The effects of medical treatment and rehabilitation in a patient with adult tethered cord syndrome in the late postoperative period.

BACKGROUND: The possibility of functional tethered cord syndrome (TCS) should be considered when adolescent patients present with unexplained lumbar, buttock, and leg symptoms. Symptoms progress if untreated. Success depends on early diagnosis, the complete untethering of the spinal cord, and rehabilitation. A rare case of adult TCS is reported. CASE REPORT: A 42-year-old female patient with lower back and leg pain, severe flexor reflex responses, and a walking disorder was evaluated. Gabapentin and tizanidine were given to treat the neuropathic pain and flexor reflex responses. An exercise program was applied to improve the walking disorder. Finally, the patient's complaints of pain considerably decreased, flexor reflex responses were reduced, and a more comfortable walking motion was observed. CONCLUSIONS: A rehabilitative approach is very important and a multidisciplinary follow-up and treatment procedure is required in the clinical healing process of all patients presenting with a tethered cord condition, whether surgical intervention is carried out or not.     

Relationship between static posture and rearfoot motion during walking in patellofemoral pain syndrome: effect of a reference posture for gait analysis

The reference posture used in angular motion calculations may play an important role in the relationship found between static posture and rearfoot motion in the frontal plane in a clinical population such as patients with patellofemoral pain syndrome. This study examined the relationship between rearfoot inversion and eversion during the stance phase of walking and the static relaxed standing measurement in women (aged 18 years and older) with patellofemoral pain syndrome and controls and examined the influence of the reference posture used when calculating dynamic motion. Two reference postures were investigated: vertical alignment between the rearfoot and the lower leg and relaxed calcaneal standing. When using the latter reference posture, a significant correlation was found between the static relaxed standing measurement and peak eversion in controls only. When using the vertical alignment reference posture, significant correlation was found only in the patellofemoral pain syndrome group for peak eversion and inversion. The positive relationship found in the patellofemoral pain syndrome group between dynamic angular measures, based on a neutral reference posture, and static relaxed standing indicated that for subjects with patellofemoral pain syndrome, the clinical rearfoot measurement of relaxed standing can be used to explain the pattern of rearfoot motion during walking.     

七叶皂苷钠搽剂配合运动疗法治疗膝骨性关节炎的临床观察

目的 探讨七叶皂苷钠搽剂配合运动疗法治疗膝骨性关节炎的临床疗效.方法选择2011年3月-2013年3月于该院收治的膝骨性关节炎患者100例,随机分为治疗组与对照组,治疗组50例,对照組50例.治疗组用七叶皂苷钠搽剂配合运动疗法,对照组用扶他林乳膏剂治疗,4周为1疗程,治疗2个疗程后,对患者疼痛、行走能力;疼痛、上下楼能力;屈曲、挛缩程度;肿胀等进行评价.结果治疗组对患者疼痛、行走能力;疼痛、上下楼能力;屈曲、挛缩程度;肿胀改善率明显优于对照组（P〈0.05）.结论七叶皂苷钠搽剂配合运动治疗膝骨性关节炎在改善患者疼痛、压痛和功能障碍及临床疗效上比效果好.     

走过心绞痛患者的临床表现与诊断

目的探讨走过心绞痛的临床特点。方法分析14例走过心绞痛患者（研究组）的临床特点、心血管危险因素及冠状动脉造影表现并与20例典型心绞痛（对照组）对比。结果与典型心绞痛患者相比,走过心绞痛组误诊率高达100%,侧支循环开放率较高（P〈0.05）,但合并心血管危险因素情况、冠状动脉病变严重程度及血运重建比例均无差异（P〉0.05）。结论走过心绞痛为冠心病的少见类型,发作症状为行走时出现心绞痛,但继续行走症状消失,易被误诊,需提高认识,减少误诊率。     

高龄拇外翻患者手术治疗体会

目的 针对高龄拇外翻患者采用较为彻底的截骨矫形手术,分析其治疗效果及手术风险.方法 手术治疗70岁以上高龄拇外翻患者38例(59足),根据畸形情况选择Austin术式或第一跖骨双段截骨术治疗,分析拇外翻角(HVA)、1,2跖间角(IMA)、近侧关节固角(PASA)角度矫正情况及足功能评分(AOFAS).结果 术后患者行...     

