本期继教园地思考题

选择题:1.儿童截肢特点()A.考虑肢体解剖结构和生长发育B.尽可能保留残肢的长度C.关节离断和邻近骨骺部位的保留比这部分以上水平的截肢更可取D.保留关节和关节远侧骨骺的截肢比关节离断更可取2.穿戴临时短桩假肢后机能训练包括()A.坐椅子动作训练B.坐地上的动作训练C.转身动作训练D.用双手杖上下阶梯训练3.假肢按功能分类不包括()A.作业用上肢假肢B.功能性上肢假肢C.运动专用假肢D.自身动力假肢4.残肢弹力绷带应用注意事项()A.大腿残肢应缠至骨盆部位B.小腿残肢应缠至膝关节以上C.上臂残肢应缠至胸廓D.前臂残肢应缠至肘关节以上E.全…     

1例单侧大腿截肢者穿戴四种假肢膝关节步行能力的评价

目的比较1例单侧大腿截肢者穿戴四种不同假肢膝关节后的步行能力,为临床开具假肢处方提供参考。方法 1例单侧大腿截肢者分别穿戴机械四连杆、气压四连杆、液压单轴和智能假肢膝关节,穿戴智能日常活动能量消耗记录仪进行计时起立与行走测试、室内6分钟步行测试、静态站立平衡测试和室外1000 m步行测试。结果截肢者穿戴智能膝关节假肢比穿戴其他膝关节假肢在步行过程中能量消耗少,步行速度快。结论不同假肢膝关节对单侧大腿截肢者步行能力影响不同。     

膝上截肢患者穿截假肢后的功能评定

２０例膝上不同水平截肢患者穿戴假肢后，利用步态分析、步行能力及假肢的悬吊能力三项指标进行功能评定。结果综合评定优秀率以膝离断假肢为最佳达８９％，依次为大腿中下１／３截肢、大腿中段截肢、大腿中上１／３截肢，髋离断假肢功能评定优秀率最低。提示骨科医题应重视截肢平面的选择。同时步态分析、步行能力及假肢悬吊能力三项评定指标为完善下肢假肢功能的评定提供了有益的参考指标。本组２０例膝上不同水平截肢患者的假肢代     

膝上截肢患者穿戴假肢后的功能评定

20例膝上不同水平截肢患者穿戴假肢后,利用步态分析、步行能力及假肢的悬吊能力三项指标进行功能评定。结果综合评定优秀率以膝离断假肢为最佳达89％,依次为大腿中下1/3截肢、大腿中段截肢、大腿中上1/3截肢,髋离断假肢功能评定优秀率最低。提示骨科医师应重视截肢平面的选择。同时步态分析、步行能力及假肢悬吊能力三项评定指标为完善下肢假肢功能的评定提供了有益的参考指标。本组20例膝上不同水平截肢患者的假肢代偿功能总优良率达76.6％。     

双侧大腿截肢患者的价值装配和使用训练

目的促进截肢患者早日掌握假肢使用方法。 方法对3例截肢患者术后进行系统康复干预，同时针对假肢装配、使用方法进行强化性训练。 结果3例截肢患者残肢创面均全部愈合，残肢端呈圆柱状，残肢肌力为5级，残肢髋关节活动范围正常，装配双侧大腿假肢后均取到满意的假肢使用疗效。 结论通过进行系统康复治疗、假肢装配及假肢使用训练后，双侧大腿截肢患者均能取得满意假肢使用效果，具有较高的独立生活能力，从而促其早日回归家庭及社会。     

计算机远程制作大腿假肢模式的探讨

目的:探索使用专业假肢计算机辅助设计软件和制作系统远程制作大腿假肢的成功率,验证加工方法的可行性。方法:大腿截肢患者16例,分为计算机加工组和手工组各8例。手工组按照常规手工流程制作大腿假肢,计算机加工组通过互联网将大腿截肢患者残肢尺寸数据传送到计算机假肢制作加工中心,通过软件设计、制作、加工及修改后快递至假肢临床接待室给患者适配假肢。试穿假肢后,评价2组患者大腿假肢临床功能及制作时间。结果:患者穿戴假肢后,2组大腿假肢临床功能评估均达到要求,在制作流程中计算机加工组的时间效率明显提高(P<0.05)。结论:通过严谨的残肢尺寸测量并进行计算机设计和远程加工的接受腔与手工制作无明显差异。大腿假肢远程加工模式是可行的,解决了偏远地区大腿截肢患者无法制作假肢的问题。     

