下肢永久性假肢装配后的功能训练和步态分析

下肢永久性假肢装配后,步态训练是最重要的。在实际训练中,患者穿戴下肢永久性假肢的步行模式应该尽可能接近于正常人的步行模式。文章着重讨论了下肢永久性假肢装配后的功能训练和步态分析方法。以期在临床工作中更好的发挥假肢的替代功能。     

下肢永久性假肢装配后的功能训练和步态分析

下肢永久性假肢装配后，步态训练是最重要的。在实际训练中，患穿戴下肢永久性假肢的步行模式应该尽可能接近于正常人的步行模式。章着重讨论了下肢永久性假肢装配后的功能训练和步态分析方法。以期在临床工作中更好的发挥假肢的替代功能。     

下肢截肢后立即装配临时假肢——一种较好的截肢康复方案

<正> 下肢截肢是晚期下肢缺血的主要治疗方针,也是下肢损伤应早期采取的手段。Shirer 认为,早期截肢可以为严重下肢损伤者提供假肢代替的机会,并有良好的远期功能恢复。对截肢术后立即,还是延期(3月～半年)装配假肢,一直存在争论。已有许多文献报告,对下肢截肢的病人的最佳康复方法是术后立即使用假肢,并逐渐负重行走.Neff 在恶性骨肿瘤治疗中阐述了对下肢截肢者适当的术后处理,特别是立即、早期、临时性和永久性假肢的装配,确保这些患者康复的最佳远期效果.Millstein复习1000多例工伤截肢后恢复工作的情况指出,截肢者可从早期假肢训练中获得好处.本文特对下肢截肢后立即装配临时假肢这一方法进行介绍和文献综述.     

碳纤维复合材料特性及在假肢领域的应用

假肢的质量对下肢截肢患者运动所消耗的能量有直接的影响,因此,在实际为患者装配选择假肢零部件时,应在充分考虑满足患者要求功能的前提下,尽可能选择质量轻的下肢配件.基于上述原因,一些强度高、质量轻的材料,如钛合金、超轻铝合金、碳纤维复合材料等,在设计与制造下肢假肢零部件时被广泛使用,使现代假肢功能更完善、质量更轻.其中,与前两种材料相比,碳纤维复合材料在假肢领域的开发和应用相对较晚.文章对碳纤维复合材料的特性进行综述,并重点介绍了近10年来碳纤维复合材料在下肢假肢领域中的应用,包括碳纤维假脚、踝关节、膝关节以及接受腔等.最后,对中国假肢领域需进一步研究的问题进行了初步探讨.     

小腿假肢对线对静态站立时下肢受力的影响

目的:研究小腿截肢患者站立状态下假肢对线对下肢受力特性的影响.方法:以假肢侧承重线和重力线作为评价指标,改变假肢矢状面和额状面的对线,采用激光测力平台测量患者静态站立时残侧承重线和重力线的位置,研究下肢受力状况的变化.结果:假肢侧承重线受踝关节对线的影响大于腿管对线调节的影响,并且力线随腿管与接受腔的前倾而前移,而额状面对线的影响很小;矢状面内重力线主要受踝关节对线调节的影响,并且与变化角近似正比例相关.结论:矢状面假肢对线调整对残侧下肢受力状况的影响较大,而额状面的对线调整影响较小.     

假肢矫形器在地震伤员康复中的应用及临床新进展

智能下肢假肢、生物信息源控制的上肢假肢、有机硅人体仿生材料等假肢新技术新材料的运用,促进了假肢矫形器临床应用的新发展。在实际应用中,应围绕伤员康复目标应用假肢矫形器。应用临时假肢装配技术、全接触接受腔技术可有效促进伤员康复。安装矫形器既要遵循生物力学原则,又要从医学角度注意可能发生的问题。科学的功能评价是应用假肢矫形器的基础。     

对下肢截肢非理想残肢假肢装配问题的探讨

本文就六年来住院下肢截肢患者的非理想残肢91例，对其中未经手术矫治的48例假肢装配问题进行讨论，认为硅橡胶袜套、辅助悬吊带、假肢与矫形器的组合应用及调整好对线等，为某些非理想残肢患者的假肢安装提供了值得推广的好方法，使其穿戴上良好的假肢，充分发挥代偿功能。     

髋关节离断智能型假肢的装配

目的 尝试为髋关节离断患者装配智能型假肢的装配技术。方法 髋关节离断智能型假肢的装配分为5个阶段进行，即装配前的准备；临时假肢的装配及训练；C-LEG假肢的配置；C-LEG假肢接受腔的制作及组装；C-LEG假肢调试。结果 患者能熟练运用C-LEG假肢在室内、外行走，能连续步行300m以上，步伐平稳，步幅、步频接近同龄正常人，在拐杖的辅助下，能正向或侧向上、下楼梯，复杂路面行走时未出现安全问题。结论 C-LEG假肢与其它下肢假肢比较，其优势是：减少身体耗能，步态完全个性化，安全性明显加强。     

下肢运动假肢的装配工艺

随着残疾人体育运动的发展．已从早期的康复手殷到近期的竞技阶段。中国截肢运动员穿戴假肢后在国际比赛场上，奋力拼搏、创造佳绩。不仅体现了我国截肢康复和假肢装配的高水平．为国争光．而且也激励着其他截肢克服困难、树立重新开始新生活的勇气和信心。本通过参加两届国际大赛的23名中国截肢运动员装配假肢，并获得优异成绩的实践，提出一些装配下肢运动假肢的有效方法。     

智能膝关节假肢研究现状及发展趋势

随着下肢截肢患者的增多以及微电子、控制等技术的不断发展,智能下肢假肢逐渐成为康复机器人领域的研究热点。作为下肢假肢系统的核心部件,高性能的膝关节假肢设计仍然是当前假肢设计中的主要技术难点。本文介绍国内外智能膝关节假肢的发展历程及研究现状,从结构设计的角度对现有膝关节假肢进行分类,分析当前膝关节假肢设计中存在的问题,最后探讨膝关节假肢的发展趋势。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.