双侧全膝关节置换后下肢深静脉血栓形成与高血压的关系

背景:下肢深静脉血栓是人工全膝关节置换后的严重并发症之一,若不能及时妥当地诊断及处理会引起患者病情迁延不愈,甚至血栓脱落造成肺栓塞,危及患者生命。目前国内外研究并未确定有高血压病的患者行全膝关节置换后会增加下肢深静脉血栓的发生率。目的:观察高血压是否会影响双侧人工全膝关节置换后患者下肢深静脉血栓的发生率。方法:回顾性分析2010年9月至2014年3月新疆医科大学第一附属医院关节外科因膝骨关节炎行双侧全膝关节置换患者的病历资料,根据患者是否合并有高血压,将其分为高血压组与对照组。在置换后通过彩色多普勒超声检查,诊断患者全膝关节置换后是否发生下肢深静脉血栓。比较两组间下肢深静脉血栓的发生率是否有差异,分析高血压与下肢深静脉血栓的关系。结果与结论:共纳入525例患者,高血压组219例,对照组306例。全膝关节置换后20例患者发生下肢深静脉血栓,发生率为3.8%,其中高血压组发生下肢深静脉血栓13例(2.5%),对照组发生下肢深静脉血栓7例(1.3%)。通过卡方检验分析,高血压组全膝关节置换后发生下肢深静脉血栓的风险是对照组患者的2.7倍,差异有显著性意义(P<0.05)。提示术前患有高血压病患者行全膝关节置换,其置换后下肢深静脉血栓发病率高于术前血压正常患者。     

全膝关节初次单侧表面置换与双侧同时置换术后并发症的比较分析

Objective To compare postoperative complications in patients firstly undergoing primary unilateral total knee arthroplasty (UTAK) and simultaneous bilateral total knee arthroplasty (SBTKA) .Methods From November 2006 to November 2009, 339 patients underwent primary UTAK and SBTKA in our hospital and followed up. The UTKA group had 178 patients (50 men and 128 women) who were aged from 26 to 81 years (mean, 64. 2 years) and a mean American Knee Society Score (KSS) of 34. 0 ± 13. 3points before surgery. The SBTKA group had 161 patients (32 men and 129 women) who were aged from 34 to 80 years (mean, 65. 3 years) and a mean KSS of 33. 4 ± 11. 1 points before surgery. The postoperative complications were compared between the 2 groups and clinical outcomes were evaluated according to KSS system. Results The patients were followed for 18. 4 months on average (range, 3 months to 3 years) . The incidence of postoperative complications was 6. 2% (11/178) in the UTKA group and 4. 3% (7/161) in the SBTKA group, with no significant difference (x2 =0. 564, P = 0. 453) . The KSS score at the final follow-up was all increased in both groups. It was 92. 5 ± 10. 6 in the UTKA group and 91. 9 ± 11. 1 in the SBTKA group, with no significant difference (t =0.511, P = 0.610). Conclusions SBTKA is not an independent risk factor for postoperative complications. Careful operative preparation and assessment, good surgical skills, comprehensive postoperative monitoring and supporting management, and proper rehabilitation can significantly reduce complications following SBTKA. But for a patient who has been complicated with multiple internal diseases, SBTKA decision should not be made before a careful tolerance assessment of the patient.     

双钢板治疗复杂pilon骨折的疗效分析

目的探讨双钢板内固定治疗Ruedi-AllgowerⅢ型pilon骨折的临床疗效。方法对2009年1月-2011年3月21例Ruedi-AllgowerⅢ型Pilon骨折采用胫骨远端双钢板内固定,观察并评价踝关节功能。结果患者术后获8～30个月随访。无骨折延迟愈合及畸形愈合。参照Tometta et al评价标准评价踝关节功能:优18例,良2例,可1例。结论采用双钢板夹持内固定治疗Ruedi-AllgowerⅢ型Pilon骨折,固定牢靠,有利于踝关节的早期无负重功能锻炼。     

美丽：一个缠绕人类心灵的情结

美是家庭力量的源泉?还是科学家从生物学角度阐明的一种思维习惯?我们对美貌的迷恋是天生的吗?     

高屈曲型人工全膝关节置换术的临床应用

全膝关节表面置换(Total knee arthroplasty,TKA)已经成为对严重膝关节病变施行外科重建的常规手术方法.     

