舒筋止痛液配合离子导入治疗膝骨关节炎75例

目的：评价中药配合离子导入治疗膝骨关节炎的效果。方法：将75例（共103个关节）膝骨关节炎患者随机分为两组,药透组在膝关节局部采用舒筋止痛液经离子导入法治疗,对照组口服盐酸氨基葡萄糖,连续治疗4周。4周后进行总体疗效、关节活动度和膝关节MRI评价。结果：药透组显效14例,有效22例,无效2例;对照组显效7例,有效21例,无效9例。结论：中药舒筋止痛液配合离子导入治疗膝骨关节炎具有较好的临床疗效。     

针刀松解配合手法整复及小夹板固定治疗膝骨关节炎临床观察

目的:观察针刀松解配合手法整复及小夹板固定治疗膝骨关节炎的临床疗效。方法:将116例(142膝)膝骨关节炎患者随机分为治疗组58例(74膝)和对照组58例(68膝)。治疗组采用针刀松解配合手法整复及小夹板固定治疗,对照组采用美洛昔康、仙灵骨葆口服治疗;治疗组为每单侧膝治疗1次为1个疗程,对照组2周为1个疗程。1个疗程后进行疗效评定,采用疼痛视觉模拟评分法(VAS)、Lysholm膝关节评分标准分析两组患者治疗前后各项评分。结果:治疗组脱落3例(4膝),对照组脱落2例(2膝)。治疗组临床治愈32膝,显效20膝,有效15膝,无效3膝,总有效率为95.71%;对照组临床治愈8膝,显效13膝,有效19膝,无效26膝,总有效率为60.61%。两组比较,差异有统计学意义(P0.05)。治疗后,两组VAS评分和Lysholm评分均有改善(P0.05),且治疗组优于对照组(P0.05)。结论:针刀松解配合手法整复及小夹板固定治疗对膝骨关节炎有较好的临床效果。     

舒筋接骨汤治疗膝骨关节炎的临床研究

目的观察舒筋接骨汤对膝骨关节炎患者WOMAC骨关节炎指数、关节压痛、肿胀、活动度及血清肿瘤坏死因子(TNF-α)、白细胞介素-1(IL-1)和转化生长因子-β(TGF-β)水平的变化的影响,从而评价其临床疗效。方法 132例膝骨关节炎患者随即分为对照组和治疗组,各66例。对照组给予口服硫酸氨基葡萄糖,治疗组给予口服舒筋接骨汤,治疗4 w后,通过比较两组患者WOMAC骨关节炎指数、VAS评分、关节压痛、肿胀、关节活动度以及血清TNF-α、IL-1、TGF-β的变化。结果 4 w后,治疗组与对照组相比两组WOMAC指数、VAS评分、关节压痛、肿胀、关节活动度评分均有下降,且两组比较差异有显著性意义(P0.05),治疗组血清中TNF-α、IL-1较对照组下降,两组比较差异有显著性意义(P0.05),血清中TGF-β较对照组上升,差异有显著性意义(P0.05)。结论舒筋接骨汤对膝骨关节炎疗效显著,可以有效抑制关节炎症,减少关节破坏,缓解改善关节炎临床症状。     

