What Is the Accuracy of Shoulder Range of Motion Measurements on Physical Exam?

The purpose of this study is to investigate a new method for measuring shoulder range of motion (ROM) in an orthopedic practice utilizing a smartphone application to improve accuracy from physical exam typically used in research. Our aim is to evaluate the application, Physio2Go (P2G), which uses a virtual goniometer, assessing validity by comparing its measurements to those taken by a universal goniometer (UG). Two observers of varying clinical experience, a research assistant and research fellow, compared measurements. Statistically, we used the intra-class correlation coefficient (ICC), standard error of measurement (SEM), and the Pearson correlation coefficient (PCC). Following validation we tested P2G in symptomatic postoperative shoulder patients measuring forward flexion (FF) and external rotation (ER). We compared P2G measurements to visual estimation (VE) done by a fellowship trained orthopedic surgeon. Statistically we used ICC, Bland- Altman plots with 95% limits of agreement (LOA), and scatter plots. We examined the impact of the application using Welch’s t-test comparing pre-to-postoperative ROM improvements using the values obtained by P2G and VE. We found high intra-rater reliability of P2G for both observers, substantial correlation between UG and P2G measurements, highly correlated inter-observer reliability for UG and P2G, and statistically significant PCC values (p < 0.05). As expected, ROM measurements of symptomatic patients comparing P2G and VE measurements demonstrated lower correlation. Bland-Altman plots demonstrated wide confidence intervals;scatterplots and histograms confirmed low agreement among measurement methods. Clinical application demonstrated varying statistical significance depending on whether measurements were done by P2G or VE. Our study found that P2G provided superior reliability compared to the customary physical exam routinely used for orthopedic research. The value of using this application instead of a UG is the ease of use and the ability for any member of the healthcare team, regardless of clinical experience to be able to produce reliable and valid measurements.

Radiographic Circularity of Capitellum and Its Relation to the Range of Motion

Background: The shape of the capitellum has been traditionally described in anatomy books as part of a sphere. Alteration in the capitellar morphology following pathologies such as fractures, osteochondrosis, and degenerative arthritis has been associated with less optimum functional results. Aim: To define the relationship between the sphericity of the capitellar morphology as measured on trauma series plain radiographs and the elbow range of motion. Methods: 40 patients were included in the study. All patients recruited from the upper limb clinics presented with non-elbow joint-related complaints. The elbow range of motion was measured using a standardized technique. Digital anteroposterior and lateral radiographs of patients’ elbows were used to measure capitellar circularity using the ImageJ processing program and circularity calculation equation. Correlation analyses were conducted between the degree of capitellar sphericity and elbow range of motion. Results: The results of measurements from the anteroposterior radiographs showed a positive correlation between increased circularity and an increase in the range of flexion, pronation, and supination. The range of extension decreased with the increased circularity of the capitellum. This trend was repeated with measures of lateral radiographs but was statistically not significant. Conclusion: Native capitellar circularity has an impact on the elbow range of motion. This should be put into consideration when dealing with pathologies that affect capitellar morphology.

Electrical Stimulation in Addition to Passive Exercise Has a Small Effect on Spasticity and Range of Motion in Bedridden Elderly Patients: A Pilot Randomized Crossover Study

Purpose: Belt electrode skeletal muscle electrical stimulation (B-SES) can stimulate large portions of muscles including deep sites without localisation of the stimulation area. The purpose of this study is to investigate both immediate treatment effects of B-SES and long-term treatment effects of B-SES with passive exercise on range of motion (ROM) and muscle tone of lower extremities in bedridden elderly patients. Methods: Outcome measures before and after B-SES treatment alone (4 Hz, 20 min, both lower extremities) were examined for the immediate effect. Outcome measures were: ROM and Modified Ashworth scale (MAS) of hip flexion and adduction;knee flexion and extension;and knee joint distance at position of flexion abduction in hip (distance of knee). A randomized crossover trial was conducted to examine the long-term effect of adding B-SES to passive exercise on ROM and MAS. Results and Discussion: The immediate effect study had 18 patients. ROM and MAS of 4 joint angles in 2 joints and distance of knee significantly improved after B-SES treatment. The long-term effect study had 11 patients. Friedman test revealed ROM and MAS of 4 joint angles in 2 joints and distance of knee significantly improved during B-SES intervention but not control intervention. B-SES in addition to passive stretch has a more statistically significant effect on contracture and spasticity in large portions of the lower extremities of bedridden elderly patients than passive stretching alone. Conclusions: We consider B-SES a useful tool to improve the ROM in lower extremities of bedridden patients.

