类风湿关节炎膝关节置换后深静脉血栓发生情况及溶栓效果研究

[目的]探讨类风湿关节炎患者行全膝关节置换术后深静脉血栓的发病率及溶栓效果研究。[方法]2009年2月～2011年5月手术治疗类风湿关节炎24例,其中男性4例,女性20例;年龄29～74岁,平均58.2岁。双膝关节置换术6例(分两次手术),6例行左膝关节置换术,12例行右膝关节置换术。全膝关节置换术后行下肢深静脉造影诊断是否有深静脉血栓形成,术后深静脉血栓形成患者使用系统性溶栓治疗。[结果]深静脉造影术后,类风湿关节炎行全膝置换术后深静脉发生率为26.7%;系统性溶栓后,临床有效率为100%。分别在术后3、6个月随访两次。[结论]类风湿关节炎行全膝关节置换术后深静脉血栓发生率不低,值得在今后的临床工作中注意;下肢深静脉造影是关节置换术后诊断深静脉血栓形成的必要手段。     

类风湿足治疗进展

类风湿性关节炎是一类广泛累及足踝部的系统性疾病,严重影响患者生活质量。对类风湿足的治疗旨在控制症状,改善功能,保留行走能力,以提高患者生活质量。早期患者可应用矫形支具、抗类风湿药物等方法改善症状,延缓病程发展。病程持续发展及保守治疗无效患者必须接受手术治疗,常经截骨术、关节成形术、关节融合术等纠正足趾畸形、稳定力线、改善行走功能。中足受累临床表现不明显,常无需手术治疗;对严重的中足及后足畸形,常采用关节融合术,可取得较好效果。根据患者不同个体情况及需要选择合适的手术是取得良好疗效的关键。该文就类风湿足的治疗进展作一综述。     

类风湿足治疗进展

类风湿性关节炎是一类广泛累及足踝部的系统性疾病,严重影响患者生活质量.对类风湿足的治疗旨在控制症状,改善功能,保留行走能力.以提高患者生活质量.早期患者可应用矫形支具、抗类风湿药物等方法改善症状,延缓病程发展.病程持续发展及保守治疗无效患者必须接受手术治疗,常经截骨术、关节成形术、关节融合术等纠正足趾畸形、稳定力线、改善行走功能.中足受累临床表现不明显,常无需手术治疗;对严重的中足及后足畸形,常采用关节融合术,可取得较好效果.根据患者不同个体情况及需要选择合适的手术是取得良好疗效的关键.该文就类风湿足的治疗进展作一综述.     

全膝关节置换术治疗类风湿关节炎的手术要点与围手术期处理体会

目的 总结全膝关节置换术治疗类风湿关节炎的手术要点及围手术期处理体会。方法 回顾性分析自2016-09—2022-05采用全膝关节置换术治疗的38例类风湿关节炎,探讨围手术期诊疗方法（预防肾上腺危象、抗类风湿治疗、抗凝、抗骨质疏松）及术中注意事项。结果 38例均获得随访,随访时间6～42个月,平均24.2个月。4例于术后7～10 d出现切口渗出、切口周围红肿,细菌培养为阴性,监测炎性指标逐渐下降,复查发现白蛋白偏低,给予输白蛋白以纠正低蛋白血症,加强换药同时嘱患者加强营养,延长抗生素应用时间至症状消失后的第3天。随访期间均未出现肾上腺危象、感染及假体周围骨折、假体松动情况。末次随访膝关节活动度、膝关节HSS评分均较术前明显增加,差异有统计学意义（P<0.05）。结论 全膝关节置换术治疗晚期类风湿关节炎应做好围手术期准备工作,不仅能有效降低肾上腺危象、假体松动、术后感染的发生率,而且能减轻患者关节疼痛、改善关节功能。     

