关节镜清理术治疗膝骨关节炎护理体会

目的:探讨关节镜清理术治疗膝骨关节炎的护理措施。方法:选取采用关节镜下清理术治疗的膝骨关节炎患者68例,对其术前和术后进行系统的护理、心理指导、病情观察、康复锻炼指导。结果:68例患者关节镜手术顺利,平均住院(7.0±0.8)d,术后膝关节功能恢复良好。8例发生膝关节积液,无感染及静脉血栓等其他并发症。结论:关节镜下清理术治疗膝骨关节炎,做好术前和术后精心护理,能避免手术并发症,是膝关节功能恢复和手术成功的重要保证。     

关节镜治疗膝关节骨性关节炎疗效观察

目的观察关节镜下治疗膝关节骨性关节炎的临床疗效。方法回顾性观察膝关节镜下清理术治疗早中期膝关节骨性关节炎和广泛清理术结合钻孔微骨折术治疗晚期膝关节骨性关节炎的疗效。结果24个月内,早中期组Lysholm功能评分由术前(41.37±3.46)分提高到(80.3±7.94)分。晚期组Lysholm功能评分由(36.58±4.27)分提高到(75.6±6.36)分。结论对早中期骨性关节炎采用关节镜下有限清理,对晚期骨性关节炎采用关节镜下广泛清理加软骨微骨折术,辅以积极康复治疗,均可取得良好疗效。     

关节镜清理术治疗老年性膝骨关节炎

目的探讨关节镜对老年性膝骨关节炎的诊断价值及治疗效果。方法自2001年10月至2003年3月使用关节镜清理治疗膝关节骨关节炎患者37例,按照Lysholm膝关节功能评分,术前膝关节功能评分为(53.6±7.3)分。随访3～15个月,平均9个月。结果本组37例病人经关节镜检查均证实有骨关节炎存在,术前摄片,21例出现病理改变,16例未发现病理改变。本组病人术后3个月症状缓解明显,Lysholm膝关节功能评分平均提高到(92.7±1.5)分,统计学分析显示术后与术前评分相比差异有显著性意义。结论关节镜清理术可有效治疗膝骨关节炎;膝关节镜术可早期诊断膝骨关节炎;其损伤小、疗效好、并发症少,可重复手术治疗,能早期恢复关节的功能。     

胫骨内侧高位截骨联合关节镜下清理术治疗膝内侧单间室骨关节炎

目的 探讨采用胫骨内侧高位截骨联合关节镜下清理术治疗膝内侧单间室骨关节炎的疗效。方法 对22例膝内侧单间室骨关节炎患者先行关节镜下清理术,再予以胫骨内侧高位截骨。采用Lysholm评分评价疗效。结果 患者均获得1年随访。切口均一期愈合,术后8周胫骨截骨处基本愈合。术后半年及1年均采用Lysholm膝关节功能评分评价疗效:术后半年优19例,良2例,可1例,优良率21/22;术后1年优18例,良2例,可2例,优良率20/22。结论 胫骨内侧高位截骨联合关节镜下清理术治疗膝内侧单间室骨关节炎可以有效改善患者膝关节症状,是一种简单、安全的手术方法。     

关节镜下关节有限清理术联合玻璃酸钠治疗膝骨关节炎

目的探讨关节镜下关节有限清理术治疗早中期膝骨关节炎(knee osteoarthritis,KOA)的疗效。方法 2004年4月~2013年10月,对45例早中期KOA在关节镜下进行刨削清理增生肥厚的炎性滑膜组织,修平退变剥脱的软骨创面,游离体摘除,去除影响关节活动的骨赘,半月板修整或成形等,术后关节腔内注入玻璃酸钠4 ml。治疗前后采用膝关节Lysholm评分进行疗效评估。结果关节镜手术时间(从关节镜进入膝关节到开始缝合切口)为(55±15)min。术后住院时间4~10 d,平均6 d。术后均无关节感染、血管神经损伤、深静脉栓塞等并发症的发生。45例随访时间3~26个月,平均12个月,Lysholm评分由术前(45.5±6.3)分提高到(78.7±8.3)分,手术前后有统计学差异(t=9.841,P=0.005)。结论关节镜下关节有限清理术联合玻璃酸钠具有创伤小,并发症少,有效缓解KOA症状,有效改善关节功能的优点,是治疗早中期KOA的有效方法。     

