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对63例膝骨关节炎膝外翻畸形患者行后稳定型人工膝关节置换术,应用HSS膝关节评分系统进行临床效果评价.本组随访8~24个月,HSS评分由术前平均34.7分提高为85.2分,外翻角由术前平均23.6°降至6.8°.所有患者日常生活能自理,无严重疼痛、功能障碍,疗效满意.提示全膝关节置换术是治疗膝骨关节炎膝外翻畸形的有效方法 . 相似文献
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《中国老年学杂志》2016,(20)
目的探讨高屈曲固定平台后稳定假体(Nex Gen-LPS-Flex)及普通固定平台后稳定假体(Nex Gen-LPS)在人工膝关节置换治疗中重度膝关节骨关节炎的中短期疗效。方法选择2010年1月至2015年2月在该院行全膝关节表面置换术的中重度膝关节骨关节炎患者67例(85膝),其中高屈曲假体组(LPS-Flex组)33例(42个膝关节),普通固定平台后稳定假体组(LPS组)34例(43个膝关节)。术后1 w~5年随访,分别于术前、术后1 w及末次随访时测定膝关节屈伸活动度,采用WOMAC健康调查表及KSS膝评分评估患者关节功能。结果术前、术后1 w及末次随访,两组KSS膝评分、WOMAC评分比较均无统计学差异(P0.05),两组膝关节屈伸活动度除末次随访时有统计学差异(P0.05)外,其他时间点均无统计学意义(P0.05)。但两组KSS膝评分、WOMAC评分、膝关节屈伸活动度均随着时间的推移逐渐改善(P0.05)。两组并发症发生率无统计学差异(P0.05)。术后6个月行膝关节X线检查,显示全部病例假体位置正常,力线良好,假体周围未见明显透亮带。结论全膝关节置换术中使用Nex Gen-LPS-Flex与Nex Gen-LPS相比,在改善患者疼痛、恢复行走功能以及手术并发症率方面无显著差别,但LPS-FLEX组膝关节屈曲功能优于LPS组。 相似文献
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2003年8月~2005年10月,我们对32例人工膝关节置换手术患者采取科学、系统的功能锻炼指导,效果满意。现将体会报告如下。临床资料:32例膝骨关节炎或类风湿膝关节炎复发患者,男12例,女20例;年龄52~75岁。经其他方法治疗无效.其中20例为双侧膝关节炎并畸形。均在硬膜外麻醉或全麻下行膝关节置换术,对患者行术前、术后功能锻炼指导。术后随访3~12个月,按Otanl’srtal分级法评定,疗效为优27例,良5例。现将功能锻炼方法及指导体会介绍如下。 相似文献
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老年骨关节炎全膝置换术疗效影响因素分析 总被引:1,自引:0,他引:1
目的探讨全膝置换术治疗老年骨关节炎(0A)的疗效及其影响因素。方法回顾性分析62例膝关节OA行膝关节表面置换术患者围手术期及术后早期随访的临床资料。根据美国膝关节外科学会(HSS)评分标准、膝关节功能及膝关节活动范围等评价患者术前及术后膝关节功能。结果62例患者膝关节HSS评分由术前的46.8分提高到术后出院时的86.2分,ROM由术前68度提高到术后的98度。结论全膝置换手术治疗老年效果确切;手术效果与术前膝关节功能、HSS评分、膝关节疼痛、术后有无重大并发症、术后早期CPM应用情况显著相关。 相似文献
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2001年5月~2003年12月,我们采用人工全膝关节置换术治疗晚期骨关节炎及类风湿关节炎26例(39膝),均取得满意疗效。现将护理体会报告如下。 相似文献
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目的研究老年双膝骨性关节炎患者选择同期和分期全膝关节置换术的治疗效果。方法选择我院2013年1月至2014年6月接受双膝关节置换术的患者49例。其中同期置换治疗患者为28例,分期置换治疗患者为21例,回顾性分析2组患者的治疗情况,比较2种手术方案的临床效果。结果同期全膝关节置换术在手术时间、住院时间方面具有优势,而分期关节置换术在术后血红蛋白、术后引流量和术后输血量方面具有优势,差异具有统计学意义(P0.05或P0.01);在并发症方面,同期全膝关节置换术后发热和并发症发生率明显高于分期治疗患者,差异具有统计学意义(P0.05);在膝关节功能评分(HSS评分)和膝关节活动度方面,2组差异无统计学意义(P0.05)。结论同期和分期双侧全膝关节置换术治疗双侧膝骨关节炎均能够取得理想的术后功能恢复,掌握好手术指征以确保取得最佳的治疗效果。 相似文献
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目的探讨单髁膝置换术(UKA)与全膝关节置换术(TKA)治疗膝关节内侧间室骨关节炎的近期疗效。方法回顾性分析2017-01~2017-10对因膝关节内侧间室骨关节炎行UKA治疗患者15例(15膝),选取同期行TKA治疗患者30例(34膝)作为对照组。术前评估并记录两组患者的疼痛视觉模拟评分(VAS)、美国特种外科医院(HSS)评分、膝关节活动度(ROM),记录手术时间、术中出血量、术后3 d血红蛋白(Hb)下降量、术后3个月及1年VAS评分、HSS评分、ROM。结果所有患者手术顺利完成。两组患者年龄、体重指数(BMI)比较差异无统计学意义(P0.05)。UKA组手术时间、术中出血量、术后3 d Hb下降量、VAS评分均低于TKA组,而HSS评分、ROM高于TKA组,差异均有统计学意义(P0.05)。结论膝关节内侧间室骨关节炎的手术治疗选择UKA更优于TKA,UKA具有手术时间短、术中出血量少、术后恢复快、功能恢复良好等优点,能够取得良好的近期疗效。 相似文献
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膝关节穿刺冲洗治疗膝骨关节炎60例疗效观察 总被引:1,自引:0,他引:1
2006年2月~2007年5月,我们采用膝关节穿刺生理盐水冲洗治疗膝骨关节炎60例,疗效满意.现报告如下. 临床资料:60例膝骨关节炎患者(81膝),男13例,女47例;年龄53-78岁,平均65岁;病程2个月~8a,平均9个月;均符合美国风湿病学会(ACR)1986年修订的膝骨关节炎的临床诊断标准. 相似文献
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目的 探究悬吊技术联合Mulligan手法用于膝骨关节炎老年人运动后膝关节疼痛康复的效果.方法 选取84例单侧膝关节运动后疼痛的膝骨关节炎老年患者,依据随机数字表法分为观察组和对照组,各42例.对照组给予常规物理治疗与悬吊训练治疗,观察组在对照组基础上给予Mulligan技术治疗.比较两组治疗开始前与治疗后视觉模拟评分(VAS)疼痛评分、QOL-BREF评分、LEFS下肢功能评分、膝关节功能评分、关节活动度、四头肌与腘绳肌肌力.结果 两组治疗后VAS评分明显降低(P<0.05),且观察组VAS评分明显低于对照组(P<0.05).两组治疗后QOL-BREF评分/LEFS评分、膝关节功能评分、关节活动度、四头肌与腘绳肌肌力较治疗前明显提高(P<0.05),且治疗后观察组QOL-BREF评分/LEFS评分、膝关节功能评分、关节活动度、四头肌与腘绳肌肌力明显高于对照组(P<0.05).结论 对于膝关节运动后疼痛的膝骨关节炎老年患者,悬吊技术联合Mulligan手法,能有效缓解膝关节疼痛、促进膝关节功能恢复,提高患者生活质量. 相似文献
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Werasak SUTIPORNPALANGKUL Noppawan P. MORALES Keerati CHAROENCHOLVANICH Thossart HARNROONGROJ 《International journal of rheumatic diseases》2009,12(4):324-328
