Objective :To investigate a new method and its clinical results in the treatment of avascular necrosis of the femoral head in young adults. Method:The necrotic bone was removed and iliac periosteum and bone with vascular pedicle was transplanted in 25 cases (28 hips) ,age 12-42 years old in this group. Rehabilitation technique were applied after surgery. The time of follow up was 3-9.5 years. To evaluate the results, we used the standard score recommended by Society of Osteonecrosis in Chinese Medical Association. Result:16 cases were excellent,7 cases good, and 2 cases fair. The rate of excellent and good was 92%. Conclusion:Transplantation of iliac periosteum and bone with vascular pedicle has the effect on revascularization and new bone formation, which following with rehabilitation methods may promote the reconstruction of the necrotic femoral head and prevent it to collapse. Thus the pathogenesis process had been stopped.

An investigation was made on the rehabilitation treatment for the injuries wounded in Wenchuan Earthquake offered in 30 hospitals of 8 provinces, including Beijing, Shanghai, Jiangsu, Shandong, Hubei, Guangdong, Cbongqing, and Sichuan. On the basis of data from this investigation, the paper made analysis and summary of the challenges and problems encountered in the said rehabilitation treatment, and raises such recommendations as relessing rehabilitation assessment principles and policies for the injuries to return to their home towns in Siehuan, clarifying the responsibilities of individual government authorities in the later-stage rehabilitation treatment of the injuries, and enhanced synergy among respective disciplines and authorities of both clinical practice and rehabilitation treatment. The goal of these recommendations is further development of the rehabilitation medicine discipline in China.

Objective To observe the effects of individual prehabilitation on the functional outcome six weeks after total knee arthroplas-ty (TKA). Methods The patients undergoing TKA from March, 2013 to August, 2015 were randomly divided into prehabilitation group (n=30) and control group (n=29). The prehabilitation group received individual rehabilitation since enrolled in the study. The control group re-ceived no prehabilitation. All the patients received regular pre-surgical education, surgery and post-surgical rehabilitation. Both groups were evaluated with Numerical Rating Scale (NRS) of pain, active range of motion (AROM), Manual Muscle Test (MMT), fall index, TimedUp and Go(TUG), and Hospital for Special Surgery-Knee Scale (HSS-KS). Results The scores of NRS reduced six weeks after TKA (t>2.342, P<0.05) in both groups, and was lower in the prehabilitation group than in the control group before and six weeks after TKA (t>2.827, P<0.01). There was no significant difference in AROM of knee flexion when enrolling and before TKA in both groups (t<0.648, P>0.05), and it increased in the control group six weeks after TKA (t>3.555, P<0.01), and no increasement was found in the prehabilitation group (t<1.608, P>0.05);the AROM of knee extension increased before TKA in the control group (Z=-2.257, P=0.024), and no increasement was found in the prehabilitation group (Z=0, P=1.000), and it decreased six weeks after TKA in both groups (Z>2.247, P<0.05). The muscle strength of trunk extention and flexion enhanced before TKA in the prehabilitation group (t>2.387, P<0.05), and no change was found in the control group (t<0.940, P>0.05). The muscle strength of trunk extensor and the upside of rectus abdominis showed no statistical difference between two groups six weeks after TKA (t<1.656, P>0.05), the muscle strength of the downside of rectus abdominis and external oblique was more in the prehabilitation group than in the control group (t=2.585, P=0.013). There was no significant difference in the fall index be-fore TKA (t<0.350, P>0.05), and it was lower in the prehabilitation group than in the control group six weeks after TKA (t=-2.837, P=0.007). The time of TUG shortened before TKA in the prehabilitation group (t=3.554, P=0.002), and it prolonged in the control group (t=-4.507, P<0.001), there was no significant difference in it between two groups six weeks after TKA (t=-0.497, P=0.622). The score of HSS-KS increased before TKA (t=-2.621, P=0.015) in the prehabilitation group, and no increasement was found in the control group (t=2.073, P=0.053), and they were higher in the prehabilitation group than in the control group before and six weeks after TKA (t>2.092, P<0.05). Conclusion Individual prehabilitation could reduce pain, and improve the trunk muscles, the ability of walking and the function of the knee before and six weeks after TKA.

Objective To investigate the isokinetic strength of knee extensors and flexors in patients with knee osteoarthritis (KOA), and to establish the correlation between the isokinetic strength and function in patients with KOA. Methods 23 patients with bilateral KOA and 14 matched normal controls finished the isokinetic test of knee extensors and flexors, the Five Times Sit-to-Stand Test (FTSST), Gait analysis, and Balance test. The KOA patients were evaluated with Visual Analog Scale (VAS) for pain and Western Ontario and McMaster University Osteoarthritis Index (WOMAC). Results It was less of the peak torque, average peak torque, average power, max rep total work, total work of knee extensors and flexors in the mainly involved limbs than the contralateral limbs (P<0.05), and more of the hamstring/quadriceps peak torque (H/Q) percentage (P<0.05) in the patients. It was less of all the observed indicators of knee extensors and average power of knee flexors in the patients than in the normal controls (P<0.05), and was more of the H/Q percentage (P<0.05). The peak torque of knee extensors correlated with the results of FTSST, walking speed, walking distance, falling index, VAS, and WOMAC-pain (P<0.05), but the peak torque of knee flexors did not (P>0.05). Conclusion It is weak of the isokinetic strength of knee extensors and flexors in patients with KOA in the mainly involved limb, as well as the isokinetic strength of knee extensors compared with the normal controls. The changes in the extensors and flexors are not equivalent. The peak torque of knee extensors significantly correlated with the pain and functions of the knee.

