人工假体置换在膝周恶性骨肿瘤中的临床应用

目的探讨人工假体在膝关节周围恶性骨肿瘤保肢术中的临床效果。方法 28例膝关节周围恶性骨肿瘤瘤段广泛切除后,采用人工膝关节假体置换重建。结果 28例患者术后根据Ennek ing评分标准评定疗效优18例,良6例,可4例,优良率85%。随访4~48个月,其中20例患者无局部复发或远处转移,8例复发或转移。结论人工假体置换重建膝关节周围骨肿瘤手术可改善膝部恶性骨肿瘤患者的早期生活质量,减少致残率,严重并发症少,患者术后关节功能、效果较满意。     

恶性骨肿瘤保肢治疗定制型人工关节的应用

目的：探讨定制型人工关节在恶性骨肿瘤保肢治疗中的应用。方法：对25例恶性骨肿瘤患者进行人工关节置换保肢治疗,其中铰链式膝关节12例,股骨近端假体6例,人工肱骨头4例,人工肩胛骨1例,人工肘关节2例。结果：随访1~7年,平均4年,局部复发率12.0%,最终保肢率80.0%;所有患者人工关节置入均超过6个月,参照MSTS（Musculo-skeletal Tumour Society）评定标准,平均得分22.4分,优良率80.0%。结论：应用人工关节置换术与恶性骨肿瘤的保肢治疗可以取得满意的疗效,掌握手术适应证、肿瘤的完整切除和软组织重建是手术成功的关键。     

股骨恶性肿瘤行BⅢb型旋转成形手术护理

随着外科手术技术的发展和进步,骨肿瘤的保肢治疗已是临床上常见的手术治疗方法.但肿瘤病变广泛累及软组织病例,实施肿瘤假体置换保肢手术存在假体反复翻修,功能差等缺点,旋转成形术是其中部分患者有价值的选择[1].旋转成形术是将肿瘤段截除后,小腿翻转180°与髋关节相连,以踝关节代替膝关节,是一种替换性截肢远端重建手术[2]....     

人工髋关节置换治疗高龄股骨颈骨折

目的探讨人工髋关节治疗高龄股骨颈骨折的临床效果。方法治疗27例75岁以上股骨颈骨折。在做好充分术前准备情况下，经后外侧入路施行全髋或半髋置换，手术强调假体位置的准确性及牢固性，术后早期活动。结果本组8例行人工股骨头置换，19例全髋关节置换，2～4周患者能扶拐下地。随访6个月～4年，患者关节功能良好，无疼痛，X线照片假体位置正常，无松动及下沉，效果满意。结论人工股骨头或全髋关节置换手术治疗高龄股骨颈骨折，有早期下地、并发症少、关节功能好、提高生活质量等优点。     

人工全膝置换手术6例

人工关节置换是治疗膝关节疼痛和功能丧失的可靠方法。由于人工膝关节材料的不断完善、手术器械固定方法的改进以及手术技术的提高，近10年人工全膝置换术日渐增多。我院200l-09～2003-04实施了9例11个关节，近期疗效满意，报告如下。     

LARS韧带保残重建手术治疗前交叉韧带损伤临床效果观察

目的 观察LARS韧带保残重建手术治疗前交叉韧带损伤的临床效果。方法 选取北部战区总医院自2018年1月至2021年1月收治的采用LARS韧带保残重建手术治疗前交叉韧带损伤的56例（56膝）患者为研究对象。比较患者术前、术后的膝关节Lysholm评分和IKDC评分,以及TDPM值;同时,观察术后并发症发生情况。结果 患者术后3、6、12个月的Lysholm评分和IKDC评分均高于术前,TDPM值均低于术前,差异有统计学意义（P <0.05）。术后出现LARS韧带断裂2例（3.6%）,Lachman实验（+）2例（3.6%）,关节僵硬3例（5.4%）。2例LARS韧带断裂患者因过度训练（跳木马）引起,均接受了二次手术,采用自体肌腱移植重建前交叉韧带。2例Lachman实验（+）患者因不适当的康复及训练导致人工韧带松弛,暂不需要手术,继续随访观察。3例关节僵硬患者经康复治疗后膝关节活动恢复正常。结论 LARS韧带保残重建手术治疗前交叉韧带损伤的临床效果良好,可促进膝关节康复和本体感觉恢复。     

