冠状动脉造影术前后患者焦虑情绪的变化

目的　观察冠状动脉造影术前后患者焦虑情绪的变化。方法　 14 5例冠状动脉造影患者在术前与术后得知检查结果后用Spielberger焦虑状态 特质自评量表测定焦虑情绪程度。结果　焦虑状态记分由术前的 35 .8± 10 .2降至术后的 31.7± 9.9(P <0 .0 1) ,焦虑特质记分由术前的 35 .7± 8.8降至34.4± 9.4 (P =0 .0 19)。亚组分析表明 ,冠状动脉正常组 (5 5例 )焦虑状态记分由术前的 37.5± 10 .5降至术后的 2 8.8± 8.2 (P <0 .0 1) ,冠状动脉异常组 (90例 )焦虑状态记分术前术后无改变。术后焦虑状态记分正常组明显低于异常组 (分别为 2 8.8± 8.2和 33.5± 10 .4 ,P <0 .0 1)。两组焦虑特质记分术前术后均无明显改变。结论　冠状动脉造影结果正常能使疑为冠心病的患者焦虑情绪明显减轻。     

Comparison of two arthroscopic pump systems based on image quality

The effectiveness of arthroscopic pump systems has been investigated with either subjective measures or measures that were unrelated to the image quality. The goal of this study is to determine the performance of an automated pump in comparison to a gravity pump based on objective assessment of the quality of the arthroscopic view. Ten arthroscopic operations performed with a gravity pump and ten performed with an automated pump (FMS Duo system) were matched on duration of the surgery and shaver usage, type of operation, and surgical experience. Quality of the view was defined by means of the presence or absence of previously described definitions of disturbances (bleeding, turbidity, air bubbles, and loose fibrous tissue). The percentage of disturbances for all operations was assessed with a time-disturbance analysis of the recorded operations. The Mann-Whitney U test shows a significant difference in favor of the automated pump for the presence of turbidity only (Exact Sig. [2*(1-tailed Sig.)] = 0.015). Otherwise, no differences were determined (Exact Sig. [2*(1-tailed Sig.)] > 0.436). A new objective method is successfully applied to assess efficiency of pump systems based on the quality of the arthroscopic view. Important disturbances (bleeding, air bubbles, and loose fibrous tissue) are not reduced by an automated pump used in combination with a tourniquet. The most frequent disturbance turbidity is reduced by around 50%. It is questionable if this result justifies the use of an automated pump for straightforward arthroscopic knee surgeries using a tourniquet.     

膝关节半月板撕裂磁共振成像与关节镜对照研究

目的分析磁共振成像（MRI）在膝关节半月板撕裂诊断中的价值。方法分析168例（共计336个半月板）临床疑诊半月板损伤患者,依次在1周内行磁共振（MR）和关节镜检查,对比MR和关节镜检查结果,探讨MRI对膝关节半月板撕裂诊断符合率。结果以关节镜为参考标准,168例（共计336个半月板）中MRI诊断半月板撕裂敏感性96．9％,特异性为87．5％,准确性为92．5％,假阳性率为12．5％,假阴性率3．1％,MRI具有术前诊断价值。结论MRI诊断半月板撕裂具有很高准确性,但仍有一定的假阳性与假阴性。     

关节镜下微创治疗儿童膝关节外侧盘状半月板损伤的疗效分析

目的 探讨关节镜下微创治疗儿童膝关节外侧盘状半月板损伤的疗效.方法 1996年3月-2008年3月共对229例盘状半月板损伤患儿进行关节镜检查以及关节镜下微创手术.男133例,女96例;年龄4～14岁[(9.2±3.5)岁].219例进行盘状半月板修整成形术(包括2例术后复发患儿),8例进行盘状半月板修整成形缝合术,2例进行盘状半月板次全切除术.手术前、后采用Lysholm评分对膝关节功能进行评定.结果 221例得到随访,8例失访,随访时间5～144个月[(65±48.9)个月].所有患儿术后6个月膝关节疼痛及肿胀症状消失或明显减轻,活动度恢复正常.术后无感染、血管神经损伤、关节活动受限等手术并发症.术前Lysholm评分为45～73分[(61.85±7.65)分],术后6个月提高至87～100分[(95.30±3.50)分](t=26.778,P<0.01).结论关节镜下微创手术治疗儿章膝关节外侧盘状半月板损伤创伤小、疗效佳,能很好地保留半月板形态,维持其生理功能,减少膝关节炎发生率.     

