To study the recovery method and effect of amputated foot after temporary ectopic implantation. Methods Two male patients with amputated foot were treated with temporary ectopic implantation in July 2001 and January 2002. Amputated foot was caused by mechanical injury and crush injury. After 6 hours, temporary ectopic implantation of amputated foot was given and replantation was done 3 months after primary operation. The recovery methods were as follows: automatic and passive motion, high pressure oxygen, massage, protective and positional feel ing training, etc. The effects of recovery was observed. Results All amputated foots survived after operation, the time of follow-up was 6 years,and 5 years and 7 months. Extension degree of first metatarsal digital joint was 12º and 15º, flex degree of first metatarsal digital joint was 15º and 13º, and extension degree of other metatarsal digital joints was 8º and 9º. Force degree of extension muscle was 4, force degree of flex muscle was 4, and two-point discrimination was 20 mm and 18 mm. Patients recovered their superficial sensibil ity, touch sense, deep pain sense and topognosis. The skin color and temperature were normal. And the patients could do some housework. Conclusion Temporary ectopic implantation of amputated foot can recover the function of amputated foot by motor and sensitive recovery methods.
Objective To establish better treatment for Monteggia fracture by evaluating the operative effect and function rehabilitation in children.Methods From 1994 to 2001, 78 children with Monteggia fracture ( 30 cases of new fracture, 48 cases of old fracture) were treated with open reduction and internal fixation.The patients were randomly divided into two groups. In the first group( 45 cases, 16 new and 29 old), radiohumeral joint was fixed with a Kirschner wire after reduction and without fixation of ulna fracture; in the second group( 33 cases, 14 new and 19 old), both radiohumeral joint and ulna fracture were fixed with Kirschner wire. Two groups were treated with plastersplint after operation. The effect of operation was evaluated according to the function criteria for bending elbow and rotation of forearm. Results All patients were followed up 6 months to 7 years( 4.6 years on average). All wound healed well without bone nonunion, delayed union and infection after operation. In the first group, 37 cases were rated as excellent, 5 good and 3 poor. The effective rate was 93.3%. In the second group, 22 cases were rated as excellent, 7 good and 4 poor. The effective rate was 87.9%.There was no significant difference between two groups( P＞0.05). Conclusion Surgical treatment is the choice for Monteggia fracture in children. It should be treated with single Kirschner wire fixing after open reduction of radiohumeral and plaster-splint .This method is simple, safe and has satisfactory results in fracture healing and function rehabilitation after operation.
OBJECTIVE: To observe the functional rehabilitation of injured peripheral nerve with electric acupuncture. METHODS: Sciatic nerve injury model was established by transection of left sciatic nerve in 60 Wistar rats, which were randomly divided into two groups. The experimental group was treated with electroacupuncture, no treatment in the control group. Change of nerve electrophysiological, power of muscle and sciatic functional index (SFI) were observed. RESULTS: Nerve muscle-action potential (MAP) and motor nerve conduction velocity (MNCV) in the experimental group were better than that of the control group (P lt; 0.01). The single muscle twitch and tetanization of gastrocnemius muscle were higher in the experimental group too (P lt; 0.05). SFI were significantly higher in the experimental group (P lt; 0.05). CONCLUSION: Electric acupuncture therapy can improve functional rehabilitation of injured peripheral nerve.
【摘要】 目的 探讨肢体深度烧伤后，影响功能康复的相关因素。 方法 采用美国日常生活自理量表和功能性日常生活量表，对2009年4月-2010年7月来门诊复诊的101例肢体深度烧伤患者的功能康复情况进行问卷调查和统计学分析。 结果 接受专业康复的患者得分明显低于自我康复患者得分，差异有统计学意义（Plt;0.01）；不同性别、不同文化程度之间的比较差异有统计学意义（Plt;0.001）；年龄14～50岁的患者对是否接受专业康复的比较，差异有统计学意义（Plt;0.001）；年龄lt;14岁、gt;50岁及婚姻状况，在是否接受专业康复的比较差异无统计学意义（Pgt;0.01）。 结论 肢体深度烧伤后患者在专业医师的指导下进行专业功能康复比自我康复的患者效果更好，使得烧伤患者社会期日常生活自理能力得到提高。【Abstract】 Objective to explore the related factors affecting the function recovery of deeply burned limps. Methods Adopting ADL body independent living scale and functional daily life scale, the questionnaire survey of the function recovery situation and statistical analysis were performed on the patients from the 101 outpatient appointment patients whose limbs were deeply burned from April 2009 to July 2010. Results The score of patients who accepted professional rehabilitation was significantly lower than that of the self healing patients, and the difference was significant (Plt;0.01); the difference of sex and the comparison between different literate degree were statistically significant (Plt;0.001); the difference in whether to accept the comparison of the professional rehabilitation among the patients with age oflt;14 years old, gt;50 years old and different marital status was not statistically significant (Pgt;0.01). Conclusion patients with deeply burned limbs recover better under the professional function recovery direction of professional doctor than the patients who have self recovery.
