现代假肢中新结构、新材料和新工艺

现代假肢包括上肢假肢和下肢假肢两大部分。章介绍了近20年来国际假肢结构，材料工艺的最新发展，对肌电假手、智能假肢、计算机辅助设计和计算机辅助制造的应用、钛合金碳素纤维材料进行了综述，对我国当前现代假肢研究与开发中存在的问题进行了初步的探讨。     

碳纤维复合材料特性及在假肢领域的应用

假肢的质量对下肢截肢患者运动所消耗的能量有直接的影响,因此,在实际为患者装配选择假肢零部件时,应在充分考虑满足患者要求功能的前提下,尽可能选择质量轻的下肢配件.基于上述原因,一些强度高、质量轻的材料,如钛合金、超轻铝合金、碳纤维复合材料等,在设计与制造下肢假肢零部件时被广泛使用,使现代假肢功能更完善、质量更轻.其中,与前两种材料相比,碳纤维复合材料在假肢领域的开发和应用相对较晚.文章对碳纤维复合材料的特性进行综述,并重点介绍了近10年来碳纤维复合材料在下肢假肢领域中的应用,包括碳纤维假脚、踝关节、膝关节以及接受腔等.最后,对中国假肢领域需进一步研究的问题进行了初步探讨.     

国内外假肢的发展历程

背景：假肢问题是康复工程研究中的重要内容之一。目的：综述国内外假肢的发展历史。方法：应用计算机检索2001-01/2011-01中国期刊全文数据库相关文章,检索词为＂假肢,假肢发展,分类,产品＂,并限定文章语言种类为中文。同时计算机检索1980-01/2011-01IEEE/IETE lectronic Library（IEL）数据库相关文章,检索词为＂prosthetics,prosthetic development,product＂,并限定文章语言种类为English。共检索到文献206篇,最终纳入符合标准的文献16篇。结果与结论：20世纪前半期,以美国为代表的工业发达国家对假肢技术开展了大规模的研究,使得假肢的理论和实践都有了重大进展。随着工业的发展,采用合金、塑料等新型材料成功研制了各式现代假肢。由于起步较晚,中国假肢产品与国外相比还有一些差距。且由于其行业的特殊性,要求假肢工作人员必须要在多学科的协作组里与外科医生、物理治疗师、作业治疗师、心理治疗师、社会工作者等其他专业人员一起工作,从而更好的为患者服务。     

计算机远程制作大腿假肢模式的探讨

目的:探索使用专业假肢计算机辅助设计软件和制作系统远程制作大腿假肢的成功率,验证加工方法的可行性。方法:大腿截肢患者16例,分为计算机加工组和手工组各8例。手工组按照常规手工流程制作大腿假肢,计算机加工组通过互联网将大腿截肢患者残肢尺寸数据传送到计算机假肢制作加工中心,通过软件设计、制作、加工及修改后快递至假肢临床接待室给患者适配假肢。试穿假肢后,评价2组患者大腿假肢临床功能及制作时间。结果:患者穿戴假肢后,2组大腿假肢临床功能评估均达到要求,在制作流程中计算机加工组的时间效率明显提高(P<0.05)。结论:通过严谨的残肢尺寸测量并进行计算机设计和远程加工的接受腔与手工制作无明显差异。大腿假肢远程加工模式是可行的,解决了偏远地区大腿截肢患者无法制作假肢的问题。     

国内外假肢的发展历程

背景:假肢问题是康复工程研究中的重要内容之一。目的:综述国内外假肢的发展历史。方法:应用计算机检索2001-01/2011-01中国期刊全文数据库相关文章,检索词为"假肢,假肢发展,分类,产品",并限定文章语言种类为中文。同时计算机检索1980-01/2011-01IEEE/IETE lectronic Library(IEL)数据库相关文章,检索词为"prosthetics,prosthetic development,product",并限定文章语言种类为English。共检索到文献206篇,最终纳入符合标准的文献16篇。结果与结论:20世纪前半期,以美国为代表的工业发达国家对假肢技术开展了大规模的研究,使得假肢的理论和实践都有了重大进展。随着工业的发展,采用合金、塑料等新型材料成功研制了各式现代假肢。由于起步较晚,中国假肢产品与国外相比还有一些差距。且由于其行业的特殊性,要求假肢工作人员必须要在多学科的协作组里与外科医生、物理治疗师、作业治疗师、心理治疗师、社会工作者等其他专业人员一起工作,从而更好的为患者服务。     

下肢假肢零部件选择与轻量化

下肢假肢的轻量化问题主要涉及到零部件的重量、性能和截肢者的活动性(度)等方面。文内论述了截肢者的状况、零部件的性能、重量和合理选择三者之间的关系,通过对近、现代下肢假肢零部件的发展状况的回顾,从下肢假肢零部件在截肢者中实际选择、运用等角度分析了三者之间的关系。     

下肢假肢零部件选择与轻量化

下肢假肢的轻量化问题主要涉及到零部件的重量、性能和截肢的活动性（度）等方面。内论述了截肢的状况、零部件的性能、重量和合理选择三之间的关系，通过对近、现代下肢假肢零部件的发展状况的回顾，从下肢假肢零部件在截肢中实际选择、运用等角度分析了三之间的关系。     