低成本下肢假肢的开发与为残疾人服务的实践

1背景据统计 ,我国现有肢体残疾人 877万人 ,其中截肢者 90万 ,上肢截肢者 2 6万人 ,下肢截肢者 6 4万人。由于种种原因 ,下肢截肢者约有 2 3万人尚未安装假肢 ,其中未安装小腿假肢者约 13万 ,未安装大腿假肢者约 10万。他们中间有的靠双拐渡过人生 ;有的双小腿截肢者靠膝盖爬行 ;有的单小腿截肢者利用竹筒、木料、钢筋等材料自制小腿假肢 ,艰难行走。这些缺肢者大多生活在农村和基层 ,由于丧失劳动能力 ,个人生存艰难、家庭生活贫困。截肢者至今未能安装下肢假肢的原因大致有 :1.1资源远离缺肢者　现有假肢安装机构和技术人员大多集中在省…     

现代截肢观念及现代截肢术后康复

截肢康复是指从截肢手术到术后处理、康复训练、临时与正式假肢的安装和使用,直到重返家庭与社会的全过程。文章重点论述了截肢部位的选择,现代截肢手术的改进,儿童截肢的特点,大腿截肢手术特点以及影响假肢穿戴的非理想残肢的康复。     

计算机辅助设计与制造系统用于大腿假肢远程加工的效果

目的探索使用专业假肢计算机辅助设计软件和制作系统进行远程制作大腿假肢的可行性。方法通过互联网,将异地假肢临床接待室的8例大腿截肢患者残肢尺寸数据传送到计算机假肢制作加工中心,利用软件数据模型库选择相应的大腿假肢接受腔口型圈并按照尺寸表进行数据模型修改,将修改后的数据模型进行实体模型加工并送至假肢临床接待室给患者适配假肢。给患者试穿假肢后按照大腿假肢临床功能评估进行评价。结果 7例患者大腿假肢临床功能评估达到要求。结论通过严谨的残肢尺寸测量并进行计算机设计和远程加工的模式是可行的。该模式可解决偏远地区大腿截肢患者无法制作假肢的问题。     

现代截肢观念及现代截肢术后康复

截肢康复是指从截肢手术到术后处理，康复训练，临时与正式假肢的安装和使用，直到重返家庭与社会的全过程。文章重点论述了截肢部位的选择，现代截肢手术的改进，儿童截肢的特点，大腿截肢手术特点以及影响假肢穿载的非理想残肢的康复。     

Causes and correction of abnormal gait patterns due to prosthesis in above-knee amputees

Abnormal gait patterns cause an increase in the energy cost of walking in above-knee amputees. Disturbances of the walking pattern are often caused both by the amputated patient himself and by incorrect prosthetic fitting. The early detection and correction of causative factors is of great importance for successful rehabilitation of these amputees. During the follow-up examinations the prosthesis must be inspected for a correct fitting and individually appropriate knee stabilizing components. Prior to any corrective measures it must be excluded that the artificial limb has been put on incorrectly by the amputee himself.     

Amputation rehabilitation and prosthetic restoration. From surgery to community reintegration

Purpose:?The purpose of this review is to summarize the literature related to the advances that have taken place in the management and rehabilitation care of limb amputation.

Results:?Prostheses for the lower and upper limb amputee have changed greatly over the past several years, with advances in components, socket fabrication and fitting techniques, suspension systems and sources of power and electronic controls. Higher levels of limb amputation can now be fitted with functional prostheses, which allow more patients to achieve independent life styles. This is of particular importance for the multi-limb amputee. The rehabilitation of more traditional lower limb levels of amputation have also greatly benefited from the technological advances including energy storing feet, electronic control hydraulic knees, ankle rotators and shock absorbers to mention a few. For the upper limb amputee, myoelectric and proportional controlled terminal devices and elbow joints are now used routinely in some rehabilitation facilities. Experimental prosthetic fitting techniques and devices such as the use of osseo-implantation for suspension of the prosthesis, tension control hands or electromagnetic fluids for knee movement control will also be briefly discussed in this paper.

