塑性弹力夹板治疗桡骨远端伸直型骨折的临床研究

目的研究塑性弹力夹板治疗桡骨远端伸直型骨折的疗效。方法选择桡骨远端伸直型骨折患者140例,分成观察组和对照组。对照组采用普通小夹板固定治疗;观察组采用塑性弹力夹板固定治疗。结果观察组患者临床痊愈率97．14％高于对照组的临床痊愈率85．71％,具有显著差异（P〈0．05）;观察组患者未出现腕关节僵硬等并发症;对照组患者有6例出现腕关节不同程度僵硬症状。结论采用塑性弹力夹板治疗桡骨远端伸直型骨折患者疗效佳,具有良好的安全性,建议临床进一步推广。     

手法复位夹板外固定配合理疗对桡骨远端骨折患者腕关节功能恢复的影响

目的探讨手法复位夹板外固定配合理疗对桡骨远端骨折患者腕关节功能恢复的影响。方法 60例桡骨远端骨折患者随机分为两组各30例,对照组行手术切开复位钢板螺钉内固定,观察组行手法复位夹板外固定配合理疗,比较两组的治疗效果。结果观察组的腕关节功能优良率显著高于对照组,疼痛缓解时间、手背消肿时间及骨折愈合时间均显著短于对照组(P<0.05)。治疗后,两组的掌倾角及尺偏角均较治疗前显著升高(P<0.05),但两组间比较无统计学差异(P>0.05)。结论手法复位夹板外固定配合理疗治疗桡骨远端骨折患者可有效缩短疼痛时间、手背肿胀时间,促进骨折愈合,改善腕关节功能。     

Biomechanical analysis of upper extremity risk in Sign Langauge Interpreting

Upper extremity cumulative trauma distorders (UECTD) have been identified as an occupational health problem in professional Sign Language Interpreters (SLI). A previous study of UECTD in SLI has indicated significant differences between interpreters working with pain and those working without pain. This earlier research focused on gross measures of hand/wrist movement, work/rest cycles, and deviations from an optimal work envelope. The present paper describes a detailed biomechanical analysis of wrist and forearm activity associated with SLI. This assessment included forearm (flexion and extension) and wrist (flexion/extension and radial/ulnar deviation) measures of movement frequency, counts of individual motion, joint movement velocities and accelerations as well as range of motion. The analyses revealed that the postures required for interpreting result in the signing hand frequently held in a fully pronated position, with the palm facing out. The wrist was most frequently in an ulnar deviation and/or extension while the elbow was flexed more than 90° and held in close to the body with the fingers pointing up. The frequency of motions for the forearm and wrist were observed to be 270 per minute (4.5 Hz), which is equivalent to 13,600 per 50 minute lecture hour. The mean absolute joint movement velocity and acceleration values were relatively high in contrast to industrial jobs with wrist and forearm accelerations between 34,754 degreees/sec² and 36,046 degrees/sec², respectively. The findings from this biomechanical analysis indicates that SLI can involve highly repetitive, awkward movements with significant accelerations of the hand and wrist. Such job characteristics may predispose interpreters to upper extremity CTD-related disorders.     

The impact of whole-hand vibration exposure on the sense of angular position about the wrist joint

Objectives: The purpose of this research is to determine the impact of whole-hand vibration on the capacity of subjects to identify previously presented positions of the hand in both wrist flexion and extension. Methods: In each movement direction, targets of 15 or 30° were presented with an imposed passive movement from the start position. During the second imposed movement, subjects were required to identify when the target position had been reached. For the vibration condition, 15 s of whole-hand vibration exposure was repeated immediately prior to each target position trial. Proprioceptive capacity was assessed by comparing the identified angular position with the reference position–angular distance expressed in terms of absolute error (AE), constant error (CE), and variable error (VE). Results: For three of the four target positions (15 and 30° flexion and 15° extension), the absolute, constant, and VEs of target identification were insensitive to vibration, whereas for the 30° extension target, both the absolute and CE were significantly different before and after the vibration application, showing the subjects overshooting previously presented target position. All three error measures were larger for the long targets than the short targets. Conclusions: Short-duration exposure to whole-hand vibration is insufficient to compromise post-vibration position sense in the wrist joint, except near the end range of joint movement in wrist extension. Complement contribution of different proprioceptive receptors (muscle, joint, and skin receptors) seems to be crucial for accuracy to reproduce passive movements, since the capacity of any individual class of receptor to deliver information about movement and position of the limbs is limited.     

