仰卧位按压复位法治疗胸椎小关节紊乱

胸椎小关节紊乱是临床常见病,是由于外伤或长期姿势不良造成胸椎小关节突关节错位甚至滑膜嵌顿而引起明显疼痛,往往伴有内脏功能紊乱的临床表现。正骨复位对其有独到的治疗效果,自2003年开始采用仰卧位按压复位法治疗胸椎小关节紊乱43例,现将治疗结果报告如下。1临床资料本组43例,男23例,女20例;年龄21～46岁,平均32.4岁;病程1周～2年,平均3.2个月;均为单节椎体受累,棘突偏左15例,偏右28例。受累部位:T33例,T45例,T56例,T68例,T79例,T89例,T93例。症状:所有的病例均表现出单侧或双侧背肌痉挛、疼痛,深呼吸时疼痛加剧,兼有胸闷、胸痛的37例,     

手法复位辅助手术治疗跟骨骨折

目的:探讨跟骨骨折手法复位对消肿、简化内固定手术操作的临床意义。方法:2005年12月至2010年11月,采用先手法复位待消肿后再行延期手术治疗跟骨骨折42例。男25例,女17例;年龄18～74岁,平均41.4岁;左侧20例,右侧22例。23例采用切开复位钢板固定,19例采用克氏针和空心钉固定。随访评价患者的平均术前、术后消肿时间,手术时间,关节功能及并发症发生情况。结果:本组均获随访,时间3～18个月,平均8.3个月。复位次日疼痛明显缓解,3～5d肿胀基本消退。术中复位简便,手术时间平均90min,术后4～7d消肿,术后未出现皮瓣坏死。术后B觟hler角平均(31±3.2)°,Gissane角(112±5.3)°,跟骨宽度(30.2±0.89)mm。按Maryland足部评分系统评价,优16例,良18例,中6例,差2例。结论:即时手法复位配合延期内固定治疗跟骨骨折可加快术前、术后消肿,简化手术操作。     

Clinical effectiveness of the activator adjusting instrument in the management of musculoskeletal disorders: a systematic review of the literature

Objective:

The purpose of this study was to conduct a systematic review of the literature investigating clinical outcomes involving the use of the Activator Adjusting Instrument (AAI) or Activator Methods Chiropractic Technique (AMCT).

Methods:

A literature synthesis was performed on the available research and electronic databases, along with hand-searching of journals and reference tracking for any studies that investigated the AAI in terms of clinical effectiveness. Studies that met the inclusion criteria were evaluated using an instrument that assessed their methodological quality.

Results:

Eight articles met the inclusion criteria. Overall, the AAI provided comparable clinically meaningful benefits to patients when compared to high-velocity, low-amplitude (HVLA) manual manipulation or trigger point therapy for patients with acute and chronic spinal pain, temporomandibular joint (TMJ) dysfunction and trigger points of the trapezius muscles.

Conclusion:

This systematic review of 8 clinical trials involving the use of the AAI found reported benefits to patients with a spinal pain and trigger points, although the clinical trials reviewed suffered from many methodological limitations, including small sample size, relatively brief follow-up period and lack of control or sham treatment groups.     

Two-dimensional manipulation of confluently cultured vascular endothelial cells using temperature-responsive poly(N-isopropylacrylamide)-grafted surfaces

Temperature-responsive hydration/dehydration changes in surface-grafted poly(N-isopropylacrylamide) (PIPAAm) were utilized for hydrophilic/hydrophobic surface property alterations in cell culture. In this report, we utilized PIPAAm-grafted surfaces to recover confluently-cultured vascular endothelial cells as coherent monolayers from this cell culture substrate and to transfer to new cell culture substrates. For this purpose, we used two different methods to recover and transfer cell monolayer cultures: (1) chitin membranes used as an apical side cell support during cultured cell transfer, allowing cell basal side reattachment to new culture substrates after transfer; and (2) a cell culture insert? (porous PET) used as both a support as well as new substrate, allowing basal surfaces of cultured cells to be exposed to the medium after transfer. In both cases, all cells grown on PIPAAm-grafted surfaces detach completely with maintenance of basement membrane-like structure. Recovered cells attach to the second culture surfaces, covering more than 60% of the new substrate, and retain approximately 90% viability and their original function as judged from tissue-type plasminogen activator secretion. This technique could be utilized to prepare novel bioartificial organs as well as cell co-culture systems by multi-layering different cell types to mimic tissue structures for tissue engineering.     