Objective:Using sonography to clarify the shoulder lesion and injury and to evaluate the relationship between sonographic findings and muscle strength of stroke patients with shoulder pain.Method:One hundred and forty three patients with shoulder pain were divided into two groups according to muscle strength of hemiplegic shoulder.Of which,76 patients were in the muscle strength of hemiplegic shoulder below MMT grade 3 group and 67 patients were in the muscle strength of hemiplegic shoulder equal or above MMT grade 3 group.All the patients received ultrasound examination of their hemiplegic shoulders.Result:The total occurrence rate of shoulder lesion and injury was 74.8％(n=107).The occurrence rate of subacromial-subdeltoid bursal hydrops or bursitis was 41.3％(n=59).The occurrence rate of hydrops or inflammation of long head of biceps tendon sheath was 24.5％(n =35).The occurrence rate of tendinitis of rotator cuff was 22.4％(n=32).The occurrence rate of partial or complete tear of rotator cuff was 20.3％(n=29).There was no statistical correlation between muscle strength of hemiplegic shoulder and severity of shoulder lesion and injury(P＞0.05).Conclusion:The occurrence rate of shoulder lesion and injury after stroke was very high.There was no correlation between the severity of shoulder lesion and injury and the muscle strength of hemiplegic shoulder.For the function rehabilitation of upper extremity of stroke hemiplegic patients it is beneficial to find the shoulder lesion and injury earlier and administer effective therapy.

Objective:To investigate the relationship between bone metabolism biochemical markers and clinic features (course,AIS,etc.)in spinal cord injury patients.Method:Totally 73 patients aged from 13 to 89 years with SCI were enrolled.The injury time was recorded,and patients' AIS was assessed.25-hydroxyvitamin D [25(OH)D],collagen type Ⅰ C-terminal telopeptide (CTX)and N-terminal propeptide of type 1 precollagen(P1NP) were measured.Result:In our observation of patients with spinal cord injury,the ratio of 25(OH)D deficience was 98.6％.Correlation between 25(OH)D and clinic features was not found.P1NP showed positive correlation with course (R=-0.235,P＜0.05)and negative correlation with AIS (R=0.442,P＜0.01).CTX showed negative correlation with AIS and age(R was-0.232 and-0.296,P＜0.05).There is no difference between tetraplegia and paraplegia (AIS C and D) in 25(OH)D、P1NP and CTX.CTX is higher in traumatic spinal cord injury patients,(Z=-.2.086,P ＜ 0.05)Conclusion:In patients with spinal cord injury,a lack of vitamin D has a high proportion.The lower AIS was,the higher P1NP and CTX was,which meant severe bone loss.Bone loss may be faster in younger SCI patients and traumatic spinal cord injury patients.

Objective To compare the acceptance of 2 different teaching modes－physicians and therapists teaching together and separately in continuing education students of rehabilitation medicine. Methods A questionnaire was filled by the students who attended the lectures of both Rehabilitation of Elbow Injury and Rehabilitation of Wrist Injury in the 9th National Orthopedic Class. The former lecture was taught by the rehabilitation physician and physical therapist together (together mode), and the latter lecture was taught by the rehabilitation physician and physical therapist separately (separate mode). The questionnaire included the choices and text questions. Results There were 45 copies of effective questionnaire all together. The satisfaction of both lectures were above 90%. As to teaching modes, 77.8% students liked together mode better, and 22.2% students preferd the separate mode. 93.9% students would or maybe use together mode in their future work, and 88.9% in separate mode. Conclusion The mode of physician and therapist giving lectures together is well accepted by students.

Most literature defines knee extension lag as the failure of the knee joint to achieve the passive extension angle, and some literature defines the inability of the knee to complete the last 15° extension as knee extension lag. Extension lag is one of the common complications after knee surgery, which seriously affects the postoperative knee joint function of patients. Disuse atrophy due to prolonged postoperative bed rest, arthrogenic muscle inhibition due to pain and (or) swelling, direct injury to the knee extensor mechanism during surgery and nerve dysfunction of the quadriceps muscle can all contribute to extension lag. While rehabilitation exercises, physical therapy and medication can significantly improve the patient's symptoms, extension lag due to the knee extension device injury requires surgery if necessary to regain normal knee function. As surgical techniques continue to be refined and rehabilitation interventions advance, the prevention of extension lag and the minimization of angle of knee extension lag need to be given adequate attention by patients, physicians, and researchers. This article reviews clinical studies related to extension lag after knee surgery, focusing on etiology, treatment, prevention and prognosis, with the aim of providing a basis and guidance for the current clinical management.

Objective:To measure the change in Young′s modulus of the biceps brachii during passive stretching and to assess the potential of shear wave elastography (SWE) as an auxiliary quantitative technique for assessing muscle tone.Methods:Forty-nine stroke survivors and 30 healthy subjects were evaluated using the modified Ashworth scale (MAS). According to their MAS scores they were divided into a healthy group, a healthy elbow group, an MAS class-0 group, an MAS class-1 group, an MAS class-1 + group and an MAS class-2 group. During passive extension of the subjects′ elbows, shear wave elastography was used to image the biceps brachii. Six points of the elbow were selected to record the instantaneous Young′s modulus ( EX) and calculate its change during the movement (Δ E). Those data were correlated with the MAS scores and compared among the groups. Results:Persons with higher MAS scores tended to have a higher Young′s modulus of the biceps brachii, and the modulus was likely to increase more with increases in the angle of elbow extension. From half of the range of motion to full extension there were significant differences in EX and Δ E between MAS class-0 and class-1 groups, as well as between the class-0 and class-1 + groups. There were, however, no significant differences between MAS class-1 and MAS class-1 + . Conclusions:MAS scores can usefully predict biceps brachii stiffness during passive elbow flexion. Shear wave elastography can quantify that stiffness and also muscle tone.