Objective:To explore the effect of chemotherapy on prognosis of patients with non-small cell lung cancer (NSCLC) undergoing total pneumonectomy.Methods:This non-random sampling cohort study included NSCLC patients undergone total pneumonectomy in the US National Cancer Institute′s Surveillance, Epidemiology, and End Results (SEER) database from 2004 to 2016, Efficacy analysis of chemotherapy were performed on the two groups which comprised pneumonectomy group, 491 (received pneumonectomy alone), combined chemotherapy group, 573 (received pneumonectomy + chemotherapy); and the prognosis of patients was analyzed by 1∶1 propensity score matching.Results:The overall survival rate (30.1% vs 16.8%, χ2=79.30, P<0.001) and cancer-specific survival rate (38.5% vs 34.3%, χ2=38.31, P<0.001) in combined chemotherapy group were increased than those in pneumonectomy group.Totally 329 pairs of NSCLC patients treated by pneumonectomy combined with chemotherapy or single pneumonectomy were obtained after propensity score matching.The overall survival (30.9% vs 17.7%, χ2=52.70, P<0.001) and cancer specific survival (39.8% vs 34.4%, χ2=27.38, P<0.001) were better in combined chemotherapy group than in pneumonectomy group.Stepwise multiple Cox regression model analysis showed that adjuvant chemotherapy was an independent factor affecting the overall survival or cancer specific survival of postoperative patients, whether before or after matching. Conclusions:Combined chemotherapy can improve the postoperative prognosis of NSCLC patients.

目的:探讨术后辅助化疗对T2 N0期行肺癌根治术的大细胞类肺癌患者预后的影响.方法:将美国SEER数据库2004年-2016年间收录的接受肺癌根治术的T2N0期311例病理类型为大细胞癌或大细胞神经内分泌癌的肺癌患者资料纳入研究,其中接受行肺癌根治术联合化疗的有96例(手术+化疗组),仅接受肺癌根治术的有215例(单纯手术组).分析并比较辅助化疗对T2N0期行肺癌根治术的大细胞类肺癌患者预后的影响,同时采用1:1倾向性匹配方法分析两组患者预后情况.结果:倾向性匹配前,与单纯手术组相比,手术+化疗组的总预后及肿瘤特异性预后均有明显优势(P<0.05);多因素Cox回归分析提示治疗方式是影响本组患者总预后及肿瘤特异性预后的关键因素(P<0.05),而病理类型对预后的影响较小(P>0.05).倾向性匹配后亚组分析发现,手术+化疗组的总预后及肿瘤特异性预后均明显优于单纯手术组(P<0.05);多因素Cox回归分析提示,治疗方式和年龄是影响本组患者总预后及肿瘤特异性预后的关键因素(P<0.05).结论:辅助化疗能够明显改善T2N0期大细胞类型肺癌患者的预后,值得临床推荐.

Objective:To explore the prognosis of resectable pulmonary large cell neuroendocrine carcinoma (PLCNEC).Methods:The data of 454 patients with T 1-4N 0-2 stage PLCNEC who received radical resection collected by SEER database from January 2004 to December 2016 were included in the study.458 patients with pulmonary small cell cancer (PSCC) who underwent radical resection at the same time were compared.The cancer specific prognosis of patients with PLCNEC who received radical resection was analyzed by 1∶1 tendency matching method Single factor and multiple factor regression analysis were used to analyze the related factors of cancer specific prognosis in patients with PLCNEC, and a nomogram was constructed to predic cancer specific prognosis. Results:Before and after propensity matching, cancer-specific survival of patients with PLCNEC was significantly better than that of patients with PSCC (both P<0.05). After propensity matching, multivariate Cox regression analysis also suggested that there were different prognosis between PLCNEC and PSCC (Wald=4.236, P<0.05). In addition, Cox regression analysis showed that T stage, N stage and chemotherapy were important factors for cancer specific survival (Wald value were 12.007, 22.230 and 7.874, P<0.05). A nomogram (C-index=0.650) was constructed to predict the prognosis of patients. Conclusions:PLCNEC has a better prognosis than PSCC, with its unique pathological and prognostic characteristics.T stage, N stage and adjuvant chemotherapy are important factors affecting the prognosis of patients with PLCNEC.

