合并异位骨化的关节功能康复治疗

目的：探讨骨关节手术后合并异位骨化患者的康复治疗方法。方法：对15例关节手术后合并较小范围异位骨化的关节功能障碍的患者，用X光片、B超检查异位骨化的范围；检测血沉、血液碱性磷酸酶和C反应蛋白，判断骨化活动情况，视情况进行适当的关节牵伸和关节松动治疗及冷疗、中药外敷等治疗，观察异位骨化的变化。结果：治疗前后膝关节活动范围有显著差异，平均角度进展31.16°（P＜0.01），肘关节伸直角度平均进展15°，肘关节屈曲进展41.67°。同时X线片和B超检查异位骨化范围无明显变化。结论：关节手术后合并异位骨化的患者在监测下采用关节牵伸和松动，并配合冷疗、中药外敷等综合治疗，可以逐步改善关节功能而不引起骨化范围扩大。     

异位骨化早期影像诊断初探

目的探讨异位骨化的早期影像表现。方法分析30例康复患者异位骨化的影像表现并复习文献。结果 X线和CT检查早期异位骨化表现为关节周围软组织水肿、密度增高;异位骨化的不同阶段MRI呈现不同的信号特点,早期表现为等或长T1长T2信号,增强扫描边缘呈"花边样"强化。结论异位骨化的不同阶段有不同的影像学特点,磁共振为诊断早期异位骨化的有效方法,X线和CT检查可用于复查。     

神经源性骨化性肌炎1例影像学表现并文献复习

神经源性骨化性肌炎（neurogenic myositis ossification,NMO）是指因中枢神经系统遭受严重损伤,而在四肢关节周围软组织内出现的异位骨化（helerotopic ossification）。根据形成原因,异位骨化可分为3类：创伤性异位骨化,神经源性异位骨化,原发性异位骨化,NMO是异位骨化的一种类型。异位骨化可发生于身体任何部位,通常在重要关节,如髋、膝关节等关节,尤其是髋关节。     

异位骨化的治疗进展

异位骨化（heterotopic ossification,HO）是指正常情况下非钙化组织发生新骨形成、关节周围软组织中出现成熟板层状骨的现象。多半发生在大关节周围,例如髋关节,肘关节。包括继发于肌肉、骨骼损伤后的异位骨化,创伤后神经源性异位骨化以及原发性进行性骨化性肌炎等。近年来随人工髋关节的广泛应用及人工髋臼骨折切开复位内固定的推广,异位骨化的发生率显著提高,日益受到骨科界的关注。     

冰袋冷敷对关节功能障碍恢复期的影响

目的研究冰敷疗法对各个关节功能障碍恢复期并发症减少的影响。方法对50例各种关节功能障碍康复治疗后的患者,包括人工关节松动术、推髌、肌力训练及关节牵伸等各种功能锻炼后,立即给予冰袋冷敷10～15 min。结果患者反应冰敷后疼痛减轻,查体关节无肿胀充血,超声检查无异位骨化肌炎的发生,大大缩短了病人住院时间。结论冰袋冷敷不仅可在关节创伤初期控制肿胀、疼痛,在关节功能障碍恢复期也具有很重要的意义,能进一步减少并发症,促进关节功能恢复。     

下肢关节周围骨质疏松性骨折诊疗与康复专家共识

下肢关节周围骨质疏松性骨折好发于老年人,可带来运动功能丢失、骨缺损、内固定丢失等风险。区别于常规骨折的术后康复,下肢关节周围骨折要求良好的手术与康复治疗以恢复运动功能,而骨质疏松性骨折要求充分的医患沟通与个性化康复以规避内固定丢失风险。本共识着眼于下肢关节周围骨质疏松性骨折的特殊性,旨在平衡康复训练要求与安全性,促进下肢关节周围骨质疏松性骨折个性化诊疗与康复的推广普及。     

四肢关节周围骨折后的功能康复

目的 探讨四肢关节周围骨折后关节功能康复的措施与长期效果.方法 针对四肢关节周围不同的损伤程度、不同的治疗方法、不同的内固定器材及不同的个体,制定个体化、科学化的锻炼方法.结果 随访78例经以下方法锻炼的四肢关节周围骨折内(外)固定患者6～25个月,平均18个月,按国际通用各关节评分标准:优良率占92.3%.结论 对四肢关节周围骨折经内(外)固定后早期实施综合性康复措施可有效促进受损关节功能康复.     

