应用静态进展性牵伸法无痛康复治疗踝关节挛缩

目的:观察运用静态进展性牵伸法进行无痛康复治疗对治疗踝关节挛缩的临床疗效,探索更符合现代康复理念的无痛康复技巧。方法:选取因骨折、跟腱断裂、神经系统损伤等原因导致踝关节挛缩的病人30例,分为观察组和对照组各15例,其中对照组进行一般性康复治疗,观察组在此基础上,每天使用JAS踝关节训练器进行静态进展性牵伸治疗,每次在一个关节活动方向上进行无痛康复治疗牵伸,每日3次,每次5组,每组5min,中间休息1min,下一组关节角度渐增,持续8周,评定患者踝关节关节活动度改善情况、VAS疼痛评分及AOFAS踝-后足评分量表评分结果。结果:治疗后,2组患者踝关节各个方向的主、被动关节活动度均较治疗前明显提高(均P0.05),观察组更高于对照组(均P0.05)。治疗后,2组疼痛程度、AOFAS踝-后足评分量表评分均明显改善(均P0.05),观察组改善更显著(均P0.05)。结论:运用静态进展性牵伸法进行无痛康复治疗对改善踝关节挛缩优于一般性康复治疗。     

静态渐进性牵伸对痉挛型脑性瘫痪患儿尖足疗效的观察

目的:观察静态渐进性牵伸治疗对痉挛型脑瘫患儿尖足的疗效。方法:60例(年龄4—12岁)痉挛型脑瘫患儿随机分为观察组(30例)和对照组(30例),观察组进行静态渐进性牵伸治疗,再配合常规康复治疗。对照组仅进行常规康复治疗。治疗前后,两组分别进行踝关节背屈活动度(ROM)、小腿三头肌肌张力评分(MAS)和GMFM量表D区(站立)、E区(走跑跳)评估。结果:两组治疗前踝关节ROM、肌张力和GMFM量表D、E区评分间差异均无显著性(P0.05),治疗3个月后,两组各项指标较治疗前均改善(P0.05),且以观察组的改善幅度较为显著,与对照组比较,组间差异有显著性(P0.05)。结论:静态渐进性牵伸治疗配合常规康复治疗能增加痉挛型脑瘫患儿踝关节背屈活动度,降低小腿三头肌肌张力,提高患儿站立和走跑跳的运动功能。     

清单式管理在急性闭合性跟腱断裂患者围手术期护理中的应用

目的：通过与传统方式的围手术期护理及康复指导比较,探讨清单式管理在急性闭合性跟腱断裂患者围手术期护理及康复指导的效果。方法：回顾性分析2016-2017年我院收治的124例急性闭合性跟腱断裂患者临床资料,其中2016年1月至2016年12月收治的62例患者为对照组,采用常规围手术期护理及康复指导；2017年1月至2017年12月收治的62例患者为试验组,根据清单式管理理念制定相应的围手术期护理和康复指导,采用Hannover跟腱评分表及VAS评分表比较两组患者在入院时、出院前及术后6个月跟腱功能恢复情况、踝关节背伸活动度及疼痛的差异。结果：两组患者入院时一般资料行比较,包括性别、年龄、VAS、踝关节背伸活动度、Hannover跟腱评分等,结果显示无统计学差异(P>0.05),具有可比性。术后6个月,试验组患者的Hannover跟腱评分高于对照组,踝关节背伸活动度大于对照组,疼痛评分低于对照组,且差异均具有统计学差异(P＜0.05)。结论：将清单式管理应用于急性跟腱断裂患者围手术期护理和康复指导,可以有效加快患者足踝部的功能恢复,缓解患者疼痛,也减少了医患和医护矛盾的产生,值得临床应用及推广。     

