BACKGROUND Necrotizing fasciitis(NF)of the upper extremities is a severe surgical pathology,and the incidence of this disease has been steadily increasing in recent decades.Surgical treatment is accompanied by the for...BACKGROUND Necrotizing fasciitis(NF)of the upper extremities is a severe surgical pathology,and the incidence of this disease has been steadily increasing in recent decades.Surgical treatment is accompanied by the formation of extensive wounds,which can be treated with significant difficulties.In recent years,negative pressure wound therapy(NPWT)has proven to be highly effective.It is also promising for the treatment of NF.AIM To explore the effectiveness of NPWT in the treatment of NF of the upper extremities.METHODS The results of the treatment of 36 patients with NF of the upper extremities in two groups(NPWT group and control group;2022−2023)were retrospectively analyzed.In the NPWT group,the NPWT method(120 mmHg;constant mode)was used after surgical treatment.The number of vacuum-assisted dressings in patients ranged from 1 to 3,depending on the dynamics of the wound process.The duration of fixation of one bandage was up to 2−3 d.In the control group,conventional methods of local wound treatment were used.The following indicators were analyzed:The treatment delay,the prevalence of inflammation,the microbial landscape,the number of debridements,the duration of wound preparation for surgical closure,and the nature of skin plastic surgery.RESULTS Most patients experienced a significant treatment delay[4 d,interquartile range(IQR):2–7 d],which led to the spread of the pathological process to the forearm and shoulder.The most common pathogens were Staphylococcus aureus(14;38.9%)and Streptococcus pyogenes(22;61.1%).The average number of debridements per patient was 5(IQR:3–7),with no difference between groups.The average time to prepare wounds for surgical closure was 11±4 d in the NPWT group and 29±10 d(P=0.00001)in the control group.In the NPWT group,the wounds were more often closed with local tissues(15;83.3%),and in the control group,split-thickness skin grafts were more often used(4;50%).CONCLUSION The predominant isolation of Staphylococcus aureus and/or Streptococcus pyogenes from the lesions allowed us to classify these patients as NF type II.Multiple debridement procedures have become a feature of this disease treatment.The use of NPWT has significantly reduced the time required to prepare wounds for surgical closure.Early closure of wounds allows for more frequent use of local tissue repair,which ensures better results.NPWT is a highly effective way to prepare wounds for early surgical closure in patients with upper extremity NF.展开更多
Objective:To analyze the effect of limb rehabilitation therapy combined with transcranial magnetic stimulation therapy on muscle activity in patients with upper limb dysfunction after cerebral infarction(CI).Methods:3...Objective:To analyze the effect of limb rehabilitation therapy combined with transcranial magnetic stimulation therapy on muscle activity in patients with upper limb dysfunction after cerebral infarction(CI).Methods:320 patients with upper limb dysfunction after CI were selected,all of whom were treated in our hospital between June 2021 and June 2023.They were randomly grouped according to the lottery method into the control group(limb rehabilitation therapy,160 cases)and the intervention group(transcranial magnetic stimulation therapy+limb rehabilitation therapy,160 cases).The upper limb function scores,neuro-electrophysiological indicators,daily living ability scores,and quality of life scores of the two groups were compared.Results:Compared with the control group,upper limb function scores and daily living ability scores in the intervention group were higher after treatment,and the neuro-electrophysiological indicators of the intervention group were lower after treatment(P<0.05).Conclusion:Transcranial magnetic stimulation therapy combined with limb rehabilitation therapy has significant effects in patients with upper limb dysfunction after CI and is worthy of promotion and application.展开更多