Aim: To compare levels of lipid peroxidation and antioxidants in synovial fluid from primary knee osteoarthritis (OA) patients with severe cartilage damage undergoing total knee replacement with those in the synovial fluid from injured knee joint patients with intact cartilage undergoing knee arthroscopy. Methods: Thirty‐two OA patients and 10 injured knee joint patients were recruited. Lipid peroxidation (thiobarbituric acid reactive substances [TBARs]), iron and glutathione (GSH) were measured using a colorimetric method. Vitamin E was measured with high‐performance liquid chromatography (HPLC). Activities of antioxidant enzymes (glutathione peroxidase [GPx], superoxide dismutase [SOD]) were analyzed with the use of a kinetic method. Results: TBARs, iron and GSH levels in synovial fluid were not significantly different between OA patients and injured knee joint patients. Antioxidant enzymes such as GPx and SOD activities also indicated no significant difference. Only vitamin E level was significantly lower in the synovial fluid of OA patients than in that of the injured knee joint patients. Conclusions: Oxidative stress may have a role in pathogenesis of knee osteoarthritis. Vitamin E supplementation may have a role in the management of patients. 相似文献
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Najia Shakoor Joel A. Block Susan Shott John P. Case 《Arthritis \u0026amp; Rheumatology》2002,46(12):3185-3189
Objective
Patients with unilateral hip or knee replacements for end‐stage osteoarthritis (OA) are at high risk for future progression of OA in other joints of the lower extremities, often requiring additional joint replacements. Although the risks of future surgery in the contralateral cognate joints (i.e., contralateral hip replacement after an initial hip replacement) have been evaluated, the evolution of end‐stage hip OA to OA involving the knee joints, and vice versa (i.e., noncognate progression) has not been investigated. Because characterization of OA progression in noncognate joints may shed light on the pathogenesis of multijoint OA, we investigated the pattern of evolution of end‐stage lower extremity OA in a large, clinical cohort.Methods
Total joint replacement (TJR) was selected as a marker of end‐stage OA, and a database comprising all lower extremity TJRs performed at a large referral center between 1981 and 2001 was accessed. Of the 5,894 patients identified, 486 patients with idiopathic OA who underwent hip replacement and 414 who underwent initial knee replacement were analyzed to determine the relative likelihood of subsequent TJRs. Patients with the systemic inflammatory arthropathy, rheumatoid arthritis (RA), were evaluated as a control population because RA progression is not considered to be a primarily mechanically mediated process.Results
The contralateral cognate joint was the most common second joint to undergo replacement in both the OA and the RA groups. However, in OA patients for whom the second TJR was in a noncognate joint, that joint was >2‐fold more likely to be on the contralateral limb than on the ipsilateral limb (hip to knee P < 0.001; knee to hip P = 0.013). In contrast, among the RA cohort, the evolution was random and no laterality for noncognate TJR was observed at either the hip or the knee (P = 0.782).Conclusion
This characterization of end‐stage lower extremity OA demonstrates that the disease evolves nonrandomly; after 1 joint is replaced, the contralateral limb is significantly more likely to show progression of OA than is the ipsilateral limb. Thus, OA in 1 weight‐bearing joint appears to influence the evolution of OA in other joints. The absence of such laterality in RA suggests that OA progression may be mediated by extrinsic factors such as altered joint loading.16.
