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中华物理医学与康复杂志
中华物理医学与康复杂志

黄晓琳

月刊

0254-1424

cjpmr@tjh.tjmu.edu.cn

027-83662874

430030

湖北省武汉市解放大道1095号同济医院内

中华物理医学与康复杂志/Journal Chinese Journal of Physical Medicine and RehabilitationCSCD北大核心CSTPCD
查看更多>>中华医学会主办。本刊主要内容包括：贯彻党和国家的卫生工作方针政策，理论与实践相结合，提高与普及相结合，积极倡导百花齐放、百家争鸣；全面介绍物理治疗、物理医学与康复领域内领先的科研成果和新理论、新技术、新方法、新经验以及对物理因子治疗、康复临床、疗养等有指导作用，且与康复医学密切相关的基础理论研究，同时密切关注国际康复医学发展的新动向。主要栏目包括论著、综述、研究报告、经验交流、继续教育、讲座、病例报告、会议纪要、书评、国内外学术动态、学术活动预告等。
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    运动预处理对脑缺血再灌注损伤大鼠缺血区脑组织血管新生及HIF-1α和VEGF蛋白表达的影响

    周璐唐丽亚蒋琼贺美燕...
    1-6页
    查看更多>>摘要：目的 观察运动预处理对脑缺血再灌注损伤大鼠缺血侧脑组织缺氧诱导因子-1α(HIF-1α)和血管内皮生长因子(VEGF)的影响，探讨运动预处理通过促进血管新生改善缺血再灌注损伤的可能机制。 方法 采用随机数字表法将36只SD雄性大鼠分为假手术组、模型组和运动预处理组，每组12只。3组大鼠给予适应性跑步训练3 d后，运动预处理组给予正式跑步训练，速度15 m/min，每天1次，每次30 min，持续14 d；假手术组与模型组大鼠不给予其它处理。正式跑步训练结束后，模型组和运动预处理组大鼠采用Zea-Longa栓线法加以改良制备大脑中动脉栓塞(MCAO)再灌注大鼠模型，假手术组仅切开颈部皮肤，暴露右侧颈动脉。造模麻醉清醒后，采用Zea-Longa评分进行神经功能缺损评分；造模24 h后，3组大鼠均采用Zea-Longa评分和改良的神经严重程度评分(mNSS)进行神经功能缺损评分，TTC染色法检测脑相对梗死面积，HE染色观察缺血侧大脑皮质组织形态学改变，免疫组化法观察缺血侧大脑皮质CD31、HIF-1α和VEGF的表达情况。 结果 ①造模麻醉清醒后，模型组和运动预处理组大鼠Zea-Longa评分均较假手术组有明显增高(P<0.01)，且模型组与运动预处理组相比，组间差异无统计学意义；②造模24 h后，模型组Zea-Longa评分、mNSS评分、脑相对梗死面积均较假手术组显著增高(P<0.01)；与模型组相比，运动预处理组Zea-Longa评分(P<0.05)、mNSS评分(P<0.01)、脑相对梗死面积(P<0.05)均明显降低；③HE染色显示，与假手术组相比，模型组大鼠缺血侧大脑皮质出现组织疏松、神经细胞数量减少、胞核溶解、呈空泡状等病理学改变；与模型组相比，运动预处理组大鼠缺血侧大脑皮质病理学改变减轻；④免疫组化显示，与假手术组相比，模型组大鼠缺血侧大脑皮质中CD31(P<0.05)、HIF-1α(P<0.01)和VEGF(P<0.05)显著升高；与模型组相比，运动预处理组CD31(P<0.01)、HIF-1α(P<0.01)和VEGF(P<0.05)进一步升高。 结论 运动预处理可有效促进脑缺血后血管新生，减轻脑缺血再灌注损伤；其作用机制可能与运动预处理激活了HIF-1α或VEGF信号途径有关。 Objective To observe any effect of exercise preconditioning on the levels of hypoxia-inducible factor-1α (HIF-1α) and vascular endothelial growth factor (VEGF) in the brain tissue of rats after induced cerebral ischemia and reperfusion, and how it might promote angiogenesis. Methods Thirty-six male Sprague-Dawley rats were randomly divided into a sham-operation group, a model group and an exercise preconditioning group, each of 12. After adaptive running training for 3 days, the exercise preconditioning group ran daily for 30 minutes at 15m/min for 14 days, while the other two groups did not exercise. Middle cerebral artery occlusion and reperfusion were then induced in the model and exercise preconditioning groups using the modified Zea-Longa suture method. Rats in the sham-operation group were only cut open to expose the right carotid artery. Right after the modeling, and again 24 hours later neurological deficit was evaluated using the Zea-Longa score and modified neurological severity scoring (mNSS). Infarct sizes were measured using 2, 3, 5-triphenyl tetrazolium chloride staining. Any morphological changes were noted using hematoxylin and eosin (HE) staining, and the expression of CD31 protein, hypoxia-inducible factor-1α and vascular endothelial growth factor in the ischemic cerebral cortex were quantified immunohistochemically. Results Right after the modelling, compared with the sham-operation group, the average Zea-Longa scores of the model and exercise groups had increased significantly, but were not significantly different from each other. Twenty-four hours later the average Zea-Longa score, mNSS score and relative cerebral infarction area of the model group had increased significantly compared with the sham-operation group, while the exercise preconditioning group′s averages had decreased significantly. The HE staining showed that compared with the sham-operation group, pathological changes such as loose tissue, reduced number of nerve cells, nucleolysis, and vacuolization of the cerebral cortex on the ischemic side were found in the model group. Compared with the model group, the pathological changes in the exercise preconditioning group were less serious. The levels of CD31 protein, HIF-1α and VEGF in the ischemic cerebral cortexes of the model group had by then increased significantly. But compared with the model group, those levels had increased more in the exercise preconditioning group. Conclusion Exercise preconditioning can effectively promote angiogenesis after cerebral ischemia and reduce chronic injury. That may be related to the activation of the HIF-1α and/or VEGF signaling pathways.

