台阶训练提高脑卒中患者患肢动态负重及步行能力的效果

目的 探讨台阶训练提高脑卒中患者患肢动态负重及步行能力的效果.方法 将脑卒中患者60例按随机数字表法分为对照组和实验组,各30例.对照组进行常规训练,即静态患侧单足负重;实验组同时进行常规训练和台阶训练.于训练前、训练4周后采用步态分析系统计算患侧单足负重时间、健侧步长、步速、步频.结果 训练前两组患侧单足负重时间、健侧步长、步速、步频比较,差异无统计学意义(P＞0.05).训练4周后两组患侧单足负重时间、健侧步长、步速均较训练前明显增加(P＜0.05),步频均明显低于训练前(P＜0.05).训练4周后实验组患侧单足负重时间、健侧步长、步速均明显长于或高于对照组(P＜0.05),步频明显低于对照组(P＜0.05).结论 台阶训练可以提高脑卒中患者患侧动态负重能力及步行能力.     

The effect of isolating the paretic limb on weight-bearing distribution and EMG activity during squats in hemiplegic and healthy individuals

Background: Neural reorganization for movement therapy after a stroke is thought to be an important mechanism that facilitates motor recovery. However, there is a lack of evidence for the effectiveness of exercise programs in improving the lower limbs.

Objective: We investigated the immediate effect of isolating the paretic limb using different foot positions ((i) foot parallel; both feet parallel, (ii) foot asymmetry; paretic foot backward by 10 cm, and (iii) foot lifting; nonparetic foot lifting by normalization to 25% of knee height) on weight-bearing distribution and electromyography (EMG) of the thigh muscle during squats.

Methods: In total, 20 patients with hemiplegia and 16 healthy subjects randomly performed three squat conditions in which the knee joint was flexed to 30°. Weight distribution was measured using the BioRescue system. Muscle activity was measured using a surface EMG system.

Results: Patients with hemiplegia exhibited significantly decreased weight bearing on the paretic foot at 0° and 30° knee flexion compared with the nondominant foot of a healthy subject. The muscle activity of the quadriceps was significantly lower in patients with hemiplegia compared to healthy subjects. Weight bearing and EMG activity of the quadriceps femoris on the paretic or nondominant side significantly increased during a knee flexion of 30° with under the foot asymmetry and foot lifting positions compared with the parallel foot position.

Conclusion: Isolating the paretic limb using the asymmetric foot positions and lifting of the foot during squats might help patients with hemiplegia to improve weight-bearing and achieve greater activation of the quadriceps muscle in the paretic limb.     

被动式负重外骨骼站立承重性能评估

目的:评估被动式负重外骨骼在穿戴者站立负重姿态下的承重性能.方法:招募7名健康成年男子作为受试者,在不穿外骨骼无负重、穿戴被动式负重外骨骼背负25 kg制式背包和不穿被动式负重外骨骼背负25 kg制式背包3种条件下保持静止站立姿态10min,观察受试者斜方肌与竖脊肌的肌电信号、肩部压力和能量消耗等指标.结果:受试者穿戴...     

经筋围刺电针治疗加康复负重训练对小脑损伤患者步态的影响

目的:探讨经筋围刺电针及康复负重训练对小脑损伤患者步态的影响.方法:40例脑卒中所致小脑损伤患者随机分为A、B 2组各20例,均在内科常规治疗的基础上,A组采用患侧臀中肌(足少阳处)经筋围刺电针治疗并配合神经促通技术、减重肌力训练、主动负重及患侧单足负重控制训练等;B组行易化技术为主的常规康复训练.治疗前后采用徒手肌力...     

Habitual use of the primate forelimb is reflected in the material properties of subchondral bone in the distal radius

Bone mineral density is directly proportional to compressive strength, which affords an opportunity to estimate in vivo joint load history from the subchondral cortical plate of articular surfaces in isolated skeletal elements. Subchondral bone experiencing greater compressive loads should be of relatively greater density than subchondral bone experiencing less compressive loading. Distribution of the densest areas, either concentrated or diffuse, also may be influenced by the extent of habitual compressive loading. We evaluated subchondral bone in the distal radius of several primates whose locomotion could be characterized in one of three general ways (quadrupedal, suspensory or bipedal), each exemplifying a different manner of habitual forelimb loading (i.e. compression, tension or non-weight-bearing, respectively). We employed computed tomography osteoabsorptiometry (CT-OAM) to acquire optical densities from which false-colour maps were constructed. The false-colour maps were used to evaluate patterns in subchondral density (i.e. apparent density). Suspensory apes and bipedal humans had both smaller percentage areas and less well-defined concentrations of regions of high apparent density relative to quadrupedal primates. Quadrupedal primates exhibited a positive allometric effect of articular surface size on high-density area, whereas suspensory primates exhibited an isometric effect and bipedal humans exhibited no significant relationship between the two. A significant difference between groups characterized by predominantly compressive forelimb loading regimes vs. tensile or non-weight-bearing regimes indicates that subchondral apparent density in the distal radial articular surface distinguishes modes of habitually supporting of body mass.     

