目的 比较3种不同神经肌肉训练方式对早期膝骨关节炎(KOA)膝关节疼痛和运动能力的效果. 方法 2022年11月至2023年5月,于北京博爱医院和社区选取早期KOA患者60例,随机分为A组、B组和C组各20例,分别采用本体感觉神经肌肉促进技术(PNF)、神经肌肉运动训练(NEMEX)和联合治疗训练(PNF+ NEMEX),共6周.治疗前后采用疼痛视觉模拟量表(VAS)、膝关节角度重现测试、股内侧肌与股外侧肌运动前反应时差值(VM-VL)、膝主动关节活动度(AROM)、10米步行测试(10MWT),以及膝关节损伤和骨关节炎评分量表(KOOS)进行评定. 结果 治疗后,3组各项评价指标均改善(|t|>2.532,P<0.05).组间比较,VAS评分A组

To evaluate the efficacy of nanohydroxyapatite/polyamide 66 (nHA/Pa66)-coated femoral stem prosthesis in total hip arthroplasty (THA) and the advantages of combined post-operative staged rehabilitation functional exercises (SRFE) in restoring hip function, 112 patients with femoral neck fractures were enrolled in the clinical study. Patients were randomized to routine and nHA/Pa66 groups. Patients in the nHA/Pa66 group were treated with nHA/Pa66-coated femoral stem prosthesis and the post-operative SRFE program. We evaluated the physical properties, cytotoxicity, and osteogenic capacity of nHA/Pa66 in an in vitro trial, and the clinical treatment, postoperative improvement in joint function (Barthel score, VAS score, Harris score), imaging performance, and incidence of adverse events were compared between groups. The porosity of nHA/Pa66 was ∼75% and its pore size was in the range of 300–500 μ m. Moreover, nHA/Pa66 had good biocompatibility and could improve bone marrow stem cells (BMSCs) activity and enhance the osteogenic function of BMSCs, effectively increasing the levels of COL I, ALP, and OCN. A combination of nHA/Pa66 and SRFE could effectively shorten hospital stay, better restore hip function, and reduce the incidence of complications. Therefore, nHA/Pa66-coated femoral stem prosthesis combined with SRFE showed great potential in THA for femoral neck fractures.

目的 探讨初次全膝关节置换术(TKA)后放置与不放置引流对术后快速康复的影响.方法 回顾性分析2018年1月至2020年9月本院接受初次TKA的膝骨关节炎患者80例.A组(n=40)术后常规放置引流管,B组(n=40)术后不放置引流管,比较两组术后血清炎症因子指标、术后疼痛评分、术后并发症发生率、术后离床活动时间、住院时间、膝关节功能评分、膝关节活动度和世界卫生组织生活质量简表评分.结果 术后第1～3天,两组C反应蛋白水平无显著性差异(t<0.410,P>0.05).术后12～48 h,两组疼痛VAS评分无显著性差异(t<0.300,P>0.05).A组术后并发症发生率为5.0％,B组为2.5％,无显著性差异(χ2=0.346,P>0.05).B组术后离床活动时间、住院时间均显著短于A组(t>4.863,P<0.001).两组手术后的膝关节功能评分、膝关节活动度和生活质量评分均显著增加(t>6.099,P<0.001),但两组间比较均无显著性差异(P>0.05).结论 TKA后放置与不放置引流不影响患者的术后并发症、膝关节功能改善情况和生活质量提高情况,但不放置引流可加快患者术后康复,促使患者尽早出院.

