武警医学院附属医院骨科王文良副教授

王文良主任长期从事临床、科研、教学工作，擅长肩肘膝关节外科手术，微创外科及关节镜手术，骨折创伤的治疗。曾先后到法国、美国、德国、香港等地学习研修。学术成绩：先后获得解放军科技进步二等奖1项，武警部队医疗成果三等奖1项。先后主持国家自然科学基金，天津市自然科学基金各1项。近年来发表论文30余篇。     

人工膝关节置换:技术发展与临床应用

人工膝关节置换是指用生物相容性与机械性能良好的金属材料制成的一种类似人体骨关节的假体,以手术方法将人工关节置换被疾病或损伤所破坏的关节面,达到切除病灶、清除疼痛、恢复关节活动与原有功能的效果。近年的关节外科发展迅速,尤其在髋和膝的人工关节置换方面每年都有较大的改进,治疗的效果有明显的进步,各种形式的假体不断推出。     

关节镜与开放式手术治疗膝关节色素沉着绒毛结节性滑膜炎的效果比较

目的比较关节镜与开放式手术治疗膝关节色素沉着绒毛结节性滑膜炎(PVNS)的效果。方法将于空军军医大学西京医院行膝关节外科手术治疗的44例PVNS患者根据手术方式分为开放式手术组(21例)和关节镜手术组(23例)。比较两组术前及末次随访时的疼痛程度、膝关节功能、关节活动度及复发情况。结果末次随访时,两组的VAS评分均降低,Lysholm评分及关节活动度均升高,且关节镜手术组的关节活动度大于开放式手术组(P<0.05)。结论关节镜及开放滑膜切除治疗均能减轻膝关节PVNS患者的疼痛,改善关节功能,且术后复发率无显著差异。但关节镜具有创伤小、恢复快及并发症少等优势,可能成为PVNS膝关节外科治疗的首选手术方式。     

全膝关节表面置换术后不同持续被动活动方式对膝关节功能康复的影响

背景:全膝置换术后需要有计划康复治疗,其目的是恢复关节活动度和肌力。膝关节持续被动活动仪早期使用,可以减轻疼痛,防止术后粘连,缩短术后恢复时间,增强康复信心,对膝关节活动度恢复非常重要。目的:观察全膝置换术后使用不同持续被动活动方式其膝关节功能康复的近远期效果。设计:同期对照观察。单位:郧阳医学院附属东风医院关节外科。对象:选择1999-07/2003-12郧阳医学院附属东风医院关节外科住院膝关节骨性关节炎和类风湿性关节炎患者407例。纳入标准:①严重膝关节骨性关节炎和类风湿性关节炎行人工膝关节表面置换治疗患者。②手术由同一…     

经关节镜监视下钬激光关节手术配合

经关节镜监视下钬激光关节手术配合大连医科大学附属一院（１１６０１１）李静林刘英杰通过关节镜监测下进行钬激光手术，在临床上已开始被应用于膝、肩、踝、腕四个环节。近年来钬激光逐渐被关节外科的医务工作者所认识，成为关节镜下手术最理想的工具。其具有损伤小、恢...     

河南省洛阳正骨医院膝部损伤科喻长纯副主任医师

喻长纯，男，1973年1月15日生，辽宁省沈阳市人，汉族。河南省洛阳正骨医院膝部损伤科副主任医师，从事膝关节外科研究10余年。1997年毕业于中南大学湘雅医学院临床医学系，获学士学位。郑州大学医学院在读硕士。2007年赴香港大学玛丽医院矫形及创伤学系关节置换外科访问学习。研究特色：初次全膝关节置换及翻修手术，复杂膝关节周围骨折及韧带损伤的治疗。     

Noyes膝关节疾病:手术、康复训练与临床预后(第2版)

正膝关节是运动创伤发生最多的关节之一。近年来,运动健身成为新的社会风尚,运动相关膝关节损伤的发生率随之增高。本书由膝关节外科权威,来自辛辛那提运动医学与骨外科中心的Noyes博士主编。Noyes博士及其团队在结合大量研究成果及团队数十年临床实践经验的基础上,建立了多种膝     

关节镜诊治膝关节病的体会

膝关节镜外科的发展,开创了膝关节外科的微创诊治手段,充分显示了其创伤小、确诊率高、康复快的优点。我们应用膝关节镜诊治６４例膝关节病患者,体会如下。     

关节外科Ⅰ类切口手术感染调查及干预评价

【目的】探讨本院关节外科Ⅰ类切口手术感染的高危因素及降低感染率的干预措施。【方法】回顾性调查2013年本院关节外科Ⅰ类切口手术患者489例,分析术后感染病例的高危因素;针对高危因素设计干预方案并进行效果评估。【结果】本院关节外科Ⅰ类切口手术感染率为10．02％;高龄是术后感染最大的高危因素;不同手术类别及不同医生组间的感染率稍有差异;优化围术期预防用抗菌药物给药方案后有助于降低手术后感染风险。【结论】应加强关节外科围术期的全方位监测工作;针对有感染高危因素的患者可优化预防用抗菌药物方案从而降低术后感染风险。     