三维动态牵伸回旋手法对冻结期冻结肩患者体表红外热像的影响

目的：探讨三维动态牵伸回旋手法对冻结期冻结肩患者体表热像的影响。方法：11例冻结期冻结肩患者,男1例,女10例。年龄47～64岁,中位数52岁。左肩7例,右肩4例。病程3～12个月,中位数6个月。采用医用远红外热成像仪采集静息状态下双肩肱二头肌肌腱长头、三角肌抵止点和冈上肌、冈下肌、小圆肌等肌腱和肌腹红外热成像图,采集完成后对图像进行存储、编辑。采用三维动态回旋手法治疗前比较患侧与健侧三角肌抵止点、肱二头肌肌腱长头、冈上肌、冈下肌、小圆肌等区域皮肤温度,并于治疗2个疗程后比较患侧治疗前后肱二头肌肌腱长头、冈上肌、冈下肌、小圆肌等区域皮肤温度变化情况。结果：治疗前患侧肱二头肌肌腱长头、冈上肌、冈下肌、小圆肌色码温值均高于健侧[（28．263±1．511）℃,（27．409±1．672）℃,t ＝8．225,P ＝0．000;（28．154±1．912）℃,（27．309±1．893）℃,t ＝5．047,P ＝0．000;（27．846±1．393）℃,（26．927±1．429）℃,t ＝6．095,P ＝0．000;（27．673±1．720）℃,（26．964±1．759）℃,t ＝4．535,P ＝0．001];双侧三角肌抵止点色码温值比较,差异无统计学意义[（27．655±1．236）℃,（27．372±0．816）℃,t ＝1．460,P ＝0．175]。治疗2个疗程后,患侧肱二头肌肌腱长头、冈上肌、冈下肌、小圆肌色码温值均高于治疗前[（29．018±1．393）℃,（28．263±1．511）℃,t ＝6．404,P ＝0．000;（29．956±1．799）℃,（28．154±1．912）℃,t ＝8．476,P ＝0．000;（28．800±1．363）℃,（27．846±1．393）℃,t ＝14．342,P ＝0．000;（28．573±1．756）℃,（27．673±1．720）℃,t ＝14．925,P ＝0．000]。结论：三维动态牵伸回旋手法治疗冻结期冻结肩,可提高肩部皮肤温度,这为临床上手法治疗冻结肩提供了切实有效的依据。     

一指禅推法频率、有效做功时间比研究

目的研究一指禅推法的频率、有效做功时间比。方法选取该手法熟练掌握者1人、初学者9人,采用No-vel Pliance Mobile System软件收集每人手法信息,整理并比较各受试者一指禅推法操作频率、有效做功期间时间比。结果各受试者操作频率都在110次/min以下,熟练掌握者频率为78次/min。熟练掌握者"次做功期"和"主做功期"的时间比基本上小于初学者组。结论一指禅推法频率应以78次/min左右为宜,"次做功期"和"主做功期"的时间比以略大于0.28为宜。     

Design and validation of an in vitro loading system for the combined application of cyclic compression and shear to 3D chondrocytes-seeded agarose constructs