Objective:This study aims to explore the application value of quantitatively evaluating and comparing the elastic modulus of shoulder girdle muscles between healthy adults and patients with scapular dyskinesis by using shear wave elastography (SWE).Methods:A case-control study was conducted. From Mar 2019 to Sep 2019, 33 patients (33 shoulders) with scapular dyskinesis(SD) including 10 males and 23 females aged 35 to 71 years from China Rehabilitation Research Center were selected into SD group. In the same period, 32 healthy volunteers (61 shoulders) including 10 males and 22 females aged from 22 to 74 years were also recruited as control group. Thickness, shear wave velocity of upper trapezius (UT), levator scapulae (LS), middle trapezius (MT), rhomboid (RM), lower trapezius (LT), and serratus anterior (SA) were measured with 2-D ultrasound and SWE. Elastic modulus was calculated. Thickness and elastic modulus of shoulder girdle muscles were compared between SD and control groups, and the effects of age and sex on thickness and elastic modulus of shoulder girdle muscles were analyzed.Results:Patients with SD had higher elastic modulus of UT, UT/MT, UT/LT(44.42±29.17) kPa (1 mmHg=0.133 kPa), 1.59±0.56, and 1.56±0.63 than healthy adults (31.00±12.68) kPa, 1.30±0.30, and 1.30±0.30, but had lower thickness of LS (0.40±0.11) cm than healthy adults (0.47±0.17) cm, and the differences were statistically significant (all P values < 0.05). The elastic modulus of RM in young patients with SD (31.14±3.93 )kPa was higher than that of young healthy adults (23.30±8.24) kPa. The UT/SA in middle-aged patients with SD (1.57±0.38) was greater than that of middle-aged healthy adults (1.30±0.33). Moreover, the UT/MT, the elastic modulus of UT, LS, and SA in elderly patients with SD [1.81±0.68, (53.59±36.99) kPa, (36.54±11.41) kPa, (18.51±8.05) kPa] were greater than those of elderly healthy adults [1.40±0.39, (32.01±11.93) kPa, (28.82±9.42) kPa, (13.04±7.23) kPa]. The differences were statistically significant (all P values<0.05). Among the 32 healthy adults and 33 patients with SD, SA was significantly thicker in males [(0.82±0.24) cm and (0.80±0.17) cm] than in females[ (0.63±0.15) cm and (0.69±0.17 )cm]. Furthermore, the elastic modulus of UT was greater in females[(32.91±13.87) kPa than in males (26.77±8.37) kPa], and the difference was statistically significant (all P values<0.05). Among the 32 healthy adults, SA thickness, elastic modulus of LT, and SA were negatively associated with age ( r=-0.334, -0.416, -0.431). UT/LT and UT/SA were positively associated with age ( r=0.317, 0.300). Among the 33 patients with SD, UT/MT and elastic modulus of LS were positively associated with age ( r=0.410, 0.399). However, the elastic modulus of RM was negatively associated with age ( r=-0.317, -0.300), and the difference was statistically significant (all P values<0.05). Conclusions:SWE can be used to quantify the elastic modulus of shoulder girdle muscles and can reflect the characteristics of imbalance of scapular muscle couple in patients with SD. This work provides certain guiding significance for prevention, early diagnosis, and precision rehabilitation of SD.

Background: Traumatic knee injury is common and highly debilitating. Its signs and symptoms usually persist long enough to produce muscle atrophy and, sometimes, even permanent contractile dysfunction. Aim: Our goal was to evaluate the effect of combined rehabilitative exercise and celecoxib treatment on the inflammatory reaction in spastic rat quadriceps after traumatic knee injury. Methods: Rats were randomly assigned to one of /bur subgroups: a control group, exercise group, celecoxib treatment group, and combined rehabilitative exercise and celecoxib treatment. From each group, quadriceps muscles were collected four, eight, 12, 16, and 20 weeks after traumatic knee injury. In addition to range of motion in each rat, expression of IL-1, IL-2, TNF-a, COX-1, and COX-2 was evaluated at each time point using real-time polymerase chain reaction and immunohistochemistry. Results: Our results showed that, consistent with an apparent decrease in range of motion after knee injury, expression of the cytokines IL-1, IL-2, COX-1, and COX-2 significantly increased in the spastic rat quadriceps, which was at least partially reversed using combined rehabilitative exercise and celecoxib treatment, resulting in reduced expression of those molecules and improved behavioral outcomes. Conclusion: This study clearly shows that combined rehabilitative exercise and celecoxib treatment relieves acute and chronic inflammation in spastic rat quadriceps after traumatic knee injury.

