类风湿关节炎和骨关节炎患者膝关节置换术后并发症的临床对照研究

目的 :对比骨性关节炎(osteoarthritis,OA)和类风湿关节炎(rheumatoid arthritis,RA)患者膝关节置换术后并发症发生情况.方法 :选取67例RA和78例OA患者,均行膝关节置换术治疗,观察并记录患者的术前,术后3d和5d的VAS评分、ROM评分,随访2年期间并发症发生情况,对比OA和RA患者膝关节置换术后并发症发生情况.结果 :与术前相比,RA组术后5d的VAS评分明显降低,OA组术后3d,5d的VAS明显降低,OA组术后3d,5d的VAS评分明显低于RA组.术前两组ROM评分无统计学差异,与术前相比,RA组术后3 d的ROM评分明显降低,OA组术后5d的ROM评分明显增加,OA组术后3d,5d的ROM评分明显高于RA组,随访2个年期间,RA组2年内翻修率和伤口并发症发生率均明显高于OA组,关节失稳,假体松动,下肢深静脉血栓发生率比较,无统计学差异.两组主要伤口并发症为伤口渗液,发生率相比无统计学差异.其他3种并发症发生率相比,也没有统计学差异.结论 :骨关节炎患者经人工膝关节置换术治疗后,并发症发生较少,膝关节活动较术前改善明显,疼痛度减轻.     

Risk of meningioma in patients with head injury: A nationwide population-based study

BackgroundHead injury has been suggested to correlate with meningioma. However, results of studies investigating the relationship between head injury and meningioma were inconsistent. Therefore, we conducted this study to assess the association between head injury and meningioma, and to determine the possible risk factors.MethodsHead injury patients aged 18 years and older, without antecedent diagnosis of brain tumor, and who were followed up for more than 30 days between January 1, 2001, and December 31, 2010, were recruited from the Taiwan National Health Insurance Research Database. Hazard ratios (HRs) of meningioma risk for head injury patients compared with an age- and sex-matched cohort were calculated by Cox proportional regression analysis. The difference in cumulative incidence between head injury patients and the matched cohort was analyzed using the Kaplan–Meier method and tested with the log-rank test.ResultsEach cohort (i.e., the head injury cohort and the matched cohort) consisted of 75,292 individuals with a mean age of 44.7 years, and 52.3% of these patients were male. The incidence rates of meningioma were 3.99/10⁵ person-years and 3.23/10⁵ person-years in the head injury cohort and the comparison cohort, respectively, with a Charlson Comorbidity Index score-adjusted HR of 1.27 (p = 0.514). There were no associations between head injury and risk of meningioma, neither overall nor in stratified analyses according to severity of head injury, age, and sex of patients.ConclusionHead injury, regardless of severity, patient sex, or age, is unlikely to be a cause of meningioma.     

膝关节骨性关节炎患者全髋置换术后下肢力线变化的研究

目的：研究膝关节骨性关节炎患者在行全髋置换术后下肢力线的变化。方法：选择患者共24例,均符合膝关节骨关节炎诊断,同时行同侧的髋关节置换术,分别测量患者手术前后下肢力线。结果：手术前后双侧髋关节偏心距差值、双侧长度差值及AR值差异均有统计学意义（P〈0.05）。手术前后患侧生理外翻角Ⅰ、Ⅱ及胫股冠状角、髋-膝-踝角差异有统计学意义（P〈0.05）,踝角、胫骨平台-骨干角差异无统计学意义（P〉0.05）。患者手术前后患侧膝关节活动度差异无统计学意义（P〉0.05）。结论：全髋关节置换术重建了患者的股骨偏心距,能一定程度改善下肢不等长,改变膝关节重力负荷中心。全髋关节置换术早期改变了下肢的力线,从而影响了膝关节负荷分布。     