Reactive synovitis of the knee joint: MR imaging appearance with arthroscopic correlation

Objective. To evaluate the use of routine MR imaging sequences in detecting and characterizing secondary reactive synovitis of the knee joint using arthroscopy as the standard of reference. Design and patients. Fifty consecutive patients with a history of knee pain who were referred for MR imaging and subsequently underwent arthroscopy of the knee comprised the study group. MR images were evaluated for the presence and appearance of synovitis reflected in synovial thickening and irregularity. Synovial thickening was graded on MR imaging as follows: 0=normal, 1=thin line of increased signal intensity, 2=increased signal intensity with frond-like or hair-like projections and a granular appearance of joint fluid. Standard knee imaging protocols were used. Results. The sensitivity, specificity, and accuracy of MR imaging in detecting synovitis compared with arthroscopy were 88%, 97%, and 95%, respectively. Grade 1 synovitis was best seen on proton-density-weighted images, demonstrating increased signal intensity of the synovium against the relatively low signal intensity of the joint fluid. Grade 2 synovitis was best seen on proton-density images and T2-weighted spin echo and fast spin echo images with fat saturation, demonstrating a granular and linear hair-like appearance of joint fluid. Axial and sagittal imaging planes were most helpful in the diagnosis of synovitis. Conclusion. Routine MR pulse sequences are useful in identifying the presence and extent of synovial abnormalities. The detection of different stages of synovial pathology should become an important part of the evaluation of the post-traumatic patient as treatment may be altered as a result. Received: 17 March 2000 Revision requested: 5 May 2000 Revision received: 8 June 2000 Accepted: 8 June 2000     

Effects of pulsed electromagnetic fields on patients’ recovery after arthroscopic surgery: prospective,randomized and double-blind study

Severe joint inflammation following trauma, arthroscopic surgery or infection can damage articular cartilage, thus every effort should be made to protect cartilage from the catabolic effects of pro-inflammatory cytokines and stimulate cartilage anabolic activities. Previous pre-clinical studies have shown that pulsed electromagnetic fields (PEMFs) can protect articular cartilage from the catabolic effects of pro-inflammatory cytokines, and prevent its degeneration, finally resulting in chondroprotection. These findings provide the rational to support the study of the effect of PEMFs in humans after arthroscopic surgery. The purpose of this pilot, randomized, prospective and double-blind study was to evaluate the effects of PEMFs in patients undergoing arthroscopic treatment of knee cartilage. Patients with knee pain were recruited and treated by arthroscopy with chondroabrasion and/or perforations and/or radiofrequencies. They were randomized into two groups: a control group (magnetic field at 0.05 mT) and an active group (magnetic field of 1.5 mT). All patients were instructed to use PEMFs for 90 days, 6 h per day. The patients were evaluated by the Knee injury and Osteoarthritis Outcome Score (KOOS) test before arthroscopy, and after 45 and 90 days. The use of non-steroidal anti-inflammatory drugs (NSAIDs) to control pain was also recorded. Patients were interviewed for the long-term outcome 3 years after arthroscopic surgery. Thirty-one patients completed the treatment. KOOS values at 45 and 90 days were higher in the active group and the difference was significant at 90 days (P < 0.05). The percentage of patients who used NSAIDs was 26% in the active group and 75% in the control group (P = 0.015). At 3 years follow-up, the number of patients who completely recovered was higher in the active group compared to the control group (P < 0.05). Treatment with I-ONE aided patient recovery after arthroscopic surgery, reduced the use of NSAIDs, and also had a positive long-term effect.     

