(扌衮)法探讨

本文就如何正确掌握Ｇｕｎ法的要领进行探讨。认为：首先要正确理解滚法旋转屈伸的含义掌握Ｇｕｎ法外旋带屈曲，屈曲偶外旋；腕伸带内旋，内旋偶腕伸的要领。其次，要正确掌握Ｇｕｎ法“度”的概念，Ｇｕｎ全过程应分为外旋阶段、屈曲阶段、收势阶段、回复过伸阶段四个部分，并强调每个阶段的“力”应量度而施。     

拇对掌功能重建术的对比性研究

目的用18种动力腱模拟拇对掌功能重建术，术后评价不同种动力腱的手术效果，为临床选择动力腱和手术操作提供参考。方法在8具新鲜成人尸体上肢标本上，利用18块动力腱，分别模拟拇对掌功能重建手术，术后测量第一掌骨的外展、旋前及屈曲角度，拇指近节的外展、旋前、屈曲及桡偏角度，以及拇指远节旋前角度。结果比较18块不同动力腱的手术效果，结果显示：以小指展肌为动力腱者，拇指旋前、屈曲角度最大；以屈肌支持带（腕横韧带）为滑车动力腱者，拇指外展、桡偏角度最大，差异有统计学意义（P〈0．05）。在以手外在肌为动力腱的拇对掌重建手术中，主要采用了以尺侧腕屈肌腱、屈肌支持带为滑车以及绕经尺骨三种方式，以此分为三组进行比较。结果显示：这三组组内差异无统计学意义（P〉0．05），而组间差异有统计学意义（P〈0．05）。术后绕经尺骨组，拇指旋前、屈曲角度最大；屈肌支持带为滑车组，拇指外展、桡偏角度最大。结论动力腱作用力方向的不同，可影响拇指的对掌角度，若动力腱方向与拇短展肌方向一致，外展及桡偏角度最大；若动力腱与第一掌骨所成角度越大，旋前及屈曲角度就越大。     

旋后肌综合征的手法治疗

旋后肌综合征在西医历来主张手术治疗,而手法治疗则未见报道,作者于1987年至1988年间,用中医手法治疗两例由肘部软组织损伤粘连造成的旋后肌综合征,疗效满意,现报告如下：病例一、张××,男,32岁,武术爱好者,一次用右掌尺侧击砖后觉右肘部疼痛,以后渐感右腕背仲受限,伸指无力。曾经西药治疗二月效果欠佳。既往右上肢无麻木疼痛乏力史。查：右肘关节屈伸正常,肘窝下2cm处有压痛及硬结,右前臂旋后稍受限；右腕稍桡偏,屈曲正常,背伸25度；各手指收展及屈曲正常,但不能完全伸直；右前臂及手感觉无障碍。颈椎照片未见异常,考虑系右旋后肌腱弓撕裂后痕压迫桡神经深支所致,用手法治疗五周,右前臂旋后功能及腕、手背伸力恢复正常。     

肘关节侧方脱位2例报告

例1男,23岁,因车祸致右肘关节畸形,活动障碍伴环、小指电灼样麻木感。查体:右肘关节外翻畸形,屈肘位,肘后三角改变,鹰嘴在关节外侧扪及,鹰嘴窝空虚,右尺侧一个半指痛觉迟钝。X线片示:右肘关节外侧方脱位,尺骨鹰嘴冠状突卡于肱骨外髁侧方,桡骨小头完全脱位,伴内髁撕脱骨折,骨块在滑车下。 例2女,15岁,武术学校学生。做侧空翻时跌伤致左肘关节畸形,活动受限。查体:左肘关节呈前臂旋前屈曲外翻畸形,肘后三角改变,尺骨鹰嘴于外下方扪及,鹰嘴窝空虚。X线示:左肘关节外侧方脱位,桡骨小头卡于肱骨外上髁的侧方,尺骨鹰嘴脱于后外下方。 讨论 当上肢后伸,前臂旋前,肘关节屈曲,腕背伸     

拇指对掌功能重建

拇指所在的第一指列占全手功能的40％,主要机理在于拇指可做垂直于手掌的轴向运动,使拇指与其它手指相对,从而产生抓握和对捏的动作。完成这一动作的解剖基础是多方面的,骨关节基础有三个：第一腕掌关节为鞍状关节,对掌时产生外展、旋前、背伸继而屈曲;拇指掌指关节为屈戍关节,对掌时产生桡偏、旋前与屈曲;指间关节为合页关节,对掌时产生屈曲,由于近节指骨远侧髁不等大,伴随屈曲时末节有轻度旋前。软组织基础是第一腕掌关节与掌指关节及指间关节的关节囊、韧带的稳定结构。对于拇指对掌的动力基础一直都存在争议,Duchnenne认为是拇短展肌、拇短屈肌、拇对掌肌;     

