Robot rehabilitation has been a primary therapy method for the urgent rehabilitation demands of paralyzed patients after a stroke. The parameters in rehabilitation training such as the range of the training, which should be adjustable according to each participant’s functional ability, are the key factors influencing the effectiveness of rehabilitation therapy. Therapists design rehabilitation projects based on the semiquantitative functional assessment scales and their experience. But these therapies based on therapists’ experience cannot be implemented in robot rehabilitation therapy. This paper modeled the global human-robot by Simulink in order to analyze the relationship between the parameters in robot rehabilitation therapy and the patients’ movement functional abilities. We compared the shoulder and elbow angles calculated by simulation with the angles recorded by motion capture system while the healthy subjects completed the simulated action. Results showed there was a remarkable correlation between the simulation data and the experiment data, which verified the validity of the human-robot global Simulink model. Besides, the relationship between the circle radius in the drawing tasks in robot rehabilitation training and the active movement degrees of shoulder as well as elbow was also matched by a linear, which also had a remarkable fitting coefficient. The matched linear can be a quantitative reference for the robot rehabilitation training parameters.
ObjectivesTo investigate the influence of the abduction angle of the upper extremities on the image quality of non-enhanced CT scan and clinical value of the patients who cannot lift with double upper limbs by vehicle accident.Methods60 patients with double upper limbs that could not lift by vehicle accidents were required to receive liver non-enhanced CT scan, the patients were divided into 3 groups according to the abduction angle (group A, B, C), 20 cases in each group, another 20 cases with standard pose as the control group (group D). The CT value and standard deviation of the liver region of interest, the erector and the background air were measured, and the contrast to noise ratio of liver images, image noise value were calculated, together with the assessment of image quality and statistic analysis.ResultsThe liver non-enhanced CT scan were completed successfully. The image quality of group D was significantly better than A, B, C (Z=–10.753, P<0.05;Z=–11.645, P<0.05;Z=–12.281, P<0.05), respectively. Group C was better than A and B (Z=–8.502, P<0.05;Z=–4.068, P<0.05), respectively. Group B was better than A (Z=–5.885, P<0.05). The CNR of the four groups of images increased gradually, group A (0.09±0.77), group B (1.56±0.83), group C (2.51±0.87), group D (2.59±0.97), respectively. There were significant differences between four groups (F=36.323, P<0.05). The image noise decreased systematically, group A (14.84±2.94), group B (13.04±1.59), group C (11.60±1.72), group D (10.44±1.13), respectively. There were significant differences between four groups (H=426.755, P<0.05).ConclusionOn the premise of safety inspection, with the enlargement of angle of the upper limbs of patients who cannot lift with double upper limbs by vehicle accidents, the image noise decreased and image quality is improved with the increase of signal noise ratio.
Objective To discuss the advantages and disadvantages of flaps in therepairment of soft tissue defects in upper extremity. Methods Based on the 2 609 cases of flaps in 2 512 patients from 1995 to 2004,the advantages and disadvantages of different sort of flaps, outcomes of treatment and indications of different soft of flaps were analyzed retrospectively. In the series, 2 089 pieces of the traditional flaps of different sorts were applied in 1 992 patients, 474 piecesof the axial flaps of different sorts were applied in 474 patients, different sorts of free flaps were used in 46 patients. Results Follow-ups were done for 1 month to 9 years (2.7 months in average). 2 531 flaps survived (97.01%); complete necrosis occurred in 10 flaps(0.38%); partial necrosis occurred in 68 flaps(2.61%). Of the 2 089 traditional flaps, 46 had partial necrosis(2.2%); 687 needed flap revisions(32.9%). Of the 474 axial flaps, 28 had complete or partial necrosis(5.9%); 82 needed revisions(17.3%). Of the 46 free flaps, 4 had complete or partial necrosis(8.7%) and nearly all the anterolateral flpas of thighs needed revisions.Conclusion Traditional flaps had the advantages of easy manipulation and the highest survival rate, however, also had the disadvantages of poor texture and many timesof operations. The flap with a pedicle had the advantage of good texture, consistent artery, free-range arc, however, the venous congestion was its disadvantage, which impaired the survival of the reverse flap. Free flap had the advantage ofgood texture and abandant donor site, but complicate manipulation was its shortage. Axial Flap with a pedicle is the optional choicefor repairing soft tissue defects in upper extremity.