膝关节炎治疗仪治疗膝骨关节炎临床观察

目的:观察膝关节炎治疗仪治疗膝骨关节炎的临床疗效。方法:选择临床分期Ⅰ~Ⅲ期膝骨关节炎患者70例(109膝),采用随机数字表法按照临床分期随机分为治疗组35例(54膝)和对照组35例(55膝)。两组均在口服盐酸氨基葡萄糖胶囊的基础上,治疗组采用膝关节炎治疗仪治疗,对照组采用TDP治疗器治疗,每次30 min,每日2次,治疗2个月,观察治疗前后不同分期的膝关节运动功能、WOMAC骨关节炎指数、临床疗效。结果:完成治疗65例(100膝),其中治疗组32例(49膝),对照组33例(51膝)。治疗后,两组膝关节运动功能评分Ⅰ~Ⅲ期均较治疗前明显增加(P0.01);治疗组Ⅰ期、Ⅱ期增加程度均高于同分期对照组(P0.01或P0.05)。两组治疗后膝关节WOMAC指数Ⅰ~Ⅲ期均较治疗前明显降低(P0.01);治疗组Ⅰ期、Ⅱ期降低程度明显高于同分期对照组(P0.01)。治疗后,两组优良率比较,Ⅰ期、Ⅱ期治疗组均高于同分期对照组(P0.05);两组总有效率比较,差异无统计学意义(P0.05)。结论:膝关节炎治疗仪能有效缓解膝骨关节炎的临床症状、改善关节功能,其中Ⅰ期、Ⅱ期膝骨关节炎患者临床疗效明显优于TDP治疗器。     

膝关节骨性关节炎关节镜下关节清理术28例

2006年1月～2010年8月,我院共行膝骨关节炎关节镜下关节清理术28例,取得了良好的效果. 1 材料与方法 1.1 病例资料本组28例(32膝),男11例(12膝),女17例(20膝),年龄48～75(48±2)岁.临床表现:膝关节反复疼痛、功能受限,伴不同程度的关节肿胀、内外翻畸形、关节交锁.病程6个月～14年.均经过半年以上休息、理疗、封闭、服用消炎镇痛药等保守治疗,效果不佳.28例均摄双膝正、侧位X线片,可见不同程度的关节退变、关节间隙狭窄、骨赘、关节积液.游离体8膝,膝内翻18膝.根据2003年中华医学会风湿病分会制定的骨关节炎诊治指南草案诊断标准,本组患者均符合膝关节骨性关节炎诊断.     

温针灸配合玻璃酸钠关节腔注射治疗膝骨关节炎临床研究

目的探讨温针灸配合玻璃酸钠关节腔注射治疗膝骨关节炎临床疗效。方法将2011年12月～2013年6月我院就诊的膝骨关节炎患者55例,随机分为观察组27例及对照组28例。观察两组的临床疗效、治疗前后关节功能评分及VAS和LKSS评分。结果观察组患者优良率为92．59％,对照组患者优良率为82．14％,两组优良率比较,差异有统计学意义（P〈0．05）。两组患者关节功能评分治疗前后比较,有统计学差异（P〈0．05）;治疗后关节功能评分研究组显著低于对照组（P〈0．05）。两组患者治疗前后VAS和LKSS评分比较,差异显著（P均〈0．05）。结论温针灸配合玻璃酸钠关节腔注射治疗膝骨关节炎疗效确切,值得在临床推广应用。     

关节镜下关节清理术治疗膝关节骨性关节炎59例

从 2 0 0 0年 11月～ 2 0 0 2年 5月我院共行关节镜下膝关节清理术 5 9例 (6 5膝 ) ,全部病例均随访 3个月～ 12个月。现总结报告如下。1　临床资料1 1　一般资料　本组共 5 9例 (6 5膝 ) ,男 2 1例 ,女 38例。年龄 4 5～ 74岁 ,平均 5 6 2岁 ,右膝 33例、左膝 2 0例、双膝 6例 ,病程 2个月～ 2 0年。1 2　临床表现及影像学资料　膝关节肿胀 2 6例、疼痛 5 5例、活动障碍 2 8例、交锁 8例、内翻畸形 10例。X线片 16膝为明显关节间隙改变及骨刺形成 ,37膝表现中等程度的骨刺生长及轻微关节间隙变窄 ,12膝呈现明显关节间隙狭窄及骨刺生成 ,1…     

全膝置换治疗内翻型膝骨关节炎31例体会

目的总结关节置换治疗内翻型膝骨关节炎的疗效。方法回顾性分析行膝关节置换治疗膝骨关节炎患者31例的临床资料。结果平均治疗11个月(1～18个月)随访。采用HSS膝关节百分系统[1]评分标准,术前评分39分(5～58分),术后平均得分89分(77～95分)。结论人工全膝关节置换是治疗内翻型膝骨关节炎有效的方法。     