关节镜结合中药热敷治疗早中期膝骨关节炎50例

目的：探讨关节镜结合中药热敷治疗早中期膝骨关节炎（KOA）的疗效。方法：将100例KOA患者,分为两组,治疗组予局麻下行关节镜清理术,结合中药热敷等治疗,对照组予中药热敷及抗炎镇痛药物治疗,观察两组的临床疗效及膝关节功能Lysholm评分。结果：治疗组总有效率91％,对照组为80％,（P〈0．05）,治疗组Lysholm评分为（89．95±0．87）分,对照组为（76．37±1．28）分,（P〈0．05）。结论：局麻下关节镜清理术结合中药热敷治疗早中期膝骨关节炎,疗效较单独中药热敷更显著。     

关节镜下射频汽化治疗膝关节骨性关节炎的病例对照研究

目的探讨膝关节骨性关节炎患者行关节镜下清理术中射频汽化的治疗作用。方法 2003年6月～2004年6月在我院行关节镜下清理术应用射频汽化治疗的40例膝骨关节炎为实验组,同期40例关节镜下清理术未应用射频汽化治疗为对照组。手术前、后采用Lysholm评分进行膝关节功能评定。结果实验组术前Lysholm评分为(53.6±6.4)分,术后提高至(83.4±4.7)分(t=21.549,P=0.000)。对照组术前Lysholm评分为(55.5±5.1)分,术后提高至(79.8±6.1)分(t=20.697,P=0.000)。实验组术后Lysholm评分总分(83.4±4.7)分和疼痛项评分(18.6±3.9)分明显高于对照组(79.8±6.1)分和(16.6±3.8)分(t=2.957,P=0.004;t=2.323,P=0.023),但2组术后力量项评分无显著差异[(6.3±1.6)分vs(6.2±1.5)分,t=0.288,P=0.774]。结论关节镜下清理术中应用射频汽化可明显改善膝关节骨性关节炎患者术后关节功能和减轻疼痛。     

关节镜下有限与广泛清理术治疗膝骨性关节炎的临床比较

目的 :评价和比较关节镜下有限和广泛清理术对膝关节骨关节炎的疗效。方法 :将本院 1999～ 2 0 0 1年间治疗的 2 42例膝骨关节炎的患者分为两组 :A组 10 0例 ,119侧膝 ,行有限清理术 ,B组 10 0例 ,12 3侧膝 ,行广泛清理术。随访 3 0～ 48个月。结果 :采用吴海山综合评分体系对膝关节OA术前术后进行评分比较 ,不同术式的 2组总有效率分别为 75 %以及 74% (P >0 0 5 ) ,两组术前膝关节综合评分A组为 11 2± 4 2 ,B组为 12 1± 5 3 (P >0 0 5 ) ,术后 1年综合评分A组为 6 5± 2 1,B组为 7 0± 2 5 ,两组差异无统计学意义 (P >0 0 5 )。两组疗效维持时间A组 3 6± 1 4年 ,B组 3 3± 1 7年 ,两组差异无统计学意义 (P >0 0 5 )。有限清理术的手术时间平均 15min ,广泛清理术平均手术时间 40min ,术后平均恢复期分别为 3和 10d。结论 :对于膝骨关节炎的疗效 ,关节镜术下有限和广泛清理术是相似的 ,且疗效维持时间无差别。但有限清理术手术时间短且创伤较小、恢复快     