    缺血再灌注运动预处理血管新生缺氧诱导因子血管内皮生长因子

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    铁代谢在有氧运动改善动脉粥样硬化小鼠心肌细胞凋亡中的作用机制研究

    刘西花马甜甜秦芳于子夫...
    7-12页
    查看更多>>摘要：目的 探讨铁代谢在有氧运动改善动脉粥样硬化(AS)小鼠心肌细胞凋亡中的作用机制。 方法 选取8周龄雄性ApoE－/－基因敲除小鼠，采用随机数字表法将其分为对照组、模型组及有氧运动组，每组9只小鼠。模型组及有氧运动组小鼠均给予"西方类型"膳食饲料喂养12周以制作AS动物模型，有氧运动组小鼠在制模期间同时进行有氧运动干预，持续训练12周，对照组小鼠则给予正常饲料喂养。于训练12周后采用TUNEL染色法检测各组小鼠心肌细胞凋亡情况；采用免疫组化技术检测各组小鼠心肌组织中铁蛋白重链1(FTH1)、谷胱甘肽过氧化物酶4(GPX4)表达；采用Western blot技术检测各组小鼠心肌组织中FTH1、GPX4蛋白水平；采用普鲁士蓝染色检测各组小鼠心肌组织中铁沉积情况；通过试剂盒检测各组小鼠心肌组织中铁、丙二醛(MDA)及谷胱甘肽过氧化物酶(GSH-PX)含量。 结果 TUNEL染色结果显示模型组出现明显心肌细胞凋亡，有氧运动组心肌凋亡情况较模型组明显减轻。普鲁士蓝染色显示模型组心肌出现明显铁沉积现象，而有氧运动组铁沉积情况较模型组明显减轻。免疫组化检测显示模型组FTH1及GPX4表达量均较对照组降低，有氧运动组上述指标表达量均较模型组明显升高。Western blot检测显示有氧运动组FTH1、GPX4蛋白水平均较模型组明显升高，且心肌组织中的铁及MDA含量明显低于模型组，GSH-PX含量显著高于模型组。 结论 有氧运动能显著改善AS小鼠心肌细胞凋亡，其作用机制可能与有氧运动改善心肌组织铁代谢、降低氧化应激水平及抑制铁超载有关。 Objective To demonstrate any role of iron metabolism in the inhibition by aerobic exercise of myocardial apoptosis in atherosclerotic mice. Methods Eight-week-old male ApoE-/- gene knockout mice were randomly divided into a control group, a model group and an aerobic exercise group, each of 9. A model of atherosclerosis was induced in the rats of the model and aerobic exercise groups by feeding them a " western" diet for 12 weeks. During that time the aerobic exercise group only was given aerobic exercise training. The control group was fed normal rat chow during that period. Myocardial apoptosis was detected using TUNEL staining, and the expression and localization of ferritin heavy chain 1 (FTH1) and glutathione peroxidase 4 (GPX4) in the myocardium used immunohistochemistry. Western blotting was applied to detect the FTH1 and GPX4 protein levels, and iron deposition in the myocardium was detected using Prussian blue staining. Iron, lipid peroxide malondialdehyde (MDA) and glutathione peroxidase (GSH-PX) in the myocardial tissue were also measured. Results The TUNEL staining showed significant apoptosis in the model group. In the aerobic exercise group it was significantly less. There was obvious iron deposition in the myocardia of the model group, which was significantly reduced in the aerobic exercise group. The average FTH1 and GPX4 levels in the model group were lower than in the control group, and significantly elevated in the aerobic exercise group.in the aerobic exercise group than in the model group. Iron and MDA levels