改良股四头肌成形术并早期康复训练治疗膝关节强直

Arthroclisisofkneeisusuallysecondarytoinjuryofkneejointandsurroundingtissuefollowingfixationatstraightenpositionforalongtime，whichseriouslyaffectspatients＇dailylifeandactivi－ties．Quadricepsplastywasconductedtolooseadhesioncompletely，earlyfunctionalexercisewasadministeredformildtomoderatepatientswithoutopportunityofconservativetherapy．FromAugust１９９６toApril２００２，２１patientswithankylosisofkneereceivedmodifiedquadricepsplastywithupperandlowerfractionalpatellarincisionandabove６－mon…     

冠心病康复的最新研究进展

急性冠状动脉事件后,患者对康复治疗需求不同,伴有心理障碍患者很难获得满意疗效回归正常生活。而存在各种危险因素患者可在改变不良生活方式后受益。有报道约1/3心肌梗死患者发病后12周内其生活质量可恢复到发病前,但多数患者焦虑和抑郁症状仍很常见,这些表现又显著影响患者的预后,如发生心力衰竭、再次梗死和死亡。目前,冠心病康复治疗主要分两种:运动疗法,心理治疗和健康教育。     

改良股四头肌成形术及术后康复治疗对膝关节僵硬的影响

目的 :探讨改良式股四头肌成形术配合术后康复治疗对膝关节僵硬疗效的影响。方法 :在对 6 0例伸直型膝关节僵硬患者的治疗中 ,对股四头肌成形术进行了部分改良 ,术后行关节松动术、被动活动等功能锻炼。结果 :所有患者均进行了 1年以上随访 ,屈膝功能由术前平均 2 3°增至 92 .6° ,其中屈膝功能达 90°以上者多为股骨干骨折或坚持术后康复训练者。结论 :改良式股四头肌成形术配合术后康复能够提高疗效 ,术后康复尤为重要。     

等速运动训练用于治疗创伤性膝关节僵直的研究

目的:研究等速运动训练对创伤性膝关节僵直在功能方面改善的作用。方法:60例膝关节僵直患者被随机分为3组,每组各20例。第1组为等速运动训练组,只采用等速运动训练治疗;第2组为常规训练组,只采用常规运动疗法进行治疗;第3组为联合治疗组,行等速运动训练加常规运动疗法。三组患者分别在治疗前后行膝关节活动度(ROM)评定、美国特种外科医院(HSS)指数评定及等速肌力测试系统评定膝关节伸肌和屈肌的峰力矩值(PT)、峰力矩与体重比值(PT/BW)、平均功率[AP]、腘绳肌峰力矩/股四头肌峰力矩值(H/Q)。结果:三组治疗后屈曲度、伸直度、屈伸弧度均较治疗前有明显改善,在改善度数方面第3组优于第1组和第2组,第1组优于第2组;治疗后三组伸屈肌群PT、PT/BW、AP值均较治疗前有改善,第3组明显优于第1组和第2组,第1组优于第2组,三组治疗后H/Q值与治疗前比较无明显差异;三组治疗后HSS指数均有改善,但是第3组在HSS指数改善方面优于第1组和第2组,第1组优于第2组。结论:等速运动训练对关节僵直的疗效明显,可以很好地改善膝关节功能,临床上可以与常规运动疗法联合应用。     

改良式踝足矫形器对膝关节运动角度的影响

目的：研究改良式踝足矫形器对膝关节运动角度的影响。方法：研究模型为10例健康大学生（22．6±1．6）岁，采用三维动作分析系统采集自由步行、穿戴标准AFO与穿戴改良式AFO步行时的动态运动数据。观察不同状态下膝、踝关节活动角度的变化。结果：（D在6种步行状态下（自由步行、普通AFO、AFO—1、AFO-2、AFO-3、AFO-4）。膝关节屈曲角度逐渐增加，且膝关节角度值在支撑相早期、支撑相中期及最大值差异有非常显著性（P〈0．01）。而支撑相晚期及最小值差异没有显著性意义（P〉0．05）。②膝关节角度值在支撑相中期时。自由步行时与穿戴普通AFO及改良式AFO之间差异均有非常显著性意义（P〈0．01）；同时穿戴普通AFO步行与改良式AFO的后两种状态（AFO-3、AFO-4）之间差异也有显著性意义（P〈0．05）。③6种步行状态下踝关节背屈角度最大值逐渐增加，自由步行时与穿戴各种AFO步行之间差异均有非常显著性意义（P〈0．01）；同时穿戴普通AFO步行与改良式AFO的最后一种状态（AFO-4）之间差异也有显著性意义（P〈0．05）。结论：改良式AFO在改变正常人踝关节背伸角度的同时，还可以控制膝关节伸展角度的变化。     

