脊髓损伤合并截肢患者的康复效果分析

目的:探讨脊髓损伤合并截肢患者的康复治疗效果。方法:1991年～2011年共收治脊髓损伤合并截肢者6例,ASIA分级A级5例,C级1例;右下肢截肢者3例,左下肢截肢者1例,左上肢截肢者1例,右下肢与右上肢截肢者1例,均进行康复评价并确定康复方案。在患者全身情况和残肢关节活动度获得改善后,对截瘫合并下肢截肢者予穿戴假肢和矫形器行站立和行走训练,合并上肢截肢者予佩戴功能性假肢等康复治疗。经过物理治疗(PT)、作业治疗(OT)训练及佩戴相应的假肢和矫形器,并经过反复训练和强化后观察康复效果。应用脊髓损伤神经学分类国际标准(ASIA标准)评估患者神经功能,使用功能独立性评定(FIM)量表评估患者生活自理能力。结果:本组病例平均住院康复时间为126d(58~236d)。5例截瘫患者ASIA神经功能无明显改善(P>0.05),但FIM运动评分显著提高(入院得分为25.83分,出院平均得分为52.17分)(P<0.05)。另1例颈脊髓损伤患者入院为不完全损伤,经过治疗后感觉评分提高58分,运动评分提高14分,FIM评分中自理活动能力提高9分,转移能力提高14分,运动能力提高5分。结论:脊髓损伤合并截肢患者经过佩戴假肢并予综合康复后,患者丧失的部分功能可得到替代,生活自理能力可得到明显提高。     

支架植入术治疗外伤性冠状动脉夹层并血栓形成致急性心肌梗死1例

患者男,63岁,车祸后全身多处(心前区、右上肢、右下肢及左上肢)疼痛1 h余,伴呼吸困难、全身大汗淋漓、心悸;既往无心脏病、糖尿病、脑血管病史。查体:右上肢、右下肢及左上肢关节活动障碍,右下肢皮下软组织肿胀、瘀青。心电图示V2导联异常Q波,V2、V3导联ST段抬高,Ⅱ、V5、V6导联ST段压低;诊断:前间壁急性心肌梗死。实验室检查:白细胞计数22.59×10⁹/L,D-二聚体13.76μg/ml,纤维蛋白原降解产物50.28μg/ml,降钙素原0.056 ng/ml,超敏肌钙蛋白Ⅰ0.204 ng/ml,肌红蛋白>1000.00 ng/ml,肌酸激酶MB亚型25.13 ng/ml。     

多发内生软骨瘤病1例

正患者,男,43岁,主因右膝关节疼痛伴活动受限10年加重1个月入院。患者10年前无明显诱因出现右膝关节疼痛,程度轻微,活动后略加重,后疼痛逐渐加重并出现右下肢活动障碍,自服止痛药物(具体药物及剂量不详)缓解疼痛,尚未影响正常生活,未予特殊治疗。1个月前,右膝关节疼痛加重,遂来我院就诊。患者既往体健,无外伤及手术史,入院查体:患者右下肢全长80 cm,较左下肢短缩7 cm,右     

高位长段颈椎管内血管畸形1例

1　病例报告患者女 ,3 5岁 ,因颈背部疼痛不适 2年 ,双上肢麻木无力 6个月 ,加重伴右下肢麻木无力 1个月而于 2 0 0 0年 12月入院。患者于 1998年 10月 ,无明诱因出现颈部疼痛不适 ,偶尔出现眩晕、头痛 ,于 2 0 0 0年 6月出现右上肢麻木无力 ,随后出现左上肢麻木无力 ,尤在激动或增加腹压时突然出现加重感。于2 0 0 0年 11月 ,右上肢麻木无力加重并出现右下肢麻木无力。入院后查体 :肩部平面以下感觉减退 ,右上肢肌力Ⅲ级 ,左上肢肌力Ⅳ级 ,右下肢肌力Ⅲ级 ,左下肢肌力正常 ,右侧Ｈｏｆｆｍａｎ征 (+ ) ,右侧Ｂａｂｉｎｓｋｉ征 (+ )。颈椎…     

