帕歌斯联合韩氏穴位神经刺激治疗手部类风湿性关节炎

类风湿性关节炎(RA)常累及手部小关节,早期表现为疼痛、局部软组织肿胀、关节活动受限,目前治疗尚较困难.自2000年1月～2001年12月,我们对60例手部类风湿性关节炎患者采用口服帕歌斯联合韩氏穴位神经刺激(HANS)治疗,取得较满意的疗效,现报告如下: 　　……     

黏弹性材料关节腔填充配合肌力训练治疗髌骨软化症120例

为探讨黏弹性材料玻璃酸钠关节腔填充配合肌力训练治疗髌骨软化症的效果。于2003-04/2006-05选择承德医学院附属医院康复医学科收治膝关节骨关节炎患者120例(179膝)。患膝屈曲90°,髌骨下内侧注射玻璃酸钠溶液2mL,1次/周,5次为1个疗程。同时,配合增强股内侧肌肌力为主的等长训练。结果表明,治疗5周后优良率达91.1%,总有效率为98.9%。优:膝关节疼痛及僵硬感消失,活动自如,膝关节屈>130°,伸0°102膝;良:膝关节疼痛及僵硬感基本消失,活动轻度受限,膝关节屈>110°,伸0°61膝;可:膝关节偶有疼痛和僵硬感,休息后即可恢复,关节活动轻度受限,膝关节屈90°,伸0°14膝;差:膝关节疼痛及僵硬感和注射前相比无改善,关节活动受限,膝关节屈<90°,伸0°2膝。     

急慢性疼痛病人电针感觉阈和痛阈的调查分析

目的:了解急性和慢性疼痛病人的电针感觉阈和痛阈的特点,以便选用适宜的电针参数进行镇痛治疗。方法:测定正常人、急性疼痛病人和慢性疼痛病人三组人群的感觉阈和痛阈,并进行相互比较。结果:急性疼痛病人的感觉阈和痛阈均低于正常人(均P<0. 01),明显低于慢性疼痛病人(均P<0. 01)。结论:急、慢性疼痛病人有不同的电针感觉阈和痛阈基础,急性疼痛病人相对较低,慢性疼痛病人相对较高。电针镇痛治疗时,电针强度的运用应因人而异。     

Mulligan动态关节松动术结合牵伸疗法治疗肩周炎的疗效观察

目的:观察Mulligan动态关节松动术结合牵伸疗法治疗肩周炎患者的临床疗效。方法:将45例肩周炎患者按照就诊顺序随机分为A组、B组、C组(对照组),每组15例。三组患者均给予牵伸疗法,A组同时给予Mulligan动态关节松动术,B组同时给予关节松动术。每组患者在治疗前及治疗2周后分别采用肩关节主动关节活动范围(ROM)评估、肩关节疼痛及功能指数(SPADI)评估对患者受累肩关节进行疗效评估。结果:经过2周的治疗,三组患者的肩关节ROM均较治疗前有显著增加(P0.05或P0.01),组间比较发现,A组肩关节ROM改善优于B组、C组(P0.05);A组及B组SPADI较治疗前有明显改善(P0.05或P0.01),但C组SPADI较治疗前未见明显改善(P0.05);组间比较发现,A组SPADI的改善优于B组(P0.05)。结论:动态关节松动术结合牵伸疗法能更好地改善肩周炎患者的肩关节活动受限,同时也能更有效地减轻肩关节的疼痛程度及提高其功能状况。     

胫骨高位减压和中药离子导入治疗膝关节骨性关节炎180例

膝关节骨性关节炎是中老年人常见病、多发病,临床主要特点为疼痛,功能受限.1990年以来我们采用胫骨高位钻孔减压和中药离子导入治疗180例,共217膝,疗效满意.资料与方法180例中男106例、女74例;年龄38～76岁,平均57岁;病程最短3个月,最长23年;均有患部疼痛,其中肿胀22例、畸形32例、活动受限46例、晚间不能入睡37例.我们依据本组患者膝关节X线表现,将其严重程度分为4级:Ⅰ,膝关节基本正常;Ⅱ,关节间隙狭窄;Ⅲ,关节线消失或轻度骨磨损;Ⅳ,骨磨损伴关节畸形半脱位(见附表).全部患者均采用减压和离子导入治疗.     

