Trunk function has been identified as an important early predictor of functional outcome after stroke and the same deteriorates on both contralateral and ipsilateral sides of the body following stroke. The primary con...Trunk function has been identified as an important early predictor of functional outcome after stroke and the same deteriorates on both contralateral and ipsilateral sides of the body following stroke. The primary contribution of the trunk muscles is to allow the body to remain upright, adjust weight shifts, and control movements against constant pull of gravity and is considered central key point of the body. Proximal stability of the trunk is a pre-requisite for distal limb mobility, balance, gait and functional activities and its positive correlation in hemiplegia has been demonstrated in a cross- sectional study. Both isokinetic and handheld dynamometer muscle strength testing demonstrated the weakness of bilateral trunk flexors, extensors and rotator muscles in both acute and chronic hemiplegic patients. This was confirmed by electromyography analysis which identified poor bilateral trunk muscles activity in patients with stroke. Trunk impairment scale is sensitive to evaluate the selective muscle control of upper and lower trunk, and it has been reported that lateral flexion of the trunk is easier than rotation of the trunk and the clinical observation concurs to the difficulty in lower trunk rotation of stroke patients. However, trunk exercises given early after stroke could produce enhanced balance performance post- stroke. This review attempts to report the evidence supporting the involvement of the trunk and its influence on balance and functional performance in post-stroke hemiplegia.展开更多
背景:聚甲基丙烯酸甲酯(PMMA)骨水泥具有良好的稳定性、可塑性和空间占位能力,是目前临床上最常用的抗生素载体之一。局部应用抗生素骨水泥可以预防、延缓甚至根除骨骼肌肉系统的感染,是目前解决骨关节感染难题的常用手段。但是,抗生素...背景:聚甲基丙烯酸甲酯(PMMA)骨水泥具有良好的稳定性、可塑性和空间占位能力,是目前临床上最常用的抗生素载体之一。局部应用抗生素骨水泥可以预防、延缓甚至根除骨骼肌肉系统的感染,是目前解决骨关节感染难题的常用手段。但是,抗生素的加入会显著影响聚甲基丙烯酸甲酯骨水泥的机械性能,并且有引发不良反应的可能。另外,有学者发现抗生素骨水泥的抗生素释放率很低,局部应用抗生素骨水泥并不能有效消灭细菌,且有引起细菌耐药的可能。因此,他们对抗生素骨水泥在控制感染方面的有效性提出了质疑,并引起了广泛热议。目的:综述抗生素骨水泥的优势与问题,并总结其在临床使用中的注意事项。方法:通过计算机在PubMed、万方、中国知网数据库中以“抗生素骨水泥、聚甲基丙烯酸甲酯、PMMA;Bone Cements、Anti-Bacterial Agents、Bone and Bones、joints、elution、release、Mechanical”为中、英文检索词,检索2017-01-01/2021-12-31发表的相关文献。排除与文章内容无关的、创新性差、重复的文献后,最终纳入68篇文献进行综述。结果与结论:目前,抗生素骨水泥仍是治疗骨关节感染的最佳选择之一。随着对抗生素骨水泥研究的不断深入,许多能改善其抗生素释放方式、抗菌能力和力学性能的新方法不断涌现出来,同时其在临床上的使用也得到了拓展。但仍然有许多问题尚未得到解决,还需进一步的研究,如抗生素的选择、剂量以及最佳的混合方法等。另外,通过对可加入聚甲基丙烯酸甲酯骨水泥的改性材料和抗生素替代物的开发与局部应用有望解决细菌耐药问题。相信随着医学、药学和生物材料科学的发展,抗生素骨水泥会在临床上得到更加广泛的应用。展开更多
