不同检查者和不同检查工具对关节活动度检查的影响

目的 观察不同检查和不同检查工具对关节活动度（ROM）检查的影响。方法 对104名健康青年人进行肩前屈、后伸、外展、内旋、外旋ROM测定，每位受试接受2位检查用通用量角器和方盘量角器检查，对比受试主动活动与被动活动、左侧与右侧、同一检查用通用量角器与方盘量角器的ROM值，以及不同检查用通用量角器、方盘量角器的ROM值。结果 无论用哪一种量角器，受试主动ROM均小于被动ROM，有显差异，但左右两侧ROM无显差异。使用通用量角器和方盘量角器相比，肩前屈ROM无显差异，肩后伸、外展、内旋、外旋ROM有显差异。不同检查用方盘量角器测量ROM值无显差异，用通用量角器测量肩内旋ROM值无显差异，肩前屈、后伸、内旋、外旋ROM值有显差异。结论 方盘量角器测量ROM的可重复性较高。为确保ROM检查结果的可比性，应由同一位检查使用同一种检查工具对患进行ROM检查。     

两种工具在四肢关节ROM测量中的比较

由11名医科大学学生和1名进修医师用两种工具分别测定11名健康青年的上、下肢各关节25个方向的关节ROM。结果发现,两种工具的测量结果存在显著相关性;不同测量者用方盘量角器在相同人身上测得的数据的标准差明显小于通用量角器.说明方盘量角器可代替通用量角器,而且其测量结果较通用量角器更为精确.     

肩关节运动时肌肉力臂改变的实验研究

目的:通过分析肩关节运动时各种肌肉的运动力臂大小及其变化,以揭示该类肌肉对肩关节不同方向运动的影响。方法:选用10侧尸体肩关节标本,分别测量三角肌的三个部分、肩袖诸肌在肩外展、前屈、后伸、内旋及外旋过程中的肌腱位移,并根据位移和关节运动角度计算力臂值。结果:在上臂外展过程中,外展0°～30°时,冈上肌力臂变化最大;外展30°～120°时,力臂变化最大的为中部三角肌。在臂后伸或前屈过程中,力臂变化最大的分别为后部三角肌或前部三角肌。在臂内旋时,肩胛下肌的力臂值最大,而臂外旋时冈下肌／小圆肌的力臂值最大。结论:在上臂外展的起始阶段冈上肌腱功效较大,其次为中部三角肌;前部三角肌和中部三角肌分别在臂的前屈和后伸过程中有较大功效;在臂内外旋过程中,肩胛下肌和冈下肌／小圆肌功效较大。     

电子量角器结合个性化测量板在直接前入路全髋关节置换术中的应用

目的 探讨使用电子量角器和个性化测量板在直接前入路(DAA)全髋关节置换术(THA)中的作用。方法回顾性分析2017年1月至2019年12月复旦大学附属金山医院骨科采用DAA入路进行THA的180例193髋初次全髋关节置换病例。其中，136髋使用电子量角器和个性化测量模板(模板组)，57髋采用常规手术(常规组)，两组患者随访时间、年龄、性别、体质量差异无统计学意义。记录两组手术时间、术后臼杯外展角、前倾角、肢体长度差异、髋关节活动度、髋关节功能HHS评分及并发症情况。结果 两组手术时间差异无统计学意义(t=0.34,P>0.05)，末次随访模板组术后髋关节HHS评分优于常规组(t=6.16,P<0.05)，且并发症发生率小于常规组(χ²=4.64,P<0.05)。模板组和常规组髋臼假体外展角、前倾角、髋关节屈曲、后伸、外旋、内旋、内收、外展差异均有统计学意义，模板组优于常规组(P<0.05)。两组之间肢体长度差异无统计学意义。随访期间均无假体感染、松动发生。结论 DAA入路结合电子量角器和个性化测量板可以提高DAA入路THA髋臼假体放置的精...     