Obesity Effect on Children Hip and Knee Range of Motion

The aim of this study was to characterize the obesity effect on children knee and hip joint range of motion. A randomized controlled trial was performed with goniometry evaluation for hip flexion, extension, abduction, adduction, external and internal rotation, and knee flexion in fifty male children (20 obese and 30 non obese), with age ranging from 6 to 12 years old. The obesity effect was found to be non-uniform across the joint range of motion. In the obesity group, a statistically significant reduction in the range of motion of hip flexion and adduction, and knee flexion was observed;and also an increase in external rotation in the hip was observed. Conclusion: Obese and overweight children present alterations in hip and knee joints mobility when compared to eutrophic children. The obesity/overweight associated with factors previously described in the literature, such as joint overload, postural deviation and sedentariness may influence the musculoskeletal development and, consequently, the motor function.

Dry needling at myofascial trigger points mitigates chronic post-stroke shoulder spasticity

Post-stroke spasticity is associated with restriction in the range of motion of the shoulder.Reducing muscular dystrophy may help relieve muscular dysfunction in patients with post-stroke shoulder spasticity.Dry needle therapy is a method of needling the trigger points using a syringe needle without the use of a drug.Dry needle therapy is commonly used for pain at the shoulder,neck,waist,and back.In this case study,a 62-year-old male patient affected with cerebral hemorrhage of the right frontal lobe had received rehabilitative treatment for 12 years.However,he still experienced shoulder spasticity.The patient received daily dry needling at the trigger points of infraspinatus,teres minor,posterior deltoid,and pectoralis major on 9 days.After the first and ninth treatment,the Modified Ashworth Scale and the passive range of motion of the shoulder was used to assess the effect of the treatment.The spasticity and range of motion of the shoulder showed obvious improvement.These results indicate that dry needling at the myofascial trigger points can effectively treat chronic poststroke shoulder spasticity.

Influence of enhancing dynamic scapular recognition on shoulder disability,and pain in diabetics with frozen shoulder:A case report

BACKGROUND Frozen shoulder(FS)is a familiar disorder.Diabetics with FS have more severe symptoms and a worse prognosis.Thus,this study investigated the influence of enhancing dynamic scapular recognition on shoulder disability and pain in diabetics with FS.CASE SUMMARY A Forty-five years-old male person with diabetes mellitus and a unilateral FS(stage II)for at least 3 mo with shoulder pain and limitation in both passive and active ranges of motion(ROMs)of the glenohumeral joint of≥25%in 2 directions participated in this study.This person received dynamic scapular recognition exercise was applied to a diabetic person with a unilateral FS(stage II).The main outcome measures were upward rotation of the scapula,shoulder pain and disability index,and shoulder range of motion of flexion,abduction,and external rotation.The dynamic scapular exercise was performed for 15 min/session and 3 sessions/wk lasted for 4 wk.After 4 wk of intervention,there were improvements between pre-treatment and post-treatment in shoulder pain,shoulder pain and disability index,shoulder ROM,and upward rotation of the scapula.CONCLUSION This case report suggested that enhancing dynamic scapular recognition may improve shoulder pain and disability;upward rotation of the scapula;and shoulder ROM of shoulder abduction,flexion,and external rotation after 4 wk.