假肢接受腔界面应力的有限元分析

假肢是用来代偿正常人体截肢部位机能和外表形状的装置,安装假肢是截肢患者恢复活动能力和外观的主要康复手段。假肢接受腔作为人与机械系统之间生物力学的界面,是截肢患者肢体残端和假肢之间载荷传递的惟一通道,必须根据患者的具体情况因人而异,以满足功能性、舒适性的要求。一个完整的残肢接受腔有限元模型包括几何模型、材料特性、载荷状况和模型边界条件。下肢残肢-假肢接受腔界面应力的有限元理论仿真要求能够达到快速建立几何模型、准确模拟不同部位的材质特性、定义人机界面的接触特征、精确施加动态载荷。假肢接受腔以人工假肢个性化制造为研究对象,运用有限元法进行生物力学分析,并集成了生物医学、三维计算机辅助设计技术和快速成型技术。     

储能假肢的原理与临床应用

通过对人体运动的生物力学分析及对储能假肢动态过程的计算机模拟研究，论述了储能假肢的原理。指出储能假肢在动力学方面有更好的仿生特征。这是储能假肢在推动人体前进方面优于传统假肢的特点。根据计算机计算结果还讨论了影响假肢储能性的各种因素。此外还介绍了我国自行研究的储能式小腿运动假肢的临床应用及实验情况．     

假肢发展对截肢观念的影响

随着科学技术的发展和对假肢研究的深入 ,现代技术条件已允许假肢达到很高的对症性 ,从而满足各种各样的残肢条件和对假肢不同的功能要求。从普及型下肢假肢到全电脑控制智能仿生腿 ,从普通的美容上肢假肢到带感应控制的肌电控制假手 ,假肢技术发展的同时又促进了截肢手术的发展 ,对原来的截肢观念产生了影响 ,从而最大限度地保留了残肢的功能 ,使截肢后的患者能更好地发挥假肢的代偿功能。1　现代假肢的发展现代假肢的发展主要集中在两个方面 ,一是假肢接受腔 ,二是假肢零部件 ,特别是功能性部件 ,如膝关节、假脚。接受腔作为患者和假肢之…     

aVR,An Index of all ECG Limb Leads,with Clinical Utility for Monitoring of Patients with Edematous States,Including Heart Failure

Background: Nonreproducibility of precordial electrocardiogram (ECG) leads in serial ECGs has led to emphasis on the limb leads for some applications. Since modern electrocardiographs measure leads I and II and calculate on line the other four limb leads, the former can substitute for the set of six limb leads. Furthermore, based on the mathematical relationship of lead aVR and leads I and II, it was hypothesized that aVR could be used as a representative index of the set of the six limb leads. The aim of this study was to evaluate whether ECG lead aVR could function as an index of all limb leads, in clinical electrocardiography. Methods: Automation‐derived and manually derived QRS voltage amplitude measurements of all limb leads in ECGs of a series of 100 randomly selected consecutive patients, and ECGs of 36 patients with various edematous states (EDST), congestive heart failure (CHF), or undergoing hemodialysis (HD), and aVR were inter‐correlated with the sums of leads I and II (ΣI&II), and the entire set of the six limb leads (Σ6LbLds). Results: Correlation of aVR with ΣI&II and Σ6LbLds was excellent (P < 0.00005); also, aVR was found to be a reliable index of the six limb leads in repeat ECGs in the patients with various EDST, CHF, or undergoing HD, in whom changes in aVR correlated with changes in patients’ body weight. Conclusion: aVR could be taken as an index of all ECG limb leads in analysis in general, and in monitoring patients with EDST, CHF, and HD in particular.     

Rabies: Epidemiology,pathogenesis, and prophylaxis

Rabies is a viralzoonosis that causes approximately 50,000 to 100,000 deaths per year worldwide. Most deaths occur in developing countries. Dogs are the major vector, especially in developing countries. The virus is usually transmitted to humans by infected saliva through the bite of a rabid animal; the incubation period averages 30 to 90 d. Hyperexcitability, autonomic dysfunction, hydrophobia, and aerophobia are characteristic of encephalitic rabies, which accounts for 80% of cases. The paralytic form is characterized by flaccid paralysis in the bitten limb, which ascends symmetrically or asymmetrically. Once symptoms develop, the disease is invariably fatal. Animal rabies can be controlled by proper induction of herd immunity, humane removal of stray animals, promotion of responsible pet ownership through education, and enactment of leash laws. Preexposure vaccination with modern cell culture vaccine is recommended for people at high risk of exposure to rabies and for travelers who spend longer than 1 mo in countries where rabies is a constant threat, or who travel in a country where immediate access to appropriate care is limited. Postexposure prophylaxis consists of prompt and thorough wound cleansing and immunization with modern cell culture vaccine, together with administration of rabies immune globulin to those individuals who have not previously received preexposure prophylaxis.     