风湿液联合玻璃酸钠治疗老年膝骨关节炎临床观察

目的:观察风湿液联合玻璃酸钠治疗老年膝骨关节炎的临床疗效。方法:将90例老年膝骨关节炎患者随机分为治疗组和对照组,每组45例。对照组给予玻璃酸钠膝关节腔内注射,每次20 mg,每周1次。治疗组在对照组治疗基础上加服风湿液,每次10 m L,每日3次。两组均以5周为1个疗程。观察两组治疗前后视觉模拟评分法(VAS)评分、Lequesne指数及实验室指标。结果:治疗后,两组患者VAS评分、Lequesne指数、红细胞沉降率和C-反应蛋白较治疗前均有改善(P0.05),且治疗组优于对照组(P0.05)。结论:风湿液联合玻璃酸钠治疗老年膝骨关节炎能够有效地缓解关节疼痛、改善关节功能,值得临床推广应用。     

玻璃酸钠注射联合关节松动术治疗膝关节骨关节炎46例临床分析

目的 探讨玻璃酸钠注射联合关节松动术治疗膝关节骨关节炎46例的临床疗效.方法 对96例住院和门诊膝关节骨关节炎患者随机分为治疗组46例,采用玻璃酸钠注射联合关节松动术治疗 对照组50例患者采用药物治疗和理疗.1个疗程后观察两组治疗前和治疗后Lysholm膝量表计分.结果治疗组和对照组各组间治疗前后比较均有效（P＜0.01）.治疗组Lysholm膝量表计分治疗后评分明显改善,评分高于对照组,与对照组比较,差异具有统计学意义（t=5.971,P＜0.01）.结论 玻璃酸钠注射联合关节松动术治疗膝关节骨关节炎优于药物和物理因子治疗.     

Effects of joint mobilization on joint stiffness and active motion of the metacarpal-phalangeal joint

Joint mobilization is a common technique used to restore joint motion; however, documentation of its effectiveness is lacking. The purpose of this study was to determine if joint mobilization is effective in counteracting joint stiffness and decreased active range of motion of the metacarpal-phalangeal joint. It was hypothesized that there would be a significant increase in range of motion in those patients who received joint mobilization. Eighteen subjects who had been immobilized for the treatment of metacarpal fractures were randomly assigned to a treatment group that received joint mobilization or a control group that received no treatment. Measurements of active range of motion and torque range of motion prior to and after treatment/rest sessions were obtained for three sessions over a 1 week period. Analyses of variance were performed on the mean changes in excursion between groups and across sessions. The joint mobilization resulted in a significantly greater increase in excursion for subjects in the treatment group over subjects in the control group (p < 0.05). Joint mobilization does appear to be able to counteract the effects of immobilization and alter joint mechanics. J Orthop Sports Phys Ther 1992;16(1):30-36.     

Endoprosthetic joint replacement of the contracted elbow joint

In a retrospective study 14 patients were reviewed 63 months after the implantation of a semi-constrained total elbow prosthesis in fourteen stiff or ankylosed elbows with a preoperative range of elbow motion of 30 degrees or less. The result, according to the Mayo Elbow Performance score, was excellent for four elbows, good for four, fair for one, and poor for five. The average arc of flexion improved from 7 to 68 degrees postoperatively with an average increase of 34 degrees in flexion, and 27 degrees in extension. There were seven complications affecting seven of the 14 elbows and four of these seven elbows underwent a revision procedure. Replacement for a stiff elbow is the least predictable, has the lowest overall rate of success and highest complication rate, than any other procedure. Nevertheless, these disadvantages must be placed in the context of alternative intervention options. The semiconstrained total elbow arthroplasty seems to be a useful option for patients older than 50 years with intrinsic stiffness involving more than 50% of the articular surface and with an ankylosed or very stiff elbow.     