人工关节置换治疗老年股骨颈骨折的临床疗效

目的探讨人工关节治疗老年股骨颈骨折的临床效果。方法回顾分析126例65岁以上股骨颈骨折,经后外侧入路行全髋或半髋关节置换。结果本组84例行人工股骨头置换,42例行全髋关节置换,术后1～4周患者扶拐下地活动。随访1.5～6.5年(平均4年10个月),患髋关节功能良好,无疼痛,X线片假体位置正常,无松动及下沉。结论人工股骨头或全髋关节置换治疗老年股骨颈骨折,有早期下地、并发症少、关节功能好的优点。     

关节置换治疗膝关节创伤后晚期严重功能障碍

目的探讨膝关节创伤后严重功能障碍的治疗以及人工关节置换治疗这类疾病的手术适应证及手术方法。方法自1997年6月至2004年6月采用人工关节置换治疗严重创伤后晚期膝关节功能障碍18例21膝,对于其中严重创伤性关节炎无明显畸形10例12膝,采用膝关节表面置换。创伤性关节炎合并膝关节20°～40°内外翻或20°～90°固定性屈曲畸形6例7膝,膝关节完全骨性强直2例2膝,患者采用可旋转铰链式膝关节。所有患者均获得随访,时间6个月～7年,平均3.5年,采用美国特种外科医院(HospitalforSpecialSurgery,HSS)评分标准对手术疗效进行评价。结果评定膝关节术后的疼痛、活动功能、关节畸形矫正以及稳定性和肌力。术前评价均为差,术后优12膝,良7膝,可2膝,总优良率90%。患者主观满意率为100%。结论关节置换治疗膝关节创伤后晚期严重功能障碍是一种有效的方法。     

氨甲环酸的不同应用方式对全膝关节置换术中及术后失血量的影响

目的：探讨氨甲环酸的不同应用方式对全膝关节置换术术中及术后失血量的影响。方法选取2013年～2014年行全膝关节置换的100例患者,分为A组50例关节置换前1 g稀释于100 mL生理盐水后静脉注射氨甲环酸;B组50例在止血带释放前关节囊缝合后局部关节腔注射浓度为3％氨甲环酸稀释溶液50 mL。结果两组在术中的失血量对比无差异（P＞0．05）,比较术后的出血量、输血量、输血人数、血红蛋白差异有统计学意义（P＜0．05）,A组优于B组。结论全膝关节置换术前10 min静脉滴注氨甲环酸能明显降低患者术后出血量及输血量,此药物安全有效,可有效用于全膝关节置换手术。     

人工肱骨头置换术治疗老年肱骨近端复杂性骨折

目的 探讨人工肱骨头置换术治疗老年肱骨近端复杂性骨折的适应证、手术要点和疗效.方法 2000-2006年共行人工肱骨头置换手术治疗老年肱骨近端复杂性骨折23例,骨水泥固定,有计划的康复训练. 结果 术后19例获得随访,平均1.8年,未发生切口感染、神经损伤、假体周围骨折,1例有半脱位.采用Neer评分系统评定人工关节功能,本组平均82.1分,其中80～89分(满意)17例,70～79分(不满意)2例,满意率为89%,无翻修病例. 结论 人工肱骨头置换术在严格掌握适应证、重视肩袖和关节稳定结构的重建、有计划的康复训练下,是治疗老年性肱骨近端复杂骨折的一种良好方法.     

小儿原发性睾丸肿瘤诊治分析

目的 探讨小儿原发性睾丸肿瘤的诊治。方法 分析小儿原发性睾丸肿瘤32例,其中卵黄囊瘤16例,畸胎瘤10例,胚胎型横纹肌肉瘤4例,表皮样囊肿2例。所有病例均行手术治疗,术中行冰冻切片活检,良性者行保留睾丸手术;恶性者行根治性睾丸切除、腹股沟淋巴结清扫术。20例恶性肿瘤病人术后行系统化疗。结果 术中冰冻病理与术后病理结果完全一致。24例获得随访,除4例卵黄囊瘤病人术后1年内因广泛转移死亡外,其余病例均无瘤生存4个月至7年,平均73个月。结论 超声对小儿原发性睾丸肿瘤有诊断价值,列为常规检查。手术为首选的治疗,术中冰冻切片活检非常必要。睾丸良性肿瘤患儿行保留睾丸手术对其生理功能、美观及心理方面均有重要意义。对预后好的病例尽量减少化疗,对预后差的病例应加强化疗。     