基于数据挖掘技术对《医学衷中参西录》中治肢体痿废方的探讨

正《医学衷中参西录》是近代中医学大家张锡纯先生的代表作,其中所述"衷中"与"参西"的原则,旨在沟通中西两医,是中西汇通思想的体现。张锡纯所创立的治肢体痿废方,对临床治疗骨伤科疾患意义重大。现探讨如下:1肢体痿废病因病机认识《素问·刺法论》中云:"正气存内,邪不可干;邪之所凑,其气必虚"。且张氏在《医学衷中参西录》中云:"元气全体原有十分,有时损去五分余五分,虽不能充体犹可支持全身"。因此,张氏认为:肢体痿废     

Severe trauma to the lower extremity: long-term sequelae

Limb salvage after major traumatic injury to the lower extremity has become commonplace in modern trauma centers. Despite initial successful limb salvage, however, long-term complications often occur. We present 121 patients who were treated for complications after major injuries to the lower limb at Rancho Los Amigos Medical Center. In general, these patients required a total of 224 surgical procedures over an average of approximately three years after injury to achieve a successful outcome. Final limb function, however, was often impaired.     

传统医学治疗下肢静脉性溃疡的研究进展

下肢静脉性溃疡Venous leg ulcer (VLU) 是一种常见的下肢血管疾病，中医叫 “臁疮”、“裤口疮”，俗称“老烂腿”。本病多见于职业病，常常因长时间站立及过多负重行走造成，现代医学认为下肢溃疡与下肢血管变病有很大关系，特点经久难以收口，或虽然溃疡愈合，常因外界因素再次复发，给患者的身心健康和生活质量造成负面的影响。中国传统医学在治疗臁疮方面，有着独到的临床经验，并有显著的治疗效果,现将最近几年来传统医学治疗下肢静脉性溃疡进展叙述如下。     

Chronic phantom sensations, phantom pain, residual limb pain, and other regional pain after lower limb amputation

OBJECTIVES: To determine the characteristics of phantom limb sensation, phantom limb pain, and residual limb pain, and to evaluate pain-related disability associated with phantom limb pain. DESIGN: Retrospective, cross-sectional survey. Six or more months after lower limb amputation, participants (n = 255) completed an amputation pain questionnaire that included several standardized pain measures. SETTING: Community-based survey from clinical databases. PARTICIPANTS: A community-based sample of persons with lower limb amputations. MAIN OUTCOME MEASURES: Frequency, duration, intensity, and quality of phantom limb and residual limb pain, and pain-related disability as measured by the Chronic Pain Grade. RESULTS: Of the respondents, 79% reported phantom limb sensations, 72% reported phantom limb pain, and 74% reported residual limb pain. Many described their phantom limb and residual limb pain as episodic and not particularly bothersome. Most participants with phantom limb pain were classified into the two low pain-related disability categories: grade I, low disability/low pain intensity (47%) or grade II, low disability/high pain intensity (28%). Many participants reported having pain in other anatomic locations, including the back (52%). CONCLUSIONS: Phantom limb and residual limb pain are common after a lower limb amputation. For most, the pain is episodic and not particularly disabling. However, for a notable subset, the pain may be quite disabling. Pain after amputation should be viewed from a broad perspective that considers other anatomic sites as well as the impact of pain on functioning.     

260个前牙桩冠修复体远期疗效分析

目的：通过病例复查,找出前牙桩冠修复工作中的问题及不足,使前牙桩冠修复技术更加完善。方法：收集临床病例进行有关项目复查。结果：成品桩钉和铸造桩核固位效果无差异,烤瓷冠满意度100%。塑料冠外观差,对龈组织刺激性大,远期效果不理想。结论：桩核的类型不影响桩冠的固位,金属烤瓷冠是前牙桩冠理想的修复材料。     

下肢截肢的非理想残肢及临床处理

对５９例下肢截肢患者理想残肢与非理想残肢进行了复习，其中非理想残肢５０例（８４．７％），分为不良残肢及残肢并发症２种，列举了它的各种表现，说明了非理想残肢对假肢穿戴的主要影响和临床处理方法。从非理想残肢发生率之高，强调了外科医生应重视截肢与假肢的现代理论与技术的必要性。现代假肢为闭合的全面接触全面承重的接受腔，故传统的截肢方法造成的园锥形残肢已不适用于现代假肢接受腔的安装。     

膝下残肢界面应力准动态有限元模型研究

目的:为计算小腿截肢患者行走过程中残肢和接受腔之间的界面压力.方法:根据残肢、骨骼和假肢接受腔的真实几何形状建立了准动态有限元模型,采用了自动面面接触模型模拟皮肤和接受腔衬套之间的边界摩擦和滑动,并在考虑行走过程中外力和惯性载荷的同时,考虑了膝关节刚体位移和残肢弹性变形之间的耦合.结果:对一个步态周期内的残肢界面压力进行了仿真计算,结果表明界面压力主要分布在髌韧带区、腘窝区、胫骨内外侧.在站立相,除髌韧带区外,其他区域的压力具有与地面反力相似的变化规律.结论:本文所建立的准动态模型考虑了患者行走过程中膝关节位移,更接近于人体真实运动,能够用于假肢接受腔界面特性的预测和现代假肢的数字化设计.