高龄膝骨关节炎患者人工单髁关节置换疗效分析

目的:探讨75岁以上膝骨性关节炎患者行人工单髁关节置换术后临床疗效。方法：自2010年4月至2015年5月应用Oxford第3代人工单髁关节治疗膝内侧间室骨性关节炎患者42例,根据手术单双侧置换情况将患者分为双侧同期置换组和单侧置换组：同期置换组11例,男3例,女8例,年龄（79.18±3.06）岁;单侧置换组31例,男13例,女18例,年龄（78.16±3.48）岁。观察比较患者患膝假体生存现状、术前后血细胞比容变化、术中及术后的失血总量,比较患者术前后膝关节HSS（Hospital for Special Surgery knee-rating）评分。结果：两组术后围手术期并发症比较差异有统计学意义（P<0.05）。42例患者获得随访,时间（5.7±2.3）年。1例既往高血压合病史患者术后第4个月发生脑血栓,1例患者在术后第4个月发生衬垫脱位,2例患者于术后3年因其他内科疾病死亡（1例心肌梗塞,1例肺癌）。双侧同期置换组术后失血总量高于单侧置换组（P<0.05）;4例行双侧同期置换患者术后分别输血2 U。两组术后9个月HSS评分除稳定性评分其他各项评分和总分均高于术前（P<0.05）。结论：内侧单间室退变的75岁以上老年骨性关节炎患者选择人工单髁关节置换术是可行的手术治疗方法。对于双膝病变75岁以上老年患者,双侧同期人工单髁关节置换术同单侧单髁关节置换手术相比,创伤大,会增加围手术期并发症发生率,影响术后快速康复,增加失血量。虽然远期疗效同单侧单髁关节置换手术相当,但为保证手术安全性,仍建议分期手术。     

掌指关节置换术治疗类风湿关节炎

目的 探讨应用掌指关节置换术治疗类风湿关节炎的方法和临床疗效.方法 2002年1月-2007年1月,对8例13指类风湿关节炎的患者,采用Swanson假体行掌指关节置换术.结果 术后伤口均Ⅰ期愈合,随访时间为9～24个月,平均15.8个月.掌指关节置换后按李庆泰等的疗效评定标准评价:优9指,良4指.结论 掌指关节置换术治疗类风湿关节炎疗效可靠,是一种较好的治疗方法.     

血友病性关节炎关节置换术后个性化预防血栓治疗的临床观察

目的 :观察血友病性关节炎关节置换术后个性化预防血栓治疗的临床意义。方法 :自2005年9月至2013年10月,11例甲型血友病性关节炎患者行关节置换术,共手术14次,其中包括1例双膝计1次,左膝6次,右膝5次,髋关节2次。11例均为男性,年龄23~57岁,平均(36.1±11.0)岁,平均体重(64.1±8.9)kg。术前结合影像学和实验室检查准确诊断和分型,评估关节功能和术后静脉血栓栓塞出现的风险,围手术期动态监测患者FactorⅧ∶C、血常规和凝血功能。结合术前风险评估,术后根据检测结果个性化调整替代药物重组人凝血因子Ⅷ(拜科奇)剂量进行预防血栓治疗,观察患者血栓发病率。同时将患者分为术后远端关节活动组和非活动组,观察记录两组患者的凝血类各项指标和出院时间。结果:根据术后FactorⅧ∶C,凝血类和血常规检查动态调整替代疗法预防血栓,纳入研究11例均未发生术后深静脉血栓或肺栓塞。早期指导肢体远端关节活动患者术后短期内APTT高于非活动组,D-2聚体低于非活动组,术后出院时间短于非活动组。结论:血友病性关节炎关节置换术后由于自身凝血功能障碍易发生出血,但并不意味着此类患者无术后血栓形成风险,根据动态检测调整替代药物剂量,完成个性化术后预防血栓、止血和凝血因子代替治疗的平衡,同时配合术后肢体远端功能,可以大大降低血栓风险,并且缩短出院时间。     

