下颌骨牙槽嵴萎缩三维有限元模型与生物力学分析

目的:利用螺旋CT建立牙槽嵴萎缩的下颌骨三维有限元模型,用于萎缩牙槽嵴的生物力学分析.方法:采用螺旋CT扫描,数字化影像数据采集,三维重建技术,并使用ANSYS6.0软件完成有限元模型的建立.结果:获得了理想的下颌骨牙槽嵴萎缩三维有限元模型,由16077个单元,23635个节点构成.结论:采用螺旋CT扫描,数字化影像数据采集,三维重建技术结合ANSYS6.0软件可以建立理想的下颌骨牙槽嵴萎缩模型.

兔关节内骨折错位关节软骨的自身修复

目的:研究并探讨不同程度纵向错位时关节运动功能的恢复及关节软骨损伤修复的形态学改变.方法:建立兔膝关节股骨内侧髁全厚(0.5mm)及两倍厚(1.0mm)关节软骨的骨折错位模型.在12周时,利用活体进行观测,并用光学显微镜和透射电镜对关节骨折错位的治疗和重建进行研究.结果:患膝关节运动功能,0.5mm错位较1.0mm错位恢复好.光学显微镜下,0.5mm错位组修复组织为类透明软骨;而1.0mm错位组修复组织则为纤维软骨.透射电镜发现,0.5mm错位较1.0mm错位修复组织软骨细胞成熟度高.结论:兔膝关节内骨折纵向错位不超过关节软骨厚度(≤0.5mm)时,软骨损伤自身修复效果满意.

骨髓基质细胞诱导为神经原及胶质细胞

目的:发现一种新的方法代替雪旺细胞用来修复周围神经缺损.方法:从大鼠抽取骨髓在体外诱导为胶质细胞并做免疫组化.结果:骨髓基质细胞在体外培养数代,显示出极强的扩增能力,并在条件培养液的作用下分化为神经原及神经胶质细胞.结论:经论证,本实验在治疗中枢及外周神经疚病方面有重要意义.

脉冲电磁场对周围神经再生的影响

目的:探讨脉冲电磁场对周围神经再生的影响及其作用机理.方法:以60只Wistar大鼠左侧坐骨神经重度钳夹伤为模型,术后随机将大鼠均分为治疗组和对照组,治疗组给予脉冲电磁场治疗.术后不同时期观测大鼠伤肢功能神经恢复情况、电生理指标和组织学检查.结果:脉冲电磁场治疗促进伤肢功能的恢复,加速了损伤神经远段Wallerian变性进程,促进雪旺氏细胞增殖,促进轴索及髓鞘再生,加速运动神经传导速度的恢复.结论:脉冲电磁场可能是通过对周围神经再生过程中多环节的调控和促进,促进周围神经再生和功能恢复的.

氮化纯钛颈椎植骨融合器的研制及生物力学测试

目的:根据国人颈椎特点设计研制了一种经氮化处理的纯钛植骨融合器,并进行生物力学测试.方法:取12具新鲜成年男性颈椎标本,分别处理成包含单、双运动功能单位的试样,模拟前路植骨及植入融合器,进行前屈、后伸、侧弯、扭转四个方面的测试,比较本融合器植入后与完整颈椎及单纯椎间植骨的稳定性,经统计学分析后自编程序拟合出载荷-位移曲线和扭矩-扭转角曲线.同时进行疲劳强度和强度破坏试验.结果:融合器植入后颈椎在各方向运动中的稳定性均明显强于单纯椎间植骨,也较完整颈椎运动功能单位稳定.结论:纯钛颈椎植骨融合器适用于前路间盘摘除减压手术的椎间固定融合,尤其是多节段病变的病例.

甲状旁腺激素对大鼠成骨细胞转化生长因子-β1基因转录的影响

目的:探讨甲状旁腺激素(PTH)对大鼠成骨细胞(ROB)的转化生长因子-β1(TGFβ1)基因转录的影响.方法:ROB被分成3组培养:(1)对照组,在每个培养周期(48h)的前6h和后42h的培养液中均不加PTH;(2)PTH间歇刺激组(间刺组),仅在前6h的培养液中加PTH;(3)PTH持续刺激组(持刺组),前6h和后42h的培养液中均加PTH.第3周期细胞内mRNA含量用RTPCR测定.结果:第3周期细胞内mRNA含量变化情况为:第6小时以间刺组高,其余二组相似;第24小时依次是间刺组>对照组>持刺组;第48小时间刺组与对照组相似,持刺组低.结论:PTH间歇与持续刺激对TGFβ1基因转录均有明显影响,该基因转录增强可能是PTH间歇刺激促成骨机制之一.

抗神经生长因子抗体对SD大鼠股骨发育的作用

目的:研究周围神经系统发育和调节功能对骨发育的影响.方法:将抗神经生长因子抗体经腹腔注射到新生SD大鼠体内,抑制周围神经系统的发育和调节功能,2d注射1次,持续两周,处理前后称量体重,处死大鼠后取全长股骨和坐骨神经.坐骨神经行Loyez髓鞘染色观察,股骨进行发育情况大体测量,并行生物力学检测.结果:药物处理对大鼠生理状态和运动能力无明显影响,处理前后处理组与对照组体重比较差异无显著性意义(P>0.05);处理组股骨冠状面中段皮质直径较对照组大(P<0.05),中径/长度比值也是处理组较大(P<0.05);生物力学检测处理组和对照组大压应力和脆性比较均差异无显著性意义(P>0.05);坐骨神经轴突密度比较,两组差异无显著性意义.结论:采用抗神经生工因子(NGF)抗体抑制周围神经系统发育和调节功能,处理组大鼠下肢长骨的外径发育较快,但所承受大压应力并无明显提高,说明骨皮质相对较薄,此外应力曲线斜率接近说明矿物/有机物比例接近,提示该变化可能是发育过程中破骨细胞的功能相对活跃,导致成骨细胞代偿性成骨增多.

体外培养的成骨细胞与珊瑚复合的实验研究

目的:观察SD大鼠成骨细胞在珊瑚表面的贴附、伸展及生长情况,并探讨珊瑚作为骨组织工程支架材料与细胞复合植入体内的佳时间.方法:分离的骨髓基质干细胞用含10%胎牛血清的DMEM培养,5d后加矿化液诱导培养,分化为骨髓基质成骨细胞.将成骨细胞与处理过的珊瑚复合,通过细胞计数检测附着后的细胞生长增殖特性,并在扫描电镜下观察细胞在珊瑚表面的贴附情况.结果:细胞接种后,在材料表面贴附良好,继续增殖.结论:珊瑚的生物相容性良好,细胞贴附后继续保持成骨细胞的表型,作为骨组织工程的支架材料有较好应用前景.

坐骨神经切断后脊髓神经细胞的凋亡变化

目的:研究一侧坐骨神经切断后,脊髓第7腰段的神经细胞的凋亡变化.方法:用DNA原位末端标记法.结果:在坐骨神经切断1d后脊髓后角内的神经胶质细胞开始出现凋亡,到第2天达到大值,白质内的胶质细胞也发生凋亡;脊髓灰质后角感觉神经元的凋亡指数大于前角运动神经元的凋亡指数.结论:坐骨神经切断后的第1天脊髓神经细胞发生凋亡,传入神经元的凋亡大于传出神经元的凋亡,神经胶质细胞在细胞凋亡过程中发挥重要作用.

动物颅骨对超声波的吸收率

目的:通过测定活体动物颅骨对不同剂量超声波的吸收情况,探讨超声波治疗颅脑疾病的安全性及有效剂量.方法:选用不同强度的超声波作用于家犬、家兔颅骨外,测定颅内接收声头的剂量,数字经统计学处理.结果:不同剂量的超声波通过家犬、家兔颅骨后平均吸收率脉冲波分别为76.1%与79.0%;连续波分别为75.9%与77.7%,两组比较差异无显著性意义(P>0.05).治疗量率平均为22.8%.结论:不同剂量的脉冲与连续超声波通过动物颅骨后吸收近似线性变化,无增减效应,作用于颅内的治疗剂量基本稳定.

骨髓基质成骨细胞与煅烧骨联合培养的实验研究

目的:探索煅烧骨(calcinedbonecalcium,CBC)作骨组织工程支架材料的可行性.方法:将CBC分纤维粘连蛋白修饰组和单纯培养液修饰组,分别与骨髓基质成骨细胞(marrowstromalosteoblast,MSO)于体外联合培养,进行扫描电镜观察和碱性磷酸酶活性检测,了解细胞在材料中的粘附、生长、增殖、分泌及材料与细胞的相互作用情况.结果:经系统处理过的CBC具有类似原骨的三维结构.体外培养12h细胞已贴附于CBC支架,复合培养7d,分布在支架上的细胞迅速分化增殖,分泌细胞外基质和矿化结节.碱性磷酸酶测定7d组的活性显著高于12h组活性(P<0.01).两组之间扫描电镜观察和碱性磷酸酶测定均未见明显差异(P>0.05).结论:CBC生物相容性好,不需作修饰即能促进成骨细胞的粘附、增殖、分泌活动,是骨组织工程的理想支架材料.

