关节镜下灌洗清理术治疗老年膝关节骨关节病83例

目的:观察关节镜下灌洗清理术治疗老年膝关节骨关节病的临床效果.方法:选择非手术治疗效果欠佳的老年膝关节骨关节病患者83例(96膝),男39例(7例为双侧膝关节),女44例(6例为双侧膝关节);年龄62～78岁.膝关节退行性关节炎根据Schvn-holtz评估法分为Ⅰ度21例,Ⅱ度57例,Ⅲ度18例.对所有患者行关节镜下灌洗清理术.结果:Schvn-hohz评估法Ⅰ、Ⅱ、Ⅲ度手术治疗优良率分别为80.9%、75.4%、33.3%.Ⅰ、Ⅱ度患者手术治疗优良率明显高于Ⅲ度患者(P<0.05),Ⅰ度患者手术治疗优良率高于Ⅱ度患者(P<0.05).结论:关节镜检有利于膝关节骨关节病的早期诊断,镜下灌洗清理术对老年早期(Ⅰ、Ⅱ度)膝关节骨关节病有良好疗效,对于Ⅲ度关节软骨退行性变者疗效不理想.     

关节注射联合关节镜治疗骨性关节炎的临床体会

目的:探讨关节镜清理术联合药物关节内注射治疗膝关节骨性关节炎的效果作用,以及对比得宝松和罗哌卡因辅助治疗膝骨性关节炎的镇痛和关节功能改善的效果。方法:收集2011年6月~2014年6月住院及门诊膝骨关节炎病人129例,筛选出纳入标准的90人分为3组,每组30人。Ⅰ组行关节镜清理术;Ⅱ组行关节镜清理术并联合注射玻璃酸钠;Ⅲ组行关节镜清理术并联合注射玻璃酸钠、得宝松和罗哌卡因。综合评定疼痛程度及治疗有效率。Ⅰ和Ⅱ组对比,Ⅱ和Ⅲ组进行对比。结果:60天内,3组疗效比较,P0.05,疗效有统计学差异。60d后,组Ⅰ与组Ⅱ、组Ⅲ疗效比较,P0.05,疗效有统计学差异;组Ⅱ与组Ⅲ疗效比较,P0.05,疗效无统计学差异。6个月后,组Ⅰ的治疗优良率为60.0%,有效率为76.7%;组Ⅱ的治疗优良率为76.7%,有效率为90.0%;组Ⅲ的治疗优良率为83.3%,有效率为93.3%。结论:关节镜清理配合得宝松和罗哌卡因治疗效果最为显著,单独运用膝关节镜清理治疗早期骨关节炎是不可取的。     

关节镜下骨髓间充质干细胞复合纤维蛋白封闭剂治疗膝关节软骨缺损

目的:比较关节镜下关节清理术联合注射骨髓间充质干细胞复合纤维蛋白封闭剂与关节清理灌洗术治疗膝关节软骨全层缺损的临床疗效。方法:对2002年1月-2005年5月膝关节全层软骨缺损患者,分别行膝关节镜下关节清理术联合注射骨髓间充质干细胞复合纤维蛋白封闭剂(实验组24例)与关节清理灌洗术(对照组21例),根据临床症状及Tenner运动评级判定疗效,随访观察6~24个月。结果:关节镜下关节清理术联合注射骨髓间充质干细胞复合纤维蛋白封闭剂总有效率91.7%,关节清理灌洗术总有效率66.7%,组间比较有统计学意义(P<0.05)。结论:关节镜下关节清理术联合注射骨髓间充质干细胞复合纤维蛋白封闭剂治疗膝关节软骨全层缺损优于关节清理灌洗术。     

关节镜清理联合局部应用万古霉素治疗17例膝关节革兰阳性菌感染疗效观察

目的:探讨关节镜下彻底清理联合关节内放置万古霉素治疗膝关节革兰阳性菌感染疗效.方法 :回顾性分析膝关节革兰阳性菌感染患者17例,均采用关节镜清理结合关节内放置万古霉素进行治疗,一期闭合手术切口,术后不置管进行灌洗,配合术后康复锻炼综合治疗.结果 :所有患者随访6~32个月,15例患者感染症状消失,2例患者进行了第2次关节镜手术,术后感染得到良好控制;在随访期间所有患者均无复发感染迹象.结论 :关节镜下彻底清理联合关节内放置万古霉素治疗膝关节革兰阳性菌感染,效果明显,疗效确切,有创伤小、药物局部应用毒副作用小、安全可靠、恢复快等优点.     

