手术松解配合瑞术康治疗拇长屈肌腱狭窄性腱鞘炎25例

目的观察拇长屈肌腱狭窄性腱鞘炎的手术治疗效果。方法选择门诊Ⅱ、Ⅲ期拇长屈肌腱狭窄性腱鞘炎25例患者收住院手术治疗,术中应用瑞术康防粘连,术后进行积极康复治疗,观察治疗效果。结果 23例患者拇指弹响、绞锁、疼痛症状完全缓解,好转2例,无1例复发,治愈率为92%。结论 A1滑车切开及腱鞘切开彻底松解,关闭伤口前喷注瑞术康防粘连胶,术后积极康复治疗对于拇长屈肌狭窄性腱鞘炎疗效可靠,值得临床推广应用。     

An electromyographic study of two different types of ballpoint pens--investigation of a one hour writing operation

Recently there has been an increasing incidence of occupational cervicobrachial disorders (OCD) and writer's cramp in office workers using ballpoint pens in writing operations. For the sake of workers who use ballpoint pens, it is essential to prevent such health hazards. It has been observed that a strong gripping pressure on the ballpoint pen significantly contributes to the development of these conditions. The present authors have been developing a new ballpoint pen by altering the grip area in such a way as to reduce the gripping pressure, and thus prevent OCD. The purpose of this study is to compare our ballpoint pen (new pen) with a conventional ballpoint pen (conventional pen) for the load that they exert on the upper limb during one hour of continuous writing. Electromyograms (EMG) and upper limb pain scores are used as indicators. The conventional pen used was selected from commercially available ballpoint pens widely used in offices. The grip area is cylindrical with an 8.3 mm diameter. It is manufactured of hard plastic, which can make it feel rigid and slippery to the user. The new pen has a cylindrical grip area that flares out at the bottom, near the pen-tip, and has a diameter ranging from 11.9-13.6 mm. In addition, the grip is constructed of a 2 to 3 mm-thick silicon rubber sleeve that is softer and less slippery in comparison with the conventional pen. Twelve students (5 males and 7 females) without any preexisting cervicobrachial disorders were asked to transcribe an English text for one hour, alternately using the two kinds of pens. The EMG of the flexor pollicis brevis was measured and recorded every second, while subjective pain scores were recorded every five minutes for the thumb, forefinger, middle finger, thenar, forearm extensor (forearm) and shoulder. The EMG of the flexor pollicis brevis and the pain scores for the thumb, forefinger, middle finger, forearm and shoulder were significantly lower for the new pen than for the conventional pen. These results suggest that after an hour of continuous writing, the new pen reduces the muscle load on the upper limb, and therefore mitigates fatigue in this area.     

Presence of Multiple Tendinous Insertions of Palmaris Longus: A Unique Variation of a Retrogressive Muscle

Background

Palmaris longus, being the most variable muscle of the upper extremity is generally considered important morphologically rather than functionally. The palmar aponeurosis represents the distal part of the tendon of Palmaris longus.

Case Details

We report here a unique case of palmaris longus presenting variation distally as its tendon divides to gain multiple attachments with the fascia covering the abductor pollicis brevis, flexor retinaculum and the tendon of flexor carpi ulnaris. In addition, it also continues as palmar aponeurosis as its normal course.

Conclusion

Presence of this kind of variation might result in compression of the median and ulnar nerves and may aggravate the complications in case of inflammation of palmar aponeurosis thus mimicking the manifestations of Dupuytren''s contracture.     

高龄患者拇指整形再造及屈拇功能重建1例分析

目的：探讨用第二足趾整形再造拇指及重建屈拇功能的临床效果。方法：回顾性分析本院2013年6月3日收治的1例高龄右手严重压砸毁损伤患者的资料,分次经历4次手术,采用第二足趾整形再造拇指及重建屈拇功能,术后对症治疗。结果：术后重建拇指存活,拇指功能恢复70%,可执笔写字,外观较好。结论：第二足趾整形再造拇指及重建屈拇功能是治疗拇指毁损伤的有效方法,值得临床推广。     

Occupational Therapy Management of Tendon Transfers in Persons with Spinal Cord Injury Quadriplegia

Upper extremity surgical reconstruction can play an important role In helping the spinal cord injured quadriplegic patient achieve maximum independence in a variety of activities of daily living. The transfer of the brachioradialis to the extensor carpi radialis brevis, the brachioradialis to the flexor pollicis longus, and the posterior deltoid to the triceps each provide opportunities for functional improvement in this patient group. The occupational therapist's understanding of functional potentials and problems unique to spinal cord injury provides a realistic perspective to the team on potential benefits of each surgery. The occupational therapist also plays a critical role in identifying appropriate surgical candidates, in establishing treatment goals with the patient, and in administering a carefully planned post-operative treatment program.     