目的 探索社会-心理因素对关节功能康复的影响.方法 2015年10月至2017年4月,骨科关节功能康复患者64例,根据汉密尔顿焦虑评分量表和汉密尔顿抑郁评分量表评分分为焦虑组和无焦虑组,以及抑郁组和无抑郁组.所有患者常规行关节功能初、中、末期评定,同时采用90项症状清单(SCL-90)和世界卫生组织残疾评定量表2.0(WHO-DAS 2.0)进行评定.关节功能评分与SCL-90、WHO-DAS 2.0评分间行Spearman相关分析.结果 抑郁组和无抑郁组间关节功能初期和末期评分均有显著性差异(|t|>2.106,P<0.05).关节功能初期评分与SCL-90人际交往因子分呈负相关(r=-0.257,P<0.05),关节功能末期评分与WHO-DAS 2.0中的维度1(r=-0.257)和维度4(r=-0.278),SCL-90总分(r=-0.263)、人际交往(r=-0.328)和敌对(r=-0.385)因子分呈负相关(P<0.05);关节功能改善分与WHO-DAS 2.0维度1评分呈负相关(r=-0.249,P<0.05).结论 社会-心理因素与关节功能有关,应探索将社会-心理评估纳入关节功能康复三期评定体系.

Objective To investigate the perioperative characteristics of hip fractures and the effects of early rehabilitation in elderly patients. Methods Clinical data of 123 elderly patients admitted to our department from January 2012 to January 2014 were retrospectively analyzed. Patients were divided into a rehabilitation group and a control group ,based on whether rehabilitation therapy was offered.Comparison was made between the two groups on postoperative mortality and postoperative complications. Results Of 123 patients ,there were 51 males and 72 females ,with a mean age of (83.5 ± 4.8)years(aged 67~96 years).Femoral fractures were seen in 32 patients and femoral intertrochanteric fractures in 91 patients.Before operation ,112 (91.1% ) patients had concomitant diseases. There were significant differences in postoperative complications and one-year mortality after operation between patients receiving early rehabilitation and controls (5/60 or 8.3% vs.14/63 or 22.2% ,4/60 or 6.7% vs.13/63 or 20.6% ,χ2=4.539 and 5.034 ,P=0.033 and 0.025 , respectively ). Conclusions Elderly hip fracture patients have many concomitant diseases before operation.With appropriate perioperative management ,well-chosen methods of anesthesia and surgery ,and early postoperative rehabilitation measures ,the incidence of perioperative complications and one-year mortality can be decreased ,and desirable surgical outcomes can be attained.

[Objective] To investigate the outcome of rehabilitation treatment on the range of motion and pathological changes in the quadrieeps in a rat modle with post-traumatic knee stiffness.[Methods] Thirty-two 9-week-old male SD rats were randomly divided into control group and rehabilitation group after establishment of the model of knee joint stiffness.Therange of motion of knee joint was measured at different time points.Pathological changes in the quadriceps were evaluated.[Results] After 12 weeks,the range of motion of knee joint was significantly improved in the rehabilitation group than in the control group (P ＜0.05).According to the pathological examination of the quadriceps,compared with the control group,the rehabilitation group had substantially recovering muscle cells.[Conclusion] Knee trauma results in stiffness.Rehabilitation treatment helps to restore the normal range of motion and muscle tissue.

晨僵是类风湿病人的一种典型症状,即病人晨起或经过一段停止活动后在受累关节出现僵硬感,活动受限,严重时可有全身关节僵硬感,起床后经活动或暖身后症状可减轻或消失.

Objective To investigate the effects of structural changes of scaffolds on the proliferation of nerve cells.Methods The primary cultured and purified Schwann cells(SCs)were included from the sciatic and brachial plexus nerve of 1-3 days oldfetal SD rats.The purified SCs were inoculated on the scaffolds with different pore sizes by the drip method to determine the proliferation of SCs. Morphology and molecular biology were used for the examination.Results The cell proliferation in the large aperture group was significantly better than that in the small aperture group.The CCK-8 cell proliferation curve showed thatthe cell proliferation at 96 h in the large aperture group(0.43±0.01)was significantly higher than that in the small aperture group(0.38±0.01)(P<0.05).The findings of ELISA showed that the expression of nerve growth factor in the large aperture group was significantly higher than that in the small aperture group(P<0.05).Conclusion Although the small aperture scaffoldmaterial stimulates the proliferation of cells at the early stage,the biological behavior of SCs was inhibited. Although the early cell base of the large aperture scaffoldmaterial is insufficient,the three-dimensionalspatial structure of the scaffold material is enough to accommodate cells,so that the number of cells gradually increases. Thus,the different three-dimensional spatial structure of the scaffold material may directly affect the proliferation of nerve cells on the scaffold material.

