背景:研究发现神经根型颈椎病的肩颈部肌肉力学性能会发生改变,且与症状程度相关.目的:利用新型肌肉定量评估仪MyotonPRO测量并对比分析神经根型颈椎病患者和正常人上斜方肌及胸锁乳突肌的肌肉性能,探讨神经根型颈椎病患者肩颈肌肉失衡现象的原因,为该病的防治及康复锻炼提供依据.方法:选择25例神经根型颈椎病患者及基线资料匹配的25例正常人,采用MyotonPRO定点测量胸锁乳突肌及上斜方肌的张力、刚度并进行对比,通过计算不对称指数来比较神经根型颈椎病患者与正常人的肌肉性能失衡情况,并收集神经根型颈椎病患者的目测类比评分、Northwick Park颈痛量表评分进行相关分析.结果 与结论:①神经根型颈椎病患者的两侧上斜方肌及胸锁乳突肌张力、刚度的平均值均大于正常人,且神经根型颈椎病患者的患侧上斜方肌张力、刚度高于对侧,差异均有显著性意义(P<0.05);②神经根型颈椎病患者的上斜方肌及胸锁乳突肌的张力、刚度的不对称指数与正常人相比,差异均有显著性意义(P<0.05),说明神经根型颈椎病患者的肌张力、刚度均高于正常人组;③神经根型颈椎病患者的目测类比评分与Northwick Park颈痛量表评分均与上斜方肌的张力、刚度均呈显著正相关(P<0.05);④提示神经根型颈椎病患者因为局部软组织炎症、疼痛、姿势等影响,通常表现出上斜方肌及胸锁乳突肌的张力和刚度升高,并且左右两侧的张力和刚度存在明显的失衡情况,这种肌肉力学性能的改变与疼痛及生活质量表现出正相关关系;故在神经根型颈椎病的防治中,需要关注肌肉的张力、刚度失衡,纠正失衡.

Objective To explore the clinical effect of "concave" suture pulling technology combined with vacuum closed drainage (Vaccum Sealing Drainage, VSD) in treating limb soft tissue wound.Methods From July 2017 to December 2021, "concave" suture pulling technique combined with VSD drainage was used to repair 29 cases, aged between 8 and 73 years, mean age of 49 years, wound in limbs and area between 1.5cmx4cm and 15cmx33cm.Results In 23 cases, the wound was closed to avoid secondary supply area damage; in 6 cases, it covered the exposed area and the residual wound was repaired by free skin graft with 100% efficiency.Conclusion "concave" suture pulling technique can well combine VSD drainage to treat limb wound defect, effectively reduce the wound area and avoid skin graft (or reduce the skin graft area) and secondary supply area injury of free flap.

目的:检验MyotonPRO肌肉弹性测试仪测量健康青年人股直肌、股内侧肌及股外侧肌肌肉弹性的复测信度和测试者间信度.方法:本研究纳入了38例健康青年人,采用MyotonPRO评估放松状态下的股直肌、股内侧肌及股外侧肌肌肉弹性,计算组内相关系数(ICC)、绝对信度,两次测量结果绘制成Bland-Altman图并进行系统偏倚分析.结果:复测信度:组内相关系数值介于0.76-0.90,测量标准误(SEM)值介于0.05-0.09,SEM％介于4.63％-7.11％,最小真正改变量(MDC)值介于0.15-0.25,MDC％介于12.83％-19.70％;测试者间信度:ICC值介于0.86-0.97,SEM值介于0.03-0.08之间,SEM％介于3.42-5.84,MDC介于0.09-0.23,MDC％介于9.48％-16.19％.Bland-Altman图形分析显示无系统性误差.结论:MyotonPRO用于健康青年人股直肌、股内侧肌、股外侧肌肌肉弹性测量具有良好的信度,可为临床提供客观依据.

