关节松动手法治疗腰椎间盘突出症266例

临床资料 1一般资料 1998年8月-2004年8月,我院采用关节松动手法治疗腰椎间盘突出症266例,其中男182例,女84例;发病年龄最小24岁,最大52岁;平均年龄38岁;病程最短2d,最长2年;均有腰腿痛症状,直腿抬高试验阳性,CT检查提示腰椎间盘突出[1],其中L4～5椎间盘突出168例,L5S1 84例,L4～5、L5S1 14例.     

内脏源性腰腿痛误诊为腰椎间盘突出症分析

我们曾遇内脏疾病引起的腰腿痛误诊为腰椎间盘突出症16例 ,现分析报道如下。1　对象和方法1.1　对象　本组男 10例 ,女 6例 ,年龄 32～ 6 8岁 ,平均 5 4.5岁。病史 1d～ 0 .5 a,平均 2 .5个月。均有腰背痛 ,其中 6例伴单侧下肢放射痛 (放射至大腿内侧 2例 ,放射至小腿后外侧及足背部 4例 ) ,2例伴会阴部放射痛 ,2例直腿抬高试验阳性伴单侧肌力减退 ,皮肤感觉减退。16例均无下肢瘫痪及大小便失禁。1.2　方法　本组均摄腰椎正侧位片 ,其中 CT检查 10例 ,MRI检查 4例 ,同时行 CT及 MRI检查 6例。显示 :L5S1 椎间盘突出4例 ,膨出 2例 ,L4.…     

骨化型腰椎间盘突出症50例分析

自 1997- 0 4～ 2 0 0 1- 12我科共手术治疗腰椎间盘突出症 2 5 7例 ,其中手术证实椎间盘骨化 5 0例 ,占 17.4% ,分析如下。1　临床资料本组男 32例 ,女 18例 ,年龄 2 1～ 6 3岁。有腰部外伤史者2 6例。病程 8个月～ 2 0 a;发生于 2个间隙 6例 (L3～ 4、L4～ 51例 ,L3～ 4、L5S1 1例 ,L4～ 5、L5S1 4例 )。合并其它椎间盘突出 (非骨化型椎间盘突出 ) 6例 ,合并腰椎管狭窄 12例 ,合并神经根管狭窄2 3例。 X线片显示椎间盘有骨化影仅 10例 ,CT显示 40例。 5 0例患者的症状体征见表 1表 1症状例数 %体征例数 %腰痛 2 754脊柱曲变改变 2 95…     

丹参注射液配合与功能锻炼定位手法治疗腰椎间盘突出症及护理50例分析

腰椎间盘突出症是中医骨伤科常见疾病。保守疗法因并发症少 ,患者痛苦小且较经济 ,常被临床采用。 1998～ 1999年 ,我们应用丹参注射液静脉注射配合牵引 ,定位手法及功能锻炼等治疗 5 0例 ,腰椎间盘突出症取得了一定的疗效 ,现介绍如下。1　临床资料5 0例中男 36例 ,女 14例。年龄最大 6 0岁 ,最小 18岁 ,平均 5 1岁。病程最长 4a,最短 3d,平均 2 a零 4个月。CT扫描均可见节段突出压迫硬背膜囊及神经根 ,其中 L4～ L5 段 34例 ,L5～ S1 段 16例。均以腰腿痛伴右腿放射疼痛及麻木为主。其中 19例腰椎侧弯畸形 ,31例直腿抬高试验低于 5 0°…     

腰椎间盘突出症误诊2例分析

2001—01～2006—08我科共收治腰椎间盘突出症误诊2例，分析如下。 1病历摘要例 1：女，47岁。以腰痛、左臀部放射痛1个月为主诉入院。查体：腰椎活动受限，左侧臀肌痉挛，直腿抬高试验左侧阳性，4字征阳性，CT示L4～5椎间盘突出，ESR50mm／h，AKP129U／L，1个月后肺部CT提示右下肺中心性肺癌，2个月后死亡。     

早期主动直腿抬高训练对腰椎间盘突出症术后康复的影响

目的探讨早期主动直腿抬高训练对腰椎间盘突出症术后患者近期疗效、远期疗效和情绪心理的影响。方法将100例行腰椎间盘突出症髓核摘除手术患者随机分为早期主动训练组50例和常规训练组50例,术后分别给予早期主动直腿抬高训练和常规训练,于术后第2周评价两组疗效、焦虑和满意度,术后第4周、8周、1年及2年随访评价两组残余腰腿痛发生率、直腿抬高试验阳性率。结果早期主动训练组总有效率为90．0％,焦虑发生率26．0％,满意度92．0％;常规训练组总有效率74．0％,焦虑发生率48．0％,满意度72．0％;早期主动训练组残余腰痛发生率在术后第4周、8周、1年和2年均低于常规训练组,残余腿痛发生率在术后第1年和第2年低于常规训练组,直腿抬高试验阳性率在术后第2年低于常规训练组（P〈0．05）。结论腰椎间盘突出症髓核摘除术后早期主动直腿抬高训练可有效提高近期和远期疗效,改善焦虑状态,提高手术满意度。     

