关节镜辅助下三联手术治疗复发性髌骨脱位

目的探讨关节镜辅助下三联手术治疗复发性髌骨脱位的近期疗效。方法对23例复发性髌骨脱位患者在关节镜辅助下行外侧支持带松解、内侧髌股韧带重建及改良Fulkerson截骨术。术后随访,评估影像学检查结果、Tegner下肢运动能力主观评分、Lysholm膝关节功能综合评分和Kujala髌股关节评分。结果 23例均获随访,时间12~36(24.3±7.82)个月。患者无髌骨再脱位或半脱位,Q角在正常范围。患膝CT显示,髌骨/股骨滑车适配角从术前13.30°±5.15°改善至末次随访时5.72°±3.32°(P0.01),髌股关节外侧张开角从术前0.70°±2.85°改善至末次随访时8.13°±2.75°(P0.01)。Lysholm评分从术前47.92分±16.23分提高至末次随访时93.27分±7.91分(P0.01);Tegner评分从术前5.32分±1.10分提高至末次随访时6.37分±0.83分(P0.01);Kujala髌股关节评分从术前55.3分±11.23分提高至末次随访时83.2分±13.91分(P0.01)。结论关节镜辅助下三联手术治疗复发性髌骨脱位能有效防止复发和恢复髌股关节功能,疗效满意。     

关节镜下与开放手术联合治疗复发性髌骨脱位

[目的] 探讨关节镜下与开放手术联合治疗复发性髌骨脱位的效果.[方法] 对26例患者,在关节镜下探查,软骨修整、钻孔,游离体摘除及外侧支持带松解,然后行开放性的内侧支持带紧缩,胫骨结节内下移抬高术.术后随访12～43个月,平均27个月.[结果] 26例患者脱位均未复发,Q角术前18.3°±4.5°,术后10.4°±1.5°(P＜0.01),IKDC膝关节功能主观评分术前48.3 4±5.2分,术后93.2±3.1分(P＜0.01),Lysholm膝关节功能综合评分术前50.8±6.9分,术后94.±3.8分(P＜0.01).[结论]此手术方法具有创伤小、恢复快、复发率低、效果可靠等优点.     

改良三联术治疗复发性髌骨不稳疗效分析

目的探讨采用改良三联术治疗复发性髌骨不稳的效果。方法对21例复发性髌骨不稳患者采用关节镜下髌骨内侧支持带紧缩术和外侧支持带松解术,辅以改良Fulkerson截骨治疗复发性髌骨不稳。了解髌骨不稳复发、患膝主观症状以及患肢整体功能康复情况。结果术后随访1.5-12（6.75±5.25）个月,髌骨不稳无复发,4例仍有膝前疼痛,但症状较术前明显改善,手术前后IKDC膝关节功能主观评分分别为（36.2±4.7）分和（91.8±5.2）分（P〈0.01）,Lysholm膝关节功能综合评分分别为（41.9±6.2）分和（92.7±6.3）分（P〈0.01）,所有患者运动能力均较术前有所改善。术后X线检查对比：髌骨-股骨滑车适合角由术前的28.1°±7.9°改善为1.6°±8.1°（P〈0.01）,髌骨外侧关节面张开角从术前的-1.2°±7.3°改善为11.6°±4.2°（P〈0.01）。结论改良三联术治疗复发性髌骨不稳具有微创、可一并处理膝关节内其他病变、同时进行胫骨结节内移及抬高、减轻髌股关节压力、从根本上矫正解剖性或生理性股四头肌角（Q角）、手术技术易于掌握等优点。     

