骨折术后运动康复安全评定的几点体会

骨科学以运动系统疾病为对象,功能康复是骨科疾病治疗的最终目的.骨科治疗与康复是不可分割的整体.但骨科治疗与康复往往未能很好地结合,探索将两个学科有机地结合起来的安全运动康复评定的几点体会,制定出合理的运动处方,为较大限度地提高骨折疾病的功能疗效.     

急性心肌梗死早期康复治疗的探讨

遵循生物-心理-社会医学模式,结合传统康复治疗从生物功能、心理功能、社会功能三方面去探讨急性心肌梗死的早期康复治疗是切实可行的,而且明显优于传统的康复治疗,实行早期康复治疗时应从生物功能、心理功能、社会功能三个方面综合考虑,不宜偏废任何一方.     

肢体自然重建理念——一种人文关怀治疗

著名的医学家、哲学家Hippocrates在公元前4世纪就指出：医生的责任仅在于促进疾病的自然康复过程,而非阻拦这个过程.患者得以治愈的根据是患者自身存在的康复能力;医生首先必须清楚：自己所治疗的对象是人,是有生命的、有思想的、活在社会上的人,而不是被修理的物件.医生能够做到的只是为患者创造或提供一定的有利于康复的条件.20世纪50年代,前苏联骨科专家Ilizarov发现了张力-应力法则,并因此创造出的牵拉再生、自然重建技术,正是很好地诠释了Hippocrates的思想.     

肢体自然重建理念——一种人文关怀治疗

著名的医学家、哲学家Hippocrates在公元前4世纪就指出:医生的责任仅在于促进疾病的自然康复过程,而非阻拦这个过程.患者得以治愈的根据是患者自身存在的康复能力;医生首先必须清楚:自己所治疗的对象是人,是有生命的、有思想的、活在社会上的人,而不是被修理的物件.医生能够做到的只是为患者创造或提供一定的有利于康复的条件.20世纪50年代,前苏联骨科专家Ilizarov发现了张力-应力法则,并因此创造出的牵拉再生、自然重建技术,正是很好地诠释了Hippocrates的思想.     

“快乐骨科”的起源、发展和临床实践

矫形外科治疗的病人都是肢体畸形残疾的弱势群体,多经历了艰难的求医过程,承载着肢体残障与尊严浩劫的心灵创伤。为了给肢体残疾者创造一个好的医疗环境,提出并建立了"快乐矫形骨科病区",包括围手术期无痛病房、医患交流科普文化墙、定期举办医患联欢等。在不断实践中,提升了医生对生命的敬畏,对现代医术的驾驭和为病人解决问题的能力。在手术治疗复杂肢体畸形残疾近4 000例中,未发生1例大的医疗冲突事件,使矫形外科病房成为肢体残疾者恢复运动功能与心灵抚慰的康复乐园。     

骨科疾病诊治中的临床思维

医学哲学是对医学科学成就总的概括,并以此为基础探讨生命活动和病程的一般规律,研究医学科学的思维方式,直至疾病预防、诊断治疗。同时研究辩证规律和范畴在医学科学中的表现,从而指导骨科医师解决在骨科疾病诊治中遇到的诸多问题,并有助于形成正确的临床思维。结合临床工作体会,探讨医学哲学在骨科疾病诊治临床思维中的应用。     

骨科疾病诊治中的临床思维

医学哲学是对医学科学成就总的概括,并以此为基础探讨生命活动和病程的一般规律,研究医学科学的思维方式,直至疾病预防、诊断治疗.同时研究辩证规律和范畴在医学科学中的表现,从而指导骨科医师解决在骨科疾病诊治中遇到的诸多问题,并有助于形成正确的临床思维.结合临床工作体会,探讨医学哲学在骨科疾病诊治临床思维中的应用.     

