多点阻滞联合手法松解治疗肩周炎

肩周炎是疼痛门诊常见病之一;患者多以疼痛伴活动受限就诊.治疗目的多以缓解疼痛,改善运动功能,预防不可逆运动障碍为主.其治疗方法有药物、物理治疗,功能锻炼,神经阻滞,手法松解,外科手术等.而神经阻滞结合手法松解因流程相对简单且安全有效在门诊病人处理时被广泛应用.本文通过对比单纯多点阻滞和多点阻滞联合手法松解术在门诊肩周炎患者治疗中的效果,为临床治疗提供参考.目的:对比单纯多点阻滞与阻滞合手法松解术治疗肩周炎的疗效.方法:取门诊肩周炎病例43例随机分为A组(n=19)和B组(n=24),A组依据患者关节疼痛部位及活动受限情况选取患侧三角肌-肩峰下滑囊、肱骨结节间沟、喙突下、肩关节腔、肩胛上切迹肩胛神经出口、四边孔腋神经出口、冈上下肌群及明显疼痛处的相应靶点行消炎镇痛液阻滞,术毕嘱患者自行患肩爬墙、钟摆、划圈等功能锻炼,每日2次,每次15分钟;B组患者行阻滞治疗后,趁患者疼痛明显缓解时当即以手法辅助患肩依次行上举、外展、内收、内旋、外旋、后伸扳肩等动作,余同A组.对患者术前、术后、术后2周的疼痛行视觉模拟评分(VSA);观察术前、术后肩关节活动情况,随访2周.结果:两组患者术后疼痛均有明显缓解,两组对比无统计学意义(P>0.05);B组患者活动度早期疗效较A组显著改善:B组早期疗效痊愈22例,有效2例,A组早期疗效痊愈11例,有效7例,无效1例(P<0.05).无明显不良反应.结论:多点阻滞联合手法松解术治疗门诊肩周炎,镇痛效果好,前期肩关节活动度改善明显,简单易行值得基层推广.     

玻璃酸钠联合关节手法松解治疗肩周炎临床观察

目的:观察肩峰下关节腔注射玻璃酸钠联合关节手法松解治疗肩周炎68例的临床效果.方法:研究对象为医院收治的136例肩周炎患者,根据随机数表法将患者分为观察组与对照组,各68例.对照组患者接受常规治疗并给予肩峰下关节腔注射玻璃酸钠,观察组则在对照组基础上联合关节手法松解治疗,对比两组患者治疗4周后肩关节疼痛改善情况、肩关节功能恢复效果及临床疗效.结果:观察组肩关节疼痛缓解及肩关节功能恢复效果均优于对照组,且临床治疗痊愈患者占比高于对照组,差异有统计学意义(P<0.05).结论:肩周炎患者接受肩峰下关节腔注射玻璃酸钠联合关节手法松解治疗,患者疼痛感明显减轻,肩关节功能恢复效果理想,临床治愈率高,治疗效果显著.     

小针刀配合手法、功能锻炼治疗肩周炎患者的临床疗效

目的:探讨小针刀配合手法、功能锻炼治疗30例肩周炎患者的临床疗效.方法:选取60例肩周炎患者,随机分为治疗组(30例)和对照组(30例),皆接受常规治疗,治疗组以小针刀、手法、功能锻炼,对照组仅以手法、功能锻炼,然后比较两组治疗前后肩关节功能评定和治疗后疗效评定.结果:①肩关节功能评定:两组患者治疗后患肩痛、ROM、ADL、肌力和形态等均明显改善,综合分值明显提高,由治疗前37.7±12.8增加到81.45±9.41,P＜0.001;②疗效评定标准:两组患者均较治疗前提高,但治疗组较对照组显著(P＜0.05).结论:小针刀配合手法、功能锻炼治疗肩周炎肩关节功能障碍具有明显疗效.     