软组织牵伸配合物理因子改善第3磨牙拔除后的张口受限及下颌功能

背景:第3磨牙拔除过程可能引起周围软组织不同程度的损伤。由于超声波和超短波均属于热疗的范围,可以使组织温度升高,有助于提高软组织牵伸的治疗效果。目的:比较软组织牵伸配合超声波、超短波改善第3磨牙拔除后张口受限及疼痛的效果。方法:选取确诊为第3磨牙拔除术后致颌面部疼痛和张口受限的患者16例,采用随机数字表法分为牵伸组与对照组,每组各8例。牵伸组患者接受超声波和超短波治疗后联合软组织牵伸;对照组仅进行超短波和超声波治疗。治疗1次/d,5次/周,连续治疗2周。结果与结论:经治疗后两组患者最大主动张口度均增大,疼痛明显减轻,颞下颌关节的功能显著提高;牵伸组张口度的改善显著优于对照组,颞下颌关节功能的提高显著优于对照组。结果说明超声和超短波治疗均能改善拔牙术后患者张口受限及疼痛症状,提高下颌功能状态;配合软组织牵伸治疗效果更好。     

膝关节活动系统静态牵伸支具在膝关节损伤术后患者康复护理中的应用

目的:探讨膝关节活动系统(JAS)静态牵伸肢具在膝关节损伤术后活动受限患者中的临床疗效。方法:将30例患者随机分为对照组和观察组各15例,对照组常规关节松动治疗,观察组在对照组基础上通过JAS进行静态进展性牵伸训练,比较两组临床效果。结果:治疗4周后,观察组膝关节活动范围(ROM)、美国特种外科医院膝关节评分(HSS)均优于对照组(P0.05);治疗8周后,两组ROM、HSS均优于同组治疗4周后(P0.05),且观察组均优于对照组同期(P0.05)。结论:应用JAS静态牵伸支具能明显改善膝关节损伤术后活动受限患者关节活动度,防止关节粘连,维持膝关节功能。     

典型骨斑点症1例

病例女,36岁,外伤后双膝关节疼痛伴轻度活动受限1周.查体：双膝关节压痛阳性,屈曲轻度受限,全身无其它不适.行双膝关节X线平片示：双膝关节干骺端多发斑点状致密影,大小不等,部分融合成斑片状,随后建议患者行拿身照相,片示：全身多个关节干骺端呈对称性斑点状致密影,颅骨平片未见异常.诊断：骨斑点症（图1～5）.     

草乌甲素片治疗常见慢性疼痛的临床研究

药物是慢性疼痛最基本、最常用的首选治疗方法.其中90%的镇痛药物是非甾体类和阿片类,有一定的治疗效果,但副作用有胃肠道不适和恶心呕吐等.草乌甲素片不属非甾体抗炎镇痛药、具有无器质性脏器毒性作用,很少有药物依赖和成瘾性的优点.现将我院2008年5月至2010年9月疼痛科用草乌甲素片治疗常见慢性疼痛200例的疗效观察报告如下:     

成人缺血性股骨头坏死 DSA 表现及介入治疗

目的 探讨成人缺血性股骨头坏死(ANFH)数字减影血管造影(DSA)介入治疗的效果.方法 对8例(12髋)ANFH患者采用经皮股动脉穿刺插管骨股头供血动脉的 DSA 检查及药物灌注.结果 11患髋有供血动脉的股骨头有不同程度和范围的染色,疼痛消失;1髋疼痛明显缓解,关节功能均恢复.治疗后3个月行DSA复查,髋关节周围交通吻合显示明显,患髋股骨头单位面积上血管数量增加.8例患者中6例髋关节疼痛、间歇性跛行等临床症状均明显改善,髋关节活动受限消失;2例临床症状轻度改善.结论 介入治疗ANFH疗效肯定,对改善局部血液循环、恢复髋关节功能、促进股骨头的新骨形成及修复起到了重要作用.     