双踝胫距关节新鲜异体骨软骨移植术

对于经常活动的年轻患者来说,胫距关节炎的治疗选择方案是很有限的。尽管关节融合术的临床效果可以接受,但存在功能缺失、步态改变以及周围关节出现远期并发症等缺陷：而关节置换术则通常适用于那些年龄更大、活动水平不高的个体;全踝关节置换术即使采用严格的选择标准,其临床效果也是报道各异。本研究旨在评估双踝胫距关节新鲜异体骨软骨移植术治疗进展性胫距关节炎的临床以及影像学结果。     

类风湿关节炎治疗中物理疗法的意义及运用

类风湿关节炎治疗方法主要包括药物治疗、功能锻炼、物理治疗、手术治疗。国内外学者均强调非药物治疗的重要性,综述类风湿关节炎患者物理疗法现状及运用进展,以期为今后临床开展类风湿关节炎物理疗法提供思路和依据。     

人工膝关节单髁关节置换术研究进展

单髁关节置换术治疗单间室骨关节炎近些年取得很大进展,引起越来越多的关注.文中综述了近年来最新的研究进展.研究表明经严格的病例选择,单髁关节置换术10年生存率达95%左右.术后关节功能好,并发症少,具有损伤小、恢复快、费用低、保存骨量等优点,是治疗单间室关节炎值得考虑的手术选择.     

掌指关节置换术治疗类风湿关节炎尺偏畸形的疗效

目的总结掌指关节置换术治疗类风湿关节炎(RA)尺偏畸形的临床疗效。方法对40例RA尺偏畸形患者采用Swanson假体掌指关节置换术。评价患者术后尺偏角度、握力、关节活动度及关节功能等指标。结果患者切口均一期愈合,无感染或坏死等早期并发症。患者均获得随访,时间4~6个月。术后3个月,尺偏角度明显纠正,掌指关节活动度及握力明显增加,MHQ评分、AIMS2评分明显改善,各项指标与术前比较差异均有统计学意义(P<0.05)。无假体断裂、脱位及假体周围骨折等并发症。结论掌指关节置换术治疗RA尺偏畸形安全有效,可有效改善手的外观,减轻疼痛,改善关节功能。     

人工跖趾关节置换的临床应用

目的：总结应用跖趾关节置换手术治疗足部疾患的临床经验,评价手术治疗效果。方法：自2009年3月至2011年6月,我科共有8例足部疾患的患者接受跖趾关节置换手术治疗,其间Freiberg病患者5例（5足）,合并躅外翻1例;第1跖趾关节骨性关节炎患者2例（2足）;第1跖趾关节创伤性关节炎患者1例（1足）。均应用Swanson人工关节假体实施跖趾关节置换手术治疗。采用美国足踝外科协会AOFAS评分系统对手术前后疼痛、行走、穿鞋及跖趾关节活动度等进行临床评价。结果：随访时间3～25个月,平均13．4个月。所有病例术后关节疼痛明显改善,活动度改善。通过AOFAS评分评定,所有患者术后较术前有明显改善。结论：Swanson人工跖趾关节置换术治疗足部疾患近期疗效满意,能明显改善关节活动度及疼痛,是一种较为可行的术式。     

人工跖趾关节置换的临床应用

目的总结应用跖趾关节置换手术治疗足部疾患的临床经验,评价手术治疗效果。方法自2011年3月至2012年6月,我科共有52例足部疾患患者接受跖趾关节置换手术治疗,其间Freiberg病患者28例（35足）,合并腮外翻15例（16足）;第1跖趾关节骨关节炎患者18例（20足）;跖趾关节创伤性关节炎患者6例（6足）。均应用Swanson人工关节假体实施跖趾关节置换手术治疗。采用美国足踝外科协会评分系统对手术前后疼痛、行走、穿鞋及跖趾关节活动度等进行临床评价。结果随访时间3—25个月,平均13．4个月。所有病例术后关节疼痛明显改善,活动度改善。通过AOFAS评分评定,所有患者术后较术前有明显改善。结论Swanson人工跖趾关节置换术治疗足部疾患近期疗效满意,能明显改善关节活动度及疼痛,是一种较为可行的术式。     