三氧重复注射联合玻璃酸钠关节腔内注药治疗膝骨关节炎的疗效分析

目的探讨应用三氧重复注射联合玻璃酸钠治疗膝骨关节炎的方法和疗效。方法将膝骨关节炎的患者100例随机分为治疗组和对照组,各50例,治疗组在膝关节腔重复注射三氧加玻璃酸钠,对照组只注射玻璃酸钠。疗程结束后评定其疗效。结果两组治疗前在膝关节压痛、平地行走痛、静息痛、晨僵等症状体征方面评分差异无统计学意义（P〉0．05）,两组治疗后在膝关节痛、平地行走痛、尤其在静息痛,晨僵等症状体征方面评分差异有统计学意义（P〈0．01）;两组近期疗效评价差异有统计学意义（P〈0．05）。结论三氧重复注射联合玻璃酸钠是治疗膝骨关节炎的有效方法,较单纯注射玻璃酸钠的效果更佳。     

脊柱侧凸常用步态特征评估参数应用及研究进展

脊柱侧凸是一种脊柱的三维畸形,其导致一系列健康问题,如疼痛、姿势异常、步行模式异常等。步态评估有助于评估脊柱畸形改变对患者生活质量和日常活动能力障碍。三维步态分析系统包含时空参数、运动学和动力学评估方法,为脊柱侧凸患者提供客观的、量化的步态分析方法。其中,表面肌电和能量监测反映脊柱侧凸患者与健康人相比步行时肌肉生理学和能量变化。本综述对脊柱侧凸的三维步态分析、表面肌电和能量监测的研究进行总结,以全面客观的反映脊柱侧凸患者步行的生物力学改变     

Leg symptoms in peripheral arterial disease: associated clinical characteristics and functional impairment

CONTEXT: Persons with lower-extremity peripheral arterial disease (PAD) are often asymptomatic or have leg symptoms other than intermittent claudication (IC). OBJECTIVE: To identify clinical characteristics and functional limitations associated with a broad range of leg symptoms identified among patients with PAD. DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional study of 460 men and women with PAD and 130 without PAD, who were identified consecutively, conducted between October 1998 and January 2000 at 3 Chicago-area medical centers. MAIN OUTCOME MEASURES: Ankle-brachial index score of less than 0.90; scores from 6-minute walk, accelerometer-measured physical activity over 7 days, repeated chair raises, standing balance (full tandem stand), 4-m walking velocity, San Diego claudication questionnaire, Geriatric Depression Score Short-Form, and the Walking Impairment Questionnaire. RESULTS: All groups with PAD had poorer functioning than participants without PAD. The following values are for patients without IC vs those with IC. Participants in the group with leg pain on exertion and rest (n = 88) had a higher (poorer) score for neuropathy (5.6 vs 3.5; P<.001), prevalence of diabetes mellitus (48.9% vs 26.7%; P<.001), and spinal stenosis (20.8% vs 7.2%; P =.002). The atypical exertional leg pain/carry on group (exertional leg pain other than IC associated with walking through leg pain [n = 41]) and the atypical exertional leg pain/stop group (exertional leg pain other than IC that causes one to stop walking [n = 90]) had better functioning than the IC group. The group without exertional leg pain/inactive (no exertional leg pain in individual who walks 相似文献   

