提高创伤性截瘫患者功能重建的康复护理管理对策

目的探讨促进创伤性截瘫患者功能重建的康复护理管理对策。方法将16例创伤性截瘫患者随机分为两组,实验组采取全面有效的护理管理,对照组实施常规护理管理。结果实验组日常生活活动能力(ADL)提高,差异具有统计学意义(P<0.05)。结论有效的护理管理能促进创伤性截瘫患者功能重建。     

中西医结合康复治疗外伤性截瘫

近年来我们采用中西医结合方法,对21例患者进行综合康复治疗,取得了满意效果,现报告如下。1 资料与方法本组21例,男16例,女5例,年龄16～75岁;其中25～45岁16例,平均年龄36岁。颈髓损伤4例,胸腰髓损伤17例,全瘫4例。21例患者中,治疗前截瘫指数为2的3例,截瘫指数为3的2例,截瘫指数为4的6例,截瘫指数为5的6例,截瘫指数为6的4例。手术治疗13例(61.9％),平均住院62 d。方法：首先借助各种辅助手段对其病情进行准确的评估：对具有绝对手术指征的患者,争取尽早采取手术治疗,手术采用短节段椎弓根螺丝钉内固定,后路减压。以便及…     

应用肋间神经转位到马尾神经及术后康复治疗外伤性截瘫致大小便功能障碍 1例报告

外伤性截瘫后出现大小便功能障碍,目前在治疗上仍很困难,最近我院骨科应用肋间神经转 位到马尾神经中,与S4～5神经根进行束膜显微吻合术,配合脊柱的内固定和术后康复训练, 患者能早期翻身活动,并在3个月左右出现便意,大小便能基本自控的疗效,现报告1例。1 病历摘要男性,35岁,未婚,外伤性截瘫伴大小便功能障碍43d,双下肢及会限部感觉运动消失,大 小便失禁,肛门指检无收缩,X线片检查：T12椎旧性骨折伴Ⅲ度滑脱,脊髓横断,MRI检查 胸椎为严重型爆裂性骨折,T12椎管呈一线状,说明脊柱完全横断,肌电图检查：肌电波消 失。手…     

循证护理在提高战创伤截瘫患者功能重建中的应用

战创伤截瘫系指战创伤引起的截瘫,绝大多数由脊柱骨折、脱位所致。截瘫后患者发生一系列生理改变,容易引起多系统并发症,受到死亡的威胁,严重影响患者的生存质量。我康复中心对2007-01—2009-12收治的16例战创伤截瘫患者,采用循证护理,康复效果明显,现报告如下。1资料2007-01—2009-12在我院康复科住院治疗的战创伤截瘫患者16例,随机分为实验组(8例)和对照组(8例),其中     

外伤性截瘫病人的功能锻炼

指导和帮助外伤截瘫病人进行功能锻炼是一项重要的护理工作。我们对20例外伤性完全截瘫病人，坚持进行训练，最长者14个月，最短者10个月，平均一年，收到良好效果，现总结报告如下。     

外伤性截瘫的家庭康复治疗

目的：杰流外伤性截瘫的康复治疗经验。方法：介绍本院建立家庭康复小组指导外伤性截瘫患中后期康复治疗经验。结果：病人治疗疾病信心增强．截瘫指数均有下降,膀胱功能明显恢复．无尿路感染．26例Ⅰ°褥疮经皮驻康复疗法痊愈。结论：外伤性截瘫家庭康复经济、方便、有效、是其治疗的重要组成部分。     

不完全性截瘫兔不同组织β-内啡肽的动态变化

目的 :探讨 β 内啡肽 (β EP)在不完全性截瘫兔不同组织中的变化及在损伤修复中的意义。方法 :测定不完全性截瘫兔 6 h、7d和 15 d血浆、脊髓、下丘脑、垂体中β EP含量的动态变化。结果 :6 h、7d和 15 d截瘫组各组织β EP均高于对照组 (P均 <0 .0 1) ,且β EP升高随时间呈下降趋势 ,以垂体下降最快 ,其次是脊髓 ,下丘脑、血浆下降缓慢。损伤早期 (6 h) ,下丘脑与垂体β EP的分泌功能呈直线负相关 ,垂体与脊髓β EP呈直线正相关 ,下丘脑与血浆中 β EP呈直线正相关。截瘫恢复期 (15 d) ,垂体、脊髓 β EP含量显著下降 ,血浆、下丘脑 β EP下降缓慢并呈直线正相关。结论 :垂体是脊髓损伤中 β EP分泌最灵敏的组织 ,由于垂体β EP升高 ,导致脊髓的 β EP升高 ,参与脊髓损伤的继发过程 ;外伤早期一系列心血管功能异常可能与外伤刺激引起下丘脑分泌 β EP致血浆含量升高有关。     

