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。     

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。     

改良方盘量角仪测颈椎活动度的研究

A、B分别为有熟练操作经验和新学会操作的两位医师,同时用改良方盘测量仪采用双盲法测量一组共20名健康志愿者(年龄23～63岁)的颈椎活动度。在颈惟的六个方向上的活动度测量中,两组资料的相关系数ICC值为0.955～0.985,呈显著相关。经t检验,两组资料无显著差别。证实:此改良的方盘测量仪是一种易掌握、方便、价廉而有用的颈椎活动度测量工具。用此改良方盘测量仪测出16例正常人颈椎活动度(除颈右弯曲外)明显大于同样年龄组16例颈椎病人的颈椎活动度。     

四肢关节功能牵引法—附器械介绍及临床应用1424例分析

本文介绍了适用于改善四肢关节活动度的关节功能牵引方法及一套专用的简易器械,从而为关节活动度的恢复提出了一项新的方法。作者通过此法的1424例临床应用,观察了对各种体创伤的疗效。在拇外展牵引病例的自身对比中证明其疗效明显地高于传统的由主动、被动运动和按摩构成的锻炼方法。从纤维组织的力学特性出发探讨了关节功能牵引作用特点,从实际疗效总结中分析了影响疗效的因素,指出关节功能牵引有疗效较好,不易引起新的损伤,痛苦少及操作方便等优点。     

依据三维空间测量原理设计的关节角度测量器

背景：Cybex NORM^TM型等速测试仪测量结果精确度较高，但其操作方法复杂，检查费用昂贵，不适用于常规临床检查。 目的：比较OTMA和Cybex NORM^TM型等速测试仪测量肩、髋、膝关节疾病治疗前后关节活动度，验证科技专利成果关节角度测量器（Orthopedics Tool Measurement Apparatus，OTMA）的科学性和实用价值。 设计、时间及地点：临床随机对照试验，2004—10／2005—03北京协和医院骨科人工关节中心。 对象：将121例患者随机分成①OTMA组：肩周炎患者22例22肩；股骨头缺血性坏死患者15例21髋；膝关节骨关节炎患者24例33膝。②Cybex组：肩周炎患者21例21肩；股骨头缺血性坏死患者16例21髋；膝关节骨关节炎患者23例33膝。 方法：分别应用OTMA和Cybex NORM^TM型等速测试仪对两组患者进行治疗前、治疗后3个月和1年随访时关节活动度测量；将测量数据分别在（膝关节）HSS评估量表，（肩关节）Karlsson疗效标准评估量表和（髋关节）Harris疗效标准评估量表中应用，填写VAS疼痛量表和SF-36等评估量表。 主要观察指标：肩、髋和膝关节的活动度值；Karlsson、Harris和HSS评分；VAS和SF-36评分。结果：OTMA的测量结果与Cybex NORM^TM测量结果之间的符合率为98-3％;测量过程能够被所有患者接受，测量操作方法的完成率100％。关节活动度与HSS、Kaflsson、Harris的评分值有相关性（P=0．002）。 结论：在三维空间测量原理指导下设计的数字化OTMA，获取结果与Cybex NORM^TM型等速测试仪相近，在测量过程中能够获得更接近于真实角度的测量值。     

不同年龄与不同位置下进行远端指间关节活动度的测量研究

摘要 目的：使用通用量角器测量远端指间关节活动度,探讨不同年龄和不同姿势对测量结果的影响。 方法：选取40名健康志愿者（20名年轻人和20名老年人）,对其在四个姿势下（即姿势1近端指间关节屈曲并主动屈曲远端指间关节、姿势2近端指间关节屈曲并被动屈曲远端指间关节,姿势3近端指间关节伸直并主动屈曲远端指间关节,姿势4近端指间关节伸直并被动屈曲远端指间关节）分别进行远端指间关节活动度的测量。 结果：在同一年龄组,近端指间关节屈曲和伸直位可对远端指间关节的活动度产生明显的影响。即使保持近端指间关节在同一姿势,远端指间关节主动活动度和被动活动度值间差异具有显著性。另外,近端指间关节伸直位时远端指间关节主动屈曲的活动度明显小于近端指间关节屈曲位时远端指间关节被动屈曲的活动度。在同一姿势下,年轻人与老年人的远端指间关节活动度也存在显著性差异。 结论：不同年龄和不同姿势可明显影响远端指间关节活动度的测量结果。     