热敏灸及康复训练治疗膝骨关节炎急性痛慢性化的临床研究

目的:观察热敏灸能否抑制膝关节骨性关节炎(KOA)患者急性痛的慢性化及是否对受损的弥漫性伤害抑制性控制(DNIC)功能具有调制作用,并与康复训练作对比,为临床推广提供理论依据。方法:将60名KOA患者随机分为热敏灸组和康复训练组,每组30例,分别进行热敏灸治疗和康复训练治疗,比较2组治疗前、中、后的视觉模拟疼痛量表(VAS)、弥漫性伤害抑制性控制(DNIC)及临床疗效。结果:2组患者VAS评分在治疗前、治疗10d及20d后均呈持续下降趋势(P0.05,0.01),且热敏灸组各时间点VAS评分均低于康复训练组(P0.01)。热敏灸组DNIC功能评分在治疗前、治疗10d及20d后均呈持续上升趋势(P0.05,0.01),且热敏灸组在治疗后各时间点DNIC功能评分明显高于康复训练组(P0.01)。康复训练组DNIC功能评分治疗前后各时间点比较差异无统计学意义。治疗20d后,2组患者膝关节Lysholm功能评分均较治疗前明显提高(P0.01,0.05),且热敏灸组明显高于康复训练组(P0.01)。结论:热敏灸能修复膝关节骨性关节炎(KOA)患者急性痛慢性化过程中受损的DNIC功能,从而阻止本病急性痛慢性化的发生。     

膝关节本体感觉训练对偏瘫患者平衡功能的影响

摘要 目的：探讨对脑卒中偏瘫患者施行膝关节本体感觉训练后其平衡功能恢复的影响。 方法：符合要求的20例受试者依年龄、性别、功能障碍程度、偏瘫侧等条件以一一配对的方式分成观察组和对照组,对照组接受常规康复治疗,观察组在常规康复治疗的基础上加强膝关节本体感觉训练。两组患者在治疗前和治疗后分别采用角度重建法测量膝关节位置觉和使用Berg平衡量表（BBS）测量平衡功能。 结果：观察组患侧膝关节位置重现的平均偏差变小（P<0.01）,屈膝30°、45°的测试中,试验后膝关节位置偏差与训练前测量值对比有显著性意义（P<0.05）。试验后,观察组与对照组患侧膝关节位置重现平均偏差比较有显著性意义（P<0.01）。试验后的BBS评分值,两组对比有显著性意义（P<0.05）。 结论：膝关节本体感觉训练对脑卒中患者的平衡功能恢复有积极的作用,对脑卒中偏瘫患者进行膝关节本体感觉训练很有必要的。     

关节训练配合体位护理对急性期脑卒中患者预后观察

目的 探讨关节训练及体位护理在急性脑卒中偏瘫患者中应用的疗效.方法 对60例偏瘫患者随机分组:实验组30例,入院后生命体征稳定后开始进行关节训练配合体位护理;对照组30例,神经内科常规护理.采用Barthel指数及FuglMeyer量表评价两组患者关节活动度和日常生活能力.结果 两组Barthel指数分别为:实验组75.43±4.71、对照组49.53±5.9(t=18.65,P＜0.05);Fugl-Meyer运动功能评分分别为:74.83±1.683、56.67±2.354(t=34.38,P＜0.05);病人满意度分别为9.62±1.38、8.69±1.48(t=32.51,P=0.00).结论 关节训练与体位护理能够改善急性脑卒中偏瘫患者肢体运动功能、提高日常生活能力和病人的满意度.

