Criteria of assessment of restriction of vital activity of patients after total endoprosthesis of the hip joint

Total endoprosthesis of the hip joint is an effective method of rehabilitation of patients with a severe pathology of the hip joint. But the lack of exact criteria of assessment of restriction of vital activity of patients after total endoprosthesis results in leveling the effects of medical rehabilitation due to the existing stereotype solution of the MSE bureau and so the majority of patients (90%) after operation get invalidization of the I and II groups for a long time without sufficient causes. Results of complex clinico-rentgenological, biomechanical, electrophysiological examinations and expert assessment of 450 patients after implantation of various domestic and foreign endoprostheses allowed the elaboration of differentiated criteria for the examination of restricted viral activity depending on the nosological form of the disease, degree of the disturbance of the statico-dynamic function, prognosis, complications, character and conditions of work.     

早期康复干预对老年人股骨粗隆间骨折手术治疗后的疗效影响

目的探讨早期康复干预对老年人股骨粗隆间骨折手术疗效的影响。方法选取60例股骨粗隆间骨折的老年患者分为两组,康复组（30例）与对照组（30例）,两组患者均予微创Gamma钉内固定处理,其中康复组术前、术后皆用综合康复训练;对照组患者仅让其术后自行遵医嘱进行功能锻练。术后两组患者定期随访,比较两组间的疗效。结果经过5～36个月（平均21个月）的随访,两组患者均获得骨性愈合,其中康复组愈合时间为（3±0．5）个月,对照组愈合时间为（3．2±0．4）个月,两组间的差异无统计学意义（t=0．435,P〉0．05）。康复组术后并发症的发生率为13．3％,对照组的为30％,两组间的差异有统计学意义（X^2=8．755,P〈0．01）;康复组术后的优良率为91．6％,而对照组的为80．2％,两组间的差异有统计学意义（X^2=8．984,P〈0．01）。结论微创Gamma钉内固定治疗老年人股骨粗隆间骨折能获得可靠固定,系统的康复治疗是保证疗效的重要措施,有助于加快患者术后功能康复,提高生活质量。     

黄芪桂枝五物汤对附带神经移植的游离足背静脉皮瓣术患者术后康复效果的影响

目的:分析黄芪桂枝五物汤对附带神经移植的游离足背静脉皮瓣术后感觉功能恢复的临床效果,为临床游离足背皮瓣移植术患者优选康复方案提供参考.方法:选取2019年2月—2021年1月我院收治的手外伤患者70例,所有患者均符合附带神经移植的游离足背静脉皮瓣术指征,并成功完成手术.按照术后康复方案不同分为对照组和观察组,每组35例...     

用加速康复外科理念治疗胃癌患者的临床应用探讨

目的探讨加速康复外科理念在胃癌患者围手术期治疗过程中的应用。方法将80例胃癌患者随机分为传统方法组(n=40)和加速康复组(n=40),比较2组患者术前1 d、术后第1、3天的外周血总淋巴细胞计数(TLC)、C反应蛋白(CRP)、IgG、IgM、IgA、CD3+、CD4+、CD8+和CD4+/CD8+水平,记录2组患者术后发热持续时间、首次排气时间,住院时间以及术后并发症情况。结果加速康复组术后首次排气时间提前,术后发热持续时间及住院时间均较传统方法组短(P<0.05),2组患者术后并发症发生率差异无统计学意义(P>0.05);2组患者术后第1天TLC与术前1 d相比降低,而CRP与术前1 d相比增高,差异均有统计学意义(P<0.01)。术后第3天加速康复组CRP较传统方法组明显降低(P<0.05),IgG、IgM、IgA、CD3+、CD4+、CD8+和CD4+/CD8+水平均比传统方法组升高(P<0.05)。结论胃癌患者行加速康复外科理念治疗是安全有效的,且能减轻手术创伤对患者免疫功能的打击,促进患者康复。     

