3D printed guide plate assisted and C-arm X-ray fluoroscopic positioning for femoral tunnel reconstruction of medial patellofemoral ligament in treating recurrent patellofemoral dislocation: a comparison of efficacies / 中华创伤杂志

Objective:To compare the efficacies of 3D printed guide plate assisted positioning and C-arm X-ray machine fluoroscopic positioning for femoral tunnel reconstruction of medial patellofemoral ligament in treating recurrent patellofemoral dislocation.Methods:A retrospective cohort study was performed on the clinical data of 60 patients with recurrent patellar dislocation admitted to the First Affiliated Hospital of Kunming Medical University from January 2018 to December 2022. The patients included 29 males and 31 females, with age range of 14-40 years [(28.6±7.6)years]. The 3D printed guide plate was used to locate the femoral tunnel in 30 patients for medial patellofemoral ligament reconstruction (3D guide group), and C-arm X-ray machine was used for another 30 patients (conventional group). (1) CT data of the knee joint were collected before surgery and at 7 days after surgery. Mimics 19.0 software was introduced to measure the distance between the center of femoral tunnel and Sch?ttle point after surgery. (2) Knee Lysholm score and Kujala score were used to evaluate the knee function before and at 3, 6, 9 and 12 months after surgery. (3) At the same time points, Opti-Knee TM 3D knee kinematics analysis system was used to collect the forward and backward displacement, up and down displacement, internal and external displacement, internal and external flipping angle, internal and external rotation angle, and flexion and extension angle of the affected knee joint. The range of each freedom degree was calculated and 6 freedom degree items of 30 healthy people were subjected to knee kinematics analysis. Results:All patients were followed up for 12-15 months [(12.3±0.7)months]. (1) The distance between the center of femoral tunnel and Sch?ttle point in the 3D guide group was (5.5±2.3)mm, smaller than that in the conventional group [(7.6±2.5)mm] ( P<0.01). (2) The Lysholm score and Kujala score of the 3D guide group and conventional gruop gradually increased after surgery (all P<0.01). There were no significant differences in the Lysholm score or Kujala score between the 3D guide group and conventional gruop before surgery and at 12 months after surgery (all P>0.05). At 3, 6 and 9 months after surgery, the Lysholm score of the 3D guide group [(70.4±4.5)points, (86.4±3.1)points, (91.2±3.2)points] and Kujala score [(74.2±5.3)points, (80.9±3.5)points, (85.2±3.2)points] were higher than those of the conventional group [Lysholm score: (67.3±5.2)points, (81.8±2.5)points, (86.2±1.9)points; Kujala score: (69.8±5.2)points, (77.6±2.1)points, (82.7±2.6)points] ( P<0.05 or 0.01). (3) Before surgery, the forward and backward displacement in the 3D guide group and conventional group [(0.6±0.1)cm, (0.6±0.2)cm], up and down displacement [(0.5±0.1)cm, (0.6±0.0)cm], internal and external displacement [(0.7±0.1)cm, (0.6±0.2)cm], and flexion and extension angle [(50.6±10.3)°, (51.6±8.5)°] were less than those in the healthy controls [(1.6±0.3)cm, (1.7±0.5)cm, (1.0±0.4)cm, (63.2±5.1)°] (all P<0.05), while the internal and external flipping angle [(17.5±4.0)°, (17.1±3.8)°] and internal and external rotation angle [(17.9±1.9)°, (17.5±1.5)°] were greater than those in the healthy controls [(11.8±3.6)°, (15.8±4.9)°] (all P<0.05). At other time points, the results of front and back displacement, up and down displacement, internal and external displacement, internal and external rotation angle in the 3D guide group and conventional group were not significantly different compared with the healthy controls (all P>0.05). The flexion and extension angle in the 3D guide group and conventional gruop were smaller than those in the healthy controls at 3 months after surgery (all P<0.05). At 6 and 9 months after surgery, the flexion and extension angle in the conventional group [(55.0±3.7)°, (57.7±4.8)°] were smaller than those in the healthy controls [(63.2±5.1)°, (63.2±5.1)°] (all P<0.05), but no significant difference was found between the 3D guide group [(61.0±4.8)°, (61.8±4.9)°] and the healthy controls (all P>0.05). The flexion and extension angle in the 3D guide group and conventional gruop was similar with that in the healthy controls at 12 months after surgery (all P>0.05). Conclusions:Compared with the C-arm X-ray machine, the 3D printed guide plate assisted positioning of femoral tunnel is more simple and accurate for the medial patellofemoral ligament reconstruction in treating recurrent patellofemoral dislocation, together with better early knee function recovery, better satisfaction of the patients, and better and faster restoration of the flexion and extension angle of knee joint kinematic function.