全膝人工关节置换伤口并发症53例分析

回顾性分析1998-01/2006-12上海长征医院骨科关节外科部收治的53例(69膝)发生全膝置换后伤口并发症患者的临床资料.伤口皮肤问题包括皮肤红肿、切口裂开、局部血肿、皮肤坏死和深部感染,分别采取相应的处理措施.其中58膝进行局部皮肤护理;6膝进行清创和二期闭合;皮肤软组织缺损的基本处置中3膝行局部肌瓣移植,1膝行筋膜皮瓣移植,1膝行筋膜皮瓣和皮肤游离移植.平均随访1.9年,所有伤口均愈合良好.提示治疗全膝置换后伤口愈合并发症,应该根据病情采取相应的处置方法.     

Stellenwert der Arthroskopie bei Gonarthrose

The relevance of arthroscopic surgery in patients with advanced osteoarthritis of the knee has been discussed controversially in recent years. Even though the idea of joint lavage in order to reduce the inflammatory component of the affected joint has not been proven to provide sufficient long-term effects, there are a variety of copathologies that can efficiently be addressed by arthroscopic surgery. The present article summarizes the indications for arthroscopic surgery in patients with osteoarthritis of the knee joint and discusses the scientific literature available on this controversial topic.     

膝关节置换术围手术期的护理经验

人工膝关节置换术是治疗关节终末期病症的必要手段,然而并发症、人工关节的翻修等问题也随之而来。本篇文章通过介绍术前护理,术后护理,心理护理,功能复健,营养补充等几大方面进行综述论证,总结近年来对于膝关节置换术的围手术期护理的经验。     

有限元数字化膝关节模型构建的研究与应用

背景：膝关节的解剖结构和力学特征决定它的生物力学特性,应用有限元分析方法对膝关节生物力学机制及损伤机制进行研究,可以有效地指导预防和治疗膝关节疾患。目的：评价有限元数字化膝关节模型构建的研究和应用价值。方法：以＂CT,MRI,膝关节,有限元,模型构建＂为关键词,采用计算机检索2005年1月至2011年11月维普数据库和万方数据库相关文章。纳入与膝关节模型构建及应用相关的文章;排除重复研究或Meta分析类文章。以9篇文献为重点讨论CT、MRI和有限元模型构建在膝关节中的研究和应用。结果与结论：CT、MRI所采集到的DICM图像在有限元模型构建中各具优缺点,有限元模型合理应用,能够为膝关节的手术提供更全面、更可靠的影像学资料,临床医师可根据模型进行手术方案设计,模拟手术流程,显著降低了手术风险,减少了患者的痛苦。     

关节镜清理术并功能锻炼后老年膝关节骨性关节病患者关节功能恢复

INTRODUCTION In recent years, arthroscope has become a new approachfor treatment ofosteoarthritis of knee joint. We obtained favorable effect of arthroscopicarticular debridement in patients with bony arthropathy of knee joint.     

Endoprothese bei Arthrose des oberen Sprunggelenks

There is no doubt that total ankle replacement has much improved in recent years. Most recent reports on current ankle prosthesis designs have shown prosthesis survival rates of 92?C98% after 5 years. Nevertheless, the underlying problems of osteoarthritis of the ankle are more critical than those of the hip or knee. Firstly, posttraumatic osteoarthritis in the ankle joint accounts for approximately 80% of cases. The surrounding soft tissues are often of poor quality and bony geometry and alignment may have changed significantly. Secondly, the patients are on average approximately 10 years younger than those with knee or hip osteoarthritis and therefore have a higher activity level. Many new ankle designs have been brought onto market in recent years and new implantation techniques and instruments may have made replacement surgery easier and more reliable. However, recognition and appropriate treatment of associated problems and pathologic processes within the hind foot complex are the key issue for long-term success in total ankle replacement.     

Knee kinematics in functional activities seven years after total knee arthroplasty

BACKGROUND: Detailed knowledge of knee kinematics during functional activities is lacking in current studies on the long-term outcome of total knee replacement surgery. The aim of this study was to assess functional knee kinematics using flexible electrogoniometry in patients seven years after unilateral primary total knee arthroplasty for osteoarthritis. METHODS: The knee joint functional movement of a cohort of patients (n=19) with knee osteoarthritis was assessed using electrogoniometry before surgery and 18-24 months and seven years after total knee surgery. The mean age of the patients (11 women and 8 men) at the time of the pre-surgery assessment was 67 years old (SD 8.0). Patient function was also assessed using the Knee Society Score and WOMAC osteoarthritis Index. FINDINGS: The function components of the Knee Society and WOMAC scores were significantly decreased at seven years compared to 18-24 months after surgery (both P<0.05). However, the majority of the functional knee flexion values derived from electrogoniometry did not decrease. Seven years after surgery, knee excursion during ascending and descending stairs was significantly improved compared to 18-24 months after surgery (both P<0.01). INTERPRETATION: The finding that functional knee motion continues to improve between 18-24 months and seven years post-surgery is of interest to both patients and those responsible for their treatment planning. Further, it was shown that the WOMAC and Knee Society Scores do not follow the same trends as the patients' functional knee kinematics seven years after total knee replacement surgery.     