软骨细胞的老化对软骨蛋白聚糖代谢的影响

目的:探讨体外培养猪耳软骨细胞在老化过程中,软骨蛋白聚糖(aggrecan)的代谢状况与分子结构的变化及其水解酶(aggrecanase)表达水平的改变.由此进一步阐明aggrecan在组织工程软骨构建中起决定性的作用.方法:取体外培养P1～P8各代猪耳软骨细胞及其培养液,爱茜蓝(AlcianBlue)法检测培养液中蛋白聚糖的含量和糖胺聚糖(glycosaminoglycan,GAG)的分子结构.RTPCR检测aggrecanase1和2的mRNA表达水平.结果:在P1细胞的培养液中,蛋白聚糖的含量和长链/高度硫酸化的GAG含量都是高的.由P4细胞开始,这2项指标均显著减少(P<0.01),且两者的变化趋势有显著的相关性(P<0.01).Aggrecanase1mRNA在前3代细胞基本无表达,P4细胞中有显著上升(P<0.01),随后逐渐减少,P8细胞又不再表达.Aggrecanase2mRNA的表达呈随机状态,与细胞代数无显著性相关(P>0.05).结论:体外培养软骨细胞的老化对aggrecan的代谢有非常大的影响.一方面aggrecan的合成减少、大分子聚合物形成受阻;另一方面胞外基质的水解作用加剧,终导致老化细胞的基质崩解.

插入式微波天线阵列诱导高温治疗长骨骨巨细胞瘤

AIM:To evaluate the surgical treatment methods of giant cell tumors (GCT) of long bone in conjunction with inserted microwave antennas induced hyperthermia.METHODS:46 patients, included the surgical procedures,the oncology results,the functions of the limbs and the complications were analyzed.RESULTS:Follow up 3.5 to 9 years (mean 5.5 years).All patients were evaluated according to oncological and orthopaedic criteria.Two tumors were recurred.Orthopaedic function were perfect in 44 patients and were fair in 2.Infection was found in 2 patients.CONCLUSION:The surgical procedure to treat the giant cell tumors of long bone by inserted microwave antennas induced hyperthermia is a definitive surgical method which is safe and confident.

基因转移技术在骨组织工程研究中的应用

利用组织工程技术可以再生骨组织,但由于成骨细胞在体外培养过程中成骨表型的逐步丧失及植入体部位局部缺乏生长因子的作用,使得成骨效率,修复效果尤其是修复长段骨缺损的能力仍不令人满意.利用基因转移技术将编码与骨组织再生有关的生长因子的基因片段移至靶细胞中,使之既发挥种子细胞的作用,又可在体内骨组织再生过程中持续高效地分泌生长因子[1],从而为上述问题的解决提供一个新的思路和技术手段.

冬泳健身机制研究进展

冬泳是在寒冷的水中进行的一项运动,易使机体产生很强的应激反应.通过科学的冬泳锻炼,能够增强冬泳者的心脑血管功能和消化功能,提高免疫力,改善血液流变学指标,提高机体抗氧化能力.

钙营养与运动

0 引言 长期以来 ,传统医学观点认为 ,我国国民并不缺乏常量元素-钙 ,以为人体能从食物中得到充足供应.另外 ,旧医学观点更错误地认为缺钙的只有儿童 ,青壮年不缺 ,老年人是钙过剩的问题.近几年研究结果表明 ,人体严重缺钙 ,正严重地危害着每一个人的生命健康 ,其中以儿童和老年人甚.百余年的医学实践证明 ,钙是人体内活跃的元素之一.钙在神经肌肉应激 ,神经冲动的传递 ,心动节律的维持 ,血液凝固 ,细胞粘着等生命过程中 ,有举足轻重的作用.

篮球运动损伤及康复治疗

0 引言 由于篮球运动的激烈对抗性特点,决定勒其各种损伤的发生.本文对本校 236名篮球选项学生的运动实践及 5个部位损伤的原因、症状、体征及治疗情况进行跟踪调查分析,旨在更好的预防和减少篮球运动的损伤.

+Gx和+Gz复合冲击下人体头部响应的实验分析

目的:研究在+Gx和+Gz复合着陆冲击作用下,人体头部动力学响应的一般特点.方法:采用HybridⅢ型假人,在航天返回舱座椅环境中,进行不同量级的复合冲击实验.结果:实验数据呈现出良好的一致性,随输入加速度的增加,头部合成加速度峰值逐渐升高,但趋势变缓,合成加速度增益逐渐降低,另外,胸背向和头盆向上的增长趋势不同;在高G值时,假人头部、胸部的合成加速度峰值和增益均呈现良好的响应变化规律.结论:采用HybridⅢ型假人进行+Gx和+Gz复合着陆冲击的研究实验和分析方法,得到了不同冲击强度下的响应变化规律.

乳腺癌术后放射治疗患者人格的调查

目的:探讨大连市乳腺癌患者放疗期间的人格.方法:采用艾森克(EPQ)人格量表.于200103/200112对正在大连市综合医院和肿瘤专科医院放射治疗的71例女性乳腺癌根治术后的患者在放疗前中后进行问卷调查.统计学方法采用配伍组方差分析.结果:乳腺癌患者放疗中后与放疗前比较,人格量表分值无显著差异,但人格量表的E因子(内外向)分值下降,治疗前后存在显著性差异,(P=0.035);N因子(神经质)、P因子(精神质)和L因子(掩饰)无显著性差异;乳腺癌患者在放疗过程中人格分值与放疗前人格分值比较呈显著正相关,(P<0.01).结论:放疗对乳腺癌患者的人格无影响,人格的四个因子中,放疗对E因子(内外向)有影响,而对N因子、P因子和L因子无明显影响;放疗期间,患者人格分值的高低取决于患者放疗前人格的状况.

腰骶神经根疾病核磁共振脊髓造影的影像学分析

AIM:To illustrate the magnetic resonance(MR) myelography features in the disease of lumbosacral nerve roots.METHODS:MR myelography using heavily T2 weighted spin echo imaging with fat suppression was performed in 75 cases with chronic pain of waist on a Siemens Magneton Impect 1.0 T MR unit.Maximum intensity projection (MIP) was used for image reconstruction.RESULTS:The thecal maugins,nerve roots and nerve root sheaths were well demonstrated on MR myelography image.In 75 patients with chronic of waist, nerve root disease was found in 11 cases. 6 nerve root abnormality(8% ),2 perineural cyst (3% ),3 neurofibroma (4% ) had their own MR myelography features.CONCLUSION:MR myelography can show the morphologic and structural change of lumbosacral nerve roots.In MR myelography image, disease of lumbosacral nerve roots has a characteristic finding.MR myelography is very useful in diagnosis of nerve root disease.

无细胞异体真皮基质在烧伤后整形患者功能部位的应用

AIM:To investigate the effect of allogeneic acellular dermal matrix(ADM) on cograft in joint functional positions of patients with post burn plastic operation. METHODS:9 patients with hypertrophic scar and joint dysfunction after severe burns were used. After pre treating with trypsin and TritonX 100, 13 reticulated ADM were overlapped with autogenous ultrathin split thickness skin grafts(USTS), and were transplanted to the scar excision wounds in the joints of four limbs at the same time. The neighbouring autogenous thin split thickness skin grafts(TSTS) were used as control.RESULTS:The composite skin grafts as well as the controls were all survived. The rejection and hypertrophic scars were not found during (1- 5) years follow up studies. The appearance, fiber and function of composite skin grafts were near to normal skins. CONCLUSION:The ADM could be used to joint functional positions of patients with post burn hypertrophic scars and could produce satisfactory plastic results as dermal substitute.

应用三维矫形系统矫治脊柱侧凸

AIM:To observe the clinical effects of three dimensional instrumentation in the correction of frontal,sagittal and axial plane deformity of scoliosis.METHODS:From June 1996 to June 2001, 52 cases of scoliosis were corrected with three dimensional instrumentation.Among them,36 cases were treated with CD system,5 cases were treated with TSRH,6 cases were treated with China Greatwall and 5 cases were treated with Scofix.RESULTS:All the patients were followed up for an average of 2 years(ranging from 1 to 4 years).The averaged frontal curve was 25.5° (ranging from 10° to 46° ),the average correction rate was 63.6% . The average sagittal curve was 27° (ranging from 20° to 35° ).CONCLUSION: Three dimensional instrumentation is effective in three dimensional correction and is an excellent tool for scoliosis correction.The fixation is reliable and the complications rarely occurred.

烧伤湿润膏与青霉素粉治疗压疮临床效果

BACKGROUND:Patients resting in bed often presented with bed sore which etiology was blocking of local capillary due to long period of local compression.

重症脑损伤低体温与心率变异的相关性

AIM:To investigate effects of heart automatic nerve variations and hypothermia(HT) therapy on heart rate variation(HRV).METHODS:We studied the dynamic electrocardiagraph (ECG) of 41 cases of severe brain injury.The patients were devided into HT therapy group(n=21, body temprature 32- 33 ℃ ),non HT therapy group(n=20) and normal control(n=20).RESULTS:In group 1, the reduction of time domain indexes and frequency domain indexes were 3- 6 folds and 30- 50 folds respectively compared with those of the control group, while the corresponding indexes reduction were 2- 3 folds and 4- 5 folds in the group 2(P< 0.05,P< 0.01,respectively).The difference between groups were significant(P< 0.05- 0.01);the HRV reduction was more significant in the cerebrovascular accident patients than that of brain injured(P< 0.05- 0.01);the HRV indexes increased significantly in resuscitated patients than those in coma(P< 0.01); the HRV in dead was much lower than that in survival(P=0.01).CONCLUSION:Injury of central nervous system can induce abnormal function of automatic nerve of heart and reduction of HRV.HT therapy can reduce HRV on a higher level;HRV examination can be applied into the prediction of prognosis of the brain injured.

