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

目的 分析儿童下肢截肢及其康复的流行病学特点与临床特征,阐述儿童截肢的原因及截肢后并发症的情况.方法 选择2016年1月至2021年3月北京博爱医院收治的下肢截肢儿童51例,分析截肢原因与截肢后并发症的相关性.结果 创伤性截肢占58.82％,主要原因为交通事故(70％);疾病性截肢占41.18％,主要原因为先天性肢体畸形(80.95％).创伤性截肢后发生残端并发症的可能性较预期更高(P<0.05);疾病性截肢后发生残端并发症的可能性较预期更低(P<0.05).结论 交通事故是儿童创伤性截肢的主要原因,其临床特征是不良残端发生率高,主要原因是软组织异常,大部分病例需要通过残端修整术改善不良残端而达到装配假肢恢复行走的目的.先天性胫骨假关节是儿童疾病性截肢的主要原因,往往经历长期的保肢治疗后仍不能避免截肢的结局.

This study aimed to explore the dynamic diffusion tensor imaging (DTI) of changes in spinal cord contusion using a canine model of injury involving rostral and caudal levels. In this study, a spinal cord contusion model was established in female dogs using a custom-made weight-drop lesion device. DTI was performed on dogs with injured spinal cords (n=7) using a Siemens 3.0T MRI scanner at pre-contusion and at 3h, 24h, 6 weeks and 12 weeks post-injury. The tissue sections were stained for immunohistochemical analysis. Canine models of spinal cord contusion were created successfully using the weight-drop lesion device. The fractional anisotropy (FA) value of lesion epicenter decreased, while the apparent diffusion coefficient (ADC), mean diffusivity (MD), and radial diffusivity (RD) values increased, and the extent of the curve was apparent gradually. The site and time affected the DTI parameters significantly in the whole spinal cord, ADC (site, P<0.001 and time, P=0.077, respectively); FA (site, P<0.001 and time, P=0.002, respectively). Immunohistological analysis of GFAP and NF revealed the pathologic changes of reactive astrocytes and axons, as well as the cavity and glial scars occurring during chronic SCI. DTI is a sensitive and noninvasive imaging tool useful to assess edema, hemorrhage, cavity formation, structural damage and reconstruction of axon, and myelin in dogs. The DTI parameters after contusion vary. However, the curves of ADC, MD, and RD were nearly similar and the FA curve was distinct. All the DTI parameters were affected by distance and time.

Objective To explore the role of fibrogenic cytokines and inflammatory cytokines in the pathogenesis of frozen shoulder. Methods From September, 2014 to April, 2016, 20 patients with frozen shoulder accepted arthroscopic surgery were included, ten of them were diagnosed as primary frozen shoulder (group A), the other ten were secondary frozen shoulder (group B). Other ten patients undergo-ing shoulder arthroscopy for instability (4 cases), rotator cuff injury (3 cases) and subacromial impingement (3 cases) were as the controls (group C). The mRNA levels of matrix metalloproteinase (MMP) 1, MMP3, tumour necrosis factor-α (TNF-α), interleukin (IL)-1, IL-6, IL-8, granulocyte-macrophage colony stimulating factor (GM-CSF) and M-CSF in synovium were analyzed with quantitative polymerase chain reaction. Results The expression of mRNA of MMP1, MMP3, TNF-α, IL-1, IL-6, IL-8, GM-CSF and M-CSF were more in group A and group B than in group C (P<0.05). There was no significant difference between group A and group B (P>0.05). Conclusion The fibro-genic cytokines and inflammatory cytokines may play a role in the pathogenesis of frozen shoulder.

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.