心理康复治疗对脑卒中后抑郁症的疗效观察

目的探讨心理康复治疗对脑卒中后抑郁症的治疗效果。方法将50例脑卒中后抑郁患者随机分为治疗组与对照组各25例。对照组采用药物治疗,治疗组采用针对性的心理康复治疗,疗程8周。应用汉密尔顿抑郁量表对两组患者进行治疗前和治疗后评分,确定临床疗效。结果两组在治疗前HAMD评分无显著差异（P〉0.05）;两组在第8周后HAMD评分均较治疗前降低（P〈0.01）;治疗组在第8周后HAMD评分显著低于对照组（P〈0.01）,临床疗效显著优于对照组（P〈0.05）。结论针对性的心理康复治疗能明显缓解脑卒中后抑郁症患者的抑郁症状,提高患者生存质量。     

Approaches to objective assessment of the individual weight bearing in patients after total endoprosthesis of the hip joint

An algorithm for the detection of weight bearing on the lower extremity after total endoprosthesis of the hip joint was developed, taking into consideration the parameters of the morphometric structure, type of pathology, method of treatment, the resulting extremity functioning and social and every-day conditions. The individual rehabilitation measures after endoprosthesis were performed in three steps and corrected depending on changes in the parameters in question. The amplitude of movements in the joint after using the method of calculation of the weight bearing on the lower extremity became close to normal in 26 patients after completion of the rehabilitation course and the statistic-dynamic indices of the extremity became stable.     

Endoscopic biliary endoprosthesis in the palliation of malignant obstruction of the distal common bile duct: a randomized trial

A total of 52 jaundiced elderly patients who had malignant obstruction of the distal common bile duct and who required palliative biliary decompression were randomized to receive either an endoscopically placed biliary endoprosthesis (10 French gauge) or conventional surgical bypass. Patients within the two treatment groups were well matched and 51 were followed until their death. Patients treated with endoprosthesis had a significantly shorter initial hospital stay than those treated surgically. In the long term, overall survival in the two groups was similar and jaundice was relieved in over 90 per cent of patients. Despite more re-admissions to hospital for those patients treated endoscopically, the total time spent in hospital still remained significantly shorter in this treatment group compared with those subjected to surgery. The endoscopically placed biliary endoprosthesis is a valuable alternative to conventional surgical bypass in the palliation of extrahepatic biliary obstruction.     

Prophylactics and treatment of postoperative hernias of the lateral abdominal walls using polypropylene endoprosthesis

An analysis of complex examination and treatment of 151 patients after planned and performed surgical interventions on organs of the retroperitoneal space was made. The patients were divided into 4 groups. The first group (of comparison) included 46 patients who were treated by lumbotomy for different diseases of organs of the urinary system. In 35 patients of the second group (prophylactics) the indications were determined and in 20 patients preventive endoprosthesis of the lateral abdominal wall using polypropylene endoprosthesis was fulfilled. Herniotomy with plasty of the lateral abdominal wall using local tissues was fulfilled in 30 patients. Prosthesing hernioplasty of the lateral abdominal wall was fulfilled in 40 patients of the main group. It was found that preventive endoprosthesis of the lateral abdominal wall allowed prevention of progressing anatomo-functional i/isufficiency and the appearance of postoperative hernias. The application of polypropylene endoprosthesis for the treatment of postoperative hernias allows obtaining 36.4% more good results as compared with the control group, 21.7% decreased number of satisfactory results and no recurrent hernias.     

Rehabilitation after hamstring anterior cruciate ligament reconstruction

A prospective comparative study was conducted involving 62 patients to determine the effects and limits of accelerated rehabilitation on clinical outcome. The study focused on whether aggressive rehabilitation after anterior cruciate ligament reconstruction with the doubled semitendinosus and gracilis tendon autograft results in stretching the graft. Thirty patients had postoperative rehabilitation according to the current conservative protocol, and 32 patients had rehabilitation using an accelerated regime. Each patient was evaluated subjectively and objectively 36 months or more after surgery. Concerning the side-to-side difference in the anterior laxity, 87% of the patients in the conservative rehabilitation group had 3 mm or less and 80% of the patients in the accelerated rehabilitation group had the same acceptable laxity. There was no significant difference between the two groups. Muscle torque was restored significantly earlier in the patients in the accelerated rehabilitation group than in the patients in the conservative rehabilitation group. Nine months after surgery, however, there were no significant differences in the torque between the two groups. Accelerated rehabilitation significantly increased the incidence of knee effusion during rehabilitation. This study showed that acceleration of postoperative rehabilitation could rapidly restore muscle strength without significantly compromising graft stability in anterior cruciate ligament reconstruction with the doubled hamstring tendon autograft. However, this study also showed that acceleration significantly increases the incidence of synovitis. Acceleration of postoperative rehabilitation has advantages and disadvantages for clinical outcome after anterior cruciate ligament reconstruction.     