臂丛麻醉下手法松解治疗肩周炎疗效观察

目的探讨臂丛麻醉下手法松解治疗肩周炎的方法及效果。方法回顾性分析2010年1月~2012年12月笔者所在医院采用臂丛麻醉下手法松解治疗肩周炎43例的临床资料。结果治愈(肩关节疼痛消失,活动正常)40例,显效(肩关节疼痛轻微,活动基本正常)3例,未发现无效病例。结论臂丛麻醉下手法松解治疗肩周炎可以解除肩关节活动受限,缓解肩部疼痛,改善患者生活质量。     

手法松解肩周炎的体会

肩周炎的治疗方法目前很多,治疗用药及神经阻滞也各不相同。但处于冻结期的肩周炎行手法松解是其共同途径,然后再进行肩关节的功能锻炼及局部用药。我院从1997年至今共收治处于冻结期的肩周炎患者147例,在无痛下行手法松解,治愈率达100％,现将松解体会报告如下：临床资料：共治疗147例,其中男性66例,女性81例,年龄41～108岁,病程2个月～5年,神经阻滞131例,全麻16例。现报告如下。     

针刺加手法松解治疗肩周炎67例

笔者自 1996年 5月开始 ,采用针刺加手法松解治疗肩周炎67例 ,取得了满意的临床效果 ,现报告如下。1　对象和方法1.1　对象　 67例患者均为常规理化检查正常 ,确诊为肩周炎者 ,其中男性 2 9例 ,女性 3 8例 ,年龄 40～ 62岁 ,病程 4个月～ 2年。1.2　治疗方法1.2 .1　针刺取穴　患侧合谷、外关、全息“肩穴”(胫骨外侧足三里外 1.5ｃｍ、下 3ｃｍ处 )。1.2 .2　操作　直刺进针 ,得气后留针 3 0ｍｉｎ至手法松解结束 ,间歇行针 2次。1.2 .3　手法松解　针刺得气留针后 ,首先痛点按摩 1～ 2ｍｉｎ ,然后双掌抱推、抱揉肩部前后两面 ,揉肩骨禺穴…     

温泉泥疗加手法加中频电疗法治疗肩周炎疗效观察

目的 观察温泉泥疗加手法加中频电疗法治疗肩周炎的疗效.方法 选取在我院住院治疗的肩周炎患者269例,随机分为两组.治疗组135例,采用温泉泥疗加手法加中频电疗法进行治疗;对照组134例,采用手法加中频电疗法治疗.均于治疗20 d后评定疗效.结果 治疗组总有效率为98.52%,对照组为88.06%,治疗组的疗效明显高于对照组(P＜0.05).结论 温泉泥疗加手法加中频电疗治疗肩周炎可获得明显的疗效.     

针刀配合手法及中药敷烤治疗肩周炎临床观察

目的观察针刀配合手法及中药敷烤治疗肩周炎的临床疗效。方法对45例肩周炎患者采用针刀配合手法及中药敷烤治疗,并与42例对照组单纯针刺做比较。结果治疗组总有效率为95．6％,而对照组总有效率为71．4％,两组比较有显著性差异（P〈0．05）。结论针刀配合手法及中药敷烤能够有效松解肩关节组织的粘连,是治疗肩周炎的有效方法。     

观察臂丛神经麻醉下肩关节松解术配合推拿手法治疗肩周炎的疗效

目的：探讨臂丛神经麻醉下肩关节松解术配合推拿手法治疗肩周炎的临床疗效。方法：将我院96例肩周炎患者分为对照组与观察组,对照组采用臂丛神经麻醉下肩关节松解术治疗,观察组在此基础上配合推拿手法治疗,对两组患者的疗效予以对比。结果：对照组治疗总有效率是85.4%,治疗组治疗总有效率是97.9%,比较两组患者的临床疗效存在统计学差异（P＜0.05）。结论：肩周炎采用臂丛神经麻醉下肩关节松解术配合推拿手法治疗具有理想疗效,值得在临床上大力推广应用。     

