康复诊断名称标准化初探(五)

(上接第5卷第3期)77.83 上肢近侧段多部位不完全纵向缺陷 incomplete longitudinal deficiency at multiple sites in proximal parts of upper limb

肺癌合并多发血栓患者抗凝治疗1例

Case presentationThe patient,a 60-year-old male,was admitted to the Chinese PLA General Hospital on Jun 1,2009,because of"cough,dyspnea and left chest pain for 2 months".He was diagnosed as poorly differentiated adenocarcinoma of left lung,with pleural and mediastinal lymph nodes,and bony metastasis.Chemotherapy was administered through retained peripherally inserted central catheters(PICC)at left brachiocephalic artery.On June 22,2009,the patient developed left upper limb edema.Ultrasoundexamination displayed venous thrombosis from ulnar vein to subclavian vein.

OBJECTIVE:To investigate the factors associated with sensory and motor recovery after the repair of upper limb peripheral nerve injuries.
DATA SOURCES:The online PubMed database was searched for English articles describing outcomes after the repair of median, ulnar, radial, and digital nerve injuries in humans with a publication date between 1 January 1990 and 16 February 2011.
STUDY SELECTION:The following types of article were selected:(1) clinical trials describ-ing the repair of median, ulnar, radial, and digital nerve injuries published in English;and (2) studies that reported sufifcient patient information, including age, mechanism of injury, nerve injured, injury location, defect length, repair time, repair method, and repair materials. SPSS 13.0 software was used to perform univariate and multivariate logistic regression analyses and to in-vestigate the patient and intervention factors associated with outcomes.
MAIN OUTCOME MEASURES:Sensory function was assessed using the Mackinnon-Dellon scale and motor function was assessed using the manual muscle test. Satisfactory motor recovery was deifned as grade M4 or M5, and satisfactory sensory recovery was deifned as grade S3+or S4. RESULTS:Seventy-one articles were included in this study. Univariate and multivariate logistic regression analyses showed that repair time, repair materials, and nerve injured were inde-pendent predictors of outcome after the repair of nerve injuries (P<0.05), and that the nerve injured was the main factor affecting the rate of good to excellent recovery.
CONCLUSION:Predictors of outcome after the repair of peripheral nerve injuries include age, gender, repair time, repair materials, nerve injured, defect length, and duration of follow-up.

上肢骨折病人两侧腋下温度比较

在临床护理工作中,生命体征的观察是必不可少的,通过观察体温,可以协助医生对疾病和机体的反应做出正确的诊断,并为护理、治疗提供依据.体温测量通常有口腔、腋窝、直肠3种方法,由于腋窝测量体温安全、简便、不易发生交叉感染,故目前临床上应用广.但上肢骨折时,患侧与健侧腋下温度有无差别,我们对2000年5月-2003年5月164例上肢骨折病人两侧腋下温度进行了观察,现报告如下.

自制上肢悬吊布巾在肱骨近端骨折非手术治疗中的应用研究

肱骨近端骨折系临床常见骨折,约占全身骨折的5%,其中85%左右可非手术治疗,但对于约15%的移位骨折非手术治疗往往不能获得满意疗效,而需手术治疗[1].非手术治疗外固定方法不同,疗效各异.2001年12月-2007年12月年对收治的180例肱骨近端骨折非手术治疗病人68例采用自制上肢悬吊布巾治疗,疗效满意,现介绍如下.

缺氧缺血性脑病患儿的家庭康复护理1例报告

GENERAL DATAChild, male, aged two months. The patient was diagnosed having severeasphyxia and having no breathing and heartbeat when born. And thechild was diagnosed as hypoxic-isehemic encephalopathy, hydro-cephalus and gray syndrome through B ultrasonic wave and CT com-bined with kinds of biochemical examintations after emergency treat-ment in Department of Pediatrics of our hospital. The physical exami-nation showed weakness of left body, slight astrophy of left lower limbmuscle, head deviate leftly, increasing of muscular tension of rightlower limb, both ears having no response for voice and swelling ofsliverand spleen. Function of silver: the level of Bilirubin, indirectbilirubin and direct bilirubin all increased. The patient had poor nu-trition and became thin extremely. But because of some reason thechild was not recruited in hospital and only got regular fol-low-up. Rehabilitation treatment: (1)Support of family in psychology:The family was instructed to do exercises in order to find detailed re-actions of every facet in time such as aimling, head not deviating leftand left upper limb straight. So the family can enjoy the happiness ofrehabilitation. The family should be given enough encouragement, thenwill have enough confidence to overcome any difficulty in the course oftreatment. (2) The changes of patient should be observed carefullywhen hyperbaric oxygenation was given, which included shortness ofbreath, irritability and nasal blood et al. If the above changes oc-curred, the treatment stopped. (3) Physical therapy: Child was given atouching of whole body every day and the action should be performedgentally. Results: After two months of treatment gray syndrome wascured and sliver and spleen were restored normal. After five and a halfmonths, both ears had response for voice and hearing was restorednormal after six months. When aged two and a half years, the intelli-gence and motion of limhs reached normal range and the musculartension of limhs improved slightly. The recovery was satisfactory.

脑卒中偏瘫所致肩关节不全脱位的早期康复

Objective To investigate the clinical implications of early rehabilitative treatment for uncomplete dislocation of shoulder after stroke.Method 420 patients received the anti－ spasticity treatment of upper limb,protecting techniques and sling were also used for all patients.Result The recovery of uncomplete dislocation of shoulder after stroke was satisfying.Conclusion Early rehabilitative treatment was beneficial for the improvement of uncomplete dislocation of shoulder after stroke.

改良强制性运动疗法治疗脑卒中恢复后期患者上肢运动功能障碍1例

传统康复观念认为,脑卒中发病后3个月是康复的"黄金时期",发病3-6个月进行康复还会有一定的恢复,6个月-1年(恢复期)康复效果常常达到一个"平台"[1].进入恢复期,患者基本是在门诊接受治疗,但许多患者往往做不到每天门诊康复治疗,从而影响了疗效.为继续改善此阶段的上肢运动功能,多数患者被采用以Bobath方法为主,配合Rood法、Brunnstrom促进法等易化技术进行的康复治疗.笔者对1例脑卒中恢复期门诊患者的上肢运动功能障碍采用改良的强制性运动疗法(modifimed con-straint-induced movement therapy,mCIMT)进行治疗,取得了明显的治疗效果.