儿童孟氏骨折的手术治疗及功能康复

目的 对儿童孟氏骨折的手术治疗及功能康复进行评价。方法 1994年～2001年对78例非手术治疗失败的新鲜及陈旧性孟氏骨折全部采用手术治疗，并随机分为两组，第1组(单针固定组)45例，其中新鲜骨折16例，陈旧性骨折29例，复位肱桡关节后，单枚克氏针固定，石膏外固定，尺骨骨折不作内固定；第2组(双针固定组)33例，其中新鲜骨折14例，陈旧性骨折19例，复位肱桡关节及尺骨骨折后，分别用克氏针固定，石膏外固定。结果 术后78例伤口愈合佳，无感染。均获随访，时间6个月～7年，平均4．6年．尺骨骨折愈合好，无骨不连及骨延迟愈合。手术疗效按肘关节屈伸及前臂旋转功能标准评价，第1组优37例，良5例，差3例，优良率93．3％；第2组优22例，良7例，差4例，优良率87．9％，两组比较无统计学意义(P＞0．05)。结论 手术治疗孟氏骨折整合复位肱桡关节，并予单枚克氏针内固定加石膏外固定，其操作简便、安全、组织损伤小及尺骨骨折愈合快，术后肢体功能恢复好。     

Late results of the operated patients with femoral neck fractures. results of the a-o technique and the endoprosthesis from 3 to 5 years after operation (author's transl)]

The late results of 133 operatively treated patients with femoral neck and trochanteric fractures were evaluated. The series consisted of 86 women and 47 men, 72 femoral neck fractures and 61 trochanteric fractures. 99 patients were treated by A-O osteosynthesis and 34 by endoprosthesis. The average age of the group with osteosynthesis was 71 and of the group with endoprosthesis 76 years. From 3 to 5 years after the operation the nailing results of the patients with femoral neck fractures were poor in 7.1 and with trochanteric fractures in 15.4 per cent. During the same observation period the results of the patients treated with endoprosthesis were poor in 14.3 per cent. There were no statistically significant difference between the A-O group and the endoprosthesis group with femoral neck fractures. Between the mortality of the nailed patients with femoral neck fractures and the endoprosthesis group there was no statistically significant difference.     

经皮椎体成形术联合鲑鱼降钙素治疗骨质疏松椎体压缩性骨折的临床观察

目的通过对比研究,观察经皮椎体成形术联合密盖息治疗骨质疏松性椎体压缩骨折的疗效。方法 2008年2月至2011年1月,我们将脊柱压缩性骨折行PVP手术患者随机分成两组,治疗组在术后当日予以肌注鲑鱼降钙素,治疗3周后改用鼻喷剂,连续使用至少3个月;观察组单纯予以椎体成形术,分别在术前,术后1周,1月,3月以及6月采用VAS评分以及Barthel指数来评估两组治疗效果。结果两组患者均在术后疼痛均有明显的缓解,但是相对于观察组,治疗组在术后1月,3月,以及6月疼痛缓解以及生活质量提高更为明显,随着随访时间的延长,这种差别越来越明显。结论椎体成形术结合鲑鱼降钙素治疗骨质疏松性椎体压缩性骨折更能缓解患者的疼痛,提高患者的生活质量,值得临床推广。     

早期康复护理对人工心脏起搏器植入术后患者肩功能恢复的影响

用微型角膜刀行角膜深板层内皮移植术治疗大泡性角膜病变患者18例．效果满意。认为做好充分的术前准备,密切的术中配合．特别是对微型角膜刀使用的准确配合,是提高手术成功率、减少并发症的重要保证。     