关节角度测量四点法的临床价值

目的 比较膝关节角度三点测量法与四点测量法的信度和效度.方法 无膝关节运动障碍者25例,在膝关节处于伸直、小角度屈曲及大角度屈曲3种位置进行三点法和四点法角度测量,拍摄X线片作为金标准.采用Bland-altman法(95%一致性区间,LOA)进行信度和效度分析.结果 关节轴心随角度变化而位移.信度(95%LOA):测量者间四点法(-5.0,2.7),三点法(-6.5,4.4);测量者内四点法A(-3.6,4.0)、B(-4.1,4.8),三点法A(-5.0,6.4)、B(-6.1,5.8).效度(95%LOA):3种关节位置测量四点法分别为(3.5,2.6)、(-3.3,3.6)和(-1.9,5.7);三点法分别为(6.8,1.1)、(-4.0,7.1)和(0,8.5).结论 关节角度测量轴心随角度变化而移位,四点法的信度和效度优于传统三点法.

Abstract：

Objective To study the clinical value of using a four-point method (FP) in measuring joint angles.Method Methods Twenty-five subjects without knee dysfunction were studied.Every knee joint was tested in extension,below 90° of flexion and above 90° of flexion with the traditional three-point method (TP) and the new four-point method.X-rays were taken as a gold standard measurement.The reliability and validity were analyzed using Bland-Altman plots,which can yield 95% limits of agreement (LOA).Results (1) The joint axis centers moved with changes in joint angle.(2) The 95% LOA of inter-tester reliability was (-5.0,2.7) with the FP and (-6.5,4.4) with the TP.The 95% LOAs of intra-tester reliability were (-3.6,4.0) for tester A and (-4.1,4.8) for tester B with the FP,while (-5.0,6.4) for tester A and (-6.1,5.8) for tester B with the TP.(3) The 95% LOAs in the three positions were (3.5,2.6) in extension,(-3.3,3.6) in mild flexion and (-1.9,5.7) in greater flexion with the FP,and ( 6.8,1.1),(-4.0,7.1) and (0,8.5) with the TP.Conclusions The FP gives better reliability and validity than the TP in joint angle measurement.     

关节角度测量器测量结果准确性及可重复使用性评价

背景：设计了一种使用简便的医用关节角度测量器,并申请获得了专利。目的：以国际标准测量器Cybex NormTM测量系统为标准,验证关节角度测量器测量结果的准确性;并将各关节病理及功能状态下的测量结果与主观量表评估结果进行相关性分析,以证实关节角度测量器的可重复使用性和实用价值。设计、时间及地点：分层随机对照试验,于2004-10/2005-03在北京协和医院骨科进行。参试者：121例患者中,肩周炎43例,股骨头缺血性坏死31例,膝关节骨关节炎47例。将患者随机分成OTMA组60例和Cybex组61例,保证被测试关节数量相同。方法：在治疗前、治疗后3个月和1年随访时,分别应用关节角度测量器和Cybex NORMTM型等速测量系统对两组患者进行关节活动度测量。将关节活动度测量结果分别在肩关节Karlsson疗效标准、膝关节HSS量表和髋关节Harris量表中应用,并填写目测类比疼痛评估量表及SF-36生活质量评估量表。主要观察指标：两组不同时间点关节活动度值的符合率;各量表得分及关节活动度间的相关性。结果：121例患者的评估完成率为100%。关节角度测量器的测量结果与Cybex NORMTM测量结果之间的符合率为98.3%。两组中HSS量表,Karlsson疗效标准,Harris量表评分值随关节活动度增加而升高（P〈0.01）,相关分析结果显示关节活动度与以上3个量表结果高度相关,符合患者的临床表现。结论：关节角度测量器测量结果准确,能被患者所接受,并可进行重复测量使用。其结果能反映患者的临床症状,实现测量辅助临床诊断的目的。     

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.     

