下肢整体训练联合髋周筋膜手法对慢性足底筋膜炎的疗效研究

目的：探索下肢整体训练联合髋周筋膜手法对慢性足底筋膜炎症状的疗效。方法：取慢性足底筋膜炎患者56例,随机分为对照组和观察组各28例,对照组接受常规治疗(体外冲击波、踝足牵伸及训练);观察组接受常规治疗及下肢整体训练联合髋周筋膜手法。2组分别于治疗前后测试美国矫形外科足踝协会踝-后足评分（AOFAS）、“第1步”数字疼痛评分(NPRS)、下肢Y平衡测试（YBT）值、髋外展和伸展肌群的峰力值;并比较观察组各指标间的相关性（Pearson分析）。结果：治疗3周后,2组AOFAS、观察组患侧YBT值较治疗前均明显提高（P<0.05）,2组NPRS较治疗前明显降低（P<0.05）,且观察组AOFAS及YBT值明显高于对照组（P<0.05）。观察组髋外展及伸展肌群峰力值均较治疗前明显提高（P<0.05）,且均明显高于对照组（P<0.05）。观察组髋外展肌群峰力值与AOFAS、YBT值具有相关性（P<0.05）,髋伸展肌群峰力值与YBT值具有相关性（P<0.05）。结论:下肢整体训练联合髋周筋膜手法可有效改善慢性足底筋膜炎患者的症状。     

足底压力测量技术在足外翻脑性瘫痪患儿康复疗效评定中的应用

目的探讨足底压力测量技术在评估足外翻脑性瘫痪(脑瘫)患儿康复疗效中的应用价值。方法收集2010年3月-2011年3月在本院康复医学科就诊,并进行综合康复治疗的61例脑瘫患儿基本临床资料。患儿均在入院时采用粗大运动功能分级系统(GMFCS)评定患儿粗大运动功能级别,61例患儿122只外翻足采用JPD1600型足底压力测量仪对足底的5个区域进行数据采集,取得足底压力及着地时相等指标,经过6个月的综合康复治疗后,再次评估上述指标,将治疗前后进行统计分析,综合评定康复治疗的疗效。结果足底压力测量技术采集的数据显示治疗前后足前掌外侧及足弓外侧缘压力改变均有统计学意义(Pa<0.05),足前掌内侧、足弓内侧及足跟压力改变差异均有统计学意义(Pa<0.01);后足支撑期中整足接触时相、离地时相改变差异均有统计学意义(Pa<0.01)。运用GMFCS分级统计的结果示足外翻脑瘫患儿治疗前后的运动功能改变差异有统计学意义(P<0.01)。结论综合化康复治疗可有效改善脑瘫患儿足外翻;足底压力测量技术能够为脑瘫足外翻患儿康复疗效评定提供有效的、客观的功能评估。     

二氧化碳激光联合祛疣洗剂治疗尖锐湿疣的疗效观察及护理

[目的]探讨二氧化碳（CO2）激光联合祛疣洗剂治疗尖锐湿疣的疗效。[方法]将127例尖锐湿疣病人随机分为3组：A组采用CO2激光联合祛疣洗剂治疗,B组采用CO2激光联合咪喹莫特乳膏治疗,C组单用CO2激光治疗,同时3组给予相同的护理干预措施。观察3组病人的治愈、复发及不良反应情况。[结果]A组治愈率和复发率分别为88．37％和11．63％,B组为81.40％和18．60％,C组为53．66％和46．34％;A组与B组相比,治愈率和复发率差异均无统计学意义（P〉0．05）;A组与C组相比,治愈率和复发率差异均有统计学意义（P〈0．01）。A组有3例病人发生不良反应,其发生率低于B组（P〈0．01）。[结论]CO2激光联合祛疣洗剂治疗尖锐湿疣疗效明显。     

2种血管神经皮瓣在足跟皮肤软组织缺损修复中的临床应用

目的 探讨足跟皮肤软组织缺损的修复法.方法 应用足底内侧血管神经皮瓣、腓肠神经营养血管皮瓣修复各种原因足跟皮肤软组织缺损17例.结果 移植皮瓣全部成活,随访6个月～5 a,外观满意,行走功能良好,供区愈合良好,足底内侧血管神经皮瓣感觉良好.结论 足底内侧血管神经皮瓣、腓肠神经营养血管皮瓣均为修复足跟皮肤软组织缺损的理想方法.     

斯奇康预防尖锐湿疣复发的临床疗效观察

目的:评价斯奇康预防尖锐湿疣复发的临床疗效。方法:将178例患者按双盲、随机原则分为对照组(n=89)和观察组(n=89),对照组仅采用CO2激光烧灼祛除疣体,观察组在对照组的基础上,术后肌肉注射斯奇康注射液,4周为一疗程。结果:治疗结束随访观察6个月后,对照组的治愈率为52.81%,总复发率为26.97%;而观察组的治愈率为88.76%,总复发率仅为6.74%。观察组的疗效明显优于对照组,P<0.05,差异具有统计学意义。结论:应用斯奇康治疗尖锐湿疣疗效高,无明显副作用,是尖锐湿疣理想的治疗方法,值得临床推广应用。     

