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1.
目的探讨膝关节骨性关节炎(OA)患者关节镜下有限清理术的疗效。方法在2004年5月.2006年1月对50例患者(男32例,女18例,平均年龄53.8岁)行关节镜外科治疗:关节镜下有限清理包括刨削增生肥厚的滑膜组织,清理关节软骨剥脱区创面和软骨碎片,切除破裂的半月板,取出游离体和磨削骨赘。结果关节镜下选择性、有限化的关节清理术创伤轻和并发症少,关节功能恢复快。随访3个月~1年,术后优良率达80.0%。结论关节镜下有限清理术治疗膝关节骨性关节炎可有效地缓解疼痛和肿胀等症状,改善功能,提高患者生活质量,延缓病程的发展。  相似文献   

2.
目的:探讨关节镜下行关节清理治疗膝关节骨性关节炎的疗效。方法:对32例(44膝)骨性关节炎患者,行膝关节镜检查,并在关节镜下行清理术。术后3个月及1年后复查,随访膝关节疼痛、肿胀及活动功能的改善情况。结果:治疗后膝关节疼痛缓解、肿胀减轻、功能改善。术后3个月复查,优良率达85%:经1年以上随访,优良率为72%,无复发及并发症。结论:关节镜下行关节清理术治疗膝关节骨性关节炎是一种疗效好且简便的方法。  相似文献   

3.
关节镜手术治疗膝骨性关节炎的体会   总被引:5,自引:1,他引:4  
[目的]探讨膝关节镜下有限清理联合透明质酸钠注射治疗骨性关节炎的疗效。[方法]本院2003年9月~2004年10期间治疗的45例(52膝),采用关节镜下清理术联合透明质酸钠注射治疗,术后早期功能锻炼。[结果]参照Lyscholm评价标准,经1a随访,优良率93.3%,未出现感染、血肿、血管及神经损伤等并发症。[结论]关节镜术下有限清理联合透明质酸钠注射治疗膝骨关节炎,术后疗效满意,笔者认为在把握好手术适应证的基础上,该方法应该作为膝骨性关节炎的首选治疗方法。  相似文献   

4.
目的:评价关节镜下清理加术后透明质酸钠注射治疗膝关节骨性关节炎的疗效。方法:对56例(64膝)骨性关节炎行镜下清理,术后每周关节腔内注射透明质酸钠2ml,共5周。结果:术后平均随访18个月,根据关节疼痛、活动度、步态及行走功能进行评分,优58例,良17例,可27例。结论:关节镜下清理加术后注射治疗膝关节骨性关节炎有较好疗效。  相似文献   

5.
目的观察分析关节镜清理术联合中药熏洗对膝关节骨性关节炎的临床疗效。方法选取2011年10月至2013年10月本院膝关节骨性关节炎患者80例,按照治疗方法不同随机平分为两组,分别行关节镜膝关节清理术结合中药熏洗(观察组)和单纯关节镜膝关节清理术(对照组)治疗。观察比较两组治疗前后膝关节活动度、Lysholm膝关节功能评分、VAS评分及临床疗效评估。结果术后通过电话或上门方式进行随访约(16.53±1.68)个月,各组组内术后膝关节活动度、VAS评分、Lysholm评分均较术前有显著差异,比较具有统计学意义,(P<0.05)。观察组术后术后膝关节活动度、VAS评分、Lysholm评分均优于对照组,比较具有统计学意义,(P<0.05)。两组术后无严重并发症发生。观察组疗效评估,临床控制14例,显效19例,有效6例,无效1例,有效率为97.5%。对照组疗效评估,临床控制11例,显效15例,有效9例,无效5例,有效率为87.5%。结论关节镜清理术联合中药熏洗治疗膝关节骨性关节炎临床疗效优于单纯关节镜清理术,方法安全可靠,适应临床广泛应用。  相似文献   

