, care decisions for patients with severe disorders of consciousness must involve surrogates. Patients, so impaired, have lost their decision-making capacity and the ability to direct their own care. Surrogates—family members, friends, or other intimates—must step in and make decisions about ongoing care or its withdrawal. This article shares the narrative experiences of these surrogate decision makers as they encounter the American health care system and accompany patients from injury through rehabilitation. Through their perspectives, the article considers challenges to ongoing care and rehabilitation that are a function of a prevailing medical infrastructure and reimbursement framework better suited to patients with acute care needs. Specific attention is paid to the ethical challenges posed by reimbursement strategies such as “medical necessity” as well as those proposed for the Affordable Care Act. The argument concludes that when it comes to care for a disorder related to consciousness, its provision is not discretionary, and its receipt is not an entitlement but a civil right.