人工关节置换术后人工关节松动的原因

人工关节置换术是治疗关节严重残疾的主要手段之一，每年接受手术的患者达数十万人。许多患者重建了关节功能，避免或减少了残疾程度，提高了生活质量和工作能力。但同时也出现了不少并发症，相当多的患者置换人工关节后出现了中、远期的人工关节松动，导致疼痛和功能障碍，需要再次手术。导致人工关节松动的原因有很多，主要有感染、假体一骨组织界面的微动磨损、过早过剧烈功能锻炼、手术方式及操作技术失误、原有关节病变加剧、人工关节的材料、生物力学设计、加工工艺不完善、患者年龄过大、体质情况差等。现就晚期感染、微动磨损等主要原因进行阐述。     

全关节置换术后假体周围感染诊断的研究进展

假体周围感染是全关节置换术后最严重的并发症之一,诊断方法较多,但都缺乏特异性,本文就假体周围感染的临床症状、体征,实验室检查,影像学检查,特殊检查以及最新的研究进展进行综述。     

Possibility of the hamatum carpometacarpal joint as a new joint donor site for interphalangeal joint restoration

Objective

This research investigates the anatomic basis for the repair and reconstruction of hand joints using transposition of the carpometacarpal (CMC) joint of the hamatum.

Methods

The morphology and structure of the CMC joints of the hamatum and the base joints of the middle phalanx were observed on 22 freshly frozen wrist specimens at Shanghai 6th People’s Hospital Research Institute of Microsurgery. The volar dorsal dia, radioulnar dia, depth of concave, and area of the joints were measured. Data were obtained through statistical analysis, and the resemblance of joints was compared in terms of morphology, structure, area, length, and diameter.

Results

The radioulnar dia of the CMC joints of the hamatum (13.54 ± 1.15 mm) did not exhibit any evident differences in the middle phalanx of the forefinger, middle finger, and ring finger, and in the distal phalanx of the thumb. The volar dorsal dia of the CMC joints of the hamatum (10.71 ± 0.93 mm) exhibited an evident difference in the middle phalanx of the ring finger. In all fingers, the depth of the ulnar and radial concave of the CMC joints of the hamatum (1.30 ± 0.08 and 0.95 ± 0.05 mm, respectively) and the area of the CMC joints of the hamatum (139.89 ± 5.44 mm²) showed an evident difference.

Conclusion

The CMC joint of the hamatum could be considered a new and viable joint donor site that could be used to repair and reconstruct the base joints of the middle phalanx.     

Total joint arthroplasty for osteoarthritis of the thumb basal joint

A survey of 43 cemented arthroplasties of the trapeziometacarpal joint with a la Caffinière prosthesis in 40 patients is presented. A 70% patient satisfaction rate was obtained, with a mean DASH score of 24.2. Good range of motion was preserved (opposition 9/10 on Kapandji's scale) and gripping force as well as key pinch force increased from 18 kg to 24 kg and from 5.3 to 6.0 kg respectively. However loosening was seen in 44% of the implants. Loosening was related to younger age. We conclude that despite good clinical outcome, radiographic loosening is a threat for the future of this implant.     

Radioulnar joint fusion for distal radioulnar joint instability

Each one of this small group of patients illustrates a rare indication for the radioulnar joint fusion procedure in distal radioulnar joint instability. The case histories tell of a last ditch effort to salvage function in an extremity crippled by painful radioulnar instability after excision of the distal ulna. The fusions healed slowly and two required repeat surgery to achieve union. Today we would routinely add iliac bone graft to the fusion area to hasten healing. Rarely indicated, this is a salvage procedure that is done after failure of other procedures geared to preserve the rotation of the forearm. These patients all had successful salvage of their extremities for activities of daily living, but only one returned to his labor job. All were worker's compensation cases in physical jobs. Two patients had had prior radiocarpal fusions, making them even more restricted in function. This procedure should be kept in mind to be used in the rare cases of painful instability of the distal radioulnar joint when traditional motion-preserving procedures have failed.