Future of Treatment of Temporomandibular Joint Dysfunctions in Parkinsonian Patients

The purpose of the study was designed to clarify the modern trends of physical therapy in treatment of temporomandibular joint dysfunctions in Parkinsonian patients, which in this respect included the degree of pain, the muscles power of both masseter and pterygoid, the range of TMJ motion, the angle of mouth opening and their effects on electromyography study in both sexes. Subjects: Thirty males and females were the same degree of disabilities according to modified Hoehn and Yahr scales (grade 3) of Parkinsonian patients, and their age ranged from 50 - 77 years old and their weight ranged from 60 - 88 kg. They were randomly divided into two equal groups (G1 and G2). G1 (control) consisted of 15 patients of both sexes and was treated by exercises therapy program and G2 (experimental) consisted of 15 Parkinsonian patients of both sexes and was treated by the same exercises therapy program and low level pulsed electromagnetic therapy. Vital signs such as blood pressure, body temperature, pulse rate and respiratory rate were measured before and after the treatment sessions. Assessments: Visual analogue scale was used to measure degree of pain. Tensiometer was used to measure the muscle power of masseter and pterygoid, the digital goniometer was used to investigate the range of TMJ movement. Moreover, standard electromyography test (EMG) was used to measure the compound muscle action potentials. Statistically the results for all groups were analyzed by t-test to compare the differences between the two groups. The statistical package of social sciences (SPSS, version 10) was used for data processing using the P-value 0.05 as a level of significance. Results showed that there were significant improvements in all variables in G2 only. However, there was a little improvement but not significant in both G1. Therefore, it could be concluded that the use of low level pulsed electro-magnetic therapy combined with exercises program was the good method to control pain of TMJ, increase of muscle power and the range of their movements together with determination of electro-myography. Our results opened a new link to manage the TMJ dysfunctions in Parkinsonian patients via the use of low level pulsed electromagnetic therapy combined with exercises program.

Shoulder joint flexibility in top athletes

Joint range of motion (ROM) is very important in daily activities, sport and in clinical diagnosis. Many factors have been reported to influence joint ROM. Musculoskeletal adaptation and some special side effects due to his or her physical demands and movement patterns in professional athletes are very important subjects in sport sciences. The present study is a comparison of shoulder joint ROM in elite athlete and non-athlete groups and its relationship to their age, post and years of their tournament play. The subjects in this study included 106 men with mean age (23.65 &#177;3.45) and mean years of tournament play (5.60 &#177;2.23). The groups of subjects included 26 handball players, 25 volleyball players, 25 soccer players and 30 non-athletes. Data were collected through questionnaires and inspection, and subjects’ ROM was measured by “Leighton flex- ometer” (r = 0.90 – 0.99) in external rotation and abduction of shoulder joint in dominant and non-domi- nant hands. Data were analyzed by correlation coefficient, t – test, ANOVA and post hock Schaffe test. The results showed that an increase in age and years of tournament play reduced the shoulder ROM of subjects (p ≤ 0.05). There were significant differences in shoulder ROM among athletic groups. Additionally, there are significant differences between dominant and non-dominant hands (p ≤ 0.05). It can be concluded that more specific stretching exercises and warm-up for shoulder in all athletes and especially in older and experienced players should be performed by coaches. The results also emphasized routine screening, corrective exercise programs and a design of preventing strategies by athletic trainers and coaches.

