膝关节骨关节炎患者等长、等速向心和等速离心测试的比较观察

目的 评价膝关节骨关节炎（OA）患者患侧及健侧膝伸肌和屈肌在等长、等速向心和等速离心收缩时的功能特性及相互间的关系。方法 应用Biodex System 3型等速测试系统对54例单侧膝OA患者进行患侧和健侧膝伸肌和屈肌的等长、等速向心及等速离心肌力测试。结果 膝OA患者患侧膝关节伸肌和屈肌在不同收缩模式下的肌力均较健侧显著下降（P＜0．05），特别是在低速向心和低速离心收缩状态时的降低幅度尤为显著；同时患者的膝关节屈／伸肌肌力（H／Q）比值和动态控制率均提示其患侧肢体存在肌力平衡异常。结论 在对膝OA患者肌肉功能进行评定时，应选用等速肌力测试并同时分析其H／Q比值及动态控制率，只有这样才能对患者的肌肉状况作出全面而客观的评定。     

膝关节骨性关节炎等速离心收缩肌力的研究

目的评价单侧膝关节骨性关节炎(OA)患者患侧和健侧膝关节股四头肌和腘绳肌的向心收缩和离心收缩肌力的变化,重点研究膝OA股四头肌和腘绳肌离心收缩功能的变化。方法应用BiodexSystem-3型等速测试系统对42例单侧膝关节骨性关节炎患者进行患侧和健侧的股四头肌及腘绳肌的向心和离心收缩功能测试。结果患侧和健侧股四头肌及健侧腘绳肌向心收缩时,当速度增加,峰力矩值显著减小;离心收缩时,随着角速度增加峰力矩未见下降;相同速度下,患侧和健侧股四头肌和腘绳肌离心收缩肌力明显大于向心收缩;膝OA患者存在股四头肌向心收缩和离心收缩肌力的下降(P<0.05),肌力缺失百分比>10%,以及腘绳肌低速向心肌力下降(P<0.05),肌力缺失百分比为14.33%。膝OA股四头肌的离心/向心肌力比值(E/C比值)低于腘绳肌,随运动速度增加,股四头肌的E/C比值明显增大。患侧股四头肌60°/s角速度下的E/C比值较健侧有显著增高(P<0.05)。结论膝OA患者股四头肌存在向心和离心收缩功能异常,提示膝OA患者的肌肉功能测试应增加离心测试,并注意加强膝OA患者股四头肌的离心收缩训练。     

慢性下腰痛患者腰屈伸肌的等速肌力评价

目的：通过对慢性下腰痛患者腰屈伸肌进行等速向心、离心肌力测试,定量评价患者腰屈伸肌肌力的变化,为慢性下腰痛患者腰屈伸肌肌肉功能的康复训练提供依据。方法：运用Ｃｙｂｅｘ － ６０００ 型等速测力系统分别对３０ 例慢性下腰痛患者及３０ 例正常人在慢速（３０°／ｓ） 和中速（９０°／ｓ） 条件下进行腰屈伸肌的等速向心和离心肌力测试,评价屈肌与伸肌的峰力矩／ 体重比值,以及腰屈伸肌向心与离心的峰力矩／ 体重比值。结果：两种测试速度下,患者组与正常组相比,腰屈肌向心测试和屈、伸肌离心测试的峰力矩／ 体重值降低,伸肌向心测试的峰力矩／ 体重值较正常组显著下降（ Ｐ＜ ０ ．００１） ;向心测试屈、伸肌峰力矩与体重比值显著增大（ Ｐ＜ ０ ．０１） ,离心测试屈、伸肌峰力矩与体重比值增大;屈肌向心、离心测试的峰力矩与体重的比值降低,伸肌向心、离心测试的峰力矩与体重的比值显著降低（ Ｐ＜ ０ ．０１） 。结论：慢性下腰痛患者腰屈伸肌存在屈伸肌力的下降及失衡,需针对性地进行屈伸肌肌力训练,以恢复屈伸肌对腰椎主动稳定和功能性活动的作用,避免肌源性下腰痛的反复发作和牵延难愈     