关节镜下髌骨支持带调整术治疗复发性髌骨脱位

目的探讨膝关节镜下髌骨内外侧支持带调整术在治疗复发性髌骨脱位中的临床疗效。方法自2002年1月～2007年12月收治47例49膝复发性髌骨脱位,脱位均有明确运动或外伤诱因,有典型髌骨外侧脱位表现,术前未接受过外科手术治疗。术中关节镜监视下紧缩缝合内侧支持带并松解外侧支持带。术后行正规康复训练。随访11～47个月,了解膝关节脱位复发情况及患膝功能恢复情况。结果术后无髌骨脱位复发,手术前后IKDC膝关节主观功能评分分别为(55.4±7.3)分和(93.6±6.8)分(P0.05);Lysholm膝关节功能综合评分分别为(58.2±7.4)分和(94.4±8.1)分(P0.05);手术后影像测量对比髌骨适合角从术前(21.2±5.3)°纠正到(6.4±3.1)°(P0.05);外侧髌股角从术前(-1.3±1.6)°纠正到(6.1±1.4)°(P0.05),上述四项指标手术前后比较,均有统计学差异。结论关节镜下行髌骨内外侧支持带调整手术创伤小,疗效满意。     

改良Maquet三联手术治疗复发性髌骨脱位12例初步报告

[目的]探讨膝关节镜下髌骨支持带调整和胫骨结节内移抬高(改良Maquet术)三联手术治疗复发性脱位的疗效。[方法]对2004年以来12例复发性髌骨脱位行膝关节镜探查外侧支持带松解,内侧支持带紧缩,胫骨结节内移抬高三联手术。术后随访平均16.5个月(10~25个月)。[结果]Q角术前(20.8±4.5)°,术后(10.2±2.1)°(P<0.01),Lysholm膝关节评分(Lysholm knee score scale,LKSS)术前(51.8±7.3)分,术后(93.4±3.4)分(P<0.01),髌股关节关系改善,无脱位发生。[结论]本手术方法具有创伤小,并发症少,功能恢复好,疗效确切的优点。     

关节镜辅助下三联术治疗复发性髌骨脱位

目的探讨关节镜辅助下三联术治疗复发性髌骨脱位的疗效。方法对18例复发性髌骨脱位患者在关节镜辅助下行外侧支持带松解、内侧髌股韧带重建及改良Fulkerson截骨三联术。术后进行髌骨外推恐惧试验,观察再脱位率,测量髌股适合角和外侧髌股角,采用Lysholm和Kujala评分评价膝关节功能。结果患者均获得随访,时间6~36个月。术后6个月内,有2例出现髌骨外侧疼痛,经康复理疗后均逐渐好转或消失。18例患者术后恐惧试验均阴性,随访期间无髌骨再脱位,Q角在正常范围。末次随访时患膝CT显示:髌股适合角5.83°±2.46°、外侧髌股角3.52°±0.64°、Lysholm膝关节功能评分93.28分±3.32分;Kujala髌股关节评分92.15分±12.43分,与术前比较差异均有统计学意义(P0.05)。结论关节镜辅助下三联术治疗复发性髌骨脱位能恢复髌股关节功能并有效防止复发。     

关节镜下髌骨支持带外侧松解内侧紧缩术治疗髌骨半脱位

目的探讨关节镜下行髌骨支持带外侧松解内侧紧缩术治疗髌骨半脱位的临床疗效。方法手术治疗44例髌骨半脱位患者,在关节镜下采用低温等离子电刀松解髌骨外侧支持带,同时采用PDS线沿髌骨内侧缘上极、中点、下极缝合加强内侧支持带,使术中膝关节屈曲过程中髌骨处于正常轨道。根据Lysholm膝关节功能评分及IKDC 2000主观评分进行术前、术后膝关节功能评估。结果 44例均获得随访,时间3~30个月。术后X线片显示髌骨位置良好。末次随访患肢膝关节活动度恢复良好,无关节僵硬、功能障碍等表现,未见复发半脱位。Lysholm评分由术前44~71(52.2±6.3)分提高到术后80~94(88.1±3.9)分(P0.001),IKDC 2000主观评分由术前42~69(52.7±6.1)分提高到术后82~97(89.7±3.1)分(P0.001)。结论关节镜下髌骨支持带外侧松解内侧紧缩术治疗髌骨半脱位,可维持髌骨活动稳定,效果良好。     

