Treinamento de força versus hidroginástica: uma análise transversal comparativa da densidade mineral óssea em mulheres na pós-menopausa

IntroductionMany studies have shown that resistance training has a positive effect on bone mineral density (BMD). However, few studies have compared the BMD of individuals undergoing resistance training and those training aquatic weight-bearing exercises.ObjectiveTo compare, in a cross-sectional study, the BMD of postmenopausal women undergoing resistance training and postmenopausal women training aquatic weight-bearing exercises.MethodsThe sample comprised 63 women divided into the following three groups: resistance training (STRENGTH: n = 15; 51.4 ± 2.7 years); aquatic weight-bearing exercises (WATER: n = 22; 54.5 ± 3.3 years); and non-trained controls (CONTROL: n = 26; 52.0 ± 3.3 years). All volunteers were on hormone replacement therapy for at least one year. The STRENGTH and WATER groups were training for at least one year prior to study beginning (mean years of training – STRENGTH: 4.5 ± 2.0; WATER: 4.2 ± 2.2).ResultsThe STRENGTH group had higher BMD of total body, femoral neck, lumbar spine L2-L4 as compared with the CONTROL group (all P < 0.05). The WATER group had higher BMD of total body, total hip, lumbar spine L2-L4 as compared with the CONTROL group (all P < 0.05). However, no difference was observed between the STRENGTH and WATER groups regarding the sites assessed.ConclusionsThose findings suggest that not only the resistance training, but also aquatic weight-bearing exercises might be a non-pharmacological strategy to prevent BMD loss in postmenopausal women.     

Posterior Sliding of the Femur During Stair Ascending and Descending in a High-Flex Posterior Stabilized Total Knee Arthroplasty

This study investigated the anteroposterior stability of the femur during stair motions. We examined 18 knees with a clinically successful high-flexion posterior stabilized total knee arthroplasty to evaluate the in vivo kinematics of stair ascending and descending using two- to three-dimensional registration. Posterior sliding of the femur was observed while shifting weight to the leg during stair ascending and descending in almost all knees. Anterior tibial post impingement was observed in 10 knees when the knee was extended in stair ascending, whereas in stair descending, the impingement was observed in 14 knees when posterior sliding of the femur occurred. The impingement contributed to the stabilization of the knee during stair motion; however, impingement may result in additional polyethylene wear and tibial post failure.     

3-matic软件测量负重状态平足指标的可行性分析

目的:比较3-matic软件与传统X线平片对平足指标测量结果是否具有一致性。方法:在3-matic软件中,根据重建的足踝部负重状态三维骨骼模型,获取足踝部负重状态下的正位、侧位及后足冠状位图像,然后进行平足相关指标的测量,并与同一个体、同一指标的普通平片测量结果进行对比。结果:两种方法对于跟骨倾斜角、距舟覆盖角、正位距骨第一跖骨角的测量,两种测量方法没有统计学差异(P>0.05)。对于侧位距骨第一跖骨角、距骨倾斜角、跟骨外移距离、内侧柱长度、内侧足弓角、外侧柱长度、外侧足弓角和跟骨外翻角的测量,两种测量方法具有显著统计学差异(P<0.05)。结论:在3-matic软件中进行平足相关指标的测量具有直观清楚、非侵袭性、测量结果稳定等优点,测量时可以根据需要去除不相关的骨块,消除骨骼重影的干扰。对于平足各指标的测量,3-matic软件测量与平片测量结果不具有一致性,因此,利用数字化技术进行平足模拟手术时,不能直接参考平片测量的正常范围。     