Physiological loading is essential for the maintenance of articular cartilage by regulating tissue remodelling, in the form of both catabolic and anabolic processes. To promote the development of tissue engineered cartilage which closely matches the long term functionality of native tissue, bioreactors have been developed to provide a combination of loading modalities, which reflect the nature of normal physiological loads. This study describes the design and validation of an in vitro mechanical system for the controlled application of bi-axial loading regimes to chondrocyte-seeded agarose constructs.The computer-controlled system incorporates a robust gripping system, which ensures the delivery of precise values of cyclic compressive and shear strain to 3D cell-seeded constructs. Sample prototypes were designed, optimised using finite element analysis and validated performing compressive and shear fatigue mechanical tests. The horizontal and vertical displacements within the bioreactor are precisely controlled by a dedicated programme that can be easily implemented. The synchronisation of the orthogonal displacements was shown to be accurate and reproducible.Constructs were successfully loaded with a combined compressive and shear loading regimen at 1 Hz for up to 48 h with no appreciable loss of cell viability or mechanical integrity. These features along with the demonstrated high consistency make the system ideally suitable for a systematic investigation of the response of chondrocytes to a complex physiologically relevant deformation profile.     

经椎弓根打压植骨与骨水泥椎体成形术治疗胸腰椎压缩骨折的生物力学比较

目的通过对非内固定状态下经椎弓根打压植骨与骨水泥椎体成形术治疗胸腰椎压缩骨折的标本进行强度和刚度测试数据分析,探讨哪一种方法更符合生物力学,为临床采用经椎弓根打压植骨术治疗胸腰椎压缩骨折提供理论依据,为PVP、PKP慎用提供参考。方法对9具冻干尸体胸腰段椎体(T12~L2)标本随机分成3组,即正常组、造成L1压缩骨折经椎弓根打压植骨和骨水泥椎体成形3组,每组3具标本,通过生物力学测试仪对各组标本在前屈、后伸、侧屈、中立位4种状态下,各组L1椎体、L1、2椎间盘测试其强度和刚度数据进行比较研究。结果椎弓根打压植骨后椎体和相应椎间盘的强度、刚度接近正常组椎体,而骨水泥椎体成形组椎体强度明显增加,刚度则明显下降。这表明目前常用骨水泥椎体成形术可改变伤椎及邻近椎间盘的生物力学特性,增加伤椎再骨折机会和增加邻近椎间盘的应力,加速其退变。结论通过此实验可以说明临床以经椎弓根打压植骨替代骨水泥椎体成形的可行性,可使骨折椎体和相邻椎间盘获得更好的生物力学康复结果。     

Biomechanical comparison of vertebral augmentation with silicone and PMMA cement and two filling grades

Purpose

Vertebral augmentation with PMMA is a widely applied treatment of vertebral osteoporotic compression fractures. Subsequent fractures are a common complication, possibly due to the relatively high stiffness of PMMA in comparison with bone. Silicone as an augmentation material has biomechanical properties closer to those of bone and might, therefore, be an alternative. The study aimed to investigate the biomechanical differences, especially stiffness, of vertebral bodies with two augmentation materials and two filling grades.

Methods

Forty intact human osteoporotic vertebrae (T10–L5) were studied. Wedge fractures were produced in a standardized manner. For treatment, PMMA and silicone at two filling grades (16 and 35 % vertebral body fill) were assigned to four groups. Each specimen received 5,000 load cycles with a high load range of 20–65 % of fracture force, and stiffness was measured. Additional low-load stiffness measurements (100–500 N) were performed for intact and augmented vertebrae and after cyclic loading.

Results

Low-load stiffness testing after cyclic loading normalized to intact vertebrae showed increased stiffness with 35 and 16 % PMMA (115 and 110 %) and reduced stiffness with 35 and 16 % silicone (87 and 82 %). After cyclic loading (high load range), the stiffness normalized to the untreated vertebrae was 361 and 304 % with 35 and 16 % PMMA, and 243 and 222 % with 35 and 16 % silicone augmentation. For both high and low load ranges, the augmentation material had a significant effect on the stiffness of the augmented vertebra, while the filling grade did not significantly affect stiffness.

Conclusions

This study for the first time directly compared the stiffness of silicone-augmented and PMMA-augmented vertebral bodies. Silicone may be a viable option in the treatment of osteoporotic fractures and it has the biomechanical potential to reduce the risk of secondary fractures.