OBJECTIVE: To determine the population prevalence and examine factors associated with hallux valgus in a primary care population. METHODS: A questionnaire was mailed to all adults age >30 years registered with 2 general practices. Validated instruments assessed self-reported hallux valgus, nodal osteoarthritis, and knee pain. The questionnaire also asked about big toe pain, joint replacement, and history of osteoarthritis and rheumatoid arthritis. Hallux valgus prevalence was calculated and standardized by the source population in terms of age, sex, knee pain, osteoarthritis, and rheumatoid arthritis. A nested case-control study was undertaken and age-sex adjusted odds ratios (ORs) were calculated between hallux valgus and age, sex, body mass index, nodal osteoarthritis, knee pain, big toe pain, joint replacement, self-reported osteoarthritis, and self-reported rheumatoid arthritis, using a binary logistic regression model. RESULTS: A total of 13,684 questionnaires were mailed and 4,249 (32%) responses were received. The standardized prevalence of hallux valgus was 28.4%. Hallux valgus was associated with age (adjusted OR 1.61 per decade; 95% confidence interval [95% CI] 1.52-1.69), female sex (adjusted OR 2.64; 95% CI 2.26-3.08), nodal osteoarthritis (adjusted OR 1.66; 95% CI 1.26-2.17), knee pain (adjusted OR 1.96; 95% CI 1.65-2.32), big toe pain (adjusted OR 3.28; 95% CI 2.48-4.33), self-reported osteoarthritis (adjusted OR 1.41; 95% CI 1.15-1.72), and self-reported rheumatoid arthritis (adjusted OR 2.04; 95% CI 1.43-2.91). CONCLUSION: Hallux valgus is prevalent in the community and is associated with age, female sex, and components of generalized osteoarthritis such as nodal osteoarthritis, knee pain, big toe pain, and self-reported osteoarthritis. 相似文献
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Enijad Sahinbegovic Tomáš Dallos Elmar Aigner Roland Axmann Matthias Engelbrecht Thomas Karonitsch Martin Farkas Thomas Karger Johann Willeit Ulrich Stölzel Gernot Keyßer Christian Datz Stefan Kiechl Georg Schett Jochen Zwerina 《The American journal of medicine》2010,123(7):659-662
Objective
Hemochromatosis is an inherited disease with iron overload and joint involvement resembling osteoarthritis. To determine the rate of joint replacement surgery in patients with hemochromatosis, we performed a cross-sectional cohort study.Methods
A total of 199 individuals with hereditary hemochromatosis were included. The prevalence of joint replacement surgery in hip, knee, and ankle joints because of secondary osteoarthritis was assessed. Data were compared with 917 healthy subjects from the population-based Bruneck study.Results
A total of 32 of 199 individuals with hemochromatosis received joint replacement surgery with a total number of 52 joints replaced. Compared with expected rates in healthy individuals, patients with hemochromatosis had a significantly higher risk for joint replacement surgery (odds ratio 9.0; confidence interval, 4.6-17.4). Joint replacement occurred significantly earlier in life in patients with hemochromatosis; 21.9% of the patients with hemochromatosis and 1.7% of healthy individuals required joint replacement before the age of 50 years (P = .0027). Moreover, patients with hemochromatosis were more likely to require multiple joint replacements (8.5%) than the control group (expected rate 0.3%; P = .0001).Conclusion
Hemochromatosis is a risk factor for joint replacement surgery because of severe secondary osteoarthritis. 相似文献18.