Correlation of isokinetic thigh muscle asymmetry with gait asymmetry at one year after anterior cruciate ligament reconstruction / 中华创伤杂志

Objective:To investigate the correlation of isokinetic thigh muscle asymmetry with gait asymmetry at one year after anterior cruciate ligament (ACL) reconstruction.Methods:A retrospective case series analysis was made on 25 patients treated by ACL reconstruction in Third Hospital of Peking University from January 2014 to January 2019. All the subjects were male, aged 17-47 years [(29.4±5.2)years]. Standard rehabilitation treatment procedures were conducted after surgery. The isokinetic muscle strength of the thigh was collected at one year after operation to evaluate knee extensor and flexor concentric strength at 60°/s, 180°/s and 300°/s, and knee extensor and flexor eccentric strength at 60°/s. The maximum concentric and eccentric strength of the knee extensor and flexor were analysed between the injured and intact side. The three-dimensional motion information and ground reaction force was collected during the stance phase of gait, and knee kinematic and kinetic parameters were calculated by inverse dynamics analysis, including the peak flexion moment, peak extension moment, first and second peak adduction moment, peak external and internal rotation moment, peak flexion angle, peak extension angle during the terminal stance phase, flexion angle at heel strike, peak abduction angle, and peak external rotation angle during terminal stance phase. Spearman correlation analysis was used to study the correlation between limb symmetry index (LSI) of isokinetic muscle strength and LSI of gait parameters.Results:One year after ACL reconstruction, the maximum concentric strength of the knee extensor and flexor at 60°/s, 180°/s and 300°/s and maximum eccentric strength of the knee flexor and extensor at 60°/s on the injured side were significantly lower than those on the normal side (all P<0.01). Compared with the intact side, the peak knee extension moment on the injured side was significantly lower during the stance phase of gait ( P<0.01), and the extension angle was insufficient during the terminal stance phase ( P<0.01). There were no significant differences between the injured and intact side in terms of peak flexion moment, first and second peak adduction moment, peak external and internal rotation moment, peak flexion angle, flexion angle at heel strike, peak abduction angle, and peak external rotation angle during terminal stance phase (all P>0.05). One year after ACL reconstruction, Spearman correlation analysis during gait stance phase showed that the LSI of 60°/s concentric strength of the isokinetic knee extensor was significantly related to LSI of peak internal rotation moment ( R=0.42, P<0.05), the LSI of 180°/s concentric strength of the isokinetic knee extensor was significantly related to LSI of peak flexion moment ( R=0.45, P<0.05), the LSI of 180°/s concentric strength of the isokinetic knee flexor was significantly correlated with LSI of peak flexion angle ( R=0.46, P<0.05), the LSI of 300°/s concentric strength of the isokinetic knee extensor was significantly correlated with LSI of peak knee flexion angle ( R=0.42, P<0.05), and the LSI of 60°/s eccentric strength of the isokinetic flexor was significantly correlated with LSI of peak knee flexion angle ( R=0.54, P<0.01). Conclusions:For patients following ACL reconstruction at one year postoperatively, a significant correlation of isokinetic thigh extensor strength asymmetry with peak knee flexion and rotation moment and peak knee flexion angle, and that of isokinetic thigh flexor strength asymmetry with peak knee flexion angle are observed during the stance phase of gait, which suggests that patients with ACL reconstruction still need systematic rehabilitation training one year postoperatively to improve muscle strength and motor function so as to reduce the risk of ACL reinjury and secondary injury.