膝关节交叉韧带低场强MRI表现及其损伤诊断

目的 :研究膝关节正常交叉韧带MRI特点和交叉韧带损伤的的MRI表现。方法 :对 2 0 0例正常膝关节交叉韧带的MRI进行回顾性分析 ,对 2 5例临床可疑交叉韧带损伤患者的MRI资料和关节镜检查行对比研究。结果 :正常膝关节矢状位MRI上显示交叉韧带最佳 ,冠状位和横断位作为补充 ,交叉韧带损伤的MRI表现为韧带连续性中断、局灶性或弥漫性肿胀、信号强度增高及断端移位 ;以关节镜检查结果为标准 ,MRI诊断交叉韧带损伤的敏感度为 91.3 % ,特异度为 91.6% ,符合率为 91.4%。结论 :MRI多方位扫描是一种准确诊断交叉韧带损伤的方法 ,矢状位显示交叉韧带最佳。     

半月板损伤MRI与关节镜表现的对照研究

目的:探讨MRI对半月板损伤的诊断价值及其对临床治疗的指导意义。方法:回顾性分析196个半月板损伤的MRI表现和关节镜表现。根据MRI信号改变将半月板损伤分为Ⅰ、Ⅱ、Ⅲ级,并与关节镜下表现进行对比分析。结果:以关节镜下表现为标准,MRI诊断准确率在Ⅰ级信号组86.96%,Ⅱ级信号组88.46%,Ⅲ级信号组90.91%,总体诊断准确率91.33%。结论:半月板损伤MRI与关节镜诊断一致性较高,有较高诊断价值。     

Degenerative joint disease on MRI and physical activity: a clinical study of the knee joint in 320 patients

We examined 320 patients with MRI and arthroscopy after an acute trauma to evaluate MRI in diagnosis of degenerative joint disease of the knee in relation to sports activity and clinical data. Lesions of cartilage and menisci on MRI were registered by two radiologists in consensus without knowledge of arthroscopy. Arthroscopy demonstrated grade-1 to grade-4 lesions of cartilage on 729 of 1920 joint surfaces of 320 knees, and MRI diagnosed 14 % of grade-1, 32 % of grade-2, 94 % of grade-3, and 100 % of grade-4 lesions. Arthroscopy explored 1280 meniscal areas and showed degenerations in 10 %, tears in 11.4 %, and complex lesions in 9.2 %. Magnetic resonance imaging was in agreement with arthroscopy in 81 % showing more degenerations but less tears of menisci than arthroscopy. Using a global system for grading the total damage of the knee joint into none, mild, moderate, or severe changes, agreement between arthroscopy and MRI was found in 82 %. Magnetic resonance imaging and arthroscopy showed coherently that degree of degenerative joint changes was significantly correlated to patient age or previous knee trauma. Patients over 40 years had moderate to severe changes on MRI in 45 % and patients under 30 years in only 22 %. Knee joints with a history of trauma without complete structural or functional reconstitution showed marked changes on MRI in 57 %, whereas stable joints without such alterations had degenerative changes in only 26 %. There was no correlation of degenerative disease to gender, weight, type, frequency, and intensity of sports activity. Therefore, MRI is an effective non-invasive imaging method for exact localization and quantification of chronic joint changes of cartilage and menisci that recommends MRI for monitoring in sports medicine. Received: 28 July 1997; Revision received: 9 February 1998; Accepted: 20 March 1998     

The effects of exergames on anxiety levels: A systematic review and meta-analysis