Objective To investigate the feasibility and effectiveness of ulnar cortex transverse transport technique in treating upper extremity thromboangiitis obliterans (TAO). MethodsA retrospective analysis was conducted on the clinical data of 7 male patients with upper extremity TAO who were admitted and met the inclusion criteria between January 2019 and July 2022. The patients ranged in age from 32 to 50 years, with a mean age of 40.1 years. The disease duration ranged from 6 to 24 months, averaging 13.6 months. The smoking history ranged from 8 to 31 years, with a mean of 18.4 years. All patients presented with finger ulcers or gangrene, including 1 case affecting the thumb and index finger, 1 case affecting the index and middle fingers, 1 case affecting the middle and ring fingers, 1 case affecting only the ring finger, and 3 cases affecting the ring and little fingers. The preoperative visual analogue scale (VAS) score was 9.1±0.7. All patients underwent treatment with the ulnar cortext transverse transport technique. The wound healing time and the disappearance time of rest pain were recorded. The VAS score was used to assess the degree of hand pain before and after operation. Serum interleukin 6 (IL-6) levels were measured before operation and at 1 month after operation. Computed tomography angiography (CTA) of the affected limb was performed before operation and at 3 months after operation to evaluate changes in blood vessels. The clinical outcomes were evaluated at 1 year after operation based on the Patwa and Krishnan grading system. ResultsAll 7 patients were followed up 12-17 months, with an average of 13.7 months. All patients experienced successful healing of ulcers, with wound healing time ranging from 14 to 21 days, averaging 17.3 days. During the follow-up, no complication occurred, and there was no recurrence of ulcers. The disappearance time of rest pain ranged from 8 to 15 days, averaging 12.1 days. The pre- and post-operative (1-month) serum IL-6 levels were (25.1±5.9) pg/mL and (11.9±2.9) pg/mL, respectively, with a significant difference (t=5.363, P=0.002). CTA examination at 3 months after operation revealed partial revascularization of upper extremity arteries and establishment of collateral circulation, showing significant improvement compared to preoperative status. The VAS scores at 1, 7, 28 days, and 6 months postoperatively were 6.4±0.8, 3.7±0.8, 0.6±0.8, and 0.1±0.4, respectively, all of which significantly improved compared to preoperative scores (P<0.05). Furthermore, the VAS scores gradually decreased over time, with significant differences observed between postoperative time points (P<0.05). At 1 year after operation, the effectiveness of all 7 patients were evaluated as excellent based on the Patwa and Krishnan grading system. ConclusionThe ulnar cortex transverse transport technique can improve blood circulation in the upper limb of patients with TAO, reconstruct microcirculation, inhibit inflammation, promote ulcer healing, and alleviate limb pain.
摘要:目的:分析汶川大地震伤员中上肢骨折的发生部位、类型及其产生机制和临床意义。方法:对地震发生后近2个月内先后送至四川大学华西医院治疗的140例上肢骨折伤员,按X线检查结果对骨折部位及类型进行分析。结果:140例伤员共183个部位发生骨折。按骨折部位分类:即肱骨60个(32.8％),桡骨51个(27.9％),尺骨41个(22.4％)及手骨骨折31个(16.9％)。按骨折类型分类:横行骨折46个(251％),斜行骨折31个(16.9％),螺旋形骨折11个(6.0％),粉碎性骨折64个(35.0％),嵌插骨折8个(4.4％),线行骨折13个(7.1％),撕脱骨折10个(5.5％)。结论:本组汶川大地震性的上肢骨折,部位以肱骨骨折为主;类型以粉碎性骨折为主。常规X线检查对上肢骨折伤员具有简便、快速和准确的诊断价值。
目的:初步评价健身钢球锻炼法治疗乳腺癌根治性手术后上肢水肿的疗效。方法:收集乳腺癌改良根治术后并发上肢水肿患者60例,按照就诊顺序随机配对分为实验组和对照组,每组各30例。实验组术后采用健身钢球锻炼患侧上肢的方法;对照组采用抬高患肢、向心性按摩和热敷的传统方法。结果:两组患侧上肢各部位术后1天均存在不同程度水肿(Plt;0.05),实验组随着时间的推移,其水肿程度不断减轻(Plt;0.05),而对照组则在术后1周内变化不明显(Pgt;0.05),并且其各部位肿胀率均高于实验组,二者差异均有统计学意义(Plt;0.05)。结论:健身钢球锻炼法对乳腺癌根治性手术后上肢水肿具有一定的短期疗效。