in the aerobic exercise group were significantly lower, on average, than among the model group, while that of GSH-PX was significantly higher. Conclusions Aerobic exercise can significantly inhibit cardiomyocyte apoptosis in atherosclerotic mice. The mechanism may be closely related to better iron metabolism, reduced oxidative stress and the inhibition of iron overload.

    有氧运动动脉粥样硬化心肌组织铁代谢凋亡

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    球囊导管扩张联合吞咽基础训练对脑桥出血后气管切开患者吞咽功能的影响

    曹芳真刘敏张春华路伟...
    13-16页
    查看更多>>摘要：目的 观察球囊导管扩张联合吞咽基础训练对脑桥出血后气管切开患者吞咽功能的影响。 方法 选取脑桥出血气管切开吞咽障碍患者40例，按随机数字表法分为观察组和对照组，每组患者20例。2组患者均采用营养神经药物联合吞咽基础训练进行治疗，观察组则在此基础上增加球囊导管扩张技术进行治疗。球囊导管扩张术每日1次，每次25 min，每周5 d，连续治疗6周。于治疗前和治疗6周后(治疗后)由1名吞咽治疗师于双盲状态下采用功能性经口摄食(FOIS)评级和Rosenbek渗漏/误吸评分量表(PAS)评级分别评估2组患者的进食能力和渗漏-误吸情况，并采用洼田饮水实验评估2组患者治疗后的疗效。 结果 治疗后，2组患者的FOIS和PAS分级与组内治疗前比较，差异均有统计学意义(P<0.05)，且观察组治疗后的FOIS和PAS分级与对照组治疗后比较，差异亦均有统计学意义(P<0.05)。治疗后，观察组的总有效率为70%，对照组的总有效率为30%，2组间差异有统计学意义(P<0.05)。 结论 球囊导管扩张术联合吞咽训练可更好地改善脑桥出血后气切患者的吞咽功能，并提高疗效。 Objective To observe any effect of supplementing basic swallowing training with balloon catheter dilation on the swallowing function of tracheostomy patients with pontine hemorrhage. Methods A total of 40 pontine hemorrhage patients with tracheostomy and swallowing disorders were divided randomly into an observation group and a control group, each of 20. Both groups were given nutritional neurodrugs and basic swallowing training, but the observation group also received 25 minutes of balloon catheter dilation, five times a week for 6 weeks. Before and after the 6 weeks of treatment one swallowing therapist evaluated the feeding ability and leakage-aspiration status of each subject assigning functional oral intake (FOIS) ratings and Rosenbek Leakage/Aspiration Rating Scale (PAS) ratings double-blinded. The Watian water swallowing test was also applied. Results After the treatment the average FOIS and PAS scores of both groups had improved significantly, with those of the observation group then significantly better than among the control group on average. The total treatment effectiveness rate was 70% in the observation group, significantly better than the 30% in the control group. Conclusion Supplementing swallowing training with balloon catheter dilation can better improve the swallowing of patients recovering from a tracheotomy after pontine hemorrhage.