脊髓损伤患者骨化性肌炎的预防及康复护理

骨化性肌炎最早由Guy Patin于1692年提出,1868年由Von Dusch命名.其实质是一种异位性骨化,是发病机制不明的少见的良性局限的骨化的软组织肿块,是肌肉及其邻近结构的局限性的、含有非肿瘤性的钙化和骨化的病变….脊髓损伤后骨化性肌炎据研究[2]报道其发病率为10%-53%,脊髓损伤患者的异位骨化属于神经源性,好发于髋关节前方,也可发生于膝、肩、肘关节等处.严重的骨化性肌炎可以限制关节活动,甚至造成关节强直,使关节丧失活动功能,因而加重了脊髓损伤患者的痛苦,影响其康复治疗的进展和效果.鉴于骨化性肌炎是一种可以防治的并发症,因此在临床护理工作中的预防和康复具有重要的意义.现报道如下.     

创伤性异位骨化的预防与治疗研究进展

异位骨化(heterotopic ossification)是指关节周围软组织中出现成熟的板层状骨的现象,也称关节周围骨化或关节周围新骨形成.其主要特点是在软组织中钙化骨迅速形成,可引起复杂性区域疼痛综合征、关节僵硬、神经嵌压、骨质疏松、压迫性溃疡等并发症.     

髋关节术后关节周围大量异位骨化的治疗

目的：通过对髋关节术后异位骨化的发生、发展及其引起的后果的分析，探讨对异位骨化的预防和治疗方法。方法：回顾2000年1月至2007年3月56例患者患者髋关节手术（其中髋臼骨折手术46例，髋关节置换术10例）的治疗方法和效果。结果：56例患者中共发生异位骨化21例，发生率37．5％。结论：髋关节术后异位骨化应早预防，早期行放射治疗或者药物治疗。非甾体类消炎药是目前公认的预防人工髋关节置换和髋臼骨折术后异位骨化形成的最有效药物。手术切除是异位骨化形成后导致严重关节功能障碍的唯一治疗手段     

Pseudoarthrosis in heterotopic ossification in spinal cord-injured patients

Heterotopic ossification (HO) of proximal joints is a common complication of spinal cord injury, traumatic brain injury, and burns, and is also seen among an array of other clinical conditions. Of the patients with HO, 3-8% develop ankylosis of the joint involved. Although the etiology of HO is not known, the main goal in its management is to retain the maximum possible functional range of movement in the joint involved. Toward this end, surgical resection of HO with etidronate disodium treatment to mobilize ankylosed joints has been reported, as has forceful joint manipulation in head-injured adults with HO. This paper presents two cases of extensive HO formation around hip and knee joints in patients who developed pseudoarthrosis. Cinradiographic assessment of the joints involved revealed pseudoarthrosis formation at the same axis as the normal anatomical plane of the joint, thus permitting functional range of movement.     

Disodium etidronate: its role in preventing heterotopic ossification in severe head injury

Heterotopic ossification (HO) occurs in up to 75% of patients who survive severe head injury and is a major factor in prolonging their rehabilitation. Prevention of HO has not been emphasized in acute care management of patients with head injury. But with spinal cord injuries and total hip arthroplasty, HO has been prevented by use of disodium etidronate (EHDP). This study compares the incidence and severity of HO in 10 patients with severe head injury who were treated with EHDP and 10 matched controls without drug treatment. Patients selected for EHDP treatment were consecutive admissions who had Glasgow Coma Scores (GCS) less than nine. Treatment was begun within two to seven days of injury with 20mg/kg/day via nasogastric tube and was discontinued if the patient awakened within two weeks (low risk of HO). After three months EHDP was given orally at 10mg/kg/day for an additional three months. Ten patients completed the treatment regime and were compared to 10 patients with similar injuries. Of the 10 patients treated with EHDP, two developed HO, while clinically significant HO was found in seven of the 10 nontreated patients (chi square = p less than 0.025). This finding could not be explained on the basis of differences in the two groups; the groups were alike in age, sex, length of coma, extracranial fracture, spasticity, type of head injury, and injury severity (GCS). These data suggest that HO may be prevented by early use of EHDP, and the results warrant further clinical trials.     

