胫前动脉皮瓣在小儿小腿及足部软组织损伤中的应用

报道８例以胫前动脉为蒂的足背或小腿外侧皮瓣翻转移位修复小儿小腿及足部软组织损伤，所有皮瓣全部成活。该皮瓣的优点是：其血管行走方向恒定，血管蒂有足够长度，皮瓣大小、形态可自由设计选择，血供丰富，血管分支多，适合于各种小腿和足部大面积深部损伤。     

下肢动脉硬化闭塞症患者血脂代谢临床的特点

目的通过比较下肢动脉硬化闭塞症(AOLL)患者和非动脉硬化闭塞(ASO)患者血脂代谢的差异,找出中老年AOLL患者血脂代谢的临床特点。方法采用回顾性病例对照研究的方法,对病例组和对照组各80例患者的高密度脂蛋白胆固醇(HDL-C)水平、血清总胆固醇(TC)水平及其比值HDL-C/TC,经方差齐性检验后采用两样本t检验进行统计学分析。结果HDL-C水平和TC水平在病例组和对照组之间差异无统计学意义,而HDL-C/TC值经方差齐性检验后进行两样本的t检验,显示两组间差异有统计学意义(P<0.01)。结论在血脂因素中单纯TC增高可能不具有独立危险性,而HDL-C降低等血脂代谢异常因素在AOLL发病中更有意义。     

小腿经络区体被组织的血管形态学研究

目的：观察小腿经络区的体被组织内血管的分布。方法：采用巨微解剖、全身动脉放射显影及图像分析技术，解剖12只下肢的体被组织，观察分析小腿经络沿线的体被组织内血管来源、分支和吻合情况。结果：足三阴经、胆经、膀胱经线区的小腿体被组织血管密度明显高于其他部位，在动脉显影X绒图像上分别形成一条明显的营养血管链；胃经沿线血管密度未见增高，也未见明显的营养血管链。结论：除胃经外，小腿经络区体被组织内均形成一条明显的皮神经营养血管链。     

Direct measured systolic pressure gradients across the aorto-iliac segment in multiple-level-obstruction arteriosclerosis

Patients with severe ischemia due to multilevel obstructions in the leg arteries both above and below the groin were assessed preoperatively by intraarterial brachial and femoral artery pressure measurements. The systolic pressure drop along aortoiliac obstructions was compared to the angiographic findings. A consistent pressure gradient was found in the various types of arterial occlusions. In patients with occlusion of both the aorta and the iliac arteries, the systolic pressure drop was about 60% (range, 50–78%, SD 9%). The various types of iliac artery occlusions resulted in quite uniform systolic pressure drops of about 50% (range 35–68%, SD 9%). In contrast, the systolic pressure drop along different types of iliac stenoses showed a wide variation, ranging from a minimal drop to about 60%. The degree of stenosis on the angiogram was correlated significantly with the pressure drop. Due to large variations, however, this angiographic information was found to be useless in the individual patient. No difference in the pressure drop was found between cases in which rich and poor collateral networks were visualized. Presented at the Elsinore Symposium September 1978     

High-arched runners exhibit increased leg stiffness compared to low-arched runners

Leg stiffness between high-arched (HA) and low-arched (LA) runners was compared. It was hypothesized that high-arched runners would exhibit increased leg stiffness, increased sagittal plane support moment, greater vertical loading rates, decreased knee flexion excursion and increased activation of the knee extensor musculature. Twenty high-arched and 20 low-arched subjects were included in this study. Leg stiffness, knee stiffness, vertical loading rate and lower extremity support moment were compared between groups. Electromyographic data were collected in an attempt to explain differences in leg stiffness between groups. High-arched subjects were found to have increased leg stiffness and vertical loading rate compared to low-arched runners. Support moment at the impact peak of the vertical ground reaction force was related to leg stiffness across all subjects. High-arched subjects demonstrated decreased knee flexion excursion during stance. Finally, high-arched subjects exhibited a significantly earlier onset of the vastus lateralis (VL) than the low-arched runners. Differences exist in leg stiffness and vertical loading rate between runners with different foot types. Differences in lower extremity kinetics in individuals with different foot types may have implications for new treatment strategies or preventative measures.     

青少年下肢高分级软组织肉瘤的介入与手术治疗

目的探讨青少年下肢高分级软组织肉瘤介入化疗后行手术治疗的临床效果。方法本组6例患者年龄12～23岁,男女各3例,肿瘤位于小腿4例、胭窝1例、大腿1例,最大径4～15cm,中位数6cm。6例患者均于术前行介入化疗2次,化疗药物为长春地辛4mg或长春新碱2mg 顺氯氨铂40～60mg 表阿霉素50～80mg。1例右侧小腿小圆细胞肉瘤患者在介入化疗间行静脉化疗1次,1例右侧小腿原始神经外胚层肿瘤患者采用介入化疗、Co^60局部放疗、静脉化疗1次及肿块广泛切除术,1例左侧大腿高分级软组织肉瘤患者介入化疗后行左股后肌间室切除术,余3例行介入化疗及肿块广泛切除术,病理诊断分别为小腿腺泡状横纹肌肉瘤、胭窝滑膜肉瘤、小腿腺泡状软组织肉瘤。结果介入化疗后肿块最大径缩小1～8cm,其中缩小8cm者系肿块完全消失。6例患者均成功保全肢体,下肢行走及运动功能无障碍。6例患者均于介入后出现轻度患肢水肿及局部胀痛,1例并发下肢毛细淋巴管炎,远期患肢局部皮肤色素沉着。随访6～20个月,患者均存活,1例于术后2个月发现肺部阴影,局部无复发。结论青少年下肢高分级软组织肉瘤行介入化疗可使肿块缩小,增加手术保肢可能。     