    脑桥出血气管切开球囊导管扩张吞咽训练

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    健侧高频重复经颅磁刺激结合生物反馈下的空吞咽训练对脑卒中后吞咽障碍的影响

    徐倩韩珍真朱冬燕王梁...
    17-22页
    查看更多>>摘要：目的 观察健侧高频重复经颅磁刺激(rTMS)结合生物反馈下的空吞咽训练对脑卒中后吞咽障碍的影响。 方法 选取符合入选标准的脑卒中后吞咽障碍患者80例，按照随机数字表法随机分为对照组、生物反馈组、磁刺激组和联合组，每组患者20例。4组患者均予以常规吞咽功能障碍训练，生物反馈组在常规训练的基础上增加生物反馈下的空吞咽训练，磁刺激组在常规训练的基础上增加健侧高频rTMS刺激，联合组则在常规训练的基础上增加健侧高频rTMS刺激联合生物反馈下的空吞咽训练进行干预。治疗频次均为每日1次，每周治疗5 d，连续治疗3周。于治疗前和治疗3周后(治疗后)，采用渗漏-误吸量表(PAS)、功能性经口摄食量表(FOIS)和标准吞咽功能评价量表(SSA)来评价4组患者的吞咽功能，并记录和比较4组患者下颌舌骨肌运动诱发电位(MEP)的潜伏期和波幅。 结果 治疗后，4组患者的PAS评分、FOIS评分、SSA评分、下颌舌骨肌MEP潜伏期和波幅较组内治疗前均显著改善，差异均有统计学意义(P<0.05)。联合组治疗后的PAS评分[(1.85±0.75)分]、FOIS评分[(5.45±1.05)分]和SSA评分[(22.45±4.45)分]均显著优于对照组、生物反馈组和磁刺激组治疗后(P<0.05)，联合组治疗后的下颌舌骨肌MEP潜伏期均显著短于对照组和生物反馈组治疗后(P<0.05)，联合组治疗后下颌舌骨肌MEP波幅显著高于对照组治疗后(P<0.05)。 结论 健侧高频rTMS结合生物反馈下的空吞咽训练可显著改善脑卒中后吞咽障碍患者的吞咽功能，及其下颌舌骨肌MEP的潜伏期和波幅。 Objective To evaluate the effect of combining contralateral high-frequency transcranial magnetic stimulation (rTMS) with biofeedback-controlled empty swallowing training on dysphagia among stroke survivors. Methods Eighty dysphagic stroke survivors were divided at random into a control group, a biofeedback group, an rTMS group and a combined treatment group, each of 20. In addition to routine dysphagia rehabilitation, the biofeedback group and the rTMS group received empty swallowing training based on biofeedback or high-frequency rTMS applied to the healthy motor cortex as appropriate. The combined treatment group was given both. The treatment was administered once daily, 5 days a week for 3 consecutive weeks. Before and after the treatment, all of the subjects′ swallowing was evaluated using the penetration aspiration scale (PAS), functional oral intake scale (FOIS) and a standardized swallowing assessment (SSA). The latency and amplitude of the mylohyoid muscle′s motor evoked potentials (MEPs) were also recorded before and after the treatment. Results After the treatment, significant improvement was observed in the average PAS, FOIS and SSA scores as well as in the latency and amplitude of the MEPs in the four groups. The average results in the combined treatment group were significantly better than in the other 3 groups. The latency of the mylohyoid muscle′s MEP was significantly shorter in the combined group than in the control and biofeedback groups on average, while the amplitude was significantly greater than in the control group. Conclusion Combining contralateral high frequency rTMS with empty swallowing training based on biofeedback can better improve the swallowing of dysphagic stroke survivors.

