Treatment and rehabilitation of post-traumatic elbow stiffness with heterotopic ossification.

AIM: To investigate surgical treatment, postoperative rehabilitation and prevention of heterotopic ossification (HO) in patients with post-traumatic elbow stiffness. METHODS: We performed a retrospective review of patients with post-traumatic elbow stiffness combined with HO between 2007 and 2021. This study was performed on a total of 15 patients (18 elbows) admitted to our hospital, consisting of 12 males and 3 females, with post-traumatic stiffness of the elbow combined with HO, where elbow function could not be recovered by rehabilitation and orthosis treatment. Fifteen patients were treated by surgical excision of heterotopic bones and release of elbow contracture combined with postoperative rehabilitation and orthosis-wearing. Comprehensive treatments, including radiation, oral ibuprofen medication, and manipulation techniques to improve range of motion, were used to prevent HO recurrence. The flexion-extension arc and functional score of the elbow were measured after treatment and compared with the preoperative measurements. Roentgenography was used to observe HO recurrence. RESULTS: After surgical treatment and postoperative rehabilitation, the patients' range of motion improved, and the functional score improved considerably. The postoperative flexion-extension arc and The Hospital for Special Surgery (HSS) functional score were statistically significantly higher than the preoperative values (p < 0.01). Roentgenographic examination showed no HO recurrence during the follow-up period. CONCLUSION: Surgical excision of heterotopic bones and elbow contracture release combined with postoperative rehabilitation and preventative HO measures can be an effective treatment for cases of post-traumatic elbow stiffness combined with HO, for which conservative treatment is ineffective.

Treating Cervical Vertigo of Elderly Patients through Sling Exercise Combined with Drug / 中国运动医学杂志

Objective To observe the clinical effect of sling exercise therapy(S-E-T)combined with drug treatment for cervical vertigo in elderly patients.Methods Forty-nine elderly patients with cervical vertigo admitted to our hospital between January 2011 and July 2014 were randomly divided into an observation group(n=27)and a control group(n=22).The observation group was given 80 mg Ginaton(Extract of Ginkgo Biloba Leaves Tablets)produced by German Dr.Willmar Schwabe GmbH & Co.KG three times a day,combined with S-E-T,including cervical stability and stretching training for 40min,focusing on the neck global muscle and local stabilize muscle rehabilitation,once every other day.The control group was provided with the same drug treatment.During the 6-month intervention,both groups were given health education by the same therapist.Both groups were assessed using the neck disability index(NDI),visual analogue scale(VAS)and evaluation scale for cervical vertigo(ESCV) before and after the intervention,as well as at the last follow-up visit.Before the treatment and at the last follow-up visit,the cervical X-ray examination and trigger point check were also conducted for both groups.Results All the forty-nine patients were followed up for 4.83 to 6.70 months,with an average of(6.01 ± 0.49)months.Significant improvement was observed in the average ESCV score for both groups after the treatment.Compared with before the treatment,there was significant improvement in the average NDI and VAS right after the treatment and at the last follow-up visit in the observation group,but only at the last follow-up visit in the control group.From the cervical X-ray,no significant differences were found in the vertebral osteophyte formation,facet joints and uncovertebral joint degeneration between the 2 groups(P＞0.05),while significant differences were observed in the number of the neck trigger points(P＜0.05).Conclusion The sling exercise therapy combined with drug treatment can significantly improve cervical function,relieve pain and vertigo symptoms in elderly patients with cervical vertigo.The effect is better than drug treatment alone.

Effects of acupuncture intervention at different stages on urinary function reconstruction of neurogenic bladder after spinal cord injury / 中国针灸

