膝关节挛缩的康复预防与治疗

本文介绍了膝关节损伤至关节强直的生物力学机制和病理学基础 ;创伤后膝关节挛缩康复早期介入时机和主要康复治疗手段 (连续被动运动、恒力持续牵引法 ,静态进展伸展法 ) ;分析了各种治疗手段和生物力学机理     

比较间歇性牵张力和持续性牵张力对成骨样细胞碱性磷酸酶分泌活性的影响

目的　比较间歇性牵张力和持续性牵张力对UMR10 6成骨细胞碱性磷酸酶分泌活性的影响。方法　利用已建立的细胞体外加力装置 ,比较在间歇性和持续性牵张力的作用下 ,UMR10 6成骨细胞碱性磷酸酶分泌活性的改变。结果　施加间歇力和持续力后UMR10 6成骨细胞碱性磷酸酶分泌活性均有增加 ,间歇力作用 2小时和 4小时 ,UMR10 6成骨细胞碱性磷酸酶分泌活性增加均有统计学意义P <0 .0 5 ,持续力 4小时时加力组与对照组相比有显著性差异P <0 .0 5 ;间歇力与持续力相比 ,无论 2小时和 4小时其碱性磷酸酶分泌活性的改变间歇力组都高于持续力组 ,差异有显著性P <0 .0 5。     

The efficacy of balloon dilation in achalasia is the result of stretching of the lower esophageal sphincter,not muscular disruption

Pneumatic dilation (PD) of the lower esophageal sphincter (LES) in achalasia is a major palliative treatment. It is generally believed, although never substantiated, that therapeutic efficacy of ballooning in achalasia is the result of the disruption and tearing of the muscular layers of the LES. To clarify this issue, we investigated the frequency of muscular disruption at the LES, 24 hours after PD, by employing the endoscopic ultrasound (EUS), in a group of 43 consented patients with achalasia. Between July 2009 and March2012, 51 consecutive adult patients with tentative diagnosis of achalasia, some with recurrence of symptoms after an earlier treatment with balloon dilation, were evaluated and underwent PD, using Rigiflex balloon without major adverse effect. Out of the 51 evaluated, 43 eligible and consenting patients who underwent EUS, 24 hours after PD, using Olympus GF‐UE 160 echoendoscope and an Aloka Prosound probe at 7.5 MHZ, are the subjects of this study. The EUS in 43 eligible patients revealed an intact LES in 36 (83.7%), small area of muscular disruption in 5 (11.6%) and small hematoma in 2 patients (4.6%). Our data convincingly demonstrate that the clinical effectiveness of balloon dilation in achalasia is not the result of muscular disruption, but of circumferential stretching of the LES. Our findings on the mechanism of action of PD in achalasia could result in modifying the current method of dilation for a safer procedure, by slowing the rate of inflation and allowing the sphincter to slowly stretch itself to the distending balloon.     

Extent of multifocality with corneal manipulation in manual small incision cataract surgery with monofocal posterior chamber intraocular lens implantation

Purpose:To compare the visual outcome in terms of multifocality in Manual Small Incision Cataract Surgery (MSICS) with and without intraoperative manipulation of corneal curvature.Methods:This was a prospective study on 80 subjects (80 eyes) who underwent MSICS with monofocal posterior chamber intraocular lens (PCIOL) implantation between January 2018 and October 2019. Intraoperative manipulation of corneal curvature using viscoelastics was performed during MSICS in 40 subjects (cases) while this intraoperative manipulation was not performed in the remaining 40 subjects (controls). Uncorrected distance visual acuity (UDVA) and uncorrected near visual acuity (UNVA) were compared at day 1, 7, 30 and 180postoperatively.Results:At 1 month and 6 months of follow up, UDVA was comparable in the 2 groups. UNVA was better in cases than controls at 1 month and6 months (P < 0.001). At 6 months of follow up,76% of cases with UDVA of 6/9 or better had UNVA of N8 while only 15% of controls with UDVA of 6/9 or better had UNVA of N8 (P <0.001). Mean near add requirement to achieve a best corrected near vision (BCNV)of N6 at 6 months was significantly lesser (P =0.002) in cases (+2.05 D) compared to controls (+2.43D).Conclusion:MSICS with intra operative manipulation of corneal curvature resulted in better unaided near visual acuity compared to that without intra operative manipulation of corneal curvature, without compromising unaided distant visual acuity.     