跟腱延长术治疗痉挛型脑性瘫痪患儿马蹄足的效果

目的评估跟腱延长术治疗痉挛型脑瘫马蹄足的效果。方法 2013年12月至2014年6月接受跟腱延长术治疗的痉挛型脑瘫马蹄足患儿17例(34足),于术前、术后8~12个月分别进行踝关节背屈关节活动度(ROM)、小腿胫前后肌群表面肌电测试,记录踝关节被动背屈、主动背屈ROM,站立位胫前肌、腓肠肌肌电均方根值(RMS)和拮抗肌协同收缩率(CR)。结果术后踝关节主动、被动背屈ROM显著增加(Z4.867,P0.001);被动背屈时腓肠肌RMS减少(t=4.31,P0.001),站立时胫前肌、腓肠肌RMS无显著性差异(Z1.291,P0.05),CR降低(t=2.38,P0.05)。结论跟腱延长术可以改善痉挛型脑瘫马蹄足患儿小腿胫前后肌群协调收缩,增加踝ROM。     

跟腱延长术治疗痉挛型脑性瘫痪患儿马蹄足的效果北大核心CSCD

目的评估跟腱延长术治疗痉挛型脑瘫马蹄足的效果。方法 2013年12月至2014年6月接受跟腱延长术治疗的痉挛型脑瘫马蹄足患儿17例(34足),于术前、术后8~12个月分别进行踝关节背屈关节活动度(ROM)、小腿胫前后肌群表面肌电测试,记录踝关节被动背屈、主动背屈ROM,站立位胫前肌、腓肠肌肌电均方根值(RMS)和拮抗肌协同收缩率(CR)。结果术后踝关节主动、被动背屈ROM显著增加(Z>4.867,P<0.001);被动背屈时腓肠肌RMS减少(t=4.31,P<0.001),站立时胫前肌、腓肠肌RMS无显著性差异(Z<1.291,P>0.05),CR降低(t=2.38,P<0.05)。结论跟腱延长术可以改善痉挛型脑瘫马蹄足患儿小腿胫前后肌群协调收缩,增加踝ROM。     

改良经皮微创修复术治疗急性闭合性跟腱断裂的疗效

目的 探讨改良经皮微创修复术对急性闭合性跟腱断裂患者踝关节功能的影响.方法 回顾性分析63例急性闭合性跟腱断裂患者的临床资料,均予以改良经皮微创修复术治疗,观察治疗后的优良率、手术时间、切口长度、平均住院时间及并发症发生率;比较术前、术后1、3、7个月的美国足踝外科协会(AOFAS)评分、跟腱完全断裂评分(ATRS)、视觉模拟评分法(VAS)评分;分析AOFAS评分与ATRS评分、VAS评分的相关性;观察术后1、3、7个月的踝关节跖屈肌力、踝关节活动度、跟腱长度.结果 63例患者经改良经皮微创修复术治疗后优良率为92.06％;手术时间(33.72±6.52) min、切口长度(2.45±0.52) cm、平均住院时间(3.14±0.32)d;术后未出现感染、跟腱撕裂、跟腱再断裂等并发症;术后随访7个月,经B超、MRI等影像学检查,患侧跟腱修复良好,跟腱断端连续性良好.单因素方差分析显示,术后1、3、7个月的AOFAS评分、ATRS评分显著高于术前,而VAS评分低于术前,差异有统计学意义(P＜0.05).Pearson相关性分析显示,AOFAS评分与ATRS评分呈正相关(r=0.902,P＜0.05),与VAS评分呈负相关(r=-0.676,P＜0.05).单因素方差分析显示,术后7个月的踝关节跖屈肌力、踝关节活动度、跟腱长度高于术后1、3个月(P＜0.05);治疗后患者满意度为88.89％.结论 改良经皮微创修复术用于治疗急性闭合性跟腱断裂疗效显著,具有损伤小、手术时间短、术后恢复快等优势.     

