髋关节术后持续被动活动机结合主动运动54例效果分析

目的探讨小儿髋关节术后用持续被动活动(CPM)机行功能锻炼的效果。方法对比分析了1999～2000年期间手术治疗的小儿发育性髋脱位和股骨头无菌性坏死54例(65个髋)患儿术后关节功能的恢复情况。结果两组患儿在应用CPM机进行被动活动时效果无明显差异,而去掉CPM机进行主动活动时,实验组关节功能恢复时间平均为54.5d,对照组为86.5d,且实验组患肢肌力明显强于对照组。结论CPM机只能部分改善患肢功能,在应用CPM机的同时加强指导及配合主动运动则能更好地改善患肢肌力和关节功能。     

Temporal changes in cortical activation during conditioned pain modulation (CPM), a LORETA study

For most healthy subjects, both subjective pain ratings and pain-evoked potentials are attenuated under conditioned pain modulation (CPM; formerly termed diffuse noxious inhibitory controls, or DNIC). Although essentially spinal-bulbar, this inhibition is under cortical control. This is the first study to observe temporal as well as spatial changes in cortical activations under CPM. Specifically, we aimed to investigate the interplay of areas involved in the perception and processing of pain and those involved in controlling descending inhibition. We examined brief consecutive poststimulus time windows of 50 ms using a method of source-localization from pain evoked potentials, sLORETA. This enabled determination of dynamic changes in localized cortical generators evoked by phasic noxious heat stimuli to the left volar forearm in healthy young males, with and without conditioning hot-water pain to the right hand. We found a CPM effect characterized by an initial increased activation in the orbitofrontal cortex (OFC) and amygdala at 250-300 ms poststimulus, which was correlated with the extent of psychophysical pain reduction. This was followed by reduced activations in the primary and secondary somatosensory cortices, supplementary motor area, posterior insula, and anterior cingulate cortex from 400 ms poststimulus. Our findings show that the prefrontal pain-controlling areas of OFC and amygdala increase their activity in parallel with subjective pain reduction under CPM, and that this increased activity occurs prior to reductions in activations of the pain sensory areas. In conclusion, achieving pain inhibition by the CPM process seems to be under control of the OFC and the amygdala.     

CPM在膝关节置换术后功能锻炼中的应用体会

目的探讨在全膝关节置换术后采用下肢关节康复器（CPM）辅助膝关节功能锻炼的治疗疗效。方法评价28例患者行全膝关节置换术后辅助持续被动活动治疗的实施效果。结果 CPM较传统方法可提高膝关节活动度、痛苦小、患者易于接受、膝关节功能优良率达90%以上。结论采用CPM机辅助持续被动活动,同时配合主动活动,可减轻患者负性情绪、降低应激反应,提高机体抵抗力、减少并发症,对患者的身体状态和功能改善起到积极作用。     

CPM在预防膝关节术后关节僵硬中的应用和护理

70年代初,著名骨科医师SaLter提出持续被动活动理论（Continuous Passive Motion．CPM）,对于骨折患者出现膝关节僵硬的治疗起到了重要作用。CPM通过对膝关节持续被动的屈伸进行关似活动的训练改善关节的活动度,促进早口康复。2007—20091年我科对81例膝部骨折术后病人早期进行CPM治疗,有效地改善了患者膝关节僵硬的出现,提高了生活质量。     

中药熏洗、中药离子导入加CPM综合治疗膝关节功能障碍24例疗效观察

目的:观察中药熏洗、离子导入配合CPM治疗膝关节功能障碍的疗效.方法:将48例膝部骨折术后膝关节功能障碍的患者随机分为治疗组和对照组各24例,治疗组以中药熏洗、离子导入配合CPM进行治疗,对照组用单独CPM进行治疗,以膝关节活动范围、疼痛程度及肿胀为指标进行临床观察,治疗1周后评价疗效.结果:膝关节活动范围、疼痛程度及...     

CPM联合玻璃酸钠在膝关节镜术后早期康复中的应用

目的:探讨早期应用下肢关节康复器(CPM)联合关节腔注射玻璃酸钠进行功能锻炼治疗膝关节镜术后的临床疗效及应用价值.方法:总结2009年6月至2010年6月住院按疗程治疗的膝关节镜术后患者120例.将患者按随机化区组设计分为CPM联合透明质酸钠关节内注射治疗组(A组)40例、单纯CPM治疗组(B组)40例和传统的康复方法治疗组(C组)40例.三组在年龄及性别等方面无明星差异.结果:随访1-3个月.A组患者关节活动度均达正常,恢复正常生活时间为19～52d(平均21.6d),B组患者关节活动度也均达正常,恢复正常生活时间为21～56d(平均27.4d),C组40例恢复正常生活时间为29～69d(平均35.6d),A组各项观察指标均有明显改善,与B、C组比较差异有统计学意义(P＜0.05),B组和C组比较差异有统计学意义(P＜0.05).结论:膝关节镜术后早期应用CPM联合关节腔注射玻璃酸钠进行功能锻炼在预后及康复时间上均有明显优势,有利于功能恢复,缩短康复时间,患者术后反应轻,能够减轻术后疼痛,促进软骨修复,改善关节功能,防止关节强值的发生.     

Strategy to confirm the presence of anti-erythropoietin neutralizing antibodies in human serum

Functional cell-based assays are the preferred method to test for the presence of anti-rHuEPO neutralizing antibodies (NAbs). However, due to the unpredictable nature of test serum matrix effects on cell-based assays, confirmatory assays are essential for verifying NAb positive results observed during the course of sample testing. The cell-based assay used for the detection of NAbs described by Wei et al. [1] used 32D-EPOR cells, a murine myeloid cell line transfected with the human EPO receptor (EPOR). The 32D-EPOR cell line responded to either rHuEPO or murine interleukin 3 (mIL-3) with proliferation. NAbs were expected to only inhibit rHuEPO-induced cell proliferation and not mIL-3 induced proliferation. Due to reliance on proliferation, the results from this cell-based assay can be confounded by the presence of non-antibody inhibitory serum factors. This paper describes a strategy for confirming that the inhibition of rHuEPO-induced proliferation in a cell-based assay is only attributable to NAbs. The strategy of antibody depletion uses a resin mixture composed of Protein G Sepharose and Protein L Sepharose (Protein G/L resin) to significantly reduce the concentration of immunoglobulins of IgG, IgM and IgA isotypes from human serum prior to testing in the cell-based assay. If the reduction in immunoglobulins in a serum sample corresponds to a reduction in inhibition of EPO-induced proliferation, it would infer that EPO neutralizing activity is antibody-mediated and not due to non-antibody inhibitory serum factors.     

连续使用卷曲霉素6个月治疗耐多药肺结核不良反应分析

卷曲霉素(Cm)是一种对结核分枝杆菌有效的多肽类抗生素[1]。根据《世界卫生组织耐药结核病防治规划指南2008紧急修订版》要求,包括卷曲霉素在内的二线注射剂的使用时间应至少6个月[2]。但国内使用卷曲霉素治疗耐药结核病疗程多在3个月以下,主要为顾忌卷曲霉素的不良反应。本研究旨在为卷曲霉素在耐药结核病治疗中的应用提供参考。