微创全膝关节置换术的研究进展

随着人们生活质量的提高，以及全球人口老龄化，膝关节骨性关节炎需要接受全膝关节置换（TKA）的患者逐年增加。美国每年约20多万患者进行了TKA，由于手术器械和手术操作的规范化，目前TKA的成功率很高。随着一批具有高水平研究成果的临床应用，以及微创技术的普及开展，人工关节假体设计和手术操作技术的13益成熟，与传统的大范围关节切开行TKA手术方法比较有明显优势。全美骨科年会的报告，TKAIO年以上随访的成功率在90％以上，结合术后康复训练计划的实施，避免或者减轻了髌骨粘连、固定，关节伸直受限，以及术后肿胀、肌肉萎缩等问题。     

Effect of electro-acupuncture combined with early rehabilitation on motor function and expressions of CD11b/CD18 and tumor necrosis factor-α in patients with acute cerebral infarction

Objective To observe the effect of electro-acupuncture combined with early rehabilitation on the motor function and expressions of the adhesion molecules CD11b and CD18 in the polymorphonuclear leucocytes (PMN) and monocytes and serum tumor necrosis factor-α (TNF-α) levels in patients with acute cerebral infarction (ACI). Methods A total of 165 ACI patients were randomly divided into control group (group A, n=50), conventional rehabilitation group (group B, n=50) and comprehensive rehabilitation group (group C, n=65). The expressions of CD11b and CD18 in the PMN and monocytes and serum TNF-α levels were determined before and at 1, 2, and 4 weeks after the treatment. Thirty-two healthy subjects were also recruited as the normal control group (group N). The neurological function of the subjects was evaluated by modified Edinburgh-Scandinavia stroke scale (MESSS) and Fugi-Meyer Assessment (FMA), and their activity of daily living (ADL) was assessed using Barthel index (BI). Results The CD11b/CD18 expression in the PMN and MN and serum TNF-α level in groups A, B and C were significantly higher than those in group N before and 1 week after the treatment (P<0.05). CD11b/CD18 expression and serum TNF-α level were significantly lower in groups B and C than in the group A at 1 week after the treatment, and significantly lower in group C than in group B (P<0.05). At 2 weeks of treatment, CD11b/CD18 and TNF-α were significantly lower in groups B and C than in the group A, being the lowest in group C (P<0.05). The scores of mESSS in both groups B and C were lower than that in group A, and the scores were lower in group C than in group B. Group C showed higher FMA scores than group B, both having higher scores than group A. At 4 weeks of treatment, the mESSS scores were significantly lower, hut the FMA and ADL score significantly higher in groups B and C than in the control group (P<0.05), and the differences were more obvious in group C. Groups B and C had greater effective rate than group A (P<0.05), and the rate was the highest in group C (P<0.05). Conclusion Electro-acupuncture combined with early rehabilitation promotes the recovery of motor function in ACI patients probably by regulating the expressions of the adhesion molecules CD11b and CD18 on the PMN and monocytes and the serum levels of TNF-α.     

脑卒中假性延髓性麻痹吞咽障碍的康复训练

假性延髓性麻痹是脑卒中的并发症之一,吞咽困难是其主要症状,重症者常行鼻饲以满足机体营养需求;轻症者可自行进食,但常因吞咽时误吸造成吸入性肺炎,严重影响病人生活质量.因此对假性延髓性麻痹吞咽困难患者进行正规的早期康复训练,可防止呼吸道并发症,缩短恢复时间,减少病残率,促使吞咽功能最大限度的得到恢复或代偿.本文总结了我科收治42例脑卒中导致假性延髓性麻痹性吞咽障碍患者对其进行康复训练的体会.     

脑卒中后遗症期的综合治疗

1　资料与方法1.1　一般资料　 12 0例病人均为住院病人 ,男 68例 ,女 5 2例 ,年龄 5 5岁～ 65岁 ,病程 1个月～ 3年 ,均根据《国家中医药管理局中医病症治疗诊断标准》评定。1.2　方法1.2 .1　中医中药　治以益气活血 ,祛瘀通络。方以补阳还五汤加减 ,黄芪、当归、赤勺、地龙、川芎、红花、桃仁等。1.2 .2　针刺疗法　①体针疗法　上肢瘫 :取合谷、手三里、肩骨禺、肩贞、巨骨、曲池、外关、臂月需等。下肢瘫 :取肾俞、环跳、殷门、伏兔、风市、梁丘、足三里、承山、昆仑、太溪、阳陵泉等。每日选穴 3个～ 7个 ,得气留针 2 0min～ 3 0min ,…     

脑中风患者整体护理

随着医学模式的转变,传统的以疾病为中心护理模式,已不能适应护理专业的发展,而整体护理由于它的先进性、实用性和科学性正得到全面广泛开展,它克服了以往责任制护理的弊端,受到住院患者的欢迎及护理人员的推崇。整体护理在神     

早期康复训练对脑卒中患者偏瘫肢体功能恢复的影响

脑卒中是临床常见病之一,其致残率较高,同时也给社会和家庭带来了很大的负担。如何采取正确的康复手段,以提高患者的生存质量已成为康复医学的重要课题之一。本研究通过对比观察,探讨早期康复训练对脑卒中偏瘫患者偏瘫肢体功能恢复的影响。1资料与方法1.1临床资料共选取40例在本院神经科或康复科接受治疗的急性脑卒中患者,所有患者均符合以下入选标准,即(1)首次发生脑梗死或脑出血(均符合1995年全国第四届脑血管病会议制定的诊断标准,且经CT或MRI证实);(2)伴有肢体运动功能障碍;③年龄40~80岁;④格拉斯哥昏迷量表评分>8分;⑤病程在2周以内…     

应用电刺激结合康复训练治疗足内翻、下垂临床观察

在脑卒中恢复期患者的康复训练中，常因患侧下肢痉挛、足下垂、足内翻等畸形，影响患者的进一步康复。我科运用电脑中频治疗仪作用于偏瘫下肢局部，增加其拮抗肌力量，同时结合偏瘫康复训练对上述患者进行治疗，取得了良好的疗效。