成人型主动脉弓中断一例

患者男,24岁。体检发现心脏杂音6年,无明显临床症状,有长期高血压病史。入院查体:脉搏120次/分,左上肢、右上肢、左下肢、右下肢的血压分别为147/96 mm Hg、143/89mm Hg、123/74 mm Hg和116/71 mm Hg。发育正常,口唇无紫绀;心尖搏动位置正常,心界大小正常,P2亢进。肝肾功能、     

实时三维超声心动图诊断主动脉缩窄一例

患者 女,30岁.因反复心悸、头晕、紫绀14年,加重19d入院.患者既往有20余年高血压病史,血压最高时达220/100mmHg,药物治疗效果差.入院后查体:右上肢血压210/50 mmHg,左上肢204/50mmHg,右下肢130/80mmHg,左下肢110/70mmHg.心界向左下扩大,胸骨左缘第3～5肋间可闻及2/6级收缩期杂音.足背动脉搏动弱.     

前路松解与后路关节融合植骨治疗不可复性寰枢关节脱位一例

患者,女,57岁.因颈部疼痛、左上肢麻木无力伴双下肢行走不稳4年,加重2个月于2017年11月5日人院.既往无颈部外伤、风湿和类风湿关节炎、结核以及肿瘤病史.体格检查:颈部外观未见明显异常,无发际低及短颈畸形,颈部旋转及屈伸活动明显受限,左上肢皮肤感觉明显减退,右下肢及双下肢皮肤感觉无减退,胸、腹部有明显束带感,鞍区感...     

颅脑贯通火器伤脑疝并休克临床治愈一例

患者,男,20岁.因左额顶部手枪弹击伤昏迷30 min入院.查体:脉搏98次/分,呼吸26次/分,血压105/67.5 mmHg(1 mmHg=0.133 kPa).深昏迷,贫血貌,左额顶见两处直径约2 cm及4 cm创口,周围见20 cm×10 cm肿胀区,两口间距约12 cm,创口出血,边缘欠整齐,有脑组织溢出.瞳孔左0.6 cm,右0.5 cm,光反射左(-),右迟钝.右侧肢体偏瘫,上肢肌力0级,下肢肌力Ⅰ级.     

胸大肌皮瓣加胸三角皮瓣联合修复下颌部洞穿性缺损一例

1　病例介绍患者　男 ,31岁。被 10 k V高压电击伤下颌部、左上肢、左下肢及右足 ,昏迷约 10分钟 ,在当地医院急救后 ,于伤后 15小时转至我院。检查 :下颌部、下唇创面焦黑炭化 ,可见下颌骨 ;左上肢肿胀 ,左手至腕上 5 cm发黑 ,手指冰凉 ;创面分布于手、腕、肘前、左足踝部及小腿内侧 ,右足 口止母趾焦黑炭化 ,左足冰凉发黑。入院 1小时行左上、下肢切开减压术。诊断 :高压电烧伤下颌部 ,左上下肢、右足 度烧伤 ,面积 15 %。入院第 2天行左上臂下段、左小腿中下 1/ 3处截肢 ,为保留左小腿中上段 ,行左腓肠肌内侧头肌瓣移位覆盖左胫骨上段…     

主动脉缩窄合并冠心病一例

患者女,54岁。因间断胸背部疼痛36年,加重伴呕吐1 d入院。查体：血压：左上肢165/100 mm Hg,右上肢150/95 mm Hg,左下肢120/70 mm Hg,右下肢115/75 mm Hg;口唇无紫绀,双肺呼吸音粗,胸骨左缘第4、第5肋间可闻及3/6级收缩期杂音,左侧足背动脉搏动可触及,右侧触不清,双下肢皮温正常。     

Neurophysiologische Kennwerte f��r die Funktionsentwicklung in der Fr��hphase nach Implantation einer Schulterendoprothese

Background

The aim of the study was to identify suitable specific measurements of functional development in the early phase after implantation of a shoulder endoprosthesis and to analyze the shoulder in its association with the patient??s ability to walk safely.

Material and methods

Data were collected and analyzed in 50 patients after implantation of a shoulder endoprosthesis on assisted movement magnitude, rest and movement pain, functional self-assessment, timed up & go (TUG) test, 10-m walking test, and grip strength.

