近端指间关节周围胶原沉积症4例分析

目的分析近端指间关节周围胶原沉积症患者临床特征。方法总结本院收治4例该病患者临床资料，实验室检查，手关节X线、MRI及肿胀组织的病理活检。结果4例患者均为青少年，男3例，女1例，发病年龄16—22岁，临床表现为无症状性近端指间关节扁平状肿胀，实验室检查均正常，手X线示软组织肿胀，MRI检查未见滑膜增生及软骨破坏，肿胀组织病理活检示胶原纤维组织沉积。结论本病为一良性疾病，认识不足易误诊为类风湿关节炎等风湿病，认识此疾病可避免误诊误治。     

不同检查者和不同检查工具对关节活动度检查的影响

目的观察不同检查者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,每位受试者接受2位检查者用通用量角器和方盘量角器检查,对比受试者主动活动与被动活动、左侧与右侧、同一检查者用通用量角器与方盘量角器的ROM值,以及不同检查者用通用量角器、方盘量角器的ROM值。结果无论用哪一种量角器,受试者主动ROM均小于被动ROM,有显著差异,但左右两侧ROM无显著差异。使用通用量角器和方盘量角器相比,肩前屈ROM无显著差异,肩后伸、外展、内旋、外旋ROM有显著差异。不同检查者用方盘量角器测量ROM值无显著差异,用通用量角器测量肩内旋ROM值无显著差异,肩前屈、后伸、内旋、外旋ROM值有显著差异。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,应由同一位检查者使用同一种检查工具对患者进行ROM检查。     

手指指间关节损伤的综合康复治疗

目的：观察综合康复治疗对手指指间关节损伤的疗效。方法：手拇、食、中指指间关节损伤患者36例,随机分为综合组和对照组各18例,均按骨科常规固定,并行超短波治疗。综合组在超短波治疗5d后配合功能训练及关节松动术治疗。结果：治疗30d后,综合组伤指的TAM优良率明显高于对照组（94％与69％,P〈0.05）。结论：综合康复治疗对手指关节损伤的治疗效果有促进作用。     

等速训练改善关节活动度的初步观察

膝关节是人体的一个重要关节 ,它有传递负荷、保存动量和提供包括小腿在内的活动力匹配的功能。但它常会因创伤、炎症、关节制动及神经损伤等原因出现僵直、功能障碍。临床上表现为膝关节屈伸运动受限、严重者伸位僵直、股四头肌纤维化、挛缩、弹性及活动度减小、髌骨活动度减少或丧失 ,给患者的生活、工作带来诸多不便、甚至终生病残。膝关节僵直的康复 ,主要在于预防 ,在膝关节创伤或手术后及早进行恰当的康复干预 ,能有效地防止膝关节功能障碍的发生 ,且创伤后开始康复的时间与康复治疗的效果明显有关[1] 。研究表明等速测试和训练在临床…     

指间关节处理对再植指运动功能恢复的影响

目的 探讨指间关节融合与保留对断指再植后运动功能的影响。方法 根据指间关节的不同处理方式,将35例断指再植成功者分为以下4组：近侧指间关节（PIPJ）保留组、PIPJ融合组、远侧指间关节（DIPJ）保留组、DIPJ融合组。在术后6个月以后随访时,测试患指的指总伸屈度（TAM）,并将各组结果进行比较。结果 PIPJ保留组TAM显著高于PIPJ融合组（P＜0．01）,PIPJ融合组TAM显著低于DIPJ融合组（P＜0．01）,而DIPJ保留组与DIPJ融合组TAM差异无显著性意义。结论 PIPJ对手指运动功能起重要作用,在断指再植术中应尽可能保留该关节,而不宜行融合,DIPJ损伤可行融合。     

