超声测量胎儿股骨皮下组织厚度与预测出生体重的相关性探讨

目的为预测新生儿出生体重.方法应用超声对100例正常孕妇在分娩前1周内测量股骨皮下组织厚度(TSTT)、双顶径(BPD)、腹围(AC)、股骨长度(FL),并与新生儿出生体重的关系进行分析.结果股骨皮下组织厚度与体重的相关性最好(R=0.9027),逐步回归分析中FTSTT的F值最大(F=198.67).结论超声测量胎儿股骨皮下组织厚度预测出生体重的方法简单、准确,有较好的临床应用价值.     

Identification of Tibial Malrotation After Nailing Using Unique CT Scan Reference Line,and Influence of Position of Leg for Distal Locking on Rotation

IntroductionTibial torsion can be measured by various clinical and radiological methods. Computed tomography (CT) scan measurement is currently the investigation of choice. The purpose of our study was to compare the clinical and CT scan methods to reveal malrotation after nailing of tibia and also to find out if leg position for distal locking has any influence on incidence of malrotation.Materials and methodsWe have included 106 patients (21–68 years) of tibia nailing, and categorised them as category A (figure of four position n = 54) and category B (knee straight position n = 52) based on limb position for distal locking. The plumb line measurement, Thigh Foot Axis (TFA) and CT scan measurement (using new reference line) were documented and compared with the uninjured limb.ResultsWe observed plumb line measurement to be the most inaccurate method followed by TFA method. CT scan measurement was the most accurate method showing external rotations (> 10º) in 32 cases (30.1%) and internal rotation (> − 10º) in five cases (4.71%). The TFA method had a sensitivity of 44% and specificity of 86% in identifying malrotations. The interobserver reliability for CT scan measurement was 0.96. Even though statistically not significant (P value), figure of four position for distal locking leads to larger number of malrotations (both external and internal rotation).ConclusionCT scan is the most accurate method of measuring malrotation. The new reference line used in our study provides accurate measurement of malrotation. The two different positions of leg for distal locking do not have a statistically significant influence on incidence of malrotation.     

Age-related site-specific muscle wasting of upper and lower extremities and trunk in Japanese men and women

GeroScience - The purpose of this study was to examine the age-related site-specific muscle loss of the upper and lower extremities and trunk in men and women. Japanese nonobese adults aged...     

Prevalence of site-specific thigh sarcopenia in Japanese men and women

The purpose of this study was to compare the prevalence of severe sarcopenia detected by total skeletal muscle mass (SM) index and of site-specific thigh sarcopenia for differing age groups in men and women. Japanese nonobese men and women aged 20 to 85 (n = 1,994, 55 % women) had muscle thickness (MTH) measured by ultrasound at six sites on the anterior and posterior aspects of the body. SM was estimated from ultrasound-derived prediction equations. Site-specific thigh sarcopenia was calculated using ultrasound-measured MTH at the anterior and posterior aspects of the thigh (MTH ratio, anterior 50 %/posterior 50 % thigh MTH (A50/P50 MTH)). Sarcopenia was defined as a SM index (SM divided by height²) of >2 standard deviations (SD) below the mean for young adults. Site-specific thigh sarcopenia was defined as a ratio of A50/P50 MTH of >2 SD below the mean for young adults. Age was inversely correlated to SM index and A50/P50 MTH in men (r = −0.480 and r = −0.522) and women (r = −0.243 and r = −0.516). The prevalence rate of sarcopenia was less than 3 % for women under the age of 60, 7 % for ages 60–69, and 24 % for ages 70–80. In men, the prevalence rate of sarcopenia was less than 7 % under the age of 50, 18 % for ages 50–59, 33 % for ages 60–69, and 47 % for ages 70–85. Compared to the sarcopenia estimated by SM index, there was a higher prevalence of site-specific thigh sarcopenia observed in both sexes. These results suggest that site-specific thigh sarcopenia appears before it is able to be detected at the whole body level.     

Intraregional differences in the absorption of unmodified insulin from the abdominal wall.