In order to stimulate the patients' active participation in the process of robot-assisted rehabilitation training of stroke patients, the rehabilitation robots should provide assistant torque to patients according to their rehabilitation needs. This paper proposed an assist-as-needed control strategy for wrist rehabilitation robots. Firstly, the ability evaluation rules were formulated and the patient's ability was evaluated according to the rules. Then the controller was designed. Based on the evaluation results, the controller can calculate the assistant torque needed by the patient to complete the rehabilitation training task and send commands to motor. Finally, the motor is controlled to output the commanded value, which assists the patient to complete the rehabilitation training task. The control strategy was implemented to the wrist function rehabilitation robot, which could achieve the training effect of assist-as-needed and could avoid the surge of assistance torque. In addition, therapists can adjust multiple parameters in the ability evaluation rules online to customize the difficulty of tasks for patients with different rehabilitation status. The method proposed in this paper does not rely on the information from force sensor, which reduces development costs and is easy to implement.
ObjectiveTo explore the clinical effect of applying the concept of enhanced recovery after surgery (ERAS) to the perioperative management of elderly patients with intertrochanteric fractures.MethodsThe clinical data of 64 elderly patients with intertrochanteric fractures admitted to West China Hospital of Sichuan University from January 2016 to December 2017 were retrospectively analyzed. Among them, 32 patients admitted from January to December in 2017 were in ERAS group, and 32 patients admitted from January to December 2016 were in control group. The control group used conventional orthopedic perioperative management measures, and the ERAS group combined the ERAS concept on the basis of conventional treatment measures for perioperative management. The incidence of perioperative complications, Visual Analogue Scale score, modified Barthel Index score, inpatient satisfaction and length of hospital stay were compared between the two groups.ResultsThere was no significant difference in age, gender, American Society of Anesthesiologists grade, combined disease, modified Barthel Index or Visual Analogue Scale score at admission, or time from injury to surgery between the two groups (P>0.05). The total incidence of perioperative complications (12.5% vs. 37.5%) and length of hospital stay [(8.09±2.33) vs. (10.41±3.63) d] in the ERAS group were lower than those in the control group (P<0.05). The Visual Analogue Scale scores of the two groups of patients before operation, on the first day and the third day after operation were lower than those at admission (P<0.05). The comparison between the two groups at each time point showed that the Visual Analogue Scale scores of patients in the ERAS group were lower than those in the control group before operation, on the first day and the third day after operation, and the differences were statistically significant (P<0.05). The modified Barthel Index scores of the two groups of patients on the third day, and 1 month, 3 months and 6 months after operation showed a rising trend with time. The modified Barthel Index scores of the ERAS group were better than those of the control group on the third day, and 1 month and 3 months after operation (P<0.05). There was no significant difference between the two groups 6 months after operation (P>0.05). The hospitalization satisfaction score of the ERAS group was 95.56±5.12, which was higher than that of the control group (92.84±5.62), and the difference was statistically significant (P<0.05).ConclusionsThe implementation of ERAS perioperative management for elderly patients with intertrochanteric fractures may reduce the incidence of perioperative complications, relieve patient pain, promote the short-term recovery of activities of daily living of patients, improve the inpatient satisfaction and shorten the length of hospital stay.