Objective:To investigate the effect of adjuvant radiotherapy on the prognosis of patients with N 2 stage non-small cell lung cancer (NSCLC) undergoing radical resection. Methods:The data of 1 208 patients with NSCLC who received radical lung cancer resection combined with chemotherapy or post-operative adjuvant radiotherapy and chemotherapy from SEER database of the United States from 2004 to 2016 were included in the study. 627 patients received radical lung cancer resection combined with chemotherapy (surgery + chemotherapy group), and 581 patients received radical lung cancer resection combined with radiochemotherapy (surgery + radiochemotherapy group). We analyzed and compared the effect of postoperative adjuvant radiotherapy on the prognosis of patients with N 2 stage NSCLC undergoing radical resection. The 1∶1 propensity matching method was used to analyze the prognosis of the two groups. Results:In the two groups of patients with stage N 2 NSCLC included in the study, the median survival time was 51 months in the operation + radiotherapy and chemotherapy group, and the 3- and 5-year cancer specific survival rates were 58.3% and 44.9%, respectively. The median survival time was 50 months in operation + chemotherapy group, and the 3- and 5-year cancer specific survival rates were 59.9% and 46.5%, respectively. There was no statistically significant difference between the two groups in cancer specific survival ( P>0.05). The result of subgroup analysis showed that the cancer specific survival of patients in operation + radiotherapy and chemotherapy group was significantly worse than that in operation + chemotherapy group ( χ2=5.085, P<0.05). Multivariate Cox regression analysis showed that age, gender, G stage, T stage and the number of lymph node metastasis were the important factors affecting the cancer specific survival of patients with N 2 NSCLC ( Wald =15.236, 7.039, 4.841, 10.155, 11.192, respectively, P<0.05). After propensity matching, there was no statistically significant difference in cancer specific survival ( P>0.05) between the two groups. However, in the T 1 NSCLC patients, the cancer specific survival of operation + radiochemotherapy group was significantly worse than that of operation + chemotherapy group ( χ2=5.364, P<0.05), while the cancer specific survival of operation + radiochemotherapy group was significantly better than that of operation + chemotherapy group in T 3-4 subgroup( χ2=4.486, P<0.05). According to the tendency matching of pathological subgroups, the cancer specific survival of surgery + radiochemotherapy group was significantly better than that of surgery + chemotherapy group ( χ2=6.279, P<0.05) in the non adenocarcinoma subgroup. And the multivariate Cox regression analysis indicated that postoperative radiotherapy was an important factor for cancer specific survival in patients with N 2 non adenocarcinoma non-small cell lung cancer ( Wald=7.300, P<0.05). However, before and after propensity matching in lung adenocarcinoma subgroup, there was no statistically significant difference in cancer specific survival between the surgery + radiochemotherapy group and the surgery + chemotherapy group ( P>0.05). Conclusions:Postoperative adjuvant radiotherapy can improve the prognosis of patients with T 3-4 or non-adenocarcinoma N 2 NSCLC. But, for other patients with N 2 non-small cell lung cancer, the choice of postoperative adjuvant radiotherapy should be cautious, especially for T 1 stage.

Objective:To observe the effects of horizontal power bicycle training on the walking ability of patients with Guillain-Barre syndrome in sub-acute period.Method:Thirty sub-acute Guillain-Barre syndrome patients were randomly divided into two groups as observation group and control group (n = 1 5 each).The patients in control group were treated only with routine rehabilitation training,and those in observation group received horizontal power bicycle training based on routine rehabilitation treatment.All patients were assessed with Berg balance scale (BBS), manual muscle test of lower limbs (MMT),assessment on ambulation capacity (walking time for 10 m and walking distance in 6 mins,Holden′s functional ambulance classification),and the ability of activities in daily living (ADL),at the time of beginning and 4 weeks later.Result:After 4-week treatment,the balance performance,muscle strength of lower limbs,and ADL in two groups were improved significantly as compared with those before treatment (P <0.05),more significantly in observation group than in control group (P <0.05).Conclusion:Horizontal power bicy-cle training can improve the walking ability of patients with Guillain-Barre syndrome in sub-acute period.