早期康复护理对PTCA术后病人恢复及并发症的影响

目的探讨早期康复护理对冠心病PTCA术后病人恢复及并发症的影响 ,评价其措施的有效性和安全性。方法将 10 2例急性心肌梗死、不稳定型心绞痛PTCA术后病人随机分为康复组和对照组各 5 1例。康复组实施系统的早期康复活动指导 ,对照组进行常规护理。比较两组活动情况及并发症发生率。结果康复组术后步行距离及上台阶数均显著优于对照组 (均P <0 .0 1) ,心血管事件发生率显著低于对照组 (P <0 .0 5 )。结论早期康复护理可促进PTCA术后病人早期康复 ,降低心血管事件发生率 ,提高其生活质量。     

手法加中药熏蒸对前交叉韧带断裂重建术后膝关节功能康复的病例对照研究

目的 :研究手法加中药熏蒸对前交叉韧带断裂重建术后关节功能康复的治疗作用和对腱-骨愈合的影响。方法:选择膝关节前交叉韧带断裂重建术后患者50例,分为治疗组(手法加中药熏蒸组)和对照组(康复治疗组)。其中对照组男16例,女9例,采用等长肌力锻炼、逐渐加大屈曲幅度和渐进性负重等常规康复治疗手段;治疗组男15例,女10例,在康复治疗基础上加用中药熏蒸和手法,中药熏药采用海桐皮汤方由熏药机加热雾化后局部熏蒸,手法治疗根据韧带愈合生物力学规律,把握屈膝程度、松解手术后粘连。采用Lysholm膝关节评分系统作为疗效评价标准,以随访中MRI上测量的骨隧道宽度变化作为腱-骨愈合情况的观察指标。结果:Lysholm膝关节评分:两组患者术前、术后1个月、术后3个月组内比较,总分均随时间推移改善(治疗组F=36.54,P0.05;对照组F=28.12,P0.05);组间比较,术后治疗组评分优于对照组(术后1个月t=0.105,P0.05;术后3个月t=5.361,P0.01)。治疗组和对照组腱-骨愈合情况在术后3个月和1年随访时胫骨和股骨侧差异均无统计学意义(P0.05)。结论:手法加中药熏蒸治疗有利于膝关节前交叉韧带断裂重建术后早期功能恢复,且不会影响腱-骨愈合。     

微波疗法在腹部手术术后康复中的临床意义

【摘要】〓目的〓探讨微波热疗法在腹部手术术后康复中的临床意义。方法〓选择2014年1月~11月在我院进行腹部手术的患者,分成治疗组(99例)和对照组(100例),治疗组在常规术后处理的基础上于术后24 h增加腹部微波热疗,记录两组术后肠鸣音恢复、肛门排气、切口愈合及住院时间,并观察记录两组患者切口疼痛评分、镇痛剂应用、切口感染及脂肪液化等数据。结果 ①治疗组上消化道溃疡穿孔、阑尾炎及胆结石/胆囊炎术后肠鸣音恢复、肛门排气及切口愈合时间均较对照组明显缩短;阑尾炎及胆结石/胆囊炎术后住院时间较对照组明显缩短;治疗组腹部肿瘤术后切口愈合时间较对照组明显缩短。而两组在腹部肿瘤术后肠鸣音恢复与肛门排气时间无明显差异,两组在上消化道溃疡穿孔及腹部肿瘤术后住院时间无明显差异。②治疗组各项术后切口疼痛评分均较对照组明显下降,使用镇痛药物例数均较对照组明显减少;除了治疗组仅阑尾炎术后切口脂肪液化及感染较对照组明显减少外,其余各项术后切口脂肪液化及感染与对照组无明显差异。结论〓微波疗法对腹部术后切口疼痛、肠道功能恢复及切口愈合有一定的积极作用。     

不同手术方法对高血压脑出血患者康复的影响

目的：探讨不同手术方法对高血压脑出血患康复影响的临床意义。方法：采用立体定向血肿排空术(34例)和骨瓣开颅术(40例)进行对照研究。结果：2组近期疗效无明显差异，远期疗效立体定向组并发症发生率低，神经功能恢复快，ADL评定优于骨瓣组。结论：微创、减压及超早期手术是高血压脑出血较佳的外科治疗方法。     