吗啡联合咪达唑仑持续静脉泵入对ICU危重病患者的镇痛镇静效果

目的 观察为ICU危重病病例实施持续静脉泵入疗法时选择配伍使用咪达唑仑和吗啡的镇痛镇静效果.方法 为我院2010年11月至2012年12月70例ICU危重病病例实施持续静脉泵入疗法,随机分组并选择使用不同的配伍用药,甲组26例病例选择的配伍用药为咪达唑仑和曲马多,乙组44例病例选择的配伍用药为咪达唑仑和吗啡,观察2组收到的镇痛镇静效果(以2种疼痛评分方法的得分作为评价标准).结果 乙组的Richmond得分在-1以下的病例例数多于甲组,乙组较甲组的镇静作用强(P＜0.05),差异性有效;乙组的数字得分在3以下的病例例数多于甲组,乙组较甲组的镇痛作用强(P＜0.05),差异性有效.结论 为ICU危重病病例实施持续静脉泵入疗法时选择配伍使用咪达唑仑和吗啡可以收到显著的镇痛镇静效果.     

Calcium intake in the elderly: validation of a dietary questionnaire

Epidemiological studies of calcium and osteoporosis have been hampered by the lack of a suitable tool for assessing calcium intake. This report describes a new frequency and amount questionnaire for measuring present and past calcium intake in the elderly. The validity of the questionnaire was tested against two commonly used standards of dietary assessment, five-day duplicate diets and seven-day weighed dietary inventories. The resulting correlation coefficients were, respectively, r = 0.76 and r = 0.69, while that for repeatability was r = 0.84. Furthermore, the questionnaire categorized subjects into thirds of the distribution of intake with almost no gross misclassification. It is suggested that the present findings may be extended to the majority of normal, healthy elderly subjects, implying wide application for the questionnaire in the assessment of calcium intake in the elderly.     

Self-reported health problems among Swedish miners one year after unemployment

Unemployment is considered to be a public health concern sincedeterioration in the health of the unemployed is often anticipated.However, for some groups, such as miners, unemployment mightimprove health due to a cessation of potentially harmful occupationalexposures. This study evaluates the health of 79 miners in oneSwedish iron-ore mine, and 226 age-matched controls from thegeneral population, during one year after the closure of themine. The participants received a questionnaire regarding medicalhistory and subjective symptoms at the beginning of the studyperiod, and after one year. Statistically significant negativeeffects on self-reported health attributable to unemploymentwere not found, although neuropsychiatric symptoms were morecommon among the unemployed miners. The miners reported a statisticallysignificant improvement in grip force (p=0.031). They had asignificantly higher prevalence of symptoms associated withmining related exposures when compared with the population controls;pain in the upper extremities [relative risk (RR)=2.27, 95%confidence interval (Cl)=1.44–3.59), back pain (RR=1.84;Cl=1.237–2.75), vasospastic disease of the fingers (RR=2.05;Cl=1.18–3.57) and obstructive respiratory symptoms (attacksof dyspnea and wheezing: RR=3.67; Cl=1.167–11.6).     

Excès de cas humains et animaux de tularémie en France au cours de l’hiver 2007–2008 : émergence ou phénomène isolé ?

Context

Tularemia is a zoonosis affecting humans and hares in France. We describe the results of surveillance in both species, in 2007 and 2008.

Methods

Human tularemia cases are mandatorily notifiable in France since 2003. In hares, surveillance relies on volunteer hunter associations in all districts of the country. Data from mandatory reports and volunteer surveillance in 2007/2008 were analyzed and compared with previous results.

Results

In 2007/2008, 144 cases were reported in humans and 117 cases in hares. This was a 100% increase compared to previous years. Human cases differed from those of previous years only by the frequency of contact with breeding animals. Human cases without any documented risk exposure were also more frequent.

Conclusion

An increase of tularemia cases occurred in 2007/2008 in both species. Complementary studies are needed to identify the species reservoir in France to understand the causes of this peak of cases.     