Objective To investigate the effects of slide stretching on rehabilitation of knee joint after trauma.Methods Seventy patients with knee joint dysfunction after trauma were equally randomized into two groups.The patients in group C received conventional therapy including physical modalities,physical therapy and massage(once a day,10 days a cycle for 4 cycles) and those in group A were treated with additional patellofemoral joints slide stretching for 20 min ones in every 10 days.The range of motion(ROM) of the knee joint was measured.The function of the knee joint was evaluated with HSSscore before and after treatment.Results After treated for 4-cycles,ROM and HSS scores were increased(P0.05).The scores of ROM and HSS of traumatic knee joints were significantly higher in group A than those in group C(115.2±14.7) degrees vs.(90.3±12.6) degrees and(83.7±14.4) points vs.(60.8±11.6) points(P0.05).Conclusion Additional use of patellofemoral joints slide stretching can effectively promote the rehabilitation of knee joint after trauma.

<正>有研究表明髋部骨折已成为老年人最常见的骨折之一。由于骨折术后不能早期下地活动,长期卧床导致的废用综合症发病率大大增加,这不仅降低了患者术后的日常生活质量,甚至导致患者死亡;据调查,老年人髋部骨折后死亡率高达

目的:研究手法对原发性"S"型脊柱侧凸的治疗效用。方法:原发性"S"型脊柱侧凸患者40例。胸右腰左侧凸25例,胸左腰右侧凸15例,男13例,女27例。平均年龄14±3岁。将40例患者随机分为两组,对照组20例患者先行侧方体表电刺激治疗,应用仪器为电脑中频治疗仪;其次进行牵引治疗,T9以上侧凸显著者行枕颌牵引,T9以下侧凸显著者行骨盆牵引治疗;在以上治疗的同时两组患者均行针对性的姿势训练;指导患者自行完成原发性"S"型脊柱侧凸的矫正体操。手法组在以上治疗的基础上再增加对胸段及腰段凸侧肌群的手法治疗。评定对照组及手法组患者治疗前及治疗3个月后胸段及腰段Cobb角的变化。所有数据均录入Excel,均采用均数±标准差表示,采用SPSS13.0统计软件,采用组间治疗前后对比,显著性水平P<0.05。结果:治疗前手法组与对照组胸段Cobb角比较无显著差异t=0.89 t=0.81 P>0.05;腰段Cobb角比较无显著差异t=0.87 t=0.88 P>0.05;治疗后手法组与对照组胸段Cobb角较治疗前均有显著性变化t=5.54 t=4.07 P<0.01;治疗后手法组与对照组腰段Cobb角较治疗前均有显著性变化t=5.98 t=4.14 P<0.01;治疗后手法组与对照组胸腰段Cobb角比较有显著性改善t=2.89 t=3.07 P<0.01。结论:手法治疗对原发性"S"型脊柱侧凸的治疗效应显著。

目的观察改良膝关节松动术治疗创伤后膝关节功能障碍的疗效。方法选取膝关节创伤后功能障碍患者90例,分成对照组和松动组,每组患者45例。对照组行中药熏蒸、运动疗法及中医推拿综合治疗。松动组在对照组治疗方法的基础上增加改良的膝关节松动术。2组患者均于治疗前及治疗6个疗程后采用膝关节评定量表进行评定,量表主要包括评定膝关节功能的膝评定量表、评定患者步行和上下楼能力的功能量表,基本分都是100分,每部分都设定有减分的评定参数。结果治疗6个疗程后,2组患者膝关节功能及步行、上、下楼评分与治疗前比较,差异均有统计学意义(P<0.05);松动组与对照组治疗6个疗程后的膝关节功能及步行上、下楼评分相比较,差异亦有统计学意义(P<0.05)。结论改良膝关节松动术能有效地改善关节活动范围和膝关节运动功能。

目的:观察综合手法治疗对肩关节功能障碍的疗效.方法:肩关节创伤后功能障碍患者90例,随机分为2组各45例,均行物理因子治疗及运动疗法,观察组在此基础上增加推拿及肩关节松动技术.结果:治疗2个月后,2组肩关节活动度(ROM)值均较治疗前明显提高(P<0.01);2组间比较,观察组提高更显著(P<0.01).结论:配合推拿及肩关节松动术对肩关节功能障碍的康复有显著促进效益.

