与关节置换相关的国人髋关节结构测量

背景:髋关节置换作为治疗严重髋关节疾病的重要手段已在临床广泛应用,如何更加合理地设计以及置入假体,预防术后并发症的发生,延长假体使用寿命得到越来越多的重视.目的:测量与关节置换相关的陶人髋关节假体相关数据.设计、时间及地点:前瞻性实验,于2008-03/06在青岛大学医学院人体形态学实验中心完成.材料:抽取青岛大学医学院人类学研究室专供科研用的长春、通辽出土的137副完整成人骨盆及股骨,其中男66副,女71副.方法:测量全部标本的髋臼外展角、髋臼前倾角、股骨颈扭转角、股骨颈干角和股骨偏心距5项指标.所得数据输入SPSS11.0软件行统计学分析,并与国内外同类文献资料比较.结果:测耸数据完整,无缺失值.髋臼外展角[男:(42.83±3.75)°,女:(42.07±4.12)°],髋臼前倾角[男:(15.31±6.95)°,女:(14.97±6.44)°],股骨颈扭转角[男:(6.76±9.39)°,女:(7.66±10.30)°]和股骨颈干角[男:(131.81±5.05)°,女:(132.82±5.83)°]的性别差异较小,无显著性意义(P>0.05).男性股骨偏心距大于女性[(44.12±5.14),(41.07±7.25)mm,P<0.05].实验结果与国内文献报道相似,但异于国外数据.结论:髋关节解剖数值的国内地区间差异较小,但与其他国家人种存在差别.适宜的假体设计有助于髋关节置换的开展和减少并发症的风险.     

人工关节置换与关节的运动性损伤

高校体育学院和体育系从事专业运动训练的学生比社会体育和体育教育专业学生的运动性损伤率要高得多。随着比赛对抗程度的明显增强,导致运动性关节损伤有上升趋势。四川省运动训练专业学生运动损伤发病率为75.75%,在运动性损伤中,关节损伤时有发生,严重的关节损伤后可能要通过人工关节置换才可以达到修复。人工关节置换可以基本符合运动损伤后关节功能恢复的生理要求,保持原关节的大部分活动度,恢复后大部分功能良好,而且假体来源不受限,无排斥反应。     

Sacroiliac joint and lumbar zygapophysial joint corticosteroid injections

The sacroiliac joint and the lumbar zygapophysial joints are both known pain generators with demonstrated pain-referral patterns. They are both amenable to image-guided intraarticular injection of corticosteroids, a procedure that is commonly performed for pain. The literature on the efficacy of intraarticular corticosteroid injections for these joints is currently limited. This article covers the diagnostic dilemmas associated with these joints, the utility of anesthetic blocks, and the literature on the efficacy of intraarticular corticosteroid injections.     

Fluoroscopically guided therapeutic sacroiliac joint injections for sacroiliac joint syndrome

OBJECTIVE: To investigate the outcomes resulting from the use of fluoroscopically guided therapeutic sacroiliac joint injections in patients with sacroiliac joint syndrome. DESIGN: A retrospective study design with independent clinical review was utilized. Thirty-one patients were included; each patient met specific physical examination criteria and failed to improve clinically after at least 4 wk of physical therapy. Each patient demonstrated a positive response to a fluoroscopically guided diagnostic sacroiliac joint injection. Therapeutic sacroiliac joint injections were administered in conjunction with physical therapy. Outcome measures included Oswestry scores, Visual Analog Scale pain scores, work status, and medication usage. RESULTS: Patients' symptom duration before diagnostic injection averaged 20.6 mo. An average of 2.1 therapeutic injections was administered. Follow-up data collection was obtained at an average of 94.4 wk. A significant reduction (P = 0.0014) in Oswestry disability score was observed at the time of follow-up. Visual Analog Scale pain scores were reduced (P < 0.0001) at the time of discharge and at follow-up. Work status was also significantly improved at the time of discharge (P = 0.0313) and at follow-up (P = 0.0010). A trend (P = 0.0645) toward less drug usage was observed. CONCLUSIONS: These initial findings suggest that fluoroscopically guided therapeutic sacroiliac joint injections are a clinically effective intervention in the treatment of patients with sacroiliac joint syndrome. Controlled, prospective studies are necessary to further clarify the role of therapeutic injections in this patient population.     