骨性关节炎与类风湿关节炎患者单侧膝关节置换术后围术期效果比较

目的 对比骨性关节炎（osteoarthritis,OA）与类风湿关节炎（rheumatoid arthritis,RA）患者单膝关节置换的围术期治疗效果。方法 2012年9月-2013年8月于本院骨科行单侧人工膝关节置换的骨性关节炎患者65例,类风湿关节炎患者43例,采用视觉模拟评分法（visual analogue scale,VAS）,关节活动度（range of motion,ROM）对两组患者进行术前、术后3 d、术后5 d评价,并比较两组患者住院时间、围术期并发症的差异。应用美国纽约特殊外科医院（Hospital for Special Surgery,HSS）膝关节评分对患者进行术前、术后1个月、3个月的功能评定。结果 术前两组各项评分差异无统计学意义（P〉0.05）,术后3 d、5 d OA组的ROM高于RA组（P〈0.05）,VAS评分低于RA组（P〈0.05）。RA组引流量、患肢膝上10 cm周径、住院时间、伤口并发症多于OA组（P〈0.05）。RA组术后1个月、术后3个月HSS评分低于OA组（P〈0.05）。结论 与骨性关节炎患者相比,类风湿关节炎患者人工膝关节置换术后围术期效果差。     

Patient satisfaction after total knee arthroplasty: an Asian perspective

INTRODUCTION

Total knee arthroplasty (TKA) is an effective method for alleviating pain and restoring knee function in patients with severe osteoarthritis. However, despite the improvements in surgical technique and postoperative care, it has been reported that up to 19% of patients are dissatisfied after their operations. The aim of this study was to evaluate patient satisfaction levels after TKA in an Asian cohort, as well as assess the correlation between patient satisfaction levels and the results of traditional physician-based scoring systems.

METHODS

The medical data of 103 Asian patients who underwent 110 TKAs between December 2008 and June 2009 were obtained from our hospital’s Joint Replacement Registry. The minimum follow-up period was one year and patient expectations were assessed before TKA. Patient satisfaction was assessed postoperatively using a 5-point Likert scale. Reasons for patient dissatisfaction were recorded. Standardised instruments (e.g. the Knee Society Score, the Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC] and the generic Short Form-36 health survey) were used to assess the patient’s functional status and the severity of symptoms pre- and postoperatively.

RESULTS

Among the 110 TKAs performed, 92.8% resulted in patient satisfaction. Patient satisfaction correlated with postoperative WOMAC function scores (p = 0.028), postoperative WOMAC final scores (p = 0.040) and expectations being met (p = 0.033).

CONCLUSION

Although there was a high level of patient satisfaction following TKA in our cohort of Asian patients, a significant minority was dissatisfied. Patient satisfaction is an important outcome measure and should be assessed in addition to traditional outcome scores.     

一期手术治疗老年双膝骨性关节炎效果观察

目的:探讨全膝关节置换结合关节镜术一期手术治疗双膝骨关节炎的效果.方法:双膝骨关节炎患者16例,男5例,女11例,年龄60～78岁.较重侧(HSS评分35～48分)行全膝关节置换术,较轻侧(HSS评分42～60分)行关节镜下松解术并下肢支具康复锻炼.结果:患者术中出血量220～300 ml,恢复快.随访9～26个月,患者关节置换侧HSS评分由(40.9±6.7)分提高至(86.4±7.0)分;关节镜术侧HSS评分由(52.2±7.3)分提高至(78.6±8.2)分.结论:全膝关节置换联合关节镜下松解术一期手术治疗老年双膝骨关节炎是一种有效方法.     