Harpagophytum-Extrakt LI 174 (Teufelskralle) bei der Behandlung unspezifischer Rückenschmerzen

PROBLEM: This randomised, double-blind, placebo controlled study was intended to investigate the effects of Harpagophytum procumbens (Devil's Claw) on sensory, motor and vascular mechanisms of muscle pain. In addition to clinical efficacy and tolerability, possible action mechanisms were analysed by means of experimental algesimetric methods. METHODOLOGY: The study was performed on patients with slight to moderate muscular tension or slight muscular pain of the back, shoulder and neck. On a double-blind randomised basis the verum group received 2x1 film tablets per day, i. e. 2x480 mg/day, of Harpagophytum extract LI 174 (Rivoltan(R)) at 8.00 a.m. and 8.00 p.m. over a certain period. The duration of the therapy was 4 weeks. Data recording at 14-day intervals was made using a visual analogue scale, pressure algometer test, recording of antinociceptive muscular reflexes, muscle stiffness test, EMG surface activity, muscular ischaemia test, clinical global score and subjective patient and physician ratings. RESULTS: A total of 31 patients in the verum group and 32 in the placebo group were treated. After four weeks of treatment there was found to be a clear clinical efficacy of the verum on the clinical global score and in the patient and physician ratings. Highly significant effects were found in the visual analogue scale, the pressure algometer test, the muscle stiffness test and the muscular ischaemia test. No difference from placebo was found in the recording of antinociceptive muscular reflexes or in the EMG surface activity. Tolerability was good; no serious adverse effects occurred. CONCLUSIONS: A highly significant clinical efficacy was achieved with a monotherapy of Harpagophytum dry extract LI 174 after four weeks' treatment at a dosage of 2x480 mg/day in cases of slight to moderate muscular pain. With regard to the action mechanisms investigated, it may be concluded that treatment with Harpagophytum extract LI 174 may be expected to have a significant influence on sensory and vascular muscular response and bring about a reduction in muscle stiffness. No central nervous effects were discovered.     

超激光疼痛治疗仪照射治疗慢性软组织损伤疼痛的疗效观察

本工作选择疼痛六诊慢性软组织损伤性疼痛患者，观察组使用点直线偏振光近红外线疼痛治疗仪Ｓｕｐｅｒ－Ｌｉｚｅｒ ＨＡ－５００（商品名“超激光疼痛治疗仪”，Ｓ－Ｌ）照射治疗；对照组使用传统的神经阻滞疗法，两组进行疗效对比观察。结果表明，两种治疗方法均有明显疗效，治疗后两组的ＶＡＳ值及其下降率、显效率、有效率，总有效率均无明显差异（Ｐ〉０．０５）。观察组的治疗次数明显多于对照组而复发率明显低于对照组（Ｐ〈     

盐酸曲马多缓释片对肌肉骨骼系统慢性疼痛患者的治疗优势

背景肌肉骨骼系统慢性疼痛可导致患者功能残疾和生活质量下降.探讨肌肉骨骼系统疾病的治疗方法,选择恰当的治疗药物对患者具有重要意义.目的评价盐酸曲马多缓释片毒曼丁对中度以上肌肉骨骼系统慢性持续性疼痛患者的镇痛效果及其耐受性.设计前后对照研究.单位北京大学人民医院关节病研究所.对象选择2000-03/06在北京大学人民医院骨科门诊求诊的患者,具有中度以上慢性非癌症性疼痛,应用非类固醇抗炎药物(nonsteroi dal anti-inflammatrry drugs,NSAIDs)疼痛缓解不满意的成人病例共40例.方法停用其他止痛药物和NSAID类药物,然后服用盐酸曲马多缓释片(奇曼丁),首剂50 mg,每12 h 1次,根据疼痛控制程度调整剂量,每次50 mg递增,最高剂量400 mg/d.观察时间为4周,受试者记录疼痛治疗手册,每周门诊随访1次,医师检查后填写临床观察表.主要观察指标患者服用药物前后的疼痛程度、疼痛缓解度和所有副作用及其严重程度.结果全部病例均完成试验,无失访,无因不能耐受而中途退出者.服药前疼痛评分平均为(6.80±1.84)分,服药后平均为(1.00±1.46)分,差异有显著性意义(P＜0.001).平均疼痛缓解度为(85.50±5.35)%,其中完全缓解和明显缓解占78%.出现的副作用有9例,总发生率为22%,其中以眩晕最常见,共有6例,其他包括恶心3例,嗜睡2例,呕吐1例,食欲缺乏1例,便秘和排尿困难1例,视力模糊1例等.结论盐酸曲马多缓释片是一种长效中枢性镇痛剂,使用方便.在治疗肌肉骨骼系统慢性疼痛方面具有优良的镇痛效果,不良反应轻,有良好的耐受性,为骨科慢性疼痛的药物治疗提供了一种新的选择.     