Results

Improvement with walking performance is accompanied by improvements in the other functional parameters. Higher grip strength values on the 6th postsurgical day (right hand) are associated with higher values of flexion. Lower values in the 10-m walking test are accompanied by higher grip strength values on the right (r=?C0.355^*), higher grip strength values on the left (r=?C0.303^*), and with higher values of flexion (r=?C0.267⁺). Lower values with the TUG test go along with higher values with grip strength in the right hand (r=?C0.251⁺).

Conclusion

Intact function of the shoulder is a prerequisite for well-directed gripping and, as a component of the postural control, has an effect on the coordination of walking safely. This study points to an increased fall risk in the early postsurgical phase after implantation of a shoulder endoprosthesis.     

Similar motion of a hand-held object may trigger nonsimilar grip force adjustments.

The tight coupling between load (L) and grip (G) forces during voluntary manipulation of a hand-held object is well established. The current study is to examine grip-load force coupling when motion of the hand with an object was either self-generated (voluntary) or externally generated. Subjects performed similar cyclic movements of different loads at various frequencies with three types of manipulations: 1) voluntary oscillation, 2) oscillating the right arm via the pulley system by the left leg (self-driven oscillation), and 3) oscillating the arm via the pulley system by another person (other-driven oscillation). During the self-generated movements: 1) the grip forces were larger and 2) grip-load force modulation was more pronounced than in the externally generated movements. The G-L adjustments are not completely determined by the mechanics of object motion; nonmechanical factors related to movement performance, for instance perceptual factors, may affect the G-L coupling.     

Effects of standing and sitting on finger-tapping speed in healthy adults

STUDY DESIGN: A repeated-measures design was used to compare finger-tapping performance (hand functional control) across 4 standing and sitting conditions of limb body support postures. OBJECTIVES: The intent was to examine the hypothesized hemispheric control interference effects of lower limb body support postures on finger-tapping performance. A secondary objective was to gain a better understanding of the relationship between lower limb posture and concurrent finger-tapping activity. BACKGROUND: In a task such as kicking a ball with the right foot, foot control theory suggests that the left hemisphere contralaterally controls right-foot kicking action. However, it can also be interpreted that the postural support (with the left foot in this example) involving the action of antigravity muscles (leg extensors) is driven ipsilaterally. Based on this explanation, we would expect a hemispheric effect to occur during standing on the left limb while performing a finger-tapping task with the right hand. This study has theoretical and clinical significance for understanding hemispheric and functional control of limbs, which may underlie the assessment of movement control and the development and use of therapeutic interventions that can potentially improve functional movement control. METHODS AND MEASURES: Ninety-eight (98) adult participants (ages 19 to 32 years) performed a finger-tapping task in 4 postural conditions: seated, standing on both feet, standing on the right foot only (RF), and standing on the left foot only (LF). RESULTS: As predicted, manual performance was significantly slower in the LF condition as compared to the standing and sitting positions. However, when comparing performance between the LF and RF conditions, the difference was minimal. CONCLUSIONS: Although support for the ipsilateral effect was not found, postural position did influence manual performance.     

Functional results after proximal row carpectomy to salvage a wrist

Proximal row carpectomy is a movement-preserving procedure in the treatment of arthrosis of the wrist. We have retrospectively assessed the objective and subjective functional results after proximal row carpectomy. Assessment of outcome included measurement of range of movement (ROM), grip strength and self-assessment of pain relief with a visual analogue scale (VAS) and the Disabilities of arm, shoulder, and hand (DASH) questionnaire. Results were graded using the Mayo and Krimmer wrist scores. Fourty-five patients (mean age 48 (30–67) years) were evaluated with a follow-up of 32 (8–115) months. Underlying conditions included: degenerative arthritis secondary to scapholunate advanced collapse deformity, or chronic scaphoid non-union (n=35), Kienböck disease stage III (n=4), chronic perilunate dislocation and fracture-dislocation (n=4), avascular necrosis of the scaphoid (n=1), and severe radiocarpal arthrosis secondary to distal radial fracture (n=1). Active ROM for wrist extension and flexion was 70° and mean radial and ulnar deviation 30.8°. Grip strength was 51% of the unaffected side. The average DASH score was 26. The intensity of the pain, measured by VAS, was reduced by 44% after strenuous activities and by 71% at rest. The Mayo and Krimmer wrist scores were 55 and 62 points indicating good results; 32 patients returned to work and 25 patients to their former occupation. Our results show that proximal row carpectomy is a technically easy operation that preserves a satisfying ROM and pain relief, and is recommended when the head of the capitate and the lunate fossa are not affected by arthrosis.     