髋、膝关节置换术后发生院内静脉血栓栓塞症的高危因素分析

目的：分析影响人工全髋及全膝关节置换术后院内静脉血栓栓塞症（VTE）形成的围术期高危因素。方法采用前瞻性队列研究,筛选纳入该科2012年10月至2013年7月分别行全髋及全膝关节置换的174例患者（共205侧手术）,包括132例髋（122侧）,73例膝（52侧）。术前及术后3～5d行双下肢血管彩超检查,确定有无血栓形成。根据术后是否发生深静脉血栓（DVT）将患者分为DVT组和非DVT组,将DVT发生与否作为因变量,年龄、性别、高血压病等10余项临床因素作为自变量,分析其相关性并筛选出DVT发生的主要影响因素。结果经双下肢血管彩超检查,174例患者中43例发现DVT,发生率24．7％。多因素Logistic回归分析表明：年龄大于或等于70岁、类风湿、术前凝血酶原时间国际标准化比值（PT‐INR）相对降低差异有统计学意义（P＜0．05）;术前血浆D‐二聚体值升高和全身麻醉差异有统计学意义（P＜0．01）;使用受试者工作特征曲线（ROC）得出结果：术前D‐二聚体作为诊断测试的临界值为764μg／L。结论年龄大于或等于70岁、PT‐INR相对降低、术前血浆D‐二聚体值升高、类风湿和全身麻醉的患者发生VTE的风险高,是髋、膝关节置换术后VTE发生的重要因素,术前D‐二聚体值为764μg／L时用作临床排除诊断较合适。     

Intra-articular glucocorticoid injections in patients with juvenile idiopathic arthritis in a Singapore hospital

INTRODUCTION

This study aimed to evaluate the efficacy and safety of intra-articular glucocorticoid (IAG) injections in our institution in children with juvenile idiopathic arthritis (JIA).

METHODS

This is a retrospective assessment of IAG injections performed by the Department of Paediatrics, National University Hospital, Singapore, from October 2009 to October 2011. A total of 26 procedures were evaluated for efficacy, considering parameters such as clinical response, changes in systemic medication, length of time between repeat injections, safety, consent-taking, pre- and post-procedural advice, compliance with aseptic technique, and post-procedural complications.

RESULTS

A total of 26 IAG injections of triamcinolone hexacetonide were administered over 17 occasions (i.e. patient encounters) to ten patients with JIA during the study period. After the injections, clinical scoring by a paediatric rheumatologist showed overall improvement by an average of 2.62 points out of 15. Besides six patient encounters that had an increase in systemic medication on the day of the injection, five required an increase within six months post injection, two required no adjustments, and one resulted in a decrease in medications. In all, 21 injections did not require subsequent injections. The mean interval between repeat injections was 7.8 months. Cutaneous side effects were noted in three anatomically difficult joints. Medical documentation with regard to patient progress was found to be lacking.

CONCLUSION

As per the recommendations of the American College of Rheumatology, we safely used IAG injections as the first-line therapy in our group of patients with oligoarticular JIA, and/or as an adjunct to systemic therapy in our patients with JIA.     

单髁关节置换术与全膝关节置换术治疗单间室骨关节炎的近期疗效比较

目的:比较单髁关节置换术(UKA)与全膝关节置换术(TKA)治疗单间室骨关节炎的近期疗效。方法:单间室骨关节炎患者24例,8例行UKA,16例行TKA。比较2组患者术前及末次随访时的疼痛视觉模拟评分(VAS)和关节美国特种外科医院评分(HSS)。结果:除TKA组1例患者因膝关节感染行假体取出,关节框置术,随访期间2组均未出现感染、假体松动、关节翻修、下肢静脉血栓形成等并发症。所有患者术后VAS评分及HSS评分均较术前明显改善(P<0.01)。末次随访时,TKA患者术后疼痛缓解VAS评分优于UKA患者(P<0.05),HSS评分比较差异无统计学意义(P>0.05)。结论:UKA和TKA治疗单间室骨关节炎的近期疗效相当,UKA术后并发症相对较少,TKA术后疼痛缓解则更为明显。     

单髁置换术与全膝置换术治疗黄土高原地区大骨节病膝关节炎的疗效对比研究

目的 比较单髁置换术(UKA)与全膝置换术(TKA)治疗黄土高原地区大骨节病膝关节炎的疗效差异.方法 选取2017年1月—2018年8月庆阳市人民医院收治的大骨节病膝关节炎患者40例作为研究对象.按手术方式分成UKA组和TKA组,比较两组患者手术时间、术后引流量、膝关节活动度、HSS评分、血红蛋白质量浓度、C反应蛋白等...     

