前交叉韧带手术后立即使用肌内效贴布

正本研究评估前交叉韧带手术后肌内效贴布的疗效。68名前交叉韧带损伤的患者被随机分配到2组,接受同样的物理治疗,实验组在术后使用肌内效贴布,对照组不使用。使用疼痛视觉模拟量表和Lysholm-Tegner量表,测量髌骨中部周长和膝关节活动度来评估患者。在术后第一二周实验组疼痛改善的效果比对照组好,二周后无明显差异。在其他三项指标中,实验组和对照组无明     

适应膝关节肌力变化：是重建前交叉韧带后康复治疗的基本原则

背景：前交叉韧带重建后早期如何干预以减少肌力下降和切取腘绳肌腱后对屈膝肌电-机械延迟的影响是一个值得研究的方向。目的：采用文献分析法重点对前交叉韧带重建后膝关节肌力的变化及康复的进展进行了综述分析。方法：以＂Anterior Cruciate Ligament;hamstring;Muscle Strength＂和＂前交叉韧带;肌力;腘绳肌;电-机械延迟＂为中英文检索词,计算机检索2000年1月至2014年1月PubMed数据库及万方医学网相关文献。选择与前交叉韧带重建后肌力的改变、评价方法及重建后肌力康复相关的文献。最终纳入34篇文献进行探讨。结果与结论：研究表明：切取腘绳肌腱会导致术后的屈膝肌力和胫骨内旋肌力的降低,从而影响膝关节的稳定性和功能活动水平。综合临床和等速肌力测试的结果,可以对前交叉韧带重建后的疗效进行综合评定,H/Q比率（屈/伸比）的改变能够用于指导前交叉韧带损伤后的康复。前交叉韧带重建后移植物塑形过程比其他动物实验研究更长,肌腱松弛度是影响电机械延迟的重要因素之一。在基本康复训练原则的基础上根据个体功能水平及时做出相应的调整,充分体现个性化训练。国内外研究均表明前交叉韧带重建肌力康复始于重建手术之前,以尽早开始肌肉收缩的再训练从而最大程度地防止肌肉萎缩。存在的问题主要集中在康复手段的更细化和科学化以及早期康复训练的＂度＂的把握上。     

肌内效贴对女性大学生膝关节肌力的影响

目的探讨肌内效贴扎对青年女性膝关节肌力的影响。方法 20名健康女大学生,用等速测试仪,以60°/s角速度,测量无贴扎、肌内效贴扎、安慰贴扎3种状态下的膝关节屈伸向心性收缩及离心性收缩相对峰力矩;用表面肌电图测试股内侧肌、股直肌、股外侧肌的肌电振幅均方根值(RMS)。结果向心性收缩时,肌内效贴扎时伸肌相对峰力矩明显高于无贴扎、安慰贴扎时(P0.01),屈肌相对峰力矩3种状态下无显著性差异(P0.05);股内侧肌在肌内效贴扎时RMS标化值明显低于未贴扎时(P0.01);股外侧肌肌内效贴扎时RMS标化值明显低于未贴扎时、安慰贴扎时(P0.01);股直肌RMS标化值3种状态下无显著性差异(P0.05)。离心性收缩时,肌内效贴扎时伸肌、屈肌相对峰力矩均明显高于无贴扎、安慰贴扎时(P0.01);股内侧肌、股外侧肌在肌内效贴扎时RMS标化值低于未贴扎时(P0.01);股直肌RMS标化值3种状态下无显著性差异(P0.05)。结论肌内效贴扎可以提高股四头肌向心性、离心性收缩肌力,增加腘绳肌离心性收缩肌力,提高股内侧肌及股外侧肌的肌纤维募集能力。     

肌内效贴对膝骨关节炎治疗效果的Meta分析

目的评价肌内效贴对膝骨关节炎(KOA)的治疗效果。方法检索Cochrane Library、PubMed、CNKI、Web of Science和PEDro中关于肌内效贴对KOA治疗的临床随机对照试验,检索时限截止2018年11月。由2名研究者按照纳入标准和排除标准独立文献筛选、提取数据、质量评价,采用RevMan5.3进行Meta分析。结果共纳6个研究。干预组与对照组相比视觉模拟评分有显著性差异(WMD=-1.28, 95%CI-2.36~-0.20, P=0.02),而对西安大略及麦克马斯特大学骨关节炎指数评分、关节活动度以及股四头肌、腘绳肌肌力的改善无显著性差异(P 0.05),其余临床结局采用描述性分析。结论肌内效贴对KOA的治疗效果尚不确定。     

