Development of Upper Limb Prostheses: Current Progress and Areas for Growth

Upper extremity prosthetic technology has significantly changed in recent years. The devices available and those under development are more and more able to approximate the function of the lost limb; however, other challenges remain. This article provides a brief perspective on the most advanced upper limb prostheses available and the challenges present for continued development of the technology.     

21及23mm双叶机械主动脉瓣血流动力学表现比较

目的：应用超声心动图评估21mm双叶机械主动脉瓣的血流动力学表现。方法：1995年2月－2001年2月间15例置换外径21mm、26例置换外径23mm St.Jude双叶机械主动脉瓣病人平均随访时间为23个月，以超声心动图评估其静息时及活动后之血流动力学表现，并加以比较。结果：置换21mm及23mm St.Jude双叶机械主动脉瓣患者的静息及活动后的跨瓣压差并无显著差异。结论：21mm St.Jude双叶机械主动脉瓣可满足大部分小瓣环患者的需要。     

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。     

Adaptations from the prosthetic and intact limb during standing on a sway-referenced support surface for transtibial prosthesis users

Abstract

Purpose: To investigate the bilateral postural adaptations as a result of standing on an increasingly unstable sway-referenced support surface with both the intact and prosthetic limb for transtibial prosthesis users (TPUs).

Method: TPUs (n = 14) and matched controls (n = 14) stood quietly in multiple foot placement conditions (intact foot, prosthetic foot and both feet) on a sway-referenced support surface which matched surface rotation to the movement of the centre of pressure (CoP). Force and motion data were collected and used to analyse CoP mean position, displacement integral and force components under intact and prosthetic limbs.

Results: Significant differences were found between prosthesis users and controls in CoP mean position in anteroposterior (1.5 (95% CI, 1.2–1.8) cm) and mediolateral directions (3.1 (95% CI, 0.5–5.7) cm. CoP displacement integrals were significantly different greater for prosthesis user group in the anteroposterior direction. Force components differences were found in all planes (anteroposterior: 0.6 (95% CI, 0.4–0.8 N); mediolateral: 0.1 (95% CI, 0.0–0.2 N & 0.3 (95% CI, 0.2–0.4) N, inferosuperior: 2.2 (95% CI, 1.4–3.0) N).

Conclusions: TPUs have bilateral static and dynamic postural adaptations when standing on a sway-referenced support surface that is different to controls, and between prosthetic and intact sides. Results further support evidence highlighting importance of the intact limb in maintenance of postural control in prosthesis users. Differences indicate clinical treatment should be directed towards improving outcomes on the intact side.

• Implications for rehabilitation

• Prosthesis users have bilateral adaptations when standing on a sway referenced support surface

• These adaptations are different to controls, and between prosthetic and intact sides.

• The intact limb is the major contributor to maintenance of postural control in prosthesis users.

• Clinical treatment should account for this when interventions are designed.

     

机械载荷对肌肉和肌腱硬度影响的研究进展

硬度可以客观反映肌肉、肌腱的功能状态。抗阻训练可导致肌肉、肌腱硬度发生改变,不同训练方式和强度对肌肉、肌腱硬度的影响不尽相同。本文综述机械载荷对健康人肌肉、肌腱硬度的影响,以及肌肉、肌腱对机械载荷的适应机制。     

功能性蹲屈测试系统在老年人下肢等长肌力测量中的重测信度

目的研究功能性蹲屈测试系统测量老年人下肢等长肌力的重测信度。方法20例老年人在仰卧位屈膝屈髋90°位置,分别测试左、右下肢持续5 s的等长肌力,记录其最大肌力和平均肌力。1周后重复测试1次。结果组内相关系数为0.77～0.88(P<0.01)。结论功能性蹲屈测试系统测量老年人的下肢等长肌力具有满意的重测信度。     

Validation of the Narrowing Beam Walking Test in Lower Limb Prosthesis Users

Objective

To evaluate the content, construct, and discriminant validity of the Narrowing Beam Walking Test (NBWT), a performance-based balance test for lower limb prosthesis users.

