关节镜下切除软组织囊肿的微创技术应用初探

目的：探讨关节镜下切除软组织囊性病变的临床价值。方法：1998年2月--2001年2月对软组织囊肿26例行关节镜下刨削方法切除病变囊壁治疗。结果：26例获随访6月--12月，平均8．6月，总有效率96．2％(25／26)，术后无并发症，仅1例右腕背腱鞘囊肿术后复发。结论：关节镜下切除软组织囊性病变手术创伤小，并发症少，成功率高，术后恢复快。     

后方入路治疗胫骨平台后髁冠状位骨折的疗效分析

目的探讨后方入路治疗胫骨平台后髁冠状位骨折的临床疗效,分析该类骨折形态、手术入路的选择以及对Schatzker分型的再认识。方法回顾分析2003年6月-2009年6月23例采用后方入路治疗胫骨平台后髁冠状位骨折患者的临床资料。男15例,女8例;年龄32～56岁,平均38岁。均为闭合性骨折。致伤原因:高处坠落伤5例,交通事故伤15例,运动损伤3例。骨折按Moore分型:Ⅰ型10例,Ⅱ型9例,Ⅳ型4例。常规行膝关节正侧位X线片、CT扫描及三维重建。患者受伤至手术时间为3～14d,平均6d。结果骨折获解剖复位17例,一般复位6例。术后切口均Ⅰ期愈合。23例均获随访,随访时间12～36个月,平均24个月。骨折于术后6～9个月达临床愈合,平均7.6个月。无神经、血管损伤、内固定失效、关节僵硬、创伤性骨关节炎、畸形愈合等并发症发生。末次随访时根据Rasmussen评分系统评定膝关节功能,获优14例,良7例,可2例,优良率为91.3%。结论胫骨平台后髁冠状位骨折少见,有其独特的形态特点,Schatzker分型不能完全涵盖该类骨折。采用后方入路可在直视下复位关节面,固定牢靠,术后可早期行功能锻炼,并发症少,是较好的手术治疗方...     

经枕颈后外侧入路治疗寰枕区腹侧病变的安全性评估

目的 对经枕颈后外侧入路手术治疗寰枕区腹侧病变的不良事件作统计,评估该术式的安全性.方法 1999～2006年,对74例寰枕区以腹侧病变压迫为主的患者进行治疗,手术经枕颈后外侧入路,先行枕骨大孔扩大及寰椎后弓切除减压,再经枕颈区硬脊膜侧方显露齿突及C2椎体做相应压迫因素切除,达到脊髓前后方同时减压,并同期完成枕颈植骨...     

围手术期康复宣教与训练对股骨干骨折患者的影响

目的 探讨康复宣教与训练等干预手段对股骨干骨折患者围手术期的影响.方法 2010年6月-2011年3月收治股骨干骨折患者90例,其中男48例,女42例;年龄17~58岁,平均38岁.开放性骨折28例,闭合性骨折62例.股骨骨折部位:上1/3骨折33例,中1/3骨折35例,下1/3骨折20例,多段骨折2例.横形骨折20例...     

不同硬对硬摩擦界面全髋关节置换术后血清钴、铬浓度及临床疗效比较

目的 比较全髋关节置换术(total hip arthroplasty,THA)中使用3种不同硬对硬界面后,2年内血清钴、铬金属离子浓度的变化,以及临床疗效有无差异.方法 90例THA患者分为陶瓷对陶瓷(COC)、陶瓷对金属(COM)、金属对金属(MOM)3组,每组30例.术前,术后3、6、12、24月检测血清钴、铬金属离子浓度,进行Harris评分,对患髋进行X片连续性观察和彩超检查.结果 3组术后24月患髋Harris评分达优率均为100％,连续X片显示髋臼假体周围未见透亮线、骨溶解等,彩超均未发现炎性假瘤.术后COM组和MOM组内金属离子浓度迅速升高,至12月时变化趋于平稳,并表现出下降趋势.但MOM组中铬离子浓度则继续上升,24月与12月时比较差异具有统计学意义(上升了0.48 μg/L,P=0.021).术后各时间点COC组相对恒定,MOM组钴、铬金属离子浓度大于COC组和COM组(P＜0.05).结论 3种硬对硬界面术后功能恢复好,无炎性假瘤、骨溶解的发生,都取得了满意的临床效果.COM血清钴、铬金属离子浓度低于MOM,高于COC.     

Development of a machine learning algorithm for prediction of failure of nonoperative management in spinal epidural abscess

BACKGROUND CONTEXTData regarding risk of failure of nonoperative management in spinal epidural abscess (SEA) are limited. Given the potential for deterioration with treatment failure, a tool that predicts the probability of failure would be of great clinical utility.PURPOSEWe primarily aim to build a machine learning model using independent predictors of nonoperative management failure. Secondarily, we aim to develop an open-access web-based application that provides a patient-specific probability of treatment failure.STUDY DESIGN/SETTINGRetrospective, case-control study.PATIENT SAMPLEPatients 18 years or older diagnosed with SEA at 2 academic medical centers and 3 community hospitals.OUTCOME MEASURESFailure of nonoperative management.METHODSThis is a retrospective cohort study of 367 patients with SEA initially managed nonoperatively between 1993 and 2016. The primary outcome was failure of nonoperative management defined as neurologic deterioration, worsened back and/or radicular pain, or persistent symptoms despite initiation of antibiotic therapy. Five machine learning algorithms were developed and assessed by discrimination, calibration, and overall performance.RESULTSNinety-nine (27%) patients failed nonoperative management. Factors determined for prediction of nonoperative management were: motor deficit, diabetes, ventral component of abscess relative to thecal sac, history of compression or pathologic vertebral fracture, sensory deficit, active malignancy, and involvement of 3 or more vertebral levels. The elastic-net penalized logistic regression model was chosen as the final model given its superior discrimination, calibration, and overall model performance. This model was incorporated into an open access web application.CONCLUSIONBy building a discriminative and well-calibrated model in a user-friendly and open-access digital interface, we hope to provide a prognostic tool that can be used to inform clinical decision-making in real-time.     