    重复经颅磁刺激生物反馈吞咽障碍脑卒中

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    SSA量表与GUSS量表在急性脑卒中吞咽障碍评估中的信度和效度对比

    潘思京郭章宝邵卫刘兵舰...
    23-27页
    查看更多>>摘要：目的 探讨并对比标准吞咽功能评估量表(SSA)、GUSS吞咽筛查量表(GUSS)在急性期脑卒中患者吞咽障碍筛查评估中的信度和效度。 方法 选取在我院住院治疗的47例急性期脑卒中患者作为研究对象，分别采用GUSS量表及SSA量表对其吞咽功能进行评估，并选用吞咽功能评估的金标准——纤维内镜下吞咽功能检查(FEES)为效标对量表筛查结果进行检验，对比SSA、GUSS量表评估急性期脑卒中患者吞咽障碍的信度和效度。 结果 GUSS量表与SSA量表的信度和效度均较好；在信度评价方面，SSA量表的重测信度、评定者间信度(重测信度ICC值＝0.828，P<0.05；评定者间信度ICC值＝0.909，P<0.05)更优于GUSS量表，GUSS量表的内在信度(Cronbach′s a系数＝0.939)则优于SSA量表；在效度评价方面，SSA、GUSS量表的结构效度及校标效度均为良好，其中GUSS量表的敏感性(72.73%)优于SSA量表，SSA量表的特异性、约登指数、曲线下面积(分别为92.86%，0.565和0.795)则优于GUSS量表；如将SSA及GUSS量表联合用于吞咽障碍筛查，则SSA＋GUSS串联诊断时的曲线下面积可达到0.767，SSA＋GUSS并联诊断时的曲线下面积为0.736。 结论 SSA、GUSS量表在筛查急性期脑卒中患者吞咽障碍方面均具有良好的信度和效度，在临床实践中可考虑单独应用SSA量表或应用SSA＋GUSS量表串联诊断，以提高吞咽障碍筛查的诊断效能，为预防卒中后误吸提供指导。 Objective To compare the reliability and validity of the Standard Swallowing Function Assessment Scale (SSA) with those of the GUSS Swallowing Function Assessment Screen (GUSS) in screening for and evaluating dysphagia among stroke survivors. Methods Forty-seven stroke survivors had their swallowing function evaluated using the GUSS scale and the SSA scale. The results were compared with those of endoscopic swallowing function examinations. Results Both scales delivered good reliability and validity. The SSA scale′s test-retest reliability had an ICC value=0.828 and an inter-evaluator reliability with an ICC value=0.909. Those were better than the GUSS scale′s values, but the latter had better intrinsic reliability (Cronbach′s α=0.939). Both scales showed good structural and calibration validity, with the sensitivity of the GUSS scale (72.73%) superior to that of the SSA scale, but the GUSS scales′ specificity, Jordan index and area under the operating characteristics curve were inferior to the SSA scale′s values. Combining the two scales in dysphagia screening could produce an area under the curve of 0.77. Conclusion Both the SSA and GUSS scales have good reliability and validity in screening for swallowing disorders after a stroke. In clinical practice, the SSA alone or the two in series can improve diagnoses so as to prevent aspiration after a stroke.