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.     

6周颈部离心训练对大学生颈部功能的影响

  目的  探讨6周颈部离心训练对大学生颈部功能的影响,为通过运动疗法改善不良姿势及预防颈椎病的发生提供依据。  方法  招募山西省某医学院52名大二学生,按性别分层后采用随机数字表法分为颈部离心训练干预组和对照组(各26名),干预组每次训练时间25 min,每周3次,共进行6周,对照组进行健康宣教。分别于训练前和训练后,测试颈部围度、力量、活动度、耐力、头颈姿势。  结果  颈部前屈、后伸、左侧屈、右旋转力量交互作用均有统计学意义(F值分别为34.25,55.96,56.49,37.13,P值均 < 0.05),6周后干预组力量为前屈(65.37±18.64)N、后伸(87.61±21.38)N、左侧屈(55.80±12.04)N、右侧屈(55.87±11.83)N,对照组力量为前屈(45.69±9.25)N、后伸(53.34±9.45)N、左侧屈(41.60±6.96)N、右侧屈(42.20±9.92)N,干预组高于对照组(t值分别为4.82,7.48,5.21,4.52,P值均 < 0.01)。颈部前屈、后伸、左侧屈、右旋转活动度交互效应均有统计学意义(F值分别为11.62,8.83,8.29,6.57,P值均 < 0.05),6周后干预组颈部活动度前屈(53.54±7.28)°、后伸(57.42±7.37)°、左侧屈(40.77±4.14)°、右旋转(85.12±6.35)°,对照组相应活动度为(45.35±9.55)°、(50.85±7.56)°、(37.19±5.86)°、(76.15±7.86)°,干预组高于对照组(t值分别为3.48,3.18,2.54,4.52,P值均 < 0.05)。颈围、右侧屈和左旋转活动度、颈部耐力、头前伸角度的时间主效应均有统计学意义(F值分别为15.79,13.94,35.90,10.17,8.61,P值均 < 0.05)。  结论  6周颈部离心训练可显著提升大学生颈部力量和关节活动度,对颈围、颈部耐力、头前伸姿势有改善作用。     

手法复位配合小夹板旋后位固定治疗Smith骨折的研究

目的探讨手法复位治疗配合小夹板旋后位固定治疗Smith骨折的疗效。方法选取40例Smith骨折患者,随机分为两组各20例。两组均给予手法复位,实验组予杉树皮夹板四夹旋后位固定4~6周,对照组予以石膏管型中立位固定4~6周,术后随访3个月,比较两组的疗效以及治疗前后的掌倾角。结果实验组治疗后的掌倾角显著优于对照组,总有效率显著高于对照组(P<0.05)。结论手法复位配合小夹板旋后位固定治疗Smith骨折的临床效果满意,可有效防止骨折再次移位。     

Is ulnar variance suitable for a parameter of Colles' fracture pre-operatively?

