前交叉韧带MRI异常患者单髁膝关节置换随访分析

目的 探讨术前膝关节核磁共振(MRI)前交叉韧带(ACL)异常结果对单髁膝关节置换术(U KA)疗效影响.方法 本研究采用t检验、秩和检验、方差分析等统计方法,回顾性分析广州医科大学附属第一医院关节外科2014年5月至2019年5月收治的单髁膝关节置换术治疗膝前内侧骨关节炎患者.纳入标准:确诊膝关节前内侧骨关节炎、膝关...     

OxfordⅢ单髁置换治疗膝骨关节炎的近中期疗效分析

目的探讨OxfordⅢ单髁置换术治疗膝关节内侧间室骨关节炎的近中期疗效。方法回顾性分析2006年8月至2012年7月南方医科大学珠江医院骨科应用膝关节单髁置换术治疗内侧间室骨关节炎患者41例共47膝,其中38例44膝获得良好随访,男18例20膝,女23例24膝,年龄45～85岁,平均65岁。通过比较手术前后疼痛的严重程度、膝关节活动度和膝关节评分,分析OxfordⅢ单髁置换的临床疗效。结果手术后患者恢复良好,没有出现切口皮缘坏死、感染、深静脉血栓形成等并发症。随访时间为3～74个月,平均38个月。末次随访膝关节活动度由术前105°提高到130°,膝关节功能术前评分（HSS评分）由57分提高到89分,优良率达97.3%。结论 OxfordⅢ单髁置换术治疗膝关节内侧间室骨关节炎近中期效果肯定,假体类型的选择、严格的手术适应证的选择、手术技术的提高以及术前前交叉韧带功能的评估对手术结果影响大,远期疗效仍需进一步观察。     

膝关节单髁置换术

膝关节单髁置换术（unicompartmenlal knee arthroplasty,UKA）是指仅对膝关节内侧或外侧室进行表面置换,其主要用于治疗局限于单一间室的骨关节炎或骨坏死。由于单髁置换术保留了交叉韧带、髌股关节及对侧胫股间室,理论上能保留更正常的关节动力学,获得更大的活动度,保留骨量便于翻修为全膝关节表面置换。     

前交叉韧带功能对膝关节单髁置换术后临床结果的影响

<正>膝关节单髁置换术(unicompartmental knee arthroplasty,UKA)是治疗膝关节前内侧骨关节炎(anteromedial osteoarthritis,AMOA)的一种有效治疗方式^[1-2]。UKA术后膝关节运动学与自然膝关节的运动学相似,术后功能优于全膝关节置换术。严格的手术适应证是获得满意临床结果的前提。然而,前交叉韧带缺失(anterior cruciate ligament deficiency,ACLD)被认为是UKA的禁忌证,ACLD情况下股骨反复的后脱位导致关节退变和胫骨平台后内侧关节软骨磨损,     

单髁置换术前判断前交叉韧带功能完整的准确性研究

目的探讨各种术前检查判断符合单髁置换标准前交叉韧带功能完整的准确性。方法回顾性分析2007年1月至2014年12月,418例(529膝)拟行单髁置换术治疗膝骨关节炎患者,所有患者术前进行Lachman试验、轴移试验和X线检查,405例膝关节行MRI检查,判断前交叉韧带是否符合单髁置换标准。观察各项检查敏感度、特异度、准确性和似然比,采用Kruskal-Wallis法进行统计学检验。结果术中检查前交叉韧带功能完整451膝,功能失完整78膝。Lachman试验准确性90.9%,阳性似然比(positive likelihood ratios,+LR)30.54,阴性似然比(negative likelihood ratios,-LR)0.53;轴移试验准确性89.2%,+LR 17.92,-LR 0.62;X线检查准确性92.8%,+LR 14.04,-LR0.14;修正X线检查准确性97.4%,+LR 153.47,-LR 0.28;MRI检查准确性32.4%,+LR 1.23,-LR 0.16;修正MRI检查准确性82.5%,+LR 4.13,-LR 0.60。经检验,各项检查准确性差异有统计学意义(P0.01)。结论侧位X线检查是目前判断骨关节炎中ACL功能完整性最准确的检查,而Lachman试验和轴移试验有较高的特异性,MRI有较高的敏感性。     