ObjectiveTo explore the feasibility and the practical value of conserving upper limb lymph nodes in axillary lymph node dissection (ALND) for early breast cancer. MethodsFrom August 2007 to January 2010, 124 patients with early breast cancer were studied and divided into two phases: phase one, from August 2007 to July 2008; phase two, from August 2008 to January 2010. Five milliliter of methylene blue was injected subcutaneously in ipsilateral forearm in all the patients before operation to locate the upper limb lymph nodes. Routine ALND was performed in 22 patients of phase one. The level Ⅱ lymph nodes and the upper limb lymph nodes were separated from the axillary lymph nodes, respectively. The lymph nodes of level Ⅱ were investigated by combining touch cytology with frozen section during operation. The lymph nodes of level Ⅰ, Ⅱ, Ⅲ, and the upper limb lymph nodes were investigated postoperatively by routine pathological examination to evaluate the feasibility of conserving the upper limb lymph nodes. One hundred and two patients in phase two were divided randomly by lottery into control group (30 cases), and conserving group (72 cases) in which upper limb lymph nodes were selectively conserved. The surgical procedure for control group was same as the phase one blue stained upper limb lymph nodes, in the conserving group were conserved selectively when the lymph nodes metastasis of level Ⅱ were not detected by combining touch cytology with frozen section during operation. The data were collected and analysed on pathological results of all patients and arm circumference was compared between control group and conserving group. Results Total 119 of 124 patients (96.0%) were found with blue stained upper limb lymph nodes. The concordance rate was 99.2% (123/124) between the intraoperative combining pathological method and the postoperative routine pathological examination. No upper limb lymph node metastasis was found in the phase one and the control group of phase two with level Ⅱ group negative. The incidence of arm lymphedema in the control group and the conserving group with level Ⅰ and Ⅱ lymph nodes dissection was 18.2% （4/22） and 20% （1/51）, respectively on 6 months after operation. The difference was statistically significant （χ 2=6,34， Plt;0.05）. ConclusionsMethylene blue being injected subcutaneously in ipsilateral upper limb can be used to show validly lymph nodes of upper limb in the axillary region. ALND with selectively conserving upper limb lymph nodes when level Ⅱ lymph nodes negative in metastasis, can prevent postoperative arm lymphedema.
Objective To observe the effect of transcranial ultrasound stimulation (TUS) on the recovery of upper limb motor function in stroke patients and explore its mechanism. Methods The inpatients with ischemic stroke and hemiplegia admitted to the Department of Rehabilitation Medicine of the Second Affiliated Hospital of Xi’an Jiaotong University between November 2019 and December 2021were prospectively included. The patients were randomly divided into a true stimulation group and a false stimulation group. All patients received routine medication treatment and rehabilitation training, with a course of 2 weeks. The patients in the true stimulation group also received TUS, and the stimulation site and mode in the false stimulation group were the same as those in the true stimulation group, but the transducer was in a non working mode. The changes in upper limb function and motor cortex electrical activity before and after treatment were compared between two groups of patients. The Wolf Motor Function Test (WMFT), Jebsen Hand Function Test (JHFT), and Fugl-Meyer Assessment-Upper Extremities (FMA-UE) were used as indicators of upper limb motor function. The motor evoked potential (MEP) latency, resting motor threshold (RMT), cortical silent period (CSP), and central motor conduction time (CMCT) were used as indicators of cortical excitability. Results A total of 30 patients were included, with 15 in the true stimulation group and 15 in the false stimulation group. There was no statistically significant difference in age, gender, course of disease, lesion side, handedness, National Institute of Health Stroke Scale score, and Barthel Index between the two groups of patients (P>0.05). Before treatment, there was no statistically significant difference in WMFT score, JHFT time, and FMA-UE score between the two groups of patients (P>0.05). After treatment, the WMFT score and FMA-UE score of both groups of patients increased compared to before treatment within the group, while the JHFT time