Smartphone goniometer has excellent reliability between novice and experienced physical therapists in assessing knee range of motion

IntroductionSmartphone app-based goniometer (SG) are emerging as an alternative to Universal Goniometers (UG) in assessing joint range of motion (ROM). This study examined whether the experience level of examiner affected the reliability of assessing knee flexion (KF) and knee extension (KE) ROM using UG and SG.MethodsParticipants with osteoarthritis of the knee or following total knee replacement were recruited. KF and KE ROM using UG and SG were assessed twice by an experienced physical therapist (PT) and a student PT (SPT). Intraclass correlation coefficients (ICC) examined the interrater (experienced PT vs SPT) and intrarater reliabilities (for experienced PT and SPT) in assessing KF and KE ROM for UG and SG. Concurrent relationships were examined between the knee ROM with pain and physical function using Pearson Correlation Coefficient (r).ResultsThe interrater reliability in assessing KF and KE ROM was excellent (ICC>0.90) between novice and experienced examiners. The standard error of measurement (SEM) for novice examiner in assessing KF was 1° and 2° while using UG and SG respectively; whereas the SEM for experienced examiner in assessing KF was 1° irrespective of which device was used. The concurrent relationships between KF and KE ROM with measures of pain and function were divergent (moderate to low correlations; r <0.7; p > 0.05).ConclusionBoth UG and SG have smaller measurement error in assessing KF and KE ROM irrespective of experience level of examiner and therefore no one tool is superior than the other for assessing knee ROM in clinical practice.     

Reproducibility and validity of digital inclinometry for measuring cervical range of motion in normal subjects

Background and Purpose . Measurements of cervical range of motion (CROM) have been extensively reported in the past decade employing simple (goniometers) as well as sophisticated (electro‐, magneto‐ and ultrasonography‐based) systems. The recent introduction of the simple, user‐friendly and relatively cheap digital inclinometer (DI) has opened a potentially new venue for measurement of this segment's motion. The purpose of the present study was to assess intra‐tester reproducibility of DI‐based findings as well as its validity in comparison to the ultrasonography‐based Zebris CMS 70P (Zebris Medizintechnik Gmbh?, Isny, Germany) for measuring CROM in normal subjects. Methods . Active CROM of healthy women (n = 15) and men (n = 15) aged 24.2(2.4) years was measured on two sessions, Test 1 and Test 2, spread over 7.2(±0.7) days apart. On Test 1, the six primary movements of the neck (flexion, F; extension, E; right and left lateral flexion, RLF and LLF; and right and left rotations, RR and LR) were measured using the DI and the Zebris. On Test 2, the same measurements were performed using the DI only. All measurements were conducted by the same tester, with the subject in the seated position. The only exception was DI measurement of cervical rotation that was performed in the supine position due to the DI gravity‐dependence, rendering DI measurements in the transverse plane irrelevant. Results . No significant differences were revealed between the two instruments with respect to the sagittal and frontal planes, whereas the DI‐based CROM in rotation was significantly greater then its Zebris‐based counterpart. The inter‐device interclass correlation coefficients (ICCs) for the frontal were 0.72 (RLF) and 0.62 (LLF), and 0.77 (F) and 0.83 (E). Poor correlations were indicated for the rotations. The intra‐tester reproducibility derived from the test–retest DI measurement indicated good to excellent reproducibility in all planes with ICCs ranging from 0.82 (LLF) to 0.94 (E). The Standard Error of Measurement ranged from 1.6° (RR) to 2.6° (F). Conclusion . DI‐based CROM measurements are reproducible and valid for recording sagittal and frontal plane motions in healthy subjects. The higher range in rotations, relative to the Zebris‐based findings, is most probably attributable to the test position. Being relatively cheap, portable and convenient for tester and subject alike, the DI seems to be an effective instrument for assessing CROM. Copyright © 2009 John Wiley & Sons, Ltd.     