Upper extremity nerve involvement in Swedish female machine milkers

Entrapment of the median nerve in the proximal forearm, the so-called pronator syndrome, is considered a rather rare condition but it is four times more common in women than in men. In this study, 23 of 30 female machine milkers with symptoms in the forearm and hand were clinically diagnosed as having the pronator syndrome. The diagnosis of median nerve involvement was based on the clinical history and on physical examination by a hand surgeon. All 23 milkers complained of aching in the volar part of the forearm and had a sensation of numbness, tingling, and decreased muscle strength in their hands, mostly in the hands which usually were statically loaded with heavy equipment. Objectively, all had an experience of tenderness over the pronator teres muscle. Furthermore, they showed reduced muscle strength, especially in the following muscles: pronator teres (PT), flexor carpi radialis (FCR), flexor pollicis longus (FPL), and flexor digitorum profundus II (FDP II). To validate the manual muscle testing, Mannerfeldt's intrinsicmeter was used to quantify the clinically observed weakness. Eight of the 23 milkers with pronator syndrome were surgically released from neuropathy and were almost symptom-free at follow-up after six months. One patient had a slight sensation of numbness and had to be given surgical carpal tunnel release later on. The external exposure of the arm during the application of the milking cluster probably causes muscle and fascial tensions that induce compression of the nerve. Further studies are needed to establish the level of the internal exposure. Am. J. Ind. Med. 33:551–559, 1998. © 1998 Wiley-Liss, Inc.     

足球锻炼对10~11岁男童下肢关节肌力的影响

目的 比较10~11岁长期足球锻炼男童和一般男童下肢肌力的差异。方法 选取身高、体重相匹配,具有2年足球锻炼经验(足球锻炼组)和一般(对照组)男童各30名,采用德国IsoMed 2000等速测试仪,对两组受试者进行髋、膝和踝关节屈伸模式的测试。结果 1)足球锻炼组的髋关节屈(t=1.314)、伸(t=1.972)和膝关节屈(t=1.897)、踝关节伸(t=1.128)峰力矩大于对照组但无统计学意义(P均>0.05);2)足球锻炼组的膝关节伸(t=-5.812)和踝关节屈(t=3.064)峰力矩显著大于对照组(P均<0.01)。结论 长期的足球锻炼显著改善了学龄男童膝关节伸肌、踝关节屈肌的力量,虽然对髋关节屈伸肌力有所改善但不显著。     

Effectiveness of a community health service program using exercise intervention for elderly people with osteoarthritis of the knees: a randomized controlled trial

OBJECTIVE: The objective of this study was to evaluate the effectiveness of an exercise program conducted as part of community health services to improve pain and physical function in elderly people with osteoarthritis of the knee (knee OA). METHODS; The subjects were 88 (12 males aged 77.8 +/- 5.4 years and 76 females aged 73.2 +/- 5.3 years) community-dwelling independent elderly people with knee OA who participated voluntarily in exercise classes sponsored by Musashino city of Tokyo. They were allocated randomly to the intervention group (n = 44) and the control group (n = 44). For the intervention group, exercise classes of 90 min duration were held 8 times over 3 months. The exercise program comprised flexibility exercises (stretching of knee and ankle joints), resistance exercises (strengthening of quadriceps, extension and flexion of the knee joint with an elastic band), and movement exercises (turning over, getting up, standing up). The subjects were instructed to perform these exercises at home every day. Knee pain scores (Western Ontario and McMaster Universities OA Index; WOMAC), peak torque of joint during knee flexion and extension, range of motion (ROM) of the knee joint, and functional fitness (standing and walking ability) were evaluated before and after the intervention period. RESULTS: Significant inter-group differences were observed for peak torque during knee flexion and standing and walking ability of females. Assessment of interactions between time and group by repeated measure ANOVA adjusted for age and sex revealed significance differences for the WOMAC score (P = 0.031), the peak torque during knee extension (P = 0.016) and knee flexion (P = 0.000), ROM (P = 0.037), standing ability (P = 0.000)and walking ability (P = 0.000). The effect of the intervention was 0.44 for WOMAC score, 0.23 for peak torque during knee extension, 0.64 for knee flexion, 0.32 for ROM, 0.81 for standing ability, and 1.13 for walking ability. CONCLUSIONS: These results suggested that the exercise program for elderly people with knee OA improved knee pain and physical function.     