前交叉韧带重建术后患者的等速肌力训练和疗效评定

目的:研究用Biodex system 3多关节等速肌力评定及训练系统对ACL重建术后患者肌力的影响。方法:将50例行ACL重建术后的患者随机分成试验组25例(等速训练患侧肌力)和对照组25例(等张训练患侧肌力)并分别进行功能训练,在术后第12、24周进行等速向心肌力测试。结果:术后第12、24周对患者进行膝关节等速向心肌力测试,试验组膝屈、伸肌患侧峰力矩/健侧峰力矩比值明显高于对照组,差异具有显著性(P<0.05),试验组在30°时的股内侧肌患侧峰力矩/健侧峰力矩比值明显高于对照组,差异具有显著性(P<0.05)。结论:通过等速训练进行系统的康复治疗可使膝关节ACL重建术后的患者短期(6个月)达到健侧屈伸肌力水平,并能达到运动水平。     

等速离心训练对膝关节骨关节炎患者的影响

目的探讨等速离心肌力训练对膝关节骨关节炎患者的康复疗效。方法运用Cybex-6000型等速肌力测试及训练系统对40例膝关节骨关节炎患者(共70个患膝)进行为期4周、每周3次的等速离心肌力训练。分别于训练前、后测定患者在60°/s、120°/s及180°/s等速运动时的峰力矩、单次最大作功量、平均功率及力矩加速能量;并将训练前、后患膝疼痛程度及下肢功能评分进行比较。结果患者经训练后,其患膝屈、伸肌群各项功能参数均有显著改善,并以屈膝肌各项功能参数的改善尤为显著;患膝疼痛及功能性行为能力评分亦均较治疗前有显著改善。结论等速离心训练能有效改善膝关节骨关节炎患者屈、伸肌群的各项功能参数(其中以屈膝肌的改善尤为显著);同时还能缓解患者疼痛,显著提高其功能性行为能力。     

推拿结合等速肌力训练治疗膝关节骨性关节炎临床疗效研究

目的:观察推拿治疗结合等速肌力训练对膝关节骨性关节炎的治疗效果。方法:从膝关节骨性关节炎(KOA)患者中随机选取60例作为观察对象,60例患者随机分为推拿结合等速治疗组(试验组)和单纯推拿治疗组(对照组)。分别将两组治疗前后的膝关节西安大略和麦克马斯特大学骨关节炎指数(WOMAC)、等速屈伸肌力测试对比分析。结果:两组治疗后膝关节WOMAC评分均较治疗前有显著改善(P0.01),其中推拿结合等速组膝关节WOMAC评分由(62.93±16.17)降为(26.20±12.68),改善较单纯推拿组更为显著(P0.01)。两组治疗干预前等速肌力测试各指标比较没有显著性差异。经过8周治疗后推拿加等速训练组膝关节伸肌峰力矩、峰力矩/体重、达峰时间、平均功率,膝关节屈肌峰力矩、达峰时间与本组治疗前比较明显改善,差异有显著性(P0.01);膝关节伸肌平均功率与本组治疗前比较有改善,差异有显著性(P0.05);推拿加等速训练组膝关节伸肌峰力矩、峰力矩/体重、达峰时间、膝关节屈肌达峰时间、屈肌/伸肌比单纯推拿组治疗后改善明显,差异有显著性(P0.05);推拿加等速训练组膝关节屈肌峰力矩与单纯推拿组治疗后比较提高明显,差异有显著性(P0.01)。结论:推拿结合等速肌力训练可以提高KOA患者膝关节屈伸肌肉力量,对于KOA的治疗具有良好的临床疗效,且明显优于单纯推拿治疗。     