    吞咽障碍标准吞咽功能评估量表GUSS吞咽功能评估量表信度效度脑卒中

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    重症监护室住院期间早产儿吸吮功能的纵向追踪研究

    邵梦烨秦秀群林叶青罗培培...
    28-31页
    查看更多>>摘要：目的 分析早产儿住院期间吸吮功能的动态变化并探讨吸吮功能异常的主要危险因素。 方法 选取在新生儿重症监护室的早产儿202例，动态评估早产儿住院期间的吸吮功能，采用广义估计方程分析其吸吮功能异常的危险因素。 结果 202例早产儿生后24 h内、经口喂养前、经口喂养1周后、经口喂养2周后和出院前，吸吮功能正常率分别为64.36%、66.83%、72.77%、76.73%和84.16%，吸吮紊乱率分别为32.18%、30.20%、25.74%、22.77%、15.34%，吸吮障碍率分别为3.46%、2.97%、1.49%、0.50%和0.50%。经多因素分析发现，使用保胎药、分娩方式、出生胎龄、出生体重、出生头围、留置胃管为重症监护室住院期间早产儿吸吮异常风险因素，P<0.05。 结论 早产儿住院期间吸吮功能异常的发生率较高，有必要在生后早期评估早产儿的吸吮功能，并重点关注未使用保胎药、顺产、出生胎龄、出生体重、出生头围、无留置胃管的早产儿。

    早产儿吸吮功能顺产胎龄纵向追踪

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    基于静息态fMRI技术观察经颅直流电刺激对脑梗死后图命名障碍患者语言相关脑区功能连接的影响

    宋彦澄康立清刘凤海王晓璇...
    32-37页
    查看更多>>摘要：目的 采用静息态功能磁共振成像(rs-fMRI)技术观察经颅直流电刺激(tDCS)对不同病程脑梗死后图命名障碍患者语言相关脑区功能连接(FC)的影响，从影像学角度探讨图命名功能的损伤及恢复机制。 方法 选取28例脑梗死后图命名障碍患者纳入患者组，根据其病程又进一步分为急性期组(共16例)和恢复期组(共12例)，同时选取18例中老年志愿者纳入正常对照组。采用tDCS阳极刺激患者左侧外侧裂后部周围区(PPR)，每周治疗5 d，治疗2周为1个疗程。于治疗前、治疗1个疗程后行rs-fMRI检查及汉语失语症心理语言评价(PACA)图命名量表评分，观察患者语言相关脑区的FC变化。 结果 治疗后急性期组及恢复期组患者PACA图命名评分均较治疗前明显改善(P<0.05)。与正常受试者比较，患者组双侧大脑半球均存在多个脑区与Wernicke区的FC减低，且以优势半球的改变更显著。经tDCS治疗后，发现急性期组及恢复期组患者双侧额颞叶与Wernicke区的FC均显著增强。进一步比较还发现，治疗后急性期组双侧颞枕叶FC均较治疗前明显增强；而恢复期组治疗前FC增强的左侧颞叶在治疗后FC则明显减低。 结论 fMRI技术可对脑梗死后图命名障碍患者语言相关脑区的FC变化进行精准、无创评估；tDCS可能通过增强双侧脑半球语言相关脑区(集中于额颞叶部位)与Wernicke区的FC以改善脑梗死患者的图命名功能。 Objective To observe the effects of transcranial direct current stimulation (tDCS) on functional connectivity (FC) in language-related brain regions of patients with picture-naming dysfunction after cerebral infarction by using resting state functional magnetic resonance imaging(rs-fMRI). Methods Twenty-eight patients with post-infarction picture-naming dysfunction were divided into an acute stage group(n=16) and a recovery stage group(n=12) according to the course of the disease, and 18 middle-aged and elderly volunteers were recruited as the normal control group.The anodic tDCS was applied on the posterior perisylvian region(PPR) of the left sylvian of the patients, 5 days a week for 2 weeks.Before and after the 2 weeks′ treatment, the rs-fMRI and Psycholinguistic Assessment of Chinese Aphasia (PACA)-picture-naming subscale were performed, and FC changes in language-related brain areas were observed. Results After treatment, the PACA scores of patients in both acute and recovery stage groups were significantly improved after treatment(P<0.05). Compared with normal subjects, FC in multiple brain regions and particularly the Wernicke area was reduced in both cerebral hemispheres among the patient group. It was more severe in the dominant hemisphere.After the tDCS treatment, FC in both frontotemporal lobes and in the Wernicke area was significantly enhanced in both the acute and recovery groups. Further comparison showed that in the acute group FC in both temporo-occipital lobes was significantly enhanced after treatment. In the recovery group, the enhanced FC in the left temporal lobe before the treatment was significantly reduced after treatment. Conclusion The fMRI technique can evaluate changes in brain connectivity in aphasia patients with picture-naming dysfunction after cerebral infarction accurately and non-invasively.tDCS may improve picture-naming function of stroke patients by enhancing the FC in bilateral language-related brain areas(concentrated in frontotemporal lobes) and Wernicke area.