植入位点及轴向对上颌中切牙即刻种植即刻负重应力影响的三维有限元分析

目的 探讨不同牙槽窝形态上颌中切牙即刻种植即刻负重时,植入位点及轴向对种植体周围骨界面应力分布的影响。方法 参照1名健康成年人口腔锥体束计算机断层(cone beam computed tomography, CBCT)影像资料,建立偏唇型、中间型、偏腭型3种牙槽窝形态的上颌中切牙即刻种植即刻负重三维有限元模型;模拟不同植入位点(根尖位点、偏腭/唇侧位点)及轴向(牙长轴、牙槽骨长轴);对已建模型以100 N力进行不同角度(0°、30°、45°、60°、90°)的应力加载;应用ANSYS软件分析种植体周围牙槽骨的应力情况。结果 成功建立12个不同牙槽窝形态上颌中切牙即刻种植即刻负重三维有限元模型。偏唇型及中间型牙槽窝形态行即刻种植即刻负重时,沿牙槽骨长轴方向偏腭位点植入种植体更易获得良好的种植体骨界面生物力学特性;偏腭型牙槽窝形态行即刻种植即刻负重时,在偏唇位点植入,不论是沿牙长轴方向还是沿牙槽骨长轴方向植入种植体,种植体周牙槽骨所受等效应力远小于根尖位点植入。结论 不同牙槽窝形态、植入位点及轴向都会对上颌中切牙即刻种植即刻负重种植体骨界面生物力学特点产生影响。临床中,应针对不同牙槽窝形...     

双钢板置入延期治疗C型Pilon骨折有效固定的比较

背景：传统切开复位内固定治疗C型Pilon骨折,骨膜广泛剥离,软组织损伤大,固定后并发症多,关节功能恢复不理想;单纯微创技术或外固定结合有限内固定对复杂的C型Pilon骨折往往难于做到解剖复位。目的：分析前外侧“L”型锁定钢板结合内侧微创经皮接骨板置入延期治疗C型Pilon骨折的疗效及并发症情况,探讨治疗C型Pilon骨折的有效固定方法。方法：选择26例C型Pilon骨折患者,均采用前外侧“L”型锁定钢板结合内侧微创经皮接骨板置入治疗,置入钢板前后均行CT三维重建,固定前及固定后定期复查X射线片并随访,观察临床疗效及并发症情况,并采用Johner-Wruhs评分系统评估疗效。结果与结论：26例患者均获随访,平均随访16个月(9-24个月),1例延迟愈合(12个月),平均愈合时间15周(11-52周),无畸形愈合,并发症：浅层感染2例,均为金黄色葡萄球菌,予敞开伤口每日换药2周后愈合;无深层感染或骨髓炎;创伤性关节炎1例,予踝关节注射玻璃酸钠后好转;无皮瓣坏死;无肌腱激惹;无断钉或退钉现象;无神经损伤。按Johner-Wruhs评分系统评分：优11例,良12例,中3例,优良率88.5%。结果证实,前外侧“L”型锁定钢板结合内侧微创经皮接骨板置入延期治疗C型Pilon骨折,复位满意,坚强内固定,早期功能煅练,关节功能恢复良好,并发症少。中国组织工程研究杂志出版内容重点：人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程全文链接：     

探讨脑卒中患者患侧负重情况与功能性移动能力的关系

目的探讨脑卒中患者患侧负重情况与功能性移动能力的关系。方法测量36例脑卒中患者患侧负重率及患侧最大负重率,进行“起立-行走”计时测试(Timed "Up and Go" Test, TUGT)及坐立测试(Sit-to-Stand Test)。用Spearman相关性分析方法对患侧负重率小于50%的患者患侧最大负重率与TUGT和坐立测试所用时间的相关性进行统计学分析。结果患侧最大负重率与TUGT所用时间呈负相关(r=-0.605,P<0.01),与坐立测试所用时间呈负相关(r=-0.456,P<0.05)。结论脑卒中患者患侧负重情况与功能性移动能力有高度相关性。     

