《明医指掌》与脏腑辨证

有明一代,脏腑辨证在金元基础上得到更广泛的应用。皇甫中就于《明医指掌》中大量运用脏腑辨证。皇甫中所运用脏腑辨证有如下特点:1)脏腑辨证,五脏为主。2)五脏辨证,肺居其首。3)脾胃病证,辨析详备。4)抓住病本,辨证入微。5)不囿成说,另辟蹊径。     

The treatment of scarring and flexion contracture after operations for injuries to the flexor tendons of the fingers by implantation of a silicone rod and tendon grafting

Summary Forty patients were studied following injuries to a flexor tendon who had undergone multiple operations which had resulted in severe scarring and contracture of the affected finger. They were then treated by release of the contracture and the insertion of a silicone rod along the site of the tendon bed. At a second operation about three months later, the rod was removed and replaced by a tendon graft. Fourteen per cent had an excellent result, 33% were graded good, 36% per cent fair and 17% poor.

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Résumé Etude de 40 blessés, ayant subi de multiples interventions après traumatisme d'un tendon fléchisseur, et présentant finalement de graves cicatrices rétractiles avec raideur du doigt atteint. Ils ont été traités par correction de l'attitude en flexion et par insertion d'une tige de silicone dans le lit du tendon. Dans un deuxième temps, environ trois mois plus tard, la tige est retirée et remplacée par une greffe tendineuse. Quatorze pour cent des résultats sont excellents, 33% sont bons, 36% moyens et 17% mauvais.

     

耳垂血、指尖血红细胞计数及其相关数值准确性的探讨

目的探讨耳垂血、指尖血RBC、Hb、血细胞比容(Hct)及其相关数值的准确性。方法30例健康志愿者同时采集耳垂血、指尖血和静脉血,并分析其RBC、Hb、Hct及其相关数值的差异。结果指尖血RBC、Hb和Hct与静脉血比较均差异无统计学意义(P>0.05),耳垂血RBC、Hb和Hct均明显较静脉血偏高(P<0.01),定量分析耳垂血RBC高于静脉血6.1%,Hb高于静脉血6.1%。除平均红细胞体积(MCV)外,静脉血、指尖血、耳垂血平均红细胞血红蛋白量(MCH)、平均红细胞血红蛋白浓度(MCHC)、红细胞体积分布宽度(RDW)比较均差异无统计学意义(P>0.05)。结论指尖血RBC、Hb和Hct与静脉血相似,而耳垂血RBC、Hb和Hct高于静脉血,如临床用耳垂血测定时需作相应校正。     

Prehension synergies: Effects of object geometry and prescribed torques

We studied the coordination of forces and moments exerted by individual digits in static tasks that required balancing an external load and torque. Subjects (n=10) stabilized a handle with an attachment that allowed for change of external torque. Thumb position and handle width systematically varied among the trials. Each subject performed 63 tasks (7 torque values × 3 thumb locations × 3 widths). Forces and moments exerted by the digit tips on the object were recorded. Although direction and magnitude of finger forces varied among subjects, each subject used a similar multidigit synergy: a single eigenvalue accounted for 95.2–98.5% of the total variance. When task parameters were varied, regular conjoint digital force changes (prehension synergies) were observed. Synergies represent preferential solutions used by the subjects to satisfy mechanical requirements of the tasks. In particular, chain effects in force adjustments to changes in the handle geometry were documented. An increased handle width induced the following effects: (a) tangential forces remained unchanged, (b) the same tangential forces produced a larger moment T ^t , (c) the increased T ^t was compensated by a smaller moment of the normal forces T ⁿ, and (d) normal finger forces were rearranged to generate a smaller moment. Torque control is a core component of prehension synergies. Observed prehension synergies are only mechanically necessitated in part. The data support a theory of hierarchical organization of prehension synergies. Electronic Publication     

Relations between surface EMG of extrinsic flexors and individual finger forces support the notion of muscle compartments

The goal of this experiment was to investigate the relationship between individual fingertip forces and the surface EMG of multi-digit muscles. The surface EMG of the hand extrinsic flexors (flexor digitorum profundis and superficialis) was recorded in eight subjects during multi-digit force production tasks. In one session, subjects pressed with all four fingers (IMRL, I=index, M=middle, R=ring, and L=little finger) with the total force ranging from 10% and 90% of their maximum force (MVC). Results showed a close linear relationship between an integrated EMG index and force. In another session, subjects produced constant total force of either 10% or 30% of their IMRL MVC, with different finger combinations such that the degree of involvement of each finger was manipulated (15 finger combinations were tested). The EMG level of the flexors depended greatly on the finger combination (P<0.001). Multi-variable regression made it possible to describe the flexor EMG as a linear function of individual fingertip forces. These results suggest that: (1) hand extrinsic flexors muscles are arranged in functional compartments serving individual fingers, and (2) each compartment has a force/EMG relationship that is close to being linear. Electronic Publication     