Foot Pain,Plantar Pressures,and Falls in Older People: A Prospective Study

OBJECTIVES: To determine whether foot pain and plantar pressure are associated with falls in community‐dwelling older adults. DESIGN: Community‐based cohort study with 12‐month prospective falls follow‐up. SETTING: Sydney and Illawarra statistical regions of New South Wales, Australia. PARTICIPANTS: Randomly recruited, community‐dwelling adults (158 men and 154 women) aged 60 and older. MEASUREMENTS: Manchester Foot Pain and Disability Index to establish baseline foot pain and dynamic plantar pressures. Participants were then classified as fallers (n=107) or nonfallers (n=196) based on their falls incidence over the following 12 months. RESULTS: Fallers had a significantly higher prevalence of foot pain than nonfallers (57.9% vs 42.1%; chi‐square=4.0; P=.04). Fallers also generated a significantly higher peak pressure and pressure‐time integral under the foot than non‐fallers. In addition, individuals with foot pain had a significantly higher peak pressure and pressure‐time integral under the foot than those without foot pain. CONCLUSION: High plantar pressures generated during gait may contribute to foot pain and risk of falls. Providing interventions to older people with foot pain and high plantar pressures may play a role in reducing their falls risk.     

HPV prophylactic vaccination: The first years and what to expect from now

New prophylactic HPV vaccines have the power to prevent many HPV infections, thus reducing the burden of HPV-associated diseases. Two vaccines composed of HPV L1 proteins self assembled into virus-like particles (VLPs) have been developed: one containing VLPS of HPV types 6, 11, 16 and 18, while the other vaccine is composed of HPV 16 and 18 VLPs. Large phase II and III clinical trials to assess prophylactic efficacy have been conducted in which both HPV infection endpoints and disease endpoints were evaluated, particularly high-grade cervical intraepithelial neoplasia--CIN2 or CIN3--as well as vulvar and vaginal intraepithelial neoplasias--VIN or VaIN--and genital warts for the quadrivalent vaccine. Very high efficacy rates were observed in different populations that included young women between 16 and 26 years of age, and older (up to 55). More recently, the quadrivalent vaccine has been shown to be efficacious in men to prevent genital and anal infection and disease caused by the types included in the vaccine. Based on demonstrated clinical efficacy and favorable safety profile, HPV prophylactic vaccine are being introduced worldwide aiming the reduction of the morbidity and mortality of tumors caused by HPV. From 2006 when first approved in the USA, hundreds of countries have licensed the HPV vaccines, a significant proportion of which are offering the vaccine to young women in national immunization programs supported by the government. The ultimate goal is to implement worldwide cervical cancer control programs to include HPV vaccination and screening with cytology and HPV DNA testing, particularly in less-developed countries where it is most needed.     

Simple and novel method to measure distal sensory nerve conduction of the medial plantar nerve

A simple and reliable method for recording sensory nerve action potentials (SNAPs) of the medial plantar nerve is described. Medial plantar SNAPs were recorded by placing surface electrodes on the sole. Ring electrodes were used for orthodromic stimulation at the big toe. Sixty-four healthy subjects ranging in age from 13 to 81 years were examined to establish normal values. Mean amplitude for the medial plantar SNAP was 4.7 +/- 2.8 microV and mean maximum conduction velocity was 43.5 +/- 6.4 m/s. The normal values for amplitude obtained for the medial plantar SNAPs were higher than those obtained by the method of Guiloff and Sherratt, and the sensitivity of our method for diagnosis of early sensory neuropathy was relatively higher. The method should therefore be useful in the diagnosis of early sensory neuropathy.     

不同人群踝关节跖屈肌群肌肉形态与力量的相关性

背景：骨骼肌肌肉形态与力量关系密切,采用CT、核磁共振等仪器对人体骨骼肌进行活体形态测量,结合相关肌肉力量测量手段探索两者之间相关关系的报道尚不多见。 目的：对比观察不同人群肌肉形态与力量的差异,探讨踝关节跖屈肌群形态特征与肌肉收缩力量之间的关系。 设计、时间及地点：对比观察,于2006-05/12在中国医科大学附属第二医院完成。 对象：选择普通男性青年学生14人作为对照组,测试前未专门从事过力量训练;另选健将级速滑运动员10人作为运动组。所有测试对象试验期间踝关节均无损伤。 方法：采用螺旋CT对受试对象双侧小腿进行不间断连续扫描,影像分析采用Xiphoid CT专用图像分析软件,由CT图像计算得出小腿围、踝关节跖屈肌横截面积,根据体视学原理采用数值积分法计算跖屈肌群体积。采用CYBEX-NORM型多关节等速测力系统对踝关节跖屈肌群进行60,120,180,240,300 (°)/s不同角速度下的等速测试。 主要观察指标：①各组受试者跖屈肌形态及不同角速度下跖屈峰力矩和跖屈相对峰力矩的变化。②各组受试者不同角速度下跖屈峰力矩与跖屈肌群体积、最大横截面积、小腿围相关性。 结果：①与对照组相比,运动组跖屈肌最大横断面积、体积和小腿围均显著增大(P < 0.05)。在踝关节等速向心测试中,运动组的跖屈向心峰力矩在每一个角速度下均显著高于对照组(P < 0.05),但随着关节运动角速度的增加,对照组和运动组的跖屈向心峰力矩都相应地减小,②在不同的角速度下,跖屈肌群最大横截面积、肌肉体积、小腿围与跖屈峰力矩之间均具有显著的正相关性(r > 0.725,P < 0.05~0.01)。 结论：跖屈肌群峰力矩变化趋势与肌肉形态相一致,肌肉形态可作为观测肌力变化的一个重要参考指标。