Difference in cortical activation during use of volar and dorsal hand splints:a functional magnetic resonance imaging study

There have been no studies reported on the difference in cortical activation during use of volar and dorsal hand splints. We attempted to investigate the difference in cortical activation in the somatosensory cortical area during use of volar and dorsal hand splints by functional magnetic resonance imaging (fMRI). We recruited eight healthy volunteers. fMRI was performed while subjects who were iftted with volar or dorsal hand splints performed grasp-release movements. Regions of interest were placed on the primary motor cortex (M1), primary somatosensory cortex (S1), posterior parietal cortex (PPC), and secondary somato-sensory cortex (S2). Results of group analysis of fMRI data showed that the total numbers of activated voxels in all ROIs were significantly higher during use of volar hand splint (3,376) compared with that (1,416) during use of dorsal hand splint. In each ROI, use of volar hand splint induced greater activation in all ROIs (M1:1,748, S1:1,455, PPC:23, and S2:150) compared with use of dorsal hand splint (M1:783, S1:625, PPC:0, and S2:8). The peak activated value was also higher during use of volar hand splint (t-value:17.29) compared with that during use of dorsal hand splint (t-value:13.11). Taken together, use of volar hand splint induced greater cortical activation relevant to somatosensory function than use of dorsal hand splint. This result would be important for the physiatrist and therapist to apply appropriate somatosensory input in patients with brain injury.     

手法复位夹板外固定治疗小儿尺桡骨双骨折32例

目的:观察手法复位夹板外固定治疗小儿尺桡骨双骨折的临床疗效。方法:对32例尺桡骨双骨折的患儿采用手法复位夹板外固定治疗。结果:32例患儿中25例一次性整复成功;术后复查X线片示骨折解剖复位18例,功能复位14例;随访时间2～5月,所有患儿骨性愈合,骨折临床愈合时间3～5周,平均4.2周。患肢前臂及腕关节功能良好,未出现后遗症及并发症。结论:手法复位夹板外固定治疗小儿尺桡骨双骨折具有创伤小、固定优良且花费少的特点,可以获得满意的临床疗效。     

手法整复屈肘90°纸夹板外固定治疗Ⅰ型肱骨小头骨折

目的：探讨手法整复Ⅰ型肱骨小头骨折的动作要点及纸夹板体系固定特点。方法：自2000年4月至2008年2月手法治疗Ⅰ型肱骨小头骨折27例,男23例,女4例;年龄5～14岁,平均8.9岁;病程1～23h,平均5.4h。术前患肘均肿胀、功能障碍。X线片示肱骨小头骨折块不同程度分离、翻转移位。整复时找到正确的复位着力点,整复动作准确、连贯、稳定并配合前臂及肘关节的被动动作,屈肘90°以纸夹板体系固定。所有患者以JOA肘关节功能评价法进行功能评分。结果：27例均获随访,时间6个月～2年,平均17个月。肘关节均无痛,活动度、功能均正常,肘关节均无动摇性。整复后未出现并发症。25例断端达到或接近解剖对位愈合,2例出现轻度肘外翻畸形。JOA评分100分25例,97分2例。结论：手法整复屈肘90°纸夹板外固定治疗Ⅰ型肱骨小头骨折稳定性强、成功率高、固定牢固、轻便且不会出现组织压疮及坏死。     

Treatment of carpal tunnel syndrome

Fifty years after its widespread recognition, a significant minority of patients with carpal tunnel syndrome continue to experience poor outcomes from treatment. Much current treatment is supported by an inadequate or nonexistent evidence base. Surgical decompression, often considered the definitive solution, gives excellent results in only 75% of cases in ordinary practice and leaves 8% of patients worse than previously. The only other interventions that are clearly of benefit are neutral-angle wrist splinting, with a success rate of 37%, and steroids, which are better given by local injection than as oral treatment. The initial response rate to injection is 70% but there are frequent relapses. Nevertheless, these conservative treatments have a negligible incidence of serious complications and should be used more widely until surgical failures can be reduced to similar levels.     