In-vivo measurementof the geometric rotation axis of the talocrucial joint during normal gait / 中华骨科杂志

Objective:To measure and compare the geometric rotation axis of the talocrucial joint at different poses during the normal gait.Methods:The kinematic data of 15 healthy volunteers, 8 females, 7 males; age, 26.2±5.4 y (range 19-39 y); height, 170.4±6.9 cm (range 160-183 cm); mass, 65.6±14.0 kg (range 52-100 kg). They were collected using the dual-fluoroscopy technique, and the spatial position of the tibia and talus was determined using the 3D-2D registration method. The medial and lateral side of the trochlear of each talus was fitted by two spheres and the geometric rotation axis of the tibiotalar joint was defined as the line connecting the origins of two spheres. Compared the position and orientation of the axis for different poses during the gait and also compared the difference of the radius of the medial and lateral spheres fitting the trochlear of each talus.Results:The radii of the medial spheres fitting the trochlear of each talus 19.52±1.47 mm,were significantly less than that of the lateral spheres 20.62±1.49 ( t=7.081, P<0.05). The averaged anterior-posterior distance between the geometric rotation point of the tibiotalar joint were 1.54±1.84, 1.71±1.69, 1.70±1.57, 1.72±1.62, 1.80±1.75, 1.96±1.86 mm, respectively, while the averaged medial-lateral distance were 0.06±1.84, -0.03±1.83, 0.08±1.83, 0.10±1.73, 0.10±1.47, 0.09±1.46 mm, respectively, and the averaged superior-inferiordistance were -21.92±1.46, -22.10±1.32, -22.10±1.50, -22.06±1.64, -21.93±1.62, -21.98±1.50 mm, respectively. The averaged angle between the geometric rotation axis of the tibiotalar joint and coronal plane were 3.31°±2.48°, 3.10°±2.67°, 3.64°±2.71°, 3.96°±3.19°, 4.28°±2.82°, 4.16°±3.11°, respectively, while the averaged angle between that and sagittal plane were 84.11°± 2.42°, 83.77°±3.19°, 83.77°±3.45°, 83.81°±3.69°, 83.99°±2.97°, 84.23°±3.01°, respectively, and the averaged angle between that and transverse plane were 4.40°±2.93°, 4.54°±3.74°, 3.97°±3.34°, 3.73°±2.49°, 3.78°±2.76°, 4.48°±2.49°, respectively. The position and orientation of the geometrical rotation axis of the tibiotalar joint at different poses during the gait showed no significant difference ( P>0.05). The rotation axis orientated from laterally and inferiorly to medially and superiorly with an averaged inclination angle from the horizontal plane of 3.74° and an averaged deviation angle from the coronal plane of 4.15°. Conclusion:The geometric rotation axis of the tibiotalar joint was fixed during the gait, therefore fitting the talar trochlea with the two-sphere model with a small radius of the medial sphere and a large radius of the lateral sphere may better mimic the kinematics of tibiotalar joint.

Efeito imediato da MWM de Mulligan em pacientes com dor no ombro / MWM Mulligan immediate effect on shoulder pain patients

Introdução: a dor no ombro leva a limitações e incapacidades entre adultos e idosos, merecendo atenção do fisioterapeuta. Objetivo: Avaliar o efeito imediato da técnica de Mulligan em pacientes com dor no ombro. Metodologia: trata-se de resultados preliminares de um ensaio clínico realizado entre julho de 2018 a julho de 2019. Pacientes com dor no ombro (n=44), de ambos os sexos, foram randomizados e submetidos a dois protocolos de tratamento: exercícios terapêuticos (n=22) e MWM de Mulligan (n=22), atendidos na Clínica Escola de Fisioterapia da UFBA. Todos os participantes responderam a um questionário clínico e sociodemográfico e realizaram avaliação da dor pela escala visual analógica (EVA) e algometria. Os pacientes foram tratados por dois fisioterapeutas experientes na área e, depois, foram reavaliados imediatamente. Resultados: mulheres predominaram, a média de idade foi de 56 anos no grupo Mulligan e 57 no grupo exercícios terapêuticos. Síndrome do manguito rotador predominou: 19 (86,4%) no grupo Mulligan e 15 (68%) no grupo exercícios. O ombro mais acometido foi o direito no Grupo Mulligan, (17 (77,3%); já no grupo exercícios, foi o esquerdo com 12 (55%). A cor negra foi a mais autorrelatada pelos pacientes, e poucos tinham o ensino superior completo. No grupo Mulligan, as ocupações mais informadas foram dona de casa, seguida de aposentados e autônomos. No grupo exercícios, não houve dona de casa, e sim mais aposentados e autônomos. Os dois grupos mostraram ser mais sedentários. Não houve diferença da dor pela EVA entre os grupos, antes e após o tratamento (p=0.79, p=0.56, respectivamente). Já a intensidade da dor mensurada pela algometria, tanto antes do tratamento (p=0.008) quanto depois do tratamento (p=0.04), foi diferente entre os grupos, com predomínio de melhora no grupo Exercícios. Conclusão: a MWM não foi mais eficaz que os exercícios terapêuticos na redução da dor do ombro, sendo que o exercício apresentou mais eficácia quando medido através da EVA e sem melhora significativa ao ser mensurada pela algometria após aplicação de uma única sessão de tratamento.

