下肢关节功能康复架在术后膝关节功能康复中的应用

目的：观察关节功能康复架在膝关节功能康复中的作用。方法：应用自己设计制造的下肢关节功能康复架,对膝关节及周围骨折病人术后８～１０ｄ,行膝关节被动活动,每日３～４次,每次伸、屈４０～５０次,伸屈结束时停留于自然位置,并辅以肌肉主动收缩锻炼,以１５ｄ为限。结果：临床应用５０例,在被动活动结束时,关节活动度≥９０度,未见移位、分离、内固定松动等骨折端的并发症。结论：关节功能康复架是膝关节及周围骨折术后膝关节早期被动活动的较理想的辅助器械;早期被动运动对关节功能康复有促进作用。     

Cryotherapy influences joint laxity and position sense of the healthy knee joint

OBJECTIVE: To investigate the influences of cryotherapy on the anteroposterior (AP) laxity and the joint position sense of the knee. DESIGN: Experimental. SETTING: University hospital in Japan. PARTICIPANTS: Twenty healthy volunteers (10 men, 10 women; age range, 21-28y) were analyzed. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: A cooling pad was applied to the knee for 15 minutes under the circulating medium at 4 degrees C. The subject's skin temperature over the anteromedial aspect of the knee was measured during the 15 minutes of cooling and again 15 minutes later. The accuracy of the knee joint position sense was evaluated before and after cooling by using a modified Skinner's method. AP displacement and anterior terminal stiffness (ATS) of the knee were obtained with a KT-2000 trade mark knee arthrometer. RESULTS: Total (AP) laxity and anterior knee laxity decreased by 1.0 and 1.2mm after 15 minutes of cooling (P=.003, P=.017), respectively. ATS and inaccuracy of position sense increased by 21N/mm and 1.7 degrees (P<.001, P=.003), respectively. All parameters had normalized at 15 minutes postcooling. CONCLUSION: Cooling for 15 minutes makes the knee joint stiffer and lessens the sensitivity of the position sense. These findings may be significant and should be taken into account for therapeutic programs that involve exercise immediately after a period of cooling.     

Predicting mechanical load of the glenohumeral joint, using net joint moments

OBJECTIVE: To evaluate the relationship between net moments for the glenohumeral joint as calculated with a model that is easy to apply (Static Strength Prediction Program (SSPP)) and the internal forces, calculated with a simulation model of the human shoulder (Delft Shoulder Model, DSM). DESIGN: Static recordings of bony landmarks of the shoulder girdle during prescribed arm motions using a three-dimensional (3D) digitizer. BACKGROUND: The SSPP is a biomechanical model for the evaluation of workload. Concerning the shoulder the output of the model consists of net moments in the glenohumeral joint. For the glenohumeral joint the relationship between net joint moments and internal load predictions is unknown, therefore it is useful to investigate whether the SSPP can be used to predict mechanical load in the glenohumeral joint. METHODS: 3D co-ordinates of bony landmarks of the shoulder girdle are recorded, in variable arm positions, in four different planes. RESULTS: A strong linear relationship between compression forces and net moments is found, which makes it reasonable to assume a direct relationship between net moments and joint compression forces. CONCLUSIONS: (a) Net joint moments appeared to be a good indicator for mechanical load in the glenohumeral joint in static situations. (b) The SSPP can be used to predict these joint moments for static situations. RELEVANCE: biomechanical models predicting mechanical load can be used in work situations in order to prevent overload and injuries, as well as in many other areas, for instance to evaluate the mechanical load during wheelchair propulsion.     

Disorders of the acromioclavicular joint

The acromioclavicular joint is a frequent source of shoulder pain.This article reviews acromioclavicular separations and other disorders affecting the joint and its surrounding structures.     

Alloplasty of the humeral joint

Background. Since 1980's, shoulder arthroplasty has become more oftenly performed procedure, and for severe comminuted fractures of proximal humerus (fou r- fragmented fractures, according to Neer's classification) has become first - line therapeutic option. At the beginnig of 90's, contemporary prinicples of shoulder arthroplasty were introduced. It is assumed that 4 mechanical parameters, i.e. range of motion, joint stability, strengh and smoothness of prosthesis components contribute to shoulder function, and we sholud reach toward their reconstruction during surgical procedure. Material and Methods. In our Department from 1995 to1999 we performed 14 shoulder hemiarthroplasties using Bio-Modular prosthesis (12 women and 2 men). Patients' age ranged from 41 to 75 years (average 61.8 years). Indications included: acute comminuted proximal humerus fractures, proximal humerus malunions, and either degenerative arthritis or rheumatoid arthrits of the shoulder. Aftertreatment consisted of passive motions introduced on the first day after an operation, followed by assisted active excercises 4- 6 weeks later, and motions against resistance, allowed 2 months postoperatively. Results. The outcomes were evaluated three years after surgery, and were measured as the score in the Constant scale and as subjective patients' assesments. Improvement was seen as an increase from average 28.3 preoperative Constant score, to 60.3 postoperatively. Subjectively, excellent outcome was reported by 4 patients, good - by 7, and fair by 2 patients. Conclusions. Our experience shows that whereas indications to shoulder artrhroplasty are not frequent in cases of fractures or orthopedic conditions of the affected region, in properly selected group of patients this procedure is effective treatment option, alleviating pain and allowing for regaining well - functioning joint, but long-lasting, at leats one-year long rehabilitation programm after surgery is mandatory.     

Sonography of the knee joint

The aim of this article is to review the sonographic appearances of common disorders involving the knee joint. Ultrasound is a sensitive method for diagnosis of tendon injuries. Injured ligaments appear swollen with mixed echogenicity. Meniscal injuries and muscle tears can be easily diagnosed. Ultrasound shows synovial thickening and effusion in inflammatory arthropathy and erosions of the articular surface in degenerative arthritis. It can be used effectively in the detection of rheumatoid arthritic activity and for grading degenerative arthritis lesions. Cystic lesions, as well as benign and malignant soft-tissue masses, are clearly delineated. Ultrasound is a safe noninvasive imaging modality that can be used for diagnosis of different disorders involving the knee joint.