异丙酚联合芬太尼在人工流产术中的疗效观察

目的 :观察异丙酚联合芬太尼在人工流产术中的临床疗效。 方法 :对 4 0例早孕妇女静推异丙酚 芬太尼混合液 ,观察宫口松弛、麻醉效果、人工流产综合征 (RAAS)发生率及出血量 ,记录入睡时间、唤醒时间、行走及离院时间。 结果 :异丙酚联合芬太尼用于人工流产术起效快 ,镇痛效果好 ,苏醒快 ,可明显减少腹痛及人工流产综合征的发生 ,与对照组比较差异有统计学意义 (P <0 .0 1) ,但在出血量及宫口松弛方面差异无统计学意义。 结论 :异丙酚配伍芬太尼用于人流术是一种安全、有效的麻醉方法 ,起到了良好的镇痛效果。     

股四针加电促进DHS术后股四头肌康复的研究

目的观察股骨粗隆间骨折患者加压滑动鹅颈钉（DHS）术后早期使用股四针（梁丘、犊鼻、伏兔、足三里）加电促进患者康复的临床疗效。方法研究者采用随机,单盲对照的研究方法,选取试验组（股四针加电治疗组）,对照组（非针灸治疗组）各30例,通过对局部疼痛的变化、大腿周径的变化、患肢肌力、首次下地时间、X片变化等指标进行临床疗效评价。结果试验组较之对照组在减轻局部疼痛,消除患肢肿胀,促进患肢肌力恢复,缩短下地时间方面有明显促进作用（P〈0.05）,有显著性差异。术后四周X片变化对比（P〉0.05）,无显著性差异。结论股骨粗隆间骨折加压滑动鹅颈钉（DHS）术后早期使用股四针加电能明显促进患者减轻局部疼痛,消除患肢肿胀,促进患肢肌力恢复,缩短下地时间,但术后四周X片变化未能提示股四针加电对骨折愈合有明显促进作用。     

热敏灸联合功能训练在膝骨性关节炎康复治疗中的应用及对患者关节功能的影响

目的 探讨热敏灸联合功能训练在膝骨性关节炎康复治疗中的应用效果及对患者关节功能的影响。 方法 选择宁波大学医学院附属医院2017年6月—2018年3月治疗的膝骨性关节炎患者64例，采用随机数字表分为对照组和观察组，各32例。对照组给予热敏灸治疗，观察组在对照组基础上联合功能训练，治疗3个月后评估患者治疗效果，采用JOA膝关节功能评分分别从疼痛及步行能力、肿胀、疼痛及上下楼梯能力和屈角度及强直、高度挛缩4个方面对患者关节功能进行评估；采用膝骨关节炎生活质量量表从社会、躯体、工作、症状及影响5个维度评估患者效果，比较2组患者临床效果、关节功能及生活质量。 结果 观察组治疗3个月总有效率为93.75%，高于对照组的71.88%(P<0.05)；2组治疗3个月后疼痛及步行能力、肿胀、疼痛上下楼梯能力、屈角度及强直、高度挛缩评分，均高于治疗前(均P<0.05)；观察组治疗3个月后疼痛及步行能力、肿胀、疼痛及上下楼梯能力、屈角度及强直、高度挛缩评分，均高于对照组(均P<0.05)；2组治疗3个月后社会、躯体、工作、症状及影响评分，均高于治疗前(均P<0.05)；且观察组均高于对照组(均P<0.05)。 结论 热敏灸联合功能训练用于膝骨性关节炎康复治疗中能获得较高的近期疗效，有助于改善患者关节功能，促进膝关节功能恢复，改善临床症状，从而提高患者生活质量，值得推广应用。      

Clay-shoveler＇s骨折合并颈髓损伤的诊断与治疗

目的 探讨Clay-shoveler＇s骨折合并颈椎脊髓损伤的临床表现、影像学特点、诊断及治疗方法.方法 回顾性分析2005年4月至2011年3月收治的8例Clay-shoveler＇s骨折合并颈椎脊髓损伤患者的临床资料并复习相关文献,总结该骨折合并颈髓损伤的特点.结果 所有患者术前均有颈胸段疼痛,特点是卧床休息时疼痛明显减轻或消失,坐或行走时疼痛复发.X线或CT检查可见颈胸段棘突骨折.MRI显示颈椎间盘突出压迫相应节段脊髓.术后患者疼痛均明显减轻或消失,神经损伤症状明显好转.结论 虽然Clay-shoveler＇s骨折发病率较低,但是患者可合并出现颈椎脊髓或神经根损伤的情况.若保守治疗无效常需要手术干预,颈后路棘突固定重建术是较好的治疗方法之一.根据患者的临床表现和影像学特点,决定是否联合颈前路减压植骨融合内固定术.     