<p><b>OBJECTIVE</b>To explore the effects of early intervention of acupuncture on urinary function reconstruction of neurogenic bladder after spinal cord injury, so as to find the optimal treatment timing of acupuncture.</p><p><b>METHODS</b>Fifty-three patients of neurogenic bladder after spinal cord injury were randomly divided into a prior-to-catheter group (25 cases) and a posterior-to-catheter group (28 cases). For the prior-to-catheter group, one week before the removal of catheter, acupoints on the abdomen and back such as Guanyuan (CV 4), Zhongji (CV 3), Baliao (Shangliao (BL 31), Ciliao (BL 32), Zhongliao (BL 33), Xialiao (BL 34), Jiaji (EX-B 2) and acupoints at distal end such as Zusanli (ST 36) and Sanyinjiao (SP 6) were selected; after the catheter removal, simple method. of water column was used to measure bladder capacity pressure to classify the type of bladder, and then different acupuncture manipulations were given; intermittent catheterization was performed if condition was allowed. The posterior-to-catheter group applied identical treatment after removal of catheter as the prior-to-catheter group. The treatment was given 5 times per week; after one-month treatment, five aspects including the time of first effective urination, time of establishing reflex urination, average residual volume of urine, time of residual urine less than 100 mL and quality of life (QOL) were evaluated.</p><p><b>RESULTS</b>After treatment, the time of first effective urination, time of establishing reflex urination, average residual volume of urine and time of residual urineless than 100 mL in the prior-to-catheter group were all superior to those in the posterior-to-catheter group (all P<0. 05) ; the score of QOL was improved in two groups after treatment (both P<0. 01), but the difference between two groups was not statistically significant (P>0. 05); each index of urination function was not significant among patients with different injured segments of spinal cord (all P>0. 05).</p><p><b>CONCLUSION</b>The early intervention of acupuncture (prior to catheter) has obvious improving function on establishing balanced bladder in patients with neurogenic bladder after spinal cord injury, which is superior to acupuncture intervention after removal of catheter, however, the effects of different injured segments on establishing balanced bladder are not different.</p>

Significance of Flexion Priority in the Rehabilitation of Posttraumatic Stiffness of Elbow / 中国康复理论与实践

@#ObjectiveTo evaluate the significance of flexion priority strategy and the principle of joint mobilization technique in the rehabilitation of posttraumatic stiffness of the elbow. Methods24 patients with posttraumatic stiffness of the elbow were divided into 2 groups, 12 patients in each group. The treatment group was treated with flexion priority strategy of joint mobilization technique only in the treatment of flexion contracture. In order to decrease the pain caused by joint mobilization training of extension and achieve the restoration of flexion as early as possible, the rehabilitation of extension was altered to self-exercise under the consultation of doctors combined with gentle passive traction by the therapist. The control group was treated with joint mobilization technique of both flexion and extension once a day. All the patients were measured the flexion range, extension range, and flexion-extension arc after 6 weeks of rehabilitation. Results6 weeks after rehabilitation, the treatment group got 124° of flexion (range 95°～135°), much better than the control group of 95° (range 80°～110°) （P<0.01）. There was no significant difference of extension degrees between the treatment group (15°, range 10°～35°) and the control group (16°, range 10°～30°) （P＞0.05）. The final arc of flexion and extension in the treatment group had an increase of 53°, significantly greater than 30° in the control group（P<0.01）. ConclusionFlexion priority strategy of elbow rehabilitation can significantly restore the flexion function of posttraumatic elbow stiffness.

Effect of Progressive Resistance Exercises Combined with Alendronate Sodium on Bone Mineral Density of Lumbar Spine in Patients with Postmenopausal Osteoporosis / 中国康复理论与实践

@#Objective To observe the effect of progressive resistance exercise combined with alendronate sodium on bone mineral density(BMD)of lumbar spine in patients with postmenopausal osteoporosis.Methods 20 patients with postmenopausal osteoporosis were randomly divided into the A and B group with 10 cases in each group.The cases of the group A were treated with progressive resistance exercises combined with alendronate sodium.Those of the group B only took alendronate sodium orally.The course of two groups was 3 months.BMD of lumbar spine was measured by dual-energy X-ray absorptiometry before and 3 months after treatment.Results Before treatment,BMD of two groups was not different.After 3 months treatment,BMD of lumbar spine were significantly improved in group A(raised 4.520±0.68%)than group B(raised 0.100±0.01%),there was a significant difference between two groups(P<0.01).Conclusion Progressive resistance exercises combined with alendronate is more efficacious than alendronate alone in restoring lumbar spine BMD in patients with postmenopausal osteoporosis.