骨质疏松与远侧指间关节变性性关节炎

目的 了解骨质疏松与远侧指间关节增生变形的关系，为临床治疗老年人常见的变性性关节炎提供依据。方法 1995/1997门诊就诊的50岁以上的女患者205例，不包括手指有创伤史及类风湿病的病例。根据手指远侧指间关节（DIP关节）的变形程度，参考Swanson分类方法，将DIP关节分为6级。选腰椎、髓关节及手指骨为测定部位进行骨密度评价。腰椎与髋关节用dual energy X-ray absorptiometry（DEXA）法，手指骨用digital image processing(DIP)法测定。以Spearmem顺位相相关系数计算，P&;lt;0.05时判定有意义。结果 （1）DIP关节的级别随着年龄的增加而增加（r=0.381,P&;lt;0.001）。（2）腰椎、髋关节及手指骨的钙盐含量与年龄存在有意义的负相关（相关系数r=-0.071,P&;gt;0.05,与髋关节r=-0.612,P&;gt;0.05）。（4）DIP关节的级别与腰椎、髋关节的钙盐含量不存在有意义的相关性（与腰椎r=-0.071,P&;gt;0.05，与髋关节r=-0.180,P&;gt;0.05）。结论 DIP关节的变形程度与骨质疏松不存在有意义的相关性，但随年龄的增加而加重。     

关节囊对第1跖趾关节活动度影响的实验研究

目的 探讨关节囊对第1跖趾关节活动度的影响,为拇外翻矫形等涉及关节囊的相关手术提供临床参考.方法 采用6例新鲜尸体足标本,固定于自制生物力学加载支架,用逐级定量的方法对第1跖趾关节进行力学加载,测量内侧关节囊紧缩前后第1跖趾关节矢状面活动范围的变化.结果 内侧关节囊紧缩前第1跖趾关节背伸68.34°4±3.05°、跖屈33.10°±3.92°,关节囊紧缩后背伸54.47°±3.95°、跖屈24.11°±2.80°.与紧缩前相比,背伸减少13.87°±2.01°,跖屈减少8.99°±2.57°,矢状面总体活动范围减少22.86°±2.61°,配对t检验显示差异有统计学意义(P<0.05).结论 各种矫正拇外翻畸形的手术对关节囊的缝合修复要适度,避免过度紧缩,术后要早期活动第1跖趾关节以尽量恢复其正常活动范围.     

扩大肩周炎患者关节活动度的康复手法探讨

目的：观察一种康复手法扩大肩周炎患关节活动度(RfM)的疗教。方法：对16例肩周炎患用非生理性被动活动加传统按摩手法治疗,作为复台治疗组．另外20例相似病人其用传统按摩手法治疗作为对照组,给予同样的治疗时间,辅以相同的物理因子治疗;结果：治疗组患前屈、后伸、外展、HBB(Hand bebiod back)四项功能均优于对照组(P<0.05)。结论：非生理性被动活动对治疗肩周炎有较好的疗效。     

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。     

几种腰前屈活动度评定方法的比较

目的探讨准确、简易、价廉的腰前屈活动度的临床评测方法.方法对50例正常青年人分别用评分法、改良的Schober法、量角器法、距离测定法和电子测角器测定法进行腰屈曲活动度的评测,并将各种方法与电子测角器法进行比较.结果评分法、量角器法和距离法与电子测角器测定的腰和髋共同屈曲度高度相关(r=0.805,0.728,-0.906;P＜0.01);改良的Schober法与电子测角器测定的腰屈曲度低度正相关(r=0.372,P＜0.01).结论距离测定法和电子测角器测定法与腰前屈活动度相关性最好.     

早期康复介入对膝部骨折术后关节活动范围的影响

目的:比较膝部骨折术后不同时期介入康复治疗对关节活动范围(ROM)的影响。方法:根据康复介入的时间将53例膝部骨折术后患者分成第1期康复组(27例)和第2期康复组(26例),分别测量两组进入第2期康复时的膝关节ROM,第2期康复1个月后膝关节ROM及随诊1年后的膝关节活动障碍例数。结果:两组进入第2期康复时及第2期康复1个月后膝关节ROM差异均有非常显著性意义(P<0.001);两组随诊1年后的膝关节活动障碍例数差异有显著性意义(P<0.05)。结论:早期介入康复对改善膝部骨折术后ROM具有重要作用。     

系统康复治疗对下肢制动后膝关节活动范围的影响

对院内康复治疗和院外锻炼对股骨干骨折术后病人及不同康复时机对下肢骨折术后病人膝关节活动范围的影响进行临床观察，结果表明：康复治疗组术后１２个月时患肢膝关节活动范围为１２９．２９°±２５．８６°，对照组为６２．１２°±４８．３９°，两组差异非常显著（Ｐ＜０．０１）；在本组病例中下肢骨折术后１２个月时膝关节活动范围的改善与术后开始康复治疗间隔时间呈显著负相关（ｒ＝－０．７３，Ｐ＜０．０１）。说明下肢骨折术后康复治疗在改善制动后膝关节功能方面明显优于自行锻炼，康复治疗得越早，效果越明显。     

Investigation of multidirectional hip range of motion and hip motion asymmetry in individuals with idiopathic scoliosis with different curve patterns

BackgroundWhile some studies of the asymmetry of lower limbs in individuals with idiopathic scoliosis exist, there is a need for multidirectional studies conducted on hip joint range of motion and its relationship to curve patterns in idiopathic scoliosis.ObjectivesThis study analyzes the hip joint range of multidirectional motions, hip motion asymmetry and investigates them according to curve patterns in individuals with idiopathic scoliosis.MethodsThe sample included 108 females with idiopathic scoliosis. Participants were divided into three groups: double curves, single thoracic curve and single lumbar curve. The range of hip flexion and extension, abduction and adduction, and internal and external rotations were assessed actively and passively with a universal goniometer. The range of motion, left–right asymmetry and the mid-points of the ranges of motion were analyzed.ResultsThe passive range of the right hip abduction was higher in the thoracic curve group vs. the lumbar curve group. Active and passive ranges of hip extension were higher in the left hip vs. right hip. Active left–right asymmetry was higher than passive left–right asymmetry.ConclusionIndividuals with idiopathic scoliosis had different hip abduction motions according to curve pattern that originated from single curves. Left–right hip asymmetry was seen for the hip extension motion. Higher left–right asymmetry for active motion than passive motion in hip abduction may indicate a problem in motion perception in individuals with idiopathic scoliosis.     

Cervical flexion: a study of dynamic surface electromyography and range of motion

BACKGROUND: In the comprehensive assessment of painful conditions, dynamic surface electromyography (sEMG) and range of motion (ROM) recordings can provide information regarding muscle spasm, antalgic postures, fear of pain (protective guarding), muscle injury, and disordered movement caused by pain. This study examines ROM and sEMG patterns observed during cervical flexion. OBJECTIVE: To demonstrate 2 distinctive sEMG recruitment and dynamic ROM patterns observed during cervical flexion and return to mid-line. DESIGN: Single-subject design with independent measurement of dynamic ROM and sEMG. SETTING: Applied clinical setting. PARTICIPANTS: Two subjects with normal ROM and cervical muscles were studied. MAIN OUTCOME MEASURE: One subject was studied with sEMG. looking at the cervical paraspinals and sternocleidomastoid muscles; the other subject was studied with an active ROM device. Three cervical movements were studied: lower cervical flexion, atlantoaxial (upper) cervical flexion, and a combination upper/lower cervical flexion. RESULTS: The active ROM device indicates larger movements (higher degrees of flexion) for the lower cervical flexion compared with upper flexion. The combined movement indicates a differential movement from 2 spinal segments. The sEMG recordings indicated differential recruitment patterns. The sternocleidomastoid recruits briskly during the flexion phase of the upper cervical flexion movement, whereas the cervical paraspinals recruit briskly during return to mid-line when the lower cervical flexion is used. The combined upper then lower cervical flexion movement recruits both sets of muscles. CONCLUSIONS: The results of the study indicate 2 distinct movement patterns associated with upper versus lower cervical flexion and 2 distinct sEMG recruitment patterns. The study suggests that these 2 distinct movements involve 2 distinct cervical segments and are associated with recruitment of different muscle groups. Applied clinical research on the cervical spine should use sEMG recordings to assess both the upper and lower flexion movements as the standard for the study of cervical flexion.     

Determination of consistent patterns of range of motion in the ankle joint with a computed tomography stress-test

Background

Measuring the range of motion of the ankle joint can assist in accurate diagnosis of ankle laxity. A computed tomography-based stress-test (3D CT stress-test) was used that determines the three-dimensional position and orientation of tibial, calcaneal and talar bones. The goal was to establish a quantitative database of the normal ranges of motion of the talocrural and subtalar joints. A clinical case on suspected subtalar instability demonstrated the relevance the proposed method.

Methods

The range of motion was measured for the ankle joints in vivo for 20 subjects using the 3D CT stress-test. Motion of the tibia and calcaneus relative to the talus for eight extreme foot positions were described by helical parameters.

Findings

High consistency for finite helical axis orientation (n) and rotation (θ) was shown for: talocrural extreme dorsiflexion to extreme plantarflexion (root mean square direction deviation (η) 5.3° and θ: SD 11.0°), talorucral and subtalar extreme combined eversion–dorsiflexion to combined inversion–plantarflexion (η: 6.7°, θ: SD 9.0° and η:6.3°, θ: SD 5.1°), and subtalar extreme inversion to extreme eversion (η: 6.4°, θ: SD 5.9°). Nearly all dorsi – and plantarflexion occurs in the talocrural joint (θ: mean 63.3° (SD 11°)). The inversion and internal rotation components for extreme eversion to inversion were approximately three times larger for the subtalar joint (θ: mean 22.9° and 29.1°) than for the talocrural joint (θ: mean 8.8° and 10.7°). Comparison of the ranges of motion of the pathologic ankle joint with the healthy subjects showed an increased inversion and axial rotation in the talocrural joint instead of in the suspected subtalar joint.

Interpretation

The proposed diagnostic technique and the acquired database of helical parameters of ankle joint ranges of motion are suitable to apply in clinical cases.     

MIPPO技术结合锁定加压钢板对A型闭合性胫骨远端骨折患者踝关节功能及活动范围的影响

目的 探讨微创经皮钢板接骨术(MIPPO)结合锁定加压钢板对A型闭合性胫骨远端骨折患者踝关节功能及活动范围的影响.方法 选取2017年2月至2020年2月收治的A型闭合性胫骨远端骨折患者48例作为研究对象,以数字法将其随机分为对照组和观察组,各24例.对照组采用普通接骨板治疗,观察组采用MIPPO技术结合锁定加压钢板治...     

活动终末端等长收缩训练对膝关节骨折术后活动范围的影响

目的:探讨在关节活动终末端进行等长收缩训练对骨折手术后3个月以上病程的患者膝关节活动范围的影响.方法:选择膝关节周围骨折手术后同定时间超过3个月,且出现明显膝关节活动功能障碍的患者28例,并随机分成治疗组和对照组.两组患者均先进行理疗(蜡疗或热敷治疗)、关节松动术等治疗,以及屈伸膝的等张收缩训练.5次/周.治疗组另于等张收缩训练后进行膝关节屈、伸活动终末端等长收缩训练,但两组患者每天总主动肌力训练时间相等.两组患者均于锻炼90d后测量角度值行统计学分析.结果:两组患者在治疗前屈、伸膝的主、被动运动角度均无明显差异(P>0.05).经过治疗和功能锻炼后,两组患者主被动屈伸膝关节角度均有显著改善(P<0.01),治疗组主动屈曲角度较对照组改善显著(P<0.05),被动屈、伸膝角度和主动伸膝角度两组间比较均无明显差异(P>0.05).结论:关节活动终末端等长收缩训练对损伤术后膝关节同定时间较长.且出现严重关节活动功能障碍的患者的功能改善有积极的意义.