There are currently many different approaches to performing exergames and there is still no consensus as to whether exergames are able to reduce anxiety levels, as well as whether exergames provide greater reductions on anxiety levels when added to traditional forms of clinical interventions. Therefore, the aim of the present systematic review and meta-analysis was to access data from studies that evaluated the effects of exergames on anxiety levels in humans. PubMed, Scopus and Cochrane databases were searched up to 22 February 2019. Inclusion criteria were acute and chronic (short-term and long-term interventions) studies which evaluated the effects of exergames in anxiety levels as primary or secondary aim. Of the 1342 studies found, 17 and 10 were included in qualitative analyses and meta-analyses, respectively. The within-group analysis found that exergames (standardized mean difference [SMD]: −0.57 [95% Confidence interval (CI): −0.86 to −0.28], P < .001) and usual care (SMD: −0.21 [95% CI: −0.34 to −0.08], P = .002) resulted in significant improvements on anxiety levels. However, the between-group meta-analysis on the effects of control interventions vs exergames (SMD: 0.02 [95% CI: −0.55 to 0.60], P = .939) found no significant difference between groups in anxiety levels reductions. There was also no significant difference (SMD: −0.04 [95% CI: −0.32 to 0.25], P = .805) between usual care vs exergames plus usual care interventions in anxiety levels reductions. Although exergames demonstrated within-group improvements in anxiety levels across different clinical populations, it was not greater than the effects from non-exercise interventions. Also, given the paucity of studies, small sample sizes, different research designs, and different population investigated, the existing evidence is insufficient to support the advantages of usual care supplemented by exergame intervention over usual care standalone in anxiety levels reduction.     

氟哌噻吨美利曲辛治疗伴有焦虑抑郁症状功能性消化的疗效分析

目的观察氟哌噻吨美利曲辛对伴有焦虑抑郁症状功能性消化不良的临床疗效。方法选取功能性消化不良患者128例,均同时伴有不同程度的焦虑抑郁状态,随机分为治疗组64例、对照组64例。对照组在心理疏导基础上根据治疗个体化原则选用常规治疗。治疗组在常规治疗基础上加用氟哌噻吨美利曲辛早晨、中午各服1片,连续治疗28 d。根据症状积分变化评定临床疗效。结果与对照组比较,治疗组显效率及总有效率均优于对照组（P〈0.05）。结论该药对伴有焦虑抑郁状态的功能性消化不良疗效确切。     

质子加权预饱和脂肪抑制序列对膝关节软骨损伤的诊断与关节镜对照研究

目的：比较质子加权预饱和脂肪抑制序列（PDW-FS）和自旋回波T2WI对诊断膝关节软骨损伤的准确性,探讨PDW-FS对软骨损伤的诊断价值。方法：对关节镜探查手术的37例45只膝关节,术前行MR检查,作回顾性分析,比较PDW-FS、T2WI序列诊断软骨损伤的价值。结果：以关节镜为标准,PDW-FS和T2WI序列的Kappa值分别为0.88和0.68,PDW-SF检查结果与关节镜结果一致性好。PDW-FS敏感度89.7%,特异度97.1%,T2WI敏感度79.1%,特异度94.8%,差异有统计学意义（χ2=4.50,P〈0.05）。结论：PDW-FS序列诊断膝关节软骨损伤的准确性优于T2WI,可准确地判断软骨损伤的范围和深度,为临床医生选择合适的治疗方案提供可靠依据。     

关节镜诊治髋关节创伤相关性疾病的疗效分析

目的探讨髋关节镜诊治髋关节创伤相关性疾病的方法及临床疗效。方法选择2011年1月至2015年1月在沈阳军区总医院采用关节镜手术治疗的髋关节创伤相关性疾病患者12例为研究对象。其中,男性9例,女性3例;年龄21~62岁,平均(44.0±2.6)岁;比较本组患者术前与末次随访时的Harris、视觉模拟评分法(VAS)评分。结果本组患者随访12~60个月,平均(38.0±1.8)个月。术后末次随访时,平均Harris评分(82.3±2.0)分,高于术前的(52.3±1.9)分;平均VAS评分(1.8±0.8)分,低于术前的(5.3±0.8)分,术前与术后比较,差异均有统计学意义(P<0.01)。结论髋关节镜是一种微创技术,对治疗髋关节创伤相关性疾病具有良好的疗效。     

Association of specific meniscal pathologies and other structural pathologies with self-reported mechanical symptoms: A cross-sectional study of 566 patients undergoing meniscal surgery

Objectives

We explored associations between specific meniscal pathologies and other concurrent structural knee pathologies with presence of self-reported mechanical symptoms in patients undergoing meniscal surgery.