Attitudes of healthcare professionals regarding different modalities used to manage acute postoperative pain

The education and perceptions of healthcare professionals regarding pain are important in acute postoperative pain management. A survey was designed to assess healthcare providers’ knowledge and beliefs regarding the use of epidural analgesia (EA) or patient controlled analgesia (PCA) for acute postoperative pain management.Completed questionnaires were obtained from 46 (72%) third and fourth year medical students (MS) prior to their lecture on pain management. Forty-seven percent of the MS felt that EA provided superior analgesia to PCA. Seventy percent of the MS believed that naloxone had a longer duration of action than morphine. Completed questionnaires were received from 38 (63%) anesthesiology house officers (HO) from all levels of clinical anesthesia (CA) training. Sixty-eight percent of the HO felt that EA provided superior analgesia to PCA. The HO correctly responded that the duration of naloxone was shorter than morphine. Completed questionnaires were received from 20 (59%) post anesthesia care unit (PACU) nurses (RN). Fifty percent of the RN reported that EA provided superior analgesia to PCA. Eighty percent of the RN responded correctly that naloxone had a shorter duration than morphine. Our data suggests that lack of knowledge and fear of side effects may negatively affect pain management [Acute Pain 4 (1) (2001) 17].     

Heterotopic ossification as an unusual complication after Guillain-Barré syndrome: a case report

Ryu S-R, Kim J-H, Choi I-S, Han J-Y, Lee S-G. Heterotopic ossification as an unusual complication after Guillain-Barré syndrome: a case report.Heterotopic ossification (HO) is the abnormal development of bone within soft tissue. It is frequently encountered after traumatic brain injury or spinal cord injury, rather than lower motoneuron disease. It has been reported as a rare complication in Guillain-Barré syndrome (GBS). We present the case of a 31-year-old woman who suffered from pain and swelling with limitation of the passive range of motion on right hip joint, and who had been diagnosed with GBS about 1 year previously. She was wheelchair-bound and had incomplete tetraplegia with flaccidity. She was diagnosed as HO based on the radiologic imaging study. She did not reveal any encephalopathy-related symptoms or signs, and hypercalcemia, and/or related metabolic derangement during 1.5-year follow-up period. Owing to the paucity of other causative factors, we presumed that the long-time hypomobility, even though not accompanied by hypercalcemia, played a major role for the development of HO. Early active rehabilitative management was initiated. The outcome is not promising because of her long-standing paralyzed state; however, it was possible to prevent the aggravation of HO.     

Heterotopic ossification following burn injury: the role of stem cells

Heterotopic ossification (HO), or the abnormal development of bone tissue in soft-tissue locations, can be physically debilitating and clinically devastating. For unclear reasons, HO is highly associated with burn injury. The objective of this review is to summarize 1) cells that are responsible for HO, 2) in vitro and in vivo models of HO and how they have contributed to our current knowledge of the disease process, 3) the effects of the adipose compartment on HO, 4) the effects of inflammation on HO, and 5) the effects of mesenchymal stem cells (MSCs) on HO. Preclinical models of HO suggest several possible mechanisms for the development of this pathologic process, including progenitor cell differentiation and paracrine modulation of local inflammatory responses. Further studies are needed to elucidate the molecular mechanisms driving HO so that targeted therapies can be developed. Current literature supports a role for MSCs in modulating heterotopic bone formation, and direct manipulation of MSCs might one day be used to prevent and treat HO.     

Risk factors for heterotopic ossification in spinal cord injury

Heterotopic ossification (HO) is a complication in 16% to 53% of spinal cord injured (SCI) patients. One third of these patients have moderate to severe HO that adversely affects function or health. Pharmacologic prophylaxis of HO for all SCI patients continues to be controversial. High-risk criteria for HO formation identified in total hip replacement patients are not applicable to SCI. A review of the literature did not reveal specific risk factors for HO with SCI. The charts of 100 randomly selected SCI patients, 50 with HO and 50 without HO, were reviewed retrospectively to learn if criteria which would predict high-risk patients could be identified. A total of 14 variables, seven demographic (age, sex, race, level of lesion, completeness of lesion, cause of injury, and geographic locus of patient) and seven medical (bladder stones, fractures, pressure sores, deep vein thrombosis, pulmonary embolism, spasticity, and urinary tract infections) were studied. Four of the 14 variables (age, completeness of lesion, presence of pressure sores, and spasticity) were significantly related to HO formation. The risk factors appear to be additive. When all were present, 92% of patients were found to have HO. Before the findings are applied clinically, it is suggested that a prospective study be conducted to confirm the risk predictive value of these factors in HO.     