目的:观察关节持续被动活动(CPM)治疗骨折后肘关节功能障碍的效果。方法:63例骨折后肘关节功能障碍患者分为CPM组33例和对照组30例,均采用常规康复治疗。CPM组加用CPM。结果:治疗2个月后,CPM组患者肘关节活动范围及有效率均明显优于对照组(P<0.05)。结论:CPM能显著提高骨折后肘关节功能障碍的疗效。

Objective:To investigate the effects of reinforced STS training on the function of the paretic lower limb and ADL in patients with hemiplegia after stroke.Methods:Forty hemiplegia patients were randomly divided into the reinforced STS training group and the control group.All patients were regularly treated with physical training.The patients in the reinforced STS training group were administered with sit-to-stand function training in addition to the above interventions.The evaluation was done pre-treatment and 1,3 and 6 months post-treatment.The Fugl-Meyer assessment (FMA) and the Modified Barthel Index (MBI) were used to assess the function of the paretic lower limb and ADL.Results:FMA-L and MBI of both groups were extremely increased (P0.01) after the treatment.At 1st and 3rd month after stroke,the lower limb motor function in the reinforced STS training group was significantly improved as compared with that in the control group (P0.05).At 3rd month after stroke,the ADL in the reinforced group was significantly improved as compared with that in the control group (P0.05).Conclusion:The reinforced STS training can significantly improve the motor function of the paretic lower limb and ADL of stroke patients.

目的:骨折后肩关节功能障碍的传统干预措施为运动疗法结合理疗及中医推拿手法,探讨肩关节松动技术增加到治疗方案中对肩关节功能障碍患者的干预效应.方法:选择2003-01/2004-12南京医科大学第一附属医院康复医学科收治的肩关节功能障碍患者90例,随机分为两组,对照组和关节松动术组各45例.对照组患者先行理疗,再行运动疗法,运动疗法总的治疗时间为每天1 h左右,结束后以中医推拿手法结束治疗.10 d为1个疗程,共进行3个疗程,各疗程间无间隔.关节松动术组在以上治疗基础上增加肩关节松动技术,1.5～2.0 h/d.盂肱关节包括:①分离牵引.②长轴牵引.③向头侧滑动.④前屈向足侧滑动.⑤外展向足侧滑动.⑥前后向滑动.⑦后向前滑动.⑧外展摆动.⑨侧方滑动.⑩水平内收摆动.(11)后前向转动.(12)内旋摆动.(13)外旋摆动.胸锁关节包括:①前后向滑动;②上下滑动.肩锁关节:后向前滑动.肩胛胸壁关节:松动肩胛骨.评定治疗前及治疗3个疗程后两组患者患肩前屈、后伸、内收、外展活动范围值.结果:90例患者全部进入结果分析.①患肩前屈、后伸、内收、外展活动范围:3个疗程后关节松动术组较对照组显著改善[(113±18,39±7,36±6,118±15)度;(87±11,30±6,25±7,79±16)度,(t=3.01～5.17,P＜0.01)].②两组患者治疗3个疗程后均较治疗前显著改善(t=3.75～7.96,P＜0.01).结论:肩关节松动术能显著改善肩关节运动功能,可能与其可以直接牵拉关节周围软组织,在短时间内分离粘连,保持软组织良好的弹性和伸展性,从而改善关节活动范围有关.

目的观察医疗体育在胸腔术后的作用.方法胸腔术后患者40例,所有患者术后无外科禁忌,均在术后24h开始进行医疗体育.评定患者咳痰能力及局部和腹式呼吸能力.结果 90%以上患者两项能力明显提高.结论医疗体育的介入为胸腔术后患者机能的全面提高提供了良好的前提,在胸腔术后的康复过程中始终贯穿,起到非常重要的作用,在今后的工作中应进一步保持和改善.

