The effect of supervised rehabilitation on strength, postural sway, position sense and re-injury risk after acute ankle ligament sprain

The effect of an early rehabilitation program, including postural training, on ankle joint function after an ankle ligament sprain was investigated prospectively. Ninety-two subjects, matched for age, sex, and level of sports activity, were randomized to a control or training group. All subject received the same standard information regarding early ankle mobilization. In addition, the training group participated in supervised physical therapy rehabilitation (1 h, twice weekly) with emphasis on balance training. Postural sway, position sense and isometric ankle strength were measured 6 weeks and 4 months after the injury, and at 12 months re-injury data were obtained. In the training group, there was a significant difference between the injured and uninjured side for plantar flexion (P < 0.01), eversion (P < 0.01) and inversion (P < 0.05), but not for dorsiflexion at 6 weeks. In the control group, there was a significant difference between the injured and uninjured side for plantar flexion (P < 0.01), eversion (P < 0.01), inversion (P < 0.01), and dorsiflexion (P < 0.05) at 6 weeks. Postural sway, but not position sense, differed between the injured and uninjured side in both groups (P < 0.01) at 6 weeks. The side-to-side percent differences were similar in both groups for all variables (P > 0.05) at 6 weeks, and there were no side-to-side differences at 4 months in either group. In the control group, 11/38 (29%) suffered a re-injury, while this number was only 2/29 (7%) in the training group (P < 0.05). These data showed that an ankle injury resulted in reduced ankle strength and postural control at 6 weeks, but that these variables had normalized at 4 months, independent of the supervised rehabilitation. However, the findings also demonstrated that supervised rehabilitation may reduce the number of re-injuries, and therefore may play a role in injury prevention.     

Prevention of anterior cruciate ligament injuries in soccer

Proprioceptive training has been shown to reduce the incidence of ankle sprains in different sports. It can also improve rehabilitation after anterior cruciate ligament (ACL) injuries whether treated operatively or nonoperatively. Since ACL injuries lead to long absence from sports and are one of the main causes of permanent sports disability, it is essential to try to prevent them. In a prospective controlled study of 600 soccer players in 40 semiprofessional or amateur teams, we studied the possible preventive effect of a gradually increasing proprioceptive training on four different types of wobble-boards during three soccer seasons. Three hundred players were instructed to train 20 min per day with 5 different phases of increasing difficulty. The first phase consisted of balance training without any balance board; phase 2 of training on a rectangular balance board; phase 3 of training on a round board; phase 4 of training on a combined round and rectangular board; phase 5 of training on a so-called BABS board. A control group of 300 players from other, comparable teams trained normally and received no special balance training. Both groups were observed for three whole soccer seasons, and possible ACL lesions were diagnosed by clinical examination, KT-1000 measurements, magnetic resonance imaging or computed tomography, and arthroscopy. We found an incidence of 1.15 ACL injuries per team per year in the control group and 0.15 injuries per team per year in the proprioceptively trained group (P<0.001). Proprioceptive training can thus significantly reduce the incidence of ACL injuries in soccer players.     

Comparison of augmented and non-augmented anterior cruciate ligament reconstruction combined with high tibial osteotomy

In a follow-up study 27 patients were evaluated after anterior cruciate ligament (ACL-)reconstruction combined with high tibial osteotomy because of chronic rupture of the ACL, cartilaginous lesions of the medial compartment and varus malalignment. They were divided into two groups. In 14 patients (non-LAD group) ACL reconstruction was performed using the central third of the autologous patellar tendon modified according to Eriksson-Trillat. Thirteen patients (LAD group) underwent repair with the same technique, but a Kennedy ligament augmentation device (LAD) in hot dog technique and fixed over the top was added. The postoperative treatment was the same in both groups. All patients were examined according to IKDC criteria. KT-1000 arthrometer testing at maximum manual traction was performed. Although the mean follow-up interval was more than double in the non-LAD group (non-LAD: 127 months vs LAD: 58 months), the subjective and clinical results, IKDC evaluation and KT-1000 arthrometer testing results were similar, showing no statistically significant difference. Further, no complications due to the use of LAD occurred. In this study no evident functional or clinical advantage from the augmentation performed could be shown.Investigation performed at the Department of Orthopaedic and Trauma Surgery, University Hospital Basle, Switzerland. No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article. Funds were received in total or partial support of the research or clinical study presented in this article. The funding sources were SUVA Assurance, Lucerne, and the science fund of the University Hospital Basle     

The role of PGE2 in the sensitization of mechanoreceptors in normal and inflamed ankle joints of the rat

Summary The role of PGE₂ in the sensitization of highthreshold tarsal joint mechanoreceptors (putative nociceptors) has been investigated in 11 arthritic and 16 normal rats. Injections of a low dose of Freund's complete adjuvant at multiple sites into the tissues surrounding the ankle joint induced a chronic unilateral monoarthritis in the injected limb. Measurements of both spontaneous activity and responses of tarsal joint mechanoreceptors to repeated graded mechanical stimuli were made. All of the mechanoreceptors examined had afferent fibres with conduction velocities in the C or A- range. Using this new model of joint inflammation we have shown that lysine acetylsalicylate reduces the mechanical sensitivity of these joint mechanoreceptors and reduces the spontaneous activity in afferent nerve fibres. Prostaglandin E₂ is unable to restore either the spontaneous activity in the afferent axon or the mechanical sensitivity of tarsal joint mechanoreceptors after lysine acetylsalicylate in the arthritic rat. Similarly, PGE₂ does not sensitize or excite tarsal joint mechanoreceptors in the normal rat. In the normal rat, however, PGE₂ potentiates the excitatory action of bradykinin and enhances the sensitizing effect of bradykinin on the responses of joint mechanoreceptors to mechanical stimulation when both substances are injected simultaneously. These results indicate that PGE₂ is not important in the sensitization of these joint mechanoreceptors in this model of chronic joint inflammation but that in other circumstances PGE₂ may be able to contribute to a sensitization of joint mechanoreceptors by enhancing the action of bradykinin.     