OBJECTIVE: Joint replacement therapy is an effective treatment option for end-stage osteoarthritis (OA) of the knee and/or hip. There are marked racial/ethnic disparities in the utilization of this procedure. The reasons for these disparities are not known. We sought to determine whether African American patients differ from white patients in their "willingness" to consider joint replacement and to determine the factors that influence this relationship. METHODS: We performed a cross-sectional survey of 596 elderly, male, African American or white patients with moderate-to-severe symptomatic knee or hip OA who were receiving primary care at the Department of Veterans Affairs outpatient clinics. RESULTS: The groups were similar with respect to age, severity of arthritis measured by the Lequesne Scale and the Western Ontario and McMaster Universities Osteoarthritis Index, and scores on the Charlson Comorbidity Index and Geriatric Depression Scale. Compared with whites, African Americans were less likely to be employed or married or to have attained a high school education, but were more likely to report a median annual household income of <10,000 dollars. They were also less likely than whites to be familiar with joint replacement and more likely to expect a longer duration of hospital course, pain, and functional disability following replacement surgery. African American patients were less "willing" than white patients to consider joint replacement (odds ratio 0.50, 95% confidence interval 0.30-0.84). However, this difference was explained by the between-group differences in expectations. CONCLUSION: African American patients were less likely than white patients to express "willingness" to consider joint replacement if the procedure was needed and recommended. This difference was explained by differences between the groups in their expectations of hospital course, pain, and function following replacement surgery. 相似文献
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OBJECTIVE: Subjects with unilateral end-stage hip osteoarthritis (OA) who undergo total hip replacement (THR) preferentially require subsequent replacement of the contralateral knee compared with the ipsilateral knee. We investigated whether this nonrandom, preferential evolution of lower extremity OA from the hip to the contralateral knee joint may be related to asymmetries in dynamic joint loading at the knees, particularly the peak external knee adduction moment, which has been associated with the progression of knee OA. METHODS: Gait analysis was performed on 50 subjects who were preoperative for unilateral THR. Twenty-two of these subjects were reevaluated postoperatively 10-23 months after undergoing successful THR. At each analysis, dynamic joint loads in the contralateral knee were compared with those in the ipsilateral knee. RESULTS: Prior to THR, the peak external knee adduction moment and peak medial compartment load were significantly higher in the contralateral knee. This asymmetry persisted after THR. CONCLUSION: Subjects with unilateral end-stage hip OA preferentially require subsequent replacement of the contralateral knee, as compared with the ipsilateral knee. Among patients with unilateral end-stage hip OA, the contralateral knee is subjected to higher dynamic joint loads than is the ipsilateral knee, and this asymmetric loading persists long after subjects have undergone successful THR. Biomechanical factors appear to be involved in the multiarticular evolution of OA of the lower extremities. 相似文献
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Tim Bongartz Christine S. Halligan Douglas R. Osmon Megan S. Reinalda William R. Bamlet Cynthia S. Crowson Arlen D. Hanssen Eric L. Matteson 《Arthritis care & research》2008,59(12):1713-1720