Background: Asymmetrical foot posture and properties alterations of the gastrocnemius muscle (GM) and Achilles tendon (AT) were observed in knee osteoarthritis (KOA). We aimed to investigate the inter-limbs asymmetries in foot posture and the properties of GM and AT and explore the association between them. Methods: A total of 62 subjects with unilateral or bilateral KOA were included in this study: 30 patients with unilateral pain and 32 patients with bilateral pain were assigned to the bilateral group (BG) and unilateral group (UG), respectively. The relatively serious leg (RSL) and relatively moderate leg (RML) were judged according to the severity of symptoms assessed by using visual analogue scale (VAS) motion. Foot posture and asymmetrical foot posture scores were assessed based on Foot Posture index (FPI-6). Subsequently, all the participants received an assessment for properties of GM and AT, including tone/tension (Hz), stiffness (N/m), and elasticity. We calculated the asymmetry index of AT (Asy -AT) in both legs and the difference of muscle properties between medial and lateral gastrocnemius (D-MLG) in the ipsilateral limb. Results: Asymmetry of foot posture was categorized into three types including normal, asymmetry, and severe asymmetry. The percentage of subjects classified as normal was higher in the BG (62.5%) than in the UG (36.67%), p < 0.05. Tension of AT and tone of lateral gastrocnemius (LG) in RSL were higher than those in RML (15.71 ± 0.91 vs. 15.23 ± 1.01; 25.31 ± 2.09 vs. 23.96 ± 2.08, p < 0.01 and p < 0.01, respectively), and stiffness of AT in the RSL was higher than that in RML (676.58 ± 111.45 vs. 625.66 ± 111.19, p < 0.01). Meanwhile, a positive relationship was found between ipsilateral FPI and tone of MG and LG in the left leg (0.246 per degree, 95% CI: −0.001, 0.129; p = 0.054 and 0.293 per degree, 95% CI: −0.014, 0.157; p = 0.021, respectively) and right leg (0.363 per degree, 95% CI: 0.033, 0.146; p = 0.004 and 0.272 per degree, 95% CI: 0.007, −0.144; p = 0.032, respectively). Moreover, a positive link was observed between asymmetrical FPI scores and K/L grade (0.291 per degree, 95% CI: 0.018, 0.216; p = 0.022). Furthermore, a significantly greater Asy-AT(tension) was detected in the UG than that in the BG (UG vs. UG: 8.20 ± 5.09% vs. 5.11 ± 4.72%, p < 0.01). Additionally, an increased asymmetrical FPI score (i.e., more severe asymmetry) was significantly associated with increases in Asy-AT(tension) and Asy-AT(stiffness) (0.42 per degree, 95% CI: 0.533, 1.881; p = 0.001 and 0.369 per degree, 95% CI: 0.596, 2.82; p = 0.003, respectively). Conclusions: The stiffness and tension of AT and the tone of LG in RSL were higher than those in RML in KOA patients, and inter-limbs foot posture and tension of AT were more asymmetrical in unilateral KOA patients compared to patients with bilateral KOA. Notably, foot posture, as an important biomechanical factor, was significantly associated with properties of GM, AT, and K/L grade in KOA patients.

Background: There is increased interest in proprioceptive training for knee osteoarthritis (KOA). However, little consensus supports the effectiveness of this intervention.Objective: This meta-analysis aimed to assess the effects of proprioceptive training on symptoms, function, and proprioception in people with KOA.Methods: The PubMed, Cochrane Library, Web of Science, and EMBASE databases were systematically searched from the inception dates to April 16, 2021 for relevant randomized controlled trials (RCTs). Data were pooled by calculating the standardized mean differences (SMDs) and 95% confidence intervals (CIs). A random-effects model was used for the analyses.Results: A total of 24 RCTs involving 1,275 participants were included in our analysis. This study indicated that compared to no intervention, proprioceptive training significantly improved pain, stiffness, physical function, joint position sense (JPS), muscle strength, mobility, and knee ROM (P < 0.05) in people with KOA. When compared to other non-proprioceptive training, proprioceptive training provided better results in terms of JPS (SMD = −1.28, 95%CI: [−1.64, −0.92], I2 = 0%, P < 0.00001) and mobility (timed walk over spongy surface) (SMD = −0.76, 95%CI: [−1.33, −0.18], I2 = 64%, P = 0.01), and other results are similar. When proprioceptive training plus other non-proprioceptive training compared to other non-proprioceptive training, the two groups showed similar outcomes, but there was a greater improvement for JPS (SMD = −1.54, 95%CI: [−2.74, −0.34], I2 = 79%, P = 0.01), physical function (SMD = −0.34, 95%CI: [−0.56, −0.12], I2 = 0%, P = 0.003), and knee ROM (P < 0.05) in the proprioceptive training plus other non-proprioceptive training group. When proprioceptive training plus conventional physiotherapy compared against conventional physiotherapy, the two groups demonstrated similar outcomes, but there was a significant improvement for JPS (SMD = −0.95, 95%CI: [−1.73, −0.18], I2 = 78%, P = 0.02) in the proprioceptive training plus conventional physiotherapy group.Conclusions: Proprioceptive training is safe and effective in treating KOA. There is some evidence that proprioceptive training combined with general non-proprioceptive training or conventional physiotherapy appears to be more effective and should be considered as part of the rehabilitation program. However, given that the majority of current studies investigated the short-term effect of these proprioceptive training programs, more large-scale and well-designed studies with long-term follow up are needed to determine the long-term effects of these proprioceptive training regimes in KOA.Systematic Review Registration:https://www.crd.york.ac.uk/prospero/#recordDetails, PROSPERO, identifier: CRD42021240587.