改良经皮与开放跟腱延长术治疗跟腱挛缩症的临床疗效比较

目的比较改良经皮与开放跟腱延长术治疗跟腱挛缩症的临床疗效。方法选取本院2009年1月~2013年12月收治的100例(106足)跟腱挛缩症患者为研究对象,入院后按照抽签随机取样法将其分为常规组(54足)和改良组(52足)。常规组采用开放跟腱延长术治疗;改良组采用改良经皮小切口跟腱延长术治疗。观察比较两组患者各项临床指标;根据踝关节背伸活动度、活动能力等比较两组治疗后临床疗效;比较两组患者切口感染、皮肤坏死、跟腱粘连等术后不良反应发生率。结果改良组患者手术时间、术中出血量、住院时间均显著低于常规组(t1=29.7、P1=0.000,t2=35.2、P2=0.000,t3=7.18、P3=0.001)。改良组有效率显著高于常规组(92.0%vs 58.0%,χ2=15.4,P=0.000),不良反应发生率显著低于常规组(20.0%vs 6.0%,χ2=4.33,P=0.036)。结论对于跟腱挛缩症患者,改良经皮小切口跟腱延长术的有效性和安全性显著优于开放跟腱延长术,值得临床推广应用。     

肉毒素治疗脑瘫患儿小腿三头肌痉挛的疗效观察

目的：观察A型肉毒毒素（BTX-A）局部注射结合康复训练治疗脑瘫患儿小腿三头肌痉挛的疗效.方法：将20例脑瘫患儿随机分为观察组和对照组各10例,2组均接受常规康复训练,观察组增加小腿三头肌BTX-A局部注射治疗,于治疗前后给予下肢改良Ashworth评分（MAS）,并评定伸膝踝关节背屈度.结果：治疗1、2、3个月后,观察组MAS评分明显低于治疗前及同时间点对照组（P＜0.01,0.05）;2组伸膝踝关节背屈度均较治疗前及同时间点对照组明显提高,且观察组更高于对照组（P＜0.01,0.05）;对照组在治疗3个月后MAS评分才低于治疗前（P＜0.05）.结论：BTX-A局部注射结合康复训练比单纯康复训练治疗小腿三头肌痉挛疗效更好.     

强化康复训练对下肢静脉畸形术后患者下肢功能恢复的影响

目的观察强化康复训练对下肢静脉畸形术后患者下肢功能恢复的影响。方法采用随机数字表法将下肢静脉畸形行血管瘤切除术后患者61例随机分为常规组30例和强化组31例。常规组采用下肢静脉畸形术后常规康复训练进行干预,强化组则进行强化康复训练。于干预前、干预后(即出院时)、出院1个月后、出院3个月后采用美国足踝矫形外科学会(AOFAS)踝-足关节功能评分(即AOFAS评分)、踝关节活动度(背屈度、跖屈度)测量、视觉模拟疼痛评分(VAS)和中文版关节炎生活质量简易评分(AIMS2-SF)分别评估2组患者的踝-足运动功能、踝关节活动度、疼痛程度和生活质量,同时记录2组患者治疗过程中不良事件(继发跟腱挛缩、出血、感染)的发生率。结果出院1个月和3个月后,2组患者的AOFAS总分、踝关节背屈角度和踝关节跖屈角度与组内干预前比较,差异均有统计学意义(P<0.05),且干预后,强化组患者的AOFAS总分、踝关节背屈角度、踝关节跖屈角度即优于组内干预前,差异均有统计学意义(P<0.05),而强化组患者出院3个月后的AOFAS总分、踝关节背屈角度、踝关节跖屈角度亦显著优于常规组出院3个月后,差异均有统计学意义(P<0.05)。干预后、出院1个月和3个月后,2组患者VAS评分和AIMS2-SF总分均显著优于组内干预前,差异均有统计学意义(P<0.05),且强化组干预后和出院一个月后的VAS评分亦显著优于常规组同时间点,差异均有统计学意义(P<0.05)。住院治疗期间,常规组患者不良事件发生率为30.0%,强化组无不良事件发生,组间比较,差异有统计学意义(P<0.05)。结论强化康复训练可促进下肢静脉畸形术后患者下肢运动功能的恢复、缓解患者疼痛的程度、改善患者的生活质量。     