BACKGROUND: To evaluate ulnar variance (UV) as a parameter for Colles' fracture as a measure of the true length of the distal radius pre-operatively, we measured UV pre-operatively in 20 patients with Colles' fractures being treated surgically using the method of perpendiculars. Because the distal fragment is by definition dorsi-flexed, the dorsal edge of the most distal part of the radius is seen proximally and the volar edge of it is seen distally on true postero-anterior x-ray of the wrist. METHODS: We measured three different UVs in x-rays. UVd is the distance from the dorsal edge of the distal radius to the distal end of the ulnar head. UVv is the distance from the volar edge of the distal radius to the distal end of the ulnar head. We calculated UVc using lateral x-ray of the wrist at the midpoint of the lunate fossa to describe the true length of the distal radius. We compared UVd with UVv or UVc in 20 patients as well as in 11 patients who had dorsal tilt over 15 degrees. RESULTS: UVv was -3.8 +/- 2.5 mm (average+/-SD). UVd was 2.2 +/- 2.4 mm. UVc was 1.7 +/- 2.2 mm. Statistically, there was a significant difference between UVv and UVd (p < 0.0001). There was no statistically significant difference between UVd and UVc. However, in 11 cases with dorsal tilt over 15 degrees, UVd was 2.2 +/- 2.8 mm and UVc was 1.1 +/- 2.7 mm. There was a statistically significant difference between both groups (p = 0.003). CONCLUSIONS: The length of the distal radius can be described by measuring UVd pre-operatively in Colles' fracture patient in general. However, the true length of the distal radius can not be described by measuring UVd pre-operatively in cases with marked dorsi-flexion of the distal fragment.     

The effect of whey protein supplementation with and without creatine monohydrate combined with resistance training on lean tissue mass and muscle strength

Our purpose was to assess muscular adaptations during 6 weeks of resistance training in 36 males randomly assigned to supplementation with whey protein (W; 1.2 g/kg/day), whey protein and creatine monohydrate (WC; 0.1 g/kg/day), or placebo (P; 1.2 g/kg/day maltodextrin). Measures included lean tissue mass by dual energy x-ray absorptiometry, bench press and squat strength (1-repetition maximum), and knee extension/flexion peak torque. Lean tissue mass increased to a greater extent with training in WC compared to the other groups, and in the W compared to the P group (p < .05). Bench press strength increased to a greater extent for WC compared to W and P (p < .05). Knee extension peak torque increased with training for WC and W (p < .05), but not for P. All other measures increased to a similar extent across groups. Continued training without supplementation for an additional 6 weeks resulted in maintenance of strength and lean tissue mass in all groups. Males that supplemented with whey protein while resistance training demonstrated greater improvement in knee extension peak torque and lean tissue mass than males engaged in training alone. Males that supplemented with a combination of whey protein and creatine had greater increases in lean tissue mass and bench press than those who supplemented with only whey protein or placebo. However, not all strength measures were improved with supplementation, since subjects who supplemented with creatine and/or whey protein had similar increases in squat strength and knee flexion peak torque compared to subjects who received placebo.     

基于BP神经网络的表面肌电信号模式分类的研究

将神经网络与AR模型相结合提出了一种表面肌电信号模式分类算法。该算法能成功地从腕伸肌和腕屈肌的两道表面肌电信号中识别脱伸、腕屈、腕内旋和腕外旋四种运动模式。实验结果表明：用AR模型参数作BP网输入的肌电模式分类器，运行速度快、识别率高、鲁棒性好，在假肢等人一机仿生系统的控制中具有很好的应用前景。     

