人工全膝关节置换术后感染的临床分析

目的　探讨全膝关节置换术后感染的原因、处理方法及临床效果。　方法　对 1987年～ 1999年 13例全膝关节置换术后感染患者的病因以及清创、一期或二期再置换等治疗方法进行总结分析。 13例患者术前膝关节平均活动度为 5 5°,HSS评分为 36 5分 ;平均随访 3年 5个月。　结果　13例感染患者经治疗后均未复发 ,80 %的患者对手术满意 ;膝关节活动度恢复至平均 85° ,HSS评分为73 5分。　结论　类风湿关节炎 (RA)、服用激素、合并糖尿病、使用铰链式假体及初次置换术前膝关节曾行其它手术是膝关节术后感染的高危因素 ;感染明确后 ,应积极进行清创合并应用敏感抗生素 ;二期置换的临床效果优于单纯清创及一期置换     

不同间隔时间对分期双侧全膝关节置换术的影响

全膝关节置换术(TKA)是当下治疗晚期膝关节骨关节炎的主要方式,包括同期双侧全膝关节置换术、分期双侧全膝关节置换术,目前对于年龄较大、术前合并症较多的患者,越来越多的医生和患者更接受分期双侧全膝关节置换术,但是在双侧全膝关节置换(BTKA)时间的选择上尚未达成统一,选择合适的间隔时间对不适合行同期双侧全膝关节置换的患者而言可以降低因双侧手术间隔时间带来的影响,包括术中及术后出血及输血情况、围术期并发症、术后功能恢复、住院费用等,因此本文就上述内容的研究进展进行综述,为临床选择合适间隔时间提供建议。     

金属对金属全髋关节置换与全膝关节置换术后早期钴铬钼离子的释出

目的 研究金属对金属伞髋关节置换与全膝关节置换术后早期患者体内钴、铬、钼离子的释出情况.方法 选择2007年5月至2008年3月实施的金属对会属全髋关节置换10例,全膝关节置换8例.假体选择采取随机原则.分别于术前和术后第2、6、12、24周采集静脉全血,应用双聚焦电感耦合等离子体质谱法测量钴、铬、钼离子在血浆样品中的浓度.结果 (1)金属对金属全髋关节置换及全膝关节置换术后患者血浆中钴、铬离子水平增高,于术后2周开始至6周增高明显,6周时离子浓度达到峰值,6周后离子浓度逐渐下降,12周下降至2周水平,24周离子下降趋势逐渐减慢.(2)金属对金属全髋关节置换术后6、12、24周钴、铬离子浓度低于全膝关节置换术患者.(3)使用锻造工艺假体患者术后血浆钴、铬离子浓度低于使用铸造工艺假体患者.(4)两组患者随访半年内钼离子浓度与术前比较差异均无统计学意义.结论 钴铬钼合金金属对金属全髋关节及全膝关节置换术后血浆钴、铬离子浓度均高于术前,离子浓度增高趋势相似.     

全膝关节置换术中髌骨处理

全膝关节置换术中是否进行髌骨置换仍有争论,术后膝前疼痛及髌股关节并发症是争论的焦点.膝前疼痛是多种因素共同作用的结果,不能简单地归咎为髌骨置换与否.全膝关节置换时是否置换髌骨应考虑原发病、病变程度、假体类型及患者活动量和体重等诸多因素.如果行髌骨置换,精湛的外科技术、合适的假体是全膝关节置换术后髌股关节并发症减少的关键;如果不行髌骨置换,患者的筛选标准是保证手术疗效的关键.     

金属对金属全髋关节置换与全膝关节置换术后早期钴铬钼离子的释出

目的 研究金属对金属伞髋关节置换与全膝关节置换术后早期患者体内钴、铬、钼离子的释出情况.方法 选择2007年5月至2008年3月实施的金属对会属全髋关节置换10例,全膝关节置换8例.假体选择采取随机原则.分别于术前和术后第2、6、12、24周采集静脉全血,应用双聚焦电感耦合等离子体质谱法测量钴、铬、钼离子在血浆样品中的浓度.结果 (1)金属对金属全髋关节置换及全膝关节置换术后患者血浆中钴、铬离子水平增高,于术后2周开始至6周增高明显,6周时离子浓度达到峰值,6周后离子浓度逐渐下降,12周下降至2周水平,24周离子下降趋势逐渐减慢.(2)金属对金属全髋关节置换术后6、12、24周钴、铬离子浓度低于全膝关节置换术患者.(3)使用锻造工艺假体患者术后血浆钴、铬离子浓度低于使用铸造工艺假体患者.(4)两组患者随访半年内钼离子浓度与术前比较差异均无统计学意义.结论 钴铬钼合金金属对金属全髋关节及全膝关节置换术后血浆钴、铬离子浓度均高于术前,离子浓度增高趋势相似.     