基于时机理论的关怀干预对心胸外科手术患儿的价值研究

目的 探讨基于时机理论关怀干预对心胸外科手术患儿的干预效果。方法 选取2021年11月至2022年11月收治的94例心胸外科手术患儿,随机分为对照组与研究组,每组47例。对照组实施常规护理干预,研究组在对照组基础上实施基于时机理论的关怀护理;比较2组康复情况、呼吸功能、医疗恐惧评分、生活质量及治疗配合度(Houpt行为量表、Franlk治疗依从性量表)、护理满意度的差异。结果 护理后,研究组患儿康复情况、呼吸功能改善优于对照组(P<0.05);护理后,2组医疗恐惧评分降低,生活质量、Houpt行为、Frankl治疗依从性及护理满意度评分升高,且研究组更优,差异均有统计学意义(P<0.05)。结论 对心胸外科手术患儿实施基于时机理论的关怀护理对改善患儿医疗恐惧及提高生活质量具有积极作用,提高患儿治疗配合度及护理满意度。     

老年人桡骨远端骨折治疗后腕关节屈伸及旋转活动的Meta分析

背景：目前老年桡骨远端骨折是否需切开复位钢板内固定以恢复影像学上的解剖复位还存在争议。 目的：对老年人桡骨远端骨折手术与非手术治疗的疗效进行系统评价。 方法：计算机检索PubMed,Springer以及万方等数据库,手工检索相关的中英文骨科杂志。收集所有对手术与非手术治疗老年人桡骨远端骨折疗效进行比较的文献。利用Cochrane协作网提供的RevMan5.0软件进行统计学分析。 结果与结论：共纳入符合标准的文献6篇,其中随机对照研究2篇,回顾性队列研究4篇。Meta分析结果显示：两组腕关节背伸活动度[MD=-0.87,95% CI(-3.31,1.58),P=0.49],屈曲活动度[MD=-2.79,95% CI(-6.47,0.88),P=0.14],旋前活动度[MD=-0.08,95% CI(-1.49,1.64),P =0.92],旋后活动度[MD=-0.7,95% CI(-3.52,2.12),P=0.63]以及并发症的发生[MD=1.35,95% CI(0.71,2.56),P=0.36] 差异均无显著性意义;手术组桡骨长度更接近于正常的解剖长度[MD=2.46,95% CI(1.78,3.15),P < 0.01];手术组尺倾角 [MD=3.73,95% CI(2.97,4.48),P < 0.000 01]以及掌倾角[MD=6.81,95% CI(3.72,9.90),P < 0.000 1]更接近于正常的解剖角度。两组患肢腕关节屈伸,旋前旋后活动度以及并发症的发生差异均无显著性意义,而手术组解剖复位程度明显优于非手术组。中国组织工程研究杂志出版内容重点：人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程全文链接：     

老年全髋关节置换术患者术后生存质量现状及影响因素

目的探讨髋关节骨性关节炎患者生存质量现状和影响因素。方法选择在该院骨科住院治疗的165例髋关节骨性关节炎患者为研究对象,按照患者有无行全髋关节置换术将其分为观察组与对照组,采用自编问卷、SF-36量表和Harris评分量表对两组患者进行测评。结果观察组SF-36量表的生存质量维度指标和总评分除社会功能维度评分外均显著高于对照组(P<0.05);而髋关节置换术患者SF-36量表中躯体健康、躯体疼痛和总体健康指标得分接近于正常人群(P>0.05),而其余维度指标评分均明显低于正常人群(P<0.05)。单因素Logistic回归分析结果显示配偶、自认为经济状况、性格、并发症和Harris评分是影响髋关节骨性关节炎患者生存质量的危险因素。结论患者生存质量同时受自身因素、家庭因素和医师因素等方面影响,在对患者进行生存质量干预时,可从多方面采取针对性措施进行干预。     