踝关节智能牵伸训练对偏瘫患者踝关节生物力学特性及其运动功能和日常生活活动能力的影响

目的 观察踝关节智能牵伸训练对脑卒中偏瘫患者踝关节生物力学特性、平衡、步行功能和日常生活活动能力的影响。 方法 将脑卒中后偏瘫患者18例按随机数字表法分为试验组和对照组,每组患者9例。2组患者均接受常规临床药物和常规康复治疗,在此基础上,试验组每日增加20 min的踝关节智能牵伸训练,对照组则将常规康复治疗时间延长20 min。于治疗前、治疗2周后（治疗后）对2组患者进行踝关节生物力学特性评估［包括踝关节僵硬度、主动关节活动度（AROM）、被动关节活动度（PROM）和肌力］和临床量表评分［包括改良Ashworth分级（MAS）、Fugl-Meyer下肢运动评分（FMA-LE）、Berg平衡量表评定（BBS）、6分钟步行试验（6MWT）、改良巴氏指数（MBI）］。 结果 治疗后,2组患者的背屈和跖屈肌力、背屈和跖屈AROM、BBS、FMA-LE评分较组内治疗前均明显改善,差异均有统计学意义（P＜0.05）,且试验组的跖屈PROM、K背屈、MBI较组内治疗前亦显著改善,差异均有统计学意义（P＜0.05）。治疗后,试验组跖屈和背屈肌力分别为（158.44±14.61）N、（130.22±22.12）N,均显著优于对照组治疗后,差异均有统计学意义（P＜0.05）。 结论 踝关节智能牵伸训练可有效地降低偏瘫患者踝关节僵硬度,改善其踝关节肌力、关节活动度和日常生活能力。     

Achilles tendon injury. 5. A model of isokinetic strength training using biofeedback.

Plantar flexion strength was isokinetically trained under visual biofeedback control in subjects with long standing unilateral soleus muscle myopathy and plantar flexion weakness after Achilles tendon rupture. The rupture had been surgically treated at least one year before training commenced. In the subjects both static and dynamic plantar flexion strengths were normalized as compared to the uninjured leg pre-training. This was accomplished by a) normalization of muscle fibre cross-sectional profile and area within the myopathic muscles, and b) faster achievement of the peak torque during the angular motion. The successful results imply that this training model can be applied when hypotrophy and possibly calf weakness prevail in the aftermath of Achilles tendon rupture.     

Effect of Achilles tendon loading on plantar fascia tension in the standing foot

BACKGROUND: The plantar fascia, which is one of the major arch-supporting structures of the human foot, sustains high tensions during weight-bearing. A positive correlation between Achilles tendon loading and plantar fascia tension has been reported. Excessive stretching and tightness of the Achilles tendon are thought to be the risk factors of plantar fasciitis but their biomechanical effects on the plantar fascia have not been fully addressed. METHODS: A three-dimensional finite element model of the human foot and ankle, incorporating geometrical and material nonlinearity, was employed to investigate the loading response of the plantar fascia in the standing foot with different magnitudes of Achilles tendon loading. FINDINGS: With the total ground reaction forces of one foot maintained at 350 N to represent half body weight, an increase in Achilles tendon load from (0-700 N) resulted in a general increase in total force and peak plantar pressure at the forefoot of up to about 250%. There was a lateral and anterior shift of the centre of pressure and a reduction in the arch height with an increasing Achilles tendon load as a result of the plantar flexion moment on the calcaneus. From the finite element predictions of simulated balanced standing, Achilles tendon forces of 75% of the total weight on the foot (350 N) were found to provide the closest match of the measured centre of pressure of the subject during balanced standing. Both the weight on the foot and Achilles tendon loading resulted in an increase in tension of the plantar fascia with the latter showing a two-times larger straining effect. INTERPRETATION: Increasing tension on the Achilles tendon is coupled with an increasing strain on the plantar fascia. Overstretching of the Achilles tendon resulting from intense muscle contraction and passive stretching of tight Achilles tendon are plausible mechanical factors for overstraining of the plantar fascia.     