地震下肢骨折伤员的康复护理

目的：探讨地震伤员下肢骨折术后的有效康复护理方法。方法：总结分析70例汶川地震伤员的临床康复护理。结果：通过迅速组建康复护理团队,加强心理护理和康复训练,确保了所有伤员无压疮及其他并发症发生,所有伤员按计划出院。结论：在专科康复护理团队护理下,通过加强伤员的心理护理和康复训练,使伤员能够得到有效的治疗,早日返回社会。     

介入治疗下肢动脉缺血性疾病的中长期疗效分析

【目的】探讨介入治疗下肢动脉缺血性疾病的中长期疗效。【方法】选择下肢动脉缺血性疾病的患者106例,其中42例患者经数字减影血管造影（DSA）证实为髂动脉和／或股动脉闭塞,64例髂动脉和／或股动脉、胭动脉不同程度管腔狭窄,术中采用经导管动脉内溶栓治疗64例,机械开通31例,经皮血管腔内成形术（PTA）101例,支架置入69例（116枚支架）,术后随访12～60个月,分析介入治疗后的中长期疗效。【结果】术中未出现血管破裂、穿孔等严重并发症;术后所有患者下肢缺血症状明显减轻或消失。随访期间1例患者于术后15个月死于急性心肌梗死,21例患者再次出现下肢缺血症状,经DSA检查6例内膜增生引起支架阻塞,6例非治疗部位血管病变进展所致下肢缺血,9例溶栓及PTA治疗部位血管再狭窄,均经PTA或支架置入治疗后症状好转出院;其余84例症状无复发,血管超声复查提示管腔通畅、血流良好。【结论】介入治疗下肢动脉缺血性疾病操作创伤小、中长期疗效好,具有良好的临床应用价值。     

Influence of Measurement Depth on the Stiffness Assessment of Healthy Liver with Real-Time Shear Wave Elastography

The purpose of this study was to determine the measurement depth range within which liver stiffness can be reliably assessed using real-time shear wave elastography (SWE) technology. Measurements were performed on phantoms and healthy volunteers. In the first group of patients, measurements were performed at depths of 2–8 cm from the probe surface. In the second group of patients, measurements were conducted 0–7 cm below the liver capsule. Success rate of measurements (SRoM), success rate of patients (SRoS) and coefficients of variation (CVs) of repeated measurements were compared. The SRoMs at 3–7 cm and the CVs at 2–5 cm from the probe surface were significantly higher and lower than those at other depths (p < 0.001), respectively. SRoS was zero 0–1 cm below the liver capsule. Furthermore, the features of 2-D stiffness mapping images were also found to change with depth. According to our results, the depth range for the most reliable liver stiffness assessment using SWE should be 3–5 cm from the probe surface and simultaneously 1–2 cm below the liver capsule.     

股动脉僵硬度、超敏C反应蛋白与2型糖尿病下肢血管病变相关性研究

目的 评价股动脉僵硬度β指数、超敏C反应蛋白(HsCRP)与2型糖尿病下肢血管病变相关性.方法 151例2型糖尿病患者,定义踝臂指数ABI＜0.9为外周血管病变组(PVD组),ABI≥0.9为非外周血管病变组(N-PVD组),正常对照组30例.测量股动脉内-中膜厚度(FA-IMT)、股动脉僵硬度β指数(FA-stiffness β)并测定HsCRP.比较各组间FA-IMT、FA-stiffness β、HsCRP的差异;再以FA-IMT不同比较不同亚组间FA-stiffness β的不同.多元回归分析FA-stiffness β、FA-IMT、HsCRP间的相关性.结果 糖尿病组FA-IMT、FA-stiffness β、HsCRP明显高于对照组(P<0.01);PVD组FA-IMT、FA-stiffness β、HsCRP明显高于N-PVD组(P<0.05);FA-stiffness β改变早于FA-IMT,且与FA-IMT无明显相关性(P>0.01);HsCRP与FA-stiffness β、FA-IMT呈正相关关系(P<0.001).结论 僵硬度β指数可作为早期评价糖尿病患者下肢血管病变的指标,超敏C反应蛋白与内中膜厚度、僵硬度明显相关.     

下肢深静脉瓣膜功能不全的彩色多普勒流速剖面图技术

目的     

袖带与肢体的力学关系及其对血压测定的影响

为探讨袖带几何参数对间接血压测定的影响，采用物理模型研究了袖带内压与被测肢体内压的关系。结果表明，对于一定的袖压，肢体内压上升的高度与袖带气囊的宽度和长度正相关，而与肢体的周径负相关．经临床实验进一步证明，对于同一组病人，选用的袖带越窄、越短，血压读数越高，与物理模型所显示的规律相符合．这一结果提示，在血压测定中，袖带是一个重要的误差来源．我们建议研究一种“自适应”袖带，以克服传统袖带的这一缺陷。     