游泳运动对大鼠创伤性关节挛缩的影响及机制

背景:早期运动是预防创伤性关节挛缩的主要方式,也是近期研究热点。游泳运动借助水的特殊物理特性,可能是潜在有益的干预方式。目的:观察游泳运动对大鼠关节挛缩发展的影响,探究游泳运动预防关节挛缩的相关机制。方法:24只SD大鼠随机分为空白对照组(n=8)和关节挛缩造模组(n=16),手术制备膝关节挛缩模型后,再随机分为手术对照组(n=8)和游泳干预组(n=8)。游泳干预组在术后第2周开始游泳干预,共干预5周。在术后第6周,测试各组大鼠体质量、术侧膝关节活动度、股四头肌直径,计算直径-体质量指数;苏木精-伊红染色观察膝关节囊和股四头肌病理变化;Masson染色观察关节囊胶原纤维化改变;免疫组化检测膝关节囊中转化生长因子β1和Ⅰ型胶原蛋白表达;Western blot检测股四头肌中MuRF1蛋白的表达。结果与结论:①与空白对照组比较,手术对照组和游泳干预组大鼠膝关节活动度下降,总伸膝受限角度和关节源性伸膝受限角度均明显增加(P<0.01),股四头肌直径下降(P<0.01),关节囊出现明显纤维化表现,股四头肌萎缩,手术对照组直径-体质量指数降低(P<0.01);与手术对照组比较,游泳干预组大鼠膝关节活动度和股四头肌直径明显增加(P<0.01),关节囊纤维化病变和股四头肌萎缩明显改善;②与空白对照组比较,手术对照组和游泳干预组大鼠关节囊中胶原纤维含量、转化生长因子β1和Ⅰ型胶原蛋白表达均增加(P<0.01);与手术对照组比较,游泳干预组大鼠关节囊中胶原纤维含量、转化生长因子β1和Ⅰ型胶原蛋白表达均降低(P<0.01);③与空白对照组比较,手术对照组和游泳干预组大鼠股四头肌中MuRF1蛋白表达增加(P<0.05);与手术对照组比较,游泳干预组大鼠股四头肌中MuRF1蛋白表达降低(P<0.05)。结果表明:早期游泳干预能够降低创伤性挛缩大鼠关节囊中转化生长因子β1和Ⅰ型胶原蛋白表达,降低股四头肌中MuRF1蛋白表达,提高关节活动度和股四头肌直径,抑制关节挛缩的发展。

Is clinically measured knee range of motion after total knee arthroplasty‘good enough?’:A feasibility study using wearable inertial measurement units to compare knee range of motion captured during physical therapy versus at home

Total knee arthroplasty is highly successful,in part due to range of motion(RoM)recovery.This is typically estimated goniometrically/visually by physical therapists(PTs)in the clinic,which is imprecise.Accordingly,a validated inertial measurement unit(IMU)method for capturing knee RoM was deployed assessing postoperative RoM both in and outside of the clinical setting.The study's objectives were to evaluate the feasibility of continuously capturing knee RoM pre-/post-op via IMUs,dividing data into PT/non-PT portions of each day,and comparing PT/non-PT metrics.We hypothesized IMU-based clinical knee RoM would differ from IMU-based knee RoM captured outside clinical settings.10 patients(3 M,69±13 years)completed informed consent documents following ethics board approval.A validated IMU method captured long duration(8–12 h/day,~50 days)knee RoM pre-/post-op.Post-op metrics were subdivided(PT versus non-PT).Clinical RoM and patient reported outcome measures were also captured.Compliance and clinical disruption were evaluated.ANOVA compared post-op PT and non-PT means and change scores.Maximum flexion during PT was less than outside PT.PT stance/swing RoM and activity level were greater than outside PT.No temporal variable differences were found PT versus non-PT.IMU RoM measurements capture richer information than clinical measures.Maximum PT flexion was likely less than non-PT due to the exercises completed(i.e.high passive RoM vs.low RoM gait).PT gait flexion likely exceed non-PT because of‘white coat effects’wherein patients are closely monitored clinically.This implies data captured clinically represents optimum performance whereas data captured non-clinically represents realistic performance.

