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排序方式: 共有1210条查询结果,搜索用时 15 毫秒
1.
【摘要】 目的 分析探讨人工真皮在重度烧伤患者关节瘢痕挛缩松解术后创面修复中的应用效果。方法 选取2018年3月至2020年9月潍坊医学院附属诸城市人民医院收治的34例重度烧伤创面愈后关节瘢痕挛缩患者作为研究对象, 根据不同治疗方法将其分为研究组 (16例) 和对照组 (18 例), 研究组患者于瘢痕松解术后采用人工真皮、负压封闭引流、湿润烧伤膏及自体刃厚皮片移植治疗, 对照组患者于瘢痕松解术后采用中厚皮片移植、负压封闭引流及湿润烧伤膏治疗, 对比观察两组患者瘢痕松解术后创面愈合时间以及瘢痕评分变化情况。结果 研究组患者瘢痕松解术后创面愈合时间为 (15.06±1.84) d, 明显短于对照组患者的瘢痕松解术后创面愈合时间 (20.61±5.05) d (t=4.152, P < 0.001); 瘢痕松解术后 3? 6? 12 个月, 研究组患者温哥华瘢痕量表 (VSS) 评分均明显低于对照组 (t = 3.136、2.258、2.389, P = 0.004、0.031、0.023)。结论 人工真皮可有效促进重度烧伤患者关节瘢痕挛缩松解术后创面愈合, 缩短创面愈合时间, 改善瘢痕增生情况, 值得临床推广应用。 相似文献
2.
《The Knee》2021
BackgroundTotal knee arthroplasty (TKA) is a successful treatment for patients with late stage osteoarthritis, yet arthrofibrosis remains a consistent cause of TKA failure. Dupuytren’s, Ledderhose and Peyronie’s Diseases are related conditions of increased fibroblast proliferation. The aim of this study was to identify whether an association exists between these conditions and arthrofibrosis following TKA.MethodsPatient records were queried from 2010 to 2016 using an administrative claims database to compare the rates of arthrofibrosis, manipulation under anesthesia (MUA), lysis of adhesions (LOA), and revision TKA in patients with independent chart diagnoses of Dupuytren’s Contracture, Ledderhose, or Peyronie’s Diseases versus those without. Complications were queried and compared using multivariate logistic regression.ResultsPatients with Dupuytren’s (n = 5,232) and Ledderhose (n = 50,716) had a significantly higher rate of ankylosis following TKA: 30-days (OR, 1.54; OR, 1.23), 90-days (OR, 1.20; OR, 1.24), 6-months (OR, 1.23; OR, 1.23), and 1-year (OR, 1.28; OR, 1.23), while patients with Peyronie’s (n = 1,186) had a higher rate of diagnosis at 6-months (OR, 1.37) and 1-year (OR, 1.35). Patients with diagnoses of any of the fibroproliferative diseases had a statistically higher risk of MUA at 90-days, 6-month, and 1-year following primary TKA. These cohorts did not have a significantly higher rate of revision TKA.ConclusionThere is an increased odds risk of arthrofibrosis and MUA in patients who have undergone TKA and have a diagnosis of Dupuytren’s Contracture, Ledderhose, or Peyronie’s Diseases. Improvements to frequency and application of post-operative treatment should be considered in these cohorts to improve outcomes. 相似文献
3.
目的 探讨关节镜下射频松解治疗臀肌挛缩的临床疗效。方法 选取我院2015年6月~2018年12月收治的12例关节镜下松解臀肌挛缩症患者为研究对象,参照刘玉杰臀肌挛缩分型:条索型6例,扇型3例,混合型2例和阔筋膜张肌挛缩型1例;均在关节镜下射频松解挛缩带,直至屈曲、内收、内旋髋关节弹响消失。通过比较术前与末次随访臀肌挛缩功能量化评分、髋关节运动评分(HOS-sport)及髋关节日常生活评分(HOS-ADL)评估疗效。结果 术后有2例出现局部血肿,经局部加压包扎后2~3 d血肿吸收;无切口感染以及坐骨神经损伤;平均随访(17±4.97)个月;末次随访臀肌挛缩功能量化评分、HOS-sport评分、HOS-ADL评分均较术前明显提高。结论 关节镜下射频松解治疗臀肌挛缩,具有创伤小、操作安全、疗效可靠的优势,是一种有效的治疗方式。 相似文献
4.
Background
Despite significant pain relief following total hip arthroplasty (THA) in patients with ankylosing spondylitis, a small subset of patients presenting with extra-articular extension contracture of hips remains unsatisfied.Methods
We retrospectively evaluated the patients with ankylosing spondylitis who underwent simultaneous bilateral THA and had extensor tightness of both hips preoperatively. They were managed with modified Z-plasty of iliotibial band. Patients with windswept deformity, commonly seen in bilateral hip arthritis caused by ankylosing spondylitis, were excluded.Results
Between July 2011 and June 2015, out of 148 patients with bilateral hip involvement, 10 patients (20 hips) had extension contracture of both hips that was addressed during surgery. All patients were followed up for a minimum of 2 years. They could sit comfortably on a chair of height 18 inches with hips and knees flexed to at least 90°. The mean postoperative sum range of motion was 144.6° with an average hip flexion of 95° (range, 90°-105°). None of them had recurrence of extension contracture. There was significant improvement in range of motion and hence ambulation and function. No radiolucent lines exceeding 2 mm were seen in any of the zones around either of the components as evaluated in latest X-rays.Conclusion
Extension contracture of hip although rare is a noticeable problem and needs to be addressed during THA. Modified Z-plasty technique of iliotibial band is a reliable method in managing these patients. 相似文献5.