6.
膝关节骨性关节炎关节镜清理术的疗效评价   总被引:3,自引:0,他引:3  
目的探讨关节镜清理术治疗膝关节骨性关节炎的疗效。方法回顾分析44例62个膝关节骨性关节炎行关节镜清理术的临床资料。结果随访2~2.5年,术后0.5、1、2年的优良率分别为85.5%(53/62)、77.4%(48/62)、66.1%(41/62),术后2年疗效显低于术后0.5年(X^2=6.332,P=0.012)。结论关节镜清理术可以有效地缓解患的关节肿痛等症状,延缓软骨退变的进程。病变程度轻疗效较好,但疗效随着时间的延长而降低。  相似文献   

7.
目的观察关节镜下治疗膝关节骨性关节炎的临床疗效。方法回顾性观察膝关节镜下清理术治疗早中期膝关节骨性关节炎和广泛清理术结合钻孔微骨折术治疗晚期膝关节骨性关节炎的疗效。结果24个月内,早中期组Lysholm功能评分由术前(41.37±3.46)分提高到(80.3±7.94)分。晚期组Lysholm功能评分由(36.58±4.27)分提高到(75.6±6.36)分。结论对早中期骨性关节炎采用关节镜下有限清理,对晚期骨性关节炎采用关节镜下广泛清理加软骨微骨折术,辅以积极康复治疗,均可取得良好疗效。  相似文献   

8.
关节镜清理加中药灌洗治疗膝关节骨性关节炎探讨   总被引:6,自引:1,他引:5  
[目的]探讨中药灌洗治疗膝关节骨性关节炎的临床效果。[方法]首先应用关节镜清理关节,再应用中药进行关节内灌洗,研究采用3组对比,以单纯清理、加用玻璃酸钠两组对比,以观察中药效果。[结果]随诊7~16个月,22例膝关节骨性关节炎病人,应用上述治疗,优17例,良3例,差2例,优良率为90.9%。[结论]中药关节内灌洗在治疗膝关节骨性关节炎中有较好的疗效。  相似文献   

9.
关节镜下骨性关节炎清理术后注射透明质酸钠疗效分析   总被引:1,自引:0,他引:1  
目的 分析膝骨性关节炎患者关节镜术后注入透明质酸钠的疗效.方法 对40例膝骨性关节炎关节镜下清理术后注射透明质酸钠,另20例对照.手术前、后采用Lysholm膝关节功能评分评定.结果 术后Lysholm评分,"疼痛"评分和"上楼"评分较术前明显提高(P<0.001).两组之间术后Lysholm评分有明显差异(P<0.05).结论 术后注入透明质酸钠可明显增强疗效.  相似文献   

10.
[目的]观察关节镜下关节清理术并透明质酸钠注射加服独活寄生汤加减治疗膝关节骨性关节炎的临床疗效。[方法]将108例患者随机分为治疗组(58例)和对照组(50例),所有患者均施行关节镜下清理术并透明质酸钠注射,治疗组在此基础上加服独活寄生汤加减。观察两组治疗效果。[结果]治疗组治愈22例,显效20例,有效20例,无效2例,总有效率96.5%,显著高于观察组的80%。治疗组疗效优于对照组(P<0.05)。[结论]关节镜下清理术并透明质酸钠注射加服独活寄生汤加减治疗膝关节骨性关节炎安全有效,可明显缓解疼痛症状,改善膝关节功能,促进术后康复,减少病情复发。  相似文献   

