单髁与全膝置换治疗老年膝单间室骨性关节炎远期疗效的meta分析

目的:采用meta分析评价单髁置换术(UKA)与全膝置换术(TKA)治疗老年膝单间室骨性关节炎的远期疗效。方法:检索PubMed、Embase、Cochrane Library、CNKI数据库,获取UKA与TKA治疗老年膝单间室骨性关节炎的随机对照(RCT)和半随机对照研究(CCT)。采用RevMan 5.0.23对术后远期优良率、翻修率及关节活动度进行meta分析。结果:共纳入6篇文献,RCT 3篇,CCT 3篇。分析结果显示,UKA与TKA术后远期优良率差异无统计学意义,RR(95%CI)=1.07(0.97~1.18),P=0.19;术后翻修率差异亦无统计学意义,RR(95%CI)=1.84(0.86~3.91),P=0.11;术后关节活动度UKA优于TKA,RR(95%CI)=0.36(0.26~0.50),P<0.001。结论:UKA治疗老年膝单间室骨性关节炎在术后关节活动度方面优于TKA。     

双侧同期全膝关节置换和单膝关节置换术临床疗效对比

目的：对双侧同期全膝关节置换和单膝关节置换术的临床疗效进行探究。方法选取我院2013年6月—2014年6月100例膝关节骨性关节炎患者为研究对象,随机分为2组,对照组采取单膝关节置换术,观察组采用双侧同期全膝关节置换术,比较分析2组的临床疗效及患者满意度。结果观察组总有效率和疗效满意度高于对照组,术后疼痛评分（VAS）低于对照组,膝关节功能评分（Lysholm）高于对照组,差异均有统计学意义（P<0.05）。结论双侧同期全膝关节置换术在膝关节骨性关节炎的治疗上可起到重要作用,帮助患者早日康复,有临床推广价值。     

早期康复训练配合CPM机对全膝关节置换术后功能恢复的影响

目的探讨早期康复训练配合CPM机对全膝关节置换术后功能恢复的效果。方法将60例患者随机分为对照组(30例)和观察组(30例),对照组采用常规的早期康复训练,观察组在早期康复训练的基础上配合CPM机。对两组患者的膝关节活动度(ROM)、美国特种外科医院(HSS)膝关节功能评分结果进行比较。结果观察组在术后2、4和6周,膝关节活动度、HSS膝关节功能评分均较对照组明显提高(P0.05)。结论早期康复训练配合CPM机有利于增加膝关节活动度及促进膝关节功能恢复。     

经皮穴位电刺激联合中药膏摩对全膝关节置换术后早期功能康复的临床观察

[目的] 评价经皮穴位电刺激联合中药膏摩对全膝关节置换术后早期功能康复的影响。[方法] 将中国中医科学院望京医院关节科81例行单侧全膝关节置换术（TKA）术后患者按随机对照原则分为试验组41例和对照组40例。术后,对照组手术患者行常规功能锻炼,试验组在对照组的基础上行经皮穴位电刺激联合中药膏摩治疗。分别记录术后第1、3、7、14天疼痛视觉模拟量表（VAS）和痛阈值评价膝部疼痛程度,记录术后第7、14天美国特种外科医院（HSS）膝关节功能评分标准评价膝关节功能。[结果] 术后第1天,两组患者患膝疼痛VAS评分和痛阈无统计学差异（P>0.05）,术后第3、7、14天,试验组VAS评分对照组（P<0.05）,痛阈值高于对照组（P<0.05）;术后第7、14天,试验组膝关节HSS评分均高于对照组（P<0.05）。[结论] 经皮穴位电刺激联合中药膏摩能有效缓解全膝关节置换术后早期疼痛,促进膝关节术后早期功能康复。     

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。     

Efficacy of interspace between the popliteal artery and the capsule of the posterior knee (iPACK) block versus periarticular local infiltration analgesia after unilateral total knee arthroplasty: Prospective randomized control trial

Objectives:To compare the efficacy of interspace between the popliteal artery and the capsule of the posterior knee (iPACK) block with periarticular local infiltration analgesia (LIA) to assess postoperative pain control and enhanced recovery after total knee arthroplasty (TKA).Methods:This research was carried out at King Saud University Medical City, Riyadh, Saudi Arabia, from September 2020 to March 2021. Eighty Patients scheduled for elective unilateral TKA were randomized to receive either iPACK or periarticular LIA along with adductor canal block under spinal anesthesia. The primary outcome was postoperative pain score, and secondary outcomes included physical rehabilitation, duration of surgery, length of post-anesthesia care unit stay, hemodynamics, and length of hospital stay.Results:The pain score during activity in iPACK group was significantly lower compared to LIA group at 4 hours postoperatively, but no significant difference was observed at 24 or 48 hours. The timed up and go test took significantly longer for patients in LIA group at 4, 24, and 48 hours compared to those in iPACK group. No significant differences in knee range of motion were observed between the 2 groups at any point.Conclusion:Based on our findings, iPACK block is an effective technique in reducing pain in the immediate postoperative period without affecting motor function, resulting in enhanced recovery following primary TKA.