单纯性踇外翻患者内侧楔骨远端关节倾斜与踇外翻关系的影像学研究北大核心CSCD

目的通过在足负重正位X线片测量与内侧楔骨远端关节倾斜相关的指标,研究其与踇外翻发生及严重程度间的关系。方法选择2018年1月—2021年2月符合标准的足负重正位X线片,测量踇外翻角(hallux valgus angle,HVA)、第1-2跖骨间夹角(intermetatarsal angle,IMA)、跖内收角(metatarsus adductus angle,MAA)、第1跖楔夹角(metatarsus cuneiform angle,MCA)、内侧楔骨远端关节倾斜角(distal medial cuneiform angle,DMCA)、第1跖骨近端关节倾斜角(proximal metatarsal articular angle,PMAA);记录第1跖楔关节(first tarsometatarsal,TMT)关节面形态。根据HVA将患者分为正常组(<15°)与踇外翻组(≥15°),比较两组患者年龄、性别、侧别、IMA、MAA、MCA、DMCA、PMAA以及TMT关节面形态。多元线性回归分析HVA、IMA的影响因素。结果 534例(679足)患者X线片符合选择标准纳入研究。其中,男220例,女314例;年龄18~82岁,平均36岁。根据HVA分组,正常组154例(168足),踇外翻组403例(511足)。两组患者性别及年龄比较,差异均有统计学意义(P<0.05);侧别比较差异无统计学意义(P>0.05)。踇外翻组IMA、MAA、MCA均大于正常组(P<0.05),DMCA与正常组比较差异无统计学意义(P>0.05)。两组TMT关节面形态均以曲面为主,差异无统计学意义(P>0.05)。经测量PMAA发现第1跖骨存在内收型、中立型和外展型3种形态,组间分型比较差异有统计学意义(P<0.05)。正常组外展型PMAA大于踇外翻组(P<0.05),内收型PMAA组间差异无统计学意义(P>0.05)。基于679足资料的多元线性回归分析显示,年龄、MCA、DMCA为HVA的影响因素(P<0.05),年龄、MAA、MCA、DMCA为IMA的影响因素(P<0.05)。结论内侧楔骨远端关节倾斜程度相对恒定,DMCA不能作为量化踇外翻的特征性角度,TMT关节面形态与踇外翻无明显关系;MAA、MCA、PMAA参与了踇外翻形成,而且MCA可以作为量化踇外翻程度的特征性角度。     

Functional outcome of early weight bearing for acute Achilles tendon rupture treated conservatively in a weight-bearing orthosis

BackgroundThe optimal management for Achilles tendon (AT) ruptures is controversial and still continues to encourage debate. Conventionally, operative repair was favoured secondary to its lower rates of re-rupture, however in more recent years, we have seen promising results and a reduction in complications with conservative management. One reason for this improvement may be due to the introduction of a functional weight-bearing orthosis, however, results for complete AT ruptures is still unclear. This study aims to evaluate the functional outcomes of early weight bearing in a functional orthosis for conservatively managed, complete AT ruptures.MethodologyThis study was done at East Kent Hospital University Foundation Trust in between 2019?2020. In this prospective study, we have analysed data from 41 patients with US diagnosed compete AT ruptures, with a gap less than 5 cm. Every patient was treated in a functional weight-bearing orthosis (VACOped®) for 8 weeks with early weight-bearing following a specific treatment protocol, followed by rehabilitation with a trained physiotherapist. All patients received a final follow-up at 1 year post injury, where we recorded the following functional outcome measurements on each leg: calf girth, single leg heel raise height, single leg heel raise repetitions and the ATRS score.ResultOur study population was predominantly male with an average age of 50 (range 22?79). The majority of the cohort were physically active, with more than 75% involved in a form of sporting activity pre-injury and 15% involved in higher level activity and competitive sport. The mean ATRS score was 82.1, with a re-rupture rate of only 2%. The average calf bulk difference was 1.6 cm, average heel raise height difference was 1.8 cm and a heel raise repetition difference of 6. There was a statistically significant correlation between ATRS score and calf muscle girth (p = 0.02). However, there was no significant correlation between ATRS score and heel raise height or single heel raise repetitions.ConclusionEarly weight-bearing in a functional orthosis provides excellent functional outcomes for conservatively managed, complete AT ruptures, and is associated with very low re-rupture rates. However, a multidisciplinary approach with a guided rehabilitation programme is essential for optimising functional outcome.     

模拟负重前后腰椎间盘变化的CT测量及其意义

目的:探讨负重前后腰椎及其间盘的变化及其临床意义。方法:对连续68例腰腿痛病人分别在模拟负重前、后扫描L3~4、L4~5、L5~S1间隙,对加压前、后各间盘矢径、冠径、斜径及L1下缘至S1上缘的前径和后径进行测量,观察各径线的变化。结果:加压后L3~4间盘矢径、冠径、斜径增加≥1mm者分别是31例、29例和34例,L4~5间盘矢径、冠径、斜径增加≥1mm者分别是48例、32例和34例,L5~S1间盘矢径、冠径、斜径增加≥1mm者分别是39例、33例和38例;加压后腰椎前径缩短≤-1mm 46例,后径缩短≤-1mm 38例。P值均<0.01,模拟负重后腰椎间盘各径增加具有显著统计学意义。结论:模拟负重后腰椎间盘扫描有利于发现轻微的椎间盘膨出和突出,并指导临床治疗。