旋后肌变性致骨间后神经卡压征一例报道

患者　女 ,15岁。患者于记事起就发现左手 3～ 5指屈曲畸形 ,不能伸指。 2年前来本院就诊。局部检查发现 :左侧伸腕时无力并伴有桡偏 ,3～ 5指不能主动伸指。拇指外展无力 ,拇、示指伸指基本正常。诊断为骨间后神经卡压征 ,因家属不同意手术而未住院。半年后患者拇指不能伸指 ,屈曲于掌心位 ;仅有示指能伸 ,功能严重受限。于 2 0 0 0年 1月 2日入院手术。局部检查 :左手伸腕时无力并出现桡偏 ,拇指处于内收屈曲位 ,3～ 5指屈曲畸形 ,拇、中环小指伸肌肌力Ｍ0 ,示指伸肌肌力Ｍ4 。左手无感觉障碍。前臂肱骨外上髁下方 4ｃｍ处明显压痛 ,并可…     

背手位手法整复治疗肱骨干外旋型骨折

肱骨干螺旋骨折可分为外旋型和内旋型二型，其中外旋型较多见。1994年～1995年间，我们采用背手位手法整复治疗肱骨干外旋型骨折10例，取得了较满意的疗效，现报告如下。临床资料本组10例中男7例，女3例；年龄25～54岁；均为外展外旋的间接暴力致伤，角度为30”～60”，其中掰腕损伤2例，冲击伤8例。治疗方法患者端坐位或站立位，肘关节于胸前屈曲90”。术者一手握住肘关节，轻柔地顺肽骨力线牵引，并将肽骨内股向前推顶，另一手掌向后推顶骨折部的远端，以纠正向外侧成角，推顶力量视原骨折成角大小而定。在牵引下逐渐伸肘内旋，绕过身体侧…     

双侧髋关节同时前后脱位1例

患者,男,55岁,敲击拆墙时被侧方倒落墙体压伤致双下肢活动不能及头皮出血2h入院。体检：右下肢内收、内旋、短缩畸形,左下肢外旋、外展屈曲畸形,双侧髋关节弹性固定,不能活动。双下肢感觉无殊,双足背伸跖屈肌力正常,头皮7cm裂伤伴活动性出血。     

斜方肌胸大肌移位重建三角肌功能观察报告

斜方肌胸大肌移位重建三角肌功能观察报告高超，李继英，孙辉峰，于振中，王新标，刘丽华三角肌是肩关节外展功能的主要动力，兼有前屈、内旋、后伸、外旋作用。当三角肌瘫痪时，即使肘、腕和手的功能良好，上肢功能也会受到很大限制。因此重建三角肌的功能历来被广大外科...     

拇对掌功能重建的新方法

目的 介绍一种简单、有效的拇对掌功能重建新方法。方法 对8例拇对掌功能丧失的患者，采用尺侧腕伸肌为动力肌，拇长伸肌腱改道后(沿拇短展肌方向作一皮下隧道，将拇长伸肌腱沿皮下隧道引至腕上1cm处掌尺侧直切口内)，牵拉改道后之拇长伸肌腱，使拇指呈对掌旋前伸拇位时，将拇长伸肌腱与尺侧腕伸肌腱作编结缝合重建拇对掌功能。结果 术后随访4～11个月，平均8．5个月，8例的拇对掌功能均恢复，达100％的有效率。除1例伸拇功能有轻微影响外，余7例均无明显障碍。结论 该术式是一种简单、有效而可靠的重建拇对掌功能的新方法。     

The range of joint motions of the extremities in healthy Japanese people--the difference according to the age (author's transl)]

The passive range of motion was measured in the shoulder, elbow, forearm, wrist, hip, knee and ankle joints in 624 healthy Japanese persons ranging from the neonatal to 80 years of age, by the method formally decided by the Japanese Orthopaedic Association and the Japanese Association of Rehabilitation Medicine in 1974, followed by a statistical analysis. 1. The joint motions, the range of motion value of which being remarkably different by age, were found among the movements in external rotation and horizontal abduction of the shoulder, extension, abduction, adduction, external rotation, internal rotation of the hip and dorsiflexion of the ankle. 2. Elbow flexion, forearm pronation and supination, wrist dorsiflexion and knee flexion showed little change by age. 3. Extension, external rotation and horizontal abduction of the shoulder, dorsiflexion of the wrist, flexion of the hip, flexion of the knee and dorsiflexion and plantar flexion of the ankle gave values exceeding the normal range indicated by the associations. 4. The fluctuation in the range of joint motion was especially wide in the infant and the aged person.     

