Background:During an experiment,a ski racer equipped with various measurement devices suffered an anterior cruciate ligament(ACL)rupture in his right knee.The aim of this study was to describe the underlying injury me...Background:During an experiment,a ski racer equipped with various measurement devices suffered an anterior cruciate ligament(ACL)rupture in his right knee.The aim of this study was to describe the underlying injury mechanism from a functional perspective.Methods:Eight giant slalom turns(i.e.,4 left turns),followed by 1 left turn at which the ACL injury occurred,were recorded by 2 video cameras,electromyography of 4 relevant muscle groups,inertial measurement units to measure knee and hip angles,and pressure insoles to determine ground reaction forces.Results:Due to a loss of balance,the ski racer began to slide sideways at the apex of a left turn.During sliding,his right(outside)leg was actively abducted upward without touching the ground.The ski racer then attempted to stand up again by dropping his leg back towards the snow surface.The end of this dropping was accompanied by a decrease in electromyographic activity in the knee stabilizing muscles.Once the inside edge of the outer ski caught the snow surface,a rapidly increasing peak force,knee flexion,and an aggressive sudden activation of the vastus medialis muscle were observed,while biceps femoris and rectus femoris further decreased their activation levels.This likely resulted in excessive anterior translation of the tibia relative to the femur,causing damage to the ACL.Conclusion:Our example emphasizes that ski racers should not get up until they stop sliding.Remember:“When you’re down,stay down.”展开更多
BACKGROUND Four-corner fusion(4CF)is a motion sparing salvage procedure that is used to treat osteoarthritis secondary to advanced scapholunate collapse or longstanding scaphoid nonunion advanced collapse.Little is kn...BACKGROUND Four-corner fusion(4CF)is a motion sparing salvage procedure that is used to treat osteoarthritis secondary to advanced scapholunate collapse or longstanding scaphoid nonunion advanced collapse.Little is known about the long-term survivorship and outcomes of 4CF.AIM To report on clinical and functional long-term outcomes as well as conversion rates to total wrist fusion or arthroplasty.METHODS The systematic review protocol was registered in the international prospective register of systematic reviews(PROSPERO)and followed the PRISMA guidelines.Original articles were screened using four different databases.Studies with a minimum Level IV of evidence that reported on long-term outcome after 4CF with a minimum follow-up of 5 years were included.Quality assessment was performed using the Methodological Index for Non-Randomized Studies criteria.RESULTS A total of 11 studies including 436 wrists with a mean follow-up of 11±4 years(range:6-18 years)was included.Quality assessment according to Methodological Index for Non-Randomized Studies criteria tool averaged 69%±11%(range:50%-87%).Fusion rate could be extracted from 9/11 studies and averaged 91%.Patient-reported outcomes were extracted at last follow-up from 8 studies with an average visual analog scale of 1±1(range:0-2)and across 9 studies with an average Disabilities of the Arm,Shoulder and Hand score of 21±8(range:8-37).At last follow-up,the cumulative conversion rate to total wrist fusion averaged 6%.There were no conversions to total wrist arthroplasty.CONCLUSION The 4CF of the wrist is a reliable surgical technique,capable of achieving a good long-term patient satisfaction and survivorship with low rates of conversion to total wrist fusion.展开更多
The aim of this study was to evaluate the course of spinal neuronal activity f ollowing spinal cord injury (SCI). In patients with a complete SCI, the leg musc le EMG activity early and up to 33 years after an SCI was...The aim of this study was to evaluate the course of spinal neuronal activity f ollowing spinal cord injury (SCI). In patients with a complete SCI, the leg musc le EMG activity early and up to 33 years after an SCI was analysed during locomo tor movements induced and assisted by a driven gait orthosis (DGO). Only in chro nic SCI patients did a premature exhaustion of neuronal activity occur. This was reflected in a reduced density and fading of leg muscle EMG activity. The early exhaustion of EMG activity was more pronounced in the leg flexor (e.g. biceps f emoris) than extensor (e.g. gastrocnemius) muscles. The timing of the leg muscle pattern remained unchanged in the chronic patients. A preserved amplitude of mo tor action potentials following repetitive peripheral nerve stimulation and duri ng spasms indicated an interneuronal site of impairment. In patients who partici pated in a locomotor training programme lasting up to 13 weeks, no positive effe ct on the slope of exhaustion was seen. It is concluded that a degradation of sp inal neuronal activity takes place following an SCI. If in the future regenerati on of spinal tract fibres becomes feasible in patients with complete SCI, such a n approach can only become functionally successful if neuronal activity below th e level of the lesion is maintained. This might be achieved by a continuous trai ning approach starting early after injury.展开更多