脑卒中患者肢体运动、构音及吞咽训练方法

1治疗性卧位 可有效防止关节挛缩变形。 (1)平卧位：给患者患肩后垫一软枕,使肩略外旋,外展 50°,伸肘,前臂旋后,手指伸展。患侧下肢保持屈髋,屈膝,踝背伸 90°,两足之间放一软枕,防小腿内收。 (2)健侧卧位：患肩前屈 90°,下垫一软枕,屈肘,前臂旋前,手伸展。患侧下肢屈髋,屈膝,踝中立位。 (3)患侧卧位：患肩前伸,前屈,其下放一软枕,伸肘,前臂旋后,手伸展。患侧下肢略后伸,屈膝,踝中立位。 2肢体功能锻炼 2.1肢体肌力训练在进行患肢训练的同时,要督促指导病人健侧肢体的主、被动运动,每日 2～ 3次,每次 15min。 (1…     

基于Kinect的人体下肢关节活动度自动测量方法

目的提高人体下肢关节活动度（ROM）测量精确度、效率，简化测量过程，提出一种基于Kinect的人体下肢ROM自动测量方法。 方法选取受试者50例，按随机数字表法分成a、b、c、d、e五组，每组10例。借助Kinect骨架追踪技术，通过计算机处理下肢各关节点的深度数据，捕捉和追踪受试者下肢各关节点的位置，在计算机交互界面上实时输出髋、膝等关节的活动度数值，与传统手工测量结果进行比较，验证该自动测量方法的准确性，同时借助语音识别、语音输出技术，优化不同活动度测量科目间的切换方式和提示信息实时发出的方法。 结果5组受试者在7项科目中测得的关节活动度数据，根据Grubbs检验法和t检验法，在检验水准α=0.05的前提下，所得髋关节外展科目（t=0.57,P=0.597），髋关节内收科目（t=0.52,P=0.621），髋关节前屈科目（t=1.01,P=0.371），髋关节后伸科目（t=0.12,P=0.902），髋关节外旋科目（t=0.00,P=1.000），髋关节内旋科目（t=0.34,P=0.753），膝关节屈曲科目（t=1.12,P=0.280）中，｜t｜值均小于检测临界值t0.025(4)=2.776，因此该测量方法所得ROM与传统手工测量结果比较，差异无统计学意义(P&rt;0.05)。 结论基于Kinect的人体下肢ROM自动测量方法实现了下肢ROM的自动测量，简化了测量过程，测量结果准确，增强了下肢ROM测量的实用性。     

三维动作捕捉分析系统COFT-Motion?评估健康受试者上肢主动关节活动度的信效度研究

目的 评价三维动作捕捉分析系统COFT-Motion^?评估健康受试者上肢主动关节活动度的信效度，为其临床应用提供客观依据。方法 2022年1-3月公开招募健康受试者入组。由评估者对健康受试者应用三维动作捕捉分析系统COFT-Motion^?和角度尺评测肩关节(前屈、后伸、内收、外展)和肘关节(屈曲、伸直)的主动关节活动度。采用Pearson相关分析评价效度，采用组内相关系数(intraclass correlation coefficient, ICC)评价信度。结果 COFT-Motion^?与角度尺评估健康受试者上肢主动关节活动度测量值呈正相关，肩关节(前屈、后伸、内收、外展)和肘关节(屈曲、伸直)主动关节活动度的Pearson相关系数分别为0.913、0.964、0.961、0.941、0.864、0.919(P<0.05)。不同评估者使用COFT-Motion?评估健康受试者肩关节(前屈、后伸、内收、外展)和肘关节(屈曲、伸直)主动关节活动度的结果显示，ICC分别为0.892、0.942、0.961、0.988...     

艾盐包热熨手三阳经对脑卒中偏瘫患者上肢运动功能的影响

目的 观察艾盐包热熨手三阳经对脑卒中偏瘫患者上肢运动功能、上肢关节活动度和偏瘫手功能分级的影响。方法选取2021年3—9月收住福建中医药大学附属康复医院神经康复科的脑卒中后偏瘫患者86例,随机分为试验组和对照组,每组各43例。对照组进行常规内科治疗、护理与康复训练,试验组在对照组的基础上进行艾盐包手三阳经热熨,1次/d,30 min/次,5次/周,连续干预4周。于干预前、干预2周后及干预4周后评估患者上肢运动功能、上肢关节活动度、偏瘫手功能分级。结果 最终81例完成试验,试验组40例,对照组41例。结果显示,干预2周后试验组的上肢运动功能与对照组比较,差异无统计学意义（P>0.05）;干预4周后试验组的上肢运动功能优于对照组（P<0.05）。上肢关节活动度方面,干预2周后试验组肩前屈、肩后伸、肩外展、肩内旋和肘屈的活动度均优于对照组（P<0.05）,干预4周后试验组肩前屈、肩后伸、肩外展、肩内旋、肩外旋、肘屈、腕掌屈和腕背伸的关节活动度均优于对照组（P<0.05）;干预2周、干预4周后,2组偏瘫手功能分级比较,差异无统计学意义（P>0.05）。结论艾盐包热...     