腓骨近端截骨术联合关节镜清理治疗膝关节内侧间室骨关节炎的疗效

目的比较腓骨近端截骨术联合关节镜清理与单髁关节置换术(UKA)治疗膝关节内侧间室骨关节炎的疗效。方法选取2014年1月至2015年1月在本院接受手术治疗的膝关节内侧间室骨关节炎患者36例(36膝),依患者自主意愿选择手术方式后分为2组:截骨术组(17例)行腓骨近端截骨术联合关节镜清理,UKA组(19例)行UKA。术后1、3、6、12个月返院随访,采用Lysholm评分、牛津膝关节评分(OKS)、膝关节损伤和骨关节炎结果评分(KOOS)评估关节活动度和关节功能,影像学随访评价假体情况、骨溶解及感染等并发症。结果两组患者年龄、性别、体质量指数、关节炎分级(均为Ⅲ~Ⅳ级)等无差别。UKA组手术时间和住院时间长于截骨术组,术中出血量及术后引流量多于截骨术组(P0.05)。36例患者均得到随访,平均随访时间12.5个月。两组患者末次随访时Lysholm评分、OKS评分、KOOS评分均较术前明显改善(P0.05)。两组患者Lysholm评分、OKS评分、KOOS评分与术前比较的改善程度无差异(P0.05)。结论腓骨近端截骨术联合关节镜清理与UKA治疗膝关节内侧间室骨关节炎的近期疗效无差异,腓骨近端截骨术联合关节镜清理是一种值得推广的术式。     

电针在膝骨性关节炎关节镜清理术后增效作用的病例对照研究

目的：探讨电针在膝骨性关节炎关节镜清理术后的增效作用.方法：2008年5月至2010年7月,收治膝骨性关节炎患者78例（78膝）,分为两组,其中试验组42例,男16例,女26例;年龄41～63岁,平均（53.62±6.53）岁;病程8 ～24个月,平均（10.35±6.42）个月;采用关节镜下有限清理术结合术后电针治疗.对照组36例,男14例,女22例;年龄40～62岁,平均（54.34±7.67）岁;病程6～25个月,平均（11.94±5.13）个月;采用单一关节镜下关节清理术治疗.两组患者术后均行股四头肌等长收缩和膝关节屈伸功能锻炼.以视觉模拟评分法（visual analog scale,VAS）和Lysholm膝关节功能评分标准进行治疗前后及组间比较.结果：所有患者获随访,时间12～30个月,平均15.6个月.末次随访时试验组和对照组VAS较术前降低,而Lysholm评分除支撑外,其余各项评分均较疗前升高.两组治疗后VAS比较差异有统计学意义;Lysholm评分在跛行、疼痛、肿胀、爬楼及下蹲方面差异有统计学意义,而交锁和不稳评分差异无统计学意义.结论：电针具有明显缓解临床症状、体征,改善膝关节活动度的作用,在膝骨性关节炎关节镜清理术后具有显著增效作用,其远期疗效优于单用关节镜清理术,对膝关节的功能改善更具优越性,是值得临床推荐的一种治疗膝骨性关节炎的中西医结合疗法.     

Vasopressor hormone response following mesenteric traction during major abdominal surgery

Background : We investigated the vasopressor hormone response following mesenteric traction (MT) with hypotension due to prostacyclin (PGI₂) release in patients undergoing abdominal surgery with a combined general and epidural anesthesia. Methods : In a prospective, randomized, placebo-controlled study we administered 400 mg ibuprofen (i.v.) in 42 patients scheduled for abdominal surgery. General anesthesia was combined with epidural anesthesia (T4-L1). Before as well as 5, 15, 30, 45, and 90 min after MT we recorded plasma osmolality, hemodynamics and measured 6-keto-PGFlα (stabile metabolite of PGI₂), TXB₂ (stabile metabolite of thromboxane A₂) active renin, and arginine vasopressin (AVP) plasma concentrations by radioimmunoassay. Catecholamine levels were assessed by high-pressure liquid chromatography (HPLC) with electrochemical detection. Results : Following MT, arterial hypotension occurred along with a substantial PGI₂ release. This was completely abolished by ibuprofen administration. Although plasma levels of 6-keto-PGF_1α (1133 (708) vs. 60 (3) ng/L, median (median absolute deviation), P=0.0001, placebo vs. ibuprofen) remained significantly elevated, blood pressure was restored within 30 min after MT in the placebo group. At the same point in time plasma concentrations of TXB² (164 (87) vs. 58 (1) ng/L, P=0.0001), epinephrine (46 (33) vs. 14 (6) ng/L, P=0.001), AVP (41 ± (18) vs. 12 (7) ng/L, P=0.0004), and active renin (27 (12) vs. 12 (4) ng/L, P = 0.001) were significantly higher in placebo-treated patients. Conclusion : Under combined general and epidural anesthesia arterial hypotension following MT due to endogenous PGI₂ release is associated with enhanced release of AVP, active renin, epinephrine and thromboxane A₂, presumably contributing to hemodynamic stability within 30 min after MT.     