The present study aimed to explore the potential diagnostic role of diffusion tensor magnetic resonance imaging (DTI) in the early stage of modified corticosteroid-induced osteonecrosis of the femoral head (ONFH). A total of 20 beagles were randomly classified (1:1) into either an experimental group (LM), which were intramuscularly injected with lipopolysaccharide (LPS) and methylprednisolone (MPS) on three consecutive days, or control (CON) group, which were injected with saline. Magnetic resonance imaging (MRI) and DTI were performed at pre-induction and 8 and 12 weeks post-induction. Apparent diffusion coefficient (ADC) values in the range of interest in the femoral head were quantified using DTI. Proximal femora were examined for ONFH at 8 and 12 weeks. The results demonstrated that ONFH developed in four beagles at 8 weeks and in six beagles at 12 weeks, whereas no ONFH was detected in the CON group. No abnormalities were detected by MRI and DTI, and no mortality occurred. In beagles with ONFH in the LM group, the ADC values were 4.7±0.2×10-4 and 4.8±0.3×10-4 mm2/sec at 8 and 12 weeks, respectively, which were significantly increased compared with the CON group (2.5±0.3×10-4 and 2.4±0.3×10-4 mm2, respectively) and the LM group without ONFH (2.6±0.4×10-4 and 2.4±0.3×10-4 mm2, respectively) (P<0.05). The results of the present study indicated that intramuscular injection of LPS and MPS may lead to early-stage ONFH in beagles. As such, the detection of locally elevated ADC values in the femoral head may aid in the early diagnosis of ONFH.

Objective To observe the effects of myelotomy on autophagy activation after traumatic spinal cord injury (SCI) in rats. Methods 54 adult female Sprague-Dawley rats were randomly assigned to sham-operated group (SG, n=18), contusion group (CG, n=18) or myelotomy group (MTG, n=18). The T10 SCI model in rats was induced with a New York University (NYU) impactor and myelotomy was performed 24 hours after SCI. They were evaluated with the BBB score 1, 7, 14 days after injury. The expression of mRNA of Beclin-1 and Bcl-2 were detected with real-time quantitative reverse transcriptase polymerase chain reaction (RT-PCR). The formation of autophagosome was investigated under electronic microscope (EM) 3 days after injury. Results BBB score was more in the MTG than in the CG 7 and 14 days after injury (P<0.05), while the expression of Beclin-1 mRNA was less (P<0.05). The expression of Bcl-2 mRNA was more in the MTG than in the CG 3 and 7 days after injury (P<0.05). The expression of Beclin-1 mRNA was negatively correlated with BBB scores (P<0.05). The formation of autophagosome was less in the MTG than in the CG. Conclusion Myelotomy can improve the recovery of motor function in rats after acute traumatic SCI, which may associate with neuroprotection mediated by inhibition of autophagy through the Bcl-2 signaling pathway.

Objective:To investigate the effects of autophagic inhibitors on the expression of myelin basic protein (MBP) after spinal cord injury (SCI) in rats. Methods: Ninety-nine rats were randomly assigned to groups of sham-operated, SCI and treatment. The T10 SCI contusion model was induced with an impactor. One μL 3-Methy-ladenine was slowly injected into spinal cord immediately before the contusion in the treatment group. The protein or mRNA expression of LC3-Ⅱ and MBP were detected by Western-blot or real-time quantitative reverse transcrip-tase polymerase chain reaction (RT-PCR) respectively. Functional recovery (BBB scores) was evaluated at 1st, 7th, 14th day post-injury. Results: The BBB score of the treatment group was higher than that in the SCI group (P=0.001) at 14th day post-injury. The protein content of LC3-II within the spinal lesion in the SCI group was signifi-cantly higher than that in the sham-operated group (P< 0.05), while the protein or mRNA level of LC3-II in the treatment group was lower than those in the SCI group (P<0.05). The protein or mRNA level of MBP in the treat-ment group at 3th, 7th, or 14th days post-injury were higher than those in the SCI group (P<0.05). Conclusion:There was overactive autophagy in spinal cord lesion after SCI in rats. The inhibitor of autophagy could protect the nervous system via decreasing the loss of MBP in rats after SCI.