The control of foot force during pushing efforts against a moving pedal

The muscle component of the force applied to a bicycle pedal (foot force) by seated humans provided insight into the organization of the motor system. Healthy adults (n=11) pedaled a stationary cycle ergometer while attempting to match peak foot force magnitude to visually presented force targets (200, 250, ..., 650 N). Pedaling cadence was maintained at 60 rpm by a motor. Measurements of the foot force, pedal angle, and crank angle were recorded. The experimental design and data analysis allowed the isolation of the muscle component of the foot force from the contributions due to gravity and inertia. A graphical representation of the muscle component of the foot force (force path) was created for each of several crank angles throughout the extension phase of the pedaling cycle. The force paths showed several highly conserved characteristics across participants and crank angles. Each force path occupied a narrow range in force space despite the ability of the participants to produce force in a wide region of force space. Three control strategies were observed in the geometry of the force paths. Eighty five percent of the force paths were linear for six of the participants, and 79% of the force paths had second-order curvature for the other five participants. The curvature was concave to the posterior for four of the participants and concave to the anterior for one participant. The linear force paths were consistent with the previously reported linear nature of the force paths for pushes against a quasi-static pedal. The observation of simple force path geometry for two tasks with dissimilar dynamic characteristics suggests that this aspect of foot force control may be common to a range of lower limb tasks and may reflect a mechanism by which the nervous system organizes the control of foot force. Electronic Publication     

Prolonged muscle vibration reduces maximal voluntary knee extension performance in both the ipsilateral and the contralateral limb in man

Previous studies have shown that prolonged vibration of the rectus femoris decreases maximal voluntary knee extension performance in the ipsilateral leg. In the present study, measurements of maximal voluntary isometric knee extension contractions with the ipsilateral (right) leg and the contralateral (left) leg were made immediately before and after vibration treatment. Significant reductions in maximal force and maximum rate of force generation occurred in both the ipsilateral and contralateral legs following 30 minutes of continuous vibration at both 30 Hz and 120 Hz, with 30 Hz causing the greatest ipsilateral effects. However, although the level of neural activation (iEMG) of the vibrated muscle (right rectus femoris) was reduced following 30 Hz vibration (P=0.026), there were no significant changes occurring in a synergistic muscle (right vastus lateralis) or in either contralateral muscle. It was concluded that muscle vibration may act through spinal reflex pathways to influence the homonymous motoneuron pool. The effects on contralateral force but not specific muscle iEMG suggest an effect on heteronymous motoneuron pools or an effect acting on central descending drive to contralateral muscles. These findings may have implications for the rehabilitation of patients with an immobilised limb. Electronic Publication     

Physical,mental, and social predictors of functional outcome in unilateral lower-limb amputees

OBJECTIVE: To study the value of physical, mental, and social characteristics as predictors of functional outcome of elderly amputees. DESIGN: Prospective, inception cohort study; comparisons with reference populations. SETTING: Main hospitals, rehabilitation centers, nursing homes, patients' own residence settings in 1 of the 3 northern provinces in the Netherlands. PARTICIPANTS: Forty-six patients older than 60 years, with unilateral transtibial or transfemoral amputation or knee disarticulation because of vascular disease. INTERVENTIONS: Measurement of physical, mental, and social predictors 2 and 6 weeks postamputation. MAIN OUTCOME MEASURES: The Sickness Impact Profile (SIP-68), Groningen Activity Restriction Scale (GARS), Timed up and go (TUG) test, and prosthetic use. RESULTS: A total of 15% of amputees died within the first year after amputation. Seventy percent lived independently at home 1 year postamputation. The functional level of the patients was low, as shown by high scores on the SIP-68 (mean, 23.6), GARS (mean, 41.2), and TUG test (mean, 23.9s). Functionally effective prosthetic use, as measured with the classification of Narang and Pohjolainen, was reached by 49%. For the SIP-68 scores, age, comorbidity, 1-leg balance, and the 15-word test predicted functional outcome in 69% of amputees. For the GARS score, age, 1-leg balance, and the 15-word test predicted functional outcome in 64%. For the TUG test, age and 1-leg balance predicted functional outcome in 42% of amputees. After correction for age, the only significant predictor for prosthetic use was 1-leg balance. CONCLUSIONS: Elderly patients with a leg amputation had a low functional level 1-year postamputation. An important part of functional outcome could be predicted 2 weeks after amputation by age at amputation, 1-leg balance on the unaffected limb, and cognitive impairment. Severe comorbidity probably also played a role. The results may be used in the general policy concerning leg amputees.     

数字化立位全脊柱与全下肢成像技术的初步研究

目的：探讨数字化立位全脊柱和全下肢成像技术。方法：在数字化X线成像设备上，检查28例全脊柱和18例全下肢患者，共得到68幅全脊柱和全下肢图像，评价图像的效果。结果：按照合格图像标准衡量图像，62幅图像一次成像合格。结论：在图像工作站实现全脊柱和全下肢成像技术，对普及全脊柱和下肢检查具有很好的推广应用价值。