Treatment outcome of the Masquelet technique in 195 infected bone defects–A single-center,retrospective case series

BackgroundThe Masquelet technique is a surgical procedure for the reconstruction of bone defects. During the first step, an osteosynthetically stabilized defect is filled with a cement spacer. The spacer induces a foreign body membrane, called a Masquelet membrane. In a follow-up procedure, the spacer is replaced by a bone graft, which ossifies in the subsequent phase.Material and MethodsA total of 171 patients with 195 septic bone defects on the extremities that had been treated with the Masquelet procedure at the BG Klinikum in Hamburg, Germany, from 2011 to 2021 were retrospectively analysed, comparing patients who reached full weight and load bearing on the affected extremity to those who failed to do so. Defect size and configuration, microbiological results and treatment methods as well as comorbidities and epidemiologic data were analysed for factors influencing the treatment outcome.ResultsIn all, 113[66%] of the patients were male, and 58[34%] were female, with an age distribution of 52 +/-16 years. Out of 171 patients, 24 patients had two defects. The number of patients that reached full weight bearing was 152[89%], the follow-up period was 2 +/-1 years (median +/- SD). Full weight bearing capability was negatively by the defect size as defects >62 mm tended to be less likely to reach full weight bearing than smaller defects. A secondary stabilization with an internal stabilization was applied in 58[34%] of all patients and positively influenced the attainment of full weight and load bearing.DiscussionWith 171 patients and 195 septic bone defects treated at a single centre with the Masquelet Technique, this study represents a comparably large cohort. Demographics, defect characteristics and treatment outcomes did not differ from those of other cohorts described in the literature. Defects larger than 62 mm showed lower chances to reach full weight bearing and can be defined as "critical defect size" for the Masquelet technique based on our data.     

The perceptions of clinicians using low-intensity pulsed ultrasound (LIPUS) for orthopaedic pathology: A national qualitative study

IntroductionLow-intensity pulsed ultrasound (LIPUS) is a non-invasive treatment modality for delayed union or non-union of acute fractures. We aimed to assess the current use of LIPUS at a national level in the United Kingdom, why and how clinicians use it, what treatment protocols are followed, and what the current perceptions are on this technology.MethodologyUsing a detailed online survey compromised of 20 questions delivered to known LIPUS users, we were able to collect qualitative data on indication of use, type of machine used, personal views on the technology, frequency of usage, and treatment protocols. Each question was peer-reviewed to exclude bias.ResultsA total of 70 respondents completed the survey. LIPUS was used by most clinicians for cases of non-union (N = 55, 78.5%) and delayed union (N = 51, 72.8%). The majority of respondents personally used a LIPUS device between 1 and 5 times in 12 months (N = 38, 54.3%). Most considered LIPUS a failure after three to six months of treatment without clinical improvement (N = 39, 55.7%). A total of 32 respondents (45.7%) mentioned the need for funding approval before accessing LIPUS technology. Poor revision surgery candidates (N = 48, 68.6%) and atrophic non-union (N = 46, 65.7%) were the most frequently cited reasons for using LIPUS technology as treatment. Most participants (N = 48, 68.6%) considered LIPUS to be cost-effective. Despite most clinicians being comfortable with the use of LIPUS, some respondents did not understand the basic science underpinning the technology nor could explain the need for LIPUS to patients comfortably.ConclusionLIPUS technology may have a significant role to play in the treatment of orthopaedic fracture related pathology. Regular users perceived the technology to be cost-effective and efficacious. Further research should standardize treatment protocols and aim to establish a national LIPUS registry     

固有免疫系统在骨关节炎发病机制中的作用及研究进展

目的综述固有免疫系统在骨关节炎（osteoarthritis，OA）发病机制中的作用及研究进展。方法查阅国内外相关文献，对固有免疫系统介导的炎症及巨噬细胞、T 细胞、补体系统在 OA 发病机制中的作用、潜在治疗靶点及研究进展进行总结。结果随着研究深入，OA 逐渐被认为是一种低度炎症状态，固有免疫系统在其发生发展过程中发挥了重要作用。目前研究主要集中于 OA 滑膜组织巨噬细胞亚群极化方面，结果显示 M1 亚群向 M2 亚群转换失败是 OA 进展的关键环节。而 T 细胞及补体系统也参与了 OA 的病理过程。结论目前有关固有免疫系统对 OA 进展作用的研究仍处于探索阶段，具体机制尚未明确。现有研究结果提示，巨噬细胞亚群极化是早期防治 OA 的潜在靶点。