内侧张开胫骨高位截骨术中未植骨的预后研究

目的研究内侧张开胫骨高位截骨术中不植骨的术后骨预合情况。方法回顾性分析2008年1月至2012年1月内侧张开胫骨高位截骨术43例,分为A、B两组,A组术中植骨(骨移植或采用羟基磷灰石人工骨),B组未植骨,比较两组骨性愈合程度、愈合时间、完全负重时间及并发症情况等。结果两组各项临床指标无统计学差异,其中A组骨愈合时间(16.42±1.53)周,B组骨愈合时间(17.80±1.72)周(P=0.08)。随访期间未出现内固定失效、钢板松动断裂、感染等并发症。结论内侧张开胫骨高位截骨术中不植骨也可获得满意预后。     

胫骨高位截骨术与腓骨截骨术治疗膝骨关节炎临床疗效比较

目的比较胫骨高位截骨术(HTO)与腓骨截骨术治疗膝关节骨性关节炎(KOA)临床疗效。 方法回顾性分析于2015年1月至2016年12月在佛山市中医院骨九科行HTO或腓骨截骨术治疗KOA的患者。HTO组共37例,男11例,女26例,平均年龄(59±3)岁;腓骨截骨组共26例,男9例,女17例,平均年龄(59±3)岁。分析比较两组的手术耗时、术中失血量、住院总花费、术后并发症、随访期内再次行膝关节置换情况。采用膝关节Lysholm评分、西安大略和曼彻斯特大学关节炎指数(WOMAC)对术前、术后6个月、术后12个月随访时膝关节功能进行评估。数据采用SPSS13.0统计学软件进行统计学分析。手术耗时、术中失血量、住院总花费、Lysholm评分、WOMAC评分均采用独立样本t检验,术后并发症、随访期内再次行膝关节置换情况比较采用卡方检验。 结果HTO组术后随访中位数15.7个月,腓骨截骨组术后随访中位数14.9个月。HTO组手术耗时(t＝21.094,P<0.05)、术中失血量(t＝9.91,P<0.05)、住院总花费(t＝65.471,P<0.05)均显著劣于腓骨截骨组。HTO组有1例(2.7%)并发症,腓骨截骨组有2例并发症(7.7%),采用Fisher确切概率法分析,差异无统计学意义(P＝0.785)。两组患者术前膝关节Lysholm评分、WOMAC评分差异均无统计学意义。术后6个月Lysholm评分HTO组显著优于腓骨截骨组(t＝2.426,P<0.05)。WOMAC评分HTO组显著劣于腓骨截骨组(t＝3.997,P<0.01)。术后12个月HTO组Lysholm评分(t＝2.979,P<0.01)、WOMAC评分(t＝－2.472,P<0.05)均显著优于腓骨截骨组。 结论行胫骨高位截骨术治疗膝关节骨性关节炎比行腓骨截骨术手术耗时长、术中出血多、住院总花费多;术后12个月的随访提示行胫骨高位截骨术能比行腓骨截骨术取得更好的膝关节功能。     

胫骨高位内外侧截骨治疗膝关节骨性关节炎临床研究

目的比较胫骨内外侧高位截骨治疗膝关节骨性关节炎的疗效,探讨影响疗效的因素。方法采用胫骨内外侧高位截骨术治疗膝关节骨性关节炎内翻畸形58例（62膝）。分别对两种术式进行综合评分。结果随访时间：内侧组平均2．1年,外侧组3．6年。采用HSS标准,内侧组优良率为97％,外侧组83．2％,经x^2检验,差异无显著性,但手术时间、膝关节术后活动改善度和术后并发症分别经x^2检验和t检验,差异有显著性。结论胫骨高位内侧截骨治疗膝关节骨性关节炎内翻畸形有手术难度小、便于膝部其他术式的联合、术后可早期活动、并发症发生率低等优点。     

胫骨高位截骨Giebel内固定治疗膝内翻的疗效观察

目的探讨胫骨高位截骨Giebel内固定术治疗膝内翻畸形的效果。方法对18膝内翻畸形患者采用胫骨高位截骨Giebel内固定。手术前后摄双下肢负重位全长X线片,测量内翻角、机械轴线和斛剖轴线并记录。结果18例均获得随访,时间8～29个月。术后1例出现腓总神经麻痹,经治疗3个月后肌力感觉完全恢复。截骨处在术后12～14周均达到骨性愈合,疼痛症状均明显缓解或消失,摄片检查下肢力线维持在术后水平。结论胫骨高位截骨Giebel内固定术治疗膝内翻畸形效果确实可靠,骨愈合率高,推迟了膝关节置换的年龄。     