探讨关节镜治疗膝关节盘状半月板损伤的临床疗效及术后疼痛的影响因素

目的研究并探讨关节镜治疗膝关节盘状半月板损伤的临床疗效,并对导致其术后疼痛的影响因素进行分析。方法回顾性分析2013年1月—2016年8月宁夏人民医院骨科收治且随访成功的200例膝关节盘状半月板损伤患者的临床资料。男性86例,女性114例,年龄12~76岁,平均45.24岁。左侧膝关节半月板损伤103例、右侧97例,损伤类型均为圆盘状;损伤分度依据MRI信号进行划分,Ⅰ度32例、Ⅱ度67例、Ⅲ度101例。所有患者均接受关节镜手术治疗,对其治疗效果进行观察,统计术后出现疼痛的病例,并分为疼痛组、无痛组,比较两组患者的Lysholm膝关节功能评分,并对两组患者的各项临床资料进行比较,对导致患者术后疼痛的影响因素进行单因素、多因素Logistics回归分析。结果经关节镜手术治疗后,200例患者的疗效评定结果为优119例、良75例、可4例、差2例,优良率为97.0%。术后56例患者出现膝关节疼痛,疼痛发生率为28.0%。疼痛组患者手术后的Lysholm评分(67.62±12.21)分明显低于无痛组(83.45±13.57)分(P0.05)。经单因素分析、多因素Logistics回归分析后得出,导致术后疼痛的影响因素主要为患者年龄大、关节软骨损伤、术后过早负重、术后未接受冷敷。结论关节镜治疗膝关节盘状半月板损伤的临床疗效显著,但术后患者容易出现膝关节疼痛,临床上应针对术后疼痛发生的相关因素进行相应的处理。     

The surgical outcome of immediate arthroscopic Bankart repair for first time anterior shoulder dislocation in young active patients

This study evaluated the surgical outcomes of young active patients with arthroscopic Bankart repair within 1 month after first-time anterior shoulder dislocation. From July 2002–October 2004, patients presented with first-time traumatic anterior shoulder dislocation and treated with arthroscopic stabilization within 1 month of injury were retrospectively reviewed. Magnetic resonance imaging and computed tomography were performed before the operation in all cases. Cases with contralateral shoulder multidirectional instability or glenoid bone loss of more than 30% on preoperative computed tomography on the injury side were excluded. All patients were treated with arthroscopic Bankart repair, using metallic suture anchors or soft tissue bio-absorbable anchors by a same group of surgeons and followed the same rehabilitation protocol. Recurrence, instability signs, range of motion, WOSI score, Rowe score and complications were assessed. Thirty-eight patients were recruited: the average age was 21 (16–30). All patients had definite trauma history. Radiologically, all patients had Bankart/Hill-Sachs lesion. All the operations were done within 1 month after injury (6–25 days). The average hospital stay was 1.2 days (1–5 days). The average follow-up was 28 months (24–48 months). There were two cases of posttraumatic re-dislocation (5.2%). The average external rotation lag was 5° (0–15) in 90° shoulder abduction when compared with contralateral side. 95% of patients had excellent or good Rowe score. The average WOSI score was 83%. There was one case of transient ulnar nerve palsy and one case of superficial wound infection. This study concluded that immediate arthroscopic Bankart repair with an accelerated rehabilitation program is an effective and safe technique for treating young active patients with first-time traumatic anterior shoulder dislocation. This study complies with the current laws of the Hong Kong Special Administration Region Government.     

The effect of anxiety on the regulation of upright standing among younger and older adults

We tested the hypothesis that fall anxiety would differentially influence the regulation of upright standing among younger and among older adults. Fall anxiety was imposed by a manipulation of environmental context that increased the threat to postural control by introducing the potential for injurious consequences should a fall occur. Fifteen younger and 15 older adults participated in this study. Regardless of age, postural control was more conservative when fall anxiety increased, however, age did not affect how anxiety influenced the regulation of postural control. Our findings imply that the motor consequences of fall anxiety are no more pervasive for older adults than for younger adults, and that age does not alter the ability to accommodate to environmental demands that heighten fall anxiety.     