With the visual illusion of the mirror,Mirror Therapy,models the primary somatosensory cortex,cortical and muscular excitability,stimulating cortical reorganization and sensorimotor recovery.Studies have shown to be e...With the visual illusion of the mirror,Mirror Therapy,models the primary somatosensory cortex,cortical and muscular excitability,stimulating cortical reorganization and sensorimotor recovery.Studies have shown to be effective in improving motor function in short and medium term,in activities of daily living,in visuospatial neglect and in reducing pain,especially in patients with complex regional pain syndrome.Objective:To report the perception of Occupational Therapists regarding the application of Mirror Therapy in professional practice.Specifically,what factors lead to its application,what are the effects and benefits of the technique,what are its advantages and limitations.Results:In the perception of Occupational Therapists,the Mirror Therapy technique has the following benefits:significant decrease in pain,improved sensitivity and functionality of the upper limb,unblocking movements in the affected limb,decreased phantom pain;as negative aspects:difficulties in spatial/environmental control,patient's perceptual/cognitive skills,high level of concentration/attention,absence of scientific evidence in neurological conditions.Conclusion:For the interviewed Occupational Therapists,the Mirror Therapy is a safe and useful technique to be applied in your professional practice that has been showing positive results in the functional recovery of patients,however,it lacks studies that identify the appropriate time to start its application and the explanation of an intervention protocol.展开更多
BACKGROUND Complex decongestive therapy(CDT)is currently recommended as the standard treatment for lymphedema.CDT is a four-step detumescence therapy that can effectively treat upper limb lymphedema after breast cance...BACKGROUND Complex decongestive therapy(CDT)is currently recommended as the standard treatment for lymphedema.CDT is a four-step detumescence therapy that can effectively treat upper limb lymphedema after breast cancer surgery,and is considered non-invasive,painless and without side effects.AIM To determine the effectiveness of a six-step CDT involving a foam granule bandage for the treatment of upper extremity lymphedema pressure after breast cancer surgical intervention.METHODS The study included 100 patients with upper extremity lymphedema after breast cancer surgery.The surgical methods were mastectomy plus axillary lymph node dissection and breast preservation plus sentinel lymph node biopsy.The study population was further divided into the experimental group and control group with 50 cases in each group.The control group was given conventional CDT(four-step method),which included skin care,freehand lymphatic drainage,foam granule pressurized bandage,and functional exercise.In the experimental group,a six-step CDT method was applied that involved a foam particle bandage combined with air wave pressure therapy in addition to the four steps of conventional CDT.Patients in both groups were given one course of treatment daily(20 times),and the changes in body moisture and subjective symptoms were measured before and after treatment,preoperatively and 20 times after treatment.RESULTS No statistically significant differences in 50-Hz bioelectrical impedance and extracellular moisture ratio were observed between the two groups before treatment,suggesting comparability of the baseline data.After treatment,the 50-Hz bioelectrical impedance of the experimental group was significantly higher than that in the control group,and the extracellular moisture ratio was significantly lower than that in the control group.A comparison of the differences between the two groups before and after treatment indicated that the treatment effect in the experimental group was better than that in the control group.After 20 treatments,according to subjective evaluations,the tightness and swelling of the limbs in the experimental group were significantly reduced as compared with those in the control group.CONCLUSION The six-step CDT method can effectively reduce lymphedema,promote lymphatic circulation,and alleviate the subjective symptoms of patients,and thereby improve the quality of life and treatment compliance among patients.展开更多