导管相关性血栓形成是外周置入中心静脉导管(peripherally inserted central catheter,PICC)留置期间最常见的并发症之一,严重时可导致非计划性拔管而影响患者的治疗进程,甚至威胁患者的生命安全。握力训练作为预防PICC相关性血栓形成...导管相关性血栓形成是外周置入中心静脉导管(peripherally inserted central catheter,PICC)留置期间最常见的并发症之一,严重时可导致非计划性拔管而影响患者的治疗进程,甚至威胁患者的生命安全。握力训练作为预防PICC相关性血栓形成的常用干预方法之一,具有有效性和实用性,但在临床实践中由于缺乏科学化、规范化、精准化训练方案的指导,患者训练依从性及其干预效果参差不齐。该文对PICC相关性血栓形成的发生机制、常用握力训练方法及局限性进行总结分析,以期为临床更好地实施握力训练干预提供参考。展开更多
文摘Trunk function has been identified as an important early predictor of functional outcome after stroke and the same deteriorates on both contralateral and ipsilateral sides of the body following stroke. The primary contribution of the trunk muscles is to allow the body to remain upright, adjust weight shifts, and control movements against constant pull of gravity and is considered central key point of the body. Proximal stability of the trunk is a pre-requisite for distal limb mobility, balance, gait and functional activities and its positive correlation in hemiplegia has been demonstrated in a cross- sectional study. Both isokinetic and handheld dynamometer muscle strength testing demonstrated the weakness of bilateral trunk flexors, extensors and rotator muscles in both acute and chronic hemiplegic patients. This was confirmed by electromyography analysis which identified poor bilateral trunk muscles activity in patients with stroke. Trunk impairment scale is sensitive to evaluate the selective muscle control of upper and lower trunk, and it has been reported that lateral flexion of the trunk is easier than rotation of the trunk and the clinical observation concurs to the difficulty in lower trunk rotation of stroke patients. However, trunk exercises given early after stroke could produce enhanced balance performance post- stroke. This review attempts to report the evidence supporting the involvement of the trunk and its influence on balance and functional performance in post-stroke hemiplegia.
文摘背景:聚甲基丙烯酸甲酯(PMMA)骨水泥具有良好的稳定性、可塑性和空间占位能力,是目前临床上最常用的抗生素载体之一。局部应用抗生素骨水泥可以预防、延缓甚至根除骨骼肌肉系统的感染,是目前解决骨关节感染难题的常用手段。但是,抗生素的加入会显著影响聚甲基丙烯酸甲酯骨水泥的机械性能,并且有引发不良反应的可能。另外,有学者发现抗生素骨水泥的抗生素释放率很低,局部应用抗生素骨水泥并不能有效消灭细菌,且有引起细菌耐药的可能。因此,他们对抗生素骨水泥在控制感染方面的有效性提出了质疑,并引起了广泛热议。目的:综述抗生素骨水泥的优势与问题,并总结其在临床使用中的注意事项。方法:通过计算机在PubMed、万方、中国知网数据库中以“抗生素骨水泥、聚甲基丙烯酸甲酯、PMMA;Bone Cements、Anti-Bacterial Agents、Bone and Bones、joints、elution、release、Mechanical”为中、英文检索词,检索2017-01-01/2021-12-31发表的相关文献。排除与文章内容无关的、创新性差、重复的文献后,最终纳入68篇文献进行综述。结果与结论:目前,抗生素骨水泥仍是治疗骨关节感染的最佳选择之一。随着对抗生素骨水泥研究的不断深入,许多能改善其抗生素释放方式、抗菌能力和力学性能的新方法不断涌现出来,同时其在临床上的使用也得到了拓展。但仍然有许多问题尚未得到解决,还需进一步的研究,如抗生素的选择、剂量以及最佳的混合方法等。另外,通过对可加入聚甲基丙烯酸甲酯骨水泥的改性材料和抗生素替代物的开发与局部应用有望解决细菌耐药问题。相信随着医学、药学和生物材料科学的发展,抗生素骨水泥会在临床上得到更加广泛的应用。
文摘导管相关性血栓形成是外周置入中心静脉导管(peripherally inserted central catheter,PICC)留置期间最常见的并发症之一,严重时可导致非计划性拔管而影响患者的治疗进程,甚至威胁患者的生命安全。握力训练作为预防PICC相关性血栓形成的常用干预方法之一,具有有效性和实用性,但在临床实践中由于缺乏科学化、规范化、精准化训练方案的指导,患者训练依从性及其干预效果参差不齐。该文对PICC相关性血栓形成的发生机制、常用握力训练方法及局限性进行总结分析,以期为临床更好地实施握力训练干预提供参考。