冷灸治疗类风湿性指间关节炎疗效观察

目的:观察冷灸对类风湿性指间关节炎的临床疗效。方法:将576例类风湿性指间关节炎随机分为治疗组(冷灸组)290例和对照组(服药组)286例,治疗时间为2个月。结果:两者总有效率虽然差异不明显,但在第二疗程末前者完全缓解率达77.2％,后者仅23.4％,经统计学处理P<0.005,两者差异有非常显著性意义。结论:冷灸治疗类风湿性指间关节炎效果优于西药抗炎剂。     

Adaptative effects of loss of vision on upright undisturbed stance

In order to evaluate the long term effect of blindness on an undisturbed postural task, seven blind individuals (BLI) were compared to twelve healthy individuals (REF) who were required to close their eyes. To this aim, centre of pressure (CP) trajectories were recorded through a force platform on which the subjects remained upright. Through a low-pass filter, the vertical projection of the centre of gravity (CG(v)) and consequently the difference CP-CG(v) were estimated. The former represents the controlled variable whilst the latter is assumed to express the resultant joint stiffness. A first analysis consisted in studying the frequency distribution of these motions. Increased mean amplitudes in both elementary motions and no difference between frequency distributions were observed for the BLI when compared to the REF group. These trajectories were then modelled as a fractional Brownian motion process in order to gain insight about the nature of the control mechanisms called into play and their spatio-temporal organisation. Moreover, the main characteristic observed in the BLI group is a decreased in CP-CG(v) motions, which, according to Winter's model, may be related to joint stiffness. In addition, reduced spatial transition point co-ordinates and more deterministic control mechanisms aimed at returning the estimated CG to an equilibrium point during the longest Deltat were observed. This phenomenon is more pronounced in the antero-posterior direction and also allows the blind subject to significantly diminish their CG sways. Finally, these features are discussed in relation to other similarly analysed investigations.     

三资企业从业人员心理卫生状况调查

[目的 ]　了解三资企业从业人员心理卫生现状。　 [方法 ]　采用症状自评量表 (SCL— 90 )对 776名三资企业从业人员心理卫生情况进行调查及分析。　 [结果 ]　三资企业从业人员SCL— 90量表得分均值高于全国常模 (P<0 .0 1) ;5年工龄以下 ,操作工人的躯体化、强迫症状、敌对、偏执、精神病性症状得分均值高于行政管理人员 (P <0 .0 5或P <0 .0 1) ;除强迫症状、精神病性症状外 ,有毒有害接触人员得分均值高于不接触有毒有害作业人员 (P <0 .0 5或P<0 .0 1) ;除敌对、精神病性症状外 ,女性得分均值高于男性 (P <0 .0 5或P <0 .0 1)。 5年以上工龄 ,除精神病性症状外 ,操作工人得分均值高于行政人员 (P <0 .0 5或P <0 .0 1) ;接触有毒有害人员以及女性得分均值分别高于不接触有毒有害人员和男性 (P <0 .0 5或P <0 .0 1)。　 [结论 ]　三资企业从业人员存在一定心理问题 ,有必要开展职业心理卫生的健康干预。     

儿童血友病429例临床回顾分析

目的探讨血友病患儿确诊时间、症状及其关节畸形等情况。 方法天津血液学研究所血液病医院于1986年7月至2004年8月，对就诊的429例血友病患儿临床症状出现时间、诊断时间及关节畸形出现的时间进行分析。 结果429例血友病患儿，均为男性，血友病A共390例，占909%，其中亚临床型5例(13%),轻型43例(110%)，中型181例(464%)，重型161例(413%)；血友病B共39例，占91%，其中亚临床型2例(51%),轻型6例(154%)，中型26例(667%)，重型5例(128%)。患儿初次出现出血症状的中位年龄为16岁(0~12岁)；但初次诊断年龄03~120岁，中位年龄为52岁(03~120岁)，两者之间差异具有显著性意义(P<001)。 结论目前血友病患儿的诊断存在延迟，替代治疗疗程和因子剂量的不足是关节畸形高发生率的原因。     

经阴道骶棘韧带固定术治疗子宫脱垂8例临床分析

目的 初步探讨保留子宫的经阴道骶棘韧带固定术治疗子宫脱垂的可行性及有效性.方法 对2006年7月至2008年12月收治的8例子宫脱垂患者进行了保留子宫的经阴道骶棘韧带固定术,合并有尿失禁者同时行尿道中段无张力悬吊术及尿道后韧带折叠术,合并阴道前后壁膨出者同时行阴道前后壁修补术.分析其临床疗效,并进行随访.结果 所有患者均成功进行该术式,根据POP-Q分度法,8例患者的子宫脱垂,阴道前后壁膨出及尿失禁等症状全部得到纠正,术中无一例发生术中、术后出血或盆腔脏器损伤.8患者术后均恢复好,无术后病率,未观察到其他与手术相关的并发症.术后平均随访18个月,患者子宫颈距离处女膜缘均4 cm,相关症状消失或明显改善.结论 对要求保留子宫的子宫脱垂患者施行经阴道骶棘韧带固定术是一种安全、简单,有效的微创手术.