Management of intermittent claudication with pentoxifylline: meta-analysis of randomized controlled trials.

OBJECTIVE: To evaluate the efficacy of pentoxifylline therapy in improving the walking capacity of patients with moderate intermittent claudication. DATA SOURCES: A search of MEDLINE for trials published between 1976 and 1994 inclusive, and a bibliographic review of all articles retrieved. STUDY SELECTION: Randomized, placebo-controlled, double-blind clinical trials were selected that evaluated the pain-free walking distance (the distanced walked on a treadmill before the onset of calf pain) and the absolute claudication distance (the maximum distance walked on a treadmill) among patients with moderate intermittent claudication. Twelve study groups in 11 trials were included in the analysis. DATA EXTRACTION: In addition to information regarding the trial design, patient characteristics, dosages and treatment periods, the means and standard deviations were collected for both the pain-free walking and absolute claudication distances. Trial quality was also assessed. DATA SYNTHESIS: Overall, there was a statistically significant improvement in the pain-free walking distance after pentoxifylline therapy (weighted mean difference 29.4 m [95% confidence interval (CI) 13.0 to 45.9 m]); this finding was based on a total sample of 612 patients (308 in the treatment groups and 304 in the control groups). A significant improvement was also noted in the absolute claudication distance (weighted mean difference 48.4 m [95% CI 18.3 to 78.6 m]); this was based on a total sample of 511 patients (258 in the treatment group and 253 in the control group). In a sensitivity analysis of the pain-free walking distance, significant treatment effects and no statistically significant heterogeneity were found when only trials were included that were "medically eligible" (involved patients with stage II disease and a pain-free walking distance of 50 to 200 m). In a similar sensitivity analysis of the absolute claudication distance, the two conditions resulting in a significant treatment effect and no significant heterogeneity were the inclusion of "medically eligible" trials and those with a shorter treatment duration (13 weeks or less). CONCLUSION: Pentoxifylline therapy may be efficacious in improving the walking capacity of patients with moderate intermittent claudication. However, properly conducted clinical trials are required to provide a true estimate of the benefit.     

玻璃酸钠注射液对膝关节骨性关节炎疗效的观察性研究

目的探讨玻璃酸钠对口服药物效果欠佳的单纯膝关节骨性关节炎的治疗效果。方法选取诊断明确的，希望继续门诊保守治疗，且经过至少一种消炎镇痛药治疗无效或效果欠佳的膝关节骨性关节炎患者125例，不经过药物洗脱期，直接改用玻璃酸钠注射液进行关节腔内注射，每周1次，共5次，比较治疗前后ISOA指数7项指标及VAS评分的差异性，评估玻璃酸钠对骨性关节炎的疗效。结果经过一个共5次关节腔内注射的标准治疗后，所有患者的病情均得到不同程度的缓解（ISOA7项指标总分治疗前后比较P〈0．05），其中对走路时疼痛及最大步行距离改善最为明显（P〈0．001）。结论玻璃酸钠关节腔内注射对未经药物洗脱的患者依然能收到明显的效果，对走路时疼痛及最大步行距离改善最为明显。     

