Sonographic Evaluation of Median Nerve for Diabetics / 中国康复理论与实践

Objective:To measure the parameters of median nerve under ultrasound in patients with diabetes mellitus to explore the relationship between ultrasonic parameters and nerve conduction study. Methods:From June to November, 2019, 79 diabetic patients were divided into diabetic peripheral neuropathy (DPN) group (n = 37) and non-DPN group (n = 42) according to the diagnosis. Their right median nerve were measured cross-sectional area (CSA) and the proportion of hypoechoic areas (HA) 5 cm and 10 cm proximal to the wrist (CSA-5, CSA-10, HA-5 and HA-10, respectively) with sonography; while the conductive latency and velocity of right median nerves were measured with nerve conductive study. Results:CSA-5, CSA-10 and HA-10 were more in DPN group than in non-DPN group (|Z| > 2.282, P < 0.05). HA-5 correlated with the motor conductive latency (r = 0.264, P < 0.05) and velocity (r = -0.270, P < 0.05); HA-10 correlated with the abnormal sensory conductive latency (r = 0.234, P < 0.05) and velocity (r = 0.363, P < 0.01), and the motor conductive latency (r = 0.235, P < 0.05) and velocity (r = -0.255, P < 0.05). Conclusion:DPN can be found under sonography, some of them are related with the nerve electrophysiology, which may be a useful tool to screen DPN.

Clinical efficacy of different rehabilitation modes for lumbar degenerative diseases after operation / 中国骨伤

OBJECTIVE@#To compare clinical effects of different postoperative rehabilitation modes on lumbar degenerative diseases, and explore influence of rehabilitation mode and other factors on postoperative effect.@*METHODS@#From June 2013 to July 2016, totally 900 patients were admitted from nine tertiary hospitals in Beijing to perform single segment bone grafting and internal fixation due to lumbar degenerative diseases were prospectively analyzed. There were 428 males and 472 females, the age of patient over 18 years old, with an average of (51.42±12.41) years old;according to patients' subjective wishes and actual residence conditions, all patients were divided into three groups, named as observation group 1 (performed integrated rehabilitation approach and orthopedic treatment model intervention), observation group 2 (performed integrated rehabilitation approach and orthopedic treatment, classified rehabilitation model intervention), and control group(performed routine rehabilitation model intervention). Visual analogue scale(VAS), Oswestry Disability Index(ODI) and Japanese Orthopaedic Association (JOA) were used to evaluate postoperative efficacy among three groups at 24 weeks. Possible factors affecting the postoperative efficacy including age, age grouping, gender, body mass index (BMI), BMI grouping, education level, visiting hospital, payment method of medical expenses, preoperative complications, preoperative JOA score, clinical diagnosis, surgery section, operative method, intraoperative bleeding volume, postoperative complications and rehabilitation mode were listed as independent variables, and postoperative ODI score at 24 weeks as dependent variables. Univariate analysis was used to analyze relationship between influencing factors and postoperative efficacy. Multiple linear regression was used to analyze relationship between influencing factors, rehabilitation mode and postoperative ODI score at 24 weeks, in further to find out the main reasons which affect postoperative efficacy, and to analyze impact of rehabilitation mode on postoperative efficacy.@*RESULTS@#All patients were followed up for 24 weeks after operation. All incisions healed at stage I with stable internal fixation. (1)Evaluation of postoperative efficacy:① There were no statistical differences in preoperative VAS and ODI among three groups(@*CONCLUSION@#Preoperative JOA score, gender, age could predict postoperative clinical effects of lumbar degenerative diseases in varying degrees treated with single level bone graft fusion and internal fixation. Different rehabilitation modes could improve clinical effects. Intergrated rehabilitation orthopedic treatment model and integrated rehabilitation approach and orthopedic treatment with classifiedrehabilitation model are superior to conventional rehabilitation model in improving patients' postoperative function and relieving pain, which is worthy of promoting in clinical.

Reliability of Morphological Measurement of Gastrocnemius Using Ultrasonography in Different Positions / 中国康复理论与实践

Objective:To investigate the reliability of the morphological measure of medial gastrocnemius by musculoskeletal ultrasound imaging on the standing and prone positions, and compare the differences in the structural parameters of the medial gastrocnemius in different positions. Methods:From December, 2017 to May, 2018, 30 healthy young subjects were measured the muscle thickness, fascicle length and pennation angle of medial gastrocnemius on the prone and standing position respectively by two testers with musculoskeletal ultrasound. One of the testers re-tested three days later. The intra-class correlation coefficient (ICC), measurement standard error (SEM) and minimum detectable change (MDC) of all muscle morphological parameters in different positions were calculated respectively, and the differences of the morphological measurement of the medial gastrocnemius between these two positions were compared. Results:In the prone position, the ICC of inter-rater was 0.932 to 0.943 and the ICC of intra-rater was 0.880 to 0.915. In the standing position, the ICC of inter-rater was 0.922 to 0.938, and the ICC of intra-rater was 0.839 to 0.925. There were significant differences in muscle thickness, fascicle length and pennation angle of medial gastrocnemius in standing position and prone position (P < 0.01). Inter-rater SEM of muscle thickness and fascicle length was less in standing position than in prone position, while intra-rater MDC of pennation angle was less in prone position. Conclusion:It is reliable to measure medial gastrocnemius in standing and prone positions with ultrasonography. Morphological measurement of gastrocnemius is more accurate in standing position, while the measurement in prone position is more sensitive.

Preliminary study of robot-assisted ankle rehabilitation for children with cerebral palsy / 北京大学学报(医学版)

OBJECTIVE@#To propose a kind of robotic ankle-foot rehabilitation system for children with cerebral palsy and to preliminarily verify its feasibility in clinical application.@*METHODS@#A robot assisted ankle-foot rehabilitation system was specially designed and developed for children with cerebral palsy and a preliminary clinical study was conducted in Department of Rehabilitation Medicine, Peking University First Hospital. Modified Tardieu Scale and joint biomechanical properties (ankle plantar flexion resistance torque under different ankle dorsiflexion angles) were measured to analyze the muscle tone and soft tissue compliance of the ankle plantar flexors pre- and post-robotic training intervention. Six children with cerebral palsy (4 girls and 2 boys, mean age: 7 years) were recruited in this study. Each subject received 5 session robotic training and each session included 10-cycle passive stretching and static hold. SPSS 19.0 software was used for data statistical analysis.@*RESULTS@#Both R1 and R2 angles of Modified Tardieu Scale for ankle plantar flexors after training were significantly higher than those before the treatments (Gastrocnemius: PR1=0.003, PR2=0.029; Soleus: PR1=0.002, PR2=0.034). The difference between R2 and R1 was of no statistical difference before and after the training (P=0.067 and P=0.067, respectively). After training, the ankle plantar flexion resistance torque under different dorsiflexion angles (0°, 10°, 20°, 30°) were significantly reduced than those before training (P=0.001, P=0.001, P=0.014, P=0.002, respectively).@*CONCLUSION@#The robot assisted ankle-foot rehabilitation system can improve the contracture and soft tissue compliance of cerebral palsy children's ankle plantar flexors. All the children in the study were well tolerated and interested with the training, easy to accept and cooperate with it. This device may be suitable for application in the rehabilitation of children with cerebral palsy. However, further randomized clinical trials with larger sample size are still needed to verify the long term efficacy of this device.