行胫骨高位截骨全膝关节置换手术患者的对照研究

目的探讨胫骨高位截骨术对随后进行的全膝关节置换术的影响。方法对23例行胫骨高位截骨术后行全膝关节置换术患者的术中情况以及术后膝关节功能与对照组进行了比较,两组患者在年龄、疾病和关节畸形方面具有可比性。结果胫骨高位截骨术后行全膝关节置换术患者的手术时间（118．5±32）与对照组（98．9±20．5）比较差异有统计学意义,伤口的并发症也较对照组多。但两组患者的围手术期的出血量和术后膝关节功能比较差异无统计学意义。结论胫骨高位截骨术后行全膝关节置换术患者的膝关节功能和活动范围与对照组相似,但其手术的技术要求较高,并发症也相对较多。     

胫骨内侧高位截骨术后胫骨相关角度的变化

目的通过测量,观察胫骨内侧高位截骨术对胫骨后倾角等相关角度的影响,探讨其临床意义。方法1997~2002年,对33例(36膝)膝关节内侧间室骨性关节炎患者行胫骨内侧高位截骨术。男6例,女27例;年龄45~72岁,平均58岁。在手术前后X线片上测量胫骨后倾角,Insall-Salvati指数,胫骨结节高度。采用配对t检验进行统计学分析。结果胫骨内侧高位截骨,术后胫骨后倾角、胫骨结节高度无丢失,差别有显著意义(P<0·05)。结论胫骨内侧高位截骨术后,胫骨后倾角无减小,无低位髌骨等并发症出现,提示该术较胫骨外侧截骨术具有优势。     

胫骨高位截骨手术并发症23例次分析

[目的] 探讨胫骨高位截骨手术并发症的发生情况，并提出预防和治疗措施。[方法]2000年1月～2004年10月采用胫骨高位截骨术治疗膝骨关节炎合并内翻畸形患者126人，21人发生手术并发症，男4例，女17例；年龄48～64岁，平均61岁。术前拍摄站立膝关节正位X线片，测量股骨一胫骨角，计算截骨角度，采用外侧闭合胫骨高位截骨术矫正膝内翻畸形。[结果] 术后随访6～12个月，平均7．5个月。共21名患者发生各类并发症23例次．发生率为16．7％。其中发生胫骨骨折4例，腓总神经麻痹3例，出现深静脉血栓形成5例，膝内翻复发病例6例，内固定失败4例（其中2例合并膝内翻复发），感染1例。[结论] 降低胫骨高位截骨手术并发症需要术者熟悉局部解剖和精确的术前设计，提高手术技巧及完善的围手术期护理。     

胫骨高位截骨术后并发症的研究进展

胫骨高位截骨术是治疗膝关节骨性关节炎的重要手段,也是保膝治疗的重要组成部分。同全膝关节置换手术一样,胫骨高位截骨术同样能够缓解疼痛、改善膝关节功能、保留较高水平的活动。术后并发症是影响胫骨高位截骨术患者生存率的重要因素,目前临床对于并发症的认识尚有争议。本文通过总结近年胫骨高位截骨术后的随访资料,对术后并发症进行系统阐述,希望为并发症的处理提供依据。     

两种截骨术治疗膝内侧间室骨关节炎的近期疗效比较

目的 比较腓骨截骨和内侧开放楔形胫骨高位截骨治疗膝内侧间室骨关节炎的近期临床疗效.方法 将40例膝内侧骨关节炎患者按截骨方式的不同分为腓骨截骨组(18例,采用腓骨截骨治疗)与胫骨截骨组(22例,采用内侧开放楔形胫骨高位截骨治疗).记录术后并发症发生情况和胫骨近端内侧角(MPTA),比较两组术后各时间点疼痛VAS评分、H...     