重复电针预处理对兔脊髓缺血再灌注损伤的保护作用

AIM:To investigate whether pretreatment with repeated electroacupuncture(EA) could induce ischemic tolerance against transient spinal cord ischemia in rabbits.METHODS: 24 male New Zealand white rabbits were randomly assigned to 3 groups(n=8 each),animals in the control group received no treatment; animals in the SP and EA group received sodium pentobarbitone 30 mg/kg each day for 5 days; animals in EA group were also received electroacupuncture at the Zusanli acupoint 30 min a day for 5 days.24 hours after the last treatment,spinal cord ischemia was induced by an infrarenal aortic occlusion for 20 min.Hind limb motor function was determined with the Tarlov criteria at 4,8,12,24 and 48 h after reperfusion.All animals were sacrificed at 48h after reperfusion and the spinal cords(L5) were removed immediately for histopathologic study.RESULTS:The neurologic outcome and histopathology(48 h) in the EA group were significantly better than the control group(P=0.006).CONCLUSION: Pre ischemic treatment with electroacupuncture significantly reduces spinal cord ischemia reperfusion injury in rabbits.

纳米材料抗厌氧菌机制研究

AIM:To investigate the antimicrobial spectrum of nanometer materials to 33 strains of ordinary anaerobic pathogenic bacteria isolated from 11 genera. METHODS:The anti anaerobic effects of nanometer materials were examined and measured by test tube dilution method.RESULTS:In most tubes, there were no bacteria growth in nanometer suspension.CONCLUSION: there is a wide antimicrobial spectrum of nanometer materials and it can effectively inhibit the growth of the anaerobic bacteria.

颈椎前路手术前后康复护理工作要点

BACKGROUND:The operation of anterior vertebrae often cause the injury of superior laryngeal nerve and inferior laryngeal nerve and it is important of enough preoperative preparations and postoperative care for pationts.

Pilon骨折的治疗与临床康复

AIM:To analyze the effect of three kinds of method on different types of Pilon fracture and advance the best treatment plan.METHODS:From March 1989 to August 2000,107 patients were regarded as having Pilon fracture by two hospitals,among which 76 cases were followed up.They were divided into three groups according to treatment method.A group included 24 cases with the treatment of manual reduction,traction of calcaneus and plaster exopexy.B group included 30 cases with the treatment of AO key shaped anatomical steal plate.C group included 22 cases with the treatment of limited internal fixation combined with exopexy stand.RESULTS:After 6 months to 8 years follow up,it was found that three kinds of treatment methods had obvious differences on the complications and effects of different types of fracture.In A group,the excellent and good rate of treatment on I type fracture was 70% ,II type was 25% ,III type was 0% .In B group,the excellent and good rate of treatment on I type fracture was 78.6% ,II type s 87.5% ,III type was 37.5% .In C group,the excellent and good rate of treatment on I type was 75% ,II type was 80% ,III type 80% .CONCLUSION:Summarizing kinds of factors,the treatment of A group applied in I type fracture,B group applied in II type fracture and C group applied in III type fracture.

功能锻炼对无骨折脱位颈髓损伤术后患者的影响

BACKGROUND:Although neural function can't recovered by function exercise in patients with cervicospinal cord injury,motor function can still achieved obvious improvement.

非血管化髂骨移植同期种植实验

AIM:To investigate the osseointegration process of titanium implant and non vascularized iliac bone grafts.METHODS:12 mongrel were divided into 4 groups randomly.Bone grafts were resected from iliac crest and then transplanted to the other side.Animals were skilled in different time after surgery,X ray pictures were taken,then histological observation were done.RESULTS:At 3rd week,bone grafts dissolved,resorbed or necrosis partly;At 6th week,new bone began to regenerated;At 9th week,the amount of new bone increased;At 12nd week,bone interface around implant formed,without soft tissue interrupt.CONCLUSION:Osseointegration can formed between non vascularized iliac bone grafts and titanium implant.

综合康复治疗对偏头痛患者的作用

BACKGROUND:Migraine is a common disease in department of neurology,but it is often overlooked because doctors think patients will recover after some time even without treatment.Although patients feel headache,they don't get to the degree looking for treatment.So therapeutic effects appeared slowly with high recurrence rate.

小切口不同椎板切除并术后训练治疗腰椎间盘突出症870例

BACKGROUND:There are many operative ways for curing prolapse of lumbar interventebral disc.We should pay attention to decreasing operative trauma when choosing operative style,keeping structure of posterior gray column of spinal cord at the most to sustain stability of spine and avoiding losing excessively the mechanical function of lumbar vertebrae.It is especially important of early postoperative subjective rehabilitation training for operative effect.

神经特异性烯醇化酶血清浓度与重型脑外伤预后的相关性研究

AIM:To eluciate the role of neuron specific enolase(NSE) in predicting prognosis after severe head injury.METHODS: 30 patients with severe head injury were involved into this study,ranging from 26 to 64 years old.Concentration of NSE in serum was measured in all cases within 12 hours after head injury.And prognosis of all patients were evaluated by GOS.RESULTS:The concentration of NSE in serum of both groups,with good or poor outcome,were higher than normal group.The concentrations within 12 hours after head injuries had a close relationship with the prognosis.As a serum marker to assess the prognosis,NSE had high positive prediction ratio.CONCLUSION:The finding suggested that NSE may be a promising predictor for assessing the prognosis after severe head injury.

针刺配合中药离子导入治疗颈椎病123例

BACKGROUND:In treatment of cervical spondylopathy,Fengch'ih and Huat'ochiachi are selected to promote flow of qi and blood in channel.Drugs may reach affected focus by ion introduction and at the same time,series of physiological reactions such as electrolysis, electrophoresis and electrodialysis when direct current flow through body can affect pH,concentration of K+ ,Na+ ,Ca2+ ,Mg2+ and permeability of cell membrane producing analgesia effect.Vessels may also be dilated to promote local circulation and improve local nutrition and metabolism.

伽玛刀治疗后的垂体卒中3例

INTRODUCTIONGamma knife has become an effective method in auxiliary treatment of neural surgery with developing of therapeutic technique.But reports about pituitary apoplexy after gamma knife treatment are quite few.From August 1998 to February 2002,156 patients with pituitary adenoma were treated with gamma knife among which pituitary apoplexy occurred in 3 cases(1.9% ),the following is the report.

颈肩肌劳损60例综合康复治疗体会

BACKGROUND:In treatment of muscle strain at neck and shoulder,dynamic balance disturbance must be dealed with and needle can detach adhesion,relax muscle,resume local blood circulation.Combined physiotherapy can improve local circulation and promote absortion of exudation.

皮簇细胞植入法对深度烧伤后创面愈合及功能恢复的影响

BACKGROUND:When traditional micronized skin is used to treat granulation wound at surface of burn,new injury is caused.In implantation of micronized skin,operative experiences needed to discern orient and lose of skin particles are the key factors affecting effect.

引导骨组织再生术增高牙槽嵴的研究

INTRODUCTIONDue to partial or systematic reasous,long term teeth deficiency can bresk the dynamic balance ofosteogenesis and osteo-destruction.

颅脑损伤患者恢复期的早期康复护理

BACKGROUND:The chief target of rehabilitation care intervention to the craniocerebral trauma patients is to regain the function to the most limits, decrease the sequela and improve the living quality and to turn back and rejoin the society.

大鼠肾缺血/再灌注损伤不同时相Fas、FasL蛋白表达及意义

AIM:To study the relationship between the expression of Fas/FasL protein and apoptosis in rats after renal ischemia/reperfusion. METHODS:Establish the models of renal ischemia/reperfusion injury in rat and SABC immunohistochemical methods were used to detect the changes of expression of Fas/FasL protein. Pathomorphological changes in renal ischemia/reperfusion injury were observed.RESULTS:The expression of Fas/FasL proteins was negative in the sham operated group.Fas/FasL proteins were increased in renal in ischemia/reperfusion group,and gradually upregulated with the duration of ischemia or reperfusion and peaked at 72 h of reperfusion.The expression of Fas/FasL proteins was stronger in 60 min ischemia group than 30 min ischemia group and they were mainly expressed in renal tubule.We observed local necrosis and inflammatory cells infiltration around infracted area in ischemia/reperfusion group by HE dyeing methods.And the necrosis area was mainly occurred around proximal convoluted tubule. CONCLUSIONS:These findings suggested that Fas/FasL proteins were over expressed after ischemia/reperfusion injury in rats renal.And Fas/FasL system was involved in the process of renal ischemia/reperfusion injury.

腓骨切取术后患者的可行性康复训练

BACKGROUND:Systematic and progressive rehabilitation exercises play important roles in accelerating the course of rehabilitation of patients with defection of mandibulla which is recovered with free fibula.

腰椎滑脱椎体间植骨固定术后的康复指导

BACKGROUND:Internal fixation of lumbral spondylolisthesis has resolved the problem caused by vertebral translocation and postoperative rehabilitation instruction can prevent moving of bone.Directed to different stages,suitable posture and rehabilitation function exercises can effectively prevent loose intervertebral grafted bone and adhesion of nerve root.

综合物理疗法为主治疗沟环综合征60例

BACKGROUND:Professor Sun JY first reported the exist of sulcus for vertebral artery at posterior arch of atlas.If vertebral artery is stimulated or compressed when passing through sulcus,artery spasm occurred leading to circulatory blocking and ischemia of brain tissue which blood was supplied by that artery.Dizziness,headache and other symptoms appeared,that is called sulcus syndrom.Therapeutic principles:Overcoming unstability between head and neck,restoring internal and external balance,dynamic and static balance;Removing stimulating and compressing factors to vertebral artery and peripheral sympathetic nerve and /or spinal nerve,ensuring normal blood supply of vertebral artery.

