高能量激光联合针对性手功能训练治疗1-2级拇腕掌关节骨性关节炎的疗效观察

目的：观察高能量激光(high-intensity laser therapy,HILT)联合针对性手功能训练对1-2级拇腕掌关节(carpometacarpal,CMC)骨性关节炎(osteoarthritis,OA)的疼痛和侧捏力的影响。方法：选择2020年4月至2022年4月诊断为1-2级CMC OA的患者42例,年龄58~80(68.90±7.58)岁,均为女性,分为观察组和对照组,各21例。观察组患者接受HILT及手功能训练4周,对照组患者接受超短波治疗及矫形器制动4周。分别在干预前、干预后即刻以及干预后12周采用疼痛视觉模拟评分(visual analogue scale,VAS)比较疼痛程度,采用测力计观测拇指侧捏力并比较手指功能恢复情况。结果：干预后即刻及干预后12周,两组患者VAS及拇指侧捏力均较治疗前改善(P<0.05)。但与对照组比较,观察组VAS减轻程度更大(干预后立即t=3.37,P<0.05,干预后12周t=9.05,P<0.05),拇指侧捏力平均值高于对照组(干预后立即t=-2.55,P<0.05,干预后12周t=-9.51,P<0.05)。结论：高能量激光联合针对性手功能训练较传统方法更能有效改善1-2级拇腕掌关节骨关节炎的疼痛和侧捏力。     

Basal metacarpal osteotomy for osteoarthritis of the thumb

Thumb metacarpal extension osteotomy provides effective treatment for the hypermobile trapeziometacarpal joint consistent with Eaton stage 1 disease. This procedure is a useful alternative to Eaton ligament reconstruction. Clinical outcomes are favorable and, should symptoms persist, the procedure does not jeopardize satisfactory execution of trapezial resection arthroplasty in the future.     

Nonoperative treatment for a double dislocation of the thumb metacarpal: a case report

Double dislocations of the thumb are rare injuries. Those reported in the English literature have all been treated operatively except one. We report the second case of a double dislocation of a thumb involving the metacarpophalangeal joint and carpometacarpal joint treated nonoperatively. Two-year results reveal a stable, pain free thumb with no evidence of arthritis or subluxation. No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.     

下颈椎在屈伸运动时的应力分布研究

目的探讨下颈椎屈伸运动对其应力分布的影响。方法取5具成人新鲜尸体颈椎标本(C2-C7),通过施加最大载荷为2.34N.m的纯扭矩,使颈椎产生前屈和后伸运动,记示C4、C5、C6前柱,中柱和后柱的应变。结果颈椎前屈时,前柱和中柱承受压应力,后柱承受拉应力,且前柱的应力大于中柱和后柱(P<0.05);后伸时,前柱受拉应力,中柱和后柱承受压应力,且前柱的应力最大(P<0.05)。前柱的应力前屈小于后伸(P<0.01),中柱的应力在前屈和后伸时相差不大,后柱的应力前屈大于后伸(P<0.01)。对于三个椎体相比较而言,前屈和后伸时前柱的应力最大(P<0.01),而C4-6前柱的应力在屈伸时无差别。中柱的应力在前屈时C4、C5较大,与C6有差别(P=0.03),而后伸时无差别。后柱的应力在前屈时,三个椎体无差别(P=0.02)。结论下颈椎屈伸运动过程中应力的变化情况可能与颈椎病的发病机制有一定的关系。     

Effect of immobilization of metacarpophalangeal joint in thumb carpometacarpal osteoarthritis on pain and function. A quasi-experimental trial

Study Design

A quasi-experimental trial.

Motion of the femoral condyles in flexion and extension during a continuous lunge

Numerous studies have reported on in‐vivo posterior femoral condyle translations during various activities of the knee. However, no data has been reported on the knee motion during a continuous flexion‐extension cycle. Further, few studies have investigated the gender variations on the knee kinematics. This study quantitatively determined femoral condylar motion of 10 male and 10 female knees during a continuous weightbearing flexion‐extension cycle using two‐dimensional to three‐dimensional fluoroscopic tracking technique. The knees were CT‐scanned to create three‐dimensional models of the tibia and femur. Continuous images of each subject were taken using a single‐fluoroscopic imaging system. The knee kinematics were measured along the motion path using geometric center axis of the femur. The results indicated that statistical differences between the flexion and extension motions were only found in internal‐external tibial rotation and lateral femoral condylar motion at the middle range of flexion angles. At low flexion angles, male knees have greater external tibial rotation and more posteriorly positioned medial femoral condyle than females. The knee did not show a specific pivoting type of rotation with flexion. Axial rotation center varied from lateral to medial compartments of the knee. These data could provide useful information for understanding physiological motion of normal knees. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 33:591–597, 2015.     