    静息态功能磁共振成像经颅直流电刺激脑梗死失语症功能连接

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    动态脊柱支撑机器人在脊髓损伤后躯干控制评定中的初步应用研究

    施杰洪王荣丽王宁华凌琛...
    38-43页
    查看更多>>摘要：目的 探讨动态脊柱支撑机器人在脊髓损伤患者坐位躯干控制能力评估中的初步应用。 方法 于2022年10月至2022年12月招募20例依赖轮椅的脊髓损伤患者。所有患者穿戴动态脊柱支撑机器人完成坐位躯干抗阻测试，嘱患者在躯干左、右、前、后4个方向施加外力的情况下维持直立坐位1 min，评测指标为反映压力中心(COP)摆动情况的8个参数(包括COPx均速、COPy均速、COPx标准差、COPy标准差、包络面积、摆动轨迹长度、平均频率、平均幅值)以及最大自主收缩(MVC)力矩。采用动态脊柱支撑机器人、躯干控制测试(TCT)、Tinetti平衡与步态量表(Tinetti量表)、改良功能性前伸测试(mFRT)和脊髓独立性评定量表第3版(SCIM-III)进行评估。分析动态脊柱支撑机器人抗阻测试结果与TCT量表、Tinetti量表、mFRT和SCIM-III所得结果的相关性。 结果 共20例患者完成左、右向抗阻测试，11例患者完成前、后向抗阻测试。左向抗阻测试中，COPx标准差、COPy标准差、包络面积和MVC与TCT、Tinetti、mFRT、SCIM-III呈低到高度相关(|r|＝0.474～0.739, P<0.05)；右向抗阻测试中，COPx均速、MVC与TCT、Tinetti、mFRT、SCIM-III呈低到高度相关(|r|＝0.461～0.740, P<0.05)；前向抗阻测试中，MVC与TCT、mFRT、SCIM-III呈中度相关(|r|＝0.632～0.672, P<0.05)；后向抗阻测试中，MVC与TCT、mFRT呈中度相关(|r|＝0.627～0.672, P<0.05)。 结论 采用动态脊柱支撑机器人可以有效评测脊髓损伤患者的反应性姿势控制能力和功能独立性。 Objective To explore the utility of a robotic trunk support brace (a RoboBDsys) in evaluating seated trunk control after a spinal cord injury (SCI). Methods Twenty wheelchair-dependent SCI patients were tested for trunk resistance while seated and wearing the RoboBDsys. In the test they were required to maintain an upright seated position for 1 minute while external forces were applied from the left, right, anterior and posterior directions. The system generated eight observations of swings of the center of pressure (COP), their mean velocity and their standard deviations. Sway area, sway path (SP), mean sway frequency (MF) and mean sway amplitude (MA) were also recorded along with the maximum voluntary contraction torque (MVC). The trunk control test (TCT), the Tinetti Balance Scale (Tinetti), the modified Functional Reach Test (mFRT) and Spinal Cord Independence Measure III (SCIM-III) were also administerd and their results were correlated with the RoboBDsys resistance test results. Results All twenty of the patients completed the resistance test in the left and right directions, but only 11 did it in the anterior and posterior directions. In the left and right-direction resistance tests the average center of pressure deviation, sway area and MVC showed some significant correlation with the TCT, Tinetti, mFRT and SCIM-III results (|r| ranging from 0.46 to 0.74). The average MVC in the anterior-direction correlated moderately with the TCT, mFRT and SCIM-III results (|r|=0.63 to 0.67), while that in the posterior-direction had moderate correlation with the TCT and mFRT results only (|r|=0.63 to 0.67). Conclusion The Robotic Brace for Dynamic Trunk Support system can be effective in assessing reactive postural control and functional independence after a spinal cord injury.