脱细胞异体真皮加自体薄皮复合移植减少瘢痕形成

BACKGROUND:Autogenous skin graft is a common method in treatment of deep burn,late survive effect of grafted skin flap is directly related to its thickness.In clinic,therapeutic effect of full thickness graft is the best.However,due to large skin providing area that can't be sutured directly and survive rate of graft at infected wound surface is very low,its clinical application is limited,especially in deep burn with large area.This study is to search a best material repairing wound surface of deep burn,reduce proliferation of scar and protect limbs function.

中药离子导入加骨刺贴治疗骨质增生症100例

BACKGROUND:Hyperosteogeny is often caused when walking or standing for a long period of time and certain postures must be kept.Traction or avulsion of muscles, hemorrhage and granulation of hematoma led to formation of spurs or lip liked hyperosteogeny.

烧伤患者234例康复治疗体会

BACKGROUND:At present,treatment of burn is not only to save life and promote healing of wound surface,but lateral rehabilitation and problems about returning to society are included.Rehabilitation treatment of burn should be performed through the entire therapeutic course.

胶原壳聚糖医用海绵疗效特征探讨

AIM:To investigate the hemostasia effect of hemostasis sponge of collagen and chitosan compound invitro and in vivo.METHODS:The hemostasis sponge of collagen and chitosan compound was made by mixing collegen I extracted by enzymelytic methods and crosslinked by glutaric dialdeiyde and then lyophilized.The New zealand rabbit were created with a 1 cm× 1 cm wound in the center artery of the ear.The center artery of the ear were transected and record the hemostasis time since pressured with hemostasis sponge of collagen and chitosan compound and observe its effects.In other experiements,1 cm× 1 cm bleeding wound were established in the liver of the rabbit.Then pressured with hemostasis sponge of collagen and chitosan compound on the wounds and record the hemostasis time; The four corner of the hemostasis sponge of collagen and chitosan compound were sutured to investigate the absorption situation with the control of gelatin treated with same procedures.RESULTS:The bleeding time using hemostasis sponge of collagen and chitosan compound was 120 seconds compared with 600 seconds of using gelatin,and the hemostasis time using hemostasis sponge of collagen and chitosan compound was 40 seconds compared with 75 seconds of using gelatin.Both the hemostasis sponge of collagen and chitosan compound and gelatin can be degradated within 5 months.CONCLUSION:Hemostasis effect of hemostasis sponge of collagen and chitosan compound is better than that of gelatin and it has an promising future in surgery.

脱细胞真皮植皮后功能训练减轻重烧伤患者瘢痕53例

BACKGROUND:Fingers with a large area of burn often necroses due to infection and dehydration and amputation of finger is often forced to perform or severe contracture of scar,stiffness of joints occurred leading to dysfunction hard to repair.

电脑中频电治疗肩关节周围炎

BACKGROUND:Periarthritis of shoulder is thought as a common disease of middle aged in motor system,which chief clinical manifestations are shoulder pain,dysfunction of joint and muscular atrophy.The main treatments of periarthritis of shoulder are kinesitherapy,physiotherapy,massage and pharmacotherapy.

脱细胞异体真皮对功能部位深度烧伤创面愈合瘢痕增生的改善作用

BACKGROUND:Because there was no thick skin for skin grafting supplied by enough area of supplying skin of patients with extensive area burn only autograft skin particle,split thickness autologous skin graft or cultural autograft can be applied in repairing wound,which cannot resolve the problems of contracture and deformity caused by scar proliferation after healing of wounds and dysfunction of joint.Acellular allodermis matrix of J 1 type is a kind of tissue with lowest antigenicity and thought as an ideal substituted material for resolving difficult problem of scar proliferation and dysfunction.

不同方式铜针介入术治疗功能部位海绵状血管瘤

BACKGROUND:Many methods are adopted in treatment of cavernous hemangioma,but those located at function site or large,extensive without capsule are still difficult to treat.

臀肌挛缩症患儿术后功能恢复的康复指导

BACKGROUND:Besides regular care for patients with contracture of fascia of gluteal muscles,early and continuous functional exercises is the key for achieving best curative effect,which also can prevent re cohesion of muscles.

全髋关节置换术后康复指导

BACKGROUND:Total hip joint replacement is commonly applied in clinic,and rehabilitation guidance after operation plays an important role in postoperative recovery.

综合康复疗法对腰椎间盘突出症的作用

BACKGROUND:Conservative therapy is very important in treatment of lumbar protrusion of lumbar intervertebral disc and symptoms can be alleviated or disappear in most patients by physical therapy,traction and other comprehensive methods.

刺激迷走神经后不同组织肿瘤坏死因子变化的实验研究

AIM:To investigate the effect of proinflammatory cytokine and anti inflammatation cytokine on liver and lung tissues in rats with endotoxemia.METHODS:Male Wistar rats were randomly divided into 4 groups: group treated with stimulating vagus nerve, group receiving lipopolysaccharide(LPS) intravenous injection after transecting vagus nerve, group treated with sham operation and group treated with injecting LPS intravenously alone, and then measured the levels of TNF α in liver and lung and those of cortisol and Alanine aminotransferase (ALT) in plasma.RESULTS:Compared with group treated with sham operation,LPS treated groups showed a significant increase in TNF level, which was at most 15 fold higher than that of the former group.There was a significant decrease in TNF level in group treated with stimulating vagus nerve,compared with both group receiving LPS intravenous injection after transecting vagous nerve and group treated only with LPS.In addition,we observed plasma cortisol level in LPS treated group was much higher than other 3 groups and the plasma ALT level was greatly lower than that of group treated only with LPS.CONCLUSION:Stimulating vagous nerve can significantly decrease the production of proinflammatory cytokine and alleviate inflammation in rats with endotoxemia.

康复护理在股骨骨折患者功能恢复过程中的作用

BACKGROUND:Dysfunction of knee joint is a common sequela after fracture of femur.The key of avoiding or decreasing dysfunction lies in early prevention,muscular practices of isometric contraction and functional exercises of knee joint as soon as possible.It is an essential component part of rehabilitation care for functional recovery of patients with fracture of femur.

综合治疗退行性膝骨关节炎65例

BACKGROUND:Single method such as Non sternondal antiinflammatory drugs(NSAID),intraarticular injection of natrium hyalunate,needle relaxing,physical treatment,functional exercises is often reported to treat degenerative gonarthritis.But multiple lesions of knee in degenerative gonarthritis indicate that single methods have some limit in treatment of deganerative gonarthritis.

应用外固定架并早期功能训练促进胫骨开放性骨折患者功能恢复的效果

BACKGROUND:Open comminuted fracture of tibia is often complicated with infection,discontinuity of bone,shorten deformity of limbs.Present methods include traction of tibia,plaster fixation,steel plate,intramedullary nailing,et al.,but all these methods have such problems like long term fixation of limbs,limited articualr function,unhealing,higher incidence of infection.External fixed frame combined with early interventional function exercises is the best method at present for promoting function recovery of affected limbs.

新型锁骨瓣移位术对肱骨头缺血性坏死及近端骨不连的实验研究

AIM:To provide a new way of operation for repairing fracture necrosis of proximal humerrus. METHODS:Observing the course,branches and distributions of thoracoacromia artery on 40 sides of adult cadaveric.RESULTS:(1)Sending off 3 to 5 periosteal branches with diameter of 0.3 to 0.5 mm along the acromial branch of thoracoacromial,which distributed at the middle outboard and formed the part of acromial artery net.The acromial length was (5.1± 0.5) cm with diameter of (1.2± 0.2) mm.(2)Sending off 1 to 3 periosteal branches with diameter of (0.2 to 0.5) mm from the clavicular branches of thoracoactomial artery,which distributes at the inside part one second.The length was (2.0± 0.1) cm with diameter of (1.2± 0.2) mm. CONCLUSION: A new operation can be designed for repairing fracture necrosis of proximal humerus by transposing clavicle periosteal(bone) flap with the acromial branch of toracoacromial artery.

康复训练在感染性假关节治疗中的作用

BACKGROUND:The key of curing infected artificial joint is how to improve bone union and close surface of wound.

超短波并药物治疗对慢性前列腺炎患者功能康复作用

BACKGROUND:The effect of simple pharmocotherapy on chronic prostatitis is not satisfying.

腓肠肌内侧头肌瓣移植对保肢术后患者肢体功能的影响

Winberg once adopted muscle flap implantation for 26 patients after excision of peripheral giant malignant tumor of knee joint.After 3- 7 years of follow up survey,all muscle flap survived,function of limbs were good which indicated that implantation with pedunculated muscle flap or muscle skin flap had an important effect on improving success rate of limb salvage of malignant tumor.

髓内钉并术后功能锻炼治疗四肢骨折

BACKGROUND:Despite of cooperative effect of internal fixation and exopexy,the treatment of extremities fracture is often complicated with nonunion and some other conditions.The reasons causing that have multiple factors,of which unsystematic rehabilitation treatment after treatment of extremities fracture with intramedullary nail.

术前并存疾病对老年颈椎手术围术期并发症的影响

AIM:To investigate the effects of preoperative other diseases on the complications of senile cervical vertebral operation in perioperative period.METHODS:800 senile cervical vertebral cases were divided into two group: group A included the cases without other comorbidities,and group B included the cases with hypertension, diabetes mellitus,coronary heart disease(CHD) or chronic obstructive pulmonary disease(COPD).We retrospectively analyzed the changes of BP,oxygen saturation(SaO2) and the incidence of cardiac arrhythmia during operation of group A and B.RESULTS:In perioperative period, the incidence of BP reduction or rising and cardiac arrhythmia in group B was more than that of group A.Incidence of SaO2 decreasing increases apparently in each stage and incidence of cerebrovascular, pulmonary complications and asphyxia led by incision bleeding increases apparently.CONCLUSION:The hypertension, CHD, diabetes mellitus and COPD were the main reasons of complications of the heart,the cerebral vessels and the lung, kidney and the incision bleeding in perioperative period of senile patients.