改良式三联手术治疗复发性髌骨脱位的疗效分析

[目的]探讨改良式三联手术(关节镜下膝关节外侧支持带松解、内侧髌股韧带重建,联合改良Fulkerson截骨术)治疗复发性髌骨脱位的效果。[方法]2010年1月²012年5月期间19例复发性髌骨脱位患者接受改良式三联手术治疗,其中2膝未行截骨内移抬高术。术后定期随访,通过临床评估、Insall疗效分析和Lysholm评分了解复发性髌骨脱位临床治疗效果。[结果]本组病例术后随访平均13个月(62012年5月期间19例复发性髌骨脱位患者接受改良式三联手术治疗,其中2膝未行截骨内移抬高术。术后定期随访,通过临床评估、Insall疗效分析和Lysholm评分了解复发性髌骨脱位临床治疗效果。[结果]本组病例术后随访平均13个月(6¹8个月),所有患者未再复发髌骨脱位、恐惧试验均为阴性。膝关节功能13例优、4例良好,优良率89.5%,其余2例因手术并发症影响治疗效果,1例术后膝关节周围异位骨化、1例膝关节粘连。术前膝关节Lysholm评分平均(61.2±5.5)分,末次随访术后Lysholm评分平均(89.3±5.4)分(P<0.05)。[结论]改良式三联手术能够有效治疗复发性髌骨脱位、恢复膝关节功能。     

关节镜下外侧支持带松解、内侧紧缩与髌股韧带重建治疗复发性髌骨脱位

目的探讨关节镜下外侧支持带松解、内侧紧缩与髌股韧带重建在治疗复发性髌骨脱位中的临床疗效。方法笔者自2011-05—2014-05诊治32例复发性髌骨脱位。术前均未行手术治疗,常规测量Q角和CT片中TT-TG值。比较手术前后Lysholm和IKDC评分。结果所有患者获得平均18(13~30)个月随访,无一例出现髌骨脱位复发,术后切口均一期愈合。术后Lysholm膝关节功能综合评分为(94.23±8.38)分,术前为(48.25±6.92)分,手术前后Lysholm评分比较差异有统计学意义(t=36.80,P0.001);术后IKDC膝关节主观功能评分为(93.20±5.33)分,与术前(35.57±5.10)分比较差异有统计学意义(t=47.23,P0.001)。结论关节镜下外侧支持带松解、内侧紧缩与髌股韧带重建治疗复发性髌骨脱位疗效确切,操作简便,可早期进行功能锻炼,有利于膝关节功能的恢复,值得临床推广。     

关节镜下髌骨支持带调整术联合胫骨结节内移抬高术治疗髌骨外侧半脱位

目的 探讨关节镜下髌骨支持带调整术联合胫骨结节内移抬高术治疗髌骨外侧半脱位的疗效.方法 自2006年3月～2008年1月对16例髌骨外侧半脱位行关节镜下髌骨支持带调整术联合胫骨结节内移抬高术.手术前后采用Lysholm膝关节功能评价表和Tegner下肢运动能力评价表进行评估,并测量手术前后屈膝20°CT片Merchant匹配角、髌骨倾斜角和髌骨外移度.结果 患者获6～28个月随访(平均16个月),术前和术后6个月Lysholm评分分别为(59.00±13.37)分和(92.14±5.15)分(P<0.05),Tegner评分分别为(2.00±1.49)分和(3.30±0.48)分(P<0.05),所有患膝运动能力均较术前有所改善.手术前后Merehant匹配角分别为(21.10±5.61)°和(一1.70±7.41)°(P<0.05),髌骨倾斜角分别为(一4.50±6.45)°和(11.60±2.27)°(P<0.05),髌骨外移度分别为(5.29±3.14)mm和(0.20±1.32)mm(P相似文献   

Reduction of Plasma Fibrinogen, Immunoglobulin G, and Immunoglobulin M Concentrations by Immunoadsorption Therapy with Tryptophan and Phenylalanine Adsorbents