    康复机器人脊髓损伤躯干控制定量评估

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    超声引导下葡萄糖注射联合腕伸肌离心训练治疗肱骨外上髁炎的疗效观察

    李言杰韩铭明王学锋孙振双...
    44-46页
    查看更多>>摘要：目的 观察超声引导下高渗(10%)葡萄糖注射联合腕伸肌离心训练治疗肱骨外上髁炎(LE)的临床疗效。 方法 采用随机数字表法将60例LE患者分为观察组及对照组，每组30例。2组患者均给予腕伸肌离心收缩训练，观察组在此基础上辅以超声引导下高渗(10%)葡萄糖注射治疗，每10天注射1次，共注射3次。于治疗前、治疗1个月后分别采用疼痛视觉模拟评分法(VAS)、上肢功能指数量表(UEFI)对2组对象患肘疼痛及上肢功能恢复情况进行评定，同时采用超声检查2组对象患肘肌腱修复情况，并对其肌腱低回声区进行半定量评分。 结果 治疗前2组患者疼痛VAS评分、UEFI评分及患肘肌腱低回声区(半定量)评分组间差异均无统计学意义(P>0.05)。治疗1个月后发现2组患者疼痛VAS评分、患肘肌腱低回声区评分均较治疗前明显降低(P<0.05)，UEFI评分均较治疗前显著升高(P<0.05)；经进一步组间比较发现，干预后观察组疼痛VAS评分[(1.9±0.7)分]、UEFI评分[(70.1±8.9)分]及患肘肌腱低回声区评分[(2.0±0.3)分]均显著优于对照组水平(P<0.05)。 结论 超声引导下葡萄糖注射联合腕伸肌离心训练能显著缓解LE患者疼痛，改善上肢功能，加速受损肌腱组织修复。

    葡萄糖注射离心训练肱骨外上髁炎肌腱

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    早期康复干预对肩袖损伤患者经手法松解术治疗后功能恢复的影响

    张月兰高玉芳王笑林庄卫生...
    47-49页
    查看更多>>摘要：目的 观察早期康复干预对肩袖损伤患者(麻醉下)手法松解术后功能恢复的影响。 方法 采用随机数字表法将68例肩袖损伤患者分为观察组及对照组，每组34例。2组患者均给予麻醉下手法松解术(MUA)治疗，对照组术后给予常规康复训练，观察组于术后早期介入系统康复干预，如术后麻醉未清醒阶段实施被动姿势控制训练，完全清醒后指导患者主动活动手指、腕关节及肘关节，后续则根据患者恢复情况逐渐增加弹性球训练、肩关节训练、扩胸运动、肌力训练等。于术前、术后2周、4周时分别采用Constant-Murley肩关节功能评分(CMS)、疼痛视觉模拟评分(VAS)、焦虑自评量表(SAS)及生活质量评分量表(SF-36)对2组患者进行疗效评定。 结果 术后2周、4周时观察组患者肩关节CMS评分[分别为(60.03±5.54)分和(85.94±4.02)分]均显著高于治疗前及同期对照组水平(P<0.05)；术后2周、4周时观察组SAS评分[分别为(50.26±3.89)分和(43.26±3.89)分]均明显低于治疗前及同期对照组水平(P<0.05)；术后48 h、术后4周时观察组疼痛VAS评分[分别为(3.14±0.65)分和(0.60±0.62)分]均明显低于治疗前及同期对照组水平(P<0.05)；术后4周时观察组SF-36评分[(84.59±3.89)分]显著高于治疗前及同期对照组水平(P<0.05)。 结论 于MUA术后早期介入康复干预能显著改善肩袖损伤患者的肩关节功能，缓解其疼痛程度及焦虑情绪，有助于提高患者日常生活质量。

    肩袖损伤手法松解术早期康复干预肩关节功能疼痛

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