Thera-Band弹力带主动运动疗法联合滑囊内注射曲安奈德对肩峰-三角肌下滑囊病变患者肩关节活动度的影响

目的探究Thera-Band弹力带主动运动疗法联合滑囊内注射曲安奈德对肩峰-三角肌下滑囊病变患者肩关节活动度的影响.方法选取我院2018年10月—2020年10月收治的68例肩峰-三角肌下滑囊病变患者为研究对象,随机分为联合组和单一组,每组34例.单一组采用滑囊内注射曲安奈德治疗,联合组采用Thera-Band弹力带主动运动疗法联合滑囊内注射曲安奈德治疗,比较两组治疗前后的疼痛程度、肩关节活动度和肩关节功能障碍程度.结果治疗后,两组的疼痛视觉模拟评分(VAS)、肩关节功能障碍指数量表(SPADI)评分均低于治疗前,且联合组VAS评分、SPADI评分均低于单一组,组间差异有统计学意义(P<0.05).治疗后,两组的肩关节活动度评分均高于治疗前,且联合组评分高于单一组,组间差异有统计学意义(P<0.05).结论采用Thera-Band弹力带主动运动疗法联合滑囊内注射曲安奈德治疗肩峰-三角肌下滑囊病变患者能够提升治疗效果,减轻疼痛,增强肩关节活动度,改善肩关节功能障碍程度.

Therapeutic observation of arthrolysis under brachial plexus anesthesia for adhesivecapsulitis of the shoulder

Objective:To objectively evaluate the short-term and long-term efficacies of arthrolysis under brachial plexus anesthesia in treating adhesive capsulitis of the shoulder(ACS).Methods:One hundred patients diagnosed with ACS were divided into two groups using the random number method.The two groups both received same active rehabilitation exercises.Besides,55 cases in the treatment group were given one session of arthrolysis under brachial plexus anesthesia,and 45 cases in the control group were given tuina treatment.Changes in the visual analog scale(VAS)score,Melle score and pressure pain index were observed I month and 3 months after treatment.The therapeutic efficacies were also compared.Results:The total effective rate was 96.4%at the 1-month follow-up and 96.4%at the 3-month follow-up in the treatment group.The total effective rate was 33.3%at the 1-month follow-up and 28.9%at the 3-month follow-up in the control group.There were significant differences between the two groups comparing the total effective rate at the two time points(both P<0.05).The scores of VAS,Melle and pressure pain were significantly different at the 1-month and 3-month follow-ups from those before treatment in the treatment group(all P<0.05);the three scores did not show significant differences at the 1-month and 3-month follow-ups compared with those before treatment in the control group(all P>0.05).Conclusion:Based on the active rehabilitation exercises,one session of arthrolysis under brachial plexus anesthesia can release the adhesion and restore the range of motion and function of shoulder joint in ACS patients.It is superior to rehabilitation exercises plus tuina treatment comparing both short-term and long-term efficacies.

全膝关节置换中BrainlabKnee3导航辅助间隙平衡技术的应用优势

背景:近年来,计算机导航技术辅助关节置换逐渐受到医疗领域的关注。文献报道计算机导航在全膝关节置换中的应用临床效果不一。为了探索新一代Brainlab Knee 3导航系统的临床效果,进行了此项研究。目的:分析计算机导航系统(Brainlab Knee 3)结合间隙平衡技术在全膝关节置换中的应用效果。方法:2020年11月至2021年5月大连市第二人民医院关节外科收治71例行全膝关节置换患者,导航组35例,术中采用计算机导航结合间隙平衡技术行全膝关节置换;传统组36例,术中采用传统手术器械定位截骨。比较两组患者术中内、外侧关节间隙差;膝关节活动度、KSS评分;髋膝踝角;冠状面股骨组件角、冠状面胫骨组件角和矢状面胫骨组件角偏差值。结果与结论:①导航组伸直位内外侧间隙差0,1,2 mm的患者分别为19,14,2例;屈膝90°位内外侧间隙差0,1,2 mm的患者分别为18,15,2例。传统组伸直位内外侧间隙差0,1,2 mm的患者分别为10,20,6例;屈膝90°位内外侧间隙差0,1,2 mm的患者分别为10,15,8例。②导航组手术时间长于传统组(P<0.05),导航组有2例患者术后形成下肢肌间静脉血栓,传统组患者均无并发症。③置换后6,12个月两组患者膝关节活动度均明显增加,导航组膝关节活动度高于传统组(P<0.05)。④置换后12个月两组患者KSS评分均明显增加,导航组KSS评分高于传统组(P<0.05)。⑤置换后6个月髋膝踝角、冠状面股骨组件角、冠状面胫骨组件角、矢状面胫骨组件角偏差值均显著小于传统组(P<0.05)。⑥结果表明,采用计算机导航结合间隙平衡技术辅助全膝关节置换对关节活动度、下肢力线、胫骨假体组件位置的准确性方面具有优势,置换后关节功能恢复良好。