Eccentric calf muscle training compared with therapeutic ultrasound for chronic Achilles tendon pain--a pilot study

A number of studies have indicated that eccentric calf muscle training has beneficial effects in the management of Achilles tendon pain for recreational athletes. The purpose of this prospective randomised single blind pilot study was to investigate their potential effectiveness compared with therapeutic ultrasound in subjects with relatively sedentary lifestyles in an NHS hospital setting. Eleven men and five women (mean age 53+/-21 years) with Achilles tendon pain of minimum duration 4 months were randomised to one of two treatment groups; either eccentric loading or ultrasound. Administration of ultrasound and regular supervision of exercises occurred over a period of 6 weeks, with unsupervised exercises continuing for another 6 weeks. Outcome measurements were taken prior to and after 2, 4, 6 and 12 weeks after commencing treatment. They included: pain on a visual analogue scale, functional index of the leg and lower limb, and the five question EuroQol generalised health questionnaire. The difference in mean score was calculated together with 95% confidence intervals assuming a normal distribution. There were no statistically significant differences between groups or clear trends over time. In addition there was considerable overlap between the confidence intervals. This is not unexpected given the small sample size. Both interventions proved acceptable to the patients with no adverse effects. On this basis we intend conducting a full multi-centred study.     

Plantarflexor muscle function in healthy and chronic Achilles tendon pain subjects evaluated by the use of EMG and PET imaging

Background

Achilles tendon pathologies may alter the coordinative strategies of synergistic calf muscles. We hypothesized that both surface electromyography and positron emission tomography would reveal differences between symptomatic and asymptomatic legs in Achilles tendinopathy patients and between healthy controls.

Methods

Eleven subjects with unilateral chronic Achilles tendon pain (28 years) and eleven matched controls (28 years) were studied for triceps surae and flexor hallucis longus muscle activity in response to repetitive isometric plantarflexion tasks performed at 30% of maximal voluntary contraction using surface electromyography and glucose uptake using positron emission tomography. Additionally, Achilles tendon glucose uptake was quantified.

Findings

Normalized myoelectric activity of soleus was higher (P < 0.05) in the symptomatic leg versus the contralateral and control legs despite lower absolute force level maintained (P < 0.005). Electromyography amplitude of flexor hallucis longus was also greater on the symptomatic side compared to the healthy leg (P < 0.05). Both the symptomatic and asymptomatic legs tended to have higher glucose uptake compared to the control legs (overall effect size: 0.9 and 1.3, respectively). Achilles tendon glucose uptake was greater in both legs of the patient group (P < 0.05) compared to controls. Maximal plantarflexion force was ~ 14% greater in the healthier leg compared to the injured leg in the patient group.

Interpretations

While the electromyography showed greater relative amplitude in the symptomatic leg, the results based on muscle glucose uptake suggested relatively similar behavior of both legs in the patient group. Higher glucose uptake in the symptomatic Achilles tendon suggests a higher metabolic demand.     

Comparison of Lower Limb Muscle Activity during Eccentric and Concentric Exercises in Runners with Achilles Tendinopathy

[Purpose] This study aimed to identify changes in muscle activation by comparing muscle activities of the affected side (AS) and non-affected side (NAS) during eccentric and concentric exercises in runners with unilateral Achilles tendinopathy. [Subjects] The study included 18 participants consisting of men and women with chronic Achilles tendinopathy in a single leg who had more than 1 year of running experience. [Methods] All subjects performed concentric and eccentric exercise with the Achilles tendon moving from full plantar flexion to full dorsiflexion for 8 seconds, and electromyography data was obtained. [Results] All muscles examined showed a significant increase in %maximal voluntary contraction (MVC) with concentric exercise compared with eccentric exercise. Compared with the NAS, the AS showed significant increases in %MVC of the rectus femoris, tibialis anterior, and lateral gastrocnemius. All interaction effects of exercise methods and injuries showed statistically significant changes. [Conclusion] Runners with Achilles tendinopathy show increases in medial gastrocnemius activity when performing eccentric exercise.Key words: Achilles tendinopathy, Eccentric exercise, Electromyography     

