近年来,臀肌肌腱病被认为是髋关节外侧疼痛的主要原因,严重影响患者生活质量,在临床上尚未引起重视或经常被误诊.就臀肌肌腱病的发病机制、临床特征、临床诊断试验、影像学检查和治疗进展进行综述.

Shape memory sponges are very promising in stopping the bleeding from noncompressible and narrow entrance wounds. However, few shape memory sponges have fast degradable properties in order to not hinder tissue healing. In this work, based on cryopolymerization, a succinic ester-based sponge (Ssponge) is fabricated using gelatin and bi-polyethylene glycol-succinimidyl succinate (Bi-PEG-SS). Compared with the commercially available gelatin sponge (Csponge), Ssponge possesses better water/blood absorption ability and higher mechanical pressure over the surrounding tissues. Moreover, in the models of massive liver hemorrhage after transection and noncompressive liver wounds by penetration, Ssponge exhibits a better hemostasis performance than Csponge. Furthermore, in a liver regeneration model, Ssponge-treated livers shows higher regeneration speed compared with Csponge, including a lower injury score, more cavity-like tissues, less fibrosis and enhanced tissue regeneration. Overall, it is shown that Ssponge, with a fast degradation behavior, is not only highly efficient in stopping bleeding but also not detrimental for tissue healing, possessing promising clinical translational potential.

Objective The purpose of this study was to investigate the effects of different durations of static progressive stretching (SPS) on posttraumatic knee contracture in rats, including range of motion (ROM), gait analysis, myofibroblast proliferation, and collagen regulation. Methods The posttraumatic knee contracture model was established, and male Wistar rats were randomly divided into the 20-minute SPS treatment, 30-minute SPS treatment (S30), 40-minute SPS treatment, untreated, immobilization, and control groups. At Week 1, 2, and 4 of treatment intervention, joint ROM and gait were measured and compared. Knee joint samples stained with hematoxylin and eosin and Masson trichrome were used to observe alterations in pathological structures. Collagen density and cell numbers in the posterior joint capsule were used to assess joint capsule fibrosis and inflammation. Immunohistochemistry was used to detect type I collagen and alpha-smooth muscle actin expression. Results The S30 group improved the most; ROM, stance, mean intensity, print area, and stride length were 115 (SD = 5) degrees, 0.423 (SD = 0.074) seconds, 156.020 (SD = 7.952), 2.116 (SD = 0.078) cm(2), and 11.758 (SD = 0.548) cm, respectively. The numbers of myofibroblasts, fibroblasts, and inflammatory cells decreased, and collagen proliferation was significantly suppressed in the S30 group compared with the other groups. Conclusion S30 significantly improved posttraumatic knee contracture in rats, with reduced type I collagen and alpha-smooth muscle actin expression, decreased the numbers of myofibroblasts and inflammatory cells, suppressed fibrotic and inflammatory changes in the joint capsule, and increased joint mobility. This study provided basic evidence for an optimal standard-of-care treatment approach for posttraumatic knee joint contracture in rats, which may have significance for humans.

背景 足跟痛可导致足踝功能障碍.体外冲击波治疗可在1?～?2?d内恢复日常生活,但冲击波疗法也存在疗效持续时间短的局限.超声药物导入是近年来一种较为新颖的给药方法,但目前尚未见将这种方法应用于足跟痛的治疗.目的 探究超声药物导入联合体外冲击波对于治疗足跟痛的疗效.方法 选取于2019年9月-?2021年9月就诊解放军总医院第一医学中心康复医学科的足跟痛患者60例,随机分为治疗组和对照组,每组30例,两组均先进行体外冲击波治疗,1次/周.治疗组在冲击波治疗后加用超声药物(双氯芬酸二乙胺乳胶剂)导入法治疗,时间为15?min,5次/周,共2周.对照组在体外冲击波后加用伪刺激超声,方法与治疗组相同.于治疗前、治疗1周和治疗2周后采用视觉模拟量表(visual?analogue?scale,VAS)和美国足踝外科协会后足评分量表(American?Orthopaedic?Foot?&?Ankle?Society,AOFAS)评估患者疼痛程度和足踝功能.结果 两组基线资料比较,差异无统计学意义(P>0.05).治疗后,两组VAS评分较治疗前均显著降低,AOFAS评分均显著提高(P均<0.05);治疗组间相比,治疗1周后两组VAS和AOFAS评分差异无统计学意义,治疗2周后治疗组VAS分数显著低于对照组(3.36±1.00?vs?4.29±1.06),AOFAS分数显著高于对照组(80.22±8.73?vs?71.44±7.58)(P均<0.05).结论 超声药物导入联合体外冲击波治疗及单纯冲击波治疗均能有效降低足跟痛患者疼痛并改善足踝功能,但联合治疗疗效更佳,推荐治疗周期至少2周.