Wrist stability after experimental traumatic triangular fibrocartilage complex lesions

PURPOSE: The aim of this study was to evaluate changes in stability of the wrist after experimental traumatic triangular fibrocartilage complex lesions. METHODS: Sixteen cadaver wrist specimens were included: 8 were fixed in neutral rotation of the forearm, 4 in maximal supination, and 4 in maximal pronation. The specimens were tested in a multiangle and torque measuring instrument. First the intact specimen was tested, second a dorsal arthrotomy was performed, and the third test was with 1 of 4 different experimental lesions according to Palmer's classification of traumatic triangular fibrocartilage complex lesions (1A-1D). Forced radioulnar deviation and internal/external rotation were recorded with a load of 0.75 Nm in the interval -60 degrees to +60 degrees of flexion. RESULTS: We found the 1C lesion to be highly significantly related to wrist stability. Forced radioulnar deviation and forced internal/external rotation were altered significantly in 35 degrees of wrist extension. The other lesions did not alter the stability of the wrist significantly and the rotation of the forearm had no influence on the outcome. CONCLUSIONS: The 1A lesion does not alter significantly wrist stability and hence the common treatment by a two-third excision of the central part of the disk will not affect wrist stability. A 1C lesion alters significantly the stability of the wrist. At 35 degrees of wrist extension forced radioulnar deviation and forced internal/external rotation were altered significantly; this might be used in a clinical test for a 1C lesion. The rotation of the forearm has no influence on the outcome.     

Range of motion and stroke frequency differences between manual wheelchair propulsion and pushrim-activated power-assisted wheelchair propulsion

BACKGROUND/OBJECTIVE: The objective of this study was to examine the use and efficacy of a pushrim-activated power-assist wheelchair (PAPAW) in the reduction of upper extremity range of motion (ROM) and stroke frequency in manual wheelchair users. METHODS: Ten manual wheelchair users were evaluated using a repeated-measures design with and without the use of a PAPAW for maximum ROM of shoulder flexion/extension, abduction/adduction, internal/external rotation, and horizontal flexion/extension; elbow flexion/extension; wrist flexion/extension, supination/pronation, and ulnar/radial deviation; and stroke frequency. Participants propelled a Quickie 2 manual wheelchair configured as a PAPAW and their own wheelchair on a computer-controlled dynamometer at 3 different resistance levels and 2 different speeds. RESULTS: The use of the PAPAW significantly (P < 0.05) decreased shoulder flexion/extension and horizontal flexion/extension, elbow flexion/extension, and wrist flexion/extension and ulnar/radial deviation for many speed and resistance combinations. Univariate analysis revealed that stroke frequency was unaltered in all cases. CONCLUSION: These findings provide the foundation for studying the utility of the PAPAW in reducing the risk of upper limb injury and neuropathy in the manual wheelchair user population.     

ACL forces and knee kinematics produced by axial tibial compression during a passive flexion–extension cycle

Application of axial tibial force to the knee at a fixed flexion angle has been shown to generate ACL force. However, direct measurements of ACL force under an applied axial tibial force have not been reported during a passive flexion–extension cycle. We hypothesized that ACL forces and knee kinematics during knee extension would be significantly different than those during knee flexion, and that ACL removal would significantly increase all kinematic measurements. A 500 N axial tibial force was applied to intact knees during knee flexion–extension between 0° and 50°. Contact force on the sloping lateral tibial plateau produced a coupled internal + valgus rotation of the tibia, anterior tibial displacement, and elevated ACL forces. ACL forces during knee extension were significantly greater than those during knee flexion between 5° and 50°. During knee extension, ACL removal significantly increased anterior tibial displacement between 0° and 50°, valgus rotation between 5° and 50°, and internal tibial rotation between 5° and 15°. With the ACL removed, kinematic measurements during knee extension were significantly greater than those during knee flexion between 5° and 45°. The direction of knee flexion–extension movement is an important variable in determining ACL forces and knee kinematics produced by axial tibial force. © 2013 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 32:89–95, 2014.     

Range Of Motion And Stroke Frequency Differences Between Manual Wheelchair Propulsion And Pushrim-Activated Power-Assisted Wheelchair Propulsion

Abstract

Background/Objective: The objective of this study was to examine the use and efficacy of a pushrim-activated power-assist wheelchair (PAPAW) in the reduction of upper extremity range of motion (ROM) and stroke frequency in manual wheelchair users.

Methods: Ten manual wheelchair users were evaluated using a repeated-measures design with and without the use of a PAPAW for maximum ROM of shoulder flexion/extension, abduction/adduction, internal/external rotation, and horizontal fle xion/extension; elbow flexion/extension; wrist flexion/extension, supination/pronation, and ulnar/radial deviation; and stroke frequency. Participants propelled a Quickie 2 manual wheelchair configured as a PAPAW and their own wheelchair on a computer-controlled dynamometer at 3 different resistance levels and 2 different speeds.

