关节镜诊治膝关节半月板损伤疗效分析

目的探讨关节镜治疗半月板损伤的方法，评价关节镜下三种手术方式的手术效果。方法对2009年1月一2012年1月行关节镜下治疗半月板损伤的患者78例，术后随访12个月～24个月，平均16个月，应用Lysholm膝关节评分进行评价，比较关节镜下不同方法治疗半月板损伤的疗效。结果Lysholm评分：半月板缝合组术前46．1±3．2分，术后87．3±9．3分；半月板部分切除成形组术前44．2±3．4分，术后80．4±6．3分；半月板全切除组术前44．3±3．4分，术后72．16±6．1分；关节镜下三种术式治疗半月板损伤疗效有统计学意义（P值均〈0．05）。三种治疗方法疗效差异有统计学意义（F=21．449，P〈0．05）。结论关节镜下治疗半月板损伤疗效显著．不同治疗方法之间疗效存在差异．半月板缝合疗效最佳。     

应用膝关节旋转半月板解剖型和固定半月板解剖型假体手术治疗膝退行性骨关节炎的临床分析

目的探讨应用膝关节旋转半月板解剖型和固定半月板解剖型假体治疗膝退行性骨关节炎的临床疗效。方法2009年2月—2013年1月选择在我院进行住院治疗的膝退行性骨关节炎患者132例,根据随机原则分为观察组与对照组各66例,行人工膝关节置换手术治疗,分别将旋转膝关节假体和固定膝关节假体进行人工植入固定,采用美国膝关节外科学会的评分系统(KSS)对患膝在术后当日与术后3个月进行膝关节评分和功能评分。结果所有患者都顺利完成手术,术中无严重并发症发生。随访3个月,观察组与对照组的总显效率分别为93.9%和80.3%,组间比较差异有统计学意义(P<0.05)。观察组的髌骨不稳、感染和下肢深静脉血栓形成等并发症发生率明显低于对照组,差异有统计学意义(P<0.05)。两组术后当天的膝关节评分和功能评分比较无统计学差异,术后3个月时评分都明显上升,同时评分在组内与组间比较有统计学差异(P<0.05)。结论人工膝关节置换手术治疗膝退行性骨关节炎有较好的预后,而旋转假体的应用能更加有效改善患膝屈伸活动和功能,疗效满意。     

创伤性膝关节脱位失稳性的临床诊治

目的探讨创伤性膝关节脱位失稳性的临床诊治。方法笔者随机选取2008年1月~2015年5月收治的80例创伤性膝关节脱位失稳性患者,依据膝关节脱位损伤类型及收治时间(伤后≥15d或15d)分两组,即新鲜损伤组(n=40)和陈旧损伤组(n=40)。应用浮髌试验、抽屉试验、CT、膝应力位X线检查等对两组患者的患膝进行检查,依据两组患者的实际病情给予单纯开放手术、单纯关节镜手术、开放手术联合关节镜手术、截肢、全膝关节置换等治疗。结果组内比较,两组患者治疗后的Lysholm膝关节评分均显著高于治疗前(P0.05);组间比较,治疗前两组患者的Lysholm膝关节评分之间的差异不显著(P0.05),治疗后新鲜损伤组患者的Lysholm膝关节评分显著高于陈旧损伤组(P0.05);新鲜损伤组患者膝关节功能恢复的优良率80.0%(32/40)显著高于陈旧损伤组45.0%(18/40,P0.05),术后不良反应发生率17.5%(7/40)低于陈旧损伤组32.5%(13/40,P0.05)。结论创伤性膝关节脱位失稳性的临床诊治宜早不宜晚,最好在15d内诊治。     

显露增强技术与股骨髁推顶技术在膝关节镜内侧半月板后角修复中应用

目的探讨应用显露增强技术与股骨髁推顶技术治疗膝关节半月板后角的临床疗效。方法选取北部战区空军医院自2016年1月至2019年6月收治的52例内侧半月板损伤患者为研究对象。应用半月板缝合系统,采用显露增强技术与股骨髁推顶技术修复内侧半月板后角水平撕裂,术后采用Lysholm评分系统进行疗效评价。结果患膝术后平均活动度为(131.5°±17.3°),显著大于术前的(114.2°±10.7°),差异有统计学意义(P<0.05);患者术后Lysholm评分为(85.3±7.1)分,显著高于术前的(65.9±9.3)分,差异有统计学意义(P<0.05)。所有患者均未出现关节内或浅表感染、下肢深静脉血栓等并发症。结论显露增强技术与股骨髁推顶技术修复内侧半月板后角疗效满意,有利于改善膝关节疼痛、活动度,增强残余半月板的稳定性。     

关节镜治疗儿童盘状半月板损伤32例体会

目的 探讨膝关节镜下手术治疗儿童膝关节盘状半月板损伤的疗效.方法 2005年1月～2008年1月,行膝关节镜下儿童盘状半月板损伤治疗32例(32膝),其中完全型21膝,不完全型11膝.根据术中情况分别予以盘状半月板部分切除成形术或完全切除术.结果 本组全部患者均获得12～20个月(平均14.5个月)随访,术后疗效根据I...     