胫骨高位截骨治疗膝关节骨关节炎并膝内翻

目的探讨胫骨高位截骨Giebel钢板内固定治疗膝关节骨关节炎并膝内翻的临床效果。方法从2008年8月至2012年2月,我科实施胫骨高位截骨Giebel钢板内固定手术治疗膝关节骨关节炎并膝内翻患者38例47膝。所有患者均以内侧间室疼痛为主。其中男13例15膝,女25例32膝;年龄36~58岁,平均48.5岁;应用HSS膝关节评分系统进行分析。结果 38例均获随访,随访18~24个月,平均20.2个月。术后未出现伤口感染、钢板螺钉断裂、膝内翻复发、骨不愈合等并发症。截骨处在术后12~14周均达到骨性愈合,疼痛症状均明显缓解或消失,摄片检查力线维持在术后水平。膝胫骨角术前平均为（102.1±4.3）°,术后平均为（91.5±4.1）°,所得资料采用配对t检验进行统计学分析,P〈0.01,具有明显的统计学差异。采用HSS膝关节评分标准进行疗效评价,优24膝,良16膝,中5膝,差2膝,优良率85.1%。结论胫骨高位截骨Giebel钢板内固定术式简单,组织创伤小,手术时间短,并发症少,患者下床活动早,功能恢复快,效果满意,是一种治疗膝内翻并膝关节骨性关节炎的良好方法。     

个性化护理在自体脂肪移植隆胸术患者围术期的应用效果

目的 探讨个性化护理在自体脂肪移植隆胸术患者围术期的应用效果。方法 选取2022年 1月-2023年3月于我院行自体脂肪移植隆胸术治疗的90例患者为研究对象,以随机数字表法分为对照组和 观察组,每组45例。对照组采用常规护理,观察组采用个性化护理,比较两组术后并发症发生情况、心理状 况、疼痛程度、治疗依从性、住院时间及护理满意度。结果 观察组术后并发症发生率为6.67%,低于对照组的 24.44%,差异有统计学意义（P＜0.05）;观察组SAS评分、SDS评分、VAS评分均低于对照组,差异有统计学意 义（P＜0.05）;观察组治疗依从性评分高于对照组,住院时间短于对照组,差异有统计学意义（P＜0.05）; 观察组护理满意度为95.56%,高于对照组的80.00%,差异有统计学意义（P＜0.05）。结论 个性化护理服务 在自体脂肪移植隆胸术患者围术期的应用效果确切,可有效调节患者的不良心理状况,减轻疼痛,提高其 依从性,同时能够降低并发症发生率,提高患者满意度,有利于缩短治疗时间,促进恢复,值得临床应用。     

腹腔镜下疝囊高位结扎术中应用优质护理的效果分析

目的探讨优质护理在腹腔镜下疝囊高位结扎术中的应用效果。 方法选取2017年4月至2018年9月,解放军总医院第六医学中心收治的腹股沟疝患儿102例,采用随机数字表法将患儿分为观察组和对照组,每组51例。2组患儿均行腹腔镜下疝囊高位结扎术,对照组围手术期给予常规护理,观察组围手术期采用优质护理。比较2组手术相关临床参数、术后第2天腹胀程度、住院期间护理质量及术后并发症发生情况。 结果观察组术后肠鸣音恢复时间、术后肛门排气时间及自主下床活动时间均明显短于对照组,差异均有统计学意义（t=6.738、6.060、2.874,P均<0.001）。观察组总并发症发生率明显低于对照组,差异有统计学意义（χ²=4.747,P=0.029）。观察组腹胀评分明显低于对照组,差异有统计学意义（t=9.738,P<0.001）。观察组病房管理、病情观察、护理操作及并发症预防评分均明显高于对照组,差异均有统计学意义（t=5.546、7.237、13.106、7.014,P均<0.001）。 结论腹腔镜下疝囊高位结扎术围手术期实施优质护理可有效提升住院期间护理质量,缓解患儿术后腹胀程度,降低术后并发症发生风险,利于患儿术后恢复。     