脊柱健康操对成都市脊柱发育异常小学生的矫治效果

  目的  观察脊柱健康操对成都市脊柱发育异常小学生的矫治效果,为改善脊柱倾斜角度和脊柱后凸角度异常提供参考。  方法  在2020年9月至2021年6月,选取成都市武侯区4所小学中高年级331名小学生,筛查出脊柱弯曲异常者94名,随机分为对照组和观察组各47例。对照组实施为期12周的常规体育活动,观察组在对照组基础上,实施12周线上线下相结合的脊柱健康操训练。采用SpineScan手持式电子脊柱测量仪测试2组对象实施前后的脊柱活动度(颈椎、胸椎的侧屈角度、前屈后伸角度以及旋转角度)、脊柱倾斜角度、脊柱后凸角度、身体平衡度(肩水平线、骶髂后棘水平线),并采用手持式肺活量计测试两组实验前后的肺活量。  结果  实施12周干预后,观察组和对照组在颈椎侧屈角度(78.36±3.72,72.39±3.17)°、颈椎前屈后伸角度(112.37±5.17,107.41±4.40)°、颈椎旋转角度(119.37±4.22,112.49±5.78)°、腰椎侧屈角度(49.37±4.12,41.85±3.37)°、腰椎前屈后伸角度(106.47±4.90,98.09±3.84)°、腰椎旋转角度(54.37±5.12,50.30±4.17)°,差异均有统计学意义(t值分别为5.24,2.82,4.02,4.96,4.36,5.75,P值均＜0.05);两组的脊柱倾斜角度(4.14±0.36,6.02±0.48)°、脊柱后凸角度(30.17±1.82、37.48±2.14)°、肩水平线不平衡度(0.96±0.18,2.30±0.37)°、骶髂后棘水平线不平衡度(0.77±0.15,1.40±0.21)°差异均有统计学意义(t值分别为-5.95,-6.74,-7.52,-6.58,P值均＜0.01);两组肺活量[(2 119.55±115.40)(2 042.47±104.35)mL]差异有统计学意义(t=4.81,P＜0.01)。  结论  脊柱健康操能提高脊柱弯曲异常小学生的脊柱关节活动度,改善脊柱倾斜角度和脊柱后凸角度异常,提高身体平衡度和肺活量。     

重复性伸腕作业劳动负荷与前臂伸肌的表面肌电特征

目的用表面肌电描记术(surface electromyography,SEMG)评价低力量负荷下,频率、重量和运动角度3个负荷因素对重复性伸腕运动中前臂肌肉应激状态和疲劳的影响。方法16名男性志愿者在规定的重量(1．96、4．90 N)、频率(8．0、33．3次/min)和角度(45°、90°)下做8组伸腕动作各20 min,并在作业开始和结束后做20%最大随意收缩力(MVC)的静态伸腕动作2～3s,采集并分析其尺侧腕伸肌和指伸肌的表面肌电信号。结果伸腕力量负荷(1．96、4．90 N)分别约为伸肌MVC手收缩力的1．40%和3．50%。当3个负荷因素的水平升高时,肌电的平均功率频率(MPF)和中位频率(MF)均降低,其中指伸肌MPF降低的差异有统计学意义(P＜0．05或P＜0．01),其MF在角度和重量两因素中的改变差异有统计学意义(P＜0．05或P＜0．01)。随负荷水平的升高,伸肌波幅值可分3～4组,组间差异有统计学意义(P＜0．05)；逐步回归分析显示,3因素负荷水平均与肌电波幅值呈正相关．结论各作业中指伸肌均明显疲劳；伸肌疲劳的首要负荷因素是频率,其次是重量和角度；MF、MPF和波幅指标可以描述低力量负荷下前臂肌肉的应激和疲劳状况。     

Workplace use of an adjustable keyboard: adjustment preferences and effect on wrist posture.

This study presents an evaluation of an adjustable keyboard based on subjective preference and wrist joint motion during typing. Thirty-five computer users used the adjustable split design keyboard for 7-14 days during their usual work and were instructed to adjust the keyboard to the opening angle they preferred. At the end of this period, three-dimensional motion analysis was performed to compare the distribution of wrist joint angles while subjects typed on a conventional keyboard and the adjustable keyboard adjusted to the subject's preferred angle. The mean preferred opening angle was 14 degrees +/- 10. The mean ulnar deviation of the subjects who selected the opening angles between 21 and 28 degrees (n = 12) decreased from 18 degrees +/- 5 on the flat to 14 degrees +/- 5 on the adjustable (p < 0.05), while those who selected 0 to 10 degrees (n = 6) and 11 to 20 degrees (n = 17) split angles showed no significant differences in ulnar deviation. Mean wrist extension on the adjustable keyboard was 17 degrees +/- 5 and was significantly less than the 24 degrees +/- 5 observed on the conventional keyboard and most likely due to the presence of palm support. On average, subjects reported that the adjustable keyboard was more comfortable (0.5 +/- 0.5) (worse = -1, same = 0, better, = 1) in comparison with the conventional keyboard.     