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8.
《The Foot》2021
PurposeGastrocnemius recession has been described in the treatment of gastrocnemius contracture. The aims of this study were: (1) to assess the change in ankle dorsiflexion after isolated medial gastrocnemius recession performed according to L.S. Barouk’s technique; (2) to compare ankle dorsiflexion after isolated medial head with complete proximal gastrocnemius recession.MethodsA cadaveric study was performed on 15 lower limb adult specimens. Isolated medial gastrocnemius head recession was initially performed, followed by an additional recession of the lateral gastrocnemius head. Ankle dorsiflexion torque was applied with 2 and 4 kg forces on second metatarsal head. Ankle dorsiflexion was measured with the knee both in extension and at 90° of flexion and values were recorded before surgery (T0), after medial head recession (T1) and after both heads recession (T2). Normality of data was assessed using the Shapiro–Wilk test, then measurements were compared in the three conditions with appropriate statistical tests.ResultsAfter isolated medial gastrocnemius recession (Δ = T1-T0), ankle dorsiflexion assessed with the knee in extension significantly increased by 5° ± 3 (range, −2 to 10) with a 2-kg torque (p = 0.02) and by 4.5° ± 3 (range, −4 to 10) with a 4-kg torque (p = 0.04). No significant difference was observed with the knee flexed at 90° (p > 0.05 for all measurements). After both gastrocnemius heads recession (Δ = T2-T1), although a further increase in dorsiflexion was noticed, statistical significance was not reached neither with the knee in extension nor at 90° of flexion (p > 0.05 for all measurements).ConclusionIn this study, isolated medial gastrocnemius head recession performed according to LS Barouk’s technique was effective in improving ankle dorsiflexion, whereas the additional release of the lateral head did not produce any significant change.Level of evidenceLevel V, cadaveric study. 相似文献
9.
Aaron R. Owen Meagan E. Tibbo Andre J. van Wijnen Mark W. Pagnano Daniel J. Berry Matthew P. Abdel 《The Journal of arthroplasty》2021,36(8):2980-2985
BackgroundAcquired idiopathic stiffness (AIS) remains a common failure mode of contemporary total knee arthroplasties (TKAs). The present study investigated the incidence of AIS and manipulation under anesthesia (MUA) at a single institution over time, determined outcomes of MUAs, and identified risk factors associated with AIS and MUA.MethodsWe identified 9771 patients (12,735 knees) who underwent primary TKAs with cemented, modular metal-backed, posterior-stabilized implants from 2000 to 2016 using our institutional total joint registry. Mean age was 68 years, 57% were female, and mean body mass index was 33 kg/m2. Demographic, surgical, and comorbidity data were investigated via univariate Cox proportional hazard models and fit to an adjusted multivariate model to access risk for AIS and MUA. Mean follow-up was 7 years.ResultsDuring the study period, 456 knees (3.6%) developed AIS and 336 knees (2.6%) underwent MUA. Range of motion (ROM) increased a mean of 34° after the MUA; however, ROM for patients treated with MUA was inferior to patients without AIS at final follow-up (102° vs 116°, P < .0001). Significant risk factors included younger age (HR 2.3, P < .001), increased tourniquet time (HR 1.01, P < .001), general anesthesia (HR 1.3, P = .007), and diabetes (HR 1.5, P = .001).ConclusionAcquired idiopathic stiffness has continued to have an important adverse impact on the outcomes of a subset of patients undergoing primary TKAs. When utilized, MUA improved mean ROM by 34°, but patients treated with MUA still had decreased ROM compared to patients without AIS. Importantly, we identified several significant risk factors associated with AIS and subsequent MUA.Level of EvidenceLevel III, retrospective comparative study. 相似文献
10.
目的 探讨关节镜下臀肌挛缩松解术对改善髌股关节不稳定的疗效。方法 选取了66例在2016年1月—2018年12月于同济大学附属第十人民医院行关节镜下臀肌挛缩松解术的患者,所选的研究对象术前必须伴有髌股关节不稳定的症状和相关影像学证据。并于术前术后评估患者的膝关节Lysholm功能评分,运用CT检查获取髌股关节相关指标并进行统计分析。结果 所有入组患者均获得了较好的临床效果,术前的髋关节活动弹响和异常姿势症状明显改善。此外,术后患者膝关节的疼痛也有显著的缓解,术前术后的Lysholm评分差异有统计学意义(P<0.05)。在膝关节CT影像学的对比中可以发现,髌骨倾斜角,髌股指数和髌骨外移度指标在术后明显减小(P<0.05)。平均的外侧髌股角术后明显增大(P<0.05)。结论 关节镜下臀肌挛缩松解术可以显著改善髌骨的外移和倾斜,从而增强髌股关节的稳定性。 相似文献