骨折治疗的动与静

骨骼是人体主要的运动器官之一,它既可以对人体解剖结构提供重要的支撑和保护,又是人类其他运动器官的连接枢纽。骨折的愈合是机体修复的自然过程,但是其中的影响因素目前尚没有完全研究清楚,因此临床上骨折治疗失败的病例仍然很多。人类如何在骨折的愈合过程中更好地遵循自然规律帮助其愈合是目前骨科医师仍然关注的热点。本文回顾骨折治疗的发展历史并结合一些临床工作的心得,从生物力学角度出发,总结在骨折治疗过程中如何把握动与静的矛盾辩证关系,认识其内在规律,为骨折治疗提供指导和帮助。     

医务社会工作对疾病治疗康复的介入思考

医务社会工作是适应新医学模式为病人提供专业化服务的一种职业,在疾病的治疗与康复工作中有着重要功能和角色作用,对顺利实现治疗康复目标、缓解生理痛苦、提供心理支持,延长生命或提高生活质量,努力回归社会均发挥着不可替代的促进作用.随着我国医学和社会的发展,新医学模式下的医务社会工作介入,必将成为普遍趋势.     

治疗感染性骨不连伴大段骨缺损的探讨与思考

感染性骨不连伴大段骨缺损是目前临床骨科较为常见、多发、治疗极为棘手的病种之一,治疗方法多种多样,但疗效却不理想,且缺乏统一的诊治与疗效判断标准,总结、分析几种临床上主要治疗方法的利弊,为该病探寻一条微创、安全、并发症少及疗效确切的可靠治疗方法.随着对Ilizarov技术的基础与临床研究的不断深入,该技术在治疗传统方法难以治愈的疾病如四肢关节严重畸形、感染性骨不连或伴有骨缺损、皮肤软组织缺损等方面显示出自身的优势,为治疗疑难骨科疾病开辟了一条新的有效途径.     

中医理念在拇趾外翻临床中的运用

探讨运用中医治病求本、阴阳学说、筋束骨、小夹板纸压垫原理、辨证施治等中医理论,构筑的中西医结合微创技术治疗拇外翻畸形的诊疗体系。从拇外翻畸形的病因、病理、矫形手术、手法复位、生物固定、术后康复等几方面,阐述对拇外翻畸形的新的矫形理念。     

Virtual environments for motor rehabilitation: review.

In this paper, the current "state of the art" for virtual reality (VR) applications in the field of motor rehabilitation is reviewed. The paper begins with a brief overview of available equipment options. Next, a discussion of the scientific rationale for use of VR in motor rehabilitation is provided. Finally, the major portion of the paper describes the various VR systems that have been developed for use with patients, and the results of clinical studies reported to date in the literature. Areas covered include stroke rehabilitation (upper and lower extremity training, spatial and perceptual-motor training), acquired brain injury, Parkinson's disease, orthopedic rehabilitation, balance training, wheelchair mobility and functional activities of daily living training, and the newly developing field of telerehabilitation. Four major findings emerge from these studies: (1) people with disabilities appear capable of motor learning within virtual environments; (2) movements learned by people with disabilities in VR transfer to real world equivalent motor tasks in most cases, and in some cases even generalize to other untrained tasks; (3) in the few studies (n = 5) that have compared motor learning in real versus virtual environments, some advantage for VR training has been found in all cases; and (4) no occurrences of cybersickness in impaired populations have been reported to date in experiments where VR has been used to train motor abilities.     

我国肢体残疾病人矫形治疗的现状分析

我国肢体残疾病人的发病率、病种分类、病情特点、医疗需求的实际情况如何?矫形外科医生队伍的建设与学术研究现状怎样?众多的肢体残疾者是否得到正确的矫形外科治疗?骨科学术界缺乏这样的分析。作者实施了2万多例各种肢体残疾的矫形手术,对其中16678例病人进行了统计分析,结果发现,近10余年来我国大医院进入以市场为主导的发展阶段,外科治疗下肢畸形与残疾的矫形外科专业,由于缺乏强大的市场推动、治疗过程较复杂等原因,而被忽视。我国矫形外科医师严重缺乏,某些下肢残缺的矫形手术治疗甚至人才断档。从而出现数以百万计的各种肢体残疾病人,因为缺少经济能力和矫形外科医师,没有得到正确的矫形外科治疗。作者分析了我国肢体残疾病人的发生率、病种、病情特点、年龄分布、经济状况和医疗需求,提出了解决这一问题的对策和建议     

Effects of a self-regulation intervention on exercise are moderated by depressive symptoms: A quasi-experimental study