前交叉韧带断裂合并内、外侧半月板后部复杂损伤的修复重建

目的：探讨前交叉韧带（anterior cruciate ligament,ACL）断裂合并内、外侧半月板后部复杂损伤修复的方法和疗效。方法：回顾性分析2016年10月～2019年10月本院收治的33例接受ACL重建手术的患者，且术中同时重建修复了外侧半月板后根部（LMPR）损伤及内侧半月板RAMP区（RAMP）损伤。根据术前患膝的轴移分度分为两组：低度轴移组25例，其中男18例、女7例，年龄16～41岁（平均26.6±8.19岁）；高度轴移组8例，其中男6例、女2例，年龄17～43岁（平均25.4±9.64岁）。记录两组的手术时间、术后并发症情况，术前、术后1年、术后2年的Lysholm膝关节评分、国际膝关节文献委员会（IKDC）评分以及术后2年的轴移分度和患膝MRI，评估ACL及内、外侧半月板后部损伤的愈合情况。结果：所有患者均获随访24～60个月（平均32.8±16.6个月）。手术时间为98±21.4 min。两组术后1年、术后2年的Lysholm膝关节评分、IKDC评分均显著优于术前（P均<0.001）。术前轴移分度：低度轴移组25例（1度15例，2度10例），高度轴移组...     

运动疗法联合臭氧治疗膝关节前交叉韧带损伤临床疗效

目的探讨运动疗法联合臭氧治疗膝关节前交叉韧带(ACL)损伤的临床疗效。方法选取自2016年1月至2018年3月中部战区总医院康复理疗科收治的160例膝ACL部分断裂患者为研究对象。根据治疗方法将患者分为联合治疗组、运动疗法组、臭氧治疗组、常规组,每组各40例。常规组患者入院后给予支具制动、局部理疗和常规康复锻炼等常规保守治疗。运动疗法组在常规组治疗基础上行运动疗法;臭氧治疗组在常规组治疗基础上行臭氧治疗;联合治疗组在常规组治疗基础上行运动疗法和臭氧治疗。治疗24周后,分别采取Lysholm膝关节评分系统、Tegner膝关节运动评分标准及Kneelax关节动度测量仪进行评分和测量,比较4组患者膝关节功能。结果联合治疗组Lysholm评分高于运动疗法组、臭氧治疗组及常规组,差异有统计学意义(P<0.05);运动疗法组Lysholm评分与常规组比较,差异有统计学意义(P<0.05);臭氧治疗组Lysholm评分与常规组比较,差异无统计学意义(P>0.05)。联合治疗组Tegner评分与常规组比较,差异有统计学意义(P<0.05);联合治疗组Tegner评分与运动疗法组和臭氧治疗组比较,差异均无统计学意义(P>0.05);运动疗法组Tegner评分与常规组比较,差异有统计学意义(P<0.05)。联合治疗组Kneelax测量值高于运动疗法组、臭氧治疗组及常规组,差异均有统计学意义(P<0.05);运动疗法组、臭氧治疗组Kneelax测量值与常规组比较,差异均无统计学意义(P>0.05)。结论运动疗法联合臭氧治疗膝关节ACL损伤有较好的治疗效果,可做为一种保守治疗方法开展应用。     

腘绳肌等速离心训练对前交叉韧带重建术后膝关节功能的影响

目的:观察腘绳肌等速离心训练(IEE)对前交叉韧带重建术后膝关节功能的影响。方法:将42例前交叉韧带(ACL)重建术后患者随机分为对照组(n=21)和治疗组(n=21)。两组患者均分阶段给予常规康复干预,治疗组在此基础上于术后1个月开始使用Biodex等速训练系统进行一周2次的腘绳肌等速离心训练。两组患者于术后1个月和4个月时采用该等速测试系统在60°/s角速度下对患肢进行向心屈、伸膝峰力矩值(PT)、腘绳肌与股四头肌肌力比率(H/Q比率)及屈膝相对峰力矩(PT/BW)的测定,并用量角器对患肢进行主动伸膝角度(AAKE)测定以及采用Lysholm膝关节评分量表(LKSS)对膝关节功能进行评定(AAKE与LKSS评分统计不区分性别)。结果:术后第1个月,治疗组进行腘绳肌等速离心训练前,两组患者患侧膝关节的屈膝PT、H/Q比率、屈膝PT/BW、AAKE以及LKSS评分差异均无统计学意义。术后第4个月,除对照组H/Q比值没有明显改变外,两组患者的其余各项数据均明显优于组内术后第1个月评定所得的数据,差异有统计学意义(P<0.01);治疗组各项数据均优于对照组,差异有统计学意义(P<0.05),其中以治疗组H/Q比值及屈膝PT/BW增大最为明显(P<0.01)。结论:腘绳肌等速离心训练能进一步改善前交叉韧带重建术后的主动伸膝角度,增加屈膝肌力并提高膝关节功能。     