Introduction: shoulder pain leads to limitations and disabilities among adults and the elderly deserving attention from the physiotherapist. Objective: to evaluate the immediate effect of the Mulligan technique in patients with shoulder pain. Methodology: these are preliminary results of a clinical trial conducted from July 2018 to July 2019. Patients (n=44) with shoulder pain of both sexes were randomized and submitted to two treatment protocols: therapeutic exercises (n = 22) and Mulligan's MWM (n = 22) attended at the UFBA School of Physiotherapy Clinic. All participants answered a clinical and sociodemographic questionnaire and underwent pain assessment by visual analog scale (VAS) and algometry. The patients were treated by two experienced physiotherapists and then reassessed immediately. Results: women predominated, the average age was 56 years in the Mulligan group and 57 in the therapeutic exercises group. Rotator cuff syndrome predominated, 19 (86.4%) in the Mulligan group and 15 (68%) in the exercise group. The most affected shoulder was the right shoulder in the Mulligan Group (17 (77.3%), while in the exercise group was the left shoulder with 12 (55%).The black color was the most self-reported by the patients and few patients had higher education. In the Mulligan group the most informed occupations were housewife followed by retirees and self-employed. In the exercise group we had no housewife but more retired and self-employed. The two groups were more sedentary. There was no difference in VAS pain between the groups before and after treatment (p = 0.79, p = 0.56, respectively), while pain intensity measured by algometry both before treatment (p = 0.008) and after treatment (p = 0.04) was different between Conclusion: Mulligan's MWM was not more effective than exercise in reducing shoulder pain, and exercise was more effective when measured by VAS and without significant improvement when measured by algometry after applying a single treatment session.

What is the best method to assess the abdominal wall? Restoring strength does not mean functional recovery / Qual é o melhor método para avaliação da parede abdominal? Restabelecer força não significa recuperação funcional

ABSTRACT Background: Restoring the contractile function to the abdominal wall is a major goal in hernia repair. However, the core understanding is required when choosing the method for outcome assessment. Aim: To assess the role of the anterolateral abdominal muscles on abdominal wall function in patients undergoing hernia repair by analysis of correlation between the surface electromyography activation signal of these muscles and torque produced during validated strength tests. Methods: Activation of the rectus abdominis, external oblique, and internal oblique/transverse abdominis muscles was evaluated by surface electromyography during two validated tests: Step: 1-A, isometric contraction in dorsal decubitus; 1-B, isometric contraction in lateral decubitus; 2-A, isokinetic Biodex testing; and 2-B, isometric Biodex testing. Results: Twenty healthy volunteers were evaluated. The linear correlation coefficient between root mean square/peak data obtained from surface electromyography signal analysis for each muscle and the peak torque variable was always <0.2 and statistically non-significant (p<0.05). The agonist/antagonist ratio showed a positive, significant, weak-to-moderate correlation in the external oblique (Peak, p=0.027; root mean square, 0.564). Surface electromyography results correlated positively among different abdominal contraction protocols, as well as with a daily physical activity questionnaire. Conclusions: There was no correlation between surface electromyography examination of the anterolateral abdominal wall muscles and torque measured by a validated instrument, except in a variable that does not directly represent torque generation.