Absorption of subcutaneously injected unmodified human 125I-insulin (5 U; 100 U ml-1) was studied concurrently from three areas of the abdominal wall (120 mm above, 120 mm lateral to, and 40 mm below the umbilicus), and one area of the thigh (upper midline), in nine Type 1 diabetic patients of normal body weight, and from deep (2 mm above muscle fascia) and superficial (3 mm beneath skin surface) sites in abdominal wall and thigh in 11 Type 1 diabetic patients. The absorption rates were followed continuously for 3 h with the patient in the supine position. Whereas 125I-insulin disappeared considerably faster from the site above the umbilicus than from sites below or lateral to the umbilicus or from the thigh (residual radioactivities after 175 min: 36 +/- 4 vs 49 +/- 5, 54 +/- 2, and 62 +/- 4 (+/- SE)%, respectively; p less than 0.05 or better), no significant differences were found between deep and superficial sites in either abdominal wall or thigh. The results suggest that insulin absorption rates from subcutaneous injection sites within the abdominal wall differ sufficiently for this to be of clinical importance.     

Unilateral absence of thigh muscles confirmed by CT scan

A 5-month-old infant is presented with congenital absence of a group of muscles of the right thigh including the three adductors, gracilis, semimembranosus and semitendinosus. The diagnosis was suspected from the conventional radiographs and was confirmed by computerized tomography.     

修薄股前外侧皮瓣修复四肢大面积软组织缺损

目的探讨修薄的游离股前外侧皮瓣修复四肢大面积软组织缺损的临床效果。方法回顾分析2003～2006年开展的8例修薄股前外侧皮瓣游离移植手术,术中仅将包含穿支血管的、大小约4cm×4cm的深筋膜与皮瓣一起切取,其余深筋膜均保留在原位,以该区域为中心向周围切除浅筋膜深层的大颗粒脂肪,去除厚度逐渐增加,形成中央厚周边薄的"铁饼样"修薄皮瓣。结果皮瓣移植共8例,术后发生血管危象1例,为静脉血栓,通过及时清除血栓、移植静脉后恢复皮瓣血液循环。结论修薄股前外侧皮瓣移植成活率高,切取时最大限度保留了供区深筋膜,减少了对供区的功能损害,避免了皮瓣臃肿,受区外观得到较大改善,适用于关节附近及肢体远端大面积创面的修复。     

基于三维步态分析的大腿假肢穿戴者步态对称性研究

目的：提出了一种面向大腿假肢穿戴者进行三维对称性步态分析的新方法。方法：根据大腿假肢的运动学特点,使用“黑箱子”的方法确定贴标志位置,并且研究实验参数在假肢步态中的变化及其趋势,利用对称性算法研究假肢步态。结果：贴标志点的新方法、步态参数的研究和步态对称性算法对大腿假肢穿戴者步态研究有实际意义。结论：这些方法对今后的三维步态分析与评估研究提供了重要的理论依据。     

Knee-extension strength,postural control and function are related to fracture type and thigh edema in patients with hip fracture

Background

Post-surgery thigh edema, loss of knee-extension strength, and reduced physical performance are common following a hip fracture. It is not known if knee-extension strength and physical performance are related to the edema and fracture type. The aim of this study was to examine the influence of fracture type and post-surgery edema on physical performances in patients with hip fracture.

Methods

Fifteen women and five men admitted from their own home to an acute orthopedic hip fracture unit were examined. Ten had cervical and ten had intertrochanteric fractures. Correlations between fracture type and thigh edema in the fractured limb (% non-fractured) to physical performances of basic mobility, postural control (sway), and isometric knee-extension strength were examined. All measures, except those of basic mobility, were conducted at the time of discharge, 8.5 days post-surgery.

Findings

Patients with intertrochanteric fractures had greater edema (111% non-fractured limb) compared with cervical fractures (104% non-fractured, P < 0.001). Thigh edema was significantly correlated to lower scores of basic mobility (r = −0.61, P = 0.004), reduced postural control (r = 0.67, P = 0.001), and fractured limb knee-extension strength deficit ([% non-fractured], r = −0.77, P < 0.001), explaining between 32% and 59% of the variance (r²) in performances.

Interpretation

Our results indicate that fracture type and the corresponding thigh edema are important factors influencing physical performances after hip fracture. These findings have important implications for rehabilitation programs and for further research in patients with hip fracture.