Objectives: To improve the diagnosis of damaged spinal motor pathways in incomplete spinal cord injury (iSCI) by assessing the facilitation of lower limbs motor evoked potentials (MEP). Methods: Control subjects (n = ...Objectives: To improve the diagnosis of damaged spinal motor pathways in incomplete spinal cord injury (iSCI) by assessing the facilitation of lower limbs motor evoked potentials (MEP). Methods: Control subjects (n = 12) and iSCI patients (n = 21) performed static and dynamic isometric foot dorsiflexions. MEPs induced by transcranial magnetic stimulation and EMG background of tibialis anterior muscle (TA) were analyzed. Static and dynamic muscle activation was performed at comparable levels of maximal voluntary contraction (MVC). The influence of the motor tasks on the excitability and facilitation of MEPs was compared between controls and iSCI patients. Results: In the controls an increased facilitation of TA MEP at lower levels of dynamic compared with static activation (10-20 % MVC) could be shown. At matched EMG background level the MEP responses were significantly increased. In the iSCI patients at a comparable level of TA activation the MEP responses were significantly reduced and 3 different patterns of MEP responses could be distinguished: i) preserved increment of TA MEP in the dynamic motor task, ii) unchanged MEP size in the dynamic and static motor task, and iii) elicitable MEPs in the dynamic motor task, which were abolished in the static motor task. Conclusions: Static and dynamic motor tasks have different effects on TA MEP facilitation. The task-dependent modulation of TA MEPs is comparable to that described for upper limb muscles. Complementary to the MEP delay this approach allows for an estimation of the severity of spinal tract damage. The task-dependent modulation of TA MEPs is an additional diagnostic tool to improve the assessment and monitoring of motor function in iSCI.展开更多
On April 26-27, 2013, the Step by Step Foundation hosted the Second International Spinal Cord Repair Meeting at the Fira Barcelona Convention Center in Hospitalet de Llobregat, Spain, highlighting some of the exciting...On April 26-27, 2013, the Step by Step Foundation hosted the Second International Spinal Cord Repair Meeting at the Fira Barcelona Convention Center in Hospitalet de Llobregat, Spain, highlighting some of the exciting research including clinical trials which show promise for treatments for this devastating disorder. This meeting brought together clinicians, clinical scientists and molecular biologists from more than 10 countries to evaluate current knowledge on clinical, cellular, and biomolecular aspects of spinal cord injury. A major goal of the conference in advancing the translation of research data to the clinic was to promote multi-pronged approaches for therapy of this complex problem.展开更多
近年来，脊髓损伤神经学分类园际标准（International Stand- ards for the Neurological Classification of Spinal Cord Injury, ISNCSCI）被用来记载脊髓损伤后运动和感觉功能的损害，目前该标准已是第六版。1992年第一份国际认可的...近年来，脊髓损伤神经学分类园际标准（International Stand- ards for the Neurological Classification of Spinal Cord Injury, ISNCSCI）被用来记载脊髓损伤后运动和感觉功能的损害，目前该标准已是第六版。1992年第一份国际认可的标准出版时，曾进行了较大的修订，修订内容包括完全性损伤与不完全性损伤的定义，展开更多
文摘Background:During an experiment,a ski racer equipped with various measurement devices suffered an anterior cruciate ligament(ACL)rupture in his right knee.The aim of this study was to describe the underlying injury mechanism from a functional perspective.Methods:Eight giant slalom turns(i.e.,4 left turns),followed by 1 left turn at which the ACL injury occurred,were recorded by 2 video cameras,electromyography of 4 relevant muscle groups,inertial measurement units to measure knee and hip angles,and pressure insoles to determine ground reaction forces.Results:Due to a loss of balance,the ski racer began to slide sideways at the apex of a left turn.During sliding,his right(outside)leg was actively abducted upward without touching the ground.The ski racer then attempted to stand up again by dropping his leg back towards the snow surface.The end of this dropping was accompanied by a decrease in electromyographic activity in the knee stabilizing muscles.Once the inside edge of the outer ski caught the snow surface,a rapidly increasing peak force,knee flexion,and an aggressive sudden activation of the vastus medialis muscle were observed,while biceps femoris and rectus femoris further decreased their activation levels.This likely resulted in excessive anterior translation of the tibia relative to the femur,causing damage to the ACL.Conclusion:Our example emphasizes that ski racers should not get up until they stop sliding.Remember:“When you’re down,stay down.”