The relationship between hemiplegic shoulder pain (HSP) and subluxation is unclear. This study aimed to determine the differences of magnetic resonance imaging (MRI) findings in HSP patients with or without subluxation after stroke, and to analyze the etiology of shoulder pain. This retrospective study included 53 patients with HSP after stroke from September 2013 to February 2020. Patients underwent MRI of the shoulder because of shoulder pain. Clinical characteristics, including age, sex, stroke duration, body mass index, stroke type, visual analog scale score, Brunnstrom stage, and MRI arthrography findings of the affected shoulder, were recorded. Patients were classified into the glenohumeral subluxation (GHS) group (n = 27) or non-glenohumeral subluxation (nGHS) group (n = 26). We found that patients with HSP may be prone to bursa effusion, rotator cuff injury, ligament injury, and cartilage injury, even though there was no significant difference between the GHS and nGHS groups. MRI revealed 14 cases of long bicipital tendon-glenoid labrum injury (51.8%) in the GHS group and 6 cases (23.1%) in the nGHS group (p = 0.030). We also found 10 cases (37%) of glenoid labrum injury in the GHS group and 2 cases (7.7%) in the nGHS group (p = 0.026). Eight cases (29.6%) and 1 case (3.8%) of bone marrow edema were found in the GHS and nGHS groups, respectively (p = 0.033). Compared with painful hemiplegic shoulder patients without subluxation, patients with subluxation may be more susceptible to some injuries, such as long bicipital tendon-glenoid labrum injury, glenoid labrum injury, and bone marrow edema. During rehabilitation, physicians need to pay attention to these injuries.

肌内效贴布疗法是将弹性治疗贴布贴于皮肤以协调肌肉功能、预防运动损伤的方法,在临床康复尤其是运动损伤的康复中应用广泛,具有消肿、镇痛、改善关节活动度、提高本体感觉、平衡功能及预防损伤的作用.本文就肌内效贴布在下肢运动损伤防治中的应用进行综述.

背景:富血小板血浆在肌骨领域已得到广泛应用,能够促进组织的修复与再生.目的:综述富血小板血浆在肌骨治疗中的作用与研究进展.方法:中文以"富血小板血浆"检索中国知网、万方数据库1977年1月至2020年2月的相关文献,英文以"Platelet rich plasma,PRP"检索PubMed、Wed of Science数据库;根据纳入及排除标准最终纳入63篇文献.结果与结论:现有证据支持使用富血小板血浆治疗膝关节骨性关节炎,但其临床疗效仍存在争议,尚需进行标准化、高质量、大样本的随机对照研究,且富血小板血浆的长期疗效需进一步证实.分析结果表明,富血小板血浆可作为一种辅助治疗方法应用于肩袖损伤的患者;治疗肱骨外上髁炎大多数研究效果肯定;富血小板血浆注射治疗腕管综合征在短期内能减少患者的疼痛,改善感觉及运动功能,且并发症发生率低,可作为轻至中度患者的治疗方法;多次注射富血小板血浆是非手术治疗的慢性髌腱炎患者的合适选择.但目前仍存在一些问题:富血小板血浆的制备尚无统一标准;相关作用机制尚未阐明;最佳适应证及治疗参数尚不清楚等,需进一步明确.

儿童周围性面瘫发病率很低,每年5-21/100000,年龄常见于5-11岁[1].特发性贝尔麻痹占所有病例的26％-76％[2],感染性、肿瘤性、外伤性、医源性、中毒性是常见的病因[3].急性中耳炎合并周围性面瘫非常罕见,一般在3岁以上[4],国外曾报道11个月和14个月的婴幼儿[3,5],本文报道了我院1例9月龄婴儿急性中耳炎合并周围性面瘫病例.