偏瘫患者与正常人日常生活活动的三维运动学分析

目的采用三维运动学分析方法研究正常人和偏瘫患者在日常生活活动（ADL）中的上肢运动学特点。 方法应用Vcion运动捕捉系统（简称Vicon系统）采集15名正常人（健康组）和10例偏瘫患者（偏瘫组）在执行抬臂、梳头、喝水、摸对侧肩、摸后口袋这5项ADL时的上肢关节三维运动数据。经数据处理得到2组的胸锁关节、肩锁关节、肩关节、肘关节、腕关节的三维运动角度和各动作的运动时间,并进行比较。 结果偏瘫组胸锁关节旋外和外展角度,肩锁关节旋内和后伸角度,肘关节屈曲角度较健康组均显著增大,差异有统计学意义（P<0.05）,而其肩锁关节内收角度,肩关节内收、外展、前屈、后伸、旋外和旋内角度较健康组则显著减小,差异有统计学意义（P<0.05）;偏瘫组运动时间较健康组显著延长,差异有统计学意义（P<0.05）。 结论初步建立了一种基于Vicon系统的上肢三维运动学分析方法,所得结果提示偏瘫患者采用与正常人不同的关节运动模式来完成ADL。     

关节镜下松解术结合肩袖修复术治疗肩袖损伤合并冻结肩疗效分析

目的探讨关节镜下松解术结合肩袖修复术治疗肩袖损伤合并冻结肩的临床疗效,观察对患者关节活动范围及生活质量量表评分的影响。方法选取2014年2月至2018年2月河北省保定市第二中心医院收治肩袖损伤合并冻结肩患者84例。按照随机数字表法将患者分为观察组43例和对照组41例,观察组做关节镜下松解术结合肩袖修复术,对照组做关节镜下单纯肩袖修复术。采用采用视觉模拟评分(visual analogue scale/score,VAS)、Constant-Murley评分、美国加州大学肩关节评分系统(the university of California at Los Angeles shoulder rating scale,UCLA)和美国肩肘外科协会评分(rating scale of the American shoulder and elbow surgeons,ASES)、生活质量量表(quality of life,QOL)对患者肩关节功能、肩袖强度和生活质量进行对比分析。结果两组术后1、3、6个月VAS评分与术前比较,差异均有显著性(P<0.05)。观察组术后1、3、6个月VAS评分均低于对照组,差异有显著性(P<0.05)。两组Constant-Murley评分比较,术后较术前,肩关节外旋、前屈、外展、内旋均提高(P<0.05);术后1个月观察组前屈、外展、内旋显著小于对照组(P<0.05);术后3、6个月,外旋、前屈、外展、内旋差异均无显著性(P>0.05)。术后6个月两组UCLA、ASES评分均较术前明显改善,组内比较差异有显著性(P<0.05)。UCLA两组比较差异无显著性(P>0.05);手术前后两组ASES评分比较差异均无显著性(P>0.05);术后6个月两组患肢外旋、前屈、内旋的肌肉力量均较治疗前显著增加,差异有显著性(P<0.05)。术前QOL评分比较差异无显著性(P>0.05),治疗6个月后,观察组QOL评分显著高于对照组,差异有显著性(P<0.05)。结论与单纯关节镜下肩袖修复术相比,关节镜下松解术结合肩袖修复术治疗肩袖损伤合并冻结肩,可以有效缓解疼痛,恢复肩关节功能活动,提高患者的生活质量。     

Goniometric reliability in a clinical setting. Shoulder measurements

The purpose of this study was to examine the intratester and intertester reliabilities for clinical goniometric measurements of shoulder passive range of motion (PROM) using two different sizes of universal goniometers. Patients were measured without controlling therapist goniometric placement technique or patient position during measurements. Repeated PROM measurements of shoulder flexion, extension, abduction, shoulder horizontal abduction, horizontal adduction, lateral (external) rotation, and medial (internal) rotation were taken of two groups of 50 subjects each. The intratester intraclass correlation coefficients (ICCs) for all motions ranged from .87 to .99. The ICCs for the intertester reliability of PROM measurements of horizontal abduction, horizontal adduction, extension, and medial rotation ranged from .26 to .55. The intertester ICCs for PROM measurements of flexion, abduction, and lateral rotation ranged from .84 to .90. Goniometric PROM measurements for the shoulder appear to be highly reliable when taken by the same physical therapist, regardless of the size of the goniometer used. The degree of intertester reliability for these measurements appears to be range-of-motion specific.     