Slot双下肢全长负重位X线摄影在全膝关节置换术前的应用

目的观察Slot双下肢全长负重位X线检查技术在全膝关节置换术前检查中的应用价值。方法对36例拟接受全膝关节置换术的患者术前行双下肢全长负重位X线检查。采用Slot技术,通过一次连续数秒曝光获得包含双髋关节至踝关节的双下肢全长负重位X线影像。结果 36例患者均一次性完成全膝关节置换术前双下肢全长负重位X线检查,其中膝关节内翻畸形34例,外翻畸形2例。所摄X线片中,患者双髋关节、股骨、膝关节、胫腓骨及踝关节均显示良好,可为术前计划提供可靠依据。结论采用Slot双下肢全长负重位X线检查技术对拟接受全膝关节置换术患者进行术前检查,能够清晰显示双下肢全长,对术前计划与评估具有重要临床价值。     

全膝关节置换术患者疼痛灾难化及影响因素调查

目的 探讨全膝关节置换术患者疼痛灾难化水平及其影响因素，为制定针对性的干预措施提供参考。 方法 采用便利抽样法，选取豫北地区5所三级综合医院的356例全膝关节置换术患者，采用一般资料调查表、疼痛灾难化量表、膝关节功能评分、正性负性情绪量表进行调查。 结果 全膝关节置换术患者疼痛灾难化总分为（31.01±7.05）分，74例（20.79%）患者疼痛灾难化总分≥38分，即达到疼痛灾难化水平。多元线性回归分析结果显示，膝关节功能、正性情绪、职业、年龄是影响疼痛灾难化的主要因素（均P＜0.01）。 结论 全膝关节置换术患者疼痛灾难化水平较高，膝关节功能低下、正性情绪得分较低、务农人员及高龄患者更容易发生疼痛灾难化，医护人员应针对主要影响因素制定干预措施，以降低疼痛灾难化的发生。     

白内障患者术前视功能期望及影响因素研究

目的 调查白内障患者术前视功能期望水平，并分析其影响因素，为白内障患者术前视功能期望的管理提供依据。方法 采用一般资料调查表、中国版视功能指数量表及艾森克人格问卷对146例拟行超声乳化联合人工晶状体植入术患者进行调查。结果 白内障患者的术前视功能期望得分为97.73（91.67，100.00）分，术后视功能得分为89.58（83.33，93.75）分。回归分析显示，患者白内障手术史、文化程度、内外向人格是术前视功能期望水平的影响因素（均P<0.05）。患者术后视觉满意度与术前期望呈负相关，与术后视功能呈正相关（均P<0.05）。结论 白内障患者术前视功能期望处于较高水平，且术前期望和术后视功能存在较大差异，患者术后视觉满意度不仅取决于术后实际视功能，也取决于其术前期望。医护人员应针对术前视功能期望影响因素进行干预，帮助患者做出更符合实际的术前期望，以提高患者满意度，减少医患纠纷。     

髌股关节置换失败后的人工全膝关节置换翻修术

背景：髌股关节置换术对于仅侵犯膝关节前间室的单发性关节炎是一种有效的治疗方法，但是当其需要行翻修手术时，是否会影响人工全膝关节置换术的结果仍不明确。本研究旨在回顾先期行髌股关节置换术后再进行人工全膝关节置换术的结果。 方法：我们用人工全膝关节置换术对10例患者共12膝失败的髌股关节置换进行了翻修，翻修原因，包括单发的进行性胫股关节炎（6膝）、单发的髌股关节轧住和轨迹不良（3膝）以及两者同时存在（3膝）。这些患者在髌股关节置换术后进行翻修术的平均时间为4年，每个膝关节均使用了后稳定型假体，未使用加长柄、填充垫或结构性骨移植物。术后对这些患者进行了临床及影像学随访，其中包括美国膝关节学会临床及功能评分（KSS）。术前我们就对这些失败的髌股关节置换术进行了评估，并获得了术前KSS评分。 结果：术后平均随访时间为3．1年，平均KSS临床评分和功能评分从术前的57分和51分分别增加至术后的96分和91分。在最近的随访中，没有临床和影像学证据表明这些患者存在髌股关节轨迹不良、松动和磨损。 结论：基于我们对本组患者的小样本短期随访经验，髌股关节置换失败后进行人工全膝关节置换翻修术不会影响其结果。 可信水平：治疗性研究，Ⅳ级。进一步可信度参见作者介绍。     

膝关节单髁置换术的临床应用初步结果分析

[目的]探讨膝关节单髁置换术治疗单室膝关节骨关节炎的临床疗效,分析影响手术效果的因素.[方法]回顾性分析2008年1月～ 2010年12月收治的17例单室膝关节骨关节炎(X线片显示内侧单室膝关节骨关节炎为主)的患者,术后平均随访30个月(12 ～48个月),疗效评估选用HSS、KSS、WOMAC评分.[结果]术后17例患者患膝关节疼痛明显缓解,关节活动度改善,生活质量提高.HSS、KSS、WOMAC评分术前及随访时差异具有统计学意义(P＜0.01).[结论]在选择适当的病例和严格掌握手术适应证的前提下,单髁置换术治疗单室膝关节骨关节炎近中期疗效满意,创伤小,术后关节活动度较全膝关节置换更大,关节功能更接近生理状态并为今后全膝关节置换留有余地.     