Low-frequency repetitive transcranial magnetic stimulation (LF-rTMS) applied to the non-lesional hemisphere is reported to significantly improve motor function of the affected upper limb in adult stroke patients with ...Low-frequency repetitive transcranial magnetic stimulation (LF-rTMS) applied to the non-lesional hemisphere is reported to significantly improve motor function of the affected upper limb in adult stroke patients with hemiparesis. For pediatric stroke patients, the beneficial effects of LF-rTMS have been already confirmed in a randomized controlled study. However, there is no report of therapeutic application of high-frequency rTMS (HF-rTMS) in this patient population. In this case series study, we introduced HF-rTMS combined with intensive occupational therapy (OT) in two pediatric hemiparetic patients. We studied two children (8- and 9-year-old boys, both right-handed) with post-stroke upper limb hemiparesis (chronic phase). Both patients underwent 22 treatment sessions of HF-rTMS/OT during 15-day hospitalization. The HF-rTMS was applied over the lesional motor cortex at a frequency of 10Hz for 15 minutes in each session. One session of intensive OT consisted of 30-min one-to-one training and 30-min self-exercise. Motor function of the affected upper limb was serially evaluated with Fugl-Meyer Assessment (FMA), Wolf Motor Function Test (WMFT), Simple Test for Evaluating hand Function (STEF), and Ten-second Test. Neither of the patients showed any adverse effects. Both patients showed improvement of motor function in the affected upper limb and were able to use the affected upper limb in some activities of daily living. In the two post-stroke pediatric patients, HF-rTMS/OT was safe and improved upper limb muscle function. Confirmation of these effects in a larger population is needed.展开更多
In chronic stage of stroke, it is necessary to pay attention to the complex spatial movements training along with the traditional restoration of balance, strength of particular muscles, and paretic limb joints mobilit...In chronic stage of stroke, it is necessary to pay attention to the complex spatial movements training along with the traditional restoration of balance, strength of particular muscles, and paretic limb joints mobility. The aim of the study was to evaluate the effectiveness of robotic therapy in the recovery of upper limb function in the chronic stage of stroke. The study involved 52 patients with ischemic stroke in the middle cerebral artery. The patients were divided randomly into 2 groups. All patients （5 days/wk × 3 wk） got gymnastics by the standard technique, massage, laser, and pulsed currents therapy. Main group patients （n = 36） extra received complex spatial movements, speed, fluidity, precision and agility training by the robotic electromechanical device Multi Joint System （MJS） （40 minutes, 5 days/wk × 3 wk）. Analysis of the results of the study showed a statistically significant difference in improving ROM of the elbow and shoulder joints, speed and accuracy of movement in the main group compared with the control. Hardware recovery of complex spatial upper limb movements in the chronic stage of stroke increases the functionality and independence of the patient＇s domestic skills.展开更多
目的观察针刺联合镜像疗法治疗脑卒中患者上肢运动功能障碍的临床疗效。方法将90例脑卒中上肢运动功能障碍患者按随机数字表法分为对照1组(30例,给予针刺治疗)、对照2组(30例,给予镜像疗法治疗)和观察组(30例,给予针刺联合镜像疗法治疗)...目的观察针刺联合镜像疗法治疗脑卒中患者上肢运动功能障碍的临床疗效。方法将90例脑卒中上肢运动功能障碍患者按随机数字表法分为对照1组(30例,给予针刺治疗)、对照2组(30例,给予镜像疗法治疗)和观察组(30例,给予针刺联合镜像疗法治疗),疗程均为2周。比较3组患者治疗前后Fugl-Meyer评估量表上肢板块(Fugl-Meyer assessment upper extremity,FMA-UE)评分,Wolf运动功能测试(Wolf motor function test,WMFT)量表评分,改良Barthel指数(modified Barthel index,MBI),国际功能、残疾和健康分类(international classification of functioning,disability and health,ICF)评分及伸腕主动运动范围(active range of motion,AROM)和基于FMA-UE评分判定临床疗效。结果观察组临床疗效优于对照1组和对照2组(P<0.05);治疗后3组患者FMA-UE评分、WMFT评分、MBI均较治疗前显著增加(P<0.05),ICF评分显著减少(P<0.05),且观察组FMA-UE评分、WMFT评分、MBI增加程度,ICF评分减少程度显著大于对照1组和对照2组(P<0.05);治疗后观察组患者伸腕AROM显著大于对照1组和对照2组(P<0.05)。结论针刺联合镜像疗法能有效改善脑卒中患者上肢运动功能障碍。展开更多