Biomechanic analysis of trapeziectomy, ligament reconstruction with tendon interposition, and tie-in trapezium implant arthroplasty for thumb carpometacarpal arthritis: a cadaver study

PURPOSE: Thumb carpometacarpal joint arthritis has been commonly treated with some combination of resection of the trapezium and interposition of a spacer using either a biologic or artificial material plus tenodesis to reconstruct the volar oblique ligament. The purpose of this study was to evaluate the biomechanic stability of the classic ligament reconstruction with tendon interposition (LRTI) or without tendon interposition compared with a newly developed 1-piece silicone trapezium implant. METHODS: Twelve cadaver arm specimens had the following procedures: resection of the trapezium, tendon interposition, ligament reconstruction, LRTI, and the silicone implant. Biomechanic testing of joint stability was performed with a physiologic loading protocol before and after each procedure. RESULTS: The implant significantly corrected the axial displacement after trapeziectomy and resulted in less radial displacement than LRTI. It significantly reduced angulation of the thumb metacarpal base but resulted in more rotation of the thumb during simulated pinch. There was no significant difference in stability measures between trapeziectomy and LRTI or ligament reconstruction without tendon interposition. CONCLUSIONS: We found several biomechanic advantages to the implant compared with LRTI. Advantages include reduction in axial and radial displacement and maintenance of the trapezial space. We attribute these advantages to the effect of the implant as a spacer. The significant rotation with the implant, however, raises questions concerning implant design and fixation. We found no biomechanic advantage to LRTI or ligament reconstruction without tendon interposition over trapeziectomy alone.     

The incidence of atrial fibrillation and the added value of thumb ECG for detecting new cases

Abstract

Objectives. To evaluate the incidence of atrial fibrillation (AF) as well as the value of thumb electrocardiography (ECG) for identification of paroxysmal AF in a Swedish cohort of middle-aged men from the general population. Design. A population based random cohort of 798 men underwent screening at the age of 50 and re-examined at the age of 60 and 71 years. At the last examination, a thumb ECG recording was conducted for 2 weeks twice a day in 479 men from the original cohort. Registered hospital AF diagnoses were retrieved from the Swedish Patient Registry from 1993 to 2014. Results. During a 21-year follow-up, 77 men (9.6%) were diagnosed with AF; of these men, 49.4% (38 of 77) had permanent AF. Fifteen of 479 (3.1%) patients had paroxysmal AF. Of those, seven had been previously diagnosed with paroxysmal AF through Patient Registry. The incidence of AF increased from 2.2 per 1000 years at risk at the age of 50–54 years to 9.3 per 1000 years at risk at the age 65–70 years. The prevalence of AF at the age of 71 years was increased from 7.1% to 9.9% using thumb ECG. Conclusions. In addition to medical history, patient register and 12-lead -ECG, the use of thumb ECG increased the number of detected paroxysmal AF by 21%.     

Convergent validity and responsiveness of the Canadian Occupational Performance Measure for the evaluation of therapeutic outcomes for patients with carpometacarpal osteoarthritis

Study DesignThis is a longitudinal, observational, multicenter, cohort study.IntroductionThumb carpometacarpal (CMC) osteoarthritis (OA) is associated with more pain and restrictions than other hand OA. The use of patient-identified occupational performance goals to guide hand therapy treatment and to measure clinical outcomes is fundamental for a patient-centered intervention. The COPM enables subjects to identify goals for hand therapy and engage in a subject-specific therapeutic process.Purpose of the StudyThe purpose of this study is to evaluate the convergent validity and responsiveness of the COPM to evaluate the relationship between the patient’s self-perception and satisfaction of performance in everyday living and pain intensity, upper limb function, and manual ability.MethodsEligible participants to multiple hand therapy centers were recruited. Outcomes measures (VAS scale, QuickDASH, MAM-36, and the COPM questionnaire) were measured at the baseline and 3 months after.ResultsOne hundred forty-five (n = 145) consecutive patients for five different hand rehabilitation centers with symptomatic thumb CMC OA were screened for eligibility criteria. COPM-P and COPM-S were the most responsive instruments, with an area under the curve of 0.88 (95% CI 0.79-0.96) and 0.88 (95% CI 0.80-0.96), respectively.ConclusionsAlthough more investigation in this area is necessary to conclude that the COPM is the best option to evaluate the effectiveness of hand therapy interventions for thumb OA. The COPM focuses on function and occupation and, in comparison with others upper limb scales, does not require the use of another complementary scale for addressing both satisfaction and ADL status. COPM is an instrument with a good convergent validity and responsiveness to evaluate the relationship between the patient’s self-perception and satisfaction in thumb CMC OA.     