目的：探讨关节镜下骨刺切除结合射频消融技术治疗跟痛症的临床效果。方法回顾性分析2011年1月至2013年1月共18例顽固性跟痛症患者的临床资料，所有患者都接受了关节镜下骨刺切除结合射频消融技术治疗。分别采用疼痛视觉模拟评分（visual analogue scale，VAS）和美国足踝外科协会（American orthopaedic foot and ankle soci-ety，AOFAS）后足评分对患者术前和术后患足的疼痛和功能进行评估。结果本组均获随访，随访时间10~16个月，平均12个月。VAS 平均评分从术前的（7.17±0.38）分降至术后的（2.01±0.16）分，AOFAS 后足功能评分从术前的（57.69±10.94）分升至术后的（86.89±8.19）分，术前术后评分比较，差异具有统计学意义（P <0.05）。结论关节镜下骨刺切除结合射频消融技术治疗跟痛症的效果令人满意，值得临床推广应用。

目的:评价踝关节45°轴斜位MRI扫描诊断下胫腓前韧带(anterior inferior tibiofibular ligament,AITFL)慢性损伤的应用价值,为临床诊断AITFL损伤提供有效方法.方法:2011年3月～2013年2月,前瞻性搜集31例慢性踝关节前外侧撞击综合征患者临床资料:男15例,女16例;年龄22～63岁,平均34.5岁.所有患者经至少6个月以上的保守治疗无效后行踝关节镜手术.受伤至手术时间为7～10个月,平均8.4个月.术前摄踝关节X线片及行常规MRI以及45°轴斜位MRI扫描诊断AITFL损伤情况.以术中关节镜下探查AITFL损伤情况作为金标准,与术前MRI扫描结果进行统计学比较分析.结果:手术探查16例存在AITFL损伤,15例未见损伤.术前常规MRI诊断AITFL损伤的灵敏度75％,特异度66.7％,Youden指数42.3％,Kappa值0.418.术前45°轴斜位MRI扫描诊断AITFL损伤的灵敏度87.5％,特异度93.3％,Youden指数80.8％,Kappa值0.807;45°轴斜位MRI扫描各指标均显著高于常规MRI扫描(P＜0.05).Kappa值显示45°轴斜位MRI扫描与手术探查结果的一致性和可靠性较高.结论:单纯根据常规MRI扫描诊断AITFL损伤可靠性低,45°轴斜位MRI诊断AITFL损伤可靠性高、准确性好,有重要的临床参考价值.

The prevalence of traumatic spinal cord injury(TSCI)is increasing year by year,and there is no fundamental change in its prognosis,therefore it seriously influences the patients’health and quality of life.After trauma,spinal cord hemorrhage and swelling without damage of the dura matter increase subdural pressure and results in exacerbation of ischemia and hypoxia,which aggravate secondary damage.Myelotomy cuts open dura,pia matter and swelling spinal cord,and evacuates necrotic tissues,which could be a potential therapeutic method for SCI.However,there is no standardized operational process on myelotomy in the treatment of TSCI.Here issues related to the surgical timing of myelotomy after traumatic spinal cord injury are discussed.

The management of heterotopic ossification (HO) is controversial. Although some reports have investigated assessment and surgical resection techniques for HO affecting one or more joints, the cases of multijoint stiffness secondary to HO are rare. This article describes a rare case of HO affecting both upper limbs of a 32-year-old man that severely interfered with activities of daily living. We present the rehabilitation management of this case and the functional outcome 1 to 2 yr after excision of the ossific masses.