背景 肩痛是脑卒中偏瘫患者最常见的症状之一,影响日常活动能力,降低生活质量.目的 分析脑卒中偏瘫肩痛患者肩关节损伤情况及发生肩关节挛缩的相关因素.方法 选取2013年10月-2019年12月解放军总医院第一医学中心康复科收治的偏瘫肩痛(hemiplegic shoulder pain,HSP)患者66例,男46例,女20例,平均年龄(57.28±12.08)岁.对患者患侧肩行MRI扫描,记录患侧肩关节磁共振结果和各项临床指标.根据是否存在关节挛缩,将患者分为关节挛缩组(35例)和非关节挛缩组(31例),比较两组各项指标差异.结果 66例中肩胛下滑囊炎/关节腔积液59例(89.39％),冈上肌肌腱损伤54例(81.82％),肱二头肌肌腱炎54例(81.82％),肩峰下-三角肌下滑囊炎50例(75.76％),喙突下滑囊炎57例(86.36％).关节挛缩组肩峰下-三角肌下滑囊炎、盂唇损伤率较非关节挛缩组高(85.71％vs 64.51％,P=0.050;62.86％vs 35.48％,P=0.026),两组其他指标差异无统计学意义.结论 肩胛下滑囊炎/关节腔积液、冈上肌肌腱损伤、肱二头肌肌腱炎是HSP患者最常见的MRI改变;肩关节挛缩患者更容易发生肩峰下-三角肌下滑囊炎及盂唇损伤.

Objective: To evaluate the effectiveness of botulinum toxin A (BTX-A) in the treatment of hemiplegic shoulder pain. Data Sources: PubMed, EMBASE, Elsevier, Springer, Cochrane Library, Physiotherapy Evidence Database, CNKI, and VIP were researched from the earliest records to September 1, 2020. Study Selection: Randomized controlled trials that compared shoulder BTX-A injections vs a control intervention in patients with a history of hemiplegic shoulder pain after stroke were selected. Among the 620 records screened, 9 trials with 301 eligible patients were included. Data Extraction: Outcome data were pooled according to follow-up intervals (1, 2, 4, and 12 wk). The primary evaluation indices were pain reduction (visual analog scale [VAS] score) and range of motion (ROM) improvement. The second evaluation indices were upper limb functional improvement, spasticity improvement, and incidence of adverse events. Cochrane risk-of-bias was used to assess the methodological quality of studies independently by 2 evaluators. Data Synthesis: Meta-analysis revealed a statistically significant decrease in the VAS score in the BTX group vs the control group at 1, 4, and 12 weeks postinjection (wk 1: standardized mean difference [SMD], 0.91; 95% confidence interval [CI], 0.27 to 1.54; wk 4: SMD, 1.63; 95% CI, 0.76 to 2.51; wk 12: SMD, 1.96; 95% CI, 1.44 to 2.47). Furthermore, the meta-analysis demonstrated a statistically significant increase in abduction at 1, 4, and 12 weeks postinjection (wk 1: SMD, 3.71; 95% CI, 0 to 7.41; wk 4: SMD, 8.8; 95% CI, 2.22 to 15.37; wk 12: SMD, 19.59; 95% CI, 9.05 to 30.13) and external rotation at 1, 2, 4 weeks postinjection (wk 1: SMD, 5.67; 95% CI, 0.88 to 10.47; wk 2: SMD, 9.62; 95% CI, 5.57 to 13; wk 4: SMD, 6.89; 95% CI, 2.45 to 11.33) in the BTX group. Conclusions: BTX-A injection provided greater analgesic effects and increased shoulder abduction and external rotation ROM compared with steroid or placebo injection for the treatment of HSP. Archives of Physical Medicine and Rehabilitation 2021;102:1775-87 (c) 2021 by the American Congress of Rehabilitation Medicine

目的 文本旨在使用深度学习方法 对精神分裂症建立自动分类模型,为临床上精神分裂症患者的鉴别诊断提供参考.方法 通过提取受试听觉稳态诱发电位的能量、相位、信噪比和微分熵作为模型输入特征,使用准确率、灵敏度、特异度和受试工作者特性曲线对深度信念网络和支持向量机构建的模型进行分析和比较.结果 深度信念网络模型的准确率、灵敏度、特异度、曲线下面积分别为85.6％、88.33％、75.50％和0.88.深度信念网络模型诊断能力明显高于基于线性核、径向基函数核、sigmoid核的三种支持向量机模型.结论 基于深度信念网络算法的诊断模型可以有效协助临床医生对于精神分裂症患者的诊断,达到早期发现疾病的效果.

目的 报道了一例误诊为军事训练伤的髂腰肌受累的布氏杆菌病,旨在提高医务人员对布氏杆菌病的认识和处置能力.方法 2019年5月17日解放军总医院第一医学中心收治1例男性战士,主因“训练后左侧髋部疼痛8d,发热6d”入院.进行了血液学和影像学检查.结果 血液标本后示人布氏杆菌IgG抗体检测(+),双侧骶髂关节CT:右侧骶髂关节间隙模糊,局部显示欠清晰.髋关节MRI示:冠状位T2脂肪抑制序列可见左侧髂腰肌走行区斑片状高信号,边界不清.经过抗感染治疗后疼痛好转出院.结论 对于反复发热、难以解释的骨骼肌肉疼痛,要注意鉴别布氏杆菌病的筛查,避免误诊.

