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。     

膝关节压力均衡术治疗膝关节退行性骨关节病的围术期护理

目的分析膝关节压力均衡术治疗膝关节退行性骨关节病(KOA)的围术期护理干预对自我管理、症状控制的影响,总结护理改进经验。方法选取相关研究对象84例,采用随机数字表分为对照组和观察组各42例,分别采用常规护理方式及在此基础上的综合护理干预,特别重视疼痛、肿胀的防控,注重提高康复训练、生活管理水平。结果观察组出院前、第3、6个月HSS评分高于对照组,第6个月观察组HSS优良率100.00%(42/42),高于对照组85.71%(36/42);观察组肿胀消退时间、术后3 d VAS均值水平、患侧膝关节训练开始时间低于对照组,术后1周膝关节训练次数,出院后膝关节训练维持时间高于对照组,差异有统计学意义(P0.05)。结论加强综合护理干预后,进一步提高了患者的疾病管理水平,症状控制效果,有助于膝关节功能恢复。     

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。     

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.     

下肢关节功能康复架在术后膝关节功能康复中的应用

目的：观察关节功能康复架在膝关节功能康复中的作用。方法：应用自己设计制造的下肢关节功能康复架,对膝关节及周围骨折病人术后８～１０ｄ,行膝关节被动活动,每日３～４次,每次伸、屈４０～５０次,伸屈结束时停留于自然位置,并辅以肌肉主动收缩锻炼,以１５ｄ为限。结果：临床应用５０例,在被动活动结束时,关节活动度≥９０度,未见移位、分离、内固定松动等骨折端的并发症。结论：关节功能康复架是膝关节及周围骨折术后膝关节早期被动活动的较理想的辅助器械;早期被动运动对关节功能康复有促进作用。     

正常肩锁关节角度与盂肱关节活动的相关性

背景:应用钩钢板固定治疗肩关节损伤或合并锁骨远端骨折时,钩钢板钩部的角度固定不变,而人体肩锁关节正常角度或在上臂运动时会发生相关变化.目的:探讨正常肩锁关节倾斜角度与肩关节活动相关性,及其临床意义.方法:纳入包含肩部CT检查的TOP图像资料97例,其中男57例,女40例,选择CT时TOP图像,在CT上用机器进行角度测量.肩锁关节角度:为肩峰长轴沿线与锁骨远端长轴沿线的夹角,盂肱关节的角度为肱骨外展与垂线的角度.结果及结论:在上肢下垂时平均肩锁角为(162.04±10.53)°.下垂平均肱骨角为(16.06±11.87)°,R=0.010(P＜0.01),说明肩关节与肩锁关节两个角度相关.在上肢上举时肩锁角(174.34±10.14)°,上举肱骨角(137.65±14.48)°,R=0.053(P＜0.01)两个角度也是相关的.提示,肩锁关节角度在肱骨上举运动时发生变化.肩关节活动时肩锁关节相关活动,既盂肱关节活动时,肩锁关节角度也随之变化.     

Novel joint cupping clinical maneuver for ultrasonographic detection of knee joint effusions

IntroductionKnee effusions occur due to traumatic and atraumatic causes. Clinical diagnosis currently relies on several provocative techniques to demonstrate knee joint effusions. Portable bedside ultrasonography (US) is becoming an adjunct to diagnosis of effusions. We hypothesized that a US approach with a clinical joint cupping maneuver increases sensitivity in identifying effusions as compared to US alone.MethodsUsing unembalmed cadaver knees, we injected fluid to create effusions up to 10 mL. Each effusion volume was measured in a lateral transverse location with respect to the patella. For each effusion we applied a joint cupping maneuver from an inferior approach, and re-measured the effusion.ResultsWith increased volume of saline infusion, the mean depth of effusion on ultrasound imaging increased as well. Using a 2-mm cutoff, we visualized an effusion without the joint cupping maneuver at 2.5 mL and with the joint cupping technique at 1 mL. Mean effusion diameter increased on average 0.26 cm for the joint cupping maneuver as compared to without the maneuver. The effusion depth was statistically different at 2.5 and 7.5 mL (P < .05).ConclusionsUtilizing a joint cupping technique in combination with US is a valuable tool in assessing knee effusions, especially those of subclinical levels. Effusion measurements are complicated by uneven distribution of effusion fluid. A clinical joint cupping maneuver concentrates the fluid in one recess of the joint, increasing the likelihood of fluid detection using US.     

Predicting mechanical load of the glenohumeral joint, using net joint moments

OBJECTIVE: To evaluate the relationship between net moments for the glenohumeral joint as calculated with a model that is easy to apply (Static Strength Prediction Program (SSPP)) and the internal forces, calculated with a simulation model of the human shoulder (Delft Shoulder Model, DSM). DESIGN: Static recordings of bony landmarks of the shoulder girdle during prescribed arm motions using a three-dimensional (3D) digitizer. BACKGROUND: The SSPP is a biomechanical model for the evaluation of workload. Concerning the shoulder the output of the model consists of net moments in the glenohumeral joint. For the glenohumeral joint the relationship between net joint moments and internal load predictions is unknown, therefore it is useful to investigate whether the SSPP can be used to predict mechanical load in the glenohumeral joint. METHODS: 3D co-ordinates of bony landmarks of the shoulder girdle are recorded, in variable arm positions, in four different planes. RESULTS: A strong linear relationship between compression forces and net moments is found, which makes it reasonable to assume a direct relationship between net moments and joint compression forces. CONCLUSIONS: (a) Net joint moments appeared to be a good indicator for mechanical load in the glenohumeral joint in static situations. (b) The SSPP can be used to predict these joint moments for static situations. RELEVANCE: biomechanical models predicting mechanical load can be used in work situations in order to prevent overload and injuries, as well as in many other areas, for instance to evaluate the mechanical load during wheelchair propulsion.     