decreased compared to before treatment within the group (P<0.05). The improvement degree of WMFT score (19.2±8.0 vs. 11.8±5.5), JHFT time [(39.3±20.4) vs. (26.0±15.9) s], and FMA-UE score [14.0 (12.0, 16.0) vs. 8.0 (7.0, 9.0)] before and after treatment in the true stimulation group were better than those in the false stimulation group (P<0.05). Before treatment, there was no statistically significant difference in MEP latency, CSP, CMCT, and RMT between the two groups of patients (P>0.05). After treatment, the MEP latency, CSP, CMCT, and RMT of both groups of patients decreased compared to before treatment within the group (P<0.05). The degree of decrease in CSP [(33.5±12.3) vs. (18.5±5.5) ms], CMCT [3.5 (2.5, 5.8) vs. 1.8 (1.5, 3.4) ms], and RMT [(19.2±12.8)% vs. (8.8±8.7)%] in the true stimulation group before and after treatment were greater than those in the false stimulation group (P<0.05). There was no statistically significant difference in the degree of decrease in MEP latency between the two groups before and after treatment (P>0.05). Both groups of patients had no adverse reactions during the treatment period. Conclusion TUS applied to the primary motor cortex can help restore upper limb motor function in stroke patients, and the mechanism of action may be related to TUS enhancing cortical excitability in the affected brain.
Objective To evaluate the long-term function of the traumaticallydamaged joint after its repair with transplantation of a fresh or a frozen allogenic joint. Methods From March 1977 to September 1993, 13 patients (9 males, 4females; age, 17-55 years) with traumatically-damaged joints underwent transplantation of the fresh or the frozen allogenic joints. Five patients had 5 damagedmetacarpophalangeal joints, 6 patients had 9 damaged interphalangeal joints, and 2 patients had 2 damaged elbow joints. So, the traumatic damage involved 13 patients and 16 joints. All the metacarpophalangeal joints and the interphalangeal joints were injured by machines and the 2 elbow joints were injured by road accidents. The patients were randomly divided into 2 groups: Group A (n=7) andGroup B (n=6). The 7patients with 8 joints in Group A underwent transplantation of fresh allogenic joints; the 6 patients with 8 joints in Group B underwent transplantation of frozen allogenic joints. The allogenic joint transplants were performed in the period from immediately after the injuries to 6 months after the injuries. The motion ranges of the transplanted joints and the X-ray films were examined after operation, and the immunological examination was performed at 8 weeksafter operation. Results The time for synostosis was 5-8 months in Group A, but4-6 months in Group B. In Group A, at 2 years after operation the metacarpophalangeal flexion was 30-40° and the interphalangeal flexion was 20-30°; however,at 6 or 7 years after operation the interphalangeal flexion was only 10-20°. The patients undergoing the transplantation with fresh elbow joints had the elbowflexion of 60° and the elbow extension of 0°, and had the forearm pronation of 30°and the forearm supination of 30°. But in Group B, at 2 years after operation the metacarpophalangeal flexion was 6070° and the interphalangeal flexionwas 40-50°; at 6 or 7 years after operation the interphalangeal flexion was still 40-50°. However, the patients undergoing the transplantation with frozen elbow joints had the elbow flexion of 90° and the elbow extension of 0°, and hadthe forearm pronation of 45° and a forearm supination of 45°. The joint motion ranges, the Xray findings, and the immunological results in the patients undergoing the transplantation of the frozen allogenic joints were significantly better than those in the patients undergoing the transplantation of fresh allogenicjoints. There was a significant difference in the immunological examination between Group A and Group B (IL2, 21.64±3.99；CD4/CD8,3.88±0.82 vs.IL-2,16.63±3.11；CD4/CD8, 2.53±0.23, P＜0.01). Conclusion Repairing the traumatically-damaged joints with frozen allogenic joints is a better method of regaining the contour, movement, and complex motion of the hands.