要素营养制剂ELENTAL对烧伤患者营养状况的维护效应

AIM:To investigate the maitainance effect of enteral feeding ELENTAL on intestine,liver and nutritional status of burned patients.METHODS:30 cases of burned patients were randomly devided into ELENTAL feeding group(E group) and intravenous nutrition group(control, D).The whole calorie in group E were supplied by feeding elemental diet ELENTAL and those in group D were supplied by intravenous nutrition from the third day after burning.the supplemented calorie and nitrogen were equal in two groups. Before the experiment and on the 5th day and 10th day,blood were drawn to examine the levels of and serum transferring.RESULTS:There were no significant difference of serum lipid and serum transferring levels on the 7th day and 10th day in burned patients.CONCLUSION:ELENTAL diet can protect intestine effectively and improve nutritious status of the burned patients.

改良型Dewar手术治疗肩锁关节完全脱位及术后的关节功能恢复

BACKGROUND:Many scholars have reported the clinical practices and effect of Dewar operation,otherwise pain and dysfunction often occur after operation.

镍钛聚髌器治疗髌骨骨折与术后康复训练的关系

INTRODUCTIONForm remembering alloy were used broadly in clinic for its effect,special mechanics and excellent tolerance and has a clinical value[1].

医疗体操对腰椎间盘突出症术后功能恢复的影响

BACKGROUND:Postoperative early rehabilitation treatment on protrusion of lumbar intervertebral discs,especially medical gymnastic is very necessary to prevent postoperative relapse and delay.

老年股骨颈骨折的康复治疗

BACKGROUND:Despite of treatment of operation or routine conservation,special psychological and physical haracteristics,osteoporosis,recession of muscular strength and long braked time on bed often cause retrograde degeneration of muscle and skeleton and the complications of delayed recovery and other diseases.To above problems,a series of continuous ways of functional rehabilitation are applied and satisfactory effects are achieved.

促肾上腺皮质激素及电针对甲醛痛敏大鼠脊髓一氧化氮合成酶阳性神经元的影响

AIM:To study the effects of adrenocorticotropic hormone (ACTH)and electroacupuncture (EA)on formalin induced nitric oxide synthetase (NOS) positive neurons increases in the spinal cord of rats.METHODS:ACTH was administered by intrathecal injection (i.t.)and EA stimulation on" jiaji" point was performed by 1 mA 50 Hz,5 mA 5 Hz and 1 mA 5 Hz respectively.The NOS positive neurons were assayed by NADPH diaphorase histochemistry.RESULTS:The results showed that both ACTH (0.5 u,i.t.)and EA stimulation (1 mA 50 Hz,5mA 5 Hz,lmA 5Hz)on " jiaji" point 30 min significantly reduced the formalin induced NOS positive neurons in the rat dorsal horn.The combinative use of ACTH (0.5 u,i.t.)and EA(1 mA 5 Hz) caused a more marked reduction of the numbers of NOS positive neurons than that of the single ACTH or EA.Those effects were partially reversed by pretreatment with either the substrate of NOS,L arginine (10 nmol,i.t.)or opioid antagonist naloxone(10 g,i.t.).CONCLUSION:These results suggests that both ACTH and EA might inhibit the formalin induced NOS positive neurons increases and have a synergic effect acting via a different pathway.

脊髓损伤后性功能障碍研究的新进展

2003年与临床康复相关的学术会议信息

网上医学信息

医学模式与烧伤的心理干预

严重烧伤与特殊部位烧伤所引起的机体循环系统、免疫系统以及神经内分泌系统等多方面的生理功能改变,深受广大临床医师的关注.但烧伤患者的心理状态和精神异常等情况尚未引起足够的重视 [1- 3],现代医学已进入生物-心理-社会医学模式,大面积严重烧伤及特殊部位烧伤愈后必然会引起患者强烈的心理反应及家庭、社会的连锁反应,考虑到社会的进步,对生活质量的追求,重新进入社会获得认可需要一个艰难的历程,呼吁烧伤界专家,精神方面专家联系深层地提出合理治疗及预防措施,更好地服务于病员.

宽频电磁波谱仪治疗烧伤创面307例

0 引言 本文用宽频电磁波谱仪照射治疗烧伤创面,观察其疗效.

烧伤的综合康复治疗

0 引言 烧伤后发生的一系列局部和全身反应以及临床过程取决于患者的烧伤面积、部位和烧伤深度.身体部位的烧伤以头、颈和上肢部位较常见,这些部位的烧伤常常导致毁容和功能上的障碍,影响患者以后的工作和生活.在烧伤早期介入物理与康复治疗,不仅可以促进创面的早期愈合,而且可以预防肥厚性瘢痕的形成和关节的挛缩,减少和减轻并发症的发生,使患者早日重返社会.

颈部植入单向扩张器修复面部瘢痕26例

0 引言 烧伤后面颊部容易遗留瘢痕,影响外观,为患者的生活和社交活动带来诸多不便.治疗上也是一个棘手问题,因为不论是采用皮片移植或是皮瓣转移修复,外观与面部正常组织差距较大,患者多不愿接受.由于面颈部位的特殊解剖关系,应用单个普通组织扩张器常不能达到预期效果,需多个扩张器联合应用 [1],增加手术复杂性.本组探讨了单个单向扩张器植入修复面部瘢痕的疗效.

烧伤患者的功能康复治疗

0 引言 随着烧伤患者治愈率的提高,国外在 20世纪 60年代已将理疗、体疗结合起来作为烧伤治疗常规,我国在 20世纪 70年代也在临床开展烧伤患者功能康复的治疗,烧伤治疗的目的,首先是使创面愈合,保住生命;其次是大限度地改善外观与恢复功能,目前临床愈来愈重视烧伤患者生存质量,关注烧伤患者功能康复治疗.本科于 1986年开始烧伤功能的康复治疗,初采用压力治疗,范围不断扩大,逐步形成疗法.

弹力套预防和治疗增生性瘢痕

0 引言 自 1997年来,本院以弹力套 (江苏扬中市长旺宏伟弹力绷带厂生产 )持续压迫换药愈合后的深Ⅱ度烧伤创面 86例 ,预防和治疗增生性瘢痕疗效较为满意.

手部烧伤的早期康复训练对患者功能恢复的影响

0 引言 手部烧伤后常因瘢痕挛缩,肌腱粘连,关节粘连,肌肉萎缩等原因影响关节活动,导致功能障碍,手烧伤治疗不应该以治愈创面为总体目标,而应把后续治疗延续下去,尽一切可能减轻或消除手烧伤后遗症,应用早期康复训练治疗手部烧伤即可达到恢复手功能的较好效果.

实验性腰椎椎管狭窄的神经功能及组织学变化

目的:旨在建立一组与临床相关联的腰椎椎管狭窄动物实验模型,探讨不同程度腰椎椎管狭窄动物神经功能(包括神经行为和脊髓诱发电位)及组织学的改变及其意义.方法:以家犬建立腰椎椎管狭窄的动物模型.实验分为A组:正常组;B组:对照组;C组:25%狭窄组;D组:50%狭窄组等4组,每组5只.分别检测各组神经功能及组织学变化.结果:50%狭窄能引起马尾神经功能改变,尤以感觉诱发电位变化更加明显.不同程度狭窄均能造成马尾神经组织学变化.结论:脊髓诱发电位和神经行为能敏感地显示马尾神经的功能改变.50%狭窄是腰椎椎管狭窄引起一系列临床表现的临界点.

脊柱牵引的生物力学问题

为科学的利用脊柱牵引疗法,从生物力学观点出发,提出了脊柱牵引应注意的有关生物力学问题,对牵引的一般性生物力学作用及临床椎体牵引的生物力学作用进行了具体分析.根据生物材料的力学特性和牵引过程,给出了正弦牵引函数及其解释,给出了应力按摩牵引函数应用实例.

快速牵引为主治疗腰椎间盘突出症1260例

0 引言 采用石家庄奥博医疗器械有限公司生产的腰椎间盘治疗机,治疗腰椎间盘突出症疗效满意.

大推拿治疗腰椎间盘突出症疗效分析

0 引言 作者通过多年的治疗实验,总结出一套大推拿疗法.为了验证效果和分析其机制,现把资料整理如下.

麦肯基力学方法与加用物理因子治疗颈椎病的效果对比分析

0 引言 麦肯基脊柱力学方法用于颈椎病的康复治疗在我国刚刚起步,相关报道尚不多见.本文探讨麦肯基力学方法对颈椎病的康复作用,并与传统的物理疗法进行比较.

YZJD型腰椎间盘治疗机治疗腰椎间盘突出症152例

0 引言 采用 YZJ D型腰椎间盘治疗机治疗腰椎间盘突出症患者,并探讨疗效机制.

从麦肯基力学原理探讨慢性腰腿痛的运动疗法

0 引言 腰背肌锻炼的运动疗法有很多,内容大致相似,如动髋、蹬足、昂胸、燕势、伸腰等均为腰背锻炼的运动方式 [1].本文在此基础上以麦肯基( McKenzie)力学原理为指导,编排了一套趣味性强,动作节律优美的运动疗法,通过将患者集中培训的方式,让他们学会后坚持锻炼,每周三四次, 40～ 60 min/次,对慢性腰腿痛的预防和治疗收效甚好.