高能震波治疗肌肉骨关节的慢性疼痛

背景目前有关用高能震波治疗肌肉骨关节慢性疼痛的报道不少,但其治疗的确切效果及作用机制不明确,有待进一步探讨.目的探讨高能震波对骨关节肌筋膜炎的治疗效果、作用机制及临床应用效应.设计以诊断为依据的非随机化同期对照研究.单位中山大学附属第一医院康复医学科.对象2001-07/2002-04中山大学第一附属医院康复科门诊救治的肌肉骨关节慢性疼痛患者90例,按就诊次序分为治疗组45例,男17例,女28例;平均年龄54岁;对照组45例,男15例,女30例,平均年龄63岁.方法治疗组采用体外冲击波治疗;对照组采用常规物理因子治疗.用简式MeGill疼痛问卷(MPQ)评估患者对疼痛的综合反应,并对肩关节活动范围及临床疗效进行评定.主要观察指标①两组治疗前后疼痛改善程度.②关节活动度的变化.③综合临床疗效.结果治疗组在治疗后感觉类,情感类,疼痛总分,目测类比定级(VAS),现有痛强度(PPI)方面与治疗前比较差异有显著性意义(t=5.69,5.67,7.06,8.37,6.21,P＜0.01).在感觉类,疼痛总分,VAS方面与对照组比较差异也有显著性意义(t=4.66,P＜0.01;t=2.52,3.40,P＜0.05).结论体外高能震波对骨关节肌筋膜炎等慢性疼痛疗效确切,临床应用上具有高效、快速、安全的特点.     

海水浴联合鼻腔海水清洗在治疗慢性单纯性鼻炎中的疗效观察

目的探讨海水浴联合鼻腔海水清洗在治疗慢性单纯性鼻炎中的疗效。方法选取72例患有慢性单纯性鼻炎的疗养员,随机分为治疗组、对照组各36例。两组患者均给予药物治疗,治疗组给予海水浴联合鼻腔海水清洗,经过两个疗程共30 d的治疗,观察治疗前后鼻腔通气及伴随症状改善情况。结果治疗组的治愈率、总有效率明显高于对照组。结论海水浴联合鼻腔海水清洗在慢性单纯性鼻炎治疗中的临床效果明显优于单纯的药物治疗,是一种便捷、无副作用、易于实施的治疗方式,值得推广。     

高能震波治疗肌肉骨关节慢性疼痛性疾病的临床研究

目的　观察高能震波对肩周炎等肌肉骨关节疾病引起的慢性疼痛的治疗效果 ,探讨其作用机制及临床应用。方法　选择 90例门诊患者 ,随机分为治疗组和对照组 ,治疗组采用ESWO AJ体外冲击波治疗机进行治疗 ,工作电压为 7～ 10kV ,冲击波频率为 60次 /min ;对照组按照病种选用相应常规物理因子疗法。采用简式McGill疼痛问卷 (MPQ)等方法进行疗效评估并比较。结果　治疗组治疗后功能明显改善 ,治愈率71.1% ,明显高于对照组 ( 4 0 .0 % ) (P <0 .0 1)。在治疗后情感类 (A)、疼痛总分 (T)与目测类比量表 (VAS)评分中 ,治疗组明显优于对照组 (P <0 .0 1或P <0 .0 5 )。且两组在治疗次数上差异有非常显著性意义 (P <0 .0 0 1)。结论　体外高能震波对肌肉骨关节疾病的慢性疼痛疗效确切 ,应用于临床具有高效、快速和安全的特点。     

A review of the efficacy and safety of devil's claw for pain associated with degenerative musculoskeletal diseases, rheumatoid, and osteoarthritis

Harpagophytum procumbens, known as devil's claw, has been used traditionally for the treatment of pain, fevers, and dyspepsia. Recently, it has become popular for the treatment of rheumatoid and osteoarthritis. Studies have yet to establish a clear mechanism of action; however, current research is focusing on pro-inflammatory mediators as well as on potential antioxidant characteristics.     