跟腱断裂修复后早期应用等速训练仪的康复测评

背景:传统跟腱断裂修复术后石膏固定时间长,效果不佳,存在较多的术后并发症.目的:探讨跟腱断裂修复后早期应用等速训练仪进行康复训练的安全性和有效性.方法:纳入2007 09/2009-09于青岛市立医院东区就诊的跟腱断裂患者11例,其中9例在跟腱修复4周后应用Isomed-2000等速训练仪进行康复训练,时间共8周.评价指标包括Arner-Lindholm评分、踝关节活动范围、屈伸肌峰力矩值等.结果与结论:随访3～12个月,平均6个月.患者Arner-Lindholm评分优良率为88.9%,踝关节活动范围、屈伸肌峰力矩值等指标均较等速训练前显著改善(P<0.05),无感染和再断裂病例.结果提示跟腱断裂修复后4周应用等速训练仪行等速康复训练是安全和有效的,可为跟腱断裂后早期活动提供参考数据.     

Clinical commentary of the evolution of the treatment for chronic painful mid-portion Achilles tendinopathy

The chronic painful Achilles tendon mid-portion was for many years, and still is in many countries, treated with intratendinous revision surgery. However, by coincidence, painful eccentric calf muscle training was tried, and it showed very good clinical results. This finding was unexpected and led to research into the pain mechanisms involved in this condition. Today we know that there are very few nerves inside, but multiple nerves outside, the ventral side of the chronic painful Achilles tendon mid-portion. These research findings have resulted in new treatment methods targeting the regions with nerves outside the tendon, methods that allow for a rapid rehabilitation and fast return to sports.     

Influence of calcaneus angle and muscle forces on strain distribution in the human Achilles tendon

Background

Heterogeneous distribution of tendon strain is considered to contribute to the development of the Achilles tendon overuse injuries. Force distribution between the three portions of the triceps surae muscle and position of the calcaneus might affect the extent of strain differences within the Achilles tendon. Purpose of this study was to determine the effect of changes in force distribution within the triceps muscle and changes in calcaneus position on intratendinous strain distribution of the Achilles tendon.

Methods

Five cadaveric Achilles tendons including complete triceps surae and calcaneus were dissected. Specimens were mounted in a loading simulator allowing independent force application for the three parts of triceps muscle and changes calcaneus eversion and inversion position. Strain was determined in different aspects of the Achilles tendon.

Findings

Changes of calcaneus position resulted in intratendinous strain differences up to 15%, changes in force distribution within the triceps muscle resulted in strain differences up to 2.5%. Calcaneal eversion was connected to a higher degree of strain in medial tendon portions, while inversion increased strain in lateral tendon portions.

Interpretation

Medio-lateral, proximo-distal and dorsal–ventral distribution of tendon strain is rather influenced by kinematics of the subtalar joint than by muscular imbalances within the triceps muscle. Clinical movement analyses should focus on motion pattern combining rearfoot eversion with high Achilles tendon load. The results indicate that twist of the Achilles tendon fascicles seems of paramount importance in balancing tendon strain. To get more insight into the Achilles tendon injuries pathogenesis future research should focus on methods monitoring heterogeneous distribution of strain in vivo.     

超声剪切波弹性成像在脑卒中患者小腿康复评定中的应用

目的 探讨超声剪切波弹性成像对脑卒中下肢运动障碍患者小腿三头肌和跟腱进行康复评定的价值。方法 2018年至2019年,脑卒中后单侧下肢运动障碍住院患者32例,于康复治疗前后,对患者双侧小腿三头肌和跟腱行超声二维测量和剪切波弹性成像检查,记录剪切波速度(SWV)以及跟腱(比目鱼肌肌腱)长度和厚度。结果 治疗前,患侧跟腱和小腿三头肌SWV较健侧增高(t > 2.426, P < 0.05);患侧跟腱长度较健侧显著增加( t = 11.801, P < 0.001);治疗后,患侧小腿三头肌SWV减低( t > 2.447, P < 0.05);患侧跟腱长度显著缩短( t = 8.577, P < 0.001)。 结论 康复治疗可降低脑卒中下肢运动障碍患者小腿三头肌肌张力。超声剪切波弹性成像可用于评价跟腱和小腿三头肌弹性特征,指导脑卒中康复。