The effect of heel-to-toe drop of running shoes on patellofemoral joint stress during running

BackgroundTraditional running shoes with heel-to-toe drops is thought to be a contributor to increased patellofemoral joint stress, which is proposed as a mechanism of patellofemoral pain.Research questionIs there an increase in patellofemoral joint stress when running in shoes with drops compared to running in shoes without a drop?MethodsLower limbs kinematics and ground reaction force were collected from eighteen healthy runners during over-ground running in shoes with 15 mm, 10 mm, 5 mm drops, and without a drop. Patellofemoral joint force and stress were calculated from the kinematic and kinetic data using a biomechanical model of the patellofemoral joint.ResultsThe peak patellofemoral joint stress was increased by more than 15% when running in shoes with 15 mm and 10 mm drops compared to running in shoes without a drop (p = 0.003, p = 0.001). The knee flexion angle was significantly increased when running in shoes with 15 mm, 10 mm and 5 mm drops (p = 0.014, p = 0.003, p = 0.002), the knee extension moment (p = 0.009, p = 0.002) and patellofemoral joint force (p = 0.003, p = 0.001) were increased when running in shoes with 15 mm and 10 mm drops, compared to running in shoes without a drop.SignificanceCompared to running in shoes without a drop, running in shoes with drops > 5 mm increase the peak patellofemoral joint stress significantly, which is mainly due to the increased knee extension moment.     

The patellar inferior pole: a new landmark of the anteromedial working portal for arthroscopic surgery of the posterior horn of the medial meniscus

We assessed the patellar inferior pole (PIP) as a new landmark of the anteromedial (AM) instrumental portal for arthroscopic surgery of the posterior horn of the medial meniscus (PHMM). Fifty normal right knees in young adults (group 1) and 50 knees from adults of various ages undergoing arthroscopic surgery for relatively simple intra-articular pathologies or diagnosis (group 2) were included. In both groups, on 30° flexion true lateral plain radiographs, the line passing through the PIP and the distalmost femoral condyle; (Kim’s AM portal line) was drawn, then the length from the anterior end of the medial tibial plateau (MTP) to the meeting point of Kim’s AM portal line with the MTP (length C) and the anteroposterior length of the MTP (length D) was measured. The length C was then taken as a percentage of length D (C–D percentage), and the distance between the PIP and the anterior joint line (length E) was measured. The average C–D percentages and lengths E were 110 ± 33.6% and 14.8 ± 3.8 mm in group 1, and 114 ± 38.4% and 16.3 ± 4.7 mm in group 2. There were no significant differences in the C–D percentages or the lengths E between the two groups. Also, in group 2, the AM portal was made at the PIP level, and we assessed the relative ease of instrument insertion to reach the PHMM and the body of the lateral meniscus (LM) using a scoring system of our own design. Fort-nine and 48 knees were classified as good for the PHMM and for the body of the LM, respectively. We concluded that the PIP can be used as a skin landmark for arthroscopic surgery of the PHMM.     

心理干预在烧烫伤焦虑患者中的应用

目的：探讨心理干预护理模式对烧（烫）伤焦虑患者的干预效果，进一步完善可供整体护理借鉴的护理措施。方法：应用情绪干预、行为干预、心理咨询和护理指导等方法，于病人人院24小时内确定实行心理干预对象，128例烧（烫）伤患者具有焦虑症状，对其中60例（实验组）连续心理干预7天，评估干预效果；另68例为对照组，除不予心理于预外，其他治疗、护理方法同实验组，两组一起评估干预效果。结果：实验组在伤后创面未全部愈合的第7天，焦虑值较干预前明显降低（P〈0．01），收缩压和脉率也明显低于干预前（P〈0．01），上述指标虽然明显低于对照组，但尚未恢复至正常水平。结论：心理干预能改善烧（烫）伤焦虑患者的焦虑状态，提高患者生存质量，但是心理干预是一项长期的护理工作，至于进行到何时终止，有待于进一步研究。