11.
目的探讨维生素D受体(VDR)在糖尿病肾病(DKD)足细胞中的表达水平及在足细胞损伤及蛋白尿缓解中的作用。方法(1)本研究纳入了65例诊断患有2型糖尿病(伴或不伴蛋白尿)的患者,并纳入了25例年龄和性别相匹配的健康体检者为对照组。根据白蛋白/肌酐(ACR)的尿排泄比例对2型糖尿病患者进行分组,分别为无蛋白尿(ACR<30 mg/g,n=24)、微量白蛋白尿(ACR 30~300 mg/g,n=18)和临床蛋白尿(ACR>300 mg/g,n=23)。另选择25例经肾活检确诊的DKD患者作为DKD组。正常肾脏组织标本均取自泌尿外科同一时期肾脏肿瘤切除患者10例。将各组检测指标进行对比,同时采用实时定量PCR、ELISA法和免疫组化法检测VDR在各组患者的血液、尿液样本和肾脏组织中的表达情况,以及使用Pearson相关分析分析VDR与尿蛋白的相关性。(2)在2型糖尿病肾病小鼠模型中对上述结果进行验证,将遗传背景均为C57BLKs/J的雄性db/db小鼠及同窝出生的db/m小鼠,随机分为正常对照组(A组)、DKD对照组(B组)、DKD二甲基亚砜处理组(C组)、DKD帕立骨化醇(VDR激动剂)处理组(D组),C、D组连续腹腔注射处理8周,对照组不做任何处理。小鼠10周龄时开始连续干预8周,在小鼠22周龄(开始干预后12周)检测各组小鼠体重、血、尿生化指标对比;Western印迹法检测β⁃catenin、VDR的变化;免疫荧光观察足细胞标志蛋白podocin及足细胞损伤蛋白α⁃SMA的表达变化。结果(1)与正常健康对照组相比,无蛋白尿组、微量白蛋白尿组和临床蛋白尿组的糖尿病患者血浆中VDR的mRNA和蛋白水平均较低(均P<0.05);与无蛋白尿组的糖尿病患者相比,微量白蛋白尿组和临床蛋白尿组的糖尿病患者血浆中VDR的mRNA和蛋白水平均较低(均P<0.05)。(2)与正常健康对照组相比,无蛋白尿糖尿病组和DKD组患者血浆中VDR的mRNA和蛋白水平均较低(均P<0.05);与无蛋白尿糖尿病组患者相比,DKD组患者血浆中VDR的mRNA和蛋白水平亦较低(均P<0.05)。(3)免疫组化结果显示,DKD组肾组织中VDR的表达明显少于正常对照组。(4)DKD患者血浆中VDR mRNA相对水平与ACR呈负相关(r=-0.342,P<0.05)。(5)各组尿液上清液中VDR的水平与血浆中的水平呈相反趋势。(6)Western印迹结果显示,B组、C组肾小球足细胞β⁃catenin蛋白表达高于D组(均P<0.05),VDR蛋白的表达低于D组(均P<0.05);免疫荧光结果显示,B组、C组肾小球足细胞podocin的表达低于D组(均P<0.05),α⁃SMA的表达高于D组(均P<0.05)。结论VDR高表达缓解DKD足细胞损伤及蛋白尿。  相似文献   

12.
Background: Anterior interosseous nerve (AIN) palsy is a very uncommon cause of upper extremity pain and weakness that comprises less than 1% of all upper extremity nerve palsies. Rarely reported but also mentioned in the literature is AIN palsy after shoulder arthroscopy. Methods: A systematic review of the literature to date using PubMed was conducted to identify patients who suffered AIN palsy after shoulder arthroscopy procedures. Articles included met the following criteria: (1) published in English; (2) primary presentation of the data; (3) patients had undergone shoulder arthroscopy before developing symptoms of AIN palsy; and (4) diagnosis was confirmed with clinical symptoms of AIN palsy. Measured outcomes included patient demographics, specific shoulder procedure, anesthesia procedure, intra-operative patient positioning, intra-operative compressive dressing, intra-operative traction, surgical versus conservative treatment, abnormal findings during decompression procedure, proposed mechanism of injury, and follow-up. Results: The search yielded 6 articles, of which 4 (13 cases) met inclusion criteria. An additional 2 cases were included in this report totaling 15 cases. The average patient age was 49 years (range: 31-64) with 73% males. At average follow-up of 24 months, 67% of patients experienced complete resolution of symptoms—more than half of which underwent surgical decompression. Patients who failed to progress experienced weakness of the flexor digitorum profundus and flexor pollicis longus muscles. Conclusions: Proposed injury mechanisms for AIN palsy after shoulder arthroscopy range from mechanical trauma, compressive hematoma, and direct anesthetic neurotoxicity. Management should be directed by clinical symptoms, imaging, and patient factors with majority of patients expected to have excellent clinical outcomes.  相似文献   