Experimental study of repairable length of nerve defects with acellular nerve allografts / 中国矫形外科杂志

[Objective]The purpose of this paper is to demonstrate whether the nerve length could affect the quality of acellular nerve and investigate the properly repairable distance of nerve defects with acellular nerve allografts.[Method]Fresh sciatic nerves were obtained from adult dogs and divided into 12 cm long segments.The nerve segments were decellularized via an improved chemical decelluarization treatment as following: Nerve segments were rinsed with cold sterile Ringer's solution and submergedin 5% Triton-100 solution 12h,and then soaked the nerve segments into 5% sodium deoxycholate for 12h.The treated nerve segments were washed in distilled water for 3h.This procedures were repeated once again.In vitro,the degrees of decellularization,demyelination and integrity of nerve fiber tubal of chemically extracted acellular nerves were observed with microscope and assessed by a score system.In vivo,the sciatic nerve of dogs on the right was exposed.In 8 cm grafted group(n=6),a 7 cm segment of sciatic nerve was removed from the midthigh level.In 10 cm grafted group(n=6),a 9 cm segment of sciatic nerve was removed at the same level.The gaps were bridged with acellular nerve allografts by 8 cm and 10 cm long segments respectively.The follow-up period was 12 month postoperatively.Motor functional recovery of the right hind following allografting was examined by neurobehavioral,electrophysiological,histological and immunohistochemical assessment.[Result]There was no difference on the degrees of decellularization,demyelination and integrity of nerve fiber tubal among every fraction of the acellular nerve from the two ends to the central portion.In 8 cm grafted group,all survival dogs(n=5) were held upright with the affected hindlimb extended so that the body's weight was supported by the distal metatarsus and toes.In 10 cm grafted group,animals were failed to held upright with the affected hindlimb.Electrophysiological studies showed that elctromyographic activity was observed in both groups.After 12 month the conduction velocity was 32.1+5.1 m/s in 8 cm grafted animals and 18.3+6.0m/s in 10 cm grafted group.In normal animals, the conduction velocity was 106.6+16.4 m/s.The conduction velocity in 10 cm grafted group was lower than 8 cm grafted(P

BIOMECHANICAL STUDY OF RECONSTRUCTION OF ANTERIOR CRUCIATE LIGAMENT (ACL) WITH DIFFERENT FIXATION METHODS OF HAMSTRING TENDON KNOT IMPLANT / 解放军医学杂志

0.05). Peak force test maximal displacement evaluation and failure energy absorption measurement showed that hamstring tendon knot or bone bolt press fit implant fixation were significantly better than B-PT-B (P0.05). Conclusion Reconstruction of ACL by hamstring tendon knot or bone bolt press fit implant fixation and tibia side tendons by weaving suture to tie a knot on the bone bridge can meet daily physiological demand.

Experimental study of chemically extracted acellular nerve allograft / 中华骨科杂志

Objective To research the immunologic reaction and the potential of chemically extracted acellular nerve allograft(CEANA) to repair peripheral nerve defects in primates. Methods Adult SD rats were used as nerve donors and adult male Wistar rats used as nerve recipient hosts. 25 mm long nerve segments were excised from SD rats' sciatic nerves. The nerve segments were decellularized via an improved chemical decelluarization treatment as follows: 1) nerve segments were rinsed with cold sterile Ringer's solution; 2)stabilized by pinning the ends to a thin plastic support, and submerged in 4% Triton-100 solution 12 h; 3)soaked into 72 mM sodium deoxycholate for 12 h; 4)washed in distilled water for 6 h. The procedures were repeated once again. Median nerve segments were obtained from macaques and decellularized according to above procedures. The CEANA from SD rats were implanted into Wistar rats subcutanously. The control group was implantation of fresh nerve allografts from SD rats. The immunogenicity of acellular nerve allograft was tested by immunohistochemical examination of the intensity of CD3+, CD4+ and CD8+ cells that infiltrated the allografts. Median nerve defects for 5 cm were created in three macaques. CEANA were interposed across the gap. The CEANA were anastomosed microsurgically to the epineurium of proximal and distal stumps. Results The number of CD3, CD4 and CD8 positive lymphocytes infiltration in CEANA was far lower than that in the control group of fresh nerve allografts at 2 weeks and 4 weeks after implantation. There was no significant evidence of inflammatory in the CEANA grafted group. In the experiment of nerve regeneration of macaques, electromyographic activity was recorded across the allografts. The conduction velocity of regenerated nerve was (40.5?6.8) m/s. Regenerated axons sprouted from the proximal portion reached the distal portion of the grafts, and Schwann cells were also present in the central portion of the CEANA. Motor end-plates were observed in reinnervated muscles. Conclusion The immunogenicity that would have initiated cell-mediated immunological rejection of CEANA are removed. The implantation of CEANA could repair the defect of median nerve 5 cm long in the arm 5 months postoperatively. The CEANA as a type of substitute of nerve autografts has the potential to repair peripheral nerve defects in primates.