Orthopaedic rehabilitation is an important part of rehabilitation resident standardization training, that is complex and unique. Introduction of the discipline, as well as optimizing teaching methods, clinical practice and test are very important for a satisfactory out-come, such as combination of theory and practice, and systematical rehabilitation procedures, principles and operation.

The primary purpose of this study was to investigate cytokine expression in the quadriceps of rats with posttraumatic knee stiffness (PTKS) and to determine the effect of exercise training on these cytokines at different follow-up time points. The PTKS rats were randomly assigned into two even groups. The treatment group received exercise training, while the control group received no treatment. Quadriceps specimens were harvested randomly from each group at 8, 12, 16, and 20 weeks. RT-qPCR and immunohistochemical analyses were used to assess the protein and mRNA expression levels of the cytokines IL-1, IL-2, TNF-α, COX-1, and COX-2. TNF-α immunostaining did not differ between the treated and control group tissues, whereas weak immunostaining was observed for all other cytokines in the specimens from the treatment group compared with those from the control group at approximately 12 and 20 weeks. The cytokine levels decreased at approximately 8 weeks in the treatment group, whereas these levels remained elevated or plateaued in the control group. These differences were statistically significant (p<0.05). This study demonstrated that the expression of cytokines IL-1, IL-2, COX-1, and COX-2 increased in the quadriceps of rats with PTKS and that exercise training affected the observed profile trends of these cytokines.

[目的]评价创伤性肘关节异位骨化(traumatic heterotopic ossification of elbow,THOE)和神经源性肘关节异位骨化(neurologic heterotopic ossification of elbow,NHOE)的手术效果,探讨影响肘关节异位骨化手术疗效的相关因素.[方法]回顾性分析2006年7月～ 2011年9月间行肘关节异位骨化切除术的58例(66肘)患者资料.38肘为THOE组,20肘为NHOE组,8肘为混合组.测量患者术前、术后的肘关节活动角度,并进行Mayo评分.以术后2年肘关节僵硬情况和DASH上肢评分功能作为评定手术疗效的指标,分析可能对疗效产生影响的因素.[结果]屈伸活动度、旋转活动度和MEPS评分,THOE组、NHOE组、混合组各组术后与术前比较差异均有统计学意义(P＜0.01).THOE组有1例出现异位骨化复发,而NHOE组有3例出现异位骨化复发.经多因素Logistic回归分析发现骨折数量(OR=16.158,P=0.005)、受伤距松解手术时间(OR=20.408,P=0.004)、术前旋转活动度(OR=12.824,P=0.005)是肘关节异位骨化切除术后2年关节僵硬的独立危险因素;而病因(OR=48.914,P＝0.006)、运动控制(OR=72.019,P=0.000)是肘关节异位骨化切除术后2年上肢功能差的独立危险因素.[结论]手术治疗NHOE和THOE的疗效均满意,但NHOE术后可能更易复发.多处骨折、合并前臂旋转受限、伤后＞12个月手术影响肘关节异位骨化手术效果.运动控制异常的NHOE不利于术后上肢功能恢复.

Objective To analyze related factors and effect of arthrolysis for forearm rotational limitation caused by post-traumatic elbow stiffness.Methods This is a retrospective case series including 44 patients (46 elbows,with a 36-month follow-up) who received arthrolysis treatment for elbow stiffness in both sagittal and rotational motion plane.Pre-and post-operation motion range of flexion and rotation,as well as the Disabilities of the Arm,Shoulder and Hand (DASH) scores were measured and analyzed orderly.Regression analysis was employed to investigate the relation between rotation motion and related factors.Results Rotational range of motion was related with upper limb function.Improvement in rotational arc of motion is negatively correlated with delay of arthrolysis for patients with more than 12 months delay after injuries and the implantation of external fixator.Synostosis,heterotopic ossification and implant block were major inhibitors of rotation recovery.Elbow arthrolysis was effective in increasing rotational range of motion.More importantly,this gain in range translated to a statistically significant improvement in upper limb function.Conclusion Rotational range of motion would directly affect upper limb function.Surgical treatment should be considered within 12 months since primary injuries.Resecting heterotopic ossification,removing implant involved in proximal radial ulnar joints,and performing postoperative special rotational rehabilitation with pain control would avoid stiffness and improve elbow function.