Abstract：

Objective To observe the prognosis of joint training combining nursing position in acute stroke patients with hemiplegic Methods Sixty patients were randomly divided into two groups, experimental group (n = 30) and control group ( n = 30) .Control group was applied conventional nursing.Experiment group was adopted joint training combining nursing position after patients vital signs stabilization.Results The Barthel index scores of the two groups were different with the experiment group of 75.43 4.71 and the control group of 49.53 5.9 (t =18.65, P＜0.05) .And Fugl-Meyer motor function index scores was 74.83 1.683, 56.67 2.354 (t =34.38, P＜0.05) respectively of the two groups; there was a higher, satisfaction score in experiment group with 9.62 1.38 than that of control group with8.69 1.48 (t=32.51, P=0.00) .Conclusions The joint training combining nursing position could improve bemiplegic stroke patients'motor function and elevate the patients'daily activity and the patients' satisfaction.     

复方七叶皂苷凝胶治疗膝关节骨性关节炎的临床研究

目的观察复方七叶皂苷凝胶 (商品名为利百素 )治疗膝关节骨性关节炎的疗效与安全性。方法 60例膝关节骨性关节炎患者 ,随机分为 2组。治疗组予复方七叶皂苷凝胶 4g均匀外涂于膝关节处皮肤 ,每天 4次 ;对照组予芬必得胶囊 60 0mg ,每天2次口服。共治疗 6周。分别运用“WesternOntarioandMcMasterUniversity骨性关节炎指数”(WOMAC)在用药 0周、2周、6周时进行评估 ,观察不良反应发生率。结果用药 2周后 ,治疗组、对照组治疗前后在三个子量表中所获分值有显著性差异 (P <0 0 5 ) ,两组间治疗效果比较有显著性差异 (P <0 0 5 ) ;用药 6周后 ,两组治疗前后有非常显著性差异 (P <0 0 0 1) ,两组间治疗效果比较无显著性差异 (P >0 0 5 )。治疗组未出现不良反应 ,对照组治疗 2周后 4例出现胃痛、恶心、食欲减退的表现 ;治疗 6周后对照组 8例出现胃痛、恶心、食欲减退的表现。结论复方七叶皂苷凝胶与芬必得均有较好的治疗效果 ,但复方七叶皂苷凝胶起效较快 ,副作用发生率较芬必得低。     

临床路径在膝关节镜手术患者中的应用研究

目的研究临床路径(CP)应用于膝关节镜手术患者的实施效果.方法采用不同病例前后对照研究,对照组30例实施传统治疗和护理,实验组30例实施CP,将两组的治疗、护理效果进行对比.结果术后首次功能锻炼时间对照组13.17h,实验组6.5h(U＝69.00,P <0.05);术后首次下床时间对照组22.79h,实验组7.0h(U＝32.00,P<0.05);术后6周膝关节活动度对照组107.78,实验组124.44(t＝-2.38,P<0.05);住院费用对照组(4158.03±969.00)元,实验组(3654.41±507.00)元(t＝2.52,P<0.05);住院天数实验组缩短到4d(χ2＝13.59,P<0.05);两组术后并发症和预后比较无统计学差异.结论在保证医疗护理质量的前提下,CP应用于膝关节镜手术患者能降低住院费用,缩短住院时间,可以在我国推广应用.     

膝关节镜术后肌力强化训练对膝关节骨性关节炎患者膝关节功能的影响

目的 探讨膝关节骨性关节炎(KOA)患者膝关节镜术后肌力强化训练的临床疗效,并分析其对膝关节功能的影响.方法 选择2018年12月至2020年12月于我院行膝关节镜手术治疗的86例KOA患者为研究对象,根据术后康复方案的不同将其分为对照组和观察组,每组43例.对照组术后进行常规康复训练,观察组在对照组基础上增加肌力强化...     