Cryotherapy influences joint laxity and position sense of the healthy knee joint

OBJECTIVE: To investigate the influences of cryotherapy on the anteroposterior (AP) laxity and the joint position sense of the knee. DESIGN: Experimental. SETTING: University hospital in Japan. PARTICIPANTS: Twenty healthy volunteers (10 men, 10 women; age range, 21-28y) were analyzed. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: A cooling pad was applied to the knee for 15 minutes under the circulating medium at 4 degrees C. The subject's skin temperature over the anteromedial aspect of the knee was measured during the 15 minutes of cooling and again 15 minutes later. The accuracy of the knee joint position sense was evaluated before and after cooling by using a modified Skinner's method. AP displacement and anterior terminal stiffness (ATS) of the knee were obtained with a KT-2000 trade mark knee arthrometer. RESULTS: Total (AP) laxity and anterior knee laxity decreased by 1.0 and 1.2mm after 15 minutes of cooling (P=.003, P=.017), respectively. ATS and inaccuracy of position sense increased by 21N/mm and 1.7 degrees (P<.001, P=.003), respectively. All parameters had normalized at 15 minutes postcooling. CONCLUSION: Cooling for 15 minutes makes the knee joint stiffer and lessens the sensitivity of the position sense. These findings may be significant and should be taken into account for therapeutic programs that involve exercise immediately after a period of cooling.     

一期双膝关节与单膝关节置换的早期评价

背景:膝关节置换一期双侧置换还是单膝分期置换一直存在着争议。目的:评价双膝关节疾病患者一期双侧全膝关节置换与选择性单侧全膝关节置换后早期临床疗效及SF-36健康问卷调查差异。方法:初次行全膝关节置换的患者144例190膝,均采用施乐辉公司假体行一期双膝全膝关节置换(双膝组)及一期选择性单膝全膝关节置换(单膝组)。观察患者膝关节置换前后活动范围、HSS评分及疼痛评分、置换后并发症及置换后SF-36量表调查结果。结果与结论:随访1年,9例失访,135例进入结果分析。膝关节置换后双膝组1例发生一过性腓总神经麻痹,1例获得性免疫缺陷综合征,1例发生切口愈合不良;单膝组发生2例切口愈合不良。膝关节置换后1年,SF-36量表调查,两组除生理职能比较差异有显著性意义(P<0.05)外,其余7方面比较差异均无显著性意义(P>0.05);两组活动范围比较差异无显著性意义(P>0.05);两组HSS评分比较差异无显著性意义(P>0.05);双膝组疼痛评分显著低于单膝组(P<0.05)。结果证实,双膝组膝关节置换后早期在疼痛评分方面优于单膝组,但SF-36量表评价、HSS膝关节功能评分及关节活动范围等方面较单膝组无明显优势。     

手部骨关节缺损关节重建治疗的研究现状

学术背景:因外伤、感染、肿瘤切除或先天性疾病等原因造成的手部掌指关节和指间关节缺损,严重影响手的功能和外形.目前关于手部骨关节缺损修复的方法很多,但尚未有一种公认的方法可以有效重建关节的解剖结构和功能,恢复关节正常的活动功能.目的:总结近年来国内外有关手部骨关节缺损关节重建的研究内容,探讨各种治疗方法的研究近况与其进展.检索策略:应用计算机检索PubMed 1980-01/2007-08的相关文章,检索词为"hand, bone and joint injury",限定文章语言种类为英文;同时检索中国期刊全文数据库、万方数据库、维普数据库1997-01/2007-08期间的相关文章,检索词"手;骨关节缺损;治疗"限定文章语言种类为中文;并检索了相关书籍等.共检索到62篇文献,对资料进行初审,纳入标准:①与治疗手部关节缺损密切相关.②同一领域选择近期发表或在权威杂志上发表的文章.排除标准:重复性研究.文献评价:文献的来源主要是骨关节缺损治疗方面的研究进展.所选用的30篇符合标准的文献中,5篇为综述,其余均为临床或基础实验研究.资料综合:①目前治疗手部骨关节缺损的方法很多,主要有关节融合、关节成形、人工关节置换、关节移植、软骨移植、细胞移植、组织工程技术等.②综合比较各种治疗方法的优缺点,如何探索快速、高效、低损伤的治疗方法是目前研究的热点.结论:手部骨关节缺损关节重建方法已有许多突破,但仍需进一步在实践中加以完善.新近的研究热点为探索快速、高效、低损伤的治疗方法开辟了新视野.     

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.