目的:系统评价三种运动疗法对乳腺癌术后患肢淋巴水肿患者上肢功能的康复效果。方法:计算机检索CNKI、万方、维普、Web of Science、PubMed、The Cochran library、Medline、Embase等数据库,搜集2005年1月-2024年5月有关三种运动疗法干...目的:系统评价三种运动疗法对乳腺癌术后患肢淋巴水肿患者上肢功能的康复效果。方法:计算机检索CNKI、万方、维普、Web of Science、PubMed、The Cochran library、Medline、Embase等数据库,搜集2005年1月-2024年5月有关三种运动疗法干预乳腺癌术后患肢淋巴水肿患者上肢功能的随机对照试验(RCT)。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用R软件与Addis软件进行网状Meta分析。结果:共纳入20项RCT,包括1736例乳腺癌术后患肢淋巴水肿患者。网状Meta分析结果显示,在乳腺癌术后患肢淋巴水肿患者手臂周径差康复方面,三种运动疗法均优于对照组(P>0.05);在乳腺癌术后患肢淋巴水肿患者上肢前屈康复方面,有氧训练干预治疗[MD=20.05(11.17,28.69),P<0.05]、抗阻训练干预治疗[MD=11.51(1.04,22.11),P<0.05]显著优于对照组的无干预治疗;在乳腺癌术后患肢淋巴水肿患者上肢后伸康复方面,有氧训练干预治疗[MD=7.72(3.67,11.54),P<0.05]、等速肌力训练干预治疗[MD=10.79(1.65,19.64),P<0.05]显著优于对照组的无干预治疗;在改善乳腺癌术后患肢淋巴水肿患者DASH评分方面,有氧训练干预治疗[MD=22.14(6.80,35.95),P<0.05]、等速肌力训练干预治疗[MD=11.48(1.16,22.34),P<0.05]显著优于对照组的无干预治疗。结论:根据定量合并证据显示,三种运动疗法均可有效改善乳腺癌术后患肢淋巴水肿患者上肢功能。等速肌力训练在干预乳腺癌术后患肢淋巴水肿患者手臂周径差,上肢前屈,上肢后伸,有氧训练在降低DASH方面更具优势。展开更多
文摘BACKGROUND Necrotizing fasciitis(NF)of the upper extremities is a severe surgical pathology,and the incidence of this disease has been steadily increasing in recent decades.Surgical treatment is accompanied by the formation of extensive wounds,which can be treated with significant difficulties.In recent years,negative pressure wound therapy(NPWT)has proven to be highly effective.It is also promising for the treatment of NF.AIM To explore the effectiveness of NPWT in the treatment of NF of the upper extremities.METHODS The results of the treatment of 36 patients with NF of the upper extremities in two groups(NPWT group and control group;2022−2023)were retrospectively analyzed.In the NPWT group,the NPWT method(120 mmHg;constant mode)was used after surgical treatment.The number of vacuum-assisted dressings in patients ranged from 1 to 3,depending on the dynamics of the wound process.The duration of fixation of one bandage was up to 2−3 d.In the control group,conventional methods of local wound treatment were used.The following indicators were analyzed:The treatment delay,the prevalence of inflammation,the microbial landscape,the number of debridements,the duration of wound preparation for surgical closure,and the nature of skin plastic surgery.RESULTS Most patients experienced a significant treatment delay[4 d,interquartile range(IQR):2–7 d],which led to the spread of the pathological process to the forearm and shoulder.The most common pathogens were Staphylococcus aureus(14;38.9%)and Streptococcus pyogenes(22;61.1%).The average number of debridements per patient was 5(IQR:3–7),with no difference between groups.The average time to prepare wounds for surgical closure was 11±4 d in the NPWT group and 29±10 d(P=0.00001)in the control group.In the NPWT group,the wounds were more often closed with local tissues(15;83.3%),and in the control group,split-thickness skin grafts were more often used(4;50%).CONCLUSION The predominant isolation of Staphylococcus aureus and/or Streptococcus pyogenes from the lesions allowed us to classify these patients as NF type II.Multiple debridement procedures have become a feature of this disease treatment.The use of NPWT has significantly reduced the time required to prepare wounds for surgical closure.Early closure of wounds allows for more frequent use of local tissue repair,which ensures better results.NPWT is a highly effective way to prepare wounds for early surgical closure in patients with upper extremity NF.
文摘Objective:To analyze the effect of limb rehabilitation therapy combined with transcranial magnetic stimulation therapy on muscle activity in patients with upper limb dysfunction after cerebral infarction(CI).Methods:320 patients with upper limb dysfunction after CI were selected,all of whom were treated in our hospital between June 2021 and June 2023.They were randomly grouped according to the lottery method into the control group(limb rehabilitation therapy,160 cases)and the intervention group(transcranial magnetic stimulation therapy+limb rehabilitation therapy,160 cases).The upper limb function scores,neuro-electrophysiological indicators,daily living ability scores,and quality of life scores of the two groups were compared.Results:Compared with the control group,upper limb function scores and daily living ability scores in the intervention group were higher after treatment,and the neuro-electrophysiological indicators of the intervention group were lower after treatment(P<0.05).Conclusion:Transcranial magnetic stimulation therapy combined with limb rehabilitation therapy has significant effects in patients with upper limb dysfunction after CI and is worthy of promotion and application.