2种人工气道气囊压力测定方法的比较研究

人工气道气囊必须充气,目的是封闭气道,但过度充气后的气囊会使气管黏膜缺血、糜烂甚至坏死等[1],因此,充气时最好有测压装置[2],以调整气囊压力在合适的范围。但目前测定气囊压力的专用气囊测压表没有普遍配置,尤其是在基层医院,因此寻找其他的测压方法是值得研究的课题。2004     

2种人工气道气囊压力测定方法的比较研究

目的 比较2种人工气道气囊压力的测定方法。方法 采自身对照法测100例患者人工气道气囊压力：采用普通血压计与德国产VBM专用气囊测压表测量，比较测定的结果。结果 资料经统计学检验，Z值=-1．300，P值=0．194，P〉0．05，2种方法比较差异无显著性。结论 普通血压计同样可准确测定人工气道气囊压力。     

A comparison of methods of evaluating cervical range of motion

OBJECTIVE: To determine whether there are differences in results when evaluating cervical range of motion (ROM) with radiographic analysis, a bubble goniometer, and a dual inclinometer and whether particular physical parameters are related to cervical ROM. METHODS: We evaluated the cervical ROM of 115 volunteers with each of the 3 clinical methods. Tape measurements of neck girth, distance from chin to sternal notch, and distances from ears to acromion were also recorded, along with sex and age. Interrater and intrarater reliabilities were determined, and the Pearson product moment correlation test and t test were performed on all data. RESULTS: Cervical ROM as determined by radiographic analysis was greater than that obtained with either a dual inclinometer or a bubble goniometer. All tape measurements were weakly correlated with all 3 means of cervical ROM evaluation, with the exception of the measurement of ear lobes to acromion, which did not correlate with radiographic analysis. There were also differences found in cervical ROM by sex and by age, with female subjects and younger subjects having a greater ROM. CONCLUSION: Compared with a dual inclinometer and a bubble goniometer, radiographic analysis provides a more accurate evaluation of cervical ROM.     

弱智儿童上肢关节活动感知能力与精细动作控制能力的相关性

目的研究弱智儿童的上肢关节活动感知能力、精细动作控制能力及它们的相关性。方法对比实验研究法。结果(1)弱智儿童在不同关节活动度(锐角、直角和钝角)感知上不存在统计学上的性别差异,但男童在3种关节活动度上的感知均比女童要差一些;(2)弱智儿童在3种关节活动度上的感知均显著落后于正常儿童,且随关节活动度的增大,感知能力愈差,达到极显著的程度(T锐角=-2.716,P<0.05;T直角=-3.471,P<0.01;T钝角=-5.493,P<0.01);(3)上肢精细控制能力上不存在性别差异,但弱智儿童的测试结果均比正常儿童要差,存在极显著的差异(T=-4.371,P<0.01);(4)精细动作控制能力与其关节活动感知能力之间存在显著相关。结论弱智儿童上肢关节活动感知能力与精细动作控制能力与正常儿童有较大的差距,加强动作技能训练是提高弱智儿童生存和生活质量的基础途径之一。     

Effect of the lumbar stability exercise on the height difference between shoulders and range of motion in older adults

[Purpose] The purpose of this study was to investigate the effect of the lumbar stability exercise on the range of motion (ROM) and height difference of the shoulder and to provide basic data to prevent musculoskeletal disorders for improvement of the quality of life of older adults. [Participants and Methods] Twenty older adults without musculoskeletal problems were divided into the lumbar stability exercise group and the passive upper arm exercise group and performed exercise for 30 minutes, 3 times a week for 5 weeks. The shoulder flexion, abduction, extension, and height difference between shoulders were measured. A paired t-test was applied for comparative analysis of data before and after exercise in both groups. [Results] In the lumbar stability exercise group, the shoulder flexion, abduction and height difference were significantly different. In the passive upper arm exercise group, the abduction was significantly different. [Conclusion] Since it was proved that the height difference and range of motion of shoulder are improved when the lumbar stability exercise is indirectly carried out without directly doing shoulder exercise, it is suggested that the lumbar stability exercise is strongly recommended for clinical uses to improve functions in older adults.