关节镜下半月板切除术与成形缝合术治疗盘状半月板损伤的临床对比研究

将收治的67例盘状半月板损伤患者分为两组,成形组32例采用关节镜下成形缝合术,切除组35例采用关节镜下全切除术,对比两组手术前后Lysholm评分、活动度、国际膝关节评分委员会(IKDC)评分。认为关节镜下半月板切除术与成形缝合术均能改善患者临床症状及膝关节功能,成形缝合术疗效优于全切除术。     

后侧入路手术治疗胫骨平台后柱骨折效果及影响因素分析

回顾性分析2008年1月~2014年1月收治的138例采用后侧入路手术治疗胫骨平台后柱骨折患者临床资料,定期随访骨折愈合情况、膝关节功能恢复情况,并根据不同膝关节功能评分分析骨折愈合的影响因素。138例骨折均愈合,未发生伤口感染、内固定失效等情况。末次随访Lysholm评分的优良率为85.51%、美国纽约特种外科医院(HSS)评分的优良率为86.96%;年龄≤50岁的患者优良率显著高于50岁的患者(P0.05);未合并半月板损伤的患者膝关节功能优良率显著高于合并半月板损伤的患者(P0.05)。后侧入路手术治疗胫骨平台后柱骨折具有较好的临床疗效,同时患者的年龄、骨折类型、是否合并半月板损伤会对患者骨折后膝关节功能产生一定的影响。     

Dealing with cancer--conversations with radiotherapy patients

Thirty in-patients treated by radiotherapy were questioned in qualitative interviews about the information they had received from the physicians and their way to deal with the disease and the physicians. Furthermore 18 persons out of this group were accompanied continuously. The confidential relationships between the patients and the author of the study brought about spontaneous conversations showing some new aspects of the way to experience disease and therapy. Despite a poor prognosis and an initially insufficient information, the patients formulated their questions openly. Generally they desired a clearer communication. They criticized above all the lack of information and attention from the physicians. A need for confidence, frankness, and the conveyance of a justified hope was expressed. The physician's stress and resulting lack of time was complained of. During the time of accompanying which lasted several weeks, it became evident that information means a way to deal with the disease to which the patient can make his individual contribution. The majority of questions as well as emotional reactions as fear or depression came from those patients who seemed to be quiet persons.     

Radiochemotherapy with temozolomide for patients with glioblastoma

Background

The objective of this retrospective analysis was to assess long-term outcome and prognostic factors of unselected patients treated for glioblastoma (GB) at a single center with surgery, standard radiotherapy (RT), and concomitant temozolomide (TMZ). From 1999?C2005, the institutional protocol included surgery and RT with TMZ. From 2005 on, adjuvant TMZ was routinely added.

Patients and Methods

Between April 1999 and September 2009, 181 patients with GB were treated with RT (60 Gy in 30 fractions) and concomitant TMZ (75 mg/m²/day throughout RT). Biopsy only had been performed in 53 patients (29.3%), 128 patients (70.7%) had undergone resection, which was complete based on postoperative MRI in 51 patients (28.2%). Adjuvant TMZ was applied in 67 of 181 patients (37%).

Results

Median overall survival (OS) and progression-free survival (PFS) were 15.0 (95% CI, 13.1?C16.8) and 7.2 months (95% CI, 5.9?C8.5), respectively. After complete resection, partial/subtotal resection and biopsy, median OS was 23.20, 14.75, and 7.89 months (p < 0.001), respectively. In multivariate Cox proportional hazards regression models, extent of resection (p < 0.0001), Karnofsky??s performance score (p < 0.0001) and adjuvant TMZ (p = 0.001) were significant independent prognostic factors for OS. RT with concomitant TMZ was well tolerated in the majority of patients and could be completed as scheduled in 146 patients (80.7%), while 11 patients (6.1%) discontinued RT. Another 35 patients (19.3%) interrupted concomitant chemotherapy.

Conclusion

RT with concomitant TMZ is a feasible regimen with acceptable toxicity in routine practice. Our data are compatible with a beneficial effect of adjuvant TMZ on OS and PFS.     