This study investigated whether a computer-based self-regulation intervention increases physical exercise in individuals with or without depressive symptoms. A total of 361 individuals in orthopedic rehabilitation, 36 of them with depressive symptoms, were recruited in Germany. In a quasi-experimental study, individuals were allocated to either a computer-based self-regulation intervention or an online questionnaire. Exercise was measured at the beginning of rehabilitation and six weeks after rehabilitation. Depressive symptoms were assessed at the end of rehabilitation. An analysis of covariance was conducted, controlling for exercise baseline, sex, and phase of assessment. A main effect for depressive symptoms (p = .005) and intervention group (p = .011), as well as a marginal interaction of intervention x depressive symptoms were found (p = .076). Results indicate that the self-regulation exercise intervention in an orthopedic rehabilitation setting seem to be only effective in non-depressed individuals. Future research should examine how health behavior change programs can be designed more effectively for individuals with depressive symptoms.     

下腰痛综合征的诊治与人文思想

下腰痛是一种常见的骨科病症,轻者可影响患者生活,重者可使患者丧失劳动力。它的发病原因有很多,治疗方法各有不同。在下腰痛的诊断中要按照适度医疗的原则选择合适的检查;在下腰痛的治疗中须按照最优化医疗的原则选择最佳的治疗方案。在治疗中要注意结合人文思想来提高下腰痛的治疗效果。     

Cognitive Rehabilitation Therapies for Alzheimer’s Disease: A Review of Methods to Improve Treatment Engagement and Self-Efficacy

Cognitive rehabilitation therapies for Alzheimer’s disease (AD) are becoming more readily available to the geriatric population in an attempt to curb the insidious decline in cognitive and functional performance. However, people with AD may have difficulty adhering to these cognitive treatments due to denial of memory deficits, compromised brain systems, cognitive incapacity for self-awareness, general difficulty following through on daily tasks, lack of motivation, hopelessness, and apathy, all of which may be either due to the illness or be secondary to depression. Cognitive rehabilitation training exercises are also labor intensive and, unfortunately, serve as a repeated reminder about the memory impairments and attendant functional consequences. In order for cognitive rehabilitation methods to be effective, patients must be adequately engaged and motivated to not only begin a rehabilitation program but also to remain involved in the intervention until a therapeutic dosage can be attained. We review approaches to cognitive rehabilitation in AD, neuropsychological as well as psychological obstacles to effective treatment in this population, and methods that target adherence to treatment and may therefore be applicable to cognitive rehabilitation therapies for AD. The goal is to stimulate discussion among researchers and clinicians alike on how treatment effects may be mediated by engagement in treatment, and what can be done to enhance patient adherence for cognitive rehabilitation therapies in order to obtain greater cognitive and functional benefits from the treatment itself.     

论疾病治疗的自然观

人体本身对各类疾病有着强大的自我抵制和修复能力,疾病的发生和康复有其自然的进展规律,治疗疾病的过程应遵循相关规律,并辅助人体的这些能力去促进机体的修复。而现实医疗中,人们在享受医学科技成果和医疗保障实惠的同时,常常伴有过度的医疗处置或过度忽视疾病的存在,从而影响疾病本身的自然康复进程,或加重病情,甚至造成二次伤害。本文从疾病治疗自然观的角度探讨了医生和患者在应对疾病时需了解的辩证思想,并就如何认识和应用疾病治疗的自然观去诊治疾病做一探讨。     

软组织生物力学与骨科临床

软组织的生物力学在骨科临床上的应用赋予骨科医生全新的理论思维,不仅纠正了传统治疗方法中的某些不足,更使新的治疗方法具有理论上的科学根据,从而提高临床疗效。临床骨科学是以人体运动系统(除骨骼外,尚包括肌肉、肌腱、韧带等软组织)为解剖学基础的,了解相关的软组织生物力学知识和基本概念,对于骨科医生在临床实践过程中的医疗行为是十分重要的。     

骨科疾病诊治中的辩证观

骨科医生在复杂的临床工作中,需要掌握科学的方法论。特别是掌握科学的辩证思维方法,建立局部与整体的观念,善于抓住主要矛盾。培养起辩证逻辑思维的能力。有助于正确分析和理解骨科疾病的诊断和治疗中的各种复杂问题,提高认识水平和实践能力。