Early outcomes and complications following joint arthroplasty in obese patients: a review of the published reports

The incidence of obesity and the number of hip arthroplasties being carried out in Australia each year are significantly increasing. There is an overrepresentation of obesity among patients presenting for elective orthopaedic surgery. The aim of this study was to present a review of published works reporting on obesity and joint replacement surgery in terms of early clinical, functional and quality-of-life outcomes. We conducted a metasearch of databases, including PubMed, Web of Science and The Cochrane Library, from January 1990 to May 2007. Studies published in English with a primary intention of exploring the relationship between obesity and joint arthroplasty were reviewed and results summarized. Key issues identified in relation to obesity and joint replacement surgery included clinical outcomes and complications, functional and quality of life and the influence of arthroplasty surgery on the management of obesity. Reports on early outcomes, that is in the first 12 months following joint replacement surgery, were included in the review. Results for these three key issues were summarized and reported separately. There is evidence in the published reports to support a correlation between obesity and complications following joint replacement surgery. Obesity has been found to be a specific risk factor for joint infection. Research on early functional and quality-of-life data as well as on the influence arthroplasty surgery has on weight management is lacking, and few conclusions can be drawn from the published reports. A study of significant size that examines all three issues in conjunction would be of value in identifying patients at high risk of failure in terms of both clinical and quality-of-life perspectives.     

Role of pulsed electromagnetic fields after joint replacements

Although the rate of patients reporting satisfaction is generally high after joint replacement surgery, up to 23% after total hip replacement and 34% after total knee arthroplasty of treated subjects report discomfort or pain 1 year after surgery. Moreover, chronic or subacute inflammation is reported in some cases even a long time after surgery. Another open and debated issue in prosthetic surgery is implant survivorship, especially when related to good prosthesis bone ingrowth. Pulsed Electro Magnetic Fields(PEMFs) treatment, although initially recommended after total joint replacement to promote bone ingrowth and to reduce inflammation and pain, is not currently part of usual clinical practice. The purpose of this review was to analyze existing literature on PEMFs effects in joint replacement surgery and to report results of clinical studies and current indications. We selected all currently available prospective studies or RCT on the use of PEMFs in total joint replacement with the purpose of investigating effects of PEMFs on recovery, pain relief and patients' satisfaction following hip, knee or shoulder arthroplasty. All the studies analyzed reported no adverse effects, and good patient compliance to the treatment. The available literature shows that early control of joint inflammation process in the first days after surgery through the use of PEMFs should be considered an effective completion of the surgical procedure to improve the patient's functional recovery.     

MIS unicondylar knee arthroplasty: surgical approach and early results

Unicondylar arthroplasty of the knee has seen a resurgence of interest in the United States. The principles of unicondylar arthroplasty of the knee are different from those for total knee arthroplasty, allowing replacement of only the affected joint compartment with less bone loss. Minimally invasive surgery allows for less soft tissue dissection with the potential for less morbidity. The key question is: will the changes associated with the minimally invasive surgery procedure improve the clinical results of the standard unicondylar arthroplasty of the knee or will the changes make the procedure too difficult and lead to an increasing failure rate? This study reviews the surgical technique and presents the 2 to 4 year results of the minimally invasive unicondylar arthroplasty of the knee 47 knees in 41 patients. The average range of motion increased from 121 degrees -132 degrees . The Knee Society pain score improved from 45-80 and the function score improved from 47-78. Only one knee has been revised. With proper patient selection, minimally invasive unicondylar arthroplasty of the knee allows for results that are at least equal to those of the standard open procedure at 2 to 4 years after the surgery.     

Studies of host response to orthopedic implants and biomaterials.