膝骨性关节炎患者膝关节疼痛指数与足底压力变化的相关性研究

目的：探讨膝骨性关节炎患者足底压力改变及疼痛对足底压力的影响。方法运用足底压力测试系统对28例单侧膝骨性关节炎疼痛患者自然行走时的步态进行测试,观察受试者单足支撑分期时段参数、足角及膝关节疼痛指数,对健、患侧足底压力各指标进行统计学分析并分析膝关节疼痛指数与各指标相关性。结果膝骨性关节炎患者患侧前足着地阶段时间百分比为（57.90±32.93）、全足支撑阶段时间百分比为（57.93±2.93）低于健侧对应百分比（60.26±2.66,P =0.007;51.53±3.84,P <0.001）;患侧足角（16.24±4.50）明显高于健侧足角（14.67±4.09）,差异有统计学意义（P =0.014）;膝关节疼痛指数与患侧前足着地阶段时间百分比（r =-0.53,P =0.004）、全足支撑阶段时间百分比（r =-0.56,P =0.002）呈负相关;与患侧足角无明显相关性（r =0.245,P =0.193）。结论膝骨性关节炎患者足底压力具有特征性,前足着地时段、全足支撑时段明显缩短、足角变大,疼痛严重影响膝骨性关节炎患者步态。     

膝关节置换患者术后疼痛及影响因素研究

目的:探讨膝关节置换患者术后疼痛特点、影响因素及对患者活动的影响。方法:对我院2010～2012年行膝关节置换的41例患者采用一般情况调查表及简明疼痛量表(BPI)进行问卷调查。结果:患者术后第3天平均疼痛强度评分为(3.70±1.30),75.6%的病人感觉手术区域疼痛,63.0%为搏动性疼痛和酸痛;女性各种疼痛评分均显著高于男性(P<0.05);不同教育水平最痛和最轻疼痛均显著不同(P<0.05);疼痛对患者影响较大的为行走(5.9)、康复锻炼(5.8)、日常活动(5.4)及睡眠(4.0)。结论:术后疼痛使患者康复时间延长,仅仅根据疼痛程度来决定镇痛方式是不够的,护理人员应该同时评估疼痛程度和对患者的影响来决定疼痛处理。     

切开或闭合复位内固定治疗后踝骨折的疗效分析

目的：探讨与分析切开或闭合复位内固定治疗后踝骨折的治疗效果。方法该研究方便选取自2010年5月—2016年3月该院收治的后踝骨折行切开或闭合复位内固定治疗的58例患者的临床资料进行回顾性分析。结果该次研究中有2例患者延迟愈合,余下56例全部为Ⅰ期愈合。术后患者愈合时间为3个月~0.5年,平均愈合时间为(4.6±0.4)个月,治疗后对患者进行12~48个月的随访,平均随访(26.4±5.2)个月,在末次随访中依照AOFAS评分标准,24例患者评分为优;28例为良;5例为可,1例为差,该组患者治疗优良率为89.7%。其中,有11例患者行走或是在负重时存在踝关节疼痛现象,给予服用止痛药和增强康复训练治疗。结论对后踝骨折患者予以良好的复位及稳固的内固定有助于踝关节的康复,有助于早期进行功能锻炼。     

Pelvic fractures diagnosed by bone scintigraphy in patients with normal radiographs after a fall

When elderly patients present with pain and difficulty walking after a fall, hip fracture is often suspected. If the x ray shows no abnormality early mobilisation is encouraged. When these patients continue to experience pain and are unable to walk, bone scintigraphy may reveal pelvic fractures. We present three illustrative cases and a retrospective review of 50 consecutive patients with pelvic fractures diagnosed by bone scintigraphy.     

关节镜清理术治疗膝关节骨性关节炎

目的：探讨关节镜下行关节清理治疗膝关节骨性关节炎的疗效。方法：对30例骨性关节炎患者行膝关节镜检查，并在关节镜下行清理术。结果：随访时间为1年，治疗后膝关节疼痛缓解、肿胀减轻、功能改善。参照刘玉杰等的疗效评价方法，优良率为75％，无复发及并发症。结论：关节镜下行关节清理术治疗膝关节骨性关节炎是一种疗效好且简便的方法。     

Walking epidural: An effective method of labour pain relief

Background: Labour pain can be deleterious for mother and baby. Epidural analgesia relieves labour pains effectively with minimal maternal and foetal side effects. A prospective open label study was undertaken to ascertain effective dosing regime for walking epidural in labour.