推拿结合等速肌力训练治疗膝关节骨性关节炎临床疗效研究

目的:观察推拿治疗结合等速肌力训练对膝关节骨性关节炎的治疗效果。方法:从膝关节骨性关节炎(KOA)患者中随机选取60例作为观察对象,60例患者随机分为推拿结合等速治疗组(试验组)和单纯推拿治疗组(对照组)。分别将两组治疗前后的膝关节西安大略和麦克马斯特大学骨关节炎指数(WOMAC)、等速屈伸肌力测试对比分析。结果:两组治疗后膝关节WOMAC评分均较治疗前有显著改善(P0.01),其中推拿结合等速组膝关节WOMAC评分由(62.93±16.17)降为(26.20±12.68),改善较单纯推拿组更为显著(P0.01)。两组治疗干预前等速肌力测试各指标比较没有显著性差异。经过8周治疗后推拿加等速训练组膝关节伸肌峰力矩、峰力矩/体重、达峰时间、平均功率,膝关节屈肌峰力矩、达峰时间与本组治疗前比较明显改善,差异有显著性(P0.01);膝关节伸肌平均功率与本组治疗前比较有改善,差异有显著性(P0.05);推拿加等速训练组膝关节伸肌峰力矩、峰力矩/体重、达峰时间、膝关节屈肌达峰时间、屈肌/伸肌比单纯推拿组治疗后改善明显,差异有显著性(P0.05);推拿加等速训练组膝关节屈肌峰力矩与单纯推拿组治疗后比较提高明显,差异有显著性(P0.01)。结论:推拿结合等速肌力训练可以提高KOA患者膝关节屈伸肌肉力量,对于KOA的治疗具有良好的临床疗效,且明显优于单纯推拿治疗。     

负重位DR片在诊断膝骨关节炎患者中的应用价值

膝骨关节炎是中老年患者中的常见疾病，拍摄负重位X线片诊断膝骨关节炎已被广泛认可，但是对于非负重位与负重位膝骨关节炎影像学表现的差异目前很少报道。对于负重位X线片的客观评价指标也无明确的阐述。本文通过应用DR技术同期对照膝骨关节炎患者非负重位和负重位X线片，讨论负重位X线片在诊断膝骨关节炎中的应用价值。     

专科护士参与层级培训的效果研究

目的:探讨专科护士参与层级培训的效果。方法:专科护士负责为本专业不同岗位、学历和能力水平的护理人员制订和实施不同形式和内容的培训方案,对全院706名临床护士进行个性化、针对性的护理培训,密切结合临床,注重培养护士的临床思维能力,定期进行效果评价、反馈、调整。结果:培训后护理人员综合评价得分、患者满意度得分均明显高于培训前(P0.05),培训后不良事件发生情况低于培训前(P0.05)。结论:专科护士参与层级培训是对目前国内护理人力资源状况而提出新的发展思路和趋势,这种层级培训管理体制,充分发挥了专科护士在专科护理领域的领头作用,有效提高了护理质量,使院内专科护理资源合理流动,实现护理质量同质化,同时也为低年资护士创造了更加安全、规范和轻松的工作环境,保障了护理安全。     

Characteristics associated with improved knee extension after strength training for individuals with cerebral palsy and crouch gait

Muscle weakness may contribute to crouch gait in individuals with cerebral palsy, and some individuals participate in strength training programs to improve crouch gait. Unfortunately, improvements in muscle strength and gait are inconsistent after completing strength training programs. The purpose of this study was to examine changes in knee extensor strength and knee extension angle during walking after strength training in individuals with cerebral palsy who walk in crouch gait and to determine subject characteristics associated with these changes. A literature review was performed of studies published since January 2000 that included strength training, three-dimensional motion analysis, and knee extensor strength measurements for individuals with cerebral palsy. Three studies met these criteria and individual subject data was obtained from the authors for thirty crouch gait subjects. Univariate regression analyses were performed to determine which of ten physical examination and motor performance variables were associated with changes in strength and knee extension during gait. Change in knee extensor strength ranged from a 25% decrease to a 215% increase, and change in minimum knee flexion angle during gait ranged from an improvement of 9° more knee extension to 15° more knee flexion. Individuals without hamstring spasticity had greater improvement in knee extension after strength training. Hamstring spasticity was associated with an undesired increase in knee flexion during walking. Subject-specific factors such as hamstring spasticity may be useful for predicting which subjects will benefit from strength training to improve crouch gait.     