目的观察改良伸直型矫形器对骨折后肘关节功能障碍的康复效用.方法肘关节骨折后患者60例,男32例,女28例,平均年龄(37.82±19.63)岁.石膏托外固定组20例,矫形器组20例,改良矫形器组20例.所有患者均行5个疗程治疗.评定治疗前后患肘伸直障碍度及患侧上肢Barthel指数.结果各组患者治疗5个疗程后较治疗前两项指标均有显著性变化P＜0.01,治疗后矫形器组与石膏外固定组相比P＜0.05,治疗后改良矫形器组与矫形器组相比P＜0.05.结论改良肘关节矫形器在骨折后肘关节功能障碍康复中有较好的治疗作用.

目的观察改良肘关节功能牵引装置的康复效应.方法肘关节功能障碍患者50例.分为对照组25例,改良器械牵引组25例,所有患者均于骨折线模糊时行康复治疗.对照组行温热疗法、主动及助力练习、关节松动技术治疗及无专用器械的关节功能牵引;改良器械牵引组为专用器械载荷牵引治疗.所有患者均接受3个疗程治疗后评定治疗前后患肘屈伸关节活动范围(Range of Motion,ROM)及患侧上肢Barthel指数.结果两组治疗前后组内比较,治疗后组间比较ROM及Barthel指数两项指标差异均有非常显著性意义.结论改良肘关节牵引器解决了以往肘关节载荷牵引上的众多细节问题,能产生较为理想的长期效应.

目的明确矫形器在骨折后肘关节功能障碍中的作用.方法70例肘关节骨折后致关节伸直功能障碍明显的患者分为两组,传统方法(包括热理疗、载荷牵引、主动运动、手法治疗)康复组患者36例(Ⅰ),传统方法结合配带肘关节伸直位矫形器患者34例(Ⅱ组),治疗时间均为1个月.评定指标包括肘关节活动范围、肘关节伸直障碍度、患侧Barthel指数.统计方法采用统计软件SPSS10.0计量资料,进行组间治疗前、后比较用配对t检验,显著性水平P＜0.05.结果治疗1个月后两组3项指标数据对比P＜0.01,t=7.31,7.28,7.36,有显著性差异.结论矫形器在骨折后肘关节功能障碍康复过程中起重要作用.

膝关节创伤后行内固定或/及外固定均会引起不同程度的膝关节功能障碍,尤其是屈膝功能障碍.传统的康复治疗方法是理疗,尤其是传导热治疗结合膝关节屈曲功能持续载荷牵伸并结合股四头肌肌力训练.笔者通过对一组膝关节功能障碍患者在传统康复治疗的基础上再配合膝关节松动术,取得良好的治疗效果.

目的明确运动疗法在腰椎间盘突出症康复中的作用程度.方法564例腰椎间盘突出症患者随机分3组,平均每组188例.Ⅰ组患者采用骨盆牵引治疗;Ⅱ组患者采用骨盆牵引及物理因子治疗;Ⅲ组患者采用骨盆牵引、物理因子及运动疗法.评定标准采用日本骨科学会下腰痛评定表.结果Ⅰ、Ⅱ、Ⅲ组治疗后与治疗前对比P<0.01,3种治疗均有效;治疗前Ⅲ组与Ⅰ、Ⅱ组对比P>0.05,差异无显著性意义,治疗后Ⅲ组与Ⅰ、Ⅱ组对比P<0.01,差异有显著性意义.结论运动疗法在腰椎间盘突出症康复中有重要作用.

Objetive: To study the result of manipulation therapy(MT) for frozen shoulders. Method: Before and after MT, the parameters of involoved shoulder extensors and flexors , abductors and adductors were isokinetically recorded on 20 patients with frozen shoulder twice. Result: Compared with the parameters measured pre-therapy most of those factors measured increased significantly afterwards (P＜0.01 ). Conclusion:Effect of MT on frozen shoulder are satisfactory and ROM are accurate and reliable.