Attenuation-Correction Induced Artifact in F-18 FDG PET Imaging Following Total Knee Replacement

Purpose: The clinical use of PET FDG in the work-up of patients with bone and soft tissue malignant tumors is rapidly increasing. The recognition of any source of artifact, therefore, is important to avoid interpretation pitfalls.Procedures: Two patients with complete knee joint replacement by metallic prosthesis in the course of their treatment for malignant bone and soft tissue sarcoma were evaluated by PET F-18 FDG imaging using a dual head coincidence gamma camera.Results: Both studies demonstrated in the attenuation-corrected images intense increase activity at the joint space between the metallic prosthetic surfaces at the level of the knee joint. No uptake, however, was noted in the same location on the non-attenuation-corrected images. Subsequent bone and thallium-201 scans confirmed the absence of tumor recurrence in the first patient. The second patient had multiple follow up F-18 FDG scans over a period of 16 months that show no changes from the baseline study.Conclusion: In the F-18 FDG PET images of patients with total knee metallic prosthesis, an intense activity tends to be seen in the joint space, only in the attenuation-corrected images. Such pattern of uptake is considered artifactual and should always be verified in the non-attenuated images.     

介入治疗在骨组织肿瘤临床治疗中的价值

目的:探讨介入治疗在骨组织肿瘤临床治疗中的价值。方法:31例骨组织肿瘤患者均接受动脉化疗和/或栓塞术,部分患者于栓塞后2~15d行外科手术;未行手术患者继续采用动脉化疗和栓塞治疗,同时加放疗、静脉化疗等综合治疗,观察临床效果。结果:21例进行了肿瘤完全切除或扩大根治术,其中6例股骨肉瘤患者局部刮除并行人工膝关节置换术;10例未进行手术治疗,加行放疗、化疗等综合治疗。手术病例术中出血量明显减少,平均术中失血为1170ml,显示肿瘤缩小、软化、组织坏死。其中统计的20例原发恶性肿瘤患者1年生存率为90%,2年生存率为75%,9例患者5年生存率44.4%。结论:介入治疗是骨组织肿瘤的有效治疗方法,术前栓塞治疗可大大减少术中出血,动脉化疗栓塞作为综合治疗的重要手段能有效延长患者生存期和提高生存质量。     

Clinical results of posterior cruciate ligament retaining TKA with alumina ceramic condylar prosthesis: comparison to Co–Cr alloy prosthesis

In a prospective study, 194 knees undergoing total knee arthroplasty (110 knees with alumina ceramic prostheses; 84 knees with Co–Cr alloy prostheses) were clinically and radiologically evaluated. Average follow-up period was 66 months (36–124 months). Average age at the time of surgery was 66 years. In the ceramic prostheses, two revision surgeries were performed because of breakage of the tibial tray and late infection, whereas two revisions of the Co–Cr alloy prostheses were carried out due to loosening and late infection. In the other patients, there were no significant differences in clinical parameters (HSS knee score and range of motion) between the two prostheses. In radiological evaluation, we could not find any radiolucent lines around the femoral ceramic component while radiolucency was present in three knees (3.6%) around the Co–Cr femoral component. Beneath the tibial tray, three knees (2.7%) showed a radiolucent line around the former prosthesis while eight knees (9.5%) demonstrated a radiolucent line around the latter prosthesis. Chi-square tests showed a significant difference in the occurrence of radiolucent line around both of the femoral and tibial prosthesis. This study demonstrated that clinical results of the alumina ceramic PCL retaining total knee prosthesis are comparable to the standard Co–Cr alloy PCL retaining total knee prosthesis. Although we could not draw any conclusions regarding the superiority of the ceramic prosthesis with respect to UHMWPE wear and long-term survivorship, this report encouraged a long-term follow-up study on ceramic prostheses. Presented in part at the meeting of the International Society of Arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine, New Zealand, 2003.     