Hyperextension trauma of the finger

In 2 patients, a man aged 30 and a woman aged 31, a hyperextension trauma of the proximal interphalangeal joint of the right index finger and the left middle finger respectively was diagnosed. The man underwent surgery for volar plate rupture in the acute phase. The woman presented 7 weeks after the trauma with a chronic flexion contracture; she had an avulsion fracture of the second phalanx and was treated conservatively with splints and exercise therapy. The hyperextension trauma of the proximal interphalangeal joint of a finger is one of the most frequently occurring hand traumas. In the more severe cases, there can be substantial damage to the structures ofthe joint capsule, such as a volar plate rupture. In the acute phase, a ruptured volar plate results in pain and dorsal dislocation. In the long term however, two significant late complications can arise: the chronic post-traumatic hyperextension deformity and the flexion contracture. These complications are difficult to treat, but can be prevented by adequate initial treatment. The diagnosis of volar plate rupture is essential to this and can be formulated after a carefully conducted history taking and physical examination usually with simple radiological studies ofthe affected digit. Treatment of a volar plate rupture can be either conservative or surgical and is directed at regaining finger function and preventing complications. For the treatment to be successful, intensive physiotherapy during follow-up is essential.     

Spine Kinematics Predict Symptom and Lost Time Recurrence: How Much Recovery is Enough?

Purpose The purpose of the study was to determine thresholds for low back kinematic measures for the amount of functional recovery necessary to reduce the risk of recurrent pain symptoms or lost time. Methods Low back kinematic ability measures were collected at baseline when the workers returned to work for full duty. The range of motion, velocity, and acceleration were collected using the lumbar motion monitor. Results Follow-up data was collected on 196 of the 206 workers. Workers with sagittal extension velocity of <40 deg./s at baseline were twice as likely to report recurrent low back pain symptoms. Workers with sagittal flexion velocity <34 deg./s were 3 times more likely to report lost time. Conclusions Kinematic functional performance measures may be used as recovery criteria in low back pain patients to minimize recurrence risk.     

Splint Suitability: A Comparision of Four Wrist Splints for Arthritics

A questionnaire was designed to gain information regarding wearer and prescriber perceptions of splint suitability. This paper presents a comparison of data gained from 88 rheumatoid arthritic patients already prescribed a dorsal, palmar, elastic or leather gauntlet wrist splint from three hospitals where all of these splint types were available. Information concerning personal details, splint usage, perceived effectiveness of the splint for use during 24 daily activities, and 12 items related to splint design qualities was collected. Results of a discriminant analysis indicated that the four splint groups differed significantly on two discriminant functions based on 24 selected variables. Sex, use of a walking stick and the occupation of homemaker contributed most to the first discriminant function. Significant differences were also found between the four groups when comparing the wearers' indicated use of splints for dressing, hanging clothes, sweeping, dusting and reading. The results support the view that certain splints are perceived to be better suited to specific patient characteristics and daily tasks. Possible explanations and recommendations for future research are offered.     

腕关节镜技术结合切开复位内固定手术治疗桡骨远端关节内骨折的早期效果观察

目的探讨腕关节镜技术结合切开复位内固定手术治疗桡骨远端关节内骨折患者的早期效果。方法82例桡骨远端关节内骨折患者随机分为两组各41例。观察组给予腕关节镜技术结合切开复位内固定手术治疗,对照组给予单纯切开复位内固定手术治疗。比较两组的手术指标,以及术后1年的腕关节活动范围、Gartland/Werley腕关节评分及腕关节功能。结果观察组的手术时间显著长于对照组(P<0.05),两组的术中出血量无统计学差异(P>0.05)。术后1年,观察组的腕关节活动度(屈曲、背伸、尺偏、桡偏),前臂旋前、旋后活动范围,以及腕关节功能优良率均显著高于对照组(P<0.05);观察组的Gartland/Werley腕关节评分显著低于对照组(P<0.05)。结论腕关节镜技术结合切开复位内固定手术治疗桡骨远端关节内骨折具有显著的临床疗效,可改善患者的腕关节功能,促进关节面恢复。     