Microspheres Based Detoxification System: A New Method in Convective Blood Purification

Abstract: A variety of protein-bound or hydrophobic substances, accumulating as a result of pathologic conditions such as exogenous or endogenous intoxications, are removed poorly by conventional detoxification methods because of low accessibility (hemodialysis), insufficient adsorption capabilities (hemosorption), low efficiency (peritoneal dialysis), or economic limitations (high-volume plasmapheresis). Combining advantages of existing methods with microspheric technology, a module-based system was designed. Major operating parameters of the latter can be modified to allow for adjustment to individual clinical situations. An extracorporeal blood circuit including a plasmafilter is combined with a secondary high-velocity plasma circuit driven by a centrifugal pump. Different microspheric adsorbers can be combined in one circuit or applied in sequence. Thus, a prolonged treatment can be tailored using specially designed selective adsorber materials. Comparing this system with existing methods (high-flux hemodialysis, molecular adsorbent recycling system), results from our in vitro studies and animal experiments demonstrate the superior efficiency of substance removal.     

Bariatric Surgery in Some "Central and East-European (former Eastern bloc)"Countries - Current Status and Prediction for the Next Millennium

Background: Obesity is increasing globallly, including in the formerly "Eastern Bloc" countries. Methods: A survey was made of obesity and bariatric surgery. Results: In the 8 East and Central European countries studied, with total population 300 million, roughly 43% of the population was overweight (BMI 25-30), 23% obese (BMI > 30), with about 15 million people morbidly obese (BMI > 40). From 0-10 morbidly obese individuals/100,000/year undergo bariatric surgery. Conclusion: Most countries were found to provide inadequate treatment for obesity.The majority of the morbidly obese are not treated effectively. However, health-care awareness of obesity and bariatric surgeons are slowly increasing.     

Synergistic interaction between the effects of propofol and midazolam with fentanyl on phrenic nerve activity in rabbits

Background: It has been shown that the depressive effects of both propofol and midazolam on consciousness are synergistic with opioids, but the nature of their interactions on other physiological systems, e. g. respiration, has not been fully investigated. The present study examined the effect of propofol and midazolam alone and in combination with fentanyl on phrenic nerve activity (PNA) and whether such interactions are additive or synergistic. Methods: PNA was recorded in 27 anaesthetised and artificially ventilated rabbits. In three groups, propofol, fentanyl and midazolam were administered intravenously in incremental doses to construct dose-response curves for the depressant effects of each one on PNA. In another two groups, the effect of pretreatment with either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. on the effects of propofol and fentanyl respectively on PNA were studied. Results: Propofol and fentanyl caused a dose-dependent depression of PNA with complete abolition at the highest total doses of 16 mg · kg^?1 i. v. and 32 μg · kg^?1 i. v., respectively. In contrast, midazolam in incremental doses to a total of 0.8 mg · kg^?1 reduced mean PNA by 63%, but approximately 12% of PNA remained at a total dose as high as 6.4 mg · kg^?1. The mean ED₅₀s, calculated from dose-response curves, were 5.4 mg · kg^?1, 3.9 μg · kg^?1 and 0.4 mg · kg^?1 for propofol, fentanyl and midazolam, respectively. Initial doses of either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. acted synergistically with subsequent doses of either propofol or fentanyl to abolish PNA at total doses of 8 mg · kg^?1 and 8 μg · kg^?1, respectively. Conclusion: Fentanyl has a synergistic interaction with both propofol and midazolam on PNA and hence potentially on respiration.     