跳跃项目训练对青少年膝关节屈伸肌肉力量的影响

背景:等速测试系统作为一种评价人体肌肉功能水平的研究方法和手段,在研究中得到了越来越广泛的应用.但运用等速肌力测试研究运动训练对青少年肌群发展影响的报道很少.目的:通过等速肌力测试,对长期进行跳高、跳远系统训练的青少年和同年龄的无训练者两类人群膝关节肌肉力量及其特征进行对比分析.设计、时间及地点:对比观察实验,于2008-10/12在河北省体育科学研究所实验室进行.对象:随机抽取河北师范大学附属中学不参加训练的志愿者20名作为普通组,抽取石家庄市体校进行跳高、跳远训练的志愿者20名作为训练组,参试者均为男性.方法:采用Cybex-6000等速测试系统,按照测试要求对参试者膝关节进行测试,测试顺序为先向心后离心.测试速度为慢速60(°)/s、中速120(°)/s、快速240(°)/s.主要观察指标:膝关节屈、伸肌群的相对峰力矩.结果:纳入实验对象40名,均进入结果分析.与普通组比较,训练组两侧膝关节60,120,240(°)/s屈、伸肌向心、离心收缩时峰力矩较高,差异有显著性意义(P＜0.01),训练组左、右两膝在3个速度上的屈肌与伸肌峰力矩比值均低于普通组.结论:跳跃项目训练对青少年膝关节屈伸肌肉力量的增长有良好的促进作用,但在青少年膝关节屈伸肌力协调发展上有所不足,造成屈伸肌比值下降,这也可能是训练方法不当所造成的.     

膝关节外伤后的等速肌力测试研究

运用Ｃｙｂｅｘ－３３０型等速测力系统对４８例膝关节外伤患者的双侧膝伸肌和屈肌进行了肌力测试。结果表明两侧膝伸肌和屈肌的峰力矩值在不同运动速度（６００°／ｓ、１２０°／ｓ和１８０°／ｓ）时均有下降，两侧比较差异非常显著。不同性别间，健侧膝伸肌和屈肌峰力矩值间无显著性差异。认为等速测试配合膝关节镜检查对某些膝关节内损伤的诊断有一定的帮助。康复训练可以提高膝屈、伸肌力（尤其是膝屈肌和伸肌峰力矩比值），对保持膝关节稳定性有重要意义。     

膝关节屈伸肌等速训练对膝骨关节炎患者步行能力的影响

目的观察膝关节屈伸肌等速肌力训练对膝骨关节炎(KOA)患者步行能力的影响。方法 2016年12月至2017年6月,将本院收治的120例KOA患者随机分为空白组、对照组和观察组,各40例。三组均采用关节腔内注射玻璃酸钠与关节松动术治疗。对照组在此基础上增加常规肌力训练,包括膝关节周围肌肉等张训练和等长静蹲练习。观察组在此基础上增加膝关节等速肌力训练,训练模式为普通等速向心/向心模式。治疗前后分别测量膝关节屈伸肌峰力矩(PT)、疼痛视觉模拟量表(VAS)评分、Lysholm评分、10米步行时间及6分钟步行距离。结果治疗4周后,三组膝关节屈伸肌峰力矩、VAS评分、Lysholm评分、10米步行时间及6分钟步行距离明显改善(P0.05),且观察组优于对照组和空白组(P0.05)。结论等速肌力训练有助于改善KOA患者步行能力。     

等速向心/离心训练对膝关节峰力矩和屈/伸肌峰力矩比影响的比较

目的分别进行4周膝关节的等速向心(c)/离心(e)训练后,比较屈膝肌(H)和伸膝肌(Q)在训练前后向心/离心收缩峰力矩(Hc、He、Qc、Qe)及其比值的变化及性别差异,为膝关节肌肉康复训练运动处方的制定提供参考。方法 2014年5~6月本校无任何训练基础的28名大学生分为向心组(n=14)和离心组(n=14),分别在BIODEX等速肌力评估训练系统4上进行每周3次、共4周的右膝等速向心/离心训练。测量向心30°/s、60°/s、90°/s和离心60°/s、90°/s、120°/s训练前后峰力矩。结果向心组训练后60°/s、90°/s的Hc、He增加(P0.05),30°/s、60°/s、90°/s的Qc增加(P0.01)。离心组训练前后无显著性差异(P0.05)。向心组He/Qc在90°/s、Hc/Qc在30°/s均下降(P0.05);离心组He/Qc和Hc/Qc变化不明显(P0.05)。向心组Qc/Qe在60o/s和90o/s,Hc/He在90o/s均提高(P0.05);离心组变化不明显(P0.05)。女性Hc、He、Qc、Qe、He/Qc与男性比较有显著性差异(P0.05)。结论等速向心和离心训练4周对伸屈膝肌向心和离心收缩力效应不同;单纯的等速向心训练使膝关节的稳定性下降;Hc/He和Qc/Qe可作为评定肌肉平衡的指标;训练需考虑性别差异。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.