椎间孔注射加针刀手法治疗腰椎间盘突出症

0 引言 腰椎间盘突出症的 (LDP)微创治疗技术发展很快,椎间孔注射是其中之一,自 1998 05/2002 05,采用椎间孔注射加针刀治疗 LDP患者 60例,报告如下.

带状疱疹后遗神经痛的好发因素及干预方法

目的:带状疱疹后遗神经痛临床常见且较难治疗,探讨其好发因素及干预方法非常有意义.方法:对23例带状疱疹后遗神经痛患者及113例未发生带状疱疹后遗神经痛患者治疗康复过程进行比较分析.结果:好发因素可能为原发病治疗欠及时、疗程较短、未合并使用激素及有特殊伴随疾病等.结论:对原发病尽早并足够疗程的治疗及适量使用激素,同时积极控制伴随疾病应是减少带状疱疹后遗神经痛发生干预方法之一.

通心络胶囊与尼莫地平防治偏头痛的疗效比较

0 引言 偏头痛是由多因素引起脑血管功能紊乱的常见病,反复发作的疼痛严重影响患者的生活和工作.然而,由于偏头痛发病机理复杂,迄今仍无一致意见,临床上治疗药物繁杂且缺乏确切疗效.通心络胶囊是治疗心血管疾病的中成药,具益气活血、通络止痛作用.

星状神经节阻滞治疗心绞痛42例

0 引言 个别心绞痛患者经内科治疗不能解除心绞痛症状,对此神经阻滞疗法具有确实的镇痛效果 [2],作者采用星状神经节阻滞( SGB),治疗心绞痛,探讨其效果和安全性.

小剂量甘露醇对急性椎动脉型颈椎病治疗作用初探

0 引言 椎动型的颈椎病急性发作,多表现头晕、恶心、呕吐,视物模糊,行走不稳等症状,是急性椎基底动脉供血不足( VBI)的一种基本病因.本文采用小剂量甘露醇疗法治疗该病.

麦肯基诊疗技术治疗颈椎病

麦肯基(McKenzie)诊疗技术是由新西兰治疗师RobinMcKenzie创立的一种主要通过姿势矫正和相关医疗体操来治疗颈腰痛的方法,提出了通过教育可以帮助患者自我治疗和预防复发的观点.现将McKenzie诊疗技术方法做以阐述.

手法治疗枕后三角肌综合征

0 引言 枕后三角肌综合征是根据微解剖学而命名的新诊断名称,运用推拿疗法治疗本症对改善症状效果较好.

慢性疼痛综合征的行为康复

0 引言 慢性疼痛是一种持续的病理过程,通常认为任何疼痛持续超过 6个月就是慢性疼痛 [1].痛觉经常伴有一种或多种感觉,组成了一种复合感觉.其特征有:抑郁、依赖、焦虑、神经质,活动能力或性欲下降.疼痛对患者的生活产生了重要影响,使相应的社会报酬降低,社会活动减少,自我控制和自我实现下降,脱离社会和失去代偿能力,患者的这些身体,情感、社会、职业等方面不适应的总合就是慢性疼痛综合征( Chyonic Pain Syndrome, CPS).它严重危害人们的身心健康,诊断和治疗都很困难,临床医师常发现药物治疗效果很差.近十几年来本中心应用多学科的综合措施治疗疼痛有一定成效,国际上对疼痛的处理也极为重视.近年来,国外对 CPS患者的行为治疗作了一些研究.

骶后孔阻滞治疗腰腿痛67例

0 引言 临床上治疗腰腿痛有很多方法,骶后孔阻滞是治疗该疾病的一种较新尝试,现报告如下.

慢性疼痛患者抑郁、焦虑状况调查

0 引言 慢性患者是指引起伤害性刺激的损伤痊愈而疼痛仍然存在 [1].该患者存在一个生理学、心理学和社会学因素之间的恶性循环,当疼痛持续 6个月以上时,患者往往出现躯体化、抑郁、焦虑、恐怖、精神病性等心身症状 [2].

快速牵引复位治疗腰椎间盘突出症200例

0 引言 为探讨 YZJ D腰椎间盘治疗机与普通牵引在治疗效果上的区别,进行了两种不同牵引方法治疗腰椎间盘突出症对比观察.

星状神经节阻滞治疗面神经麻痹

0 引言 采用星状神经节阻滞治疗面神经麻痹 30例,并观察其在恢复面肌功能中的作用.

经皮腰椎间盘摘除术病例选择与疗效关系

目的:探讨经皮穿刺腰椎间盘摘除术治疗腰椎间盘突出症的病例选择与疗效关系.方法:199412/200112,采用经皮穿刺腰椎间盘摘除术治疗腰椎间盘突出症125例;随访3个月～7年,对所有病例的年龄、病程、影像学表现与疗效关系进行回顾性对照分析.结果:根据MacNab腰腿痛手术后疗效判断标准,显效80例,有效22例,总有效率81.6%;影像学表现为原发性骨性椎管狭窄、椎间隙变窄、椎弓裂致椎体滑脱、椎间盘重度膨出、黄韧带肥厚、病程超过10年者,PLD有效率为77.8%.结论:PLD佳适应证为单纯"包容性"腰椎间盘突出症."包容性"腰椎间盘突出合并症及病程超过10年者可谨慎选择PLD治疗.

不同方法治疗冻结期肩周炎60例

0 引言 肩周炎的冻结期肌肉疼痛,关节活动功能明显受限,临床治疗方法较多,如药物治疗,神经阻滞和局部注药治疗,物理因子治疗,软组织按摩等.但各种方法的单一使用在临床均不能达到治愈的目的,现通过选择 3种不同组合的治疗方法,试图选择出佳治疗方案.

颈椎间盘切吸术后对颈椎稳定性的影响

探讨颈椎间盘切吸术后对颈椎稳定性的影响.采用万能试验机加载、百分表接触测量法.将6具新鲜尸体颈椎随机分两组:前路组和后路组各3具.模拟临床手术分别对切吸间盘、髓核摘除术后颈椎运动(前屈、后伸、左/右侧弯)范围进行测试,同时与完整颈椎时的运动测量结果进行对照.前路组切吸间盘后,手术及相邻节段屈、伸运动范围均不同程度增加,但无统计学意义.髓核全部摘除后相邻节段屈、伸运动范围分别增加17.8%和27.6%(P<0.05).后路组:半椎板切除和间盘切吸术后相邻节段运动范围无统计学意义上的增加,髓核全部摘除后屈、伸运动范围分别增加15%和25%,统计学差异有显著性意义(P<0.05).两组手术前后侧弯运动范围无显著意义变化.颈间盘切吸术后对颈椎稳定性无明显影响.

运动疗法改善肩周炎肩关节功能障碍

观察运动疗法对肩关节周围炎的治疗效果,尤其是改善肩关节功能障碍的疗效.治疗组33例和对照组33例均采用磁疗和电脑脉冲按摩治疗仪,治疗组另加用运动疗法再与对照组进行疗效对比.治疗组肩关节活动度各向改善评分均高于对照组,P<0.05,肩痛评分比较,t=2.3578,P<0.05,以上2项评分均差异具有显著性意义,治疗组疗效优于对照组.在采用磁疗和电疗基础上加用运动疗法,能进一步缓解肩痛及增加肩关节活动范围,有恢复肩关节功能,提高肩周炎的治疗效果.

肉毒毒素A治疗颈源性头痛的双盲研究

目的:颈部骨骼肌源性头痛目前尚无治疗的有效方法,观察肉毒毒素A治疗颈部骨骼肌源性头痛的疗效.方法:采用双盲原则,将40例颈源性头痛患者随机分为治疗组和对照组,分别接受浓度为50U/ml肉毒毒素A溶液和生理盐水颈部多个肌筋膜扳机点注射.结果:头痛情况采用头痛月天数和头痛指数进行评估,治疗组在治疗后两周、四周时头痛月天数(2.0±2.4,2.2±2.6)和头痛指数(2.5±3.5,3.5±3.6)明显减低,和对照组(14.6±5.2,16.1±5.2和24.2±14.1,26.3±11.2)及治疗前(14.7±5.8和32.6±19.6)差异均有显著性意义(P<0.01).结论:肉毒毒素A颈部肌筋膜扳机点注射是治疗颈部骨骼肌源性头痛的有效方法.

情绪与原发性血管收缩性头痛关系分析

0 引言 原发性血管收缩性头痛多与职业或精神因素有关.几年来,我们对 10例患者进行监测,并分析了脑血流图的波幅在 0. 04 Ω以下患者的心理情绪与头痛发作的相关性.

神经阻滞治疗带状疱疹后神经痛54例

0 引言 带状疱疹和带状疱疹后神经痛虽然对人无直接生命威胁,但由于剧痛难忍,严重影响患者生活与工作.使患者急需镇痛治疗,本科止痛门诊采用局麻药+维生素 B族+利美达松激素进行局部神经阻滞,治疗带状疱疹性神经痛报告如下.

芬太尼、异丙酚麻醉下手法松解肩周炎70例

0 引言 肩周炎的传统疗法为按摩、针灸、局封及药物对症治疗,但疗程长,患者痛苦大,个别重症病例,难以使肩关节活动,经治疗缓解症状后复发率较高.本文探讨采用芬太尼、异丙酚麻醉下进行手法松解治疗"冻结肩",且随访复发率较低.