Remote measurement via the Internet of upper limb range of motion in people who have had a stroke

An Internet-based goniometer has recently been developed which can be used for the remote quantification of joint range of motion (ROM). We evaluated the validity and intra- and inter-rater reliability of this goniometer for the measurement of upper limb ROM in 10 people who had had a stroke. The movements on which the device was evaluated were shoulder flexion, shoulder abduction, elbow flexion, wrist flexion, wrist extension, forearm supination and forearm pronation. Measurements performed using the Internet-based goniometer were compared with measurements made using the most widely accepted clinical joint ROM measurement tool, the universal goniometer. The Internet-based goniometer was found to be a valid tool for the measurement of upper limb ROM, with the disagreement between the two measurement tools ranging from 1.1-2.4 degrees . The Internet-based goniometer was also shown to possess a high level of intra- and inter-rater reliability (all intra class correlation coefficients>0.93). The results suggest that therapists can confidently use the Internet-based goniometer to measure the upper limb ROM in people who have had a stroke.     

家庭延续性康复护理对2岁以下脑神经损伤幼儿拇指内收情况的改善分析

目的 研究家庭延续性康复护理对2岁以下脑神经损伤幼儿拇指内收的改善情况。 方法 纳入56例脑神经损伤伴有拇指内收情况的患儿为研究对象,随机数字表法分为观察组和对照组各28例。两组在院内均接受相同的治疗护理措施,观察组出院后在常规院外护理干预的基础上采用延续性康复护理干预,对照组仅进行常规院外护理干预。3个月后评定两组患儿拇指内收肌肌张力、关节活动范围和干预优良率差异。 结果 干预3个月后,两组拇指内收肌肌张力显著降低,[掌指关节(MP)+指间关节(IP)]活动范围显著增加(P<0.05);且观察组患儿拇指内收肌肌张力降幅、(MP+IP)活动范围增幅均大于对照组(P<0.05)。观察组干预优良率明显高于对照组(P<0.05)。 结论 家庭延续性康复护理对改善2岁以下脑神经损伤患儿的拇指内收情况有积极意义,可针对此类疾病广泛应用。     

全髋关节置换后髋关节前屈后伸活动范围计算

目的探讨全髋关节置换术后髋关节前屈后伸活动范围的计算方法。方法1、用数学方法推导人工全髋关节前曲和后伸时股骨假体柄上臼柄撞击点位置的数学表达式:(1)设股骨假体前倾角a,股骨假体颈干角的补角的余角J,股骨假体颈柄的半径为L。(2)通过函数求导数的方法确定股骨假体柄上头颈结合圆上距矢状面距离最小点位置。(3)人工髋关节前曲和后伸时股骨假体柄上臼柄撞击点位于头颈结合截面圆上距该圆圆心距离h=L(1-sin2a)/(1+sin2a)的水平弦与圆在后方的交点。2、求出人工髋关节屈伸活动时臼柄撞击点所具有的外展角或前倾角b=arcsin[cosa2k2-2-2(1+sin2a)]/2k(k为头颈比)。3、根据髋臼外展角和前倾角动态变化规律得出全髋关节置换术后髋关节前屈后伸活动范围数学表达式。结果全髋关节置换术后髋关节前屈后伸活动范围ROM=180°-arcsin[tg2Atg2B-(tg2A+tg2B)(tg2b-tg2A)-tgAtgB]/(tg2A+tg2B)-arcsin[tg2Atg2B-(tg2A+tg2B)(tg2b-tg2B)-tgAtgB]/(tg2A+tg2B)(A和B分别为髋臼杯前倾角和外展角)。结论全髋关节置换术后髋关节前屈后伸活动范围与头颈比呈正相关,与股骨假体颈前倾角呈负相关。髋臼杯外展角与后伸活动度正相关与前屈活动度呈负相关、髋臼杯前倾角与后伸活动度负相关与前屈活动度呈正相关,该公式准确、可靠,值得临床参考。     

针灸推拿综合治疗肩关节周围炎临床效果观察

目的：探讨针灸推拿综合治疗对肩关节周围炎的效果。方法：以本院2012年1月-2013年1月收治的60例肩关节周围炎患者为研究对象,随机数字表法分为观察组与对照组,对照组使用单一的针灸治疗,观察组患者给予针灸推拿综合治疗。对比两组临床效果。结果：观察组患者在疼痛、肌力、稳定性、肩关节功能及肩关节平均活动度等5个评价肩关节功能的指标方面,得分均高于对照组,观察组患者有效率高于对照组,比较差异有统计学意义（P〈0.05）。结论：针灸推拿综合治疗可以在肱骨近端骨折内固定患者中起到积极作用,可以提高患者肩关节功能、稳定内固定效果,改善患者预后水平。     