Conclusion:?It is possible to conclude from this review that many advances have occurred that have greatly impacted the functional outcomes of patients with limb amputation.     

Amputation rehabilitation and prosthetic restoration. From surgery to community reintegration

Purpose: The purpose of this review is to summarize the literature related to the advances that have taken place in the management and rehabilitation care of limb amputation.

Results: Prostheses for the lower and upper limb amputee have changed greatly over the past several years, with advances in components, socket fabrication and fitting techniques, suspension systems and sources of power and electronic controls. Higher levels of limb amputation can now be fitted with functional prostheses, which allow more patients to achieve independent life styles. This is of particular importance for the multi-limb amputee. The rehabilitation of more traditional lower limb levels of amputation have also greatly benefited from the technological advances including energy storing feet, electronic control hydraulic knees, ankle rotators and shock absorbers to mention a few. For the upper limb amputee, myoelectric and proportional controlled terminal devices and elbow joints are now used routinely in some rehabilitation facilities. Experimental prosthetic fitting techniques and devices such as the use of osseo-implantation for suspension of the prosthesis, tension control hands or electromagnetic fluids for knee movement control will also be briefly discussed in this paper.

Conclusion: It is possible to conclude from this review that many advances have occurred that have greatly impacted the functional outcomes of patients with limb amputation.     

Amputation rehabilitation and prosthetic restoration. From surgery to community reintegration

PURPOSE: The purpose of this review is to summarize the literature related to the advances that have taken place in the management and rehabilitation care of limb amputation. RESULTS: Prostheses for the lower and upper limb amputee have changed greatly over the past several years, with advances in components, socket fabrication and fitting techniques, suspension systems and sources of power and electronic controls. Higher levels of limb amputation can now be fitted with functional prostheses, which allow more patients to achieve independent life styles. This is of particular importance for the multi-limb amputee. The rehabilitation of more traditional lower limb levels of amputation have also greatly benefited from the technological advances including energy storing feet, electronic control hydraulic knees, ankle rotators and shock absorbers to mention a few. For the upper limb amputee, myoelectric and proportional controlled terminal devices and elbow joints are now used routinely in some rehabilitation facilities. Experimental prosthetic fitting techniques and devices such as the use of osseo-implantation for suspension of the prosthesis, tension control hands or electromagnetic fluids for knee movement control will also be briefly discussed in this paper. CONCLUSION: It is possible to conclude from this review that many advances have occurred that have greatly impacted the functional outcomes of patients with limb amputation.     

Safety and function of a prototype microprocessor-controlled knee prosthesis for low active transfemoral amputees switching from a mechanic knee prosthesis: a pilot study

Purpose: Aim of this pilot study was to assess safety and functioning of a microprocessor-controlled knee prosthesis (MPK) after a short familiarization time and no structured physical therapy.

Materials and methods: Five elderly, low-active transfemoral amputees who were fitted with a standard non-microprocessor controlled knee prosthesis (NMPK) performed a baseline measurement consisting of a 3?D gait analysis, functional tests and questionnaires. The first follow-up consisted of the same test procedure and was performed with the MPK after 4 to 6?weeks of familiarization. After being refitted to their standard NMPK again, the subjects undertook the second follow-up which consisted of solely questionnaires 4?weeks later.

Results: Questionnaires and functional tests showed an increase in the perception of safety. Moreover, gait analysis revealed more physiologic knee and hip extension/flexion patterns when using the MPK.

Conclusion: Our results showed that although the Genium with Cenior-Leg ruleset-MPK (GCL-MPK) might help to improve several safety-related outcomes as well as gait biomechanics the functional potential of the GCL-MPK may have been limited without specific training and a sufficient acclimation period.

• Implications for Rehabilitation

• Elderly transfemoral amputees are often limited in their activity by safety issues as well as insufficient functioning regarding the non microprocessor-controlled knee prostheses (NMPK), thing that could be eliminated with the use of suitable microprocessor-controlled prostheses (MPK).