Objective. Impaired static stability and proprioception have been observed in individuals with knee osteoarthritis (KOA), which serves as a major factor increasing risk of fall. This study aimed to investigate the effects of backward walking (BW) on static stability, proprioception, pain, and physical function in KOA patients. Methods. Thirty-two subjects with knee osteoarthritis were randomly assigned to either an BW group (BG, n = 16) or a control group (CG, n = 16). The participants in the BG received combination treatment of a 4-week BW training and conventional treatments, while those in the CG was treated with conventional treatments alone. All the participants were tested for the assessment of static stability [center of pressure (COP) sway, including sway length (SL, mm) and sway area (SA, mm2)] and proprioception [average trajectory error (ATE, %) and completion time (CT, second)]. Additionally, pain and knee function scores were measured by the numerical rating scale (NRS) and the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) Index, respectively. The assessments were conducted before and after intervention. Results. The COP sway (SA and SL), ATE, NRS, and WOMAC showed a significant decline at week 4 in the two groups in contrast to their baseline ( P < 0.05 ). Moreover, after 4-week intervention, the SA [(610.50 ± 464.26) mm2 vs. (538.69 ± 420.52) mm2], NRS [(1.56 ± 0.63) vs. (2.25 ± 0.86)], and WOMAC [(11.69 ± 2.50) vs. (16.19 ± 3.94)] showed a significantly greater decrease in the BG compared to the CG ( P < 0.05 , respectively). However, the proprioception (ATE and CT) was closely similar between both groups at week 4 ( P > 0.05 ). Conclusion. BW is an effective adjunct to conventional treatment in reducing pain, improving physical function and static stability for KOA patients. It should be taken into consideration when developing rehabilitation programs for people with KOA.

Background: There is an increasing interest in acupuncture for promoting post-operative rehabilitation, but the effectiveness of acupuncture for rehabilitation after total knee arthroplasty (TKA) remains controversial. Objective: This study aims to investigate the effect of acupuncture on rehabilitation after TKA. Methods: Database searches of PubMed, EMBASE, CINAHL, and China National Knowledge Infrastructure (CNKI) were conducted to obtain articles published until August 2020. All identified articles were screened, and data from each included study were extracted independently by two investigators. Meta-analysis was performed to examine the effects of acupuncture on pain, range of knee motion, function, and nausea/vomiting after TKA. Results: A total of nine randomized clinical trials were included according to the inclusion and exclusion criteria in this review. Compared with routine treatment, acupuncture combined with routine treatment showed a significantly greater pain reduction at 8, 12, 24, and 48 h post-operatively after TKA. Meanwhile, we found that the acupuncture groups showed a significant function improvement and a lower percentage of nausea/vomiting in comparison with the control groups after operation. However, acupuncture groups demonstrated no statistically significant improvement in post-operative pain at 4 h, 7 days, 14 days, and more than 21 days, and no significant difference in range of knee motion was observed between the acupuncture groups and control groups after surgery. Conclusions: Acupuncture, as a supplementary treatment after TKA, could improve function and reduce nausea/vomiting. However, the effect of acupuncture on pain relief may be mainly achieved within post-operative 48 h, and it had no efficacy in improving range of knee motion. More large-scale and high-quality studies are warranted.

随着社会老龄化的加剧,膝痹(膝骨关节炎,KOA)的发病率逐年攀升,目前我国对KOA的治疗以药物及外科手术为主,忽略了膝关节周边肌肉组织的治疗,因此基于文献证据制定相关的专家共识,以用于指导临床实践是现阶段亟待解决的焦点、难点问题.本共识主要从“训练康复方式”、“训练强度、频率、疗程”、“随访”、“康复评定”4个方面提出了符合我国骨科特色的肌肉训练康复推荐建议,避免因医生诊疗水平不同导致的医疗资源浪费,实现更好的社会、经济效益.

