改良腕手关节矫形器对脑卒中偏瘫患者腕手关节屈肌痉挛及运动功能的疗效

目的探讨改良腕手关节矫形器对偏瘫患者腕手关节屈肌痉挛及运动功能的疗效。方法脑卒中后偏瘫患者56例分为观察组与对照组各28例。两组均接受常规康复训练,包括运动疗法、作业疗法、痉挛肌电刺激疗法,观察组加用改良腕手关节矫形器,于每天训练结束后累计穿戴4~8 h,每次30~60 min,休息15 min。分别于治疗前、治疗4周、治疗8周及治疗12周对两组患者采用改良Ashworth量表(MAS)、简式Fugl-Meyer评定(FMA)进行评定,采用量角器测量患侧腕关节主动掌屈、背伸、桡偏、尺偏关节活动度(AROM)。结果治疗4周时,两组均未见明显改善,两组间也无显著性差异。治疗8周时,两组MAS和FMA评分较治疗前和治疗4周时改善(P0.05),观察组明显优于对照组(P0.01);观察组腕关节各方向AROM与治疗前比较均有提高(P0.05),其中背伸AROM较对照组明显提高(P0.01)。治疗12周时,观察组MAS和FMA评分较治疗8周时进一步明显改善(P0.01),且明显优于对照组(P0.01);观察组背伸、掌曲、桡偏AROM优于对照组(P0.05)。结论改良腕手关节矫形器可明显缓解脑卒中后偏瘫患者腕手关节屈肌痉挛,促进腕手关节运动功能恢复。     

自制踝足矫形带对痉挛型偏瘫脑性瘫痪足下垂患儿下肢运动功能的疗效

目的观察自制自制踝足矫形带对痉挛型偏瘫脑瘫足下垂患儿下肢运动功能的疗效。方法 24例痉挛型偏瘫脑瘫足下垂患儿随机分为观察组和对照组各12例。两组患儿均行常规康复训练,对照组行步态训练,观察组佩戴自制踝足矫形带行步态训练,共12周。治疗前后分别采用腓肠肌改良Ashworth量表(MAS)、踝关节主动背屈活动度(ROM)和粗大运动功能测量(GMFM-88)D区(站立)、E区(走跑跳)进行评定。结果治疗后,两组MAS评分明显降低(P0.01),观察组低于对照组(P0.05);两组ROM、GMFM-88的D区和E区评分均明显高于治疗前(P0.01),观察组高于对照组(P0.05)。结论佩戴自制踝足矫形带行步态训练能进一步降低痉挛型偏瘫脑瘫患儿患侧的腓肠肌张力,增加踝关节活动度,提高下肢运动功能。     

Effect of Ankle Torque on the Ankle–Foot Orthosis Joint Design Sustainability

The ankle joint of a powered ankle–foot orthosis (PAFO) is a prominent component, as it must withstand the dynamic loading conditions during its service time, while delivering all the functional requirements such as reducing the metabolic effort during walking, minimizing the stress on the user’s joint, and improving the gait stability of the impaired subjects. More often, the life of an AFO is limited by the performance of its joint; hence, a careful design consideration and material selection are required to increase the AFO’s service life. In the present work, a compact AFO joint was designed based on a worm gear mechanism with steel and brass counterparts due to the fact of its large torque transfer capability in a single stage, enabling a compact joint. Further, it provided an added advantage of self-locking due to the large friction that prevents backdrive, which is beneficial for drop-foot recovery. The design was verified using nonlinear finite element analysis for maximum torque situations at the ankle joint during normal walking. The results indicate stress levels within its design performance; however, it is recommended to select high-grade structural steel for the ankle shaft as the highest stresses in AFO were located on it.     

膝控制矫形器治疗老年重症卒中偏瘫患者康复疗效观察

目的探讨穿戴膝控制矫形器进行康复治疗对中老年重度卒中偏瘫患者下肢功能恢复的影响。方法符合入组标准的28例下肢本体感觉受累和(或)合并单侧空间忽略的偏瘫患者,分为矫形器组(常规康复治疗的基础上佩戴膝矫形器进行直立体位治疗,14例)和对照组(包括直立位训练的常规康复治疗,14例)2组。分别于训练前和训练后1月采用Fugl-Meyer下肢运动功能评定量表、Brunel平衡量表、Holden步行功能分级、划线试验和改良Barthel指数等对患者的运动、平衡、行走和日常生活能力进行评价。结果 1月后2组间比较,除划线试验、Fugl-Meyer下肢运动功能评定量表评分无显著性差异外,Brunel平衡量表、Holden步行功能量表、改良Barthel指数得分均有显著性差异(P0.05或P0.01),矫形器组疗效明显优于对照组。结论膝控制矫形器对重度老年卒中偏瘫患者下肢功能性活动能力恢复有较好的疗效,可积极推荐使用。     

Robotic gait trainer in water: Development of an underwater gait-training orthosis

Purpose.?To develop a robotic gait trainer that can be used in water (RGTW) and achieve repetitive physiological gait patterns to improve the movement dysfunctions.