13.
目的观察不同尿钙水平Gitelman综合征(GS)患者的临床特点,探讨尿钙在GS疾病临床分型中的价值。方法收集2016—2018年来自中国国家罕见病注册系统(NRSC)、在北京协和医院行SLC12A3基因检测诊断为GS患者的临床资料,分析其尿钙特点,比较不同尿钙水平患者的临床和实验室检查指标。氢氯噻嗪试验按照标准操作流程进行,测定患者基线和用药后3 h内氯离子排泄分数改变量的最大值(ΔFECl)。结果共有83例GS患者被纳入研究,其中低尿钙患者53例(63.86%)。低尿钙组尿钙/肌酐比明显低于非低尿钙组[(0.085±0.058)mmol/mmol比(0.471±0.284)mmol/mmol,t=7.349,P<0.001]。两组患者在年龄、性别、估算肾小球滤过率、血压、血尿电解质水平、代谢性碱中毒方面差异均无统计学意义。低尿钙组患者乏力(χ2=4.595,P=0.032)及多尿(χ2=5.778,P=0.016)发生比例低于非低尿钙组,两组患者在其他临床症状方面差异无统计学意义。低尿钙和非低尿钙组各有16例患者行氢氯噻嗪试验,中位ΔFECl结果分别为0.539%(0.430%,1.283%)和0.829%(0.119%,1.298%),均提示对氢氯噻嗪无反应,组间差异无统计学意义(U=130.000,P=0.956)。结论GS患者中低尿钙比例为63.86%,尿钙水平与疾病临床表型、NCC功能损伤严重程度之间均无明确相关性。  相似文献   

14.
目的探讨罗伊适应模式对患者腹股沟疝无张力疝修补术后恢复情况的影响。 方法将2016年1月至2019年5月在秦皇岛市第二医院择期进行无张力修补术治疗的120例腹股沟疝患者,按照随机数字法分为对照组和观察组,每组各60例。对照组采用常规护理治疗,观察组在对照组的基础上采用罗伊适应模式。比较2组患者的术后临床指标、心理状态、围手术期并发症发生情况及满意度。 结果术后观察组患者的首次排气时间、恢复正常饮食时间、离床活动时间和术后住院时间均低于对照组(P<0.05);术后观察组患者的抑郁自评量表(SDS)和焦虑自评量表(SAS)评分显著低于对照组(P<0.05);术后2组患者均无切口感染发生,2组患者尿潴留、急性疼痛、认知功能障碍、发热、血肿等发生率相比无统计学差异(P>0.05);术后观察组患者护理满意度为96.67%,显著高于对照组的83.33%(P<0.05)。 结论在常规护理的基础上,罗伊适应模式用于患者腹股沟疝无张力修补围手术期,能有效改善术后患者的焦虑/抑郁情绪,不增加围手术期并发症,促进术后患者的恢复及提高治疗满意度。  相似文献   

15.

Objective:

To demonstrate the role of magnetic resonance imaging (MRI) in determining the treatment protocol for hydatid disease of the spine.

Design:

Case report; literature review.

Findings:

Diffusion-weighted MRI can help differentiate complicated infected hydatidosis from abscesses, epidermoid cysts from arachnoid cysts, and benign from malignant vertebral compression fractures. It is also helpful in differentiating between abscesses and necrotic tumors.

Conclusion:

Diffusion-weighted MRI can help differentiate between infections requiring immediate surgery and those that can be treated medically with antihelmintic treatment.  相似文献   