针对性围手术期护理干预对面部外伤整形美容患儿依从性及满意度的影响

目的:探究针对性围手术期护理干预对面部外伤整形美容患儿依从性、满意度及情绪的影响。方法:选取110例面部外伤患儿,随机分为两组,对照组(55例)给予常规围手术期护理,观察组(55例)给予针对性围手术期护理。干预1个月后检测两组患儿的各项指标。结果:干预后,观察组患儿依从性为90.91%、护理满意度为90.91%高于对照组的70.91%、72.73%,差异均有统计学意义(P<0.05);观察组患儿的心理评分、生理评分、环境评分、社交评分均显著高于对照组,差异有统计学意义(P<0.05);两组患儿的SAS、SDS评分均下降(P<0.05),且观察组患儿的SAS、SDS评分显著低于对照组,差异有统计学意义(P<0.05)。结论:针对性围手术期护理干预可以显著改善小儿面部外伤整形美容手术患儿的依从性、满意度及焦虑抑郁程度。     

临床护理路径应用于成年男性腹腔镜腹股沟疝无张力修补术围手术期的效果评价

目的探讨临床护理路径在成年男性腹腔镜腹股沟疝修补术围手术期的应用及效果。方法我科自2015年3月至2017年2月采用腹腔镜术式(完全腹膜外腹股沟疝无张力修补术,TEP)治疗成年男性腹股沟疝149例,依据护理方法将患者分为两组(住院号单号为路径组,双号为对照组):路径组(72例)与对照组(77例)。观察组采用腹股沟疝临床护理路径对患者进行全面的宣教及干预,对照组采用一般护理宣教和干预。主要比较两种护理方式的总住院天数、术后住院天数、术后6 h、24 h疼痛评分、住院总费用、健康知识掌握情况及护理满意度等资料。结果和对照组相比,路径组患者住院时间缩短、术后6 h、24 h疼痛评分明显降低,护理满意度比对照组明显增高(P0.05)。结论临床护理路径的应用降低了住院时间,减轻患者疼痛,提高护理满意度。     

Patient satisfaction after medial opening high tibial osteotomy and microfracture

High tibial osteotomy has become an accepted treatment for patients with varus degenerative arthritis of the knee. We sought to determine factors associated with patient satisfaction and functional outcome following medial opening wedge high tibial osteotomy for the degenerative varus knee. Sixty-one patients (14 women and 47 men) undergoing medial opening wedge osteotomy and chondral resurfacing procedure (microfracture) for medial knee pain, with minimum 2-year follow-up, were identified through our clinical database. Mean patient age was 52.2 years (range: 35-65 years). Thirty patients were treated with plate fixation, and 31 with distraction osteogenesis and external fixation. Nineteen patients had Outerbridge grade III or IV patellofemoral lesions at initial surgery. The mean preoperative Lysholm score of 49.9 improved postoperatively to 75.4 (P < .001). Mean satisfaction score was 7.6 (1 = not satisfied, 10 = very satisfied). Women showed a significantly higher improvement in Lysholm and satisfaction scores than men (P = .029, P = .034). A positive correlation was observed between satisfaction and postoperative Lysholm score (P < .001). The independent multivariate predictor of patient satisfaction was the postoperative Lysholm score. Medial opening wedge high tibial osteotomy is an efficacious surgical option for the treatment of the degenerative varus knee, as demonstrated by both patient satisfaction and functional outcome scores.     

Primary stability with tibial press-fit fixation of patellar ligament graft: An experimental study in ovine knees