Results: The use of the PAPAW significantly (P < 0.05) decreased shoulder flexion/extension and horizontal flexion/extension, elbow flexion/extension, and wrist flexion/extension and ulnar/radial deviation for many speed and resistance combinations. Univariate analysis revealed that stroke frequency was unaltered in all cases.

Conclusion: These findings provide the foundation for studying the utility of the PAPAW in reducing the risk of upper limb injury and neuropathy in the manual wheelchair user population.     

In vivo flexor tendon forces increase with finger and wrist flexion during active finger flexion and extension.

The effects of different hand motions and positions used during early protected motion rehabilitation on tendon forces are not well understood. The goal of this study was to determine in vivo forces in human flexor digitorum profundus (FDP) and flexor digitorum superficialis (FDS) tendons of the index finger during active unresisted finger flexion and extension. During open carpal tunnel surgery (n = 12), flexor tendon forces were acquired with buckle force transducers, and finger positions were recorded on video while subjects actively flexed and extended the fingers at two different wrist angles. Mean in vivo FDP tendon forces varied between 1.3N +/- 0.9 N and 4.0 N +/- 2.9 N while mean FDS tendon forces ranged from 1.3N +/- 0.5 N to 8.5 N +/- 10.7 N. FDP force increased with active finger flexion at both wrist angles of 0 degrees or 30 degrees flexion. FDS force increased with finger flexion when the wrist was in 30 degrees flexion, but was unchanged when the wrist was in 0 degrees of flexion. Tendon forces were similar regardless of whether the fingers were moving in the flexion or extension direction. Active finger flexion and extension with the wrist at 0 degrees and 30 degrees flexion may be used during early rehabilitation protocols with limited risk of repair rupture. This risk can be further decreased for a FDS tendon repair by reducing wrist flexion angle.     

Tibiofemoral movement 1: the shapes and relative movements of the femur and tibia in the unloaded cadaver knee

In six unloaded cadaver knees we used MRI to determine the shapes of the articular surfaces and their relative movements. These were confirmed by dissection. Medially, the femoral condyle in sagittal section is composed of the arcs of two circles and that of the tibia of two angled flats. The anterior facets articulate in extension. At about 20 degrees the femur 'rocks' to articulate through the posterior facets. The medial femoral condyle does not move anteroposteriorly with flexion to 110 degrees. Laterally, the femoral condyle is composed entirely, or almost entirely, of a single circular facet similar in radius and arc to the posterior medial facet. The tibia is roughly flat. The femur tends to roll backwards with flexion. The combination during flexion of no anteroposterior movement medially (i.e., sliding) and backward rolling (combined with sliding) laterally equates to internal rotation of the tibia around a medial axis with flexion. About 5 degrees of this rotation may be obligatory from 0 degrees to 10 degrees flexion; thereafter little rotation occurs to at least 45 degrees. Total rotation at 110 degrees is about 20 degrees, most if not all of which can be suppressed by applying external rotation to the tibia at 90 degrees.     

A dynamic extensor brace reduces electromyographic activity of wrist extensor muscles in patients with lateral epicondylalgia

STUDY DESIGN: Semiexperimental study. OBJECTIVE: To investigate the effect of an external wrist extension force on extensor muscle activity during hand gripping in patients with lateral epicondylalgia. BACKGROUND: Lateral epicondylalgia or "tennis elbow" is a common, often disabling ailment affecting millions of people. An optimal treatment strategy remains to be identified. The use of an external wrist extension force may reduce the extensor muscle activity during gripping in these patients. METHODS: Muscle activity of the extensor carpi radialis brevis (ECRB), extensor digitorum communis (EDC), and extensor carpi radialis longus (ECRL) was measured using surface EMG. Subjects gripped at an intensity of 10%, 20%, and 30% of the maximum voluntary contraction (MVC) force with and without the dynamic extensor brace and with and without an applied external wrist extension force of 1%, 2%, and 3% of MVC. RESULTS: At all levels of MVC gripping, the EMG signal of the ECRB and EDC were significantly lower for gripping with than without brace. An extension force of 3% of the MVC force significantly reduced the EMG signal of all muscles in almost all measurement conditions. CONCLUSIONS: The results of this study indicate that the dynamic extensor brace as well as the external extension force significantly reduced the EMG signal of the wrist extensor muscles during gripping in patients with lateral epicondylalgia. Based on these results, the dynamic extensor brace could be a promising new intervention for lateral epicondylalgia.     

陈旧性桡骨远端骨折治疗20例

目的 通过对20例陈旧性桡骨远端的治疗及术后功能评价总结陈旧性桡骨远端骨折的治疗方法.方法 2017年1月-2018年10月,采用单侧或双侧切开复位内固定或内外固定加外固定治疗陈旧性桡骨远端骨折20例.均为闭合性骨折,按AO分型:A2型1例,A3型2例,B1型2例,C1型12例,C3型3例.所有患者均为手法复位不满意者...