失匹配负波(mismatch negativity,MMN)是事件相关电位(event-related potential,ERP)的一种,是一种内源性时间相关电位成分,它不依赖于受试者对给定任务的注意力,无需受试者主动参与.因此,对于无意识的、不能给与主动反馈或依从性较差的患者,MMN有较高的诊断价值.同时,它也有简单、非侵入性等特点,故较多地应用于神经、精神、心理等疾病的诊断中,是ERP临床研究的热点之一.

近年来我国脑卒中发病率明显增高,已成为危害居民生命健康的重大公共卫生问题.神经肌肉电刺激疗法应用低频脉冲电流刺激神经或肌肉使其收缩,达到恢复功能的作用,已广泛应用脑卒中患者康复治疗中,并取得良好的效果.本文就神经肌肉电刺激疗法在脑卒中康复治疗中的应用研究进行综述.

复杂性区域疼痛综合征(complex regional pain syndrome,CRPS)是一组以四肢疼痛为主要表现的临床综合征.其发病机制尚不明确,目前缺乏确切有效的治疗方式,给患者及家庭带来了极大的不良影响.本文就近年来CRPS的流行病学、发病机制、评估、诊断和治疗方法的最新研究进展做一综述.

目的 应用剪切波弹性超声成像技术测量脑卒中患者不同屈肘角度和深度时痉挛肱二头肌(BBM)的剪切波速度(SWV),并探索SWV值与痉挛临床评估指标是否有相关性.方法 选取2019年06月～2020年2月解放军总医院收治的脑卒中偏瘫患者35例,应用剪切波弹性超声成像技术分别测量痉挛侧BBM屈肘90°和完全伸肘时浅层和深层的SWV值,并进行改良Ashworth量表、改良Tardieu量表、Fugl-Meyer上肢运动功能、关节活动范围等临床评估,采用Spearman分析SWV值和临床评估指标之间的相关性.结果 不论浅层或深层,屈肘90.时BBM的SWV值与改良Tardieu分级、Fugl-Meyer上肢评分均有显著相关性,与改良Ashworth分级、痉挛角、肘关节被动关节活动度(PROM)无显著相关性;当完全伸肘时,BBM的SWV值与改良Ashworth分级、改良Tardieu分级、痉挛角、Fugl-Meyer上肢评分、肘关节被动关节活动范围均有显著相关性;SWV值与肘关节主动关节活动范围无显著相关性.结论 剪切波弹性超声成像技术可定量评估脑卒中后痉挛BBM的痉挛程度,为帮助临床决策和指导干预手段提供了可能.

Joint contracture is one of the common musculoskeletal disorders. It has seriously disturbed patients' activities of daily living in various aspects. The pathogenesis of it is eager to explore to distinct degree. Nowadays the thickeness and fibrosis of joint capsular is redarded as the major reason to joint contracture. It is reported that excessive fibroblasts and myofibroblasts activity, collagen hyperplasia, and extracellular matrix (ECM) deposition in these fibrotic condtions lead to the contracture. In addition, upregulators of myofibroblast and collagen synthesis, transforming growth factor-beta 1 (TGF-β1), and connective tissue growth factor (CTGF) were shown to be increased. Altered levels of cytokines were also thought to play a role in this process as elevated levelsof tumor necrosis factor-α(TNF-α), matrix metalloproteinases(MMPs) and abnormal distribution tissue inhibitors of MMPs(TIMPs) were demonstrated in contracted capsules. At present, the methods for clinical treatment of joint contracture mainly include two major categories:stretching therapy, physical factor therapy, exercise therapy, botulinum toxin injection and other non-surgical treatments, arthroscopic lysis, open lysis, and other surgical treatments. Surgical treatment is performed when non-surgical treatment is difficult to achieve further improvement. It has a good effect on mild to moderate joint contracture, but it is difficult to completely restore joint activity for serious joint contracture. Although clinical treatment methods are diverse, the clinical effects are staggered and the effectiveness of their treatment is controversial. Joint contracture is an important challenge faced by orthopedics and rehabilitation physicians, therapists and patients. The review summarized the pathogenesisand treatment of joint contracture and provided a theoretical basis for clinical diagnosis and treatment.

产后腹直肌分离症会影响患者的躯干功能,引起腰背痛,严重者可造成腹疝.但是目前对于腹直肌分离的诊治没有统一的标准,康复方法多种多样.为此,本文对产后腹直肌分离最新的诊断和康复治疗研究进展进行综述.