Effectiveness of using tranexamic acid in total hip and total knee arthroplasty: Single tertiary center experience

Objectives:To measure the effectiveness of tranexamic acid (TXA); in total joint arthroplastyin terms of reducing post-operative blood loss.Methods:A retrospective cohort study in which patients who had underwent total hip arthroplasty (THA) and TKA between 2010-2018 in a single tertiary center. Those had received TXA (group 1) and those who had received no-TXA (group 2) were evaluated. Unpaired student’s t-test was used to compare TXA and no-TXA groups for continuous variables and Chi-square test was used for categorical variables. A p-value<0.05 was considered significant.Results:A total of 385 patients were included, 180 patients received TXA, and 205 patients received no-TXA. Post-operative blood loss was significantly less in TXA group (13.41±9.51, p<0.001). Total drainage output was significantly lower in TXA group compared to no-TXA (373.98±246.12 vs. 487.11±307.13 mL, p<0.001). Blood transfusion units were significantly less in TXA group than in the control group (20 units; 11.1% vs. 50 units; 24.4%, p<0.001).Conclusion:Tranexamic acid use in TKA and THA is effective in reducing post-operative blood loss in terms of drop in Hg level, total drainage output and blood transfusion rate.     

Production of a polyclonal antibody against osteogenic protein-1, and its role in the diagnosis of osteoarthritis

INTRODUCTION

Osteoarthritis (OA) is a progressive degenerative disorder of the articular cartilage. Available diagnostic radiography has been poorly associated with the progress and severity of this clinical disease. As osteogenic protein-1 (OP-1) has been identified as a bone morphogenetic protein with a major role in cartilage repair, we aimed to evaluate its potential role in the diagnosis of OA.

METHODS

This was an experimental study conducted at the Department of Biochemistry, Sikkim Manipal Institute of Medical Sciences, India. Polyclonal antibodies (i.e. anti-OP-1[f]) were raised against OP-1 in mice, and subsequently used in a sandwich enzyme-linked immunosorbent assay (ELISA) to detect the presence of OP-1 in the synovial fluids of 75 osteoarthritic patients. For the purpose of correlation, the radiographic assessments of the knees of the 75 patients were graded using the Kellgren-Lawrence scoring system.

RESULT

The polyclonal antibody (i.e. anti-OP-1[f]) raised against OP-1 was able to detect the presence of OP-1 in the synovial fluids of all the osteoarthritic patients via sandwich ELISA. The level of the OP-1 was found to be much higher than the reference range and correlated positively with the severity of OA (r = 0.24; p = 0.04).

CONCLUSION

Our study shows that the polyclonal antibody, anti OP-1(f), could be used for the immunodiagnosis of osteoarthritis via sandwich ELISA.     

人工全膝关节置换术治疗类风湿性关节炎短期临床疗效研究

目的:观察人工全膝关节置换术(TKA)治疗类风湿性关节炎短期临床疗效。方法:对36例(47膝)类风湿关节炎(RA)患者施行TKA,采用HSS评分对患者术前术后膝关节功能进行评估,同时对术后的影像学资料进行评价,采用SF-36健康量表对患者术前术后的生活质量进行评估,采用满意度量表对TKA后患者满意度进行对比。结果:31例(40膝)获得平均(3.65±0.95)年(2⁵年)随访,膝关节HSS评分由术前平均(44.89±13.95)分提高到术后平均(88.46±5.97)分,手术前后比较差异有统计学意义,其中优秀26膝,良好11膝,可2膝,差1膝,优良率92.50%;膝关节活动度由术前(70.05±25.71)°提高到术后(97.26±15.29)°,术前、术后的ROM比较差异有显著意义;膝关节内外翻畸形、屈曲挛缩畸形状况也得到改善。膝关节假体采用膝关节学会X线评价与计分系统评价未见假体松动。患者术后SF-36评分各评分均较术前得到明显改善,其中PCS术前平均(27.48±4.59)分,提高至术后平均(47.68±6.98)分,手术前后比较差异有统计学意义;MCS术前平均(42.46±5.63)分,提高至术后平均(53.99±5.74)分,手术前后比较差异有统计学意义。患者TKA后随访满意度满意率90%。结论:TKA治疗类风湿性关节炎短期临床疗效良好,患者生活质量得到明显提高,且满意度高。     

Preoperative physiotherapy and short-term functional outcomes of primary total knee arthroplasty

INTRODUCTION

Physiotherapy is an important part of rehabilitation following arthroplasty, but the impact of preoperative physiotherapy on functional outcomes is still being studied. This randomised controlled trial evaluated the effect of preoperative physiotherapy on the short-term functional outcomes of primary total knee arthroplasty (TKA).