高龄膝关节表面置换围手术期并发症

背景:高龄患者多伴有重要器官的功能减退和合并症,关注围手术期治疗是膝关节表面置换成功的关键.目的:70岁以上患者膝关节表面置换围手术期的常见并发症特点分析.设计、时间及地点:回顾性分析,2002-01/12赣南医学院第一附属医院和北京大学人民医院病例资料.对象:行膝关节表面置换109例168膝,男29例,女80例;单膝置换50例,年龄70～85岁,平均(74.2±15.1)岁;双膝置换59例,年龄70～85岁,平均(73.4±13.2)岁.92例(84.4%)体形肥胖,88例合并内科疾病.方法:手术由同一组人员完成.全部病例髌骨置换,使用假体均为Scorpio后稳定型膝关节假体.采用膝前正中切口和内侧髌旁入路,术中切除前后交叉韧带,清理后关节囊骨赘生物及游离体.假体安装完成后测试髌股关节轨迹,直至达到指压试验要求.假体均采用抗生素真空搅拌骨水泥固定,屈曲位缝合切口.主要观察指标:①置换后早期并发症.②膝关节功能评定.结果:①置换过程中及置换后24 h以内发生高血压8例,低血压7例,心律失常6例,在相关科室治疗下,均安全度过围手术期.肺栓塞1例,伤口深部感染1例,肺部感染3例,泌尿系感染5例,速避宁导致的血小板急速下降并发症1例,一过性认知精神障碍1例,术后膝关节脱位1例.②HSS膝关节评分由置换前的26.1分提高到出院时的82.0分,功能评分由置换前的32.1分提高到出院时的89.1分.③经过平均12.4个月的随访,失访18例,回访率83.5%.回访的91例置换后膝关节疼痛消失或减轻、无假体松动和继发感染者,HSS膝关节评分由出院时82.0分增高至85.4分,功能评分由出院时的89.1分增高至92.3分.结论:熟练操作技巧,积极治疗合并症可有效预防置换后围手术期感染、脱位等并发症发生.     

人工膝关节置换治疗重症膝关节病118例

选择2000-06/2007-01贵州省人民医院骨科收治的行人工全膝关节置换患者118例(138膝),男45例,女73例;年龄52～81(61±8)岁;类风湿性关节炎28例(34膝),创伤性关节炎6例(6膝),严重骨性关节炎84例(98膝),其中合并外翻畸形14例(18膝),合并内翻畸形25例(28膝).所选假体类型Link Gemini假体38膝,Zimmer Nexgen 68膝,Depuy pfc sigma旋转平台32膝.全部患者均获得随访,随访时间10个月～6 年(平均28个月).置换前膝关节HSS评分(34.00±7.65)分,末次随访时 (81.00±6.89)分,其中优87膝(63%),良43膝(31%),可8膝(6%),优良率94%.118例患者中发生感染4例,3例单膝置换后下肢发生深静脉血栓形成,经抗凝及对症处理痊愈.3例(4膝)置换后2个月发生膝关节疼痛,检查膝关节无红肿,无压痛,活动度基本正常,摄X射线平片示假体位置良好,行股神经封闭后症状缓解.提示全膝关节置换是治疗重症膝关节疾病的有效方法.     

Management of cartilage defects in the shoulder

Articular cartilage lesions of the glenohumeral joint are an especially difficult clinical problem to manage, particularly in the younger, more active patient. Left untreated, these lesions may progress in the long-term, leading to further pain and disability. While shoulder arthroplasty remains a viable option in older patients with glenohumeral arthritis, concerns over component longevity and loosening in younger patients make it less attractive in that age group. Arthroscopic joint debridement with loose body removal, often with capsular release, has been successful in select, more sedentary patients. More recent techniques, including autologous chondrocyte implantation (ACI), osteochondral grafting (allograft versus autograft), interpositional arthroplasty, and microfracture surgery, have been evaluated for use in the shoulder. These procedures have experienced success in weight bearing joints, including the knee and ankle. Despite the good clinical results in the shoulder with short-term follow-up reported in some small series, the treatment of chondral injuries in the glenohumeral joint remains a challenging problem.