肌内效贴在运动损伤康复及预防中的作用

本文探讨肌内效贴的临床效果和作用机制,特别是肌内效贴在运动损伤预防和康复中的应用。肌内效贴对疼痛、肿胀、关节活动度和肌肉力量有多方面的影响。     

关节镜下前交叉韧带重建术后不同冰敷方式 应用的效果观察

目的探究不同冰敷方式应用于关节镜下前交叉韧带重建术后的效果。方法选取2019年10月至2020年10月南通市第三人民医院收治的关节镜下前交叉韧带重建术后患者108例，按随机数表法分为两组，各54例。对照组术后创口局部给予间断冰敷，观察组给予72 h持续冰敷。比较两组患者患肢肿胀情况、疼痛程度、膝关节活动度以及舒适度。结果干预后，观察组患者患肢肿胀情况优于对照组（P＜0.05）；疼痛程度轻于对照组（P＜0.05）；膝关节活动度大于对照组（P＜0.05）；舒适度高于对照组（P＜0.05）。结论关节镜下前交叉韧带重建术后患者给予创口局部72 h持续冰敷，较间断冰敷法能够更好缓解患肢肿胀情况及疼痛程度，提高术后患者的膝关节活动度与舒适度。     

关节镜下前交叉韧带重建的术后康复

目的探讨关节镜下自体半腱肌、股薄肌肌腱双束重建前交叉韧带手术的康复治疗方法。方法前交叉韧带断裂病人46例,关节镜下重建前交叉韧带,术后给予系统康复治疗,应用等速测评指导训练,锻炼采取循序渐进的方式实施,并采用LYSHOLM评分标准进行膝关节功能评分。结果 46例中43例恢复正常的关节活动度,LANCHMAN前抽屈试验均转为阴性,LYSHOLM评分优良率为91.3%,等速肌力测试术后峰力矩较术前平均提高35%。结论恰当的术后康复治疗能安全、有效地促进前交叉韧带重建术后患肢的功能恢复。     

肌内效贴联合常规康复治疗对偏瘫患者早期手肿胀的疗效观察

目的:观察肌内效贴联合常规康复治疗对偏瘫患者早期手肿胀的疗效。方法:选取36例偏瘫患者分为对照组17例和观察组19例,2组均进行常规康复治疗,观察组在此基础上采用肌内效贴贴扎治疗,对照组在此基础上采用无张力肌内效贴贴扎治疗,贴扎疗程均为14d。分别于治疗前及治疗后7、14d评估患者手部肿胀程度(掌指关节、8字缠绕法围度差)和掌指关节活动度(ROM)受限度。结果:治疗7及14d后,2组掌指关节围度差、8字缠绕法围度差及掌指关节ROM受限度均较治疗前呈持续下降趋势(P0.05),且观察组低于对照组(P0.05)。结论:肌内效贴联合常规康复治疗能明显减轻偏瘫患者早期患手肿胀,增加掌指关节活动度,其效果优于常规康复治疗。     

前交叉韧带重建术后超早期中医介入的康复疗效观察

目的:观察膝关节前交叉韧带重建术后超早期(术后当天)中医介入的康复疗效.方法:将60例前交叉韧带重建术患者随机分为治疗组和对照组(各30例),对照组采用常规康复训练方法,治疗组在常规康复训练的基础上配合超早期中医康复方法,包括:中药冷敷方、循经点穴推拿、中药熏洗等观察两组主观疼痛感、膝关节围度、膝关节活动度、Lysholm及国际膝关节评分委员会(IKDC)评分.结果:治疗组与对照组相比较,前者膝关节疼痛程度、肿胀程度、关节活动度,以及治疗3个月Lysholm和IKDC评定均优于后者(P＜0.05).结论:前交叉韧带重建术后配合超早期中医治疗的康复方案,可以更好地减轻膝关节疼痛、肿胀度并改善膝关节活动度.     