METHODS

50 patients with primary knee osteoarthritis who underwent unilateral primary TKA were randomised into two groups: the physiotherapy group (n = 24), whose patients performed physical exercises for six weeks immediately prior to surgery, and the nonphysiotherapy group (n = 26). All patients went through a similar physiotherapy regime in the postoperative rehabilitation period. Functional outcome assessment using the algofunctional Knee Injury and Osteoarthritis Outcome Score (KOOS) scale and range of motion (ROM) evaluation was performed preoperatively, and postoperatively at six weeks and three months.

RESULTS

Both groups showed a significant difference in all algofunctional KOOS subscales (p < 0.001). The mean score difference at six weeks and three months was not significant in the sports and recreational activities subscale for both groups (p > 0.05). Significant differences were observed in the time-versus-treatment analysis between groups for the symptoms (p = 0.003) and activities of daily living (p = 0.025) subscales. No significant difference in ROM was found when comparing preoperative measurements and those at three months following surgery, as well as in time-versus-treatment analysis (p = 0.928).

CONCLUSION

Six-week preoperative physiotherapy showed no significant impact on short-term functional outcomes (KOOS subscales) and ROM of the knee following primary TKA.     

全膝关节置换术对膝骨关节炎患者的近期疗效

目的 比较2种治疗方法对膝骨关节炎患者膝关节功能的改善效果。方法 选取2016年1月— 2018年1月天津医科大学总医院滨海医院收治的膝骨关节炎患者116例为研究对象。按随机抽签法将其分为观察组和对照组。对照组予以关节镜下清除术治疗,观察组予以全膝关节置换术治疗。对所有患者进行为期6个月的随访。比较两组手术前后患者膝关节功能评分（HSS）、视觉模拟法（VAS）、焦虑自评量表（SAS）评分变化情况,疗效以及生活质量情况。结果 观察组优良率[91.38%（53/58）]较对照组[72.41%（42/58）]高（P?<0.05）。观察组HSS评分比对照组高（P?<0.05）,而VAS、SAS评分比对照组低（P?<0.05）。术后观察组各项SF-36量表评分均比对照组高（P?<0.05）。结论 全膝关节置换术应用于符合适应证的膝骨关节炎患者中的效果显著,有利于改善患者膝关节功能,减轻疼痛,改善焦虑情绪,且有效提高生活质量,值得临床推广应用。     

人工全膝关节置换术治疗类风湿性关节炎患者的临床疗效

目的探讨人工全膝关节置换术治疗类风湿性关节炎患者的临床疗效及术后膝关节功能的影响。方法本文选择我院2012年4月～2017年3月收治的73例患者随机分为观察组(n=37)和对照组(n=36)。两组均进行常规基础药物治疗,对照组给予玻璃酸钠膝关节腔局部注射治疗,观察组给予人工全膝关节置换术治疗。比较两组ROM评分、HSS评分及SF-36评分。结果治疗后,两组ROM评分明显高于治疗前,差异有统计学意义(t=-15.308,P=0.000;t=2.205,P=0.032);而且,观察组ROM评分明显高于对照组,差异有统计学意义(t=2.205,P=0.032)。两组HSS评分较治疗前均显著升高,差异均有统计学意义(P0.05);而且,观察组HSS评分明显高于对照组,差异有统计学意义(P0.05)。两组SF-36评分与治疗前比较均显著升高,差异有统计学意义(P0.05);观察组SF-36评分显著高于对照组,差异有统计学意义(P0.05);但观察组GH评分与对照组比较无明显差异,差异无统计学意义(P0.05)。结论 TKA治疗RA临床疗效显著,可有效根除患者疼痛症状,改善患者膝关节功能,提高患者生活质量,值得推广应用。     