ObjectiveTo evaluate therapeutic results of surgical treatment of posttraumatic elbow stiffness with heterotopic ossification.MethodsA retrospective review of analysis was performed 16 case of patients who underwent open surgical treatment for posttraumatic elbow stiffness by the senior author from July 2008 to December 2010. The study group included 12 males and 4 females, with an average age 38.1 years (range 14 to 59 years). The time from injury to surgery averaged 8.9 (rang 6 to 19) months. We performed elbow open release with excision of the heterotopic ossification. The patients were given indomethacin for 6 weeks after operation. We examined elbow range of motion and used Mayo Elbow Performance Score (MEPS) for evaluations before and after operation.ResultsThe range of flexion to extension of the elbow improved 32°±17.4° to 108°±16.7°. The range of pronation to supination improved from 45°±8.8° to 80.0°±11.0°. The MEPS improved from 52.0±11.2 to 82.0±8.1 (t=8.722, P<0.001) and there were significant differences before and after surgery. Recurrence of heterotopic ossification occurred in one of sixteen cases. Two cases fracture at ulna pinhole with hinged external fixation.ConclusionOpen elbow release with excision of heterotopic ossification is a valuable procedure for post-traumatic stiffness.

Background: Hip fractures in elderly patients prone to a variety of perioperative complications. Perioperative delirium (POD) has been paid more attention in recent years. <br> Objective:To investigate the incidence, risk factors and protective factors of POD in the elderly with hip fracture. <br> Methods:A retrospective analysis was performed in 384 elderly patients with hip fracture treated by surgery from January 2001 to January 2013. There were 206 females and 178 males with a mean age of 78.3 years (range, 65 to 95 years). Gen-der, age, operative time, surgical approach, anesthesia, blood transfusion, medications and complications were taken as inde-pendent variables, and the incidence of POD was taken as dependent variable for Logistic regression analysis. <br> Results:The mean hospital stay of the 384 patients was 15.8 days (range, 7 to 35 days). POD occurred in 79 patients, and the incidence of POD was 20.6%. The age, operation time, anesthesia, complications, blood transfusion and medication were enrolled into Logistic regression equation (P<0.05). Advanced age, extremely-long operative time, general anesthesia, complications (cerebrovascular disease, especially) were risk factors for POD, while medications and blood transfusion were protective factors. Gender and surgical approach were not significantly related to POD (P>0.05). <br> Conclusions:Elderly hip fractures are often complicated by POD. Orthopaedic surgeons should carefully evaluate periopera-tive factors related to POD, avoid general anesthesia, decrease surgical time, and actively manage complications. It is essen-tial to take transfusion and drug prophylaxis for high-risk patients.

Neurogenic heterotopic ossification (NHO) is a common complication in patients with spinal cord injury (SCI) and traumatic brain injury (TBI). Although there are many reports regarding the etiology, pathophysiology, and medical management, few studies elaborate the anatomical details of NHO, which leads to ankylosis of the hip joint. A prospective study on surgical resection of NHO in patients with hip ankylosis was conducted. Radiography and magnetic resonance imaging (MRI) were used to assess the relationship of the NHO block with the blood vessels, peripheral nerve, and surrounding muscles and bones. The anatomical relationships were also assessed and documented during the surgical procedures. NHO, which is anterior to the hip and causes hip ankylosis, settles into tissue planes without involving the tissue itself and does not disrupt the femoral neurovascular structures. The NHO bone block can then fuse to the cortex of adjacent bone. During resection, the normal bony contour should be exposed as a marker to guide the resection in order to avoid iatrogenic fracture.