磁共振成像对老年膝关节退行性骨关节病的诊断探究

目的探讨磁共振成像在老年膝关节退行性骨关节病中的临床诊断价值。方法选取85例老年膝关节退行性骨关节病患者,采用西门子Emotion16CT,GE HDxt1.5T磁共振成像扫描仪进行检查,根据磁共振成像表现对患者半月板病变部位进行评估分级,总结磁共振成像的特征性表现。结果半月板病变分级结果为Ⅰ级14例(16.5%)、Ⅱ级42例(49.4%)、Ⅲ级29例(34.1%);特征性表现为关节骨质增生(骨赘37例,囊肿66例)、韧带改变(11例前后交叉韧带损伤)、关节游离体(6例)、关节腔积液(髌上囊积液67例)。结论 1.5T磁共振成像可以为老年膝关节退行性骨关节病的损伤分级及解剖结构提供直接影像依据,诊断价值较高。     

膝关节骨关节病的临床护理观察

目的探讨膝关节骨关节病的临床护理措施。方法回顾分析55例患者的临床资料。结果本组患者均手术均手术成功,护理效果满意。无创伤性膝关节炎和膝关节内翻、外翻畸形。膝、踝关节功能正常。术后患者生活能够自理并能基本恢复正常工作。根据Rasmussen评分,55例患者中,优:47例,良8例,优良率100%。结论关节镜治疗关节骨关节病配合围术期精心护理,可明显改善膝关节功能,且没有并发症发生,术后患者生活质量大大提高。     

关节镜手术与保守治疗对膝关节骨关节病的临床疗效对比

目的探究治疗膝关节骨关节病过程中采取关节镜手术与保守治疗的临床疗效对比。方法选取本院2016年1月至2017年1月所收治的膝关节骨关节病患者120例,将这些患者分为观察组和对照组,每组60例,对照组患者实施保守治疗方案,观察组患者实施关节镜手术治疗,比较两组患者临床疗效及关节功能情况。结果观察组患者临床治疗总有效率高于对照组患者,术后膝关节功能恢复情况优于对照组患者,比较具有统计学意义(P<0.05)。结论对膝关节骨关节病患者治疗过程中实施关节镜手术临床治疗效果显著,复发率低,促进了患者膝关节功能恢复,该方法值得被临床推广使用。     

关节镜下清理并置管冲洗治疗膝关节化脓性关节炎27例

目的 探讨关节镜下清理及术后大流量持续冲洗治疗膝关节化脓性关节炎的效果.方法 我科2007年9月-2011年10月采用关节镜下清理及术后持续大流量冲洗治疗膝关节化脓性关节炎27例(29膝).结果 本组26例(28膝)获得随访,1例失访,随访时间6～36个月.获随访患者关节感染均治愈,无复发,无切口感染等手术并发症;手术后平均住院日10 d;术后6个月采用Lysholm评分标准评定疗效:优20例(21膝),良5例(6膝),差1例(1膝),优良率为96.43%.结论 采用关节镜下清理及术后持续冲洗治疗膝关节化脓性关节炎具有损伤小、清理彻底、治疗时间短、并发症少等优点,是一种理想的治疗方法.     

人工膝关节置换治疗重度膝关节退行性骨关节病

目的 分析并探讨人工膝关节置换术治疗重度膝关节退行性骨关节病的临床疗效.方法 回顾性分析我院采用全膝关节置换术治疗的重度膝关节退行性骨关节病患者的临床资料.结果 本组全部患者术后均获得3个月至5年随访,平均随访15.8个月.术前12例患者下肢力线不正均>10°,术后仅见1例>5°.本组置换后关节的疼痛程度、关节功能以及活动度等指标均有显著改善.全部患者均可独立完成坐起动作、独立行走以及上下楼梯运动.结论 人工膝关节置换手术在治疗重度膝关节退行性骨关节病方面疗效理想,值得临床广泛推广.     