6～11岁杜氏进行性肌营养不良儿童与正常儿童下肢肌力对照分析

目的 比较6～11岁杜氏进行性肌营养不良(DMD)患儿与正常儿童下肢肌力差异,为开展DMD患儿的肌力训练提供科学依据。方法 2015年4月-2017年4月选择DMD患儿和正常儿童各20例,其中DMD患儿男19例,女1例;正常组男18例,女2例,两组儿童平均年龄均为(9.0±1.7)岁。采用手持式肌力测定仪(HHD)测定下肢髋、膝、踝等部位肌群肌力,比较DMD与正常儿童下肢肌群间及不同年龄间的肌力差异。结果 DMD组下肢肌力除足跖屈肌群以外均明显弱于正常组(P＜0.05);DMD组中6岁～组和9～11岁组各组肌群肌力差异无统计学意义(P＞0.05);在6岁～组中DMD患儿双侧髋外展和足趾屈肌力与正常组差异无统计学意义(P＞0.05),DMD组足趾屈肌力甚至高于正常儿童; 9～11岁组中DMD患儿除足趾屈肌群外髋屈曲、髋伸展、髋外展、膝屈曲、膝伸展和踝背屈肌群肌力都已经显著落后于正常儿童(P＜0.05)。结论 DMD患儿下肢肌群除足跖屈肌外均明显低于正常组儿童。开展DMD患儿下肢力量训练应关注所有肌群,在较大年龄组尤其需要重视髋膝伸展肌群。     

按摩松解联合牵伸法对大学生颈肩肌肉失衡的干预效果

探讨按摩松解法联合神经肌肉本体促进(PNF)牵伸法对大学生颈肩肌肉失衡的干预效果,为有效改善大学生颈肩健康状况提供参考.方法 选取2017年3月至2018年3月某大学84名因长时间低头导致颈肩肌肉失衡且自愿参与的大学生作为研究对象,使用随机数字表法分为两组(每组42人):对照组进行常规力量训练,观察组在对照组基础上增加按摩松解法、PNF牵伸法进行治疗干预.对比两组干预前后的颈肩肌肉疼痛程度、关节活动度、圆肩角度、头前伸角度等.结果 与干预前相比,观察组干预后的视觉模拟评分法(VAS)评分明显降低,对照组无显著变化,观察组干预后的VAS评分为(3.23±1.29)分,低于对照组的(4.26±1.42)分(P<0.05).观察组干预后的头前伸角度和圆肩角度分别为(28.24±4.14)°,(35.68±6.29)°,对照组分别为(32.21±6.27)°和(41.86±5.38)°,差异均有统计学意义(P值均<0.05).观察组干预后的颈关节屈曲、伸展、左旋、右旋、左屈、右屈活动度分别为(67.24±7.15)°,(68.82±4.66)°,(73.21±4.83)°,(73.56±5.13)°,(38.18±5.14)°,(38.85±2.33)°,均高于对照组(P值均<0.05).观察组干预后的肌张力(左)、肌张力(右)、肌肉硬度(左)、肌肉硬度(右)、肌肉弹力(左)、肌肉弹力(右)水平分别为(10.21±0.63)Hz,(10.13±0.72)Hz,(174.64±18.15)N/m,(164.34±16.73)N/m,(0.74±0.25)和(0.71±0.33),均显著低于对照组(P值均<0.05).结论 按摩松解法联合PNF牵伸法配合常规力量训练能够有效减轻大学生颈肩肌肉失衡引起的疼痛,改善头前伸及圆肩角度,纠正颈肩姿势不良,恢复颈肩功能.     

Dynamic low back functional motion capacity evaluation

Most current functional capacity evaluations focus on range of motion and strength as measures of Wellness. The goal of this study was to evaluate the dynamic functional motion capacity of controls (those without low back pain) and low back pain patients in the three cardinal planes of the body. The hypothesis was that injury would not only affect sagittal motion but also lateral and twisting motion that would load the spine in a different manner. Twenty-six age and gender matched controls and low back pain patients were tested. Trunk motion parameters of range of motion (ROM), velocity, and acceleration were measured in all three planes of the body as subjects performed three separate tasks eliciting motion in each of the three cardinal planes of the body. Controls exhibited significantly higher performance than low back pain patients in all three planes of the body for velocity and acceleration but not ROM. Single parameter discriminant function models indicated that the velocity and acceleration motion parameters distinguished between LBP patients and the control group more effectively than ROM in the cardinal planes. Multiple parameter discriminant function demonstrated that coupled motion models further increased the ability to distinguish between the control and patient groups. These results provide insight into new methods of evaluating functional capacity using velocity, acceleration, and coupling which may provide valuable information in determining the recovery of a patient.     