Calf stretching and plantar fascia-specific stretching for plantar fasciitis: A systematic review and meta-analysis

BackgroundPlantar fasciitis (PF) is the most common cause of heel pain. A calf stretching (CS) and a plantar fascia-specific stretching (PFSS) are two stretching techniques commonly administered by health care providers.ObjectiveTo evaluate the literature on the application of these two stretching techniques in the treatment of PF and investigate their effectiveness and efficacy.MethodA search of PubMed, Web of Sciences, PEDro, CINHAL and Scopus was conducted. Studies that applied stretching as a co-intervention were excluded. The risk of bias was assessed to determine the internal validity of the included trials. The GRADE approach was adopted to determine the overall quality. Pooled analysis was performed to determine the treatment effects of CS and PFSS in terms of the mean difference in the visual analog scale pain score.ResultsEight articles were found that represented randomized controlled trial and met the inclusion criteria. There was very low-quality evidence that the combined CS and PFSS was less effective in the short term than the other therapies. Comparison between CS and PFSS revealed moderate quality evidence for a larger effect of pain score reduction for PFSS treatment over CS, while very low-quality evidence supported that combined CS and PFSS or CS alone was superior to sham stretching.ConclusionThere was moderate to very low-quality evidence of the effectiveness of stretching for PF. The treatment effect of stretching was large and comparable to other therapies. Future trials of higher quality are needed to clarify findings or to confirm findings.     

Does stretch training induce muscle hypertrophy in humans? A review of the literature

Stretch training is widely used in a variety of fitness‐related capacities such as increasing joint range of motion, preventing contractures and alleviating injuries. Moreover, some researches indicate that stretch training may induce muscle hypertrophy; however, studies on the topic have been primarily relegated to animal and in vitro models. The purpose of this brief review was to evaluate whether stretch training is a viable strategy to induce muscle hypertrophy in humans. An extensive literature search was performed using PubMed/MEDLINE, SciELO and Scopus databases, using terms related to stretching and muscle hypertrophy. Only human trials that evaluated changes in measures of muscle size or architecture following training protocols that it was performed stretching exercises were selected for inclusion. Of the 10 studies identified, 3 observed some significantly positive effects of stretch training on muscle structure. Intriguingly, in these studies, the stretching was carried out with an apparatus that aided in its performance, or with an external overload. In all studies, the subjects performed stretching at their own self‐determined range of motion, and no effect was observed. Of the 5 available studies that integrated stretching into a resistance training programme, 2 applied the stretching in the interset rest period and were the ones that showed enhanced muscle growth. In conclusion, passive, low‐intensity stretch does not appear to confer beneficial changes in muscle size and architecture; alternatively, albeit limited evidence suggests that when stretching is done with a certain degree of tensile strain (particularly when loaded, or added between active muscle contractions) may elicit muscle hypertrophy.     

Dynamics of viscoelastic creep during repeated stretches

The present study examined the viscoelastic creep responses in vivo during repeated constant-torque stretches in human skeletal muscle. Twelve healthy participants completed four consecutive 30-s constant-torque passive stretches of the right plantar flexor muscles. Position and surface electromyographic (EMG) amplitude values were quantified at every 5-s period and the percent change in position was quantified for each 5-s epoch relative to the total increase in ankle joint position for each stretch. In addition, the absolute changes in position were plotted on a logarithmic time scale and fit with a linear regression line to examine both the rate of increase (slope) and the overall increase in position over the entire stretch (y-intercept). The percent change and slope were similar (P>0.05) over all four stretches, with the majority of increases in position occurring within the initial 15-20 s of each stretch (84%). Absolute ankle joint position and the y-intercept increased (P<0.05) following both the first and second stretch but plateaued (P>0.05) after the third stretch. In addition, EMG amplitude values did not change (P>0.05) during or between each 30-s stretch. These data indicate that the amount and rate of viscoelastic creep were similar during practical durations of constant-torque stretching despite no change in ankle joint position following three 30-s stretches.