固定平台单髁置换治疗外侧单间室膝骨关节炎的早期疗效

目的探讨外侧固定平台单髁关节置换术治疗外侧单间隙骨关节炎手术策略及早期疗效。 方法选取2016年8月至2017年1月在济南军区总医院骨病科行膝关节外侧单髁关节置换术病人11人,纳入标准：外侧单间隙骨关节炎;无关节外畸形,不伴或伴轻度膝外翻畸形;前后交叉韧带及内外侧副韧带完整;共11膝,男性5人,女性6人。平均年龄(57±6)岁,身体质量指数为(29.5±2.7),术前行膝关节负重正侧位、双下肢全长正位及髌骨轴位X线片检查。行外侧单髁关节置换术,手术入路选择膝关节正中切口,沿髌骨外缘切开关节囊,清理外侧间室,胫骨行髓外定位进行垂直及水平截骨,股骨切除软骨至软骨下骨,调和骨水泥,安放假体。应用牛津大学膝关节评分系统(OKS)及美国膝关节协会评分系统(KSS)评价术后功能改善情况。采用Mann-Whitney U检验进行统计学分析。 结果11名病人均获得随访,随访时间平均(5.0±1.1)月,术后OKS及KSS评分均得到明显改善,OKS评分(Z ＝－11.345,P <0.05)和KSS评分(Z ＝－15.542,P<0.05)差异具有统计学意义,膝关节功能良好,术后病人满意度改善。随访终点均未发现并发症。 结论外侧单髁关节置换术治疗外侧单间隙骨关节炎是1种有效的保膝治疗方式,可以有效保存膝关节韧带,减少截骨量,患者术后膝关节功能良好。     

前交叉韧带在膝关节单髁置换术中作用的研究进展

膝关节单髁置换术（ unicompartmental knee arthroplasty,UKA）具有创伤小、恢复快、最大限度保留骨量、患者接受度高等优点，合适的病例选择是保证其疗效的关键因素。前交叉韧带（anterior cmciate ligament，ACL）缺陷一直被多数学者视为单髁置换术的禁忌证。对于骨性关节炎患者，多伴有ACL不同程度的损伤，如何选择适合单髁置换的病例，术前如何判断，对于ACL缺陷的病例采用何种方法治疗，这些问题都困扰着临床医师。本文将围绕以上问题进行文献回顾。一、ACL缺陷为单髁置换术的禁忌证     

膝关节单髁置换术的发展研究进展

<正>1单髁置换术发展史随着人们对膝关节骨关节炎认识的加深,对于全关节严重破坏的患者,认为应用全膝关节表面置换(total knee arthroplasty,TKA)的手术方法可有效治疗骨关节炎。但临床工作中发现,许多骨关节炎患者仅一侧间室出现了明显的破坏,研究者开始考虑一种治疗单侧胫股关节间室病变的术式—膝关节单髁置换术     

关节镜下治疗前交叉韧带摩擦撞击症

回顾性分析关节镜下治疗膝关节股骨髁、胫骨嵴摩擦撞击前交叉韧带的疗效。方法对126例膝关节退行性骨关节炎关节镜下治疗,28例前交叉韧带磨损撞击者,镜下观察行膝关节清理、髁间窝扩大成形术、胫骨骨嵴摘除术。结果本组28例均获随访,随访时间12～16个月,平均18个月.术后关节功能明显改善。结论膝关节骨性关节炎部分股骨髁、胫骨嵴增生磨损前交叉韧带,关节镜手术应注意观察前交叉韧带磨损情况.手术处理后可获得良好效果。     

单髁置换术治疗膝内侧间室关节炎合并前交叉韧带缺陷

膝关节前交叉韧带(ACL)损伤是一类临床常见的疾病,Johnson DL等[1]报道ACL撕裂伤的年发病例数超过25万.关节镜下ACL重建术是一种较好的办法,患者能够获得较快,较好的功能恢复.然而,ACL缺陷并不常常单独存在,较多情况同时合并膝关节骨关节炎(OA),患者常表现为膝关节疼痛和(或)膝关节不稳定.尤其是对于相对年轻以及偏好运动的患者,采取何种治疗以获得疼痛的长期缓解,同时尽可能恢复较高的活动水平,一直以来争议不断.近5年来膝关节单髁置换术(unicompartmental knee arthroplasty,UKA)联合前交叉韧带重建术(anterior cruciate ligament reconstruction,ACLR)作为一种有效的治疗手段,取得了良好的治疗效果,现就这一临床技术应用的进展进行综述.     