番泻叶治疗截瘫病人便秘的临床研究

目的 探讨番泻叶治疗截瘫病人便秘的最佳剂量及饮水量。方法 对不同溶媒和不同剂量的番泻叶进行了预试验、药检试验和临床试验。结果 果导与不同剂量（2g、4g、6g）番泻叶对截瘫病人排便效果比较,差异有非常显著意义P＜0．01;不同剂量番泻叶的应用病人的药物反应不同,6g番泻叶临床药物反应显著。结论4g番泻叶溶于400ml溶媒,用开水浸泡15min为治疗截瘫病人便秘的最佳剂量及饮水量。     

冷冻肋间神经预防胸部手术后疼痛的临床观察研究

目的 探讨肋间神经冷冻术预防开胸术后疼痛的效果及并发症的发生.方法 随机选取行开胸术的患者578例为冷冻组(A组),并随机选取同期行开胸手术的患者137例为对照组(B组).观察各组患者术后疼痛及止痛药的使用情况,并观察其并发症的发生情况.结果 A组止痛有效率与B组相比差异有统计学意义(P＜0.05);且并发症发生率差异亦有统计学意义(P＜0.05).结论 肋间神经冷冻能有效预防开胸术后剧烈疼痛,减少并发症,值得推广.     

协同护理在外伤性截瘫患者恢复膀胱功能中的作用

目的探讨协同护理对外伤性截瘫患者膀胱功能恢复的影响。方法将66例外伤性完全截瘫患者随机分为治疗组和对照组，每组33例。两组均接受相同的膀胱功能强化训练，但治疗组更强调协同护理，然后对两组进行治疗后的指标评定。结果治疗组膀胱功能恢复及尿路感染的发生率明显低于对照组（P〈0．05），留置尿管的时间比对照组明显缩短（P〈0．01）。结论协同护理体现了护士、患者和家属为一护理集体的协商作用，对外伤性截瘫患者膀胱功能恢复效果显著。     

外伤性截瘫病人家庭康复护理指导

通过对３５２例外伤性截瘫病人的护理，认为此类病人出院前应做好以下几方面的家庭康复护理准备：（１）加强心理护理，充分调动病人及家属的积极性，使其树立信心；（２）进行排尿机能和规律性排便训练；（３）指导功能锻炼；（４）制订家庭康复计划。     

Spectral Analysis of Ultrasound Radiofrequency Backscatter for the Detection of Intercostal Blood Vessels

Spectral analysis of ultrasound radiofrequency backscatter has the potential to identify intercostal blood vessels during ultrasound-guided placement of paravertebral nerve blocks and intercostal nerve blocks. Autoregressive models were used for spectral estimation, and bandwidth, autoregressive order and region-of-interest size were evaluated. Eight spectral parameters were calculated and used to create random forests. An autoregressive order of 10, bandwidth of 6?dB and region-of-interest size of 1.0?mm resulted in the minimum out-of-bag error. An additional random forest, using these chosen values, was created from 70% of the data and evaluated independently from the remaining 30% of data. The random forest achieved a predictive accuracy of 92% and Youden's index of 0.85. These results suggest that spectral analysis of ultrasound radiofrequency backscatter has the potential to identify intercostal blood vessels. (jokling@siue.edu) © 2018 World Federation for Ultrasound in Medicine and Biology     

不同家庭及社会支持对截瘫病人康复的影响

为探讨不同家庭及社会支持对截瘫病人康复的影响,对50例出院截瘫病人进行为期2a的随访。结果显示：家庭经济状况好,照顾者文化程度高,家庭、社会支持程度高的病人,肢体功能恢复情况、自理能力明显高于对照组,并发症发生率明显低于对照组。说明家庭、社会支持在截瘫病人康复中的必要性和重要性。     