胸小肌移植重建拇对掌功能的解剖与临床研究

目的研究选择性胸小肌移植重建拇对掌功能术式的临床解剖基础及临床治疗的效果。方法在20侧成人尸体胸部及上肢标本上，观测和比较胸小肌及拇对掌肌的解剖数据，行移植模拟试验以评估新术式的可行性；依据解剖研究结果，按新的手术方式施行临床手术治疗5例，术后随访拇对掌功能恢复情况。结果解剖研究结果显示：胸小肌位置恒定，具备独立的动、静脉和神经支配；移植肌与受区对掌肌匹配；临床手术治疗5例，术后随访6～12个月，拇对掌功能恢复，肌力均达到4级以上，大鱼际部外形满意。结论胸小肌移植重建拇对掌功能这一术式有其临床解剖基础，移植手术能达到恢复对掌功能的要求，是一种新的对掌功能重建方法。     

指背血管蒂岛状皮瓣修复拇指组织缺损

目的 探讨拇指组织缺损的修复方法。方法 利用8具尸体16只手进行解剖学研究，观察了拇指背动脉、第1掌背动脉及食指桡侧指背动脉。临床上分别以拇指背动脉、示指桡侧指背动脉为蒂于手背侧设计岛状皮瓣进行应用。结果 拇指背动脉外径0．24～0．46mm，平均0．37mm，示指桡侧指背动脉0．26～0．56mm，平均0．44mm，血管恒定。临床应用拇指背血管蒂逆行皮瓣、示指桡侧指背血管蒂皮瓣修复拇指组织缺损12例；皮瓣带人桡神经指背支形成有感觉皮瓣，效果更满意。结论 以指背血管为蒂的手背侧皮瓣是修复拇指组织缺损的较为理想方法。     

Exercise handout and one-on-one hand therapy for management of stiffness after plaster cast immobilization of simple phalangeal and metacarpal fractures in children: A randomized,noninferiority trial

Study DesignThis is a noninferior, single-blind, randomized controlled trial.IntroductionJoint stiffness is common after plaster cast immobilization for simple phalanx and metacarpal fractures in children. The limited literature suggests this joint stiffness in children resolves without one-on-one therapy; however, without robust studies confirming that there is no detrimental effect from withdrawing treatment, many children are still referred.Purpose of the StudyThe purpose of this study was to determine if an educational handout for self-management of stiffness is noninferior to one-on-one hand therapy for achieving full range of motion (ROM).MethodsParticipants were randomly assigned to group one who received the handout or group two who received hand therapy in addition to the handout. The ROM was measured by composite flexion and total active motion (TAM). The noninferiority margin was 10% difference between the two groups in the proportion of participants who achieved full ROM at two weeks after cast removal.ResultsSixty participants in each group completed the study. Group difference for composite flexion was 1.7% (95% CI: −3.9% to 7.2%), demonstrating noninferiority. Group difference for TAM was inconclusive at 8.3% (95% CI: −2.1% to 18.7%). Sensitivity analysis adjusting for participants with full composite flexion at the baseline resulted in the group difference for composite flexion of 3.1% (95% CI: −3.6% to 9.8%), maintaining noninferiority, but group difference for TAM at 10.4% (95% CI: 0.0% to 20.9%), was inconclusive with the handout group significantly worse.ConclusionAn educational handout is noninferior to hand therapy for achieving full ROM in composite flexion but not TAM. This needs to be taken into consideration for changing clinical practise.     

不同尿蛋白检测在肾脏疾病中的临床观察及诊断价值

目的 探讨尿微量白蛋白(mALB)、尿转铁蛋白(TRF)、尿胱蛋白酶抑制剂C(Cystatin C)、尿β2-微球蛋白(β2 - MG)、尿免疫球蛋白IgG(IgG)检测在肾脏疾病中的敏感性及临床价值.方法 选择2011年3月～2011年8月在新疆维吾尔自治区人民医院肾病科住院的肾脏疾病患者50例作为病例组,健康体检者30例为对照组.采用酶联免疫法(ELISA)检测尿mALB、TRF、Cystatin C、β2 - MG及IgG的含量,并以ROC曲线分析其敏感性.结果 病例组患者尿mALB、TRF、Cystatin C、β2 - MG及IgG的测定浓度明显高于对照组,差异具有统计学意义(P ＜0.001),通过ROC曲线、诊断试验结果显示:尿β2 - MG、mALB、TRF、IgG、Cystatin C曲线下面积为0.998、0.950、0.950、0.919、0.833,95％可信区间分别为0.001～1.000、0.904～0.997、0.894～1.000、0.851 ～0.987,0.739～0.927.尿β2 - MG、mALB、TRF较尿IgG、Cystatin C更具有敏感性(P ＜0.001).结论 尿β2 - MG、mALB、TRF、IgG及Cystatin C联合检测可作为肾损害性疾病的敏感指标,对延缓肾脏疾病的进展具有重要的临床意义.     

Quality control for clinical islet transplantation: organ procurement and preservation, the islet processing facility, isolation, and potency tests

Pancreatic islet transplantation has become one of the ideal treatments for patients with type 1 diabetes mellitus due to improvements in isolation techniques and immunosuppression regimens. In order to ensure the safety and rights of patients, isolated islets need to meet the criteria for regulation as both a biological product and a drug product. For the constant success of transplantation, therefore, all investigators involved in clinical islet transplantation must strive to ensure the safety, purity, and potency of islets in all the phases of clinical islet isolation and transplantation. In this review, we summarize the quality control for clinical islet isolation and transplantation, and the latest topics of pre-transplant islet assessment.