舒芬太尼复合罗哌卡因对下肢骨肿瘤术后硬膜外自控镇痛疗效的临床研究

目的探讨舒芬太尼复合罗哌卡因对下肢骨骨肿瘤术后硬膜外自控镇痛疗效的临床疗效差异。方法选择ASAⅠ~Ⅱ级,连续硬膜外麻醉行下肢骨肿瘤手术病人120例,随机分为对照组和观察组各60例,观察组采用舒芬太尼复合罗哌卡因,对照组采用芬太尼复合罗哌卡因,比较两组自控硬膜外镇痛的疗效及并发症。结果观察组术后6、24和48h的VAS评分显著低于对照组(P0.05);观察组各时间点镇静评分均显著大于对照组(P0.05),但均在2~4分区间,对照组追加其它镇痛剂比例显著高于观察组(P0.05),两组并发症发生率比较差异无统计学意义(P0.05)。结论舒芬太尼复合罗哌卡因用于下肢骨科术后自控硬膜外镇痛,镇痛效果优于芬太尼,不良反应少,值得临床推广应用。     

综合保肢治疗术对老年下肢骨肉瘤患者预后的影响

【目的】探讨综合保肢治疗术对老年下肢骨肉瘤患者生存率、肿瘤复发率及生存期的影响。【方法】选择老年下肢骨肉瘤患者ioo例,根据患者具体病情及意愿分为两组,每组50例。以接受常规截肢治疗者为对照组,以接受综合保肢治疗者为观察组,比较两组术后6个月、12个月及18个月的生存率、肿瘤复发率及患者生存期。【结果】两组术后6个月及术后12个月时的生存率及肿瘤复发率比较,差异无统计学意义（P〉0．05）;而观察组术后18个月时的生存率明显高于对照组,复发率明显低于对照组（P〈0．05）;观察组生存时间明显高于对照组（P〈0．05）。【结论】与常规截肢治疗相比,综合保肢治疗可提高患者18个月生存率,同时有效的降低18个月复发率,对于延长患者的生存时间有着显著的意义。     

预防骨水泥型髋臼假体部件放置不良性脱位的改良全髋关节置换术

目的探讨骨水泥型髋臼假体部件放置不良性脱位的预防措施。方法1 999年 1 0月至 2 0 0 3年4月 ,先后采用传统的 (1 999年 1 0月至 2 0 0 1年 2月 )、改进后的 (2 0 0 1年 3月至 2 0 0 3年 4月 )骨水泥髋臼假体置入方法 ,分别进行骨水泥型全髋置换术 87例和 80例。对两种置杯方法分别进行研究 ,并对其术中、术后脱位的并发症进行对比分析。结果采用传统的骨水泥置杯方法 ,发生脱位 7例 ,其中术中、术后Ⅲ类人工全髋关节脱位分别为 3例、4例 ;采用改进后的髋臼假体置入方法无Ⅲ类脱位发生 ,两者脱位发生率相比差异有显著性 (P <0 .0 5 )。结论改进型骨水泥杯置杯法是预防和减少假体不良性脱位的较好方法     

The Reliability of the GNRB® Knee Arthrometer in Measuring ACL Stiffness and Laxity: Implications for Clinical Use and Clinical Trial Design

BackgroundStability of the knee is dependent on multiple factors including integrity of the anterior cruciate ligament (ACL). Greater knee joint laxity appears to negatively affect dynamic joint function and therefore reliable and valid measures of ACL stiffness and laxity are clinically valuable.PurposeThe aim of this study was to investigate the reliability of the GENOUROB, (GNRB®) knee arthrometer device in measuring both stiffness and laxity of the ACL, and to provide information on sample size calculation for future clinical trials.Study DesignCross-sectional test-retest studyMethodTwelve healthy student participants (age 24-30 years; 6 females and 6 males) completed testing on two different testing dates. Anterior tibial translation and stiffness were measured using the GNRB® device at forces of 134N and 200N. Reliability analyses were performed using intraclass correlation coefficients (ICC). SEM, MDC, and sample size calculations were also determined.ResultsAverage anterior tibial displacements of 3.63mm and 5.32mm were found for 134N and 200N of force respectively. ICC values for intra-rater, inter-rater, and test-retest reliability were similar across measures of anterior tibial translation and stiffness, ranging from .72 to .83 (95% CI: .54 to .90). The standard error of measurement (SEM) for anterior tibial stiffness ranged from 3.47 mm/N to 3.76 mm/N. Minimal detectable change (MDC) for test-retest anterior tibial stiffness was 9.6 mm/N. Sample sizes for crossover and parallel design studies were determined.ConclusionACL laxity and stiffness measures were found to be reliably obtainable using the GNRB® knee arthrometer under the strict control of the individual’s alignment to the device and patellar pad forces. Reliable laxity and stiffness values may assist practitioners in clinical reasoning and the development of individualized ACL rehabilitation programs. Additionally, the sample size calculations presented may aid in future research design.Level of Evidence3