RESUMO Racional: A devolução da funcionalidade contrátil da parede abdominal é uma das metas no reparo das hérnias abdominais. Contudo, o entendimento do core deve necessariamente fazer parte na escolha do método de avaliação desse desfecho. Objetivo: Avaliar o papel dos músculos da parede anterolateral na função da parede abdominal com base na correlação entre o sinal de ativação muscular obtido na eletromiografia de superfície e torque produzido durante testes de força validados. Métodos: A ativação dos músculos reto abdominal, oblíquo externo, e oblíquo interno e transverso foi avaliada por eletromiografia de superfície durante dois testes validados. Etapa: 1-A, contração isométrica em decúbito dorsal; 1-B, contração isométrica em decúbito lateral; 2-A, teste isocinético no Biodex; e 2-B, teste isométrico no Biodex. Resultados: Foram avaliados 20 voluntários saudáveis. O coeficiente de correlação linear entre os dados de valor quadrático médio/Pico obtidos análise do sinal da eletromiografia de superfície para cada músculo e o Pico de torque foram sempre <0,2 e estatisticamente insignificantes (p<0.05). A relação agonista/antagonista demonstrou correlação positiva, significativa e de fraca a moderada no músculo externo oblíquo (Pico, p=0,027; valor quadrático médio, 0,564). Os resultados eletromiografia de superfície estiveram positivamente correlacionados nos diferentes protocolos de contração abdominal e também com um questionário de atividade física diária. Conclusões: Não houve correlação entre o exame de eletromiografia de superfície e o torque mensurado por um instrumento validado, exceto em uma variável que não representa diretamente a geração de torque.

Muscle stiffness regulation and electromyographic changes of the lower limbs during descending stairs after visual deprivation / 中国组织工程研究

BACKGROUND: The balance and control of the human body depend on the coordination between the vestibular system of the inner ear, the proprioceptors and the visual system, as well as the central nervous system. However, it is unclear about the muscle stiffness regulation and motion control strategy for the lower limbs by the changes in neural control and sensory integration caused by visual deprivation (the eyes are blindfolded). OBJECTIVE: To compare the difference of muscle stiffness regulation and electromyography changes of the lower limbs during descending stairs in children and adolescents with the eyes blindfolded or not, and then to reveal the regulatory effects of visual sense on neuromuscular control and muscle stiffness regulation in adolescents. METHODS: Twenty adolescents with normal vision were randomly divided into blindfolded group and unblindfolded group (n=10 per group). The two groups of subjects were required to descend stairs from three different heights (20, 30, 40 cm) and do their best to perform a squat jump after landing. All subjects were asked to repeat the above-mentioned action thrice, and the data for the most natural actions were analyzed. Vision-based motion imaging analysis system, JP6 060 3 D force-plate, and 8-channel wireless surface electromyography testing system were utilized to test the kinematic (landed knee and ankle joint angles), kinetic (joint stiffness and stiffness of the lower limbs), and electromyography parameters (rectus femoris, biceps femoris, tibialis anterior, gastrocnemius) of the subjects during descending stairs. All the data were processed using SPSS17.0 software. RESULTS AND CONCLUSION: (1) During landing from three different heights, the knee and ankle joint angles of the blindfolded group were significantly larger than those of the unblindfolded group. At the moment of the appearance of the peak reacting force during landing, the knee joint angle of the blindfolded group was smaller than that of the unblindfolded group. Furthermore, the intergroup difference in the ankle joint angle was related to the height of the stair. (2) The first peak vertical force and its relative mean value during landing from different heights were significantly higher in the unblindfolded group compared to the blindfolded group, and both parameters significantly increased with the height increase. (3) During landing from different heights, the stiffness values of the knee joints and lower limbs in the unblindfolded group were significantly higher than those in the blindfolded group, and the stiffness values in the two groups were significantly increased with the height increase. (4) At the moment of pre-landing from different heights, the electromyography activities of the biceps femoris, tibialis anterior, gastrocnemius in the unblindfolded group were significantly higher than those in the blindfolded group, whereas during the buffer period, the electromyography activities of the rectus femoris, biceps femoris, tibialis anterior, gastrocnemius were significantly lower in the blindfolded group than in the unblindfolded group. (5) In conclusion, during descending stairs from different heights, visual deprivation (no visual feedback) reduces the capabilities of identification and environmental observation. The lack of vision may result in a significant decline in the performance of related movements, and thus the central nervous system cannot receive information, thereby impacting the implementation of the action.