Chronic musculoskeletal pain in chronic fatigue syndrome: recent developments and therapeutic implications

Patients with chronic fatigue syndrome (CFS) experience chronic musculoskeletal pain which is even more debilitating than fatigue. Scientific research data gathered around the world enables clinicians to understand, at least in part, chronic musculoskeletal pain in CFS patients. Generalized joint hypermobility and benign joint hypermobility syndrome appear to be highly prevalent among CFS sufferers, but they do not seem to be of any clinical importance. On the other hand, pain catastrophizing accounts for a substantial portion of musculoskeletal pain and is a predictor of exercise performance in CFS patients. The evidence concerning pain catastrophizing is supportive of the indirect evidence of a dysfunctional pain processing system in CFS patients with musculoskeletal pain. CFS sufferers respond to incremental exercise with a lengthened and accentuated oxidative stress response, explaining muscle pain, postexertional malaise, and the decrease in pain threshold following graded exercise in CFS patients. Applying the scientific evidence to the manual physiotherapy profession, pacing self-management techniques and pain neurophysiology education are indicated for the treatment of musculoskeletal pain in CFS patients. Studies examining the effectiveness of these strategies for CFS patients are warranted.     

Methadone treatment of chronic non-malignant pain and opioid dependence--a long-term follow-up.

Iatrogenic opioid addiction among chronic pain patients was the initiative for starting a methadone programme for pain patients at the University Hospital of Uppsala. The aims were to improve pain relief and quality of life in pain patients with problematic opioid use and to investigate background factors explaining problems with opioid use. METHODS: Records of all 60 patients included in the methadone programme 1994-2002 were studied. An interview was done after a mean of 34 months of methadone treatment regarding pain relief, quality of life and side effects on 48 patients. RESULTS: Titration of oral methadone mixture in daily doses ranging from 10 to 350 mg (mean 99.5 mg) was done on all patients. Background factors were low back and musculoskeletal pain in 40%, psychiatric disease in 68%, and substance use disorder in 32% of the patients. Before methadone treatment all patients were on sick leave. After treatment five patients returned to work. Ten patients failed treatment, 4 due to intractable nausea, 4 to drug diversion, 1 because of methadone related arrhythmia and 1 because of insufficient analgesia. Pain relief was rated good by 75% and moderate by 25% of the patients. Global quality of life was rated at mean of 50(0-100), which favourably compares with Swedish chronic pain patients mean 33(0-100). CONCLUSION: A structured methadone programme can be used for treating chronic pain patients with opioid dependence improving pain relief and quality of life. However, side effects and serious adverse events may limit the beneficial effects of the method.     

全麻下单纯肩关节松解与复合术后帕瑞昔布钠治疗肩周炎疗效对比

目的:对比全麻下单纯肩关节松解与复合术后帕瑞昔布钠(特耐)治疗肩周炎的疗效。方法:肩周炎病例53例随机分为A组(n=24)和B组(n=29),A组采取丙泊酚静脉麻醉下肩关节松解术,B组采取丙泊酚静脉麻醉下肩关节松解复合术后特耐静滴。对患者术前,术后1、2、3天疼痛进行VAS评分,观察术前、术后肩关节活动情况,随访1个月。结果:术中肌松效果满意53例(100%),B组患者术后疼痛较A组明显下降,B组患者活动度较A组显著改善,B组近期疗效为痊愈者26例(90%),有效者3例(10%),A组近期疗效痊愈者17例(71%),有效4例(17%),无效3例(12%)。无明显不良反应。结论:全麻下肩关节松解复合术后特耐治疗肩周炎较单纯肩关节松解术镇痛效果好,早期肩关节活动度改善显著。