Ostraceous and inverse psoriasis with psoriatic arthritis as the presenting features of advanced HIV infection

Knowledge of both the common and atypical presentations of human immunodeficiency virus (HIV)-associated dermatoses may be helpful in arousing suspicion of HIV, especially in patients with no reported risk factors. Herein, we report the case of an otherwise healthy, nonpromiscuous 29-year-old man who presented to our institution with an eight-week history of plaques with oyster shell-like scales on the trunk, extremities and genital area. The plaques were associated with fever, and intermittent knee pain and swelling. Initial diagnostic tests were suggestive of drug hypersensitivity syndrome, and the patient’s condition improved with treatment using oral prednisone. However, the lesions recurred when the dose of prednisone was tapered, even after the culprit drug had long been discontinued. Repeat skin punch biopsy and arthrocentesis revealed a diagnosis of psoriasis vulgaris with psoriatic arthritis. Due to the atypical presentation of psoriasis, the patient was counselled to undergo HIV testing, which came back positive. Clinicians should be attuned to the skin signs heralding HIV/acquired immunodeficiency syndrome, in order to facilitate early diagnosis and treatment.     

髋或膝关节炎患者血清组织蛋白酶D 和α-1 抗胰蛋白酶活性水平

目的：检测髋、膝关节炎患者血清中组织蛋白酶D(cathepsin D，CAT-D)及α-1抗胰蛋白酶(alpha-1 antitrypsin，AAT)的活性，以探索这两种酶可否作为检测软骨退行性变的血清生化指标。方法：收集晚期髋或膝关 节炎患者(病例组)70例；健康对照组100人。分别运用ELISA法检测病例组术前、行关节置换术后10 d及对照组血清 中CAT-D和AAT活性，对2组数据进行比较。结果：与对照组相比，病例组患者术前血清中CAT-D活性降低了25% (P<0.05)，术后10 d血清中CAT-D活性进一步下降50%以上(P<0.05)；术前血清AAT活性无差异(P>0.05)，术后增高了 约80%(P<0.05)。两种酶活性在髋与膝关节炎之间比较亦无差异(P>0.05)。性别、高血压、糖尿病等对CAT-D和AAT的 活性无影响(P>0.05)。两种酶亦没表现出与年龄的相关性。结论：AAT可能是骨关节炎进展过程中一个炎症因子。 CAT-D和AAT不受性别、年龄、是否合并高血压及糖尿病等影响，有希望成为检测软骨退行性变过程的血清生化指标。     

人工全膝关节置换术对骨关节炎患者HSS评分、膝关节活动度及生存质量的影响

目的:探讨人工全膝关节置换术对骨关节炎患者HSS评分、膝关节活动度及生存质量的影响.方法:随机选取2016年8月-2018年8月宁夏回族自治区石嘴山市宁夏第五人民医院骨科骨关节炎患者60例,随机分为2组:一组常规抗炎治疗组(保守治疗组,30例),一组人工全膝关节置换术组(手术治疗组,30例),对2组患者的膝关节活动度、HSS评分、临床疗效、生存质量进行统计分析.结果:手术治疗组患者的WOMAC骨关节炎指数评分、VAS评分均显著低于保守治疗组(P<0.05),AKS膝、功能评分均显著高于保守治疗组(P<0.05),膝关节最大屈曲角度显著大于保守治疗组(P<0.05),HSS评分显著高于保守治疗组(P<0.05),治疗的优良率96.7%(29/30),显著高于保守治疗组76.7%(23/30)(P<0.05),S-FMMFA评分、BBS评分、RMI评分均显著高于保守治疗组(P<0.05),躯体、认知、角色、社会功能评分均显著高于保守治疗组(P<0.05).结论:人工全膝关节置换术较常规抗炎治疗更能有效提升骨关节炎患者HSS评分、膝关节活动度及生存质量.