数据手套在手外伤患者评估中的应用初探

目的 研究制作一款可辅助康复医师及治疗师评估手外伤患者康复程度的数据手套评估系统。 方法 本研究设计并制作一款包含有13个6轴惯性传感器的数据手套,并选取10例健康受试者和3例在邵逸夫医院康复科治疗的手外伤患者进行试戴,将手套中每个传感器采集的X轴、Y轴、Z轴3个方向的加速度及角速度数据传输到电脑终端,并运用角度解算算法计算被试者各手关节活动度。为验证该数据手套是否能有效反映手外伤患者手关节活动能力,本研究同时采用传统量角器测量方法对数据手套结果进行对比。 结果 与传统量角器测量方法比较,本研究制作的数据手套评估系统能在更短时间内获得更准确、直观的健康者及手外伤患者手关节活动度数据,降低了康复医师及治疗师评估手外伤患者康复情况的难度。 结论 本研究制作的数据手套评估系统能有效辅助康复医师及治疗师对手外伤患者恢复情况进行评估。     

手肌腱吻合术后的康复

手肌腱断裂吻合术后常因皮肤瘢痕及肌腱粘连导致手功能障碍 ,Ⅱ期手术松解效果欠满意。我科1996年 3月至 2 0 0 1年 12月 ,对手肌腱吻合术后的患者进行程序化的康复训练 ,取得良好的效果。1　资料与方法1.1　一般资料　手肌腱吻合术后患者 76例 ,男 5 1例 ,女 2 5例 ;年龄 14～ 4 9岁 ,平均 2 5岁。致伤类型为压轧伤、切割伤和炸裂伤 ,共 16 8指 187条肌腱 ,其中屈指肌腱断裂 15 4条 ,伸指肌腱 33条 ,屈伸肌腱均有断裂 19指 ;所有断裂肌腱均为Ⅰ期吻合手术。按就诊时单双数随机分为观察组与对照组各 38例。1.2　方法　①观察组 :术后 2 4～ …     

持续被动运动在膝关节置换术后早期康复治疗中的作用

目的评价持续被动运动(CPM)在膝关节置换术后早期康复治疗中对疼痛和膝关节主动屈伸活动度的作用。方法 20例(40膝)女性重度骨性关节炎患者行双膝关节同时置换术。分为实验组和对照组,每组10例20膝。实验组术后每天2次行CPM和主动康复治疗,对照组每天2次主动康复治疗。术前、术后2周和3个月应用疼痛视觉模拟评分(VAS)和角度测量仪评估两组患者的疼痛和膝关节主动屈伸活动度。结果术后2周和3个月,两组患者的疼痛评分和膝关节活动度均无显著性差异(P>0.05)。与术前相比,疼痛评分和膝关节主动屈伸活动度在术后3个月均有明显改善(P<0.01)。结论进行主动康复治疗后,CPM的辅助应用对膝关节置换术后3个月内疼痛和关节活动度的改善无明显促进作用。     

手臂稳定度在手外伤功能评估与康复治疗中的应用

本组共150例，其中男性108例．女性42例，年龄7～67岁．其中16～45岁134例，占89％。受伤类型：压扎伤62例，切割伤31例，撕裂伤20例．烧灼伤16例，其它21例。实施手术：断指再植11例．皮瓣穆植25例，肌腱移植7例，清创缝合107例。     

持续被动运动机在膝关节镜术后康复中的应用

[目的]探讨持续被动运动(CPM)机在膝关节镜术后康复中的应用。[方法]对38例膝关节镜术后病人应用CPM机行早期功能锻炼,2周～3周后进行膝关节活动度及功能评估。[结果]膝关节活动度优32例,良5例,差1例;1例住院活动度较差病人术后1个月随访膝关节活动度也达到85°;38例病人术后出院随访均无关节功能障碍出现,未发生下肢静脉血栓形成、关节肿胀、疼痛。[结论]在膝关节镜术后应用CPM机进行关节早期康复锻炼能改善膝关节活动度及功能。     