The use of implanted biomaterials in orthopedic surgery has increased rapidly during the past two decades. Total joint replacement of the hip or knee joint has become common treatment; at the same time, an increasing number of fractures are treated with osteosynthesis. The original Charnley low-friction arthroplasty of the hip is still widely used and gives in large series excellent results. Aseptic loosening of this arthroplasty has been thought to be due to wear debris of the methylmethacrylate used for fixation of the implants, or to debris generated from wear of the polyethylene socket. To date, many different materials have been tried in order to reduce wear and generation of macrophage irritating submicron sized particles, or to provide more biocompatible components. However, trials to improve the methylmethacrylate cement or to invent better polyethylenes have often failed. Diamond coating of the metallic components seems promising: there is less wear and diamond is very biocompatible in bulk and small particulate form. Biodegradable implants have also been found useful in treating fractures. Bioactive bioabsorbable materials may also make possible a tissue engineering approach and can be used as carriers for selected drugs and cytokines. Because many promising materials and designs have failed in clinical use, extensive theoretical and experimental testing is mandatory before introducing new materials and implants in a clinical setting.     

Distraction arthroplasty

Few joint-preserving surgical options exist for the patient who has ankle arthritis refractory to conservative measures. Therefore, continuous effort is afforded to the development of additional treatment options for such patients. Distraction arthroplasty has been proposed as one of these options for the patient in whom fusion or joint replacement is not appropriate. Although the mechanism of action remains unknown, the reports of several researchers support the potential beneficial effects that can be obtained from joint distraction arthroplasty in the severely osteoarthritic ankle. Furthermore, the studies published to date suggest that these effects may not only persist for years but also improve as time progresses during the first several years after treatment. Although additional laboratory studies are needed to understand the biochemical and biomechanical effects of distraction, additional prospective clinical studies are also needed to further understand its efficacy and appropriate patient population. The data thus far suggests that joint distraction arthroplasty may be a viable alternative treatment to arthrodesis and replacement for the young patient who has a congruent, painful, mobile, arthritic ankle joint.     

Pelvic Support Osteotomy in the Treatment of Patients With Excision Arthroplasty

Resistant hip infection in adults can be a complicated problem that does not respond to surgical and medical treatment. In such cases, the only remaining option is excision arthroplasty. This line of treatment can eradicate the infection but also is associated with poor function. In some cases, conversion of excision arthroplasty to artificial joint replacement is associated with too great a risk because of local hip surgical risks or low immunity with risk of recurrent infection. Pelvic support osteotomy with the Ilizarov modification can present an alternative solution for such patients. This study included 11 patients with resistant hip infection who were treated using excision arthroplasty. Pelvic support osteotomy then was used to improve hip stability and abductor muscle function. The Ilizarov modification was applied to correct mechanical alignment of the limb and the limb length discrepancy. Harris hip scores improved in all patients: the average score preoperatively was 43.5 (range, 31-50), whereas at final followup, the average score was 70.9 (range, 65-80). Pelvic support osteotomy, along with the Ilizarov modification, can provide an alternative treatment to improve function in patients previously managed with excision hip arthroplasty and Girdlestone surgery.     

Total joint arthroplasty for steroid-induced osteonecrosis in cardiac transplant patients

Ten cardiac transplant patients have had bilateral total hip or knee surgery for treatment of osteonecrosis secondary to corticosteroid immunosuppression. Nine had bilateral total hip arthroplasty and one had bilateral total knee arthroplasty for osteonecrosis of the tibial plateaus. The only immediate postoperative complication was in a single hip patient who had a nonfatal pulmonary embolism. Two patients died from cardiovascular causes; the remaining eight had excellent results from arthroplasty, with an average Harris hip rating of 95 at a mean follow-up period of 34 months. No patient had required revision surgery and radiographic follow-up examination has revealed no evidence of loosening of any of these cemented arthroplasties. One patient developed a late hematogeneous sepsis of one hip seven years after replacement from atypical mycobacterium three months following renal transplantation, which was done 11 years after cardiac transplantation. Total joint arthroplasty has resulted in excellent clinical and radiologic results in this patient population. Despite the increased risks of major surgery in these immunocompromised transplant recipients, total joint arthroplasty appears to be a safe and effective method of treatment of osteonecrosis of the hip.