Immunoscintigraphy of septic loosening of knee endoprosthesis: a retrospective evaluation of the antigranulocyte antibody BW 250/183

Immunoscintigraphy with the use of the antigranulocyte antibody BW 250/183 is a reliable method for detecting infection, especially in septic loosening of hip prostheses, for which purpose quantitative interpretation of the time-activity course is employed. Therefore, we retrospectively studied whether similar results could be achieved in knee prostheses. We verified 28 scintigraphic examinations in 26 patients by histology. Scintigraphy was performed during an early (4–6 h post injection) and a late phase (23–25 h post injection). Infection was diagnosed when activity around the knee prosthesis increased by more than 10% compared with bone marrow. We found a sensitivity and a negative predictive value of 100%, a specificity of 80%, a positive predictive value of 81% and an accuracy of 89%. Specificity and accuracy are lower than in the evaluation of hip prostheses; however, in comparison to other scintigraphic modalities, scintigraphy with the antigranulocyte antibody BW 250/183 is superior in excluding infection and has better specificity and accuracy. Therefore, as in the case of hip prostheses, the described methodology appears to be the scintigraphic modality of choice for knee prostheses.     

透明质酸钠预防膝关节内骨折内固定后膝关节粘连的疗效观察

目的　探讨膝关节内骨折内固定术后预防膝关节粘连的方法。方法　全部膝关节内骨折患者接受骨折内固定术。其中观察组术后关节腔内注射透明质酸钠 ,而对照组则不用 ,观察术后膝关节伸屈活动度以评价疗效。结果　 6 4例患者中 5 6例获得随访 ,随访时间 8～ 2 4个月 ,观察组术后平均膝关节活动度为 ( 85 .3± 1 9.6 )°;对照组为 ( 76 .4± 1 6 .8)°。观察组术后平均膝关节活动度明显大于对照组 ,两者有显著差异 (P <0 .0 5 ) ,表明透明质酸钠治疗组结果优于对照组。结论　膝关节内骨折内固定术后透明质酸钠关节腔内注射 ,可有效防止关节粘连     

Fluoroscopic and gait analysis of the functional performance in stair ascent of two total knee replacement designs

Understanding total knee replacement mechanics and their influence on patient mobility requires accurate analysis of knee joint kinematics and traditional full body kinematics and kinetics. Three-dimensional fluoroscopic and gait analysis techniques were carried out on patients with either mobile bearing or posterior stabilized knee prostheses during stair ascent. Statistically significant correlation was found between knee flexion at foot strike and the position of the mid-condylar contact points, and between maximum knee adduction moment and corresponding lateral trunk tilt. A more complete and powerful assessment of the functional performances of different TKR designs can be performed in-vivo by combining gait and fluoroscopic analyses.     

Current topics in the radiology of joint replacement surgery

Several methods of total hip joint replacement are currently used. Radiographic appearances after cemented, bone ingrowth, press-fit, and bipolar hip prostheses are reviewed. The roles of nuclear medicine and arthrographic procedures for identifying complications are discussed. Total knee prostheses and, in particular, complications related to the patellar component are described.     

膝关节腱鞘巨细胞瘤MRI诊断

目的：探讨MRI对膝关节腱鞘巨细胞瘤的诊断及鉴别诊断价值。方法：回顾性分析经病理证实的18例膝关节腱鞘巨细胞瘤患者的影像学资料,其中行MRI平扫18例,增强扫描17例。结果：18例中肿瘤呈局限型15例,弥漫型3例。病灶主体在T1WI上接近于骨骼肌信号11例,稍低于骨骼肌信号5例,介于骨骼肌与皮下脂肪信号之间2例。在T2WI上4例信号介于骨骼肌与皮下脂肪之间,5例接近于骨骼肌信号,9例稍低于骨骼肌信号,信号不均匀。17例行增强扫描,13例呈中度或明显不均匀强化,2例中度均匀强化,2例轻度不均匀强化。14例病变边缘于T1WI及T2WI上可见完整（2例）或不完整（12例）的低信号包膜影,6例痛灶内可见低信号的分隔影。结论：MRI能反映膝关节腱鞘巨细胞瘤的病理特点,对本病的诊断及鉴别诊断有重要价值。