目的 应用剪切波弹性超声成像技术定量评估脑卒中患者痉挛的肱二头肌(biceps brachii muscle,BBM)在不同屈肘角度以及肌肉不同深度的硬度变化.方法 选取2019年5月1日-2020年1月20日就诊于解放军总医院第一医学中心的脑卒中偏瘫患者共20例,其中男性16例,女性4例,平均年龄53.8(30～75)岁.应用实时剪切波弹性超声定量比较BBM痉挛侧与非痉挛侧、屈肘90° 与屈肘0° 以及浅层与深层杨氏模量的差异.结果 屈肘0° 时,痉挛侧BBM杨氏模量值中位数均明显大于健侧杨氏模量值(中位数:浅层57.2 vs 31.0,P<0.01;深层74.2 vs 32.5,P<0.01);痉挛侧BBM在屈肘90°时的杨氏模量值中位数明显小于屈肘0° 时的杨氏模量值(中位数:浅层39.1 vs 57.2,P<0.01;深层42.6 vs 74.2,P<0.01);当痉挛侧屈曲0° 时,BBM浅层的杨氏模量值中位数明显小于深层(57.2 vs 74.2,P<0.01).屈肘0° 时,BBM浅层和深层杨氏模量均与改良Ashworth分级(Modified Ashworth Scale,MAS)呈正相关(浅层:r=0.612,P=0.004;深层:r=0.732,P=0.000).结论 剪切波弹性超声成像技术可用于评估脑卒中后BBM硬度的变化.

OBJECTIVE:To investigate the effect and mechanism of static progressive stretching (SPS) in different durations on traumatic knee contracture in rats. METHODS:Seventy male Wistar rats were randomly divided into three groups, including surgical modeling group ( n=50), control group (CON, no surgery, no treatment, n=10) and trauma without immobilization group (TRA, no treatment, n=10). The knee contracture model was established, and 50 surgical modeling rats were randomly divided into five groups including static progressive stretching treatment for 20 minutes group (S20 min, n=10), treatment for 30 minutes group (S30 min, n=10), treatment for 40 minutes group (S40 min, n=10), untreatment group (UNT, no SPS, n=10) and modeling group (MOD, n=10, euthanized after immobilization for histological staining and Western blot). Individuals in the S20 min, S30 min, and S40 min groups were anesthetized and submitted to SPS. One treatment session took place every other day. A total of 8 sessions were given till the final treatment session on the day 16. On the day 0, 8, and 16 of intervention, the range of joint motion (ROM) and gait analysis were measured and compared. After the ROM measurements and gait analysis, the rats were euthanized on the day 16 and the samples were stained with HE and Masson methods. The changes of pathological organization were observed. Western blot was used to detect the expressions of transforming growth factor-β1 (TGF-β1) and interleukin-6 (IL-6). RESULTS:① ROM：the ROM of S30 min group recovered similar to that of the S20 min and S40 min groups after 8 days of treatment ( P>0.05), and was the best among all the surgical modeling groups after 16 d of treatment ( P<0.05). The ROM of S20 min, S30 min and S40 min groups significantly improved on the day 8 and day 16 comparing with that on day 0 ( P<0.01). ② Gait analysis: the stands in the S30min group improved best on the day 8 and day 16 ( P<0.05) , and better than that on day 0 ( P<0.05). The stride length of the S30 min group progressed similar to that of the S40 min group on the day 8 ( P>0.05), and there was no difference among three groups on the day 16 ( P>0.05). The stride length of the S30 min group appeared to recover more quickly on the day 8 ( P<0.05), and those of S20 min and UNT groups recovered significantly on the day 16 ( P<0.05). In addition, the swings in the S30 min group improved best ( P<0.05), and it appeared to recover better on the day 16 ( P<0.05). There was no statistical difference in terms of the swing speed among the four surgical modeling groups on the day 8 ( P>0.05). The swing speed of the S30min group increased most than those of the other three groups ( P<0.05), and it was much better on the day 8 and day 16 comparing with that on the day 0 ( P<0.05 ). ③ HE and Masson staining: the fibrosis and inflammation of the S30min group were significantly suppressed comparing to the other groups on the day 16. ④ Western blot: The protein expression levels of TGF-β1 and IL-6 were significantly lower than those in the other intervention groups including the S20 min, S40 min and UNT groups on the day 16 ( P<0.05). CONCLUSION:Static progressive stretching treatment for 30 min could significantly improve the traumatic knee contracture in rats. The mechanism may be that the SPS decreased the expressions of TGF-β1 and IL-6, reduced the adhesion and inflammation of joint capsule. Therefore it relieved the pain and increased the joint mobility by reconstructing the structure of the capsule and suppressing the fibrotic changes.