Method.?The RGTW is a hip-knee-ankle-foot orthosis with pneumatic actuators; the control software was developed on the basis of the angular motions of the hip and knee joint of a healthy subject as he walked in water. Three-dimensional motions and electromyographic (EMG) activities were recorded in nine healthy subjects to evaluate the efficacy of using the RGTW while walking on a treadmill in water.

Results.?The device could preserve the angular displacement patterns of the hip and knee and foot trajectories under all experimental conditions. The tibialis anterior EMG activities in the late swing phase and the biceps femoris throughout the stance phase were reduced whose joint torques were assisted by the RGTW while walking on a treadmill in water.

Conclusion.?Using the RGTW could expect not only the effect of the hydrotherapy but also the standard treadmill gait training, in particular, and may be particularly effective for treating individuals with hip joint movement dysfunction.     

学龄前儿童先天性脊柱侧凸矫形手术围术期输血的相关因素分析——一项单中心回顾性分析

目的回顾性分析学龄前儿童（≤72个月）行先天性脊柱侧凸矫形手术围术期血液管理的临床特点及相关影响因素。方法针对2年以来行先天性脊柱侧凸矫形手术的110例学龄前儿童（≤72个月）相关资料进行回顾性分析,组间比较采用t检验,组内比较采用重复测量的方差分析,多元Logistic回归分析被用来确定异体红细胞输注的独立预测因子。结果共有91例患儿（83％）术中输入异体红细胞,与术中异体红细胞输入量存在明显相关性的因素有患儿的体重、术前Cobb角、融合节段、手术时间、截骨数量、失血量以及术前血红蛋白（hemoglobin,Hb）浓度、红细胞比容（hematocrit,Hct）、血小板（bloodplatelet,Pit）计数,其中独立因素有Cobb角、截骨数量、术前Hb浓度、Hct、Pit计数。输血患儿与未输血患儿比较,术中截骨率、术中出血量和术后24h伤口引流量显著增加,术后住院时间也明显延长。结论可作为围术期输血评估的独立因素有Cobb角、截骨数量、术前Hb浓度、Hct、Plt计数,而与患儿的年龄、体重、融合节段及手术时间无明显相关性,有助于对学龄前儿童先天性脊柱侧凸矫形手术围术期输血需求的早期识别和准确评估,保证患儿的生命安全。     

支具加显微外科手术治疗重度虎口瘢痕挛缩的临床研究

目的 总结支具加显微外科手术在重度虎口瘢痕挛缩治疗的作用，探讨重度虎口瘢痕挛缩综合治疗的重要性。方法 自2000年4月-2004年10月。对76例重度虎口挛缩患者术前采用支具被动牵引治疗后，根据虎口挛缩情况进行植皮、“Z”字成形术度各种带蒂或游离皮瓣修复，拆线后，再以支具固定，以物理测量评价疗效。对所有数据进行统计学分析。结果 76例患者，术前进行15-90d治疗，虎口角、虎口宽度、手功能均明显增大。2例取消手术治疗，16例简化手术方案，35例缩小取皮范围。结合手术治疗74例，6个月后随访，虎口扩大优69例，良7例；手功能优16例，良33例，中25例，差2例。结论 支具加显微外科手术可有效扩大虎口、简化手术难度，缩小取皮范围，预防术后虎口再度挛缩的几率，是一种简便、有效的治疗方法。     

脑性瘫痪患儿踝足矫形器配戴前后对运动功能的量化评价

Becauseofmotordisablementofpatientswithcerebralpalsy,providingandsupportingthemakindofwayorasuitableassistanttechnologyforexploringtheirsurroundingsincorrespondingphaseswillimprovegreatlytheiropportunitiesofgettingindependence犤1犦.Children'motorfunctionwasassessedwithself-madequantitativeassessmentscaleaccordingtotheforth,fifthfunctionareaofmotorassessmentscaleofchildrenwithcerebralpalsyafteroneweekofwearingorthopedicinstruments.Thisarticleexplorestheroleofanklefootorthopedicinstrumentsinenha…     

低龄低位伸直型髁上骨折的经皮穿针加矫形托外固定治疗

目的探讨关节内低龄低位伸直型髁上骨折经皮穿针加矫形托外固定治疗效果。方法总结本组23例此种特殊类型低位髁上骨折,描述经皮克氏针加矫形托外固定治疗特殊类型低龄低位伸直型髁上骨折复位、进针方法以及外固定的方法。结果本组23例病例随访3个月至1年,骨折全部愈合,平均临床愈合时间3周,无并发症。结论经皮穿针加矫形托外固定治疗关节内低龄低位伸直型髁上骨折具有创伤小、固定可靠、减少手法及切开手术对局部骨骺、Ranvier区损伤机率,减轻肱骨内外侧骨骺的不平衡发育,减少肘内翻畸形发生的优点。