Outcome of Functional Electrical Stimulation in the Rehabilitation of a Child with C-5 Tetraplegia

Abstract

Hand function was provided for a six-year-old child with C-5 American Spinal Injuries Association (ASIA) classification-A tetraplegia through a percutaneous intramuscular (IM) functional electrical stimulation (FES) system. In conjunction with implantation of 10 percutaneous IM electrodes for provision of grasp and release of her right hand, reconstructive surgery was performed to provide upper extremity positioning to optimize hand use. The subject participated in FES training over a nine-week period for approximately five hours weekly, with an additional five hours each week dedicated to exercise and conditioning of her arm muscles.

Physical and functional assessments included range of motion (ROM), manual muscle testing (MMT), activities of daily living (ADL) abilities and the Canadian Occupational Performance Measure (COPM), used to evaluate the effect of stimulated hand function and surgical reconstruction on functional ability. These were conducted prior to FES and surgery and repeated after rehabilitation training.

With rehabilitation and training, the child was able to control her FES system. Physical assessments revealed increased strength of both shoulders and more useful range of arm movement. Functional assessments show that the FES system enabled her to perform age-appropriate ADL that previously were achievable only with physical assistance. Her overall level of independence in ADL ability increased, as (lit) self-rated levels of satisfaction and performance on chosen activities. Positive gains demonstrated here suggest the need for further studies of FES systems in young children with SCI. () Spin.il Cord Med 1999;22:107–113)     

Visuokinesthetic perception of hand movement is mediated by cerebro-cerebellar interaction between the left cerebellum and right parietal cortex

Combination of visual and kinesthetic information is essential to perceive bodily movements. We conducted behavioral and functional magnetic resonance imaging experiments to investigate the neuronal correlates of visuokinesthetic combination in perception of hand movement. Participants experienced illusory flexion movement of their hand elicited by tendon vibration while they viewed video-recorded flexion (congruent: CONG) or extension (incongruent: INCONG) motions of their hand. The amount of illusory experience was graded by the visual velocities only when visual information regarding hand motion was concordant with kinesthetic information (CONG). The left posterolateral cerebellum was specifically recruited under the CONG, and this left cerebellar activation was consistent for both left and right hands. The left cerebellar activity reflected the participants' intensity of illusory hand movement under the CONG, and we further showed that coupling of activity between the left cerebellum and the "right" parietal cortex emerges during this visuokinesthetic combination/perception. The "left" cerebellum, working with the anatomically connected high-order bodily region of the "right" parietal cortex, participates in online combination of exteroceptive (vision) and interoceptive (kinesthesia) information to perceive hand movement. The cerebro-cerebellar interaction may underlie updating of one's "body image," when perceiving bodily movement from visual and kinesthetic information.     

Outcome of functional electrical stimulation in the rehabilitation of a child with C-5 tetraplegia

Hand function was provided for a six-year-old child with C-5 American Spinal Injuries Association (ASIA) classification-A tetraplegia through a percutaneous intramuscular (i.m.) functional electrical stimulation (FES) system. In conjunction with implantation of 10 percutaneous i.m. electrodes for provision of grasp and release of her right hand, reconstructive surgery was performed to provide upper extremity positioning to optimize hand use. The subject participated in FES training over a nine-week period for approximately five hours weekly, with an additional five hours each week dedicated to exercise and conditioning of her arm muscles. Physical and functional assessments included range of motion (ROM), manual muscle testing (MMT), activities of daily living (ADL) abilities and the Canadian Occupational Performance Measure (COPM), used to evaluate the effect of stimulated hand function and surgical reconstruction on functional ability. These were conducted prior to FES and surgery and repeated after rehabilitation training. With rehabilitation and training, the child was able to control her FES system. Physical assessments revealed increased strength of both shoulders and more useful range of arm movement. Functional assessments show that the FES system enabled her to perform age-appropriate ADL that previously were achievable only with physical assistance. Her overall level of independence in ADL ability increased, as did self-rated levels of satisfaction and performance on chosen activities. Positive gains demonstrated here suggest the need for further studies of FES systems in young children with SCI.     