Vasopressor hormone response following mesenteric traction during major abdominal surgery

Background : We investigated the vasopressor hormone response following mesenteric traction (MT) with hypotension due to prostacyclin (PGI₂) release in patients undergoing abdominal surgery with a combined general and epidural anesthesia. Methods : In a prospective, randomized, placebo-controlled study we administered 400 mg ibuprofen (i.v.) in 42 patients scheduled for abdominal surgery. General anesthesia was combined with epidural anesthesia (T4-L1). Before as well as 5, 15, 30, 45, and 90 min after MT we recorded plasma osmolality, hemodynamics and measured 6-keto-PGFlα (stabile metabolite of PGI₂), TXB₂ (stabile metabolite of thromboxane A₂) active renin, and arginine vasopressin (AVP) plasma concentrations by radioimmunoassay. Catecholamine levels were assessed by high-pressure liquid chromatography (HPLC) with electrochemical detection. Results : Following MT, arterial hypotension occurred along with a substantial PGI₂ release. This was completely abolished by ibuprofen administration. Although plasma levels of 6-keto-PGF_1α (1133 (708) vs. 60 (3) ng/L, median (median absolute deviation), P=0.0001, placebo vs. ibuprofen) remained significantly elevated, blood pressure was restored within 30 min after MT in the placebo group. At the same point in time plasma concentrations of TXB² (164 (87) vs. 58 (1) ng/L, P=0.0001), epinephrine (46 (33) vs. 14 (6) ng/L, P=0.001), AVP (41 ± (18) vs. 12 (7) ng/L, P=0.0004), and active renin (27 (12) vs. 12 (4) ng/L, P = 0.001) were significantly higher in placebo-treated patients. Conclusion : Under combined general and epidural anesthesia arterial hypotension following MT due to endogenous PGI₂ release is associated with enhanced release of AVP, active renin, epinephrine and thromboxane A₂, presumably contributing to hemodynamic stability within 30 min after MT.     

A Teaspoon Pump for Pumping Blood with High Hydraulic Efficiency and Low Hemolysis Potential

Abstract: Virtually all blood pumps contain some kind of rubbing, sliding, closely moving machinery surfaces that are exposed to the blood being pumped. These valves, internal bearings, magnetic bearing position sensors, and shaft seals cause most of the problems with blood pumps. The original teaspoon pump design prevented the rubbing, sliding machinery surfaces from contacting the blood. However, the hydraulic efficiency was low because the blood was able to "slip around" the rotating impeller so that the blood itself never rotated fast enough to develop adequate pressure. An improved teaspoon blood pump has been designed and tested and has shown acceptable hydraulic performance and low hemolysis potential. The new pump uses a nonrotating "swinging" hose as the pump impeller. The fluid enters the pump through the center of the swinging hose; therefore, there can be no fluid slip between the revolving blood and the revolving impeller. The new pump uses an impeller that is comparable to a flexible garden hose. If the free end of the hose were swung around in a circle like half of a jump rope, the fluid inside the hose would rotate and develop pressure even though the hose impeller itself did not "rotate"; therefore, no rotating shaft seal or internal bearings are required.     

Microspheres Based Detoxification System: A New Method in Convective Blood Purification

Abstract: A variety of protein-bound or hydrophobic substances, accumulating as a result of pathologic conditions such as exogenous or endogenous intoxications, are removed poorly by conventional detoxification methods because of low accessibility (hemodialysis), insufficient adsorption capabilities (hemosorption), low efficiency (peritoneal dialysis), or economic limitations (high-volume plasmapheresis). Combining advantages of existing methods with microspheric technology, a module-based system was designed. Major operating parameters of the latter can be modified to allow for adjustment to individual clinical situations. An extracorporeal blood circuit including a plasmafilter is combined with a secondary high-velocity plasma circuit driven by a centrifugal pump. Different microspheric adsorbers can be combined in one circuit or applied in sequence. Thus, a prolonged treatment can be tailored using specially designed selective adsorber materials. Comparing this system with existing methods (high-flux hemodialysis, molecular adsorbent recycling system), results from our in vitro studies and animal experiments demonstrate the superior efficiency of substance removal.     

Tissue perfusion in relation to cardiac output during continuous positive-pressure ventilation and administration of propranolol or verapamil

Background : Our objective was to determine whether administration of propranolol or verapamil modifies the hemodynamic adaptation to continuous positive-pressure ventilation (CPPV), in particular the regional distribution of cardiac output (CO).
Methods : General hemodynamics and regional blood flows assessed by microsphere technique (15 (μm) were recorded in 16 anesthetized pigs during spontaneous breathing (SB) and CPPV with 8 cm H₂O end-expiratory pressure (CPPV8) before and after intravenous administration of propranolol (0.3 mg · kg⁻¹ followed by 0.15 mg · kg⁻¹ · h⁻¹, n=8) or verapamil (0.1 mg · kg⁻¹ followed by 0.3 mg · kg⁻¹ · h⁻¹, n=8).
Results : CPPV8 depressed CO by 25% without shifts in its relative distribution with the exception of a noteworthy increase in adrenal perfusion. Propranolol increased arterial blood pressure, and due to a fall in heart rate, CO dropped by 25%. The kidneys and, to a lesser extent, the splanchic region and central nervous system received increased fractions of the remaining CO at the expense of skeletal muscle flow. Similar patterns were seen during SB and CPPV8 such that the combination of propranