综合康复治疗脊柱骨质增生症的疗效观察

采用牵引、直流电离子导入法、康复治疗机及脉冲中频电疗等方法，对384例脊柱骨质增生患者进行了同步、交叉综合康复治疗，平均治疗20天。结果优良率为75％，本文还对脊柱骨质增生病因及治疗的机理进行了深入细致的讨论。     

综合康复治疗脊柱骨质增生症的疗效观察

采用牵引、直流电离子导入法、康复治疗机及脉冲中频电疗等方法，对384例脊柱骨质增生患进行了同步、交叉综合康复治疔，平均治疗20天。结果优良率为75％，本还对脊柱骨质增生病因及治疗的机理进行了深入细致的讨论。     

膝关节骨质增生症康复锻炼方法探讨

膝关节是人体的基本负重关节,担负着身体的全部重量,且活动度大,关节易受损.膝关节骨质增生症是膝关节疼痛最常见的原因之一,膝关节之所以最常受累主要是生物学老化、退变、与伤力作用引起[1],我科根据膝关节骨质增生症的病理机理,结合临床,给予膝关节穴位注射正清风痛宁、玻璃酸钠、腰宁,膝关节中频电疗、中药熏蒸等保守治疗,配合正确的康复锻炼方法,取得较满意的效果.     

脊柱牵引康复的生物力学分析

目的：从生物力学观点出发，初步探讨脊柱牵引康复疗法的作用机制。为临床确定正确的牵引处方及牵引设备研制提供理论依据。 资料来源：应用计算机检索PUBMEDl995-01／2005-12期间的相关文章，检索词为“biomechanics，traction（tow）therapy，spine，clinical．rehabilitation medicine”，并限定文章语言种类为English。同时计算机检索万方数据库2000-01／2005-12期问的相关文章，检索词为“脊柱牵引，生物力学，生物数学，临床，康复医学”，并限定文章语言种类为中文。 资料选择：对资料进行初审，并查看每篇文献后的引文。纳入标准：文章所述内容应与脊柱牵引康复疗法的研究相关。排除标准：重复研究或Meta分析类文章。资料提炼：共收集到36篇相关文献，17篇文献符合纳入标准，排除的19篇文献为内容陈旧或重复。符合纳入标准的17篇文献中，2篇涉及脊柱的生物力学致病机制，8篇涉及脊柱牵引的一般方式，7篇涉及脊柱牵引疗法的康复机制。 资料综合：牵引康复疗法是治疗脊柱疾患的主要方法之一。临床牵引一般的过程分为加载、保持和卸载三个阶段。临床上脊柱（含颈椎）牵引治疗方法的研究多是在牵引力的大小或牵引时体位的调整等应用方面，缺乏深入、系统的理论研究。在对脊柱牵引康复疗法的生物力学机制研究中，牵引是以拉伸的方式作用于脊柱，正是脊柱“长期主要外力为压力”的相逆作用的外力。在相逆作用力下，生物系统的反馈作用，病变的机体向着反致病机制的方向发展。 结论：脊柱康复牵引治疗机制主要是牵引初期组织间的相对位移（几何位移）、持续牵引力作用下的生物材料的塑形（应力塑形）以及生物材料的力-电、力-化学耦合效应（多物理化学耦合）。     

脊柱牵引康复的生物力学分析

目的:从生物力学观点出发,初步探讨脊柱牵引康复疗法的作用机制,为临床确定正确的牵引处方及牵引设备研制提供理论依据。资料来源:应用计算机检索PUBMED1995-01/2005-12期间的相关文章,检索词为“biomechanics,traction(tow)therapy,spine,clinical,rehabilitationmedicine”,并限定文章语言种类为English。同时计算机检索万方数据库2000-01/2005-12期间的相关文章,检索词为“脊柱牵引,生物力学,生物数学,临床,康复医学”,并限定文章语言种类为中文。资料选择:对资料进行初审,并查看每篇文献后的引文。纳入标准:文章所述内容应与脊柱牵引康复疗法的研究相关。排除标准:重复研究或Meta分析类文章。资料提炼:共收集到36篇相关文献,17篇文献符合纳入标准,排除的19篇文献为内容陈旧或重复。符合纳入标准的17篇文献中,2篇涉及脊柱的生物力学致病机制,8篇涉及脊柱牵引的一般方式,7篇涉及脊柱牵引疗法的康复机制。资料综合:牵引康复疗法是治疗脊柱疾患的主要方法之一。临床牵引一般的过程分为加载、保持和卸载三个阶段。临床上脊柱(含颈椎)牵引治疗方法的研究多是在牵引力的大小或牵引时体位的调整等应用方面,缺乏深入、系统的理论研究。在对脊柱牵引康复疗法的生物力学机制研究中,牵引是以拉伸的方式作用于脊柱,正是脊柱“长期主要外力为压力”的相逆作用的外力。在相逆作用力下,生物系统的反馈作用,病变的机体向着反致病机制的方向发展。结论:脊柱康复牵引治疗机制主要是牵引初期组织间的相对位移(几何位移)、持续牵引力作用下的生物材料的塑形(应力塑形)以及生物材料的力-电、力-化学耦合效应(多物理化学耦合)。     

脊柱牵引的生物力学问题

为科学的利用脊柱牵引疗法，从生物力学观点出发，提出了脊柱牵引应注意的有关生物力学问题，对牵引的一般性生物力学作用及临床椎体牵引的生物力学作用进行了具体分析。根据生物材料的力学特性和牵引过程，给出了正弦牵引函数及其解释，给出了应力按摩牵引函数应用实例。     

黄氏骨刺方加减治疗骨质增生症300例报告

1999年12月-2002年12月,笔者依照广州市越秀区杂病医院黄振鸣老中医经验方[1],加减治疗颈腰骨质增生症300例,取得较满意的疗效.     

自主研制脊柱康复治疗床治疗腰椎间盘突出症疗效观察

目的探讨自主研制脊柱康复治疗床治疗腰椎间盘突出症的临床效果。方法将116例患者分为两组,治疗组58例采用脊柱康复治疗床治疗、中药熏蒸疗法、手法治疗;对照组58例除不接受脊柱康复治疗床的治疗,其他方法同治疗组;比较两组治疗效果。结果治疗组总有效率96.55%,对照组总有效率86.21%,两组比较差异有统计学意义(P0.05)。结论自主研制脊柱康复治疗床治疗腰椎间盘突出症,疗效显著,值得推广。     

综合康复治疗腰椎间盘突出症200例

腰椎间盘突出症是由于椎间盘在退变的基础上受到相应的损伤或应力作用 ,造成纤维环破裂和髓核组织突出 ,压迫神经根或马尾神经引起腰腿痛和相关神经症状。作者于 1 997～ 1 999年应用非手术疗法治疗 30 0例取得较好效果。1　资料与方法1 .1　一般资料　腰椎间盘突出症患者 30 0例 ,男1 64例 ,女 1 36例。年龄 2 3～ 72岁 ,平均 46岁。病程最短 7d,最长 1 2年。有外伤史 2 58例 ,无外伤史 42例。所有患者均有腰痛 ,部分患者伴有下肢放射痛、麻木及无力 ;脊柱侧弯 1 67例 ;直腿抬高试验阳性2 94例 ,全部病例均经 CT或 MRI检查确诊。随机分为…     

颈椎间盘突出症的康复治疗

从1993-1997年我院采用两种非手术治疗方法治疗椎间盘突出症70例,现报告如下。     

不同卧位对重症监护患者局部压力影响的研究

重症监护患者常有循环障碍、姿势固定、营养不良、贫血、水肿、应用血管活性药物，加上意识不清、焦虑、精神失常、多汗、大小便失禁以及局部皮肤的摩擦和剪切作用等而很容易发生压疮。鉴于危重监护患者常处于被动体位，不同卧位对受压部位产生的压力以及受压部位承受的压力，本研究对2005年9月-2006年4月在我院住院的47例患者根据病情需要并结合患者舒适原则制订了不同的卧位，并动态收集压力监测数据，以指导临床，取得很好的临床效果，现报道如下。     

糖尿病患者患病初期负性情感分析与干预效果评价

目的探讨脊柱后路内固定术后迟发性感染患者进行外科治疗时的护理要点。方法对骨科行脊柱后内固定术后并发迟发性感染的27例患者采用手术清创及双套管置管冲洗灌注引流，同时行抗生素治疗，对护理要点进行总结。结果患者平均住院时间为18d，所有患者在相应的外科处理和抗生素治疗后伤口均未出现窦道和不愈合。结论伤口清创、双套管冲洗引流同时配合药物治疗是治疗脊柱后路内固定术后迟发性感染的一种安全有效的治疗方法；术前心理护理、饮食护理，术后体位护理、管道护理及药物不良反应的观察，及细致的出院指导是患者顺利康复的重要保证。     

Predictors for identifying patients with mechanical neck pain who are likely to achieve short-term success with manipulative interventions directed at the cervical and thoracic spine

Objective

The purpose of this study was to identify the prognostic factors for individuals with mechanical neck pain likely to experience improvements in both pain and disability after the application of an intervention including cervical and thoracic spine thrust manipulations.

Methods

Patients presenting with mechanical neck pain participated in a prospective single-arm trial. Participants underwent a standardized examination and then received a series of thrust manipulations directed toward the cervical, cervicothoracic, and thoracic spine. Participants were classified as having achieved a successful outcome at the second and third sessions based on their perceived recovery. Potential prognostic variables were entered into a stepwise logistic regression model to determine the most accurate set of variables for the prediction of treatment success.

Results

Data from 81 subjects were included in the analysis, of which 50 experienced a successful outcome (61.7%). Five variables including pain intensity greater than 4.5 points; cervical extension less than 46°; presence of hypomobility at T1; a negative upper limb tension test and female sex were identified. If 4 of 5 variables were present (likelihood ratio, +1.9), the likelihood of success increased from 61.7% to 75.4%.

Conclusions

This study identified several prognostic clinical factors that can potentially identify, a priori, patients with neck pain who are likely to experience a rapid response to the application of an intervention including both cervical and thoracic spine manipulations. However, no combination of the variables was able to dramatically increase the posttest probability.     

Reference values and reliability for lumbopelvic strength and endurance in asymptomatic subjects

Background

Assessing the lumbopelvic region is useful for detecting many musculoskeletal dysfunctions and also performance deficits. Several clinical tests are used to assess this region, however, reference values and results related to method, reliability and error measurements of these tests have not been reported.

Biomechanical analysis of two-step traction therapy in the lumbar spine

Traction therapy is one of the most common conservative treatments for low back pain. However, the effects of traction therapy on lumbar spine biomechanics are not well known. We investigated biomechanical effects of two-step traction therapy, which consists of global axial traction and local decompression, on the lumbar spine using a validated three-dimensional finite element model of the lumbar spine. One-third of body weight was applied on the center of the L1 vertebra toward the superior direction for the first axial traction. Anterior translation of the L4 vertebra was considered as the second local decompression. The lordosis angle between the superior planes of the L1 vertebra and sacrum was 44.6° at baseline, 35.2° with global axial traction, and 46.4° with local decompression. The fibers of annulus fibrosus in the posterior region, and intertransverse and posterior longitudinal ligaments experienced stress primarily during global axial traction, these stresses decreased during local decompression. A combination of global axial traction and local decompression would be helpful for reducing tensile stress on the fibers of the annulus fibrosus and ligaments, and intradiscal pressure in traction therapy. This study could be used to develop a safer and more effective type of traction therapy.     

Rehabilitation of cancer patients including creative therapies

When sufficient experience had been accumulated to support the view that intensive aftercare of the consequences of cancer will have a favourable impact on the individual's prognosis, the German social insurance institutions extended coverage to aids for vocational reintegration, and a medical indication of cancer rehabilitation. Own experience gathered since in the longterm care of cancer patients, which lasted up to three years, almost invariably brought about improvements in the quality of life, often a prolongation of survival time that was worth living, and occasionally a shorter incapacity for work. The decisive factor in this connexion was found to be individualized occupational therapy measures, which, when appropriate, included art and music therapy, structured psychotherapy that included relaxation exercises and group talks as well as recreational activities, both active and passive. The significance of these therapy plans is understood when one takes into account that cancer patients tend to withdraw from their environment due to their anxieties and an impaired self-worth. On account of misconceptions on the disease and its causes those affected by it are often kept away from and further isolated, which aggravates the already existing deficit of social contacts. Insufficient ability to creatively use excessive leisure time will invariably entail brooding over one's personal fate, with depressive reactions being an often unavoidable result.     

脊柱骨折专用翻身垫的制作与临床应用研究

目的 探讨脊柱骨折专用翻身垫在临床中的应用.方法 选择2007年1月～2007年12月收治骨科住院的患者92例,随机分为观察组和对照组,每组各46例.观察组使用脊柱骨折专用翻身垫行翻身护理,对照组采用单人枕头行翻身护理.观察两组病人翻身的效果、皮肤受压情况及患者对护理工作满意度情况.结果 两组患者皮肤受压情况无统计学意义(P0.05);观察组病人翻身效果、患者对护理工作满意度等方面显著优于对照组,差异有显著性(P<0.05).结论 在临床中应用自制的专用翻身垫使患者维持正确卧位姿势,脊柱受力均匀,骨折不易移位,减轻了病人痛苦,从而增加了护理满意度.     

Clinical tests for screening and diagnosis of cervical spine myelopathy: a systematic review

Objective

The purpose of this review was to investigate the diagnostic accuracy for screening and confirmation of clinical tests for cervical spine myelopathy (CSM) and to investigate the quality of the studies that have investigated these values.

Methods

This study was a systematic review that used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Search terms for PubMed included myelopathy; diagnosis, differential; sensitivity and specificity; and physical examination. Search terms for Cumulative Index to Nursing and Allied Health Literature were limited to myelopathy and sensitivity and specificity. Qualitative assessment included report of diagnostic accuracy metrics (sensitivity, specificity, and positive and negative likelihood ratios) and quality scores using the Quality Assessment of Diagnostic Accuracy Studies tool. Scores were created for single tests and clustered test findings.

Results

After evaluation, 12 full-text articles were selected, scored, and tabulated. Nearly all of the 18 tests demonstrated high levels of specificity and low levels of sensitivity, suggesting that they are poor screening tools. Only one study was scored as high quality. One study involved clustering of test findings but was considered low quality.

Conclusion

Nearly all of the clinical tests for CSM seem to be poor screening tools, which implies that manually oriented clinicians may perform treatment methods in a situation of doubt or uncertainly. More high-quality studies are needed, and manual therapists need to be cognizant that the current clinical tests for CSM lack strong diagnostic accuracy measures that are necessary for clinical decision making.     

1166例脊柱手术围术期临床红细胞和血浆输注情况调查

目的评估各类脊柱手术围手术期用血情况,以了解本院血液保护工作取得的临床成效及存在的问题。方法收集1996年1月1日—2005年12月31日本院骨科1166名围术期曾输血的脊柱手术患者血库原始资料,分析采取血液保护措施后,不同手术种类与临床用血的变化趋势。结果10年来红细胞输注量随手术量的增加递增,但患者的平均输注量逐年降低,以术中减少为主;红细胞输注量的手术种类以脊柱肿瘤手术为主;新鲜冰冻血浆用量自2004年迅速增加,且以术中增加幅度最明显。结论血液保护工作对控制脊柱手术患者术中红细胞的输注量有一定的成效,但新鲜冰冻血浆用量的急剧增加是临床合理使用还是有滥用情况,尚需要进一步的调查研究证实。