Active Shoulder Range of Motion in Persons Aged 60 Years and Older

The purpose of this study was to present active shoulder range of motion (ROM) measurements obtained from healthy personsaged 60 years and older. One hundred two volunteers participated this study. The right shoulder of these subjects was examined for active shoulder flexion, abduction, internal and external rotation. Measurements were recorded from a full round plastic goniometer. Results showed that the mean active shoulder ROM was significantly different (p < .0001) than the known American Academy of Orthopaedic Surgeons' standard for this age group. From the sixth through ninth decade ROM decreased linearly, statistically significant for abduction and external rotation by some decades. Additionally, women had statistically significant greater ROM than men for flexion, abduction and internal rotation. From a clinical perspective it is apparent that individuals sixty years of age and older have less active shoulder ROM than the known standard. These findings should prove useful to clinicians when evaluating and rehabilitating patients with shoulder dysfunctions.     

Light resistance and stretching exercise in elderly women: effect upon flexibility

Decreased range of motion (ROM) due to disuse limits the older adult's ability to perform daily activities. The flexibility of five joints of 46 women (aged 65 to 89 years) was measured by goniometer before and after a 25-week exercise program. Three groups were formed: a control group who did no exercise (C) (n = 13), a group who exercised with light weights (EW) (n = 17), and a group who exercised with no weights (EN) (n = 16). Subjects who exercised (EN and EW) gained significantly greater ROM in ankle plantar flexion, shoulder flexion, shoulder abduction, and left neck rotation than C subjects. No significant differences were found between groups in hip flexion, right neck rotation, wrist flexion or extension, or ankle dorsiflexion. The only difference between exercise treatments was that the EN group gained significantly more ROM in shoulder abduction than the EW. The use of arm weights may have limited shoulder ROM during exercise, resulting in less improvement for shoulder abduction. Comparison with data from other studies suggests age-related loss in flexibility at the shoulder joint. Exercise generally increased shoulder ROM and may be capable of reversing loss in flexibility due to disuse.     

Joint Range of Motion in Flaccid Hemiplegia

The effect of muscle tone on passive range of motion (PROM) in affected joints and comparison joints on the unaffected side was investigated in 15 patients with flaccid paralysis hemiplegia. PROM was measured in the shoulder and hip in flexion, extension, abduction, adduction and internal and external rotation using the plastic universal goniometer. PROM in the elbow and knee was assessed in flexion and extension. Wrist PROM was measured in flexion, extension and radial and ulnar deviation. Additionally, ankle dorsiflexion, plantarflexion, eversion and inversion PROM were assessed. Decreased muscle tone significantly affected shoulder (p = 0.006), wrist (p = 0.032) and hip (p = 0.003) PROM. Significant differences between the affected and unaffected sides were found in shoulder PROM in extension (p = 0.014), adduction (p = 0.001) and internal (p = 0.034) and external rotation (p = 0.007). Wrist PROM was significantly different in flexion (p = 0.048) and extension (p = 0.001), and hip PROM was significantly different in abduction (p = 0.029), adduction (p = 0.012) and external rotation (p = 0.001). Surprisingly, although muscle tone had no influence on ankle PROM, there was a significant difference in ankle plantarflexion PROM (p = 0.013). In conclusion, in flaccid hemiplegia, decreased muscle tone affects the PROM in the shoulder, wrist and hip. Differences in PROM between the unaffected and affected side are evident in shoulder extension, adduction and internal and external rotation, wrist flexion and extension, hip abduction, adduction and external rotation, and ankle plantarflexion.     