Thera-Band弹力带训练联合关节松动术治疗冻结肩对患者日常生活活动能力的影响

目的研究Thera-Band弹力带训练联合关节松动术治疗冻结肩对患者日常生活活动能力的影响。方法选取2019年6月至2020年12月清远市清新区人民医院收治的肩周炎患者60例,按随机数字表法随机分成对照组和观察组,各30例。两组患者均予牵伸疗法,对照组予以关节松动术干预治疗,观察组予以Thera-Band弹力带训练联合关节松动术干预治疗,并对比两组患者干预治疗后肩部疼痛程度、生活质量情况、关节活动度及关节局部形态改善情况。结果治疗前两组疼痛视觉模拟评分(VAS)差异无统计学意义(P>0.05);治疗6周后观察组VAS评分明显低于对照组(P<0.05)。治疗前两组关节活动度差异无统计学意义(P>0.05);治疗6周后观察组关节活动度明显大于对照组(P<0.05)。治疗前两组肩关节功能评分差异无统计学意义(P>0.05);治疗6周后观察组肩关节功能评分明显高于对照组(P<0.05)。治疗前两组日常活动分度差异无统计学意义(P>0.05);治疗6周后观察组日常活动分度明显优于对照组(P<0.05)。结论Thera-Band弹力带训练联合关节松动术治疗冻结肩对患者日常生活活动能力有改善效果。

肌骨超声在不同时期痛风性关节炎中的超声表现特征及其与关节活动度的相关性分析

目的:探讨肌骨超声在不同时期痛风性关节炎中的超声表现特征及其与关节活动度的相关性。方法:选取2020年1月—2023年12月新疆医科大学第六附属医院收治的痛风性关节炎患者80例,将处于慢性期间歇期急性发作和首次发作的患者分为急性发作组(n=50),将慢性期非急性发作的患者分为非急性发作组(n=30)。依照DAS28评分结果进行不同关节活动度分组,分为缓解期组(n=15),低活动期组(n=21)、中活动期组(n=32)与高活动期组(n=12),对比不同关节活动度痛风性关节炎患者肌骨超声评分,并分析相关性。结果:急性发作组的病程短于非急性发作组(P<0.05);急性发作组的痛风石、双轨征人数低于非急性发作组,滑膜炎人数高于非急性发作组(P<0.05);肌骨超声诊断痛风性关节炎急性发作的准确率、灵敏度、阳性预测值分别为90.00%、93.75%、95.74%;不同关节活动度患者关节积液评分、骨侵蚀评分、血流信号评分、滑膜增生评分及总分对比,差异有统计学意义(P<0.05),且高活动期组高于中活动期组、低活动期组与缓解期组(P<0.05);Spearman相关分析结果显示:关节积液评分、骨侵蚀评分、血流信号评分、滑膜增生评分及肌骨超声总评分与痛风性关节炎关节活动度呈正相关(P<0.05)。结论:不同时期痛风性关节炎肌骨超声表现特征具有一定差异,通过肌骨超声可对急性期痛风性关节炎的诊断提供重要参考,且肌骨超声评分与痛风性关节炎关节活动度具有密切关系,可作为评估患者疾病活动度的重要手段。