Objective To analyze the perioperative efficacy of enhanced recovery after surgery (ERAS) in the treatment of lumbar disc herniation using unilateral biportal endoscopy technique. Methods A total of 55 patients who received unilateral biportal endoscopy technique for the treatment of lumbar disc herniation in Tianjin Hospital between January and December 2020 were selected and randomly divided into the traditional group and the ERAS group according to random number table method. The routine inpatient care management was adopted in the traditional group, while the holistic integrated care plan was formulated in the ERAS group according to the multidisciplinary collaboration of the accelerated rehabilitation plan. The first postoperative exhaust time, the first time out of bed, length of hospital stay, hospital costs, Visual Analogue Scale (VAS) scores before operation, one day and three days after operation, Oswestry Disability Index (ODI) scores before operation and one month after operation, and the excellent and good rate of modified MacNab efficacy one month after operation were compared between the two groups. Results There were 28 cases in the traditional group and 27 cases in the ERAS group. The first postoperative exhaust time [(2.31±1.02) vs. (3.19±0.87) h], the first postoperative ambulation time [(1.06±0.40) vs. (2.00±0.53) d], length of hospital stay [(3.8±0.8) vs. (4.6±0.8) d], and hospital cost [(32.18±9.10) thousand yuan vs. (39.81±11.10) thousand yuan] in the ERAS group were all less than those in the traditional group, and the differences were statistically significant (P<0.05). The VAS scores of the ERAS group one day after operation (3.2±0.8 vs. 4.1±0.8) and three days after operation (1.4±0.5 vs. 1.7±0.5) were lower than those of the traditional group (P<0.05). The ODI scores of the ERAS group one month after operation was lower than that of the traditional group (13.3±4.0 vs. 16.6±4.8, P<0.05). In the modified MacNab efficacy evaluation one month after surgery, there was no significant difference in the excellent and good rate between the ERAS group and the traditional group (96.3% vs. 96.4%, P>0.05). Conclusions ERAS regimen can significantly accelerate the patients’ recovery, including shortening the first exhaust time, facilitating early ambulation, and reducing the hospital stay and hospitalization expenses. Meanwhile, ERAS regimen can effectively reduce the postoperative pain of the patients, and promote early functional recovery.
ObjectiveTo summarize the early postoperative pain management strategies for anterior cruciate ligament reconstruction (ACLR), and to select a reasonable and effective pain management plan to promote functional rehabilitation after ACLR. MethodsThe literature about the early postoperative pain management strategies of ACLR both domestically and internationally in recent years was extensiverly reviewed, and the effects of improving postoperative pain were reviewed. ResultsCurrently, physical therapy and oral medication have advantages such as economy and simplicity, but the effect of improving postoperative pain is not satisfactory, often requires a combination of intravenous injection or intravenous pump, which is also a common way to relieve pain. However, in order to meet the analgesic needs of patients, the amount of analgesic drugs used is often large, which increases the incidence of various adverse reactions. Local infiltration analgesia (LIA), including periarticular or intra-articular injection of drugs, can significantly improve the early postoperative pain of ACLR, and achieve similar postoperative effectiveness as nerve block. LIA can be used as an analgesic technique instead of nerve block, and avoid the corresponding weakness of innervated muscles caused by nerve block, which increases the risk of postoperative falls. Many studies have confirmed that LIA can alleviate postoperative early pain in ACLR, especially the analgesic effects of periarticular injection are more satisfactory. It can also avoid the risk of cartilage damage caused by intra-articular injection. However, the postoperative analgesic effect and timeliness still need to be improved. It is possible to consider combining multimodal mixed drug LIA (combined with intra-articular and periarticular) with other pain intervention methods to exert a synergistic effect, in order to avoid the side effects and risks brought by single drugs or single administration route. LIA is expected to become one of the most common methods for relieving postoperative early pain in ACLR. ConclusionEarly pain after arthroscopic ACLR still affects the further functional activities of patients, and all kinds of analgesic methods can achieve certain effectiveness, but there is no unified standard at present, and the advantages and disadvantages of various analgesic methods need further research.
Stroke is an acute cerebrovascular disease in which sudden interruption of blood supply to the brain or rupture of cerebral blood vessels cause damage to brain cells and consequently impair the patient's motor and cognitive abilities. A novel rehabilitation training model integrating brain-computer interface (BCI) and virtual reality (VR) not only promotes the functional activation of brain networks, but also provides immersive and interesting contextual feedback for patients. In this paper, we designed a hand rehabilitation training system integrating multi-sensory stimulation feedback, BCI and VR, which guides patients' motor imaginations through the tasks of the virtual scene, acquires patients' motor intentions, and then carries out human-computer interactions under the virtual scene. At the same time, haptic feedback is incorporated to further increase the patients' proprioceptive sensations, so as to realize the hand function rehabilitation training based on the multi-sensory stimulation feedback of vision, hearing, and haptic senses. In this study, we compared and analyzed the differences in power spectral density of different frequency bands within the EEG signal data before and after the incorporation of haptic feedback, and found that the motor brain area was significantly activated after the incorporation of haptic feedback, and the power spectral density of the motor brain area was significantly increased in the high gamma frequency band. The results of this study indicate that the rehabilitation training of patients with the VR-BCI hand function enhancement rehabilitation system incorporating multi-sensory stimulation can accelerate the two-way facilitation of sensory and motor conduction pathways, thus accelerating the rehabilitation process.