Background: Backward walking (BW) training is increasingly used in rehabilitation for stroke, but relevant evidence remains unclear. Objective: To determine the effect of BW training on patients with stroke. Methods: A keyword search was conducted in PubMed, EMBASE, CINAHL, and China National Knowledge Infrastructure database for articles published until November, 2019. Two investigators screened the articles and extract data from each included study. Meta-analysis was performed to estimate the effect of BW on stroke. In addition, the quality of evidence was evaluated by GRADE (grading of recommendations, assessment, development, and evaluation; version:3.6) approach. Results: A total of ten studies were included according to the inclusion and exclusion criteria in the review. All included studies described some positive influences of BW on stroke relative to the control group (forward walking or conventional treatment). Compared to control group, there is a statistically significant improvement for BW group in gait velocity (mean difference [MD] = 6.87, 95%CI: [1.40, 12.33],P = .01,I-2 = 3%), Berg balance score (MD =3.82, 95%CI: [2.12, 5.52],P< .0001,I-2 = 0%), and walk test (MD =0.11, 95%CI: [0.02, 0.20],P = .02,I-2 = 36%). Conclusions: For patients with stroke, BW training, as an adjunct an adjunct to conventional treatment, can improve Berg balance score (moderate evidence), walk test performance (very low evidence), gait velocity (very low evidence). More large-scale and high-quality studies are warranted.

"筋骨并重"是骨折治疗原则之一,近年来逐渐用于慢性筋骨病的防治.广义上"筋骨并重"中的"筋"包含肌肉,狭义上的骨、筋、肉均有其独立结构及名称."骨筋肉并重"是"筋骨并重"理论的延伸和拓展,其更重视肌肉对于慢性筋骨病发生和发展的影响,强调肌肉功能和质量的恢复是慢性筋骨病防治中的重要环节.本文对"筋骨并重"及"骨筋肉并重"理论进行了总结,并对"骨筋肉并重"理论在慢性筋骨病防治中的应用进行了探讨.

Background Interlimb asymmetries are considered to be closely related to knee osteoarthritis (KOA), but foot posture asymmetries in patients with KOA are scarcely reported. Objectives We aimed to explore the asymmetrical difference in foot posture between the healthy adults and KOA patients and the relationship between foot posture asymmetry and static stability. Methods 21 subjects suffering from KOA in the patient group (PG) and 21 healthy adults in the control group (CG) were included in this study. Foot postures on both feet were evaluated by using the foot posture index (FPI); subsequently, asymmetrical FPI scores between two feet were calculated for the two groups. Meanwhile, all the participants were tested with a standing on Dynamic and Static Balancing Instrument (Pro-kin 254P, TecnoBody Company, Italy) for bilateral stability assessment, and center of pressure (COP) parameters including sway length (SL, mm) and sway area (SA, mm2) were recorded. Results Compared to CG, a larger percentage of supinated feet was examined in relatively severe legs (5, 23.81%), relatively moderate legs (4, 19.05%), and merged results (9, 21.43%) of PG (P < 0.05), and the percentage of severe asymmetry (38.1%) was higher in the PG (P < 0.05). Moreover, these relationships between the absolute value of asymmetry score and SL or SA were significant in CG and PG, the P values below 0.01. Conclusions Foot posture asymmetry is significantly associated with static stability both in KOA patients and healthy adults, and more severe asymmetry in foot posture was observed in KOA patients, so it is critical to evaluate foot posture asymmetry for treatment and rehabilitation for patients with KOA.