文摘BACKGROUND Four-corner fusion(4CF)is a motion sparing salvage procedure that is used to treat osteoarthritis secondary to advanced scapholunate collapse or longstanding scaphoid nonunion advanced collapse.Little is known about the long-term survivorship and outcomes of 4CF.AIM To report on clinical and functional long-term outcomes as well as conversion rates to total wrist fusion or arthroplasty.METHODS The systematic review protocol was registered in the international prospective register of systematic reviews(PROSPERO)and followed the PRISMA guidelines.Original articles were screened using four different databases.Studies with a minimum Level IV of evidence that reported on long-term outcome after 4CF with a minimum follow-up of 5 years were included.Quality assessment was performed using the Methodological Index for Non-Randomized Studies criteria.RESULTS A total of 11 studies including 436 wrists with a mean follow-up of 11±4 years(range:6-18 years)was included.Quality assessment according to Methodological Index for Non-Randomized Studies criteria tool averaged 69%±11%(range:50%-87%).Fusion rate could be extracted from 9/11 studies and averaged 91%.Patient-reported outcomes were extracted at last follow-up from 8 studies with an average visual analog scale of 1±1(range:0-2)and across 9 studies with an average Disabilities of the Arm,Shoulder and Hand score of 21±8(range:8-37).At last follow-up,the cumulative conversion rate to total wrist fusion averaged 6%.There were no conversions to total wrist arthroplasty.CONCLUSION The 4CF of the wrist is a reliable surgical technique,capable of achieving a good long-term patient satisfaction and survivorship with low rates of conversion to total wrist fusion.
文摘The aim of this study was to evaluate the course of spinal neuronal activity f ollowing spinal cord injury (SCI). In patients with a complete SCI, the leg musc le EMG activity early and up to 33 years after an SCI was analysed during locomo tor movements induced and assisted by a driven gait orthosis (DGO). Only in chro nic SCI patients did a premature exhaustion of neuronal activity occur. This was reflected in a reduced density and fading of leg muscle EMG activity. The early exhaustion of EMG activity was more pronounced in the leg flexor (e.g. biceps f emoris) than extensor (e.g. gastrocnemius) muscles. The timing of the leg muscle pattern remained unchanged in the chronic patients. A preserved amplitude of mo tor action potentials following repetitive peripheral nerve stimulation and duri ng spasms indicated an interneuronal site of impairment. In patients who partici pated in a locomotor training programme lasting up to 13 weeks, no positive effe ct on the slope of exhaustion was seen. It is concluded that a degradation of sp inal neuronal activity takes place following an SCI. If in the future regenerati on of spinal tract fibres becomes feasible in patients with complete SCI, such a n approach can only become functionally successful if neuronal activity below th e level of the lesion is maintained. This might be achieved by a continuous trai ning approach starting early after injury.
文摘Objectives: To improve the diagnosis of damaged spinal motor pathways in incomplete spinal cord injury (iSCI) by assessing the facilitation of lower limbs motor evoked potentials (MEP). Methods: Control subjects (n = 12) and iSCI patients (n = 21) performed static and dynamic isometric foot dorsiflexions. MEPs induced by transcranial magnetic stimulation and EMG background of tibialis anterior muscle (TA) were analyzed. Static and dynamic muscle activation was performed at comparable levels of maximal voluntary contraction (MVC). The influence of the motor tasks on the excitability and facilitation of MEPs was compared between controls and iSCI patients. Results: In the controls an increased facilitation of TA MEP at lower levels of dynamic compared with static activation (10-20 % MVC) could be shown. At matched EMG background level the MEP responses were significantly increased. In the iSCI patients at a comparable level of TA activation the MEP responses were significantly reduced and 3 different patterns of MEP responses could be distinguished: i) preserved increment of TA MEP in the dynamic motor task, ii) unchanged MEP size in the dynamic and static motor task, and iii) elicitable MEPs in the dynamic motor task, which were abolished in the static motor task. Conclusions: Static and dynamic motor tasks have different effects on TA MEP facilitation. The task-dependent modulation of TA MEPs is comparable to that described for upper limb muscles. Complementary to the MEP delay this approach allows for an estimation of the severity of spinal tract damage. The task-dependent modulation of TA MEPs is an additional diagnostic tool to improve the assessment and monitoring of motor function in iSCI.
文摘On April 26-27, 2013, the Step by Step Foundation hosted the Second International Spinal Cord Repair Meeting at the Fira Barcelona Convention Center in Hospitalet de Llobregat, Spain, highlighting some of the exciting research including clinical trials which show promise for treatments for this devastating disorder. This meeting brought together clinicians, clinical scientists and molecular biologists from more than 10 countries to evaluate current knowledge on clinical, cellular, and biomolecular aspects of spinal cord injury. A major goal of the conference in advancing the translation of research data to the clinic was to promote multi-pronged approaches for therapy of this complex problem.
文摘近年来，脊髓损伤神经学分类园际标准（International Stand- ards for the Neurological Classification of Spinal Cord Injury, ISNCSCI）被用来记载脊髓损伤后运动和感觉功能的损害，目前该标准已是第六版。1992年第一份国际认可的标准出版时，曾进行了较大的修订，修订内容包括完全性损伤与不完全性损伤的定义，