文摘With the visual illusion of the mirror,Mirror Therapy,models the primary somatosensory cortex,cortical and muscular excitability,stimulating cortical reorganization and sensorimotor recovery.Studies have shown to be effective in improving motor function in short and medium term,in activities of daily living,in visuospatial neglect and in reducing pain,especially in patients with complex regional pain syndrome.Objective:To report the perception of Occupational Therapists regarding the application of Mirror Therapy in professional practice.Specifically,what factors lead to its application,what are the effects and benefits of the technique,what are its advantages and limitations.Results:In the perception of Occupational Therapists,the Mirror Therapy technique has the following benefits:significant decrease in pain,improved sensitivity and functionality of the upper limb,unblocking movements in the affected limb,decreased phantom pain;as negative aspects:difficulties in spatial/environmental control,patient's perceptual/cognitive skills,high level of concentration/attention,absence of scientific evidence in neurological conditions.Conclusion:For the interviewed Occupational Therapists,the Mirror Therapy is a safe and useful technique to be applied in your professional practice that has been showing positive results in the functional recovery of patients,however,it lacks studies that identify the appropriate time to start its application and the explanation of an intervention protocol.
文摘BACKGROUND Complex decongestive therapy(CDT)is currently recommended as the standard treatment for lymphedema.CDT is a four-step detumescence therapy that can effectively treat upper limb lymphedema after breast cancer surgery,and is considered non-invasive,painless and without side effects.AIM To determine the effectiveness of a six-step CDT involving a foam granule bandage for the treatment of upper extremity lymphedema pressure after breast cancer surgical intervention.METHODS The study included 100 patients with upper extremity lymphedema after breast cancer surgery.The surgical methods were mastectomy plus axillary lymph node dissection and breast preservation plus sentinel lymph node biopsy.The study population was further divided into the experimental group and control group with 50 cases in each group.The control group was given conventional CDT(four-step method),which included skin care,freehand lymphatic drainage,foam granule pressurized bandage,and functional exercise.In the experimental group,a six-step CDT method was applied that involved a foam particle bandage combined with air wave pressure therapy in addition to the four steps of conventional CDT.Patients in both groups were given one course of treatment daily(20 times),and the changes in body moisture and subjective symptoms were measured before and after treatment,preoperatively and 20 times after treatment.RESULTS No statistically significant differences in 50-Hz bioelectrical impedance and extracellular moisture ratio were observed between the two groups before treatment,suggesting comparability of the baseline data.After treatment,the 50-Hz bioelectrical impedance of the experimental group was significantly higher than that in the control group,and the extracellular moisture ratio was significantly lower than that in the control group.A comparison of the differences between the two groups before and after treatment indicated that the treatment effect in the experimental group was better than that in the control group.After 20 treatments,according to subjective evaluations,the tightness and swelling of the limbs in the experimental group were significantly reduced as compared with those in the control group.CONCLUSION The six-step CDT method can effectively reduce lymphedema,promote lymphatic circulation,and alleviate the subjective symptoms of patients,and thereby improve the quality of life and treatment compliance among patients.
文摘Low-frequency repetitive transcranial magnetic stimulation (LF-rTMS) applied to the non-lesional hemisphere is reported to significantly improve motor function of the affected upper limb in adult stroke patients with hemiparesis. For pediatric stroke patients, the beneficial effects of LF-rTMS have been already confirmed in a randomized controlled study. However, there is no report of therapeutic application of high-frequency rTMS (HF-rTMS) in this patient population. In this case series study, we introduced HF-rTMS combined with intensive occupational therapy (OT) in two pediatric hemiparetic patients. We studied two children (8- and 9-year-old boys, both right-handed) with post-stroke upper limb hemiparesis (chronic phase). Both patients underwent 22 treatment sessions of HF-rTMS/OT during 15-day hospitalization. The HF-rTMS was applied over the lesional motor cortex at a frequency of 10Hz for 15 minutes in each session. One session of intensive OT consisted of 30-min one-to-one training and 30-min self-exercise. Motor function of the affected upper limb was serially evaluated with Fugl-Meyer Assessment (FMA), Wolf Motor Function Test (WMFT), Simple Test for Evaluating hand Function (STEF), and Ten-second Test. Neither of the patients showed any adverse effects. Both patients showed improvement of motor function in the affected upper limb and were able to use the affected upper limb in some activities of daily living. In the two post-stroke pediatric patients, HF-rTMS/OT was safe and improved upper limb muscle function. Confirmation of these effects in a larger population is needed.