Abstract Immunoadsorption (1A) therapy with tryptophan (TR-350) or phenylalanine (PH-350) adsorbents has been used to reduce the concentration of serum antibodies in human lymphocyte antigen (HLA)-immunized patients. Other forms of plasma purification have been reported to reduce the level of fibrinogen, which affects the blood properties. In this study we investigated the effects of IA therapy using both adsorbents on plasma fibrinogen and immunoglobulins G and M in 13 patients (8 patients were treated with TR-350, and 5 patients were treated with PH-350). During each session 1 plasma volume (2.8 ± 0.4 L of plasma) was processed through the immunocolumn and then returned to the patient together with the blood cells. Compared with the pretreatment values, the plasma fibrinogen, IgG, and IgM concentrations were significantly reduced after IA therapy (p < 0.01 for TR-350; p < 0.04 for PH-350). There was a positive correlation between the degree of reduction of plasma proteins and the number of IA treatments given. A nonpara-metric test (Wilcoxon's signed-rank test or the Mann-Whitney test) was used for statistical analysis. We conclude from our study that IA therapy effectively lowers the plasma levels of fibrinogen, IgG, and IgM and thus can be considered a valuable alternative to other blood purification methods.     

The multiply injured child

Blunt trauma is the principal cause of childhood death in many developed countries. This review outlines the differences between adults and children with respect to resuscitation and treatment of orthopaedic injuries in a child with polytrauma. Recent advances in techniques of fracture stabilization are reported.     

Development of Selective Low-Density Lipoprotein (LDL) Apheresis System: Immobilized Polyanion as LDL-Specific Adsorption for LDL Apheresis System

Abstract: Low-density lipoprotein (LDL) is widely recognized as one of the major risk factors for developing coronary heart diseases. Despite intensive development of LDL-lowering drugs, there still exist those patients with refractory hyperlipidemia whose plasma LDL levels are not sufficiently lowered by drugs. LDL apheresis, direct removal of plasma LDL from circulating blood, is thought to be the most promising treatment for such refractory patients. Various techniques, such as the use of an im-munoadsorbent utilizing an anti-LDL antibody, have been used in an attempt to achieve the selective removal of LDL. However, none were widely used because of complications, poor selectivity, and so forth. To establish a safe and effective LDL apheresis system, we chose a synthetic affinity adsorbent as the LDL-removing device. Synthetic polyanion compounds were used as the affinity ligands for LDL adsorbent to simulate the anion-rich sequence of LDL binding sites in the human LDL receptor. Among various polyanion compounds, those polyanions with sulfate or sulfonate groups and hydrophilic backbone were found to have strong affinity for LDL. In contrast, polyanions with carboxyl groups showed poor affinity. Dextran sulfate (DS) was selected as the affinity ligand of LDL adsorbent for its high affinity and low toxicity. The influence of its charge density and molecular weight on its affinity for LDL was suitable. The affinity rapidly increased as the charge density increased, then, reached a constant value. Little affinity was found for either the DS monomer (glucose sulfate) or DS with a molecular weight higher than 10⁴ daltons whereas DS with molecular weights in the midrange showed strong affinity. DS with a midrange molecular weight was immobilized on cellulose hard gel to give LDL adsorbent clinical application. The adsorbent demonstrated an excellent selectivity for LDL and very low density lipoprotein (VLDL) in vitro. Adsorption of high-density lipoprotein and major plasma proteins was almost negligible. Additional study of the LDL-binding mechanism revealed that DS directly interacts with positively charged sites on LDL, which demonstrates that the nature of the interaction is the same as that of LDL receptor. An LDL adsorption column (Liposorber) packed with an LDL adsorbent and polysulfone hollow-fiber plasma separator (Sulflux) was developed as an efficient LDL apheresis system. Clinical investigation proved that this system is capable of intensively lowering the plasma LDL level without affecting major plasma components.     