Influence of dopexamine hydrochloride on haemodynamics and regulators of circulation in patients undergoing major abdominal surgery

Background: Catecholaminergic support is often used to improve haemodynamics in patients undergoing major abdominal surgery. Dopexamine is a synthetic vasoactive catecholamine with beneficial microcirculatory properties. Methods: The influence of perioperative administration of dopexamine on cardiorespiratory data and important regulators of macro- and microcirculation were studied in 30 patients undergoing Whipple pancreaticduodenectomy. The patients received randomized and blinded either 2 μg · kg^?1 · min^?1 of dopexamine (n=15) or placebo (n=15, control group). The infusion was started after induction of anaesthesia and continued until the morning of the first postoperative day. Endothelin-1 (ET-1), vasopressin, atrial natriuretic peptide (ANP), and catecholamine plasma levels were measured from arterial blood samples. Measurements were carried out after induction of anaesthesia, 2 h after onset of surgery, at the end of surgery, 2 h after surgery, and on the morning of the first postoperative day. Results: Cardiac index (CI) increased significantly in the dopexamine group (from 2.61±0.41 to 4.57±0.78 1 · min^?1 · m^?2) and remained elevated until the morning of the first postoperative day. Oxygen delivery index (DO₂I) and oxygen consumption index (VO₂I) were also significantly increased in the dopexamine group (DO₂I: from 416±91 to 717±110 ml/m² · m²; VO₂I: from 98±25 to 157±22 ml/m² · m²), being significantly higher than in the control group. pHi remained stable only in the dopexamine patients, indicating adequate splanchnic perfusion. Vasopressive regulators of circulation increased significantly only in the untreated control patients (vasopressin: from 4.37±1.1 to 35.9±12.1 pg/ml; ET-1: from 2.88±0.91 to 6.91±1.20 pg/ml). Conclusion: Patients undergoing major abdominal surgery may profit from prophylactic perioperative administration of dopexamine hydrochloride in the form of improved haemodynamics and oxygenation as well as beneficial influence on important regulators of organ blood flow.     

A comparison of the inhibitory effects of four volatile anaesthetics on the metabolism of chlorzoxazone, a substrate for CYP2E1, in rabbits

Background: Halothane inhibits in vitro and in vivo activity of cytochrome P-450 (CYP) 2E1. There are several fluorinated volatile anaesthetics besides halothane, and most of them are defluorinated by CYP2E1. It is unclear whether other fluorinated anaesthetics inhibit the in vivo activity of CYP2E1.
Methods: We compared the inhibitory effects of therapeutic concentrations of four inhalational anaesthetics, halothane, enflurane, isoflurane, and sevoflurane, on chlorzoxazone metabolism in rabbits receiving artificial ventilation.
Results: All four inhalational anaesthetics decreased arterial blood pressure and increased plasma chlorzoxazone concentration. However, no significant differences in the plasma chlorzoxazone concentration were found between the four anaesthetics. The estimated chlorzoxazone clearance increased after beginning inhalation with all four agents, but no significant difference in clearance was noted between agents.
Conclusions: At therapeutic concentrations, the in vivo inhibitory effect on chlorzoxazone metabolism was similar for all four inhalational anaesthetics examined, even though their chemical characteristics and extent of hepatic metabolism differ considerably.     

Systemic analgesia adapted to the children's condition

A concept of balanced analgesia using nonsteroidal anti-inflammatory drugs (NSAIDs), paracetamol (acetaminophen), opioids, and corticosteroids can also be used in patients with pre-existing illnesses. NSAIDs are the most effective treatment for acute pain of moderate intensity in children; however, these drugs should be avoided in patients at increased risk for serious side effects, e.g. patients with renal impairment, bleeding tendency, or extreme prematurity. NSAIDs can be given with minimal risks to the younger child with mild to moderate asthma, and, in these patients, the use of steroids can be encouraged; in addition to their antiemetic and analgesic action, a beneficial effect on asthma symptoms can be expected. In the non-intubated child with cerebral trauma, exaggerated sedation caused by opioids and increased bleeding tendency caused by NSAIDs must be avoided. In neonates and small infants, the oral administration of sucrose or glucose is helpful to minimize pain reaction during short uncomfortable interventions.     