文摘In chronic stage of stroke, it is necessary to pay attention to the complex spatial movements training along with the traditional restoration of balance, strength of particular muscles, and paretic limb joints mobility. The aim of the study was to evaluate the effectiveness of robotic therapy in the recovery of upper limb function in the chronic stage of stroke. The study involved 52 patients with ischemic stroke in the middle cerebral artery. The patients were divided randomly into 2 groups. All patients （5 days/wk × 3 wk） got gymnastics by the standard technique, massage, laser, and pulsed currents therapy. Main group patients （n = 36） extra received complex spatial movements, speed, fluidity, precision and agility training by the robotic electromechanical device Multi Joint System （MJS） （40 minutes, 5 days/wk × 3 wk）. Analysis of the results of the study showed a statistically significant difference in improving ROM of the elbow and shoulder joints, speed and accuracy of movement in the main group compared with the control. Hardware recovery of complex spatial upper limb movements in the chronic stage of stroke increases the functionality and independence of the patient＇s domestic skills.
文摘目的观察针刺联合镜像疗法治疗脑卒中患者上肢运动功能障碍的临床疗效。方法将90例脑卒中上肢运动功能障碍患者按随机数字表法分为对照1组(30例,给予针刺治疗)、对照2组(30例,给予镜像疗法治疗)和观察组(30例,给予针刺联合镜像疗法治疗),疗程均为2周。比较3组患者治疗前后Fugl-Meyer评估量表上肢板块(Fugl-Meyer assessment upper extremity,FMA-UE)评分,Wolf运动功能测试(Wolf motor function test,WMFT)量表评分,改良Barthel指数(modified Barthel index,MBI),国际功能、残疾和健康分类(international classification of functioning,disability and health,ICF)评分及伸腕主动运动范围(active range of motion,AROM)和基于FMA-UE评分判定临床疗效。结果观察组临床疗效优于对照1组和对照2组(P<0.05);治疗后3组患者FMA-UE评分、WMFT评分、MBI均较治疗前显著增加(P<0.05),ICF评分显著减少(P<0.05),且观察组FMA-UE评分、WMFT评分、MBI增加程度,ICF评分减少程度显著大于对照1组和对照2组(P<0.05);治疗后观察组患者伸腕AROM显著大于对照1组和对照2组(P<0.05)。结论针刺联合镜像疗法能有效改善脑卒中患者上肢运动功能障碍。
文摘目的:系统评价三种运动疗法对乳腺癌术后患肢淋巴水肿患者上肢功能的康复效果。方法:计算机检索CNKI、万方、维普、Web of Science、PubMed、The Cochran library、Medline、Embase等数据库,搜集2005年1月-2024年5月有关三种运动疗法干预乳腺癌术后患肢淋巴水肿患者上肢功能的随机对照试验(RCT)。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用R软件与Addis软件进行网状Meta分析。结果:共纳入20项RCT,包括1736例乳腺癌术后患肢淋巴水肿患者。网状Meta分析结果显示,在乳腺癌术后患肢淋巴水肿患者手臂周径差康复方面,三种运动疗法均优于对照组(P>0.05);在乳腺癌术后患肢淋巴水肿患者上肢前屈康复方面,有氧训练干预治疗[MD=20.05(11.17,28.69),P<0.05]、抗阻训练干预治疗[MD=11.51(1.04,22.11),P<0.05]显著优于对照组的无干预治疗;在乳腺癌术后患肢淋巴水肿患者上肢后伸康复方面,有氧训练干预治疗[MD=7.72(3.67,11.54),P<0.05]、等速肌力训练干预治疗[MD=10.79(1.65,19.64),P<0.05]显著优于对照组的无干预治疗;在改善乳腺癌术后患肢淋巴水肿患者DASH评分方面,有氧训练干预治疗[MD=22.14(6.80,35.95),P<0.05]、等速肌力训练干预治疗[MD=11.48(1.16,22.34),P<0.05]显著优于对照组的无干预治疗。结论:根据定量合并证据显示,三种运动疗法均可有效改善乳腺癌术后患肢淋巴水肿患者上肢功能。等速肌力训练在干预乳腺癌术后患肢淋巴水肿患者手臂周径差,上肢前屈,上肢后伸,有氧训练在降低DASH方面更具优势。