Artificial organs 2010: a year in review

In this Editor's Review, articles published in 2010 are organized by category and briefly summarized. As the official journal of The International Federation for Artificial Organs, The International Faculty for Artificial Organs, and the International Society for Rotary Blood Pumps, Artificial Organs continues in the original mission of its founders "to foster communications in the field of artificial organs on an international level."Artificial Organs continues to publish developments and clinical applications of artificial organ technologies in this broad and expanding field of organ Replacement, Recovery, and Regeneration from all over the world. We take this time also to express our gratitude to our authors for offering their work to this journal. We offer our very special thanks to our reviewers who give so generously of time and expertise to review, critique, and especially provide such meaningful suggestions to the author's work whether eventually accepted or rejected and especially to those whose native tongue is not English. Without these excellent and dedicated reviewers the quality expected from such a journal could not be possible. We also express our special thanks to our Publisher, Wiley-Blackwell, for their expert attention and support in the production and marketing of Artificial Organs. In this Editor's Review, that historically has been widely received by our readership, we aim to provide a brief reflection of the currently available worldwide knowledge that is intended to advance and better human life while providing insight for continued application of technologies and methods of organ Replacement, Recovery, and Regeneration. We look forward to recording further advances in the coming years.     

Avaliação do clube de revista de anestesiologia por meio de mudanças semânticas

Background and objectives

The interactive approach of a journal club has been described in the medical education literature. The aim of this investigation is to present an assessment of journal club as a tool to address the question whether residents read more and critically.

Methods

This study reports the performance of medical residents in anesthesiology from the Clinics Hospital – University of São Paulo Medical School. All medical residents were invited to answer five questions derived from discussed papers. The answer sheet consisted of an affirmative statement with a Likert type scale (totally disagree–disagree–not sure–agree–totally agree), each related to one of the chosen articles. The results were evaluated by means of item analysis – difficulty index and discrimination power.

Results

Residents filled one hundred and seventy three evaluations in the months of December 2011 (n = 51), July 2012 (n = 66) and December 2012 (n = 56). The first exam presented all items with straight statement, second and third exams presented mixed items. Separating “totally agree” from “agree” increased the difficulty indices, but did not improve the discrimination power.

Conclusions

The use of a journal club assessment with straight and inverted statements and by means of five points scale for agreement has been shown to increase its item difficulty and discrimination power. This may reflect involvement either with the reading or the discussion during the journal meeting.     

Soluble TNFα Receptors Are Increased in Chronic Renal Insufficiency and Hemodialysis and Inhibit Neutrophil Priming by TNFα

Abstract: The oxidative burst of neutrophils from azotemic patients is refractory to priming by tumor necrosis factor-α (TNFα). Soluble TNFα binding proteins (TNFR) accumulate in the plasma of azotemic patients. To test the hypothesis that these increased sTNFR concentrations inhibit TNFa priming of oxidative burst activity, we measured plasma sTNFR concentrations in nondialyzed azotemic patients, hemodialysis patients, and normal subjects, and determined TNFa priming of fMet-Leu-Phe-stimulated superoxide production in neutrophils incubated in plasma with differing levels of sTNFR. These sTNFR concentrations increased significantly as creatinine clearance decreased and were significantly greater in hemodialysis patients than could be accounted for by loss of renal function alone. TNFα primed superoxide production by normal neutrophils in normal plasma, but this effect was significantly reduced in plasma with increased concentrations of sTNFR. Neutrophils from azotemic and hemodialysis patients were refractory to priming by TNFα in autologous plasma, and incubation in normal plasma only partially corrected this defect. We conclude that sTNFR accumulate as a result of the loss of renal function and hemodialysis and inhibit TNFα priming of neutrophils in azotemic and hemodialysis patients, but that these cells also have an intrinsic functional defect.     

Lymphocytapheresis

Abstract: Leukocytapheresis has long been performed with the centrifugal method. But in 1989 in Japan, the Asahi Medical Co. developed the extracorporeal leukocyte-removal filter, Cellsorba. This filter consists of non-woven fabric, which can remove leukocytes from whole blood during extracorporeal circulation. In the incipient stage, this filter was applied to collagen diseases, rheumatoid arthritis, and systemic lupus erythematosus. During the following studies, this filter has been found to have an immunosuppressive effect. Now, it is beginning to be applied to various kinds of autoimmune diseases. Moreover, this filter has recently been recognized to be effective in inflammatory bowel diseases, ulcerative colitis, and Crohn's disease. The outline of Cellsorba and the application of this filter is described here.