杜仲腰痛丸对大鼠非压迫性髓核突出神经根损伤的组织形态学研究

目的：观察杜仲腰痛丸对大鼠非压迫性髓核突出神经根损伤的组织形态学变化。方法：取健康雄性Wistar大鼠50只，随机分为假手术组（A组）、模型组（B组）、伸筋丹组（C组）、杜仲腰痛丸高低剂量组（分别为D、E组），每组10只。将大鼠自身的尾椎髓核取出移植于左侧L5、L6神经根背侧，造成大鼠非压迫性髓核突出模型，观察2周时神经根组织形态学变化。结果：B、C、D、E组神经根均产生明显可见的组织形态改变，但C、D、E组改变程度较B组减轻。结论：杜仲腰痛丸可减轻非压迫性髓核突出神经根损伤所导致的组织形态病理学改变，改善或抑制炎症反应，有保护神经根的作用。     

The Efficacy and Safety of Acetaminophen in Total Joint Arthroplasty: Systematic Review and Direct Meta-Analysis

BackgroundOral and intravenous (IV) acetaminophen has become widely used perioperatively as part of a multi-modal pain management protocol for primary total joint arthroplasty (TJA). The purpose of our study is to evaluate the efficacy and safety of acetaminophen in support of the combined clinical practice guidelines of the American Association of Hip and Knee Surgeons, American Academy of Orthopaedic Surgeons, Hip Society, Knee Society, and American Society of Regional Anesthesia and Pain Management.MethodsWe searched MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials for studies published prior to September 2019 on acetaminophen in primary TJA. All included studies underwent qualitative and quantitative homogeneity testing followed by a systematic review and direct comparison meta-analysis to assess the efficacy and safety of acetaminophen.ResultsIn total, 1287 publications were critically appraised yielding 17 publications representing the best available evidence for analysis. Oral and IV acetaminophen demonstrates the ability to safely reduce postoperative pain and opioid consumption during the inpatient hospital stay. No evidence was available to assess the efficacy and safety of oral acetaminophen after discharge.ConclusionModerate evidence supports the use of oral and IV acetaminophen as a non-opioid adjunct for pain management during the inpatient hospitalization. Strong evidence supports the safety of oral and IV acetaminophen when appropriately administered to patients undergoing primary TJA. Although there is lack of robust evidence for use of acetaminophen following discharge, it remains a low-cost and low-risk option as part of a multimodal pain regimen.     

膝关节骨性关节炎并膝内翻行胫骨高位截骨术临床疗效与人体质量指数关系的研究

目的：探讨膝骨性关节炎并膝内翻行胫骨高位截骨手术的临床疗效与人体质量指数(BMI)间的关系。方法：研究对象为住院行胫骨高位截骨手术的膝关节骨性关节炎并膝内翻的患者，共110例(136膝)。术前记录患者身高、体重，并记算BMI(体重／身高^2，kg／m^2)。根据日本骨科学会膝关节损伤功能评分标准评出患者术前及术后的膝关节功能总分。将BMI与术前及术后评分进行相关分析。结果：BMI与术前及术后的评分之间存在线性相关。手术前后评分之差与BMI间的回归系数b=-1．79，有统计学意义(P＜0．01)，且|b|＞1，说明手术前后的评分之差受BMI的影响，BMI越小者，手术前后评分差越大，反之评分差越小。术后的评分与，BMI间相关系数r=-0．715，回归系数b=-2．63，说明BMI越大，评分越低。当术后评分等于75．00时，BMI=24．00，其95％的CI为(23．60833，24．30760)。结论：BMI越大，即肥胖，是影响胫骨高位截骨手术疗效的不利因素，可取BMI≤24为手术适应证的标准。     

消肿止痛合剂预防全髋关节置换术后异位骨化的临床分析

目的:分析消肿止痛合剂预防全髋关节置换术后异位骨化形成的临床疗效.方法:对49例在甘肃省中医院行人工全髋关节置换术的患者,术后口服消肿止痛合剂,50 mL/次,2次/d,治疗4周.术后3周、12周、3月、6月、12月对患者进行随访,拍双髋正位、闭孔斜位、髂骨斜位X线片,观察有无异位骨化形成;同时采用Brooker 分级...     

A meta-analysis evaluates the efficacy of intravenous acetaminophen for pain management in knee or hip arthroplasty

Background

The objective of this study was to assess whether intravenous acetaminophen for patients undergoing knee or hip arthroplasty could reduce the opioid consumption and improve pain management.

Evolution of an Opioid Sparse Pain Management Program for Total Knee Arthroplasty With the Addition of Intravenous Acetaminophen

BackgroundPerioperative pain management for patients undergoing total knee arthroplasty (TKA) improves patient outcomes and facilitates recovery. In this study, we compared the effects of preoperative oral acetaminophen vs intravenous (IV) acetaminophen administered once intraoperatively and once postoperatively.MethodsTwo standardized, multimodal analgesia protocols were compared in patients undergoing primary, unilateral TKA. The oral acetaminophen cohort (OA) received doses of oral acetaminophen preoperatively and an as-needed basis postoperatively (n = 698). The IV acetaminophen cohort (IA) received 2 doses of IV acetaminophen, one intraoperative and one 6 hours postoperatively, with no oral acetaminophen given (n = 318). No other variables were significantly changed during the study period.ResultsThe IV acetaminophen group demonstrated less narcotic usage on postoperative day 0 (OA: 13.3 mme [morphine mg equivalents], IA: 6.2 mme, P < .001) and overall usage (OA: 66.1 mme, IA: 48.5 mme, P < .001). Pain scores were statistically and clinically significantly decreased in the immediate postoperative (the first 8 hours) for the IA group (OA: patient-reported pain scores of 4.0; IA: patient-reported pain scores of 2.0, P < .001). Both groups progressed and completed their physical therapy similarly for each postoperative day. Length of stay and percent discharge home were slightly improved in the IA group as well, however did not reach statistical difference.ConclusionAn iterative approach to multimodal pain management after TKA led to improvements in narcotic usage, pain scores, and several quality measures. IV acetaminophen is an integral and effective part of our opioid-sparing multimodal pain regimen in TKA.