Valpar 4 系统在手外伤康复中的应用研究

目的评价Valpar 4 系统在手外伤康复中的作用。方法将40 例手外伤患者,随机分为对照组和观察组各20 例。对照组进行常规康复治疗,观察组在此基础上,采用Valpar 4 系统进行技能模拟训练,两组患者分别在治疗前,治疗2 周、4 周后进行手关节总主动活动度(TAM)、上肢功能评定表(DASH)和Carroll 手功能评定(UEFT)。结果治疗2 周后,对照组TAM较治疗前显著改善(P<0.001),观察组TAM、DASH、UEFT均较治疗前显著改善(P<0.001),且DASH、UEFT疗效显著优于对照组(P<0.001)。治疗4 周后,对照组TAM、UEFT较治疗前显著改善(P<0.001),观察组TAM、DASH、UEFT均显著改善(P<0.001),且疗效均优于对照组(P<0.05)。结论Valpar 4 系统能改善手外伤患者手指关节活动度、手功能及上肢功能,尤以上肢从事日常活动的能力改善更为显著。     

早期康复对手外伤手部功能恢复的影响

目的：观察早期系统康复对手功能的影响。方法：对33例手外伤手术后的患者术后第2天行早期康复治疗：与术后3—5个月始行康复治疗的19例手外伤患者的治疗效果进行比较。结果：早期组拇指及其他各指功能、握力、FIM评分均优于恢复期组（P〈0．01或P〈0．05），对指功能的恢复两组比较，早期组明显优于恢复期组。结论：手外伤后及时手术处理是保证手功能恢复的前提，物理因子、运动疗法、作业疗法、康复工程的早期介入能较好的改善活动度，促进手功能的恢复。     

腕部屈肌腱损伤修复术后的康复治疗

目的:探讨腕部屈肌腱损伤修复术后康复治疗的介入时机及有效方法。方法:11例腕部屈肌腱损伤修复术患者列入本研究。治疗组9例,康复介入时间为3—6周,损伤累及39指、64条屈指肌腱及14条屈腕与掌长肌腱;对照组2例,康复介入时间超过术后6周,分别为术后10周和12周,损伤累及10指、17条屈指肌腱及2条屈腕与掌长肌腱。所有病例均接受每日1次,每周5次的以肌腱损伤康复为主的康复治疗。治疗次数:治疗组20—50次,平均33±7.62次;对照组分别为30次和60次,平均45次。于治疗开始前、结束的次日,分别对患者屈肌腱受伤的手指及健手的相应手指进行主动关节活动度的测量。结果:治疗组伤指的优良率由治疗前的5.13%提高至89.79%,而对照组治疗前、后的伤指优良率没发生变化,仅为60%;经治疗两组伤指的TAM百分率均明显提高,但治疗组的提高幅度明显大于对照组,两者比较差异呈显著性意义(P<0.001)。结论:腕部屈肌腱损伤修复术后的患者,尽管康复介入的时间已超过术后3周,但经特定的康复治疗程序后仍可获得很好的功能恢复。     

手臂稳定度在手外伤功能评估与康复治疗中的应用

１临床资料本组共１５０例，其中男性１０８例，女性４２例，年龄７～６７岁，其中１６～４５岁１３４例，占８９％。受伤类型：压扎伤６２例，切割伤３１例，撕裂伤２０例，烧灼伤１６例，其它２１例。实施手术：断指再植１１例，皮瓣移植２５例，肌腱移植７例，清创缝合...     

高屈曲度膝关节假体置换后改良与常规康复方法的效果比较

背景:应用高屈曲度膝关节假体置换后患者获得更好关节活动度不仅仅取决于手术,而与置换前关节的活动度、置换后康复锻炼等因素密切相关.目的:探讨分析改良锻炼方法在高屈曲度膝关节假体置换后临床应用的效果,并与常规功能锻炼进行比较.方法:将90例行高屈曲度膝关节假体置换的患者随机分为观察组和对照组.对照组膝关节假体置换后进行常规功能锻炼;观察组膝关节假体置换后使用镇痛药和肌松药,并按膝踝屈伸、并膝下蹲及屈膝锻炼等方法循序渐进进行改良功能锻炼.采用膝关节功能HSS评分及膝关节活动度评价膝关节功能及手术效果.结果与结论:高屈曲度膝关节假体置换后膝关节功能评分及关节活动度都有明显改善,观察组置换后不同时间点膝关节功能评分及膝关节活动度均明显优于对照组(P均<0.001).结果说明膝关节置换后应尽早进行功能锻炼,而改良锻炼法对于提高高屈曲度膝关节假体置换后关节活动度和关节功能具有较好的促进作用.     