关节镜手术在膝关节骨关节病中的临床疗效

目的：对关节镜技术在膝关节骨关节病中的临床疗效进行评价,为早期全面诊断膝关节骨关节病并为其治疗提供依据。方法收集67例膝关节骨关节患者病例资料,通过对关节镜术手术前后的检查,从关节内滑膜、炎症、髌股关节、软骨、增生骨赘程度与部位、半月板及其附件结构改变方面的功能进行评价。结果关节镜手术可以全面诊断膝关节骨关节病,术后在膝关节骨关节病中的疼痛、肿胀、活动度三方面明显改善。结论关节镜手术创伤小、疗效好、恢复快,为早期全面诊断膝关节骨关节病并为其治疗提供依据。     

Degraded and undegraded carrageenans and experimental gastric and duodenal ulceration

The prevention of histamine-induced gastric and duodenal ulceration in the guinea-pig has been examined using a series of undegraded and degraded carrageenans. Undegraded carrageenans were active at lower doses than degraded carrageenans. The high viscosity of the undegraded carrageenans in solution prevented their use in larger doses. Degradation of carrageenan without serious loss of sulphate, gives a product which allows the dose to be increased to an extent that its effect more than offsets the slight loss in activity caused by the degradation. No single feature of carrageenan structure can be related to anti-ulcer activity although degradation, and hence reduction of molecular size, generally reduces activity. Sulphate contents over 30% have little apparent effect on activity; κ-carrageenans were not consistently different in anti-ulcer activity from Λ-carrageenans. This contrasts with the antipeptic activity of carrageenans where κ-carrageenans are less active than their Λ-counter-parts. As with antipeptic activity, the degree of anti-ulcer activity is probably determined by a combination of structural features which includes molecular size and polyanionic properties.     

Affective and Anxiety Disorders and Alcohol and Drug Dependence:

Depression and anxiety frequently coexist in patients with substance use disorders. This clinically-oriented article examiens the relationship between these conditions and emphasizes data showing that substances of abuse can cause signs and symptoms of both depression and anxiety. These substance-related syndromes appear to have a different course and prognosis than uncomplicated, independent anxiety and major depressive disorders, and clinicians should consider the role of alcohol and other drugs in all patients presenting with these complaints. The authors will also outline an approach for diagnosing and managing patients with the combination of a substance use and depressive or anxiety disorder.     

Alcohol and Substance Use and Abuse in Women and Children

No abstract available for this article.     

Excretion and biotransformation of alfentanil and sufentanil in rats and dogs

The excretion and biotransformation of alfentanil (ALF) and sufentanil (SUF), two recent analogues of the synthetic opioid fentanyl, were studied after single iv administration of the tritium-labeled drugs in male rats and dogs. The drugs were almost completely metabolized in the two species, which resulted in a large number of metabolites. The excretion of the metabolites was rapid and exceeded 95% within 4 days, except for that of ALF metabolites in dogs (about 85%). For ALF, excretion of the radioactivity with the urine (73% in rats, about 76% in dogs) exceeded that with the feces. For SUF, excretion of the radioactivity with the urine amounted to 38 and 60% and that with the feces to 62 and 40%, in rats and dogs, respectively. Bile-cannulated rats excreted 68% with the bile within 24 hr after SUF dosing, and about 22% of this biliary radioactivity was subjected to enterohepatic circulation. After an ALF dose, the biliary excretion amounted to 24%, and the enterohepatic circulation was minimal. The main metabolic pathways of the two drugs were the oxidative N-dealkylation at the piperidine nitrogen and at the amide nitrogen, oxidative O-demethylation, aromatic hydroxylation, and the formation of ether glucuronides. N-[4-(Hydroxymethyl)-4-piperidinyl]-N-phenylpropanamide (M6) was the main metabolite of both ALF and SUF in rats. In dogs, the glucuronide of N-(4-hydroxyphenyl)propanamide (M5) was the main metabolite of ALF. After SUF dosing in dogs, N-[4-(methoxymethyl)-4-piperidinyl]-N-phenylpropanamide was more abundant than M5.