颈丛加痛点阻滞治疗颈肩综合征37例

0 引言 颈肩综合征为多种原因引起的颈肩疼痛，传统用药物或局部封闭治疗效果欠佳。颈丛加痛点阻滞治疗颈肩综合征方法简便 [1－ 3]，但要注意用药量，预防并发症。

星状神经节阻滞治疗脑梗死后遗症32例

0 引言 1883年 Liverpool和 Alexander在结扎椎动脉治疗癌症时,误伤了颈部交感神经,却取得了明显的治疗效果. 1920年开始推广非手术经皮的星状神经节阻滞疗法,很快成为一种用途广泛的治疗方法.脑梗死患者,经常用各种方法治疗后,仍残留不同程度的神经功能缺损.用星状神经节阻滞术治疗脑梗死后遗的偏瘫、失语为一有益尝试.

针刀松解治疗臀上皮神经综合征73例

0 引言 臀上皮神经综合征是指臀上皮神经经过髂嵴骨纤维管处由各种原因造成卡压或嵌顿等损伤而引起的疼痛,采用针刀松解疗法治疗该病,操作技巧与临床疗效有哪些相关性.

CT导引下经皮穿刺治疗腰椎间盘突出症的临床应用

0 引言 经皮穿刺腰椎间盘切吸术 (PLD)治疗椎间盘突出大部分是在 X线透视下进行的,由于 X线透视很难分辨穿刺路径上的组织器官,尤其是变异结构,使操作过程具有较大盲目性,更不能显示术中间盘及周围相应变化.而在 CT导引下经皮穿刺治疗腰椎间盘突出症可避免以上缺陷.

慢性疼痛患者情绪障碍调查

0 引言 慢性疼痛是临床各科的常见症状,多见于慢性内科病、神经疾患、腰椎间盘突出,腰肌劳损,骨关节病变、骨质增生、癌症晚期等.长期的慢性疼痛给患者心理带来了负面的影响,严重地影响了患者的生活质量和疾病的康复过程.本文通过对本院 2001 01/07住院的慢性疼痛患者情绪障碍的调查,旨在发现慢性疼痛对患者情绪的影响.

星状神经节阻滞治疗头痛36例

0 引言 头痛患者在疼痛门诊占一定的比例,病情复杂,病程长,治疗上没有什么特别的方法,近年来星状神经节阻滞治疗的临床应用越来越广泛,一些医院疼痛门诊对头痛的患者采取星状神经节阻滞术进行治疗.

婴幼儿医源性坐骨神经损伤的神经肌电图改变

0 引言 通过对 60例医源性坐骨神经损伤的婴幼儿患者进行肌电图检查,旨在检查分析神经肌肉受损的程度而为临床诊断提供可靠的依据.

节段性运动诱发电位和体感诱发电位对脊髓损害的定位价值

目的:应用节段性运动诱发电位(motorevoked,potential,MEP)体感诱发电位(shortsensoryevokedpotential,SSEP)技术对1例资料完整的截瘫患者早期的脊髓损害定位诊断分析,并对相关文献进行探讨.方法:采用日本光电MEB5504神经电生理仪和国产CCSI型皮层刺激仪联机对1例患者进行节段性MEP和SSEP的不同水平脊髓段检测.结果:非损害脊髓段波形出现,损害节段面处波形不出现,其上位神经组织处亦不出现波形.结论:节段性MEP和SSEP对早期脊髓损害功能的判定准确,节段性MEP的定位诊断更精确.

腕管综合征60例电生理改变特征分析

0 引言 腕管综合征是常见的神经嵌压症,电生理检查可为临床及手术提供可靠的诊断依据.

经皮电刺激在周围神经嵌压治疗中的应用

目的:观察周围神经嵌压征在手术松解后应用经皮电刺激治疗的早期临床效果.方法:选择近5年来收治的28例周围神经嵌压的病例,经手术神经松解后,随机分为电刺激组(14例)和对照组(14例),于术后4周、8周、12周给予功能评定及神经电生理检查.结果:在4周、8周、12周的神经功能评定优良率电刺激分别为71%、86%、100%;对照组分别为50%、57%、71%.统计学显示电刺激组优于对照组(P<0.05).结论:经皮电刺激有效提高了周围神经嵌压征患者的神经功能康复.

急性中、重型脑外伤后早期癫痫的脑电图监测及预后评价

目的:探讨急性中重型脑伤后早期癫痫发生的高危因素;诊断昏迷状态中非惊厥性癫痫或非惊厥性癫痫持续状态(NCS或NCSE).方法:选用视频脑电监测系统,对86例急性中重型脑伤患者进行1周的EEG监测.结果:(1)86例脑伤患者中7例(8.14%)有癫痫的临床发作,6例(6.98%)为NCS或NCSE.(2)脑伤越重特别是有颅内出血者,早期癫痫发生的可能性越大,尤其是NCSE,差异有显著性意义;性别、年龄差异无显著性意义.结论:重型、特重型脑伤及颅内出血者是早期癫痫发生的高危因素,特别是NCSE;脑伤后昏迷状态即使没有癫痫的临床发作也应常规进行EEG监测,以便临床及时处理.

神经系统疾病手术后偏瘫患者早期康复的应用体会

0 引言 随着神经影像诊断技术的进步,显微神经外科手术水平的提高以及急诊抢救手段的不断完善已经可以使脑出血、颅脑外伤以及脑肿瘤患者得到及时救治,明显降低了患者死亡率和致残率,但对于运动区受累的患者术后出现肢体瘫痪或不全瘫痪的情况仍时有出现,因此于偏瘫早期实施恰当、合理的康复治疗,对患者出院后的康复及自理能力的恢复存在重要意义.

偏瘫体操对重型颅脑损伤偏瘫患者的康复作用

目的:探讨偏瘫体操对重型颅脑损伤偏瘫患者的康复疗效.方法:早期行偏瘫体操康复训练重型颅脑损伤偏瘫患者与同等条件下但未行偏瘫体操康复训练的同类患者比较.结果:经过偏瘫体操训练3个月后,提高1个级别为有效,提高2个级别为显效.2组患者疗效经χ2检验,差异有非常显著性意义(P<0.01),康复组疗效显著优于对照组.结论:重型颅脑损伤偏瘫患者早期加用偏瘫体操进行康复干预,能更快更好更大程度改善患者的平衡功能、运动功能,进而提高日常生活能力.

高压氧治疗颅脑损伤时机选择的探讨

目的:探讨高压氧(HBO)在颅脑损伤治疗中的时机选择及治疗体会.方法:外伤后除常规治疗外,快速确定HBO治疗对象、治疗时机并行HBO.疗程视病情而定.结果:经过1～3或更多疗程的HBO辅助治疗,许多外伤后急重并发症和远期后遗症都能得到控制或改善.结论:颅脑外伤后辅以HBO治疗的有效性是肯定的,治疗时机、对象选择、伤情、疗程、年龄、治疗细节均是影响疗效的需考虑因素,越快HBO治疗消除伤后脑水肿、建立侧支循环,疗效将越好.

髁部骨折致肘关节功能障碍的治疗

0 引言 肱骨髁部骨折行切开复位内固定术后,由于内固定不牢固或术后处理不当,导致肘关节功能障碍,使上肢正常功能受到严重影响.因骨折术后引起肘关节功能障碍,在适当时机施行手术松解,可以部分地改善肘关节功能.

人工全髋置换术后下肢不等长的预防

探讨人工全髋置换术后双下肢不等长的发生率和分析相关因素.将患者分为3组,选择髋臼底内下方泪点下缘作为参照点,分别测量并统计了240例初次单侧全髋置换术,40例单侧翻修术以及69例双侧全髋置换术患者术前和术后双髋正位X线片上肢体不等长的发生率和长度.初次单侧全髋置换术组中术前患肢短缩者为185例,短缩率为77%,短缩超过15mm者60例,占25%.手术后短缩率降至22%(54例),短缩超过15mm者降至3%(7例);但是有25%患者(61例)患肢出现延长,长者为20mm.在单侧翻修组40例患者中,术前患侧短缩者35例(87.5%),等长者2例(5%),患侧延长者3例(7.5%).手术后共有12例(30%)双下肢等长,短缩者降至17例(42.5%),而术后患肢增长者增至11例(27.5%).双侧初次置换组69例患者中术前术后不等长无明显变化.全髋术后肢体不等长是相当常见的手术并发症.除患者术前即存在严重不等长以外,术者忽视术前设计和手术操作方法有误时引起术后肢体不等长是主要因素.

高龄髋部骨折患者的围手术期康复治疗

通过对高龄髋部骨折患者围手术期康复治疗的回顾性分析,为此类患者得到更好的康复治疗提供依据.248例高龄髋部骨折患者中有204例进行了手术治疗,手术治疗率82.3%.手术治疗者平均年龄77.8岁.包括股骨颈骨折行人工关节置换和空心钉内固定治疗,以及股骨粗隆间骨折行加压滑动鹅头钉内固定治疗.经积极的手术和围手术期康复治疗,大多患者恢复良好.对高龄髋部骨折患者采取积极的手术和围手术期康复治疗方法,提高康复水平和生活质量.

双侧人工全膝关节同期置换术的康复训练

0 引言人工全膝关节置换术是通过手术将病损的膝相关节全部由人工制造的关节假体所替代，其疗效十分确切，15年以上的临床优良率已≥90%[1]，术后康复训练也是影响手术成败的关键.

半月板损伤术后关节强直的康复治疗

0 引言 半月板损伤术后膝关节强直,主要是由于术后未及时进行早期功能锻炼,关节制动时间过长引起.若膝关节屈曲范围 < 60°,将给患者日常活动带来极大不便.近年来主张采用综合康复治疗膝关节强直,可防止关节僵硬股四头肌萎缩,增强肌力,加强关节稳定性,增进关节活动度的作用,故可加快关节功能的恢复.