Purpose: To investigate the initial fixation strength and to assess the value of tibial press-fit fixation of the bone-tendon-bone graft in anterior cruciate ligament reconstruction. Type of Study: Nonrandomized control trial. Methods: For tibial press-fit fixation, the tibial bone block of the bone-tendon-bone graft is countersunk in a bony groove at the distal tunnel outlet and fixed over a bone bridge with 2 No. 6 Ethibond sutures. The bone cylinder harvested from the tibial tunnel using an oscillating hollow saw is plugged into the tibial tunnel parallel to the graft, thus providing for additional anchoring of the graft by tibial press-fit fixation. In a comparative experimental study in 46 ovine knees, this fixation method was assessed for its value in anterior cruciate ligament reconstruction. A tibial bone tunnel was placed in routine manner in each ovine tibia using a target drill unit and an oscillating hollow saw. The complete patellar ligament, proximally attached to the patella and distally to a cylindrical bone block (20 × 8.4 mm), served as graft. Tibial fixation in group A (n = 10) was done using a titanium interference screw (20 × 8 mm), in group B (n = 10) using a titanium staple, in group C (n = 12) using suture fixation over a bone bridge, and in group D (n = 14) using the press-fit fixation described above. In a materials testing machine, all specimens were subjected to continuously increasing load until failure at a velocity of 1 mm/second. Ultimate failure load, stiffness, stress-strain characteristics, and failure mode were evaluated. Results: Ultimate load to failure was 572 N (range, 473 to 680 N) in group A, corresponding to a fixation stiffness of 17.68 N/mm. For group B, ultimate load to failure was 608.4 N (range, 511 to 727 N) and stiffness of 19.92 N/mm. Bone block dislocation was the failure mode in groups A and B. Group C with exclusive suture fixation showed an ultimate load to failure of 304.5 N (range, 120 to 327 N) and a stiffness of only 6.96 N/mm. The mode of failure was suture cutout caused by the bone block in 9 of the cases and untying of the suture knot in 3 cases. Group D with press-fit fixation showed a significantly higher primary stability of 758 N (range, 513 to 993 N) relative to group C, with a corresponding stiffness of 25.12 N/mm (P < .02). In this group, the mode of failure was ligamentous rupture from the bone block. Regarding mechanical properties, no significant differences were seen between groups A, B, and D. Conclusions: Tibial press-fit fixation allows for metal-free fixation with high primary stability. By refilling the bone tunnel, the ligament (with a rather small cross-sectional diameter compared with hamstrings) is safely fixed within the bone tunnel to prevent potential postoperative tunnel enlargement due to movement of the graft within the tunnel. Anchoring the graft at the entrance into the joint, it provides for reduced graft length and adequate elasticity and accomplishes the requirements of fixation at the correct anatomic insertion site.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 17, No 9 (November-December), 2001: pp 963–970     

Do microfractures improve high tibial osteotomy outcome?

The aim of this study was to determine if microfractures improve the outcome of high tibial osteotomy in patients with medial compartmental osteoarthritis in genu varum. Forty patients presenting with Outerbridge grade III and IV chondropathies on the femoral and/or the tibial joint surface underwent high tibial osteotomy with Puddu plates (Arthrex, Inc, Naples, Florida) for primary medial compartment osteoarthritis in genu varum at our institution. Patients were randomly assigned to either the high tibial osteotomy plus microfractures group (A; n=20) or the high tibial osteotomy alone group (B; n=20). Final assessment was conducted 5 years postoperatively, including clinical response measured by the International Knee Documentation Committee (IKDC), Lysholm score, and patient satisfaction score. All patients were blinded to the treatment received and followed the same rehabilitation protocol. A statistically significant improvement between pre- and postoperative values was observed for Lysholm and IKDC scores in both groups, without any statistically significant difference between them. Regarding the satisfaction score, there were no differences between the 2 groups in terms of preoperative self-assessment (P>.05), whereas postoperative subjective satisfaction at 5-year follow-up was significantly higher in group A than in group B (P=.0036).Our study results provide further evidence that medial tibial osteotomy is an effective surgical option for treating a varus knee associated with medial degenerative arthritis in patients wishing to continue accustomed levels of physical activity. In particular, patient satisfaction was higher among those who underwent the combined treatment involving high tibial osteotomy to correct femorotibial angle and microfractures.     

优质护理在正颌正畸矫治牙颌面畸形的围手术期中的应用

探讨在正颌正畸矫治牙颌面畸形围手术期中应用优质护理的临床效果。方法 选取中日友 好医院2022年1月-2023年1月收治的80例正颌正畸矫治牙颌面畸形患者为研究对象，按随机数字表法分为 观察组和对照组，每组40例。观察组采用优质护理，对照组采用常规护理，比较两组护理效果、术 后恢复指标、心理状态、并发症发生率及护理满意度。结果 观察组总有效率为97.50%，高于对照 组的82.50%（P ＜0.05）；观察组术后VAS评分低于对照组，术后拆线时间、总住院时间短于对照组 （P ＜0.05）；观察组护理后SAS、SDS评分低于对照组（P ＜0.05）；观察组并发症发生率为2.50%，低 于对照组的17.50%（P ＜0.05）；观察组护理满意度为97.50%，高于对照组的82.50%（P ＜0.05）。结论 针对牙颌面畸形患者，在正颌正畸矫治围手术期中引入优质护理措施，能够有效提升治疗效果，降低术 后相关并发症风险，改善患者预后，值得临床应用。