一期翻修术治疗全膝关节置换术后感染

目的 报告全膝关节置换(total knee arthroplasty,TKA)术后感染一期翻修术的方法,分析其近期随访疗效.方法 2005年4月至2009年12月施行TKA术后感染一期翻修术22例,其中资料完整的随访6个月以上的患者16例,男5例,女11例;年龄49～75岁,平均65岁.均明确诊断为单侧TKA术后关节腔内感染.慢性感染(Ⅲ型)14例,迟发血源性感染(Ⅳ型)2例.术前美国膝关节协会评分(Knee Society Score,KSS)的功能评分平均为(37.25±16.23)分.翻修距初次手术时间为2～73个月,平均23.9个月.术中彻底清除肉芽坏死组织及瘢痕,用碘伏浸泡伤口,脉冲冲洗.14例骨缺损严重者采用带延长柄髁限制型假体,2例采用表面假体,抗生素骨水泥固定.结果 随访6～59个月,平均25个月.1例手术失败,分析原因可能与清创不彻底有关,8个月后行二期再翻修.1例于术后9个月出现局部疼痛,红细胞沉降率和C反应蛋白增高,经抗生素治疗1个月后疼痛消失,实验室检查恢复正常.其余14例在随访期间均无感染复发或再感染.末次随访时KSS功能评分平均(85.88±12.85)分,患者满意率87.5%(KSS功能评分75分以上,14/16).结论 对TKA术后感染患者行一期翻修术,经术中彻底清创,牢固固定假体及正确使用抗生素,术后平均2年的随访疗效良好,具有治疗周期短、费用低的特点,患者满意度高.但其中长期结果还需进一步随访观察.

Abstract：

Objective To evaluate the short term clinical results of single-stage revision for infected total knee arthroplasty (TKA). Methods Twenty-two unilateral infected TKA were revised through onestage implant exchange using antibiotics loaded cement from April 2005 to December 2009. Sixteen patients who were followed up at least 6 months were included in this study. There were 5 male and 11 female with the mean age of 65 years old (range 49 to 75) in this group. Fourteen patients were diagnosed as late chronic infection (＞ 4 weeks) and 2 cases as hematogenous spread delayed infection. The average Knee Society Score (KSS) functional score was 37.25±16.23. The average time from primary arthroplasty to revision was 23.9months (range 2 to 73). During the operation, the inflammatory, necrotic and scar tissue must be removed radically. Constrained condyle knee (CCK) prosthesis with stem were used in 14 cases with severe bone loss and primary prosthesis were used in 2 cases. All cases were fixed with antibiotics-loaded cement. Results All cases were followed up for the average 25 months (range 6 to 59 months), Infection recurred in one case who had to undergo another two-stage revision. One case who complained of local knee pain with elevated ESR and CRP 9 months postoperatively responded to appropriate one-month course of antibiotic therapy. The average KSS functional score was 85.88±12.85 and the satisfactory rate was 87.5% at last follow-up. Conclusion Good outcomes can be reached by radical debridement, correct choice of implant, careful perioperative management, and effective antibiotics in single-stage revision for infected TKA.     

全膝关节置换术中使用止血带疗效与安全性的meta分析

目的 系统评价全膝关节置换术(TKA)中使用止血带疗效与安全性.方法 计算机检索Medline、PubMed、EMASE、Cochrane Library、中国生物医学文献数据库、Highwire、CNKI、VIP、万方数字期刊群,搜索国内外关于TKA中是否使用止血带的随机对照研究资料,采用RevMan 4.2.2软件进行meta分析.结果 纳入研究19篇,外文15篇,中文4篇,共计1159例膝关节置换术患者.meta 分析结果显示:TKA术中使用止血带与不使用止血带两组在术中失血量(P=0.000)、深静脉血栓(P=0.020)、大腿疼痛例数(P=0.000)、膝关节血肿例数(P=0.030)、切口感染例数(P=0.040)、皮肤淤斑面积(P＜0.000)、术后3 d膝关节周径增加率(P=0.000)方面差异有统计学意义,但在总失血量(P=0.100)、输血例数(P=0.150)、手术时间(P=0.120)、住院时间(P=0.350)、肺栓塞例数(P=0.310)、皮肤水泡例数(P=0.170)方面差异无统计学意义.结论 TKA中使用止血带能减少术中出血量,但并不减少总失血量与输血例数,不提高手术效率,不缩短住院时间,不促进术后膝关节功能恢复,且可能增加下肢深静脉血栓、切口感染、膝关节血肿与淤斑发生率,引起膝关节肿胀与大腿疼痛;建议在TKA中尽量少用止血带.