湿润烧伤膏与手术联合治疗褥疮的护理

目的 :减少溃疡期褥疮的术前准备时间 ,缩短褥疮的总病程。方法 :将 1996年 5月至 2 0 0 2年 5月收住院的 4 2例溃疡期褥疮病人按随机原则分为 2组 ,2 1例术前用湿润烧伤膏纱换药处理 ,为A组 (试验组 ) ;2 1例用庆大霉素紫草油纱布换药处理 ,为B组 (对照组 )。 2组病例的年龄、性别、发病原因、病灶部位、病灶范围等经统计学处理 ,无显著性差别 ,有可比性。两组病人均换药至创面新鲜行皮瓣转移手术 ;比较两组平均术前换药时间 ,及换药 +手术的总住院日。术前术后两组患者均运用护理程序施行整体护理。结果 :A组术前平均换药时间为 8 4 9± 2 2 3天 ,B组为 15 6 0± 6 70天 ;A组平均治愈时间为 2 0 5 0± 4 81天 ,B组为 35 31± 7 70天。结论 :湿润烧伤膏换药与庆大霉素紫草油纱布换药比较 ,前者可明显缩短褥疮手术的术前准备时间及病人的总住院天数。     

Bronchogenic carcinoma: staging with MR compared with staging with CT and surgery

Thirty-three patients suspected of having bronchogenic carcinoma were studied prospectively using magnetic resonance (MR). In this group, 30 underwent examination with computed tomography (CT), 15 underwent thoracotomy, six had mediastinal biopsy procedures performed, and eight underwent bronchoscopy. MR studies, which included transaxial spin-echo imaging (TR, 0.5 and 2.0 sec; TE, 28 and 56 msec) of all patients and sagittal or coronal imaging of 18, were performed without knowledge of CT findings, using only plain radiographs as a guide. CT and MR studies were interpreted separately. CT and MR provided comparable information regarding the presence and size of mediastinal lymph nodes. MR better discriminated mediastinal nodes from vascular structures. However, in two of 11 patients who had multiple mediastinal lymph nodes that were normal in size at CT examination and surgery, MR suggested a confluent abnormal mass, probably because of its poorer spatial resolution. MR was superior to CT in showing enlarged hilar lymph nodes, but CT was better for demonstrating bronchial abnormalities. In three of four patients who had a proved hilar mass with distal obstructive pneumonia, MR (TR, 2.0 sec) helped distinguish between the mass and collapsed lung.     

臭氧治疗船员下肢损伤89例

2006年10月至2007年4月,我科采用引进的德国赫尔曼Medozon型臭氧发生装置系统产生的臭氧治疗船员下肢损伤89例,疗效满意.现报告如下.     

Tumor Burden Assessment with Positron Emission Tomography with

Objective: In patients with advanced cancer, total tumor burden affects the likelihood of tumor response and has important implications for prognosis. The aim of this study was to select the optimum 2-[F-18]fluoro-2-deoxy-D-glucose-positron emission tomography (FDG PET) tumor uptake parameter to accurately measure tumor burden in advanced metastatic renal cell cancer, in comparison with volumes measured with computed tomography (CT), as a reference test.Materials and Methods: Six patients with metastatic renal cell carcinoma measurable on CT were studied. CT and FDG PET scans were carried out on all patients within 4 weeks prior to their entry into a phase I-II radioimmunotherapy trial. CT-based evaluation of disease extent (tumor volume) and 4 PET-based measurements (standardized uptake value[SUVmax], SUVav, volume, and total lesion glycolysis [TLG]) were performed independently by a radiologist (VN) and a nuclear medicine physician (TA). The degree of correlation between conventional (CT) extent of disease and parameters describing tumor concentration of FDG was then determined.Results: Fifty-seven CT-measurable metastatic lesions in lung, abdomen, and scalp were evaluated in 6 patients. There was a high correlation between CT and FDG PET volume estimates for lesions greater than 5 cm(3) in size. However, a PET-derived parameter that embodies both FDG uptake and lesion size, the TLG, correlated better with CT-derived tumor volume than did FDG PET volume alone.Conclusion: Using CT volume as a gold standard, the optimal PET-based estimate of total tumor burden in patients with metastatic renal cancer is the sum over all lesions of the total lesion glycolysis.     

MEBO药纱门诊治疗烧(烫)伤71例的体会

作者报道用MEBO药纱敷盖门诊治疗烧（烫）伤71例，均获治愈。经随访1年，深Ⅱ度创面疤痕发生率为15％（3／20），浅Ⅲ度创面疤痕发生率为38．9％（7／18）。     

多虑平、雷尼替丁治疗消化性溃疡81例临床观察

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