n-HA/PA66复合生物活性人工椎体支撑植骨治疗胸腰椎爆裂型骨折合并截瘫

目的:探讨用前路椎管减压、自行研制的纳米羟基磷灰石/聚酰胺66(n-HA/PA66)复合生物活性人工椎体支撑植骨治疗胸腰椎爆裂型骨折合并截瘫的临床疗效。方法:2003年12月—2006年1月收治胸腰椎爆裂型骨折合并截瘫40例,年龄17～62岁。受伤部位:T_(12)5例、L_1 16例、L_2 13例、L_3 6例。神经损害按Frankel分级:A级7例、B级19例、C级8例、D级6例。所有病例均行前路椎管减压、n-HA/PA66复合生物活性人工椎体支撑植骨、钛钉板或钉棒系统内固定。结果:所有病例术后均获得6～25个月(平均13个月)的随访。神经功能:除5例Franel A级和2例D级无变化外,其余均有1～2级的改善。其中由A级到B级2例;B级到C级7例,B级到D级12例;C级到D级5例,C级到E级3例;D级到E级4例。36例伤椎接近解剖复位,6例复位良好。术前伤椎前缘高度平均为椎体的42.8%,术后平均为90.5%,重建的椎体高度无丢失。矢状面Cobb角术前平均为28.4°,术后平均为14.6°。n-HA/PA66复合生物活性人工椎体于术后3～6个月骨性融合。无感染、无椎体移位和断钉等并发症。结论:前路n-HA/PA66复合生物活性人工椎体支撑植骨能有效恢复和维持伤椎的结构和高度,可避免取自体髂骨植骨,是一种有效的脊柱前路重建方法。     

截瘫病人反射性膀胱功能的康复训练

截瘫病人由于脊髓损伤 ,排尿功能失去大脑控制 ,使排尿功能紊乱或丧失 ,加之长期卧床 ,易引起泌尿系感染。为了使截瘫病人提高生活质量 ,早期进行膀胱功能训练 ,是截瘫病人康复的一个重要问题 ,是提高疗效的关键。1　临床资料本组 2 6例 ,男 16例 ,女 10例 ,年龄 17岁～ 5 5岁     

Kinematic and Electromyographic Analysis of Wheelchair Propulsion on Ramps of Different Slopes for Young Men With Paraplegia

Chow JW, Millikan TA, Carlton LG, Chae W, Lim Y, Morse MI. Kinematic and electromyographic analysis of wheelchair propulsion on ramps of different slopes for young men with paraplegia.

Objective

To gain insight into the biomechanics of upslope wheelchair stroking by examining the changes in kinematic and electromyographic characteristics of wheelchair propulsion over ramps of different slopes.

Design

Repeated-measures design. Each subject pushed up a wooden ramp (7.3m long) 3 times at self-selected normal and fast speeds for each of these slopes: 0°, 2°, 4°, 6°, 8°, 10°, and 12°.

Setting

A biomechanics laboratory.

Participants

Young men (N=10) with paraplegia.

Interventions

Not applicable.

Main Outcome Measures

Electromyographic activity of extensor carpi radialis, triceps brachii, antero-middle and postero-middle deltoids, pectoralis major, and latissimus dorsi, and stroking kinematics.

Results

Forward lean of the trunk increased as the slope increased. The triceps brachii, antero-middle deltoid, and pectoralis major were more active during the push phase, while the postero-middle deltoid was more active during the recovery phase. Both extensor carpi radialis and latissimus dorsi were active throughout a stroke. Major adjustments in stroking kinematics and significant increases in muscle activity occurred at slopes between 4° and 10°.

Conclusion

In addition to a decrease in stroking speed, the stroking pattern becomes more compact (decreased push angle and relative recovery time, increased stroke frequency) and the trunk becomes more active with increasing slope.     

Functional Assessment of Lower Extremities in Hereditary Spastic Paraplegia

Braschinsky M, Parts K, Maamägi H, Gross-Paju K, Haldre S. Functional assessment of lower extremities in hereditary spastic paraplegia.

Objectives

To characterize the spasticity and range of motion (ROM) in patients with hereditary spastic paraplegia (HSP) and to correlate these parameters with walking speed.

Design

An observational population-based cohort study.

Setting

Patient data were acquired from a population-based epidemiologic study performed earlier in Estonia.

Participants

Persons (N=46) (mean age, 50.1y) with clinically confirmed HSP diagnosis (mean duration, 20.9y) participated in the study.

Interventions

Active and passive ROMs were measured with a plastic 360° goniometer. Spasticity was evaluated by using the modified Ashworth scale (MAS). The time it took a patient to walk 10m was recorded.

Main Outcome Measures

Measurements included testing of active and passive ROM as a marker for mobility, the MAS for spasticity, and time to complete a 10-m walk.

Results

A higher degree of spasticity in hip muscles was associated with lower values of active ROM and slower walking. Walking speed was negatively correlated to disease duration and participant age.

Conclusions

The present study provides analysis of the contributions of spasticity and ROM to walking speed in HSP, both factors negatively influence gait in persons with HSP.