显微内窥镜手术治疗腰椎间盘突出症的护理

我院 2 0 0 0年 6月～ 2 0 0 1年 5月对 118例腰椎间盘突出症患者行椎间盘切除术和椎板切除术(ＭＥＤⅡ )手术 ,现将护理体会介绍如下。1　资料与方法1.1　一般资料118例中 ,男 78例 ,女 4 0例 ,年龄 17～ 6 8岁 ,平均 5 0岁 ,病程 2 0天～ 5年。 118例均有不同程度的腰痛和下肢放射性疼痛 ,下肢后侧牵拉样疼痛 ,直立、喷嚏、咳嗽、排便时加重 ,直腿抬高试验均为阳性 ,ＣＴ检查确认为腰椎间盘突出。其中Ｌ4 ,5突出 6 6例 ,占 5 5 9% ,Ｌ5～Ｓ1突出 32例 ,占 2 7 1% ,Ｌ4 ,5,Ｌ5～Ｓ1突出 2 0例 ,占 16 9%。1.2　手术方法我院采用局麻。患…     

外周血T淋巴细胞与腰椎间盘突出类型及直腿抬高试验的相关性

目的:观察腰椎间盘突出症患者外周血T淋巴细胞变化水平,探讨患者外周血T淋巴细胞水平变化与其突出类型、体征的关系.方法:收集2008-01/10在天津医科大学总医院需外科治疗的49例单阶段腰椎间盘突出症患者外周血,男26例,女23例.发病部位:L_(4～5) 22例,L_5S_1 27例.治疗前直腿抬高试验阳性34例,阴性15例.根据术中所见腰椎间盘位置分为破碎疝出组30例和退变突出组19例.以同期健康献血者20名为对照组.采用流式细胞仪检测外周血T淋巴细胞分类.结果:破碎疝出组CD3~+、CD4~+、CD4~+/D8~+水平较对照组高(P<0.05),CD8~+低于对照组(P<0.05);直腿抬高试验阳性组CD4~+、CD4~+/CD8~+水平较阴性组高,阳性组CD8~+水平较阴性组低,差异有显著性意义(P<0.05).破碎疝出组直腿抬高试验试验阳性率高于退变突出组直腿抬高试验阳性率.结论:腰椎间盘疝出后出现外周血T淋巴细胞免疫变化,且其不同病理类型也存在差异,T细胞介导免疫反应在患者体征发生、发展中起重要的作用.直腿抬高试验可能有助于证实突出间盘对神经根的损伤及治疗方式的选择.     

三维牵引治疗腰椎间盘突出伴腰椎滑脱138例

腰椎间盘突出可造成退行性腰椎滑脱 ,〔1〕在临床上并不少见 ,我院 1995～ 2 0 0 0年共收治腰椎间盘突出伴腰椎滑脱 13 8例 ,作者采用三维牵引治疗 ,疗效满意 ,现总结报告如下。资料与方法1 1 一般资料　本组 13 8例 ,其中男 5 6例 ,女 82例 ;发病年龄 3 4～ 66岁 ,平均 5 0 8岁 ;病程 1～ 12年 ,平均 5 63年。本组 13 8例均有慢性腰疼 ,其中单侧下肢疼 82例 ,双侧下肢疼 2 1例 ,间歇性跛行 12例 ;13 8例均有腰部活动受限及病椎棘突旁局限压痛 ,伴放射痛 115例 ,直腿抬高试验阳性 115例。所有病例均行ＣＴ及腰椎侧斜位片检查 ,ＣＴ显示Ｌ4…     

腰椎间盘突出症综合康复治疗

1995年 2月 - 2 0 0 0年 11月收治腰椎间盘突出症患者144例 ,男 88例 ,女 5 6例 ;年龄 2 4- 6 5岁 ,平均 38.6岁 ;病程 2月 - 4年 ;腰骶部疼痛 133例 (其中向下肢放射 96例 ) ,单纯性腿部疼痛 11例 ,少数患者表现为单侧或双侧下肢无力 ;体检患者腰部有不同程度的定点压痛、下肢感觉减退或直腿抬高试验阳性 ;132例影像学检查示 L4- 5 突出 38例 ,L5 - S1 突出 47例 ,L4- 5 、 L5 - S1 突出 46例 ,L2 - 3突出1例 ;132例中正中型 46例 ,旁正中型伴侧隐窝、椎间孔受压 6 9例 ,同时有正中型、旁正中型 17例 ,其中后纵韧带、黄韧带肥厚 2 1例 ,…     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.