Changes in Occlusal Relationships in Mixed Dentition Patients Treated with Rapid Maxillary Expansion: A Prospective Clinical Study

Objective:To prospectively measure occlusal changes in mixed dentition patients who underwent a standardized early expansion protocol.Materials and Methods:The treatment sample consisted of 500 patients who were assigned to three groups according to molar relationship: Class I (n  =  204), end-to-end (n  =  166), and Class II (n  =  130). All patients were treated with a bonded rapid maxillary expander (RME) followed by a removable maintenance plate and a transpalatal arch. Mean age at the start of treatment was 8.8 years (T₁), with a pre–phase 2 treatment cephalogram (T₂) taken 3.7 years later. The control sample consisted of the cephalometric records of 188 untreated subjects (Class 1, n  =  79; end-to-end, n  =  51; Class II, n  =  58).Results:The largest change in molar relationship was noted when the Class II treatment group (1.8 mm) was compared with the matched control group (0.3 mm). A positive change was seen in 81% of the Class II treatment group, with almost half of the group improving by ≥2.0 mm. The end-to-end treatment group had a positive change of 1.4 mm, compared with a control value of 0.6 mm, and the Class I group of about 1 mm compared with controls, who remained unchanged (0.1 mm). Skeletal changes were not significant when any of the groups were compared with controls.Conclusion:The expansion protocol had a significantly favorable effect on the sagittal occlusal relationships of Class II, end-to-end, and Class I patients treated in the early mixed dentition.     

Unilateral or "side-locked" migrainous headache with autonomic symptoms linked to night guard use

Night guards are commonly prescribed as a palliative measure for bruxism, temporomandibular joint symptoms, and associated disorders. We describe a patient with a 10- to 12-year history of night guard use with concurrent unilateral side-locked migrainous headaches with autonomic symptoms characteristic of trigeminal autonomic cephalgia. These headaches were refractory to numerous pharmacological interventions. Upon self-initiated cessation of night guard use, there was complete remission of headaches. We believe the headaches were initiated by night guard-initiated irritation of the trigeminal nerve and a trigeminal autonomic reflex resulting in unilateral migrainous headache with autonomic signs.     

个体化牙周夹板在治疗儿童下颌骨骨折中的应用

目的探讨个体化牙周夹板在治疗儿童下颌骨骨折中的治疗效果。方法选择儿童下颌骨颏部及颏孔区骨折15例病例,取得印模,灌注石膏模型,制作牙周夹板,采用颌周固定术,观察疗效。结果15例患儿均恢复正常咬关系,骨折愈合。结论个体化牙周夹板是治疗儿童下颌骨骨折的一种简单易行、效果可靠的方法。     

Arthrocentesis versus non-surgical intervention as initial treatment for temporomandibular joint arthralgia: a randomized controlled trial with long-term follow-up

Arthrocentesis for arthralgia of the temporomandibular joint (TMJ) is often only indicated when conservative, non-surgical interventions have failed. However, performing arthrocentesis as initial therapy may facilitate earlier and better recuperation of the joint. The aim of this study was to assess the efficacy of this therapy with a long-term follow-up. Eighty-four patients were randomly allocated to receive either arthrocentesis as initial treatment (n = 41) or non-surgical intervention (n = 43). Pain (100-mm visual analogue scale, VAS) and mandibular function impairment questionnaire scores (MFIQ, 0–100) were recorded at 3, 12, and 26 weeks, and ≥ 5 years (median 6.2, interquartile range 5.6–7.4 years). Univariable analyses were performed and linear mixed-effect models were constructed. Patients in the arthrocentesis group experienced significantly lower TMJ arthralgia compared to those treated non-surgically (pain during movement: −10.23 mm (95% confidence interval −17.86; −2.60); pain at rest: − 8.39 mm (95% confidence interval −13.70; −3.08)), while mandibular function remained similar in the two groups (MFIQ −2.41 (95% confidence interval −8.61; 3.78)). Of the final sample, 10 patients (10/39, 26%) in the non-surgical intervention group and two patients (2/34, 6%) in the arthrocentesis group received additional treatment during follow-up. Thus, initial treatment with arthrocentesis reduced TMJ arthralgia more efficaciously than non-surgical intervention in the long term, while maintaining similar mandibular function.     

皮牵甩臂疗法治疗肱骨外科颈骨折44例

[目的]观察皮牵甩臂疗法治疗肱骨外科颈骨折的疗效。[方法]将66例肱骨外科颈骨折患者随机分为皮牵甩臂治疗组和夹板固定对照组,观察骨折复位情况与肩关节活动情况,并进行比较。[结果]两组间骨折复位疗效评定结果差异无显著性(P>0.05),但肩关节活动疗效评定结果间差异具有显著性(P<0.01)。[结论]皮牵甩臂疗法和夹板固定疗法均具有良好的骨折复位效果,但皮牵甩臂疗法对于肩关节功能的恢复具有更好的疗效。