多因素综合康复治疗对肩关节周围炎的影响

目的探讨电刺激和关节松动术等综合康复疗法对肩关节周围炎的影响.方法63例肩关节周围炎患者,分为治疗组(32例)和对照组(31例);治疗组应用两种不同参数的电刺激作用于肩关节周围的肌肉;两组均给予关节松动术治疗.结果治疗组疗效优于对照组.u=2.49（P<0.05）,差异显著。论多种疗法的综合康复治疗对肩关节周围炎的疗效较好。     

改良股四头肌成形术并早期康复训练治疗膝关节强直

Arthroclisisofkneeisusuallysecondarytoinjuryofkneejointandsurroundingtissuefollowingfixationatstraightenpositionforalongtime，whichseriouslyaffectspatients＇dailylifeandactivi－ties．Quadricepsplastywasconductedtolooseadhesioncompletely，earlyfunctionalexercisewasadministeredformildtomoderatepatientswithoutopportunityofconservativetherapy．FromAugust１９９６toApril２００２，２１patientswithankylosisofkneereceivedmodifiedquadricepsplastywithupperandlowerfractionalpatellarincisionandabove６－mon…     

断指再植手术中定时更换外科手套的效果研究

目的探讨断指再植手术中每2.5h更换外科手套的效果,为临床护理提供依据。方法选择2014年4-12月我院收治的断指再植手术110例患者,随机分为对照组58例,观察组52例,其中,观察组采取每2.5h更换手套的干预措施,比较两组手术中手套破损情况。结果对照组55%的手术出现手套破损,观察组26.9%的手术出现手套破损,差异有统计学意义(P0.05);观察组手套破损率为3%,对照组手套破损率为10%,差异有统计学意义(P0.05)。结论断指再植手术中每2.5h更换外科手套能明显降低手术中手套破损。     

剖宫产术中更换无菌手套预防产后切口感染的探讨

目的探讨剖宫产手术术中更换无菌手套对术后切口感染的影响,分析剖宫产手术中更换无菌手套对预防产后切口感染的有效性。方法对2008年7～10月的120例剖宫产手术过程进行细菌学跟踪检测,寻找引起感染的因素。按照手术月份将120例分为对照组和实验组,对照组采取传统的方式,实验组在术中处理完宫腔后术者更换无菌手套,将监测结果进行对照分析。结果实验组患者术后的感染率明显低于对照组（P〈0．05）。结论剖宫产手术术中更换无菌手套能有效预防产后切口的感染。     

Effects of early rehabilitation in improvement of paediatric burnt hands function

BACKGROUNDHands are one of the most common burn sites in children. Hypertrophic scar contractures in hands after wound healing result in further reductions in their range of motion (ROM), motility, and fine motor activities. Rehabilitation can improve the function of hands. But the optimal time of rehabilitation intervention is still unclear. Therefore, this study was designed to investigate the effects of early rehabilitation management of paediatric burnt hands and to compare the efficacy between early and later rehabilitation intervention.AIMTo investigate the effects of early rehabilitation management of paediatric burnt hands. METHODSA total of 52 children with burnt hands were allocated into the early intervention group (≤ 1 mo from onset) and a late intervention group (> 1 mo from onset) between January 2016 and December 2017. The children received the same rehabilitation programme including skin care, scar massage, passive ROM exercises, active ROM exercises, compression therapy, orthotic devices wearing and game or music therapy. Rehabilitation assessments were performed before and after the rehabilitation treatment.RESULTSIn the early intervention group, the ROM of the hands was significantly improved after rehabilitation (P = 0.001). But in the late group the effect was not significant statistically (P = 0.142). In the early group, 38.5% of the patients showed significant improvement, while in the late group, 69.2% of the patients showed no significant improvement. The time from onset to posttraumatic rehabilitation (P = 0.0007) and length of hospital stay (P = 0.003) were negatively correlated with the hand function improvement. The length of rehabilitation stay was positively correlated with the hand function improvement (P = 0.005). CONCLUSIONThese findings suggest that early rehabilitation might show better results in terms of ROM.     