Enslaving effects in multi-finger force production

When a person produces isometric force with one, two, or three fingers, the other fingers of the hand also produce a certain force. Enslaving is the involuntary force production by fingers not explicitly involved in a force-production task. This study explored the enslaving effects (EE) in multi-finger tasks in which the contributions of the flexor digitorum profundus (FDP), flexor digitorum superficialis (FDS), and intrinsic muscles (INT) were manipulated. A new experimental technique was developed that allows the redistribution of the muscle activity between the FDP, FDS, and INT muscles. In the experiment, ten subjects were instructed to perform maximal voluntary contractions with all possible one-, two-, three-, and four-finger combinations. The point of force application was changed in parallel for the index, middle, ring, and little fingers from the middle of the distal phalanx, to the distal interphalangeal joint, and then to the proximal interphalangeal joint. It was found that: (1) the EE of similar amplitude were present in various experimental conditions that involved different muscle groups for force production; (2) the EE were large on average--the slave fingers could produce forces reaching 67.5% of the maximal forces produced by themselves in a single-finger task; (3) the EE were larger for neighboring fingers; and (4) the EE were non-additive--in most cases, the EE from two or three fingers were smaller than the EE from at least one finger. EE among different muscles suggest a widespread neural interaction among the structures controlling flexor muscles in the hand as the main mechanism of finger enslaving.     

Motor redundancy during maximal voluntary contraction in four-finger tasks

The goal of the study was to investigate force-sharing patterns in multi-finger tasks. Maximal normal force (MNF) as well as the force-time curves produced by individual fingers were measured in 10 young male subjects in three tasks: (1) holding an instrumented handle in a pad opposition with the thumb at seven different locations, from opposing the index finger (L₀) to opposing the little finger (L₆); (2) holding the handle in a pad opposition with the thumb at an individually selected comfortable location; and (3) pressing with the four fingers against the same handle fixed to the external support. We found that: (1) The moment due to the normal finger forces changed systematically when the thumb position varied from L₀ to L₅ /L₆, and it was equal to zero at a certain middle position of the thumb, the neutral position. At this position, the shear force produced by the fingers was zero. (2) The total MNF changed in an ascending-descending manner when the thumb position varied from L₀ to L₅ /L₆. The highest value of the maximal total normal force was produced at a position of the thumb that was preferred as the most comfortable position in the grip task. (3) In the press task, the neutral line – the line with respect to which the moment generated by the four fingers equals zero – was at the same location as the preferred thumb position in the grip tasks. (4) Larger total normal force corresponded to smaller total shear forces. (5) In grip tasks, with the thumb in a comfortable position, the force-force relationships among fingers were approximately linear. Hence, in these thumb positions, the force-sharing pattern was established at the beginning of the trial. At the extreme positions of the thumb, irregular patterns of the force-force relationships were observed. (6) In trials with different thumb locations, a significant correlation was found between the maximal force produced by the index and small fingers. (7) Peak force exerted by individual fingers in the multi-finger tasks was much smaller than the maximal force displayed by the same fingers in the single-finger tasks. The peak force depended on the thumb position and varied from 11.3% to 65.2% of the maximal force exerted by the same finger in the single-finger task. With the thumb in the comfortable position, the relative peak force for all fingers was approximately at the same level, 50–55%. The data are in agreement with the hypothesis that the total force is shared among individual fingers, minimizing the moment with respect to the functional hand axis. Received: 18 August 1997 / Accepted: 19 March 1998     

Responses to whole body and finger cooling before and after an Antarctic expedition

Summary Eight subjects, who were indoor workers and not habitually exposed to cold, spent 53 days in Antarctica. They did mainly geological field work often requiring the use of bare hands. The effects of the expedition on responses to a whole body cold exposure test, a finger blood flow test and a cold pressor test were studied. After the expedition, during whole-body cooling the time for the onset of shivering was delayed by 36 min (P<0.001) and forearm and thigh temperatures were 1.5°C higher (P<0.05) at the end of exposure. During local cooling of the finger with 10°C perfusion, finger vascular resistance was 14.9 (SEM 6.6) mmHg · ml^–1 · min · 100 ml (P<0.05) lower and finger temperature 3.9 (SEM 0.8) °C higher (P< 0.01). However, the decrease in rectal temperature during wholebody cooling was unaltered and the response to a cold pressor test was unchanged. The data would indicate that partial acclimatization to cold had been developed. Changes in forearm temperature were correlated with the duration of cold exposure of the hands (P < 0.05) and finger vascular resistance and finger temperature were correlated with responses to cooling before the expedition (P<0.001 and P<0.01, respectively). Because the ambient temperature was not clearly lower in Antarctica in comparison to Finland, the reason for the changes developed seems to be the increased exposure to the outdoor climate in Antarctica.     

AO微型钢板治疗手部掌指骨骨折的疗效分析

目的 研究应用AO微型钢板内固定治疗手部骨折的疗效。方法 对手部掌、指骨骨折23例30处行切开复位,AO微型钢板内固定治疗。结果 术后外固定时间为2～3周,随访2～10个月,骨折全部愈合,伤手掌指关节和指间关节伸屈功能恢复正常。结论 AO微型钢板内固定治疗手部骨折可缩短术后外固定时间,早期进行功能锻炼,有利于患手功能恢复,是治疗手部骨折较为理想的方法。     

小儿足趾移植拇手指再造的特点

目的 探索小儿足趾移植拇手指再造与成人的区别．使该技术在小儿中得到更合理的应用。方法时24例30指小儿足趾移植的病历进行回顾性分析,并经过3年半～15年的随访,记录每人的功能情况。结果 再造指外形发育良好,感觉灵敏,26指对指功能优良,22指抓握力量接近正常,供足均无明显不适。结论 4岁左右是小儿足趾移植拇手指再造的合适年龄,鞭炮炸伤是小儿拇手指缺损的主要伤因,其手术、术后治疗以及康复训练等均有其特殊性。