Estudo comparativo das técnicas de cinesioterapia respiratória convencional e associado às diagonais de membros superiores na reexpansão torácica em indivíduos adultos jovens / Comparative study of conventional techniques of kinesiotherapy respiratory and associate members of the diagonal in the upper chest reexpansion in adults

Objetivo - A expansibilidade torácica é definida como o movimento observado no tórax durante uma incursão inspiratória e expiratória, este movimento pode facilmente ser alterado após alguns procedimentos cirúrgicos que exijam a presença de drenos torácicos. O objetivo do presente trabalho foi avaliar cirtometria torácica em pacientes com drenos torácicos que realizam fisioterapia convencional ou associadas a diagonais de membros superiores. Método - Os pacientes que possuíam drenos torácicos foram divididos em dois grupos, o grupo controle realizava somente fisioterapia convencional e o grupo tratado realizava fisioterapia convencional associada a diagonais de membros superiores, após a execução dos procedimentos a cirtometria era avaliada em ambos os grupos. Resultados - A expansibilidade obtida após a realização de ambas as técnicas não foram estatisticamente significante em relação às medidas pré-terapêutica. Conclusão - Não houve diferença estatisticamente significante entre os dois métodos realizados para a reexpansão torácica em pacientes com dreno de tórax. Sugere-se que esta pesquisa seja posteriormente estendida para um número maior de sessões, para que possivelmente obtenha uma diferença estatisticamente significante. Recomenda-se também que se realizem trabalhos utilizando outras variáveis tais como força muscular respiratória,volumes e capacidades pulmonares.

Objective - The chest expansion is defined as the movement observed in the chest during an incursion into inspiratory and expiratory, this movement can easily be changed after some surgical procedures that require the presence of chest drains. The objective of this study was to evaluate thoracic expansion in patients with chest tubes or performing physiotherapy associated with the upper diagonal. Method - Patients who had chest tubes were divided into two groups, the control group performed only conventional physiotherapy and treatment group performed physical therapy associated with the upper diagonal, after performing the procedures cirtometry was evaluated in both groups. Results - The expansion obtained after performing both techniques were not statistically significantly higher than the pre-therapy. Conclusion - There was no statistically significant difference between the two methods performed to reexpansion in patients with chest tube. It is suggested that this research is subsequently extended to a larger number of sessions to possibly get a statistically significant difference. It is also recommended that work is carried out using other variables such as respiratory muscle strength, lung volumes and capacities.

Cuidados básicos de un paciente con necesidad de moverse y mantener una buena postura / Basic care of a patient with need to move and maintain good posture

Se presenta un caso con la finalidad de dar a conocer la metodología aplicada en un estudio de caso de un paciente con la alteración en la necesidad de moverse y mantener una buena postura de acuerdo con el modelo de las 14 necesidades básicas de Virginia Henderson; orientada con el proceso de enfermería como el método científico de resolución de problemas del paciente. El estudio se realizó bajo el sistema de enseñanza tutorial durante el curso de la especialización de enfermería infantil. La recolección de datos se hizo a través de un instrumento, haciendo énfasis en la exploración física utilizando el método clínico llegando así a un análisis cualitativo de donde se derivan los diagnósticos jerarquizados de enfermería, de acuerdo al grado de independencia-dependencia que se presentó en el continuum; para posteriormente planear, ejecutar y evaluar cada una de las intervenciones de enfermería. Se concluye que gracias a la metodología aplicada se logró identificar los problemas básicos del adolescente, esto permitió realizar un plan de intervenciones de enfermería que favoreció la resolución de necesidades alteradas. Sin duda es un aspecto que cambia la práctica tradicional de enfermería.

The present case study has the purpose to make known the methodology in a case study of an adolescent with the alteration in the need "to Move and Keep a Good Posture" according to the 14 fundamental need proposals of Virginia Henderson oriented with the nursing process as the scietific method of problem solving for the patient. The study was done under the tutorial teaching system during the Specialization in Child Nursing care course. It is worth to mention that the data date gathering was done through an instrument, making emphasis in physical exploration using the clinical method reaching a qualitative analysis where hierarchical nursing diagnoses are derived from, according to the independence-dependence degree that was represented in the continuum and later planing, executing and evaluating every one of nursing interventions. It is concluded that as a consequence of the applied methodology. Basic problems in the adolescent could be identified, and as a result of an intervention plan in nursing that helped in the altered needs became possible, changing indeed the traditional practice in nursing.