Intraoperative autotransfusion is associated with modest reduction of allogeneic transfusion in prosthetic hip surgery

Background: The efficacy of intraoperative salvage and washing of wound blood and the predictors of allogeneic red cell transfusions in prosthetic hip surgery are insufficiently known.
Methods: In 96 patients, undergoing primary or revision surgery, salvaged and washed red cells and, if necessary, allogeneic blood were used to keep haematocrit not lower than 33%. The bleeding of red cells during hospital stay was calculated from the red cell balance. The preoperative red cell reserve (millilitres of red cells in excess of a haematocrit of 33%) was estimated and the difference between this volume and the total bleeding of red cells was retrospectively used to classify patients with regard to the need for red cells. Stepwise regression analysis was used to define patient-related variables associated with allogeneic blood transfusion.
Results: Preoperative knowledge of the type of operation (primary, revision), the preoperative red cell reserve, and the body mass could predict roughly half of the need for banked blood (r²=0.45). Only one-third of the total bleeding of red cells was retransfused. For complete avoidance of allogeneic blood, autotransfusion was most effective in patients with a moderate need (0–4 u). However, 32% of such patients required allogeneic blood.
Conclusions: Autotransfusion has a limited efficacy to decrease the need for allogeneic blood, and other blood-saving methods should be added for this purpose. It is difficult to predict the need for allogeneic blood preoperatively.     

缺氧对肾小管上皮细胞分泌外泌体的影响

目的    观察缺氧对肾小管上皮细胞分泌外泌体的影响,探讨外泌体在缺氧致肾脏损伤中的作用及机制。 方法    （1）常氧（21% O₂）及缺氧（1% O₂）分别处理大鼠肾小管上皮细胞（NRK-52E）48 h,收集细胞上清液并使用高速梯度离心法分离外泌体。采用透射电镜、纳米示踪分析、Western印迹、蛋白浓度定量鉴定并比较两组外泌体的基本特性。（2）在共培养实验中,以不同浓度（1、10、50、100、300 mg/L）的常氧外泌体、缺氧外泌体分别干预脂多糖（LPS）诱导的大鼠原代腹腔巨噬细胞,使用实时荧光定量PCR与酶联免疫吸附试验（ELISA）法分别检测巨噬细胞白细胞介素6（IL-6）、肿瘤坏死因子α（TNF-α）、诱导型氮氧化物合酶（iNOS）水平;使用Western印迹法检测巨噬细胞磷酸化（p）STAT/STAT及细胞因子信号传导抑制蛋白1（SOCS1）的蛋白表达;最后,使用实时荧光定量PCR法检测常氧外泌体与缺氧外泌体中炎性反应相关微RNA（microRNA,miR）的表达差异。 结果    （1）离心得到的囊泡具有外泌体典型的结构,粒径小于150 nm,表达外泌体标志蛋白CD63,说明分离得到外泌体。缺氧对肾小管上皮细胞分泌的外泌体形态、粒径分布比例无明显影响,但提高了外泌体的分泌量。（2）缺氧外泌体相比于常氧外泌体促进了LPS诱导的M1型巨噬细胞IL-6、TNF-α、iNOS 的表达和分泌（均P＜0.01）,同时提高STAT的磷酸化水平并减少SOCS1的蛋白表达（均P＜0.01）;对炎性反应相关microRNA检测发现缺氧外泌体中miR-155、miR-27a表达量较常氧外泌体明显升高（P＜0.05）。 结论    缺氧可改变外泌体的生物学功能,表现为协同促进LPS诱导的M1型巨噬细胞的表型转化,这可能是慢性肾脏病微炎性反应状态持续的原因之一。     

In Vitro Function and Durability Assessment of a Novel Polyurethane Heart Valve Prosthesis

Abstract While flexible-leaflet, central-flow prosthetic heart valves promise relief from anticoagulation therapy, they continue to be restricted by inadequate durability. In consequence, a novel trileaflet valve, made entirely from polyurethane, has been developed. A batch of 6 consecutively manufactured polyurethane valves was subjected to hydrodynamic function and accelerated fatigue testing. Computerized data acquisition and control systems have been introduced to improve valve testing methodologies. In terms of hydrodynamic function, the polyurethane valve demonstrates transvalvular pressure gradients similar to those for a bioprosthetic valve (Carpentier-Edwards) and levels of retrograde flow significantly less than those for either the bioprosthetic valve or a bileaflet mechanical valve (St Jude Medical). The equivalent of 10 years of cycling without failure has been exceeded by all 6 polyurethane valves in accelerated fatigue tests with 2 valves remaining intact after 674 million cycles (equivalent to approximately 17 years) in continuing tests. Highspeed photography revealed considerable differences in leaflet motion between valves cycled at accelerated and physiological rates.