托吡酯改善痉挛型脑瘫合并癫痫患儿的肌张力及关节活动度情况的临床观察

目的:观察痉挛型脑瘫合并癫痫患儿经妥泰/托吡酯治疗后肢体肌张力和关节活动度的改善情况。方法:随机将痉挛型脑瘫合并癫痫患儿分为对照组28例和观察组20例,观察组给予妥泰/托吡酯,其余治疗措施两组相同。分别于治疗前、治疗后半年对患儿进行肌张力评级,测量髋关节被动屈曲角度、膝关节被动屈曲角度。结果:对照组和观察组患儿的肌张力、髋关节、膝关节的改善效率两组比较差异有统计学意义(P<0.05),说明经妥泰/托吡酯治疗后患儿肌张力以及髋关节、膝关节活动度改善情况明显优于对照组。结论:应用妥泰/托吡酯治疗能够在短时间内降低痉挛型脑瘫患儿的肌张力,增加关节活动度,为中医推拿及功能训练打下良好基础,减轻患儿康复训练中的痛苦,充分体现中西医药整体化治疗的优势。     

Can Botulinum Toxin Decrease Carer Burden in Long Term Care Residents With Upper Limb Spasticity? A Randomized Controlled Study

ObjectiveTo evaluate whether botulinum toxin can decrease the burden for caregivers of long term care patients with severe upper limb spasticity.MethodThis was a double-blind placebo-controlled trial with a 24-week follow-up period.SettingA 250-bed long term care hospital, the infirmary units of 3 regional hospitals, and 5 care and attention homes.ParticipantsParticipants included 55 long term care patients with significant upper limb spasticity and difficulty in basic upper limb care.InterventionsPatients were randomized into 2 groups that received either intramuscular botulinum toxin A or saline.Main outcome measuresThe primary outcome measure was provided by the carer burden scale. Secondary outcomes included goal attainment scale, measure of spasticity by modified Ashworth score, passive range of movement for shoulder abduction, and elbow extension and finger extension. Pain was assessed using the Pain Assessment in Advanced Dementia Scale.ResultsA total of 55 patients (21 men; mean age = 69, SD =18) were recruited. At week 6 post-injection, 18 (60%) of 30 patients in the treatment group versus 2 (8%) of 25 patients in the control group had a significant 4-point reduction of carer burden scale (P < .001). There was also significant improvement in the goal attainment scale, as well as the modified Ashworth score, resting angle, and passive range of movement of the 3 regions (shoulder, elbow, and fingers) in the treatment group which persisted until week 24. There were also fewer spontaneous bone fractures after botulinum toxin injection, although this did not reach statistical significance. No significant difference in Pain Assessment in Advanced Dementia scale was found between the 2 groups. No serious botulinum toxin type A–related adverse effects were reported.ConclusionLong term care patients who were treated for upper limb spasticity with intramuscular injections of botulinum toxin A had a significant decrease in the caregiver burden. The treatment was also associated with improved scores on patient-centered outcome measures.     

两种药物试敏皮内注射方法的效果评价

目的探讨药物试敏皮内注射的最佳方法,从而减轻患者痛苦,提高护理质量。方法分别采用直式法(在前臂掌侧下外1/3处与腕横纹皮肤垂直进针)和横式法(在前臂掌侧下外1/3处与腕横纹皮肤平行进针)两种注射法对248例门急诊患者进行皮内注射,观察受试对象的疼痛反应、试敏结果的变化。结果实验法与常规法相比疼痛程度、试敏结果阳性率比较,有非常显著性。结论在前臂掌侧下外1/3处与腕横纹皮肤平行进针法对皮肤的刺激小,可减轻患者疼痛,对皮肤组织的损伤小而减少假阳性率的发生。