雷米芬太尼联合丙泊酚用于腹腔镜胆囊切除术麻醉的疗效分析

目的:观察分析雷米芬太尼联合丙泊酚用于腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)麻醉的临床疗效。方法:选取2005年1月至2012年5月收治的50例拟行LC的患者,随机平均分为两组,对照组使用芬太尼复合丙泊酚进行麻醉,治疗组使用雷米芬太尼联合丙泊酚。分别监测记录两组患者基础值(T1)、行气管插管(T2)、建立人工气腹(T3)及切皮后1 min(T4)的心率(heart rate,HR)及平均动脉压(mean arterial pressure,MAP);观察记录两组患者呼吸、意识恢复时间,拔管时间,切口疼痛程度,患者术中知晓率及24 h内恶心呕吐状况。结果:治疗组各时点的MAP及HR明显低于对照组(P<0.05)。治疗组术后呼吸恢复时间、意识恢复时间、拔管时间明显短于对照组(P<0.05),术后疼痛者明显少于对照组(P<0.05),两组患者术中均未出现知晓情况,术后24 h内恶心呕吐发生率差异无统计学意义(P>0.05)。结论:雷米芬太尼联合丙泊酚用于LC手术麻醉具有停药后苏醒更快、延迟性呼吸抑制发生率更低等优点,适于非住院患者手术麻醉,利于门诊手术患者的早期康复。     

镜像神经元理论在脑梗死患者上肢关节运动康复治疗中的应用

目的探讨镜像神经元理论在脑梗死患者上肢关节运动康复治疗中的应用及对患肢功能的影响。方法选取2017年11月-2018年11月收治的脑梗死患者92例,按随机数字表法为对照组与观察组。在脑梗死上肢关节运动康复治疗中,对照组进行常规康复治疗,观察组在对照组上肢关节康复治疗的基础上加用镜像神经元理论。对比两组肢体功能评分、生活质量量表得分以及两组患肢关节活动度。结果治疗前两组肢体功能评分差异均不具可比性(P>0.05),经治疗,两组肢体功能评分均比治疗前提高,且观察组评分显著高于对照组(P<0.05);治疗前两组生活质量得分差异无可比性(P>0.05),治疗后2、3、4周观察组生活质量量表得分均高于对照组(P<0.05);治疗前两组上肢各关节活动度无明显差异(P>0.05),治疗后观察组肩关节前驱、肘关节伸展、腕关节背伸的关节活动度均优于对照组(P<0.05)。结论在脑梗死患者上肢关节运动康复治疗中应用镜像神经元理论,可以改善患者上肢运动功能,提高患者生活质量,应用效果良好,值得推广。     

腹腔镜腹壁疝修补术联合围手术期康复训练对成人腹壁疝患者术后胃肠功能恢复及复发的影响

目的探讨腹腔镜腹壁疝修补术联合围手术期康复训练对成人腹壁疝患者术后胃肠功能恢复及复发的影响。 方法分析2016年2月至2018年12月在北京怀柔医院就诊的80例腹壁疝患者,根据患者所采取的手术方法分为对照组和观察组,各40例。2组均采用腹腔镜内补片植入术,观察组无康复介入,治疗组采用术前1周、术后3周的康复训练,训练内容包括腹式呼吸训练、腹内外斜肌、腹横肌、多裂肌、盆底肌等核心肌群激活训练。记录手术相关指标及胃肠功能恢复指标;检测并比较2组治疗前后血清白细胞介素-6（IL-6）、C-反应蛋白（CRP）水平;统计术中及术后并发症;随访1年,观察疝复发率。 结果相较于对照组,观察组术后疼痛时间和下床活动时间均缩短（P<0.05）,手术时间和术中出血量无明显差异（P>0.05）;观察组术后首次肠鸣音时间、肛门排气时间和首次排便时间均显著低于对照组（P<0.05）;术后2组IL-6和CRP水平均高于术前（P<0.05）,但观察组IL-6和CRP水平低于对照组（P<0.05）;观察组尿潴留发生率低于对照组（P<0.05）,2组患者的术中出血、肠管损伤、血清肿、慢性疼痛、复发率差异无统计学意义（P>0.05）。 结论腹腔镜腹壁疝修补术联合围手术期康复训练可促进成人腹壁疝患者术后胃肠功能恢复,降低机体炎性反应,且安全性高,降低术后复发率,具有较好的临床推广应用价值。