Prevalence and Risk Factors of Work-Related Musculoskeletal Disorders in Massage Practitioners

INTRODUCTION: Massage practitioners are at high risk for work-related musculoskeletal disorders (WMSDs). We investigated the prevalence and risk factors. METHODS: We randomly selected 161 visually impaired practitioners. Demographics, musculoskeletal symptoms, and working postures were analyzed with multivariate logistic regression. RESULTS: Results indicated that about 71.4% had at least one WMSD in 12 months. Prevalence rates were finger or thumb, 50.3%; shoulder, 31.7%; wrist, 28.6%; neck, 25.5%; arm or elbow, 23.6%; forearm, 20.5%; and back, 19.3%. Working duration >20 years had an adjusted odds ratio (OR) for finger or thumb 4.0-4.5 with 95% confidence interval (CI) 1.5-13.8, client contact >4 h/day (adjusted OR for finger = 3.2, 95% CI=1.3-8.1), and < or =7-kg pulp-pinch strength (adjusted OR for upper extremity = 2.9-3.2, 95% CI=1.2-8.3). Adjusted ORs for lower-back symptoms were 3.1 (95% CI=1.3-7.8) and 3.6 (95% CI=1.4-9.6), respectively, for lack of neutral neck posture and for inappropriate working-table height. CONCLUSION: WMSDs were prevalent among massage practitioners.     

足趾移植拇指再造术1例的护理

目的：介绍1例左第二足趾移植拇指再造术的护理经验。方法：术前注意保护供区皮肤和血管、控制感染源。术后提供舒适的环境、密切观察患指末梢血液循环情况、积极做好＂三抗＂的护理,并且有计划、有步骤地对患指进行康复训练。结果：术后2周出院,随访半年余,再造拇指外形美观,功能满意。结论：预防血管危象是保证再造拇指成活的关键护理措施。     

Variation of the fibular part of the plantar aponeurosis among present-day Japanese

The plantar aponeurosis consists of the tibial and fibular parts. It is already known that the form of the fibular part markedly varies according to individuals. However, there have been few anatomical observations on this variation and none have statistically analysed it. This paper is concerned with the variation of the fibular part of the aponeurosis. Observations were carried out by dissecting thirty-nine present-day Japanese cadavers. The variations observed were classified into four types according to the Loth's method. It was clarified by means of the Chi-square test that the percentage of the medial fibre bundle is significantly higher in present-day Japanese than in Europeans, that is up to 20.5%. It was also found that the top portion of the medial fibre bundle, if it exists, is the origin of a part of the transverse head of the adductor pollicis muscle and the flexor digiti minimi brevis muscle in some cases.     

改良Kessler交叉缝合法修复屈指肌腱断裂

目的总结用改良Kessler交叉缝合法修复屈指肌腱断裂的临床应用及体会。方法自2006年1月-2008年12月间我院共收治96例296条急性屈指肌腱断裂的患者,其中男51例,女45例,左侧33例,右侧63例,其中屈拇长肌腱40条,示指屈指浅肌腱29条,示指屈指深肌腱20条,中指屈指浅肌腱27条,中指屈指深肌腱21条,环指屈指浅肌腱32条,环指屈指深肌腱24条。小指屈指浅肌腱27条,小指屈指深肌腱24条;I区损伤61条,II区损伤78条,III区损伤64条,IV区损伤52条。V区损伤41条;年龄8～56岁,平均41岁。本组96例296条肌腱均采用改良Kessler交叉缝合法修复。结果本组病例伤口一期愈合89例。二期愈合7例。有86例251条获得随访,随访时间8个月～1年7个月,平均11．5个月。随访期内肌腱再断裂3例4条．术后肌腱粘连15例31条。肌腱再断裂及术后肌腱粘连的病例二期手术治愈。根据1975年美国手外科学会推荐的TAM（total active movement,TAM）系统评定方法：优146条,良89条,可11条,差5条,优良率93．6％。结论采用改良Kessler交叉缝合法修复屈指肌腱断裂是一种安全、有效的方法。