Osteoarthritis (OA) is associated with the presence of inflammation. Sialic acid (SA), an acetylated derivative of neuraminic acid, is reported to be a useful biomarker of inflammation. The aim of the present study was to investigate the correlation between SA levels in the serum and synovial fluid (SF) and radiographic severity in patients with knee OA. A total of 234 patients with knee OA were recruited for the study, as well as 20 patients that had suffered a knee injury or fracture (without knee OA) and 160 healthy controls. Radiological grading of OA in the knee was conducted according to the Kellgren-Lawrence (KL) grading system. SA levels in the serum and SF were measured using Warren's thiobarbituric acid assay. The results demonstrated that knee OA patients exhibited significantly elevated levels of serum SA when compared with the healthy controls, and also significantly elevated levels of SF SA when compared with the knee fracture patients. Higher SA levels in the SF were identified in knee OA patients with KL grade 4 as compared with patients with KL grade 2 or 3. In addition, OA patients of KL grade 3 had significantly higher SA levels in the SF as compared with patients with KL grade 2 (P<0.01). The SA levels in the SF of the knee OA patients positively correlated with the KL grades (r=0.353; P<0.01). However, there was no significant correlation identified between serum SA levels and KL grade. Therefore, SA levels in the SF positively correlated with the radiographic severity of OA, thus, SA levels in the SF may serve as a biomarker for the progression of OA.

Objective Explore discipline of expression of inflammatory cytokines in quadriceps for post-traumatic knee stiffness and rehabilitation process.Methods Sclect thirty-six,9-week-old,male SD rats.Establish knee joint stiffness model.Choose quadriceps to detect immunohistochemistry and Reverse transcriotion-polymerase chain reaction (RT-PCR) of Interleukin (IL)-1,IL-2,Tumor necrosis factor-α (TNF-α),cyclooxygenase (COX)-1 and COX-2.Results Comparation of rehabilitation and observation groups:(1) After 12 weeks,IL-1 rehabilitation group IA (Integrated optical density) value:158 976.8 ± 27 475.8,the observation group IA value:338 956.1 ± 32 126.7,IL-2 rehabilitation group IA value:274 188.1 ± 20 514.8,the observation group IA value:410 647.7 ± 24 070.6,there are significant differences between two groups (P ＜ 0.05).(2) After 8 weeks,COX-1 rehabilitation group IA value:413 716.7 ± 40 176.8,the observation group IA value:500 528.2 ± 28 400.5,COX-2 rehabilitation group IA value:294 577.5 ±28 712.6,the observation group IA value:420 301.2 ±30 663.4,there are significant differences between two groups (P ＜ 0.05).(3) mRNA levels of RT-PCR measurement results are consistent with the above between two groups.Conclusion Knee trauma caused by the stiffness.In the rehabilitation process,IL-1,IL-2,COX-1 and COX-2 inflammatory cytokine expression of quadriceps increased firstly and then decreased.

Objective To compare the efficacy and complications among three surgical treatments of femoral intertrochanteric fractures in elderly patients.Methods Totally 209 elderly patients with femoral intertrochanteric fracture were divided into 3 groups:DHS group[n =115,patients treated with dynamic hip screws (DHS)],PFNA group [n=57,patients treated with proximal femoral nails anti-rotation (PFNA)] and SEFT group [n=37,patients treated with singlearm external fixator technique (SEFT)].The length of hospitalization,operative time,bleeding volume,hip function scores and complications were compared among the three groups.Results All patients were followed up for 5-12 months (10.6 months in average).The length of hospitalization,operative time,bleeding volume,weight-bearing time and Harris hip score in postoperative 3 months were (14.3±2.7) d,(102.4±22.7) min,(240.8±38.4) ml,(50.2±7.7) d,(88.7±12.8) min in DHS group,(11.2±3.4) d,(50.3±15.6) min,(80.5±18.7) ml,(22.6±4.8) d,(92.6±15.4)min in PFNA group,(15.1±3.3) d,(35.8±10.9) min,(52.6±12.9) ml,(55.4±10.1) d,(87.3 ± 12.6) min in SEFT group,respectively.There were significant differences in the length of hospitalization,operative time,bleeding volume,weight-bearing time and Harris hip score in postoperative 3 months among the three groups (all P ＜ 0.05),while there was no significant difference in healing time among the three groups (all P＞0.05).The incidence of complications was highest in DHS group,higher in SEFT group,and lowest in PFNA group (all P＜0.05).Conclusions DHS is more suitable for patients with good physical condition and stable fractures.SEFT is suitable for patients with poor condition,who can not tolerate trauma,anesthesia and bleeding.PFNA has more advantages including stable fixation,less invasive,less complications and wide indications,which is more suitable for femoral intertrochanteric fractures than the other two treatments.