改良方盘量角仪测颈椎活动度的研究

A、B分别为有熟练操作经验和新学会操作的两位医师,同时用改良方盘测量仪采用双盲法测量一组共20名健康志愿者(年龄23～63岁)的颈椎活动度。在颈惟的六个方向上的活动度测量中,两组资料的相关系数ICC值为0.955～0.985,呈显著相关。经t检验,两组资料无显著差别。证实:此改良的方盘测量仪是一种易掌握、方便、价廉而有用的颈椎活动度测量工具。用此改良方盘测量仪测出16例正常人颈椎活动度(除颈右弯曲外)明显大于同样年龄组16例颈椎病人的颈椎活动度。     

CONCURRENT VALIDITY OF DIGITAL INCLINOMETER AND UNIVERSAL GONIOMETER IN ASSESSING PASSIVE HIP MOBILITY IN HEALTHY SUBJECTS

Background:

Hip range of motion is an important component in assessing clinical orthopedic conditions of the hip, low back and lower extremities. However it remains unclear as to what constitutes the best tool for clinical measurement. The purpose of this study was to investigate the concurrent validity of passive range of motion (ROM) measurements of hip extension and hip internal and external rotation using a digital inclinometer and goniometer.

Design:

Criterion Standard

Setting:

Clinical research laboratory

Participants:

30 healthy subjects without pain, radicular symptoms or history of surgery in the low back or hip regions.

Main Outcome Measures:

Passive hip range of motion for extension, hip internal rotation and hip external rotation. A digital inclinometer and universal goniometer were utilized as the tools for comparisons between measurements.

Results:

There was a statistically significant difference (p < 0.05) between the goniometer and digital inclinometer in measured hip ROM except for measurements of right hip external rotation (p > 0.05). The mean difference between the goniometer and digital inclinometer in left hip extension, internal rotation and external rotation were 3.5°, 4.5° and 5.0° respectively. The mean difference between the two devices in right hip extension, internal rotation and external rotation were 2.8°, 4.2° and 2.6° respectively. On average, the difference between the goniometer and digital inclinometer in extension was 3.2°, internal rotation was 4.5° and external rotation was 3.8°. The digital inclinometer had greater measurement during EXT and ER. Furthermore, there was no statistically significant difference (p > 0.05) in hip ROM between the left and right side for either goniometric or digital inclinometer measurements.

Conclusions:

This results of this study indicate that a significant difference exists between the two devices in all measurements with exception of right hip extension. The differences were noted to be between 3–5 degrees for all planes measured. These findings suggest that caution should be used if these two devices are to be used interchangeably to quantify passive hip range of motion in either clinical practice or when comparing studies that utilize different instruments.

Level of Evidence:

2b     

Clinical reliability and usability of smartphone goniometers for hip range of motion measurement

[Purpose] This study aimed to utilize the objective measurements and a survey questionnaire for assessing the intra- and inter-rater reliability, measurement time, and usability of a smartphone application type of goniometer to measure the hip joint angles. [Participants and Methods] Three examiners (physiotherapists) measured the hip joint range of motion using universal and smartphone goniometers on 30 daycare center rehabilitation patients. Reliability was calculated using the intra-class correlation coefficient. The examiners completed a questionnaire survey for assessing the usability of the goniometers. [Results] The intra-rater reliability was high, but the inter-rater reliability was low. Measurement times using the two instruments showed no difference. The usability questionnaire findings suggested that the smartphone goniometer was easier to use than the universal goniometer. [Conclusion] Reliability within the raters was high, but reliability among the raters was low. However, both goniometric devices provided a satisfactory range of motion measurement data when a single evaluator used the same device for all measurements.     

脑卒中偏瘫患者康复治疗前后的三维步态分析

目的分析脑卒中偏瘫患者康复治疗前后的三维步态特点。方法采用三维步态分析仪对28 例脑卒中偏瘫患者6 周的常规康复训练前后分别进行三维步态分析检查。结果治疗后患侧下肢站立相百分比较前增加(P<0.05),摆动相百分比较前减少(P<0.05),较前接近正常值;患侧下肢的步长、跨步长,步速均较前增加(P<0.05);患者髋关节内收外展、屈曲伸展,膝关节屈曲伸展,踝关节内外旋转、内翻外翻、背屈跖屈均较前改善(P<0.05)。结论三维步态分析系统能定量地评价患者的步态情况,可作为康复疗效评定的指标之一。