关节置换术后假体周围感染的实验室诊断

关节假体周围感染(PJI)是关节置换术后发生的严重并发症,需尽快明确诊断、积极治疗,以避免产生严重的不良后果。由于实验室传统检查方法敏感性和特异性的限制,PJI的诊断至今仍面临巨大挑战。近年来,一些兼具高敏感性和高特异性的检测方法,包括生物标志物检测和病原学检测方法在PJI诊断方面具有良好的应用前景。文章对关节置换术后PJI早期诊断的研究进展作一综述,以便为临床诊治提供参考。     

颞颌关节重建术治疗颞颌关节真性强直临床观察

目的 探讨颞颌关节重建术的临床疗效。方法用喙突和／或自体肋骨肋软骨游离移植时31例颞颌关节真性蠢直患者进行关节重建术，根据手术前后患者张口度变化、咬合关系、下颌前伸和侧方运动功能的改善，并通过关节开闭口位X射线片采分析关节间隙。综合评价手术治疗效果。结果30例患者术后张口度增大2．0cm以上，咬合关系、下颌前伸及侧方运动功能好，重建的关节具有正常的关节间隙，功能和外形好。结论喙突游离移植、自体肋骨肋软骨游离移植是治疗颞下颌关节真性强直的理想方法。     

Acromioclavicular joint separations

Acromioclavicular (AC) joint separations are common injuries of the shoulder girdle, especially in the young and active population. Typically the mechanism of this injury is a direct force against the lateral aspect of the adducted shoulder, the magnitude of which affects injury severity. While low-grade injuries are frequently managed successfully using non-surgical measures, high-grade injuries frequently warrant surgical intervention to minimize pain and maximize shoulder function. Factors such as duration of injury and activity level should also be taken into account in an effort to individualize each patient’s treatment. A number of surgical techniques have been introduced to manage symptomatic, high-grade injuries. The purpose of this article is to review the important anatomy, biomechanical background, and clinical management of this entity.     

Trapeziometacarpal joint arthritis

Trapeziometacarpal (TM) joint arthritis is a common cause of radial-sided wrist pain that preferentially affects women. It is diagnosed by a thorough history, physical examination, and radiographic evaluation. While radiographs are used to determine the stage of disease, treatment is dependent on symptom severity. Nonoperative treatment frequently consists of activity modification, non-steroidal anti-inflammatory drugs (NSAIDs), splinting, and corticosteroid injections. After failure of conservative treatment, various surgical options exist depending on the stage of disease. This article reviews the literature supporting the various surgical treatment options. Special consideration is given to the comparison of trapeziectomy with and without tendon interposition and ligament reconstruction.     

Temporomandibular joint disease

The best therapy for painful temporomandibular joint problems in most cases appears to be the least. Recommendations are made on the basis of a study of 90 patients.     

Temporomandibular joint disorders

Temporomandibular joint disorders are common in adults; as many as one third of adults report having one or more symptoms, which include jaw or neck pain, headache, and clicking or grating within the joint. Most symptoms improve without treatment, but various noninvasive therapies may reduce pain for patients who have not experienced relief from self-care therapies. Physical therapy modalities (e.g., iontophoresis, phonophoresis), psychological therapies (e.g., cognitive behavior therapy), relaxation techniques, and complementary therapies (e.g., acupuncture, hypnosis) are all used for the treatment of temporomandibular joint disorders; however, no therapies have been shown to be uniformly superior for the treatment of pain or oral dysfunction. Noninvasive therapies should be attempted before pursuing invasive, permanent, or semi-permanent treatments that have the potential to cause irreparable harm. Dental occlusion therapy (e.g., oral splinting) is a common treatment for temporomandibular joint disorders, but a recent systematic review found insufficient evidence for or against its use. Some patients with intractable temporomandibular joint disorders develop chronic pain syndrome and may benefit from treatment, including antidepressants or cognitive behavior therapy.     

Degenerative joint disease

Management of degenerative joint disease depends on the nature of the process and distribution of the joint disease. Simple modalities such as rest or exercise may be appropriate. Analgesics have a role to play, as do anti-inflammatory drugs and intraarticular corticosteroid injections.     

Acromioclavicular joint dislocations

Acromioclavicular (AC) dislocation is a common injury especially among sportsmen. There is still a lack of consensus on whether to conserve or operate type III AC joint dislocations. Even among surgeons inclined to operate AC joint dislocations there is no unanimity on which surgical technique. There are a plethora of choices between mechanical fixation or synthetic materials or biologic anatomic reconstructions. Even among surgeons, there is a choice between open repairs and the latest—arthroscopic reconstructions. This review of AC joint dislocations intends to analyze the available surgical options, a critical analysis of existing literature, actual technique of anatomic repair, and also accompanying complications.     

Prosthetic joint infection

Infection is the second most common cause of prosthetic joint failure. Signs and symptoms associated with prosthetic joint infection may develop weeks or even years following arthroplasty. While some patients with prosthetic joint infection present with findings consistent with acute septic arthritis, many present with pain alone. Morbidity and cost associated with repeat surgery, prolonged medical treatment and joint immobilization render importance to the accurate and timely diagnosis, and appropriate treatment of prosthetic joint infection. No consensus exists, however, in terms of the most cost–effective diagnostic methods or the ideal medical and/or surgical interventions. This review describes diagnostic tests and available treatment for prosthetic joint infection and gives a practical approach to this challenging clinical entity.