Heterotopic ossification in combat amputees from Afghanistan and Iraq wars: five case histories and results from a small series of patients

Heterotopic ossification (HO) is excess bone growth in soft tissues that frequently occurs in the residual limbs of combat amputees injured in Operation Iraqi Freedom and Operation Enduring Freedom, or Iraq and Afghanistan wars, respectively. HO can interfere with prosthetic use and walking and delay patient rehabilitation. This article describes symptomatic and/or radiographic evidence of HO in a patient series of combat amputees rehabilitating at a military amputee care clinic (27 patients/33 limbs). We conducted a retrospective review of patient records and physician interviews to document evidence of HO symptoms in these limbs (e.g., pain during prosthetic use, skin breakdown). Results showed HO-related symptoms in 10 of the 33 residual limbs. Radiographs were available for 25 of the 33 limbs, and a physician identified at least moderate HO in 15 of the radiographs. However, 5 of the 15 patients who showed at least moderate radiographic HO did not report adverse symptoms. Five individual patient histories described HO onset, symptoms, treatments, and outcomes. These case histories illustrated how HO location relative to pressure-sensitive/pressure-tolerant areas of the residual limb may determine whether patients experienced symptoms. These histories revealed the uncommon but novel finding of potential benefits of HO for prosthetic suspension.     

胰岛素抵抗与亚临床甲状腺功能减退症的相关性

目的探讨胰岛素抵抗与亚临床甲状腺功能减退症的相关性。方法选择37例甲状腺功能减退患者和38例甲状腺功能正常受试者,依据其空腹FT3,FT4,TSH水平分为3组:健康对照组38例、临床甲状腺功能减退组(甲减组)19例、亚临床甲状腺功能减退组(亚甲减组)18例。均给予口服葡萄糖耐量试验,检测其空腹及餐后2h血糖和胰岛素浓度。分别计算稳态模式胰岛素抵抗指数(HOMA-IR)及胰岛素敏感性指数(ISI-Matsuda)。结果和对照组相比,亚甲减组、甲减组空腹和餐后2h血胰岛素浓度均升高(P<0.05);亚甲减组和甲减组HOMA-IR比对照组升高(P<0.05);亚甲减组、甲减组ISI-Matsuda比对照组降低(P<0.01)。结论亚临床甲状腺功能减退症和甲状腺功能减退症存在胰岛素抵抗,监测或治疗此类患者可以降低胰岛素抵抗及其相关疾病的风险。     

血红蛋白氧合酶-1在急性心肌梗死中的表达

目的　观察血红蛋白氧合酶 1( HO 1)在急性心肌梗死中的表达情况。方法　选择急性心肌梗死确诊病例 4 5例及经冠状动脉造影确诊的非心肌梗死冠状动脉粥样硬化性心脏病患者 5 0例作为研究对象 ,以冠状动脉造影正常的 4 0例患者作为正常对照组。利用免疫组化方法对心绞痛患者外周血单个核细胞中HO 1的表达进行定位分析 ,并通过计算机图像分析系统分析 HO 1表达的程度及强度。通过 Western blot对 HO 1表达水平进行定量分析。结果　 HO 1表达于胞浆。冠心病患者 HO 1表达水平高于对照组 ,急性心肌梗死患者 HO 1表达明显高于非心肌梗死冠状动脉粥样硬化性心脏病患者 ( P<0 .0 1)。结论　急性心肌梗死时 ,HO 1表达水平明显升高     

小儿腭裂修复术后低氧血症的观察及护理

用脉搏血氧饱和度仪观察了160例小儿腭裂修复术后低氧血症的发生率及特点,发现有40．6％的病例发生了低氧血症,而且大部分发生在术后30min内,及时氧疗并保持呼吸道通畅是预防和纠正术后低氧血症的关键。