• The safety and functioning of a prototype MPK (GCL-MPK) specifically designed for the needs of older and low-active transfemoral amputees was assessed in this pilot study.

• The GCL-MPK showed indicators of increased safety and more natural walking patterns in older and low-active transfemoral amputees in comparison to the standard NMPK already after a short acclimatisation time and no structured physical therapy.

• Regarding functional performance it seems as if providing older and low-active transfemoral amputees with the GCL-MPK alone without prescribing structured prosthesis training might be insufficient to achieve improvements over the standard NMPKs.

     

对影响假肢穿戴的非理想残肢康复问题的探讨

截肢患者穿戴假肢才能发挥代偿功能 ,假肢代偿功能的水平与残肢条件密切相关 ,一些残肢由于并发症等原因而影响假肢穿戴。本文就我院 8年来收住院的 16 4例截肢患者中 81例影响假肢穿戴的非理想残肢康复问题进行讨论。提出影响假肢穿戴的非理想残肢的概念 ;非理想残肢的种类及对假肢穿戴的主要影响 ;康复的原则和方法 ,假肢制作技术的改进和主要的手术方法 ,以达到改善非理想残肢条件 ,使其可以穿戴良好的假肢 ,发挥满意的代偿功能的目的。     

Techniques de rééducation des amputés transfémoraux en utilisant des pieds prothétiques avec restitution d’énergie

This article is intended as a review of the most relevant studies investigating the link between the use of prosthetic components and the rehabilitation approaches required to optimize the functional outcome. It provides an overview of the most important characteristics of prosthetics feet and their influence on the rehabilitation outcome and, in conclusion, it describes how the rehabilitation techniques should be applied to increase the effectiveness of use of the prosthesis. In different studies shock-absorption, flexibility, roll-over characteristics and energy return are proven to be important contributors to the functionality of the prosthetic foot. The techniques described in this article have been used on a large population of transfemoral and transtibial amputees and proven to have a positive influence on gait efficiency, balance and overall functionality. The combination of the techniques applied and the prosthetic components used defines the potential functional outcome of the amputee. It is therefore important to consider the rehabilitation of an amputee as a multidisciplinary task divided between rehabilitation doctors, prosthetists, physical therapists and occupational therapists in some cases.     

The outcome of a bilateral leg amputation according to Syme;s technique as a result of posttraumatic complications: a case report

Background. The purpose of this article is to present the problems encountered in treatment and rehabilitation, including prosthesis fitting, in the case of a 17-year-old female patient who underwent a bilateral leg amputation using Syme's method. Case history. The patient incurred crushing injuries of both feet and the knee joints, resulting from a severe multi-organ injury. As a result of post-traumatic changes and deformations of the feet, including algodystrophic changes, amputation proved to be the only procedure that would restore the patient locomotive capacity. Outcome. As a result of the treatment applied, the patient regained the ability to move about, while the primary limitation on her locomotive abilities turned out to be the status of her knee joints, which had been severely damaged in the accident.     

Evaluation of prosthetic usage in upper limb amputees

Purpose: Upper limb amputations cause severe functional disability and lower the patient's self body image, with severe psychological implications. Many parameters are involved in the successful rehabilitation of upper limb amputations. The aim of this study was to investigate whether there are any parameters that might predict the successful prosthetic rehabilitation of upper limb amputees.

Method: The records of 45 patients who had undergone an upper limb amputation were traced. The patients were evaluated according to four parameters: (1) Modified upper extremities amputees' questionnaire; (2) Pain level according to Visual Analog Scale (VAS), range from 1 (lowest) up to 10 (highest); (3) Pain type - phantom or pain in the stump; (4) Functional assessment of prosthetic usage.

Results: Thirty (71.43%) of the patients reported difficulties with prosthesis usage. Twenty-three patients (54.76%) were satisfied with their prosthesis - 19 had cosmetic prosthesis and four had body-powered prosthesis.

Conclusion: No significant affect of the amputation level except for trans-wrist amputation with 100% prosthesis use. No significant difference was found between prosthesis type and the correlation to stump problems.

The above-elbow amputees, with dominant hand amputation, who used functional prosthesis (body-powered), achieved the best functional outcome and result.