Consequences of combining strength and endurance training regimens

A common belief among many clinicians and trainers is that intensive simultaneous training for muscle strength and cardiovascular endurance is counterproductive. To test this premise, 14 healthy, untrained men trained four days per week for 20 weeks on a bicycle ergometer for endurance (END Group, n = 4), on an isokinetic device for increased torque production (ITP Group, n = 5), or on both devices (COMBO Group, n = 5). The ITP and COMBO groups had equal torque gains throughout the study (234 +/- 45 and 232 +/- 23 N.m, respectively). After 11 weeks, both END and COMBO groups had similar gains in maximal oxygen consumption (VO2max) (in milliliters per kilogram of body weight per minute). During the last half of the study, however, the END Group had a significant gain in VO2max (p less than .05) of 4.7 +/- 1.2 mL.kg-1.min-1, whereas the COMBO Group had a nonsignificant gain (p greater than .05) of 1.8 +/- 0.6 mL.kg-1.min-1. In harmony with this finding, the END Group showed a significant increase (p less than .05) in citrate synthase activity (15.5 +/- 7.9 mumol.g-1.min-1), whereas the COMBO Group had no significant increase. The authors concluded that simultaneous training may inhibit the normal adaptation to either training program when performed alone. The extent of the interference probably depends on the nature and intensity of the individual training program. [Nelson AG, Arnall DA, Loy SF, et al: Consequences of combining strength and endurance training regimens.     

The effects of sensorimotor training on knee proprioception and function for patients with knee osteoarthritis: a preliminary report

OBJECTIVE: To investigate the effects of a sensorimotor training programme in osteoarthritic patients. DESIGN: Randomized, single-blind, controlled trial. SETTING: Kinesiology laboratory at School of Physical Therapy. PARTICIPANTS: A total of 60 patients were randomly assigned to the training group and the control group. Only 29 patients (training group, 15; control group, 14) completed the study. INTERVENTION: The training group underwent a sensorimotor training programme using a sling suspension system complemented by a routine physical therapy. The control group underwent a routine physical therapy. MAIN MEASURES: Active joint repositioning, functional testings, and self-reported function with the Western Ontario & McMaster Universities Arthritis Index before and after the eight-week intervention. RESULTS: There were significant differences between the two groups with respect to the improvement in proprioception as measured by active joint repositioning (the changes in the absolute error were 1.9+/- 1.7 degrees , training group versus 0.1 +/- 2.8 degrees , control group (P<0.05), and in self-reported functional difficulty (33.2 +/-35.1, training group versus 8.0+/- 10.2, control group; P<0.05)). There was no significant difference between the two groups in other outcomes. CONCLUSION: A sensorimotor training using a sling suspension system improved the patients' proprioception in the knee joints and their self-reported function. Thus, these exercises may serve as an exercise programme for patients with knee osteoarthritis.     

膝关节骨性关节炎患者步态运动学参数的研究

目的：定量分析膝关节骨性关节炎（knee osteoarthritis,KOA）患者步态运动学参数的变化特点。方法：利用三维动作分析系统对轻病组、重病组膝关节骨性关节炎患者和对照组各30名进行运动学参数测试。结果：两组患者与对照组的时空参数相比,支撑期百分比参数较大（P〈0.05）。关节角度方面,轻病组、重病组分别和对照组相比,最大伸髋角度明显减小（P〈0.05）;足跟着地期伸膝角度、支撑期最大屈膝角度和支撑期最大伸膝角度等参数均明显减小（P〈0.05）;踝关节支撑期最大跖屈角度和最大背屈角度较小（P〈0.05）,重病组与其他两组的差异较大（P〈0.001）。结论：KOA患病组与对照组步态的运动学参数存在明显差异,说明患者为减少患病部位的负荷采取了相应的代偿策略。     

膝关节骨关节炎膝屈伸肌训练效果的差异性

目的 探讨膝关节骨关节炎患者屈、伸膝肌练习效果的差异性。方法 18例膝关节骨关节炎患者(26个患膝)进行3～6周、每周3次的肌力练习,伸膝肌和屈膝肌练习的程度相同。练习前、后测定60°/s、120°/s和180°/s等速运动的峰力矩、单次最佳做功和力矩加速能。结果 屈膝肌参数(包括60°/s的单次最佳做功,120°/s的峰力矩、单次最佳做功和力矩加速能,180°/s的峰力矩和力矩加速能)均较伸膝肌参数有显著增加。结论 膝关节骨关节炎患者的伸膝肌和屈膝肌的练习效果不同,屈膝肌力改善程度好于伸膝肌。伸膝肌在功能性活动中起的作用更大,必须更注重伸膝肌的练习。