A specific exercise program and modification of postural alignment for treatment of cervicogenic headache: a case report

STUDY DESIGN: Case report. OBJECTIVE: To describe an intervention approach consisting of a specific active-exercise program and modification of postural alignment for an individual with cervicogenic headache. BACKGROUND: The patient was a 46-year-old male with a 7-year history of cervicogenic headache. He reported constant symptoms with an average intensity of 5/10 on a visual analogue scale where 0 indicated no pain and 10 the worst pain imaginable. Average pain intensity in the week prior to the initial evaluation was 3/10 secondary to trigger point injections. The patient's headache symptoms worsened with activities that involved use of his arms and prolonged sitting. METHODS AND MEASURES: The patient was treated 7 times over a 3-month period. Impairments of alignment, muscle function, and movement of the cervical, scapulothoracic, and lumbar regions were identified. Outcome measurements included headache frequency, intensity, and the Neck Disability Index (NDI) questionnaire. Intervention included modification of alignment and movement during active cervical and upper extremity movements. The patient also received functional instructions focused on diminishing the effect of the weight of the upper extremities on the cervical spine. RESULTS: The patient reported a decrease in headache frequency and intensity (1 headache in 3 weeks, intensity 1/10) and a decrease in his NDI score from 31 (severe disability) to 11 (mild disability). The patient also demonstrated improvement in upper cervical joint mobility, cervical range of motion, scapular alignment, and scapulothoracic muscle strength. CONCLUSION: Interventions that included modification of alignment in the cervical, scapulothoracic, and lumbar region, along with instruction in a specific active-exercise program to address movement impairments in these 3 regions, appeared to have been successful in relieving headaches and improving function in this patient.     

A cause and cure of some cases of "writer's cramp"

Writer's cramp is a very disabling condition characterized by difficulty in fine movements of the hand such as writing, shaving, or performing surgery. It is associated with pain in the forearm and upper arm. Women with writer's cramp experience comparable difficulty. An analysis of 100 cases of ruptured C6 disk, proved at operation and taken at random from the files of Semmes-Murphey Clinic, was carried out, and showed that 60 of these had pain in the right arm and 40 had pain in the left arm. Twenty of those with right arm pain had writer's cramp. There was one questionable case of writer's cramp in the left arm. Of the 20 who had writer's cramp, 13 had complete relief of writer's cramp and pain, 1 had no relief (Dr. Butts), and there were 6 lost to follow-up. At least one cause of writer's cramp is suggested, but no claim is made that this is the only cause.     

Thoracic spine dysfunction in upper extremity complex regional pain syndrome type I

STUDY DESIGN: Case study. OBJECTIVE: To demonstrate the importance of assessment and treatment of the thoracic spine in the management of a patient with signs and symptoms of upper extremity Complex Regional Pain Syndrome Type I (CRPS-I). BACKGROUND: The patient was a 38-year-old woman who suffered a traumatic injury to her left hand. Five months after injury, she presented with severe pain, immobility of the left arm, and associated dystrophic changes. She was unable to work and needed help in some activities of daily living. METHODS AND MEASURES: The patient was treated for 3 months in 36 visits. Initial treatment consisted of cutaneous desensitization, edema management, and gentle therapeutic exercises. However, further examination indicated hypomobility and hypersensitivity of the upper thoracic spine. Joint manipulation of the T3 and T4 segments was implemented. The patient's status was monitored and range of motion, strength, temperature, and skin moisture were measured. RESULTS: Immediately after the vertebral manipulation, there was a significant increase in the left hand's skin temperature and a decrease in hyperhydrosis as measured by palpation. Shoulder range of motion increased from 135-175 degrees and the patient reported reduced pain from 6/10 to 3/10 on a scale from 0 to 10, where 0 represents no pain. The decrease in the patient's dystrophic and allodynic symptoms permitted further progress in functional re-education. The patient was discharged with full return to independence and initiation of a vocational retraining program. CONCLUSION: Assessment and treatment of the thoracic spine should be considered in patients with upper extremity CRPS-I.