The reliability of MyotonPRO that can monitor the mechanical properties of tissues is still unclear. This study aimed to analyze the within-day inter-operator and between-day intra-operator reliability of MyotonPRO for assessing tone and stiffness of quadriceps femoris and patellar tendon at different knee angles. The tone and stiffness of healthy participants (15 males and 15 females, aged 24.7±1.6 years) in the supine and resting position were measured using the MyotonPRO device. The measurements were quantified at 0°, 30°, 60°, and 90° of knee flexion. The intraclass correlation coefficient (ICC), standard error of measurement (SEM), and minimal detectable change (MDC) were calculated and a Bland-Altman analysis was conducted to estimate reliability. The results indicated excellent inter-operator reliability (ICC > 0.78) and good to excellent intra-operator reliability (ICC > 0.41). The inter-operator SEM measurements ranged between 0.1-0.9 Hz and 3.8-37.9 N/m, and intra-operator SEM ranged between 0.5-1.3 Hz and 7.9-52.0 N/m. The inter-operator MDC ranged between 0.3-2.5 Hz and 10.5-105.1 N/m, and intra-operator SEM ranged between 1.1-3.3 Hz and 21.9-144.1 N/m. The agreement of inter-operator was better than that of intra-operator. The study concluded that MyotonPRO is a reliable device to detect the tone and stiffness of quadriceps femoris and patellar tendon.

MyotonPRO is a portable device to measure the tone and stiffness of tissues which may reflect on the health of tissues. This protocol uses MyotonPRO device to measure the tone and stiffness of quadriceps femoris and patellar tendon. Measurement points would be confirmed as follows:RF measurement would be taken at two-thirds of the distance between the anterior superior iliac spine (ASIS) and the superior pole of the patella. In order to identify the muscle belly of VM and VL, subjects should active contract the lower limbs and force the hip and knee extending, then the measurement points would be taken the spot of the most salient points of each belly (near the knee joint). Measurement points of patellar tendon would be taken at a point midway between the patella distal and tuberosity of tibial when knee flexed at 90°.

Background: To evaluate the clinical effectiveness and safety of Huangqi injection (HI) in treating chronic heart failure (CHF) systematically. Methods: A literature search was conducted for retrieving randomized controlled trials (RCTs) on CHF treated by HI in the Cochrane Library, PubMed, Embase, China Biology Medicine disc, China National Knowledge Infrastructure Database, China Science and Technology Journal Database, Wanfang Database up to June, 6, 2017, and then the included RCTs were assessed by the Cochrane Risk of Bias Assessment Tool. The clinical total effective rate, left ventricular ejection fraction (LVEF), and others outcomes were analyzed by Review Manager 5.3 in random-effect model, the funnel plot were depicted as well. Meanwhile, the sensitivity analysis was carried out by STATA 12.0. Results: Sixteen RCTs involved 1864 patients were included. The result of HI group was more efficient in the clinical total effective rate (RR = 1.19, 95% confidence intervals (95% CI) [1.14–1.26], P < .00001). In addition, HI plus western medicine (WM) could improve LVEF (MD = 4.64, 95% CI [3.52–5.75], P < .00001), and others cardiac indexes. Meanwhile, a combination of HI and WM also can perfect 6 minutes walk test (6MWT). Three RCTs reported no serious adverse drug events/adverse drug reactions occurred. Conclusion: Compared with WM, a combination of HI and WM was more efficacious in improving the clinical total effective rate, and perfect patients’ condition, but more evidence-based medicine researches needed to support this study further.

Background: To evaluate the clinical effectiveness and safety of Huangqi injection (HI) in treating chronic heart failure (CHF) systematically.Methods: A literature search was conducted for retrieving randomized controlled trials (RCTs) on CHF treated by HI in the Cochrane Library, PubMed, Embase, China Biology Medicine disc, China National Knowledge Infrastructure Database, China Science and Technology Journal Database, Wanfang Database up to June, 6, 2017, and then the included RCTs were assessed by the Cochrane Risk of Bias Assessment Tool. The clinical total effective rate, left ventricular ejection fraction (LVEF), and others outcomes were analyzed by Review Manager 5.3 in random-effect model, the funnel plot were depicted as well. Meanwhile, the sensitivity analysis was carried out by STATA 12.0.Results: Sixteen RCTs involved 1864 patients were included. The result of HI group was more efficient in the clinical total effective rate (RR=1.19, 95% confidence intervals (95% CI) [1.14-1.26], P<.00001). In addition, HI plus western medicine (WM) could improve LVEF (MD=4.64, 95% CI [3.52-5.75], P<.00001), and others cardiac indexes. Meanwhile, a combination of HI and WM also can perfect 6minutes walk test (6MWT). Three RCTs reported no serious adverse drug events/adverse drug reactions occurred.Conclusion: Compared with WM, a combination of HI and WM was more efficacious in improving the clinical total effective rate, and perfect patients' condition, but more evidence-based medicine researches needed to support this study further.