16.
BACKGROUND: Sugammadex rapidly reverses rocuronium- and vecuronium-induced neuromuscular block. To investigate the effect of combination of sugammadex and rocuronium or vecuronium on QT interval, it would be preferable to avoid the interference of anaesthesia. Therefore, this pilot study was performed to investigate the safety, tolerability, and plasma pharmacokinetics of single i.v. doses of sugammadex administered simultaneously with rocuronium or vecuronium to anaesthetized and non-anaesthetized healthy volunteers. METHODS: In this phase I study, 12 subjects were anaesthetized with propofol/remifentanil and received sugammadex 16, 20, or 32 mg kg(-1) combined with rocuronium 1.2 mg kg(-1) or vecuronium 0.1 mg kg(-1); four subjects were not anaesthetized and received sugammadex 32 mg kg(-1) with rocuronium 1.2 mg kg(-1) or vecuronium 0.1 mg kg(-1) (n=2 per treatment). Neuromuscular function was assessed by TOF-Watch SX monitoring in anaesthetized subjects and by clinical tests in non-anaesthetized volunteers. Sugammadex, rocuronium, and vecuronium plasma concentrations were measured at several time points. RESULTS: No serious adverse events (AEs) were reported. Fourteen subjects reported 23 AEs after study drug administration. Episodes of mild headache, tiredness, cold feeling (application site), dry mouth, oral discomfort, nausea, increased aspartate aminotransferase and gamma-glutamyltransferase levels, and moderate injection site irritation were considered as possibly related to the study drug. The ECG and vital signs showed no clinically relevant changes. Rocuronium/vecuronium plasma concentrations declined faster than those of sugammadex. CONCLUSIONS: Single-dose administration of sugammadex 16, 20, or 32 mg kg(-1) in combination with rocuronium 1.2 mg kg(-1) or vecuronium 0.1 mg kg(-1) was well tolerated with no clinical evidence of residual neuromuscular block, confirming that these combinations can safely be administered simultaneously to non-anaesthetized subjects. Rocuronium and vecuronium plasma concentrations decreased faster than those of sugammadex, reducing the theoretical risk of neuromuscular block developing over time.  相似文献   

17.
目的探讨血浆凝血因子VIII(factor VIII,FVIII)水平与IgA肾病(IgAN)患者临床参数及预后的关系。方法收集2016年1月至2016年12月中南大学湘雅二医院确诊的IgAN患者的临床资料。按照时间依赖的受试者工作特征曲线(ROC)得出的血浆FVIII预测IgAN预后的临界值,将患者分为高FVIII组(FVIII>140.50%)和低FVIII组(FVIII≤140.50%),比较两组患者肾活检时基线临床参数的差异。以估算肾小球滤过率(eGFR)下降≥30%或进入终末期肾脏病(ESRD)为终点事件,采用Kaplan-Meier生存曲线及Cox回归方程法分析血浆FVIII水平对IgAN患者预后的影响。结果共93例IgAN患者纳入本研究,中位随访时间为35.15(33.77,36.76)个月,12例(12.90%)患者发生终点事件。高FVIII组患者年龄、血肌酐、尿素氮、血三酰甘油、血总胆固醇、血浆纤维蛋白原、D-二聚体、24 h尿蛋白量、蛋白C、蛋白S和eGFR下降速率高于低FVIII组(均P<0.05);eGFR、血白蛋白、中位随访时间低于低FVIII组(均P<0.05)。Kaplan-Meier生存分析结果显示,与低FVIII组比较,高FVIII组患者肾脏累积生存率降低(χ2=5.635,P=0.018)。在校正收缩压、eGFR、尿蛋白、肾小管萎缩/间质纤维化程度等因素后,多因素Cox回归分析结果显示,高血浆FVIII水平是IgAN患者肾脏预后不良的独立危险因素(HR=4.147,95%CI 1.055~16.308,P=0.042)。结论血浆FVIII水平与IgAN患者临床指标及预后相关,高血浆FVIII水平是IgAN患者肾脏预后不良的独立危险因素。  相似文献   