Objective To explore the method to establish animal model of early osteonecrosis of the femoral head (ONFH) induced by steroid. Methods 20 healthy male Beagles were randomly divided into control group and experimental group with 10 dogs in each group. The experimental group was injected lipopolysaccharide 10μg/kg and methylprednisolone 20 mg/kg for 3 days consecutively. The control group was injected normal saline. 2 months and 4 months after administration, both groups were performed magnetic resonance imaging (MRI). 5 animals were sacrificed respectively at 2 months and 4 months after administration in each group, and bilateral femoral head speci-mens were obtained to perform histological examination. Plasma prothrombin time (PT), activated partial thromboplastin time (APTT), anti-thrombin III (AT-III) were tested before and 24 h after administration. Results In the experimental group, the pathological results showed that there were 4 ONFH 2 months and 6 ONFH 4 months after administration and MRI did not show any abnormality. Compared with the control group, the PT, APTT, AT-III in the experiment group shortened significantly after administration (P<0.001). Conclusion Modified steroid-induced method can establish the animal model of early ONFH. Hypercoagulation and low fibrinolysis may be the reason of ste-roid-induced osteonecrosis.

Objective: To discuss the necessity of adding content about evidence-based medicine into rehabilitation medicine undergraduate education. Methods: 95 students of 2011-2012 clinical rehabilitation medicine undergraduate classes were divided into control group and observation group randomly according to balloting method. The control group was taken traditional teaching mothod,while the observation group was taken evidence-based medical teaching method. The teaching effectiveness of two groups was evaluated.Results:(1) In control group, the master degree of etiology, diagnostic tests, therapeutic trials, adverse drug reactions, disease prognosis,clinical economics, health technology assessment and clinical decision analysis were significantly lower than those of the observation group(P 0.05);(2)In control group, the test scores, clinical skills assessment results and student questionnaire scores were significantly lower than those of the observation group(P 0.05);(3)In control group, the rate of consulting teacher or senior doctor, reading magazines and retrieving from MEDLINE within 3 weeks were significantly lower than those of the observation group(P0.05).Conclusion: Evidence-based medicine teaching model is significantly better than the traditional teaching mode. It should be popularized in rehabilitation medical education.

Although previous studies have shown functional efficacy of myelotomy for the treatment of spinal cord injury (SCI), the underlying mechanism remained unknown. This study aimed to determine the relationship between myelotomy-mediated neuroprotection and autophagy following SCI by evaluating the expression of microtubule-associated protein light chain 3 (LC3-II) and mammalian target of rapamycin complex 1 (mTORC1). Ninety-nine adult female rats were randomly assigned to either sham-operated group (SG), model group (MG), or 24 h-myelotomy group (MTG). SCI at T10 was induced with a New York University impactor, and myelotomy was performed 24 h after SCI. Functional recovery was evaluated via the open-field test. The protein expression of LC3-II was analyzed by Western blot, and the mRNA expression of LC3-II and mTORC1 were detected by real-time quantitative reverse transcriptase polymerase chain reaction. Rats in the MTG exhibited significantly better performance in the hind limbs compared to those in the MG on day seven and fourteen post-injury. Myelotomy suppressed the protein and mRNA expression of LC3-II on day three, seven and fourteen post-injury and increased the mRNA expression of mTORC1 in the MTG on day three and seven post-injury. The LC3-II protein expression was significantly and negatively correlated with BBB scores at day seven and fourteen post-injury. These results showed that myelotomy-induced neuroprotection in a rat model of SCI was likely mediated by inhibition of autophagy by activation of the mTORC1 signaling pathway.

Incision of the spinal cord (myelotomy) after spinal cord injury (SCI) is a surgical treatment which is mainly performed within 24 hours after SCI. However, many patients are first seen outside the established time window of 24 hours. Furthermore, little attention has been given to its efficacy and mechanism after 24 hours. In this study, dorsal longitudinal incision of spinal cord on SCI rats was performed at 72 hours after SCI to remove the liquefied necrotic gray matter. The results indicated that after myelotomy, locomotor function of hindlimbs significantly improved from 21st day after SCI. There was also increased residual white matter area at the rostral and caudal segments to the injury center when examined at day 42 after the injury. These results suggested that myelotomy at 72 hours after injury has protective effect on the spinal cord.