Variations in Surgeons' Recovery Expectations for Patients Undergoing Total Joint Arthroplasty: A survey of the AAHKS Membership

Recovery expectations (RE) after total hip and knee arthroplasty (THA–TKA) influence outcomes. We surveyed AAHKS members to determine variation in surgeon RE. Four vignettes depicting patients with high and low expectations after THA and TKA were distributed with a validated RE survey. Responses were analyzed for clinically significant differences between surgeons and within surgeons. Of 1049 surgeons surveyed, 358 (34%) responded. There was a clinically significant difference in 85% (high-THA), 46% (low-THA), 74% (high-TKA), and 57% (low-TKA) of pairs. Disagreement was significantly greater in high expectation vignettes. Individual surgeons distinguished between high and low expectation patients in 76% (THA) and 72% (TKA) of cases. There was no association between surgeon RE and practice demographics. Wide variations in RE were observed, especially among high expectation patients.     

Patients'' expectations of colorectal surgery for cancer

Objective The primary objectives of surgery for colorectal cancer are to achieve radical resection of the tumour and to ensure a satisfactory quality of life for the patient. But what is satisfactory quality of life for the patients? What do patients desire? The goal of our exploratory investigation was to evaluate prospectively the patient pre‐operative expectations as objectively as possible and to analyse results in relation to age, gender and socio‐economic status. Methods In the period from 1998 to 2001, 167 patients were given a questionnaire consisting of 15 questions prior to surgery. The questionnaire included various aspects that were thought to influence the patient's quality of life. Moreover the patients were given the opportunity to rate the questions they considered most important. Results The following five points were considered most important by the total group of patients: Complete cure of the disease was rated most important (95%); it was the prime expectation of the patients. This was followed by the avoidance of a stoma (81%), a reliable control of defaecation (52%), normal digestion (44%) and little pain (26%). Conclusion Age, gender and education influence the pre‐operative expectations of patients undergoing surgery for colorectal cancer. In addition to the surgical standard, the care of the individual patient must be given due consideration in the treatment strategy.     

Do Patient Expectations Influence Patient-Reported Outcomes and Satisfaction in Total Hip Arthroplasty? A Prospective,Multicenter Study

Background

The relationship between patient expectations and patient-reported outcomes (PROs) in total hip arthroplasty (THA) patients is controversial. The purpose of this study was to examine the impact of preoperative patient expectations on postoperative PROs and patient satisfaction.

The Use of Biologic DMARDS Identifies Rheumatoid Arthritis Patients with More Optimistic Expectations of Total Knee Arthroplasty

Background

Preoperative expectations of total knee arthroplasty (TKA) correlate with postsurgical satisfaction, and are linked to outcomes. Rheumatoid arthritis (RA), and other chronic diseases, may lower expectations, although new biologic medications have greatly enhanced patients’ quality of life.

Questions/Purposes

The purpose of this study is to compare preoperative expectations of RA to those of matched osteoarthritis (OA) patients undergoing TKA, and examine the subset of RA on biologic DMARD therapy.

Methods

For a cross-sectional study, RA and OA identified from an institutional TKA registry were matched on age, sex, prior TKA, and preoperative function. Expectations were measured using the Hospital for Special Surgery (HSS) Knee Expectations Survey. Expectations and quality of life measures were assessed preoperatively and scores were compared between RA and OA.

Results

One hundred fourteen RA cases, 46.5% on biologics, were matched to 228 OA cases. The average expectations score was not significantly lower for RA compared to OA (72.9 ± 20.7 vs. 77.2 ± 18.3, p = 0.040. RA on biologics had expectations similar to OA (total expectation score 76.3 ± 18.1 vs. 77.4 ± 17.4, p = 0.71), while RA not on biologics had expectations that were significantly lower (69.9 ± 22.4 vs. 77.1 ± 19.0, p = 0.03).

Conclusion

Use of biologics in RA patients was associated with higher expectations, similar to those of OA patients, but the effect on outcomes is not known. Further studies should assess the effect of higher expectations in RA patients on outcomes.

Electronic supplementary material

The online version of this article (doi:10.1007/s11420-014-9380-1) contains supplementary material, which is available to authorized users.     

Patient expectations predict greater pain relief with joint arthroplasty

We examined the relationship between patient expectations of total joint arthroplasty and functional outcomes. We surveyed 1799 patients undergoing primary hip or knee arthroplasty for demographic data and Western Ontario McMaster University Osteoarthritis Index scores at baseline, 3 months, and 1 year of follow-up. Patient expectations were determined with 3 survey questions. The patients with the greatest expectations of surgery were younger, male, and had a lower body mass index. Linear regression modeling showed that a greater expectation of pain relief with surgery independently predicted greater reported pain relief at 1 year of follow-up, adjusted for all relevant covariates (P < .05). Patient expectation of pain relief after joint arthroplasty is an important predictor of outcomes at 1 year.