Biomechanical performance of powder-free examination gloves

Biomechanical performance studies were undertaken for powder-free, latex and nitrile examination gloves. Using standardized tests, examination glove performance was judged by measuring glove thickness, glove puncture force, glove tape adhesion force, glove donning force, glove stiffness, and immediate unrecovered stretch. Even though the nitrile examination gloves were thinner than the latex examination gloves, they exhibited a greater puncture resistance. In addition, tape adherence to the N-Dex nitrile glove was the lowest. Moreover, measurements of the handling characteristics of the nitrile examination gloves demonstrated that they are an acceptable alternative to latex examination gloves. While these biomechanical studies demonstrate the superiority of the nitrile examination gloves, clinical glove evaluation is still needed to determine their performance in the health care setting.     

Validity of eyeball estimation for range of motion during the cervical flexion rotation test compared to an ultrasound-based movement analysis system

Headache is a common and costly health problem. Although pathogenesis of headache is heterogeneous, one reported contributing factor is dysfunction of the upper cervical spine. The flexion rotation test (FRT) is a commonly used diagnostic test to detect upper cervical movement impairment. The aim of this cross-sectional study was to investigate concurrent validity of detecting high cervical ROM impairment during the FRT by comparing measurements established by an ultrasound-based system (gold standard) with eyeball estimation. Secondary aim was to investigate intra-rater reliability of FRT ROM eyeball estimation. The examiner (6 years experience) was blinded to the data from the ultrasound-based device and to the symptoms of the patients. FRT test result (positive or negative) was based on visual estimation of range of rotation less than 34° to either side. Concurrently, range of rotation was evaluated using the ultrasound-based device. A total of 43 subjects with headache (79% female), mean age of 35.05 years (SD 13.26) were included. According to the International Headache Society Classification 23 subjects had migraine, 4 tension type headache, and 16 multiple headache forms. Sensitivity and specificity were 0.96 and 0.89 for combined rotation, indicating good concurrent reliability. The area under the ROC curve was 0.95 (95% CI 0.91–0.98) for rotation to both sides. Intra-rater reliability for eyeball estimation was excellent with Fleiss Kappa 0.79 for right rotation and left rotation. The results of this study indicate that the FRT is a valid and reliable test to detect impairment of upper cervical ROM in patients with headache.     

持续被动活动在全膝关节成形术后康复中的应用研究

从持续被动活动(CPM)在全膝关节成形术(TKA)后早期功能锻炼中的作用、应用效果及方案的制定方面,对CPM在TKA术后中应用现状进行综述。     

早期持续被动运动对膝骨折术后关节活动范围的影响

目的 :探讨早期持续被动运动 (continuouspassivemotion ,CPM)训练对膝骨折术后关节活动范围的影响。方法 :4 7例膝关节骨折患者分为G0、G1、G2和G3组 ,在完成常规物理治疗后 ,G1、G2和G3组分别在术后第 1、2和 3周时开始CPM训练 ,共 4周。结果 :治疗第 6周时测量 4组患膝关节活动范围 ,平均值分别为 (6 4± 5 )°、(89± 7)°、(78± 4 )°、(71± 3)°。组间比较差异有显著性。结论 :膝关节骨折术后早期CPM训练能更快促进膝功能康复。     

自制约束手套在神经外科躁动患者中的应用

目的探讨自制约束手套在神经外科躁动患者中的应用效果。方法将60例躁动患者随机分为实验组和对照组,每组各30例。对照组采用传统约束工具对患者进行约束护理,实验组采用自制约束手套对患者进行约束护理,比较两组患者约束过程并发症的发生率。结果两组患者总并发症发生率比较,均P<0.01,差异具有统计学意义,实验组总并发症发生率低于对照组。结论自制约束手套可明显减少躁动患者皮肤破损和意外拔管的发生率,保证了患者的安全,提高了护理质量和患者满意度。