基于“同气相求”理论巨刺法治疗手太阳经证肩周炎急性期的临床研究

目的:分析以“同气相求”理论为基础巨刺法治疗手太阳经证急性期肩周炎的临床疗效。方法:选取2022年1月—2022年12月本院收治的手太阳经证急性期肩周炎98例患者进行研究,随机数字表法分成对照组(常规针刺法)和观察组(以“同气相求”理论为基础巨刺法)各49例,观察两组临床疗效;治疗前后肩关节活动度、视觉模拟量表(VAS)得分、肩关节功能评分、血清细胞介素-6(IL-6)、白细胞介素-8(IL-8)、肿瘤坏死因子-α(TNF-α)、C-反应蛋白(CRP)、血细胞比容、血浆黏附、全血低切以及高切水平。结果:观察组总有效率高于对照组,差异具有统计学意义(P<0.05)。治疗前,两组外展、后伸、前屈和外旋时的肩关节活动度比较差异无统计学意义(P>0.05);治疗后,观察组外展、后伸、前屈和外旋时的肩关节活动度均高于对照组,差异具有统计学意义(P<0.05)。治疗前,两组肩关节功能评分比较差异无统计学意义(P>0.05);治疗1周及2周,观察组肩关节功能评分高于对照组,差异具有统计学意义(P<0.05)。治疗前,两组IL-6、IL-8、TNF-α及CRP水平比较差异无统计学意义(P>0.05);治疗后,观察组IL-6、IL-8、TNF-α及CRP水平均低于对照组,差异具有统计学意义(P<0.05)。治疗前,两组血细胞比容、血浆黏附、全血低切和全血高切水平比较差异无统计学意义(P>0.05);治疗后,观察组血细胞比容、血浆黏附、全血低切及全血高切水平均低于对照组,差异具有统计学意义(P<0.05)。结论:以“同气相求”理论为基础巨刺法对手太阳经证急性期肩周炎疗效理想,能提高患者的肩关节活动度,减轻其疼痛感及炎症反应,改善其肩关节功能及局部血供。

神经肌肉电刺激系统联合康复训练在脑卒中后肢体功能障碍患者康复中的应用价值

目的:探究神经肌肉电刺激系统联合康复训练在脑卒中后肢体功能障碍患者康复中的应用价值。方法:选取2022年1—12月第九〇九医院收治的95例脑卒中后肢体功能障碍患者作为研究对象。按照随机数字表法分为对照组(n=47)和观察组(n=48)。观察组行康复训练联合神经肌肉电刺激系统干预,对照组仅接受康复训练干预,两组均持续干预3个月。比较两组干预前后改良Ashworth量表(MAS)评分、患肢各关节主动活动度、脑卒中康复运动功能评定量表(STREAM)评分。结果:干预前,两组MAS评分、患肢各关节主动活动度、STREAM评分比较,差异均无统计学意义(P>0.05);干预后,两组患侧上肢肌肉痉挛、下肢肌肉痉挛评分均低于干预前,且观察组均低于对照组,差异均有统计学意义(P<0.05);干预后,两组肩关节外展、肘关节屈曲、腕关节掌屈、手掌指关节屈曲、髋关节内外旋、膝关节屈伸主动活动度均高于干预前,且观察组均高于对照组,差异均有统计学意义(P<0.05)。干预后,两组上肢运动、下肢运动、基本活动评分及总分均高于干预前,且观察组均高于对照组,差异均有统计学意义(P<0.05)。结论:在脑卒中后肢体功能障碍患者康复中应用神经肌肉电刺激系统联合康复训练可以有效缓解其肌肉痉挛情况,改善关节活动度,提高肢体运动功能。