18.
BACKGROUND: The National Institute for Clinical Excellence (NICE) guidelines of 2002 recommended the use of ultrasound (US) for central venous catheterization in order to minimize complications associated with central line placement. An ongoing audit of line placement by anaesthetists in the theatre complex of a tertiary referral centre looked at the associated complication rates. The objective of the study was to compare complication rates pre- and post-implementation of NICE guidelines. METHODS: This prospective, single centre audit looked at all patients in whom a central venous catheter was placed for surgery. Complication rates were assessed for procedures that were performed pre- and post-implementation of NICE guidelines. In total, 438 patients were identified for the study, and the procedures were performed either by trainee or by consultant anaesthetists. RESULTS: The pre- and post-implementation complication rates were 10.5% (16/152) and 4.6% (13/284), respectively, representing an absolute risk reduction of 5.9% (95% CI 0.5-11.3%). Comparison of those procedures in which US was used when compared with the landmark technique after implementation found a reduction of 6.9% in complications (95% CI 1.4-12.4%). The reduction in complication rates was larger for specialist registrars than for consultants (11.2% vs 1.6%). CONCLUSIONS: The implementation of NICE guidelines has been associated with a significant reduction in complication rates in our tertiary referral centre. In the light of the cross-speciality evidence of US superiority and our results, it is imperative that routine use of US guidance becomes more widespread.  相似文献   

19.
The protective effect of a new oligomeric derivative of prostaglandin B2, known as OC-5186, was evaluated using time-sharing spectrofluorometry in the coldpreserved rat liver. Experiments were divided into three groups: in group A, a 5000 ng dose of OC-5186 was administered via the peripheral vein, 1000 ng via the portal vein, and 200 ng/ml in University of Wisconsin (UW) solution; in group B, the OC-5186 dosage was ten times greater than that in group A; in group C (control group), liver procurement and storage were performed without OC-5186. At 0, 12, and 24 h after cold preservation at 4°C, the liver was perfused for 30 min at 12°C with oxygenized Krebs-Henseleit solution, after which the perfusate was switched to deoxygenized Krebs-Henseleit solution. Time sharing spectrofluorometry was used to follow NADH fluorescence at 450 nm with a 360-nm excitation wavelength, as well as the reflectance of cytochrome aa 3 with 605 minus 620 nm from oxidation to reduction. Rate constants of NADH fluorescence and cytochrome aa 3 reflectance were used as indices of integrity of the mitochondrial respiratory chain. In group C, the rate constant of NADH fluorescence decreased significantly (P<0.05) from the control value of 8.31±0.21×10-3 (sec-1) to 4.97±0.15×10-3 and 5.58±0.16×10-3 (mean±SEM) at 12 and 24 h after cold preservation, respectively. By contrast, in groups A and B, the rate constant of NADH fluorescence was maintained at significantly (P<0.05) higher levels of 6.57±0.54×10-3 and 7.29±0.48×10-3, and 6.94±0.44×10-3 and 6.86±0.44×10-3 at 12 and 24 h, respectively. The rate constant of cytochrome aa 3 reflectance between the OC-5186 groups and the control group was not significant. It is concluded that OC-5186 has a protective effect on the mitochondrial respiratory chain against cold-preservation and/or reperfusion injury.  相似文献   

20.
Orthotopic DA (RT1a) into Lewis (RT11) rat kidney allografts and control Lewis-into-Lewis grafts were assessed by magnetic resonance imaging (MRI) and perfusion measurement after intravenous injection of a superparamagnetic contrast agent. MRI anatomical scores (range 1–6) and perfusion rates were compared with graft histology (rank of rejection score 1–6). Not only acute rejection, but also chronic events were monitored after acute rejection was prevented by daily cyclosporine (Sandimmune) treatment during the first 2 weeks after transplantation. In acute allograft rejection (n=11), MRI scores reached the maximum value of 6 and perfusion rates were severely reduced within 5 days after transplantation; histology showed severe acute rejection (histologic score 5–6). In the chronic phase (100–130 days after transplantation), allografts (n=5) manifested rejection (in histology cellular rejection and vessel changes), accompanied by MRI scores of around 2–3 and reduced perfusion rates. Both in the acute and chronic phases, the MRI anatomical score correlated significantly with the histological score (Spearman rank correlation coefficient r s 0.89, n=30, P<0.01), and perfusion rates correlated significantly with the MRI score or histological score (r s values between-0.60 and -0.87, n=23, P<0.01). It is concluded that MRI represents an interesting tool for assessing the anatomical and hemodynamical status of a kidney allograft in the acute and chronic phases after transplantation.  相似文献   

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