自体腘绳肌双束与单束重建膝关节前交叉韧带

背景：前交叉韧带重建的方式是决定修复效果的关键因素。自体腘绳肌双束与单束重建膝关节前交叉韧带是临床上常用的修复方法。目的：比较自体腘绳肌双束与单束重建膝关节前交叉韧带的临床疗效。方法：回顾分析了2005-05/2009-06于中南大学湘雅二医院住院的56例急性前交叉韧带Ⅲ度损伤的患者,其中36例行单束自体腘绳肌重建术,20例行双束自体腘绳肌重建术,所有患者前交叉韧带的重建均由同一医师完成,术后随访16～42个月,评估患者的关节活动度、稳定性等指标。结果与结论：随访期间,所有患者的关节活动度均恢复正常,无伸膝受限。两种重建术后患者的Lysholm-Tegner和IKDC膝关节综合功能评定结果、KT-1000检测结果差异均无显著性意义（P〉0.05）,术后1年,取出界面螺钉时行关节镜检查,所有患者均未见明显的重建韧带松弛,说明双束与单束自体腘绳肌重建急性前交叉韧带损伤疗效相近。     

Live a legacy or live a lie: a choice

This article is about the result of a choice to Live a Legacy or Live a Lie. The choice led to the development and implementation of a clinical practice model (CPM) designed to create a healthy, healing integrated practice culture. The focus is on the foundation of the model that is a unique ongoing process called the Core Belief Review. The purpose of the review is to uncover those things that matter most for both those who give and receive care. The ongoing open communication process provides insights and truths about reality and a sense of direction related to the nature of the work necessary to create and sustain the best places to give and receive care. The results of the review feedback from 2500 providers and recipients of care are correlated to the actions taken to address the complexities of the point-of-care reality and the clinical outcomes reached as a result of collaboration and lessons learned within an International Consortium.     

Intensive care use in a developing country: a comparison between a Tunisian and a French unit

Objectives: To compare the variations in intensive care (ICU) outcome in relation to variations in resources utilization and costs between a developed and a developing country with different medical and economical conditions. Design and setting: Prospective comparison between a 26-bed French ICU and an 8-bed Tunisian ICU, both in university hospitals. Patients: Four hundred thirty and 534 consecutive admissions, respectively, in the French and Tunisian ICUs. Measurements: We prospectively recorded demographic, physiologic, and treatment information for all patients, and collected data on the two ICU structures and facilities. Costs and ICU outcome were compared in the overall population, in three groups of severity indexes and among selected diagnostic groups. Results: Tunisian patients were significantly younger, were in better health previously and were less severely ill at ICU admission (p < 0.01). French patients had a lower overall mortality rate (17.2 vs 22.5 %; p < 0.01) and received more treatment (p < 0.01). In the low severity range, the outcome and costs were similar in the two countries. In the highest severity range, Tunisian and French patients had similar mortality rates, while the former received less therapy throughout their ICU stays (p < 0.05). Conversely, in the mid-range of severity, mortality was higher among Tunisian patients, and a difference in management was identified in COPD patients. Conclusion: Although the Tunisian ICU might appear more cost-effective than the French one in the highest severity group of patients, most of this difference appeared in relation to shorter lengths of ICU stay, and a poorer efficiency and cost-effectiveness was suggested in the mid-range severity group. Differences in economical constraints may partly explain differences in ICU performances. These results indicate where resource allocation could be directed to improve the efficiency of ICU care. Received: 15 December 1997 Accepted: 8 July 1998     

Caring for a patient with a urostomy in a community setting

Around 7500 people in the UK have a urostomy. A urostomy is normally performed if a person has bladder cancer, congenital bladder abnormalities. Many people who have a urostomy have long term conditions and may require the help and support of community nurses. This article examines common complications of urostomy including stomal complications, urinary tract infections and dermal complications. Although stoma complications are common and can affect quality of life, many people with a stoma tend not to seek help. Community nurses can provide care and support to optimize stoma management and enable the person with a urostomy to enjoy the best possible quality of life.