甩手疗法和电磁场刺激对肱骨近端骨折术后肩关节功能的影响

探讨甩手疗法和电磁场刺激等综合康复治疗在肱骨近端骨折术后对肩关节功能的影响.对1993/2001以来收治的96例肱骨近端骨折的术后患者,分为治疗组(78例)和对照组(18例),治疗组进行综合康复治疗,分别观察1个月及6个月后的临床疗效.按骨折愈合情况、疼痛、肌力、稳定性、肩关节功能和关节活动度评估,治疗组疗效优于对照组.综合康复治疗对预防肩关节僵硬,恢复肩关节功能有良好的促进作用.

臀肌挛缩症的康复训练

探讨臀肌挛缩症术后康复训练的有关问题.199001/200106共收治臀肌挛缩症患者162例,全部行手术治疗,术后指导患者进行康复训练.本组病例随访6个月～2年,优良率达98%.臀肌挛缩症术后应指导患者早期、积极地进行功能锻炼,一方面可以改善挛缩带周围正常组织的伸展舒张情况,另一方面可以减轻手术后的瘢痕粘连,取得良好效果.

对人工全膝关节置换术后患者的康复指导

0 引言 人工全膝关节置换术目前已成为治疗晚期膝关节病变效果肯定的方法.通过全膝关节置换不仅可以解除疼痛、矫正畸形,同时还能改善膝关节的活动范围,提高患者的生活质量.为提高人工膝关节置换术后肢体功能,全膝关节置换术后对患者的康复指导十分重要.

遗传性多发性外生性骨疣家系报告

0 引言 遗传性多发性外生性骨疣( Hereditary multiple exostoses, EXT)是一种累及软骨化骨的以骨骼系统多发性外生骨疣为特征的常染色体显性遗传病.在临床工作中发现了 EXT家族是 3代共 38例成员的家族,国内尚未见如此庞大发病家族的报道.

指深屈肌腱损伤修复术后中西医结合治疗效果分析

0 引言 手指深屈肌腱损伤后常用的方法是损伤肌腱手术缝合,术后常规治疗,但往往给患者留下不同程序的手指功能障碍.为了尽可能降低术后的手指功能障碍,从 1995/2000开始,采用术后功能锻炼并中药薰洗与常规治疗进行对比观察,探讨其疗效.

可控排尿装置在膀胱造瘘中的应用

0 引言 耻骨上膀胱造瘘术的应用,在临床上解决了下尿路梗阻和神经性膀胱患者的尿液引流问题,但随之而来的多种并发症及护理上的麻烦也不断增加 [1～ 2].能否有更好的办法既能引流尿液,甚至和正常人那样自动排尿,又能尽量减少并发症呢 ?可控性排尿装置的应用希望能解决此类问题.

在日本进修作业治疗有感

0 引言 2001 06/2002 01,在日本福冈县残疾人康复中心进修作业治疗 (OT).其间,参观了国立福冈东医院康复科、诚爱康复医院、综合脊髓损伤中心,兵库县综合康复中心等康复机构,并在福冈东医院附属康复学院旁听了 OT专业二年级的部分课程,对日本的 OT状况有了一些了解,对我国 OT的建设与发展有些思考.

嗅神经鞘细胞移植修复成鼠半横断胸髓损伤

目的:观察嗅神经鞘细胞(olfactoryensheathingcells,OECs)移植对脊髓轴突再生及神经功能恢复的促进作用.方法:将分离、培养3W的SD大鼠OECs,移植于12只成年SD大鼠胸10水平左侧半横断脊髓两断端;12只对照动物只注入等量DMEM;移植后6个月行下肢功能评价、运动诱发电位(MEP)检测、组织学和免疫组化检查.结果:实验组及对照组动物存活率均为83.4%.实验组9只(9/10)动物下肢功能有不同程度的改善,其中3只可以主动攀登;上述9只动物左下肢可记录到MEP;组织学检查见宿主再生轴突长入断端间组织,周围有髓鞘碱性蛋白阳性物质存在.对照组中2只(2/10)下肢功能稍改善,并能记录到MEP;组织学检查见轴突变性,瘢痕形成,无轴突再生.结论:OECs移植后可在脊髓中产生髓鞘样物质,促进宿主脊髓轴突再生及神经功能部分恢复.

颈椎黄韧带骨化症31例诊治体会

0 引言 黄韧带骨化( Ossification of Ligamentum flavum,OLF)好发于下胸椎 [1],发生于颈段相对较少.颈椎黄韧带骨化多合并有后纵韧带骨化和 /或发育性颈椎椎管狭窄等,会导致颈椎管狭窄等,压迫脊髓或神经根.其临床表现多样化,早期诊断困难.

诱发电位在组织移植复脊髓损伤中的变化及意义

目的:通过测定诱发电位变化探讨不同神经组织移植对成鼠损伤脊髓功能恢复的影响.方法:成鼠胸髓损伤后,分别移植带血管蒂正中神经(VPN组)、孕14d胚胎脊髓(FSC组)、带血管蒂正中神经加胚胎脊髓(V+F组).术后1,2,4,8,12周行体感诱发电位(SEP)和运动诱发电位(MEP)检查.结果:各组SEP和MEP的峰潜伏期在2～8周内均有恢复,V+F组显著优于对照组(P<0.05).结论:带蒂神经与胚胎脊髓联合移植对脊髓传导功能的恢复有较好作用.

截瘫患者神经性胃肠功能紊乱的康复指导

0 引言 截瘫患者常因神经性损伤而致胃肠功能紊乱,患者极易发生腹胀与便秘,对截瘫患者发生腹胀与便秘进行康复指导,可改善此类患者的常见难题.

脊髓损伤致神经源性膀胱/肠道的康复评价与治疗

目的:行为管理、药物治疗及间隙性清洁导尿等,是目前脊髓损伤致神经源性膀胱和神经源性肠道的主要康复治疗措施.这些康复治疗措施应建立在对患者进行功能评定和科学管理的基础上.方法:采用康复评定Team会的形式,对具体的脊髓损伤患者的病情进行讨论,分析各项化验、检查指标,从而制定出合理的康复治疗方案,再对患者进行有针对性的康复治疗.结果:经过3个月康复治疗,患者膀胱及肠道功能恢复.结论:康复评价会是一种好办法,治疗一段时间后对患者的功能提高情况采用同期性康复评估.因此,可以对患者的处理方案进行调整.

关于干细胞研究的思考

干细胞是近年来细胞生物学和医学研究中热门的课题之一.由于它在防治疾病上实际的和潜在的重要性以及新型药物研制等方面可能有的巨大商机,特别是伦理上的争议,引起学术界和社会各界的广泛关注.目前,科学文献上不断有关于干细胞研究动态和进展的介绍,新闻媒体常常是跟踪追击,有时还作了夸大其词和不真实的报道,对此科技工作者应有所认识和警惕.

干细胞:未来疾病治疗的新希望

随着相关领域的发展以及先进的技术出现,未来恢复和刺激患者自身的干细胞治疗疾病的策略将使临床修复工作变得更加容易.干细胞作为治疗手段可能主要用于两个领域:细胞治疗和基因治疗.但未来干细胞治疗也必需面临诸多问题的挑战,如排除传染性、癌变可能、免疫错乱以及受观注的道德争论.另外,未来的干细胞临床治疗工作将集中在:对人胚胎发育机制及影响因素的深入认识;筛选和评定药物对细胞的药理和毒、副作用;定向制造组织、器官,用于移植、修复或治疗.利用干细胞的更新作用和刺激局部治疗活性的能力,正在为临床疾病治疗打开一条新的成功之路.

功能神经外科的进展

功能神经外科是神经外科的一个新的分支,已广泛应用于功能性疾病如运动障碍病、癫痫、疼痛和精神障碍疾病的治疗.近年来,神经电生理学、神经影像学以及新的植入材料的进展,使功能神经外科的疗效和安全性有了很大的提高.目前功能神经外科领域所采用的新技术及临床应用方面有诸多的新进展.

物理疗法在国外的临床应用

物理疗法在各种临床疾病的治疗和很多疾病的康复中发挥了巨大的作用,尽管目前物理疗法处于发展比较缓慢时期,但国外依然有一些新的物理疗法问世,另外,有关一些物理因子的生物效应的研究和一些物理疗法应用技术等方面都有一些进展,作者在回顾近几年来部分国外理疗、康复医学文献的基础上,分别对电疗法(直流电、低频电刺激、中频电疗法、高频电疗法)、光疗法、磁疗法、超声波疗法、冷疗法的国外临床应用进展做以介绍.

脊髓损伤的循证医学

脊髓损伤的治疗与功能恢复

麦肯基力学诊断治疗技术(续四):麦肯基对下腰痛的治疗方法

1 麦肯基 (McKenzie)对下腰痛总的治疗原则 [1] McKenzie认为通过手法和松动术获得的运动范围增加也可以通过某一种形式的练习获得.当练习以某一种频率进行时,则形成一种节律性被动牵伸.这时练习则可能视为一种松动术.相似的方式,被动的松动也可被视为一种手法治疗.因此,在许多情况下,教会患者自我进行脊柱"松动"和"手法"是可能的.在治疗的初始阶段,减少治疗师的操作,大程度地发挥患者自身的"技术",患者会由此意识到其疼痛减少和恢复极大程度地是因为自我努力的结果.因此, McKenzie选择两种治疗力量(治疗师产生的力量和患者产生的力量)进行力学治疗.治疗师产生的力量包括按摩、手法和徒手、持续或间歇牵引.患者产生的力量可以是静态的,如:患者改变并保持一种新的姿势;也可是动态的,如:患者进行练习.