补肾养血方治疗老年膝关节骨关节炎的效果

目的观察补肾养血方加减治疗老年膝关节骨关节炎(KOA)的效果。方法选取该院2019年10月至2022年12月收治的106例老年中重度KOA患者为研究对象,根据用药方案分为两组。两组均给予关节镜下清理治疗,对照组术后24h在关节腔内注射玻璃酸钠治疗。养血方组在对照组基础上给予补肾养血方加减治疗,比较两组治疗效果。结果与治疗前比较,两组膝关节伸直活动度治疗后下降,膝关节屈曲活动度治疗后升高,但治疗后无统计学差异(P>0.05)。与治疗前比较,两组血清白细胞介素-17(IL-17)、肿瘤坏死因子-α(TNF-α)、CC趋化因子配体18(CCL18)治疗后下降,且养血方组低于对照组(P<0.05);两组血清转化生长因子β1(TGF-β1)治疗后升高,且养血方组高于对照组(P<0.05)。与治疗前比较,两组滑膜厚度、关节腔积液厚度治疗后下降,且养血方组低于对照组(P<0.05);与治疗前比较,两组中医症状积分、视觉模拟(VAS)平分、骨关节炎指数量表(WOMAC)评分治疗后下降,且养血方组低于对照组(P<0.05);两组下肢Fugl-Meyer(FMA)评分治疗后升高,且养血方组高于对照组(P<0.05)。两组不良反应发生率比较,未见统计学差异(P>0.05)。结论补肾养血方加减治疗老年中重度KOA可促进炎症的吸收,改善膝关节活动度,促进膝关节功能恢复。

关刺法不同针刺频率及留针时效对膝骨性关节炎患者疼痛、最大主动关节活动度及血清FGF-2水平的影响

目的:探究关刺法不同针刺频率及留针时效对膝骨性关节炎(KOA)患者疼痛、最大主动关节活动度及血清成纤维细胞生长因子-2(FGF-2)水平的影响。方法:将100例KOA患者随机分为关刺1组(50例,治疗时需留针40 min, 3 d/次)与关刺2组(50例,治疗时需留针30 min, 2 d/次),治疗3周后,观察比较两组患者治疗前后的疼痛评分、骨关节炎指数(WOMAC)评分、最大主动关节活动度及血清FGF-2水平的变化情况。结果:关刺1组总有效率(45/50,90.00%),关刺2组总有效率(48/50,96.00%),两组比较差异无统计学意义(P>0.05)。治疗后,关刺1组、关刺2组KOA患者的疼痛评分和WOMAC评分(关节功能评分、僵硬评分、疼痛评分与总分)均低于治疗前,差异具有统计学意义(P<0.05),关刺2组KOA患者的疼痛评分、WOMAC评分(关节功能评分、僵硬评分、疼痛评分与总分)均低于关刺1组,差异具有统计学意义(P<0.05);关刺1组、关刺2组KOA患者的最大主动关节活动度和血清FGF-2表达水平均高于治疗前,差异具有统计学意义(P<0.05),关刺2组KOA患者的最大主动关节活动度、血清FGF-2表达水平均高于关刺1组,差异具有统计学意义(P<0.05);两组治疗期间均未出现明显的不良反应。结论:采用关刺法留针30 min, 2 d 1次的方法治疗KOA效果确切,可降低患者疼痛程度,提高血清FGF-2水平,并能改善患者最大主动关节活动度。

保乳术联合乳腔镜腋窝淋巴结清扫术治疗早期乳腺癌的效果

目的探讨保乳术联合乳腔镜腋窝淋巴结清扫术治疗早期乳腺癌的效果。方法选取2021年9月至2022年12月淄博市妇幼保健院乳腺甲状腺外科收治的66例早期乳腺癌患者作为研究对象,按照单双号分组法分为对照组和观察组,每组各33例。对照组行保乳术联合常规腋窝淋巴结清扫术,观察组行保乳术联合乳腔镜腋窝淋巴结清扫术。比较两组肩关节活动度、并发症总发生率、引流管留置时间及术后引流量。结果术后3个月,两组肩关节活动度均小于术前,但观察组大于对照组(P<0.05)。观察组并发症总发生率低于对照组(P<0.05)。观察组引流管留置时间短于对照组,术后引流量少于对照组(P<0.05)。结论保乳术联合乳腔镜腋窝淋巴结清扫术治疗早期乳腺癌,可减少对肩关节活动度的影响,降低并发症发生率,缩短引流管留置时间,减少术后引流量,值得临床推广。