Occupational health hazards in mining: an overview

This review article outlines the physical, chemical, biological, ergonomic and psychosocial occupational health hazards of mining and associated metallurgical processes. Mining remains an important industrial sector in many parts of the world and although substantial progress has been made in the control of occupational health hazards, there remains room for further risk reduction. This applies particularly to traumatic injury hazards, ergonomic hazards and noise. Vigilance is also required to ensure exposures to coal dust and crystalline silica remain effectively controlled.     

Manufacture and use of nanomaterials: current status in the UK and global trends

This paper provides an overview of the production and use of nanomaterials (NMs), particularly in the UK. Currently, relatively few companies in the UK are identifiable as NM manufacturers, the main emphasis being the bulk markets in metals and metal oxides, and some niche markets such as carbon nanotubes and quantum dots. NM manufacturing in the UK does not reflect the global emphasis on fullerenes, nanotubes and fibres. Some assumptions have been made about the types of NM that are likely to be imported into the UK, which currently include fullerenes, modified fullerenes and other carbon-based NMs including nanotubes. Many university departments, spin-offs and private companies have developed processes for the manufacture of NMs but may only be producing small quantities for research and development (R&D) purposes. However, some have the potential to scale up to produce large quantities. The nanotechnology industry in the UK has strong R&D backup from universities and related institutions. This review has covered R&D trends at such institutions, and appropriate information has been added to a searchable database. While several companies are including NMs in their products, only a few (e.g. manufacturers of paints, coatings, cosmetics, catalysts, polymer composites) are using nanoparticles (NPs) in any significant quantities. However, this situation is likely to change rapidly. There is a need to collect more information about exposure to NPs in both manufacturing and user scenarios. As the market grows, and as manufacturers switch from the micro- to the nanoscale, the potential for exposure will increase. More research is required to quantify any risks to workers and consumers.     

深圳公立医院管理体制改革制度设计

深圳公立医院管理体制改革实行政事分开、管办分开,在理事会架构下按法定机构模式组建市医管中心,落实公立医院运营管理自主权.作者从当前公立医院管理体制的弊端入手,介绍了深圳市进行公立医院管理体制改革的基本思路及改革方案设计的主要举措,深入剖析了的改革方案的特点,并对改革效果进行了预测.     

Effects of nitrogen dioxide on red blood cells of rats: Changes in components of red cell membranes during in vivo exposure to NO2

Red cell membranes, prepared from red blood cells of rats exposed to 4, 10, or 20 ppm nitrogen dioxide (NO₂) for 1 to 10 days, were examined for evidence of changes in membrane components. Appreciable changes were not found in contents of phospholipid and cholesterol during exposure to 10 ppm NO₂. By contrast, protein content altered with the time of exposure. Moreover, changes in protein composition were observed by employing sodium dodecyl sulfate — polyacrylamide gel electrophoresis. Twenty-four-hour exposure to NO₂ at the concentration above 10 ppm resulted in a marked increase in the percentage of lysophosphatidylethanolamine (LysoPE) to the total phospholipids. The prolonged exposure to 10 ppm NO₂ gave rise to a further increase in LysoPE, whereas the percentage of phosphatidylethanolamine (PE) showed a gradual decrease. A 1-day exposure to 4.0 ppm NO₂ also caused an increase in sialic acid content and decreases in those of PE and hexose. In addition to contents of these components the percentage of LysoPE increased 5 days after exposure and the elevated values were maintained up to the end of exposure period. These results demonstrate that red blood cells in circulation exhibit different membrane properties in terms of lipid and carbohydrate composition during 10 days of exposure to 4.0 ppm NO₂.     

Investigating clusters in the workplace and beyond

Clusters of disease are common and occur in the workplace and in the general community. They often arouse considerable concern among the population. Investigations have sometimes lead to exciting new knowledge, but in general the investigation of clusters is difficult and often unrewarding, especially for community clusters. In the workplace, investigations are more likely to find associations and even new causes, but still many clusters remain enigmatic. Despite this, there are many reasons for investigating clusters, including allaying community concern and identifying uncontrolled exposures. A structure for investigating clusters in the workplace is suggested.