个性化Bego种植体负重方案选择及稳定性影响因素

背景：目前关于种植体即刻负重或延期负重方案的选择尚存在一定的争议。 目的：探讨基于种植体稳定系数值的Bego种植体负重方案选择,并分析影响种植体稳定性的相关因素。 方法：选择植入后种植体稳定系数值≥50的单个Bego种植体患者62例,共74颗种植体。随机分为试验组31例36颗种植体,予以种植后即刻负重;对照组31例38颗种植体,予以延期负重。比较两组Bego种植体负重后1,2,3,4,6,8,12周种植体稳定系数值,分析影响Bego种植体稳定性的相关因素。 结果与结论：试验组即刻负重的最低稳定系数出现在负重后第二三周,对照组延期负重的最低稳定系数出现在负重后第三四周。两组Bego种植体负重后1,2,3,4,6,8,12周种植体稳定系数值差异均无显著性意义(P > 0.05)。经回归分析,患者年龄、骨质类型和种植体长度与Bego种植体稳定性呈正相关,口腔卫生情况与Bego种植体稳定性呈负相关。说明Osstell测量种植体稳定系数值≥50的单个Bego种植体采用即刻负重与延期负重对种植体具有相似的稳定性,临床可以根据患者自身状况,在Osstell测量种植体稳定系数值的指导下,选择个体化的Bego种植体负重方案。中国组织工程研究杂志出版内容重点：生物材料;骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性;组织工程全文链接：     

关节镜下微骨折术结合术后早期负重治疗距骨骨软骨损伤的临床疗效

Background The time until weight-bearing after arthroscopic microfracture when treating osteochondral lesions of the talus （OLT） is very important to the clinical outcomes of the operation.However,there have been no consistent opinions regarding the optimal time to start weight-bearing postoperatively.Many opinions advocate that weight-bearing should begin not earlier than the sixth or eighth week postoperatively,whereas others point out that earlier weight-bearing could also obtain satisfactory outcomes.The purpose of our study was to evaluate the clinical outcomes of early weight-bearing after arthroscopic microfracture during the treatment of OLT.Methods Fifty-eight ankles in 58 patients with a single OLT ＜2 cm2 were retrospectively studied.All lesions were treated with arthroscopic debridement and microfracture under local anesthesia.After the operation,the patients were allowed to bear full weight under the protection of figure-8-shaped splints.The visual analog scale （VAS） for pain and the American Orthopaedic Foot and Ankle Society （AOFAS） ankle—hindfoot scale were evaluated preoperatively and at six postoperative timepoints （1st day,1st month,3rd month,6th month,12th month,and 24th month）.Patients were followed up for 24-52 months （mean （34.97±7.33） months）.Results All 58 patients achieved excellent recovery with significant relief of their symptoms.The VAS score decreased from 7.31±1.0 preoperatively to 0.95±0.76 at the 24th month follow-up （P=0.000）,whereas the AOFAS score improved from 53.53±8.57 preoperatively to 87.62±5.42 at the 24th month follow-up （P=0.000）.Conclusion The successful clinical outcomes of this study demonstrated that early weight-bearing after the treatment of OLT with arthroscopic microfracture can be allowed.     

老年人髋部骨折术后早期活动研究进展

对老年人髋部骨折手术早期负重活动的必要性、下地负重锻炼的时机、早期负重活动效果研究进展进行了综述。     

强化患侧下肢负重训练对脑卒中患者平衡与功能性步行能力的影响

目的：探讨强化患侧下肢负重训练对脑卒中偏瘫患者平衡与功能性步行能力的影响。方法：将符合入选标准的脑卒中偏瘫患者随机分为观察组和对照组（各20例）。两组患者均采用常规康复治疗和平衡训练法,在此基础上,观察组加入负重率生物反馈下强化患侧下肢负重的训练方法。以上平衡训练两组均进行30min/d,6d/周,共6周。分别于治疗前、后用Berg平衡量表（BBS）、起立-行走计时测试（TUGT）和改良功能性前伸测试（MFRT）评定平衡与步行功能。结果：6周治疗后,两组的BBS和MFRT值均较治疗前明显提高（P<0.01）,TUGT较治疗前缩短（P<0.01）;观察组的BBS、TUGT和MFRT值均优于对照组（P<0.01,P<0.05,P<0.05）。结论：在常规平衡训练基础上,负重率反馈下强化患侧下肢负重的训练能更有效地改善脑卒中偏瘫患者的平衡与功能性步行能力。     

The Frequency,Reasoning, and Impact of Repeated Radiographs at the Initial Orthopedic Arthroplasty Visit

BackgroundPatients presenting to an orthopedic clinic with joint pain often seek prior care and imaging before consultation. It is unknown how often orthopedic surgeons must repeat imaging and whether repeat imaging has an impact on diagnosis or management. The purpose of this study was to determine the frequency, reason, and impact of repeating radiographs in outpatient orthopedic clinics.MethodsPatients ≥18 years of age presenting with hip and/or knee pain were prospectively enrolled at five arthroplasty clinics from January 2019 until June 2020. Before the initial visit, surveys were distributed to patients regarding the reason for their visit, prior care, and prior diagnostic imaging. At the conclusion of the visit, surgeons reported if repeat radiographs were obtained, and if so, surgeons documented the views ordered, the reasoning for new films, and if diagnosis or management changed as a result. Patients were grouped based on repeat imaging status, and of those with repeat imaging, subgroup analysis compared patients based on if management changed.ResultsOf 292 patients, 256 (88%) had radiographs before their office visit, and 167 (65%) obtained repeat radiographs. Radiographs were most commonly repeated if they were inaccessible (47%), followed by if they were non–weight-bearing (40%). Repeated radiographs changed the diagnosis in 40% of patients and changed management in 22% of patients.ConclusionMost patients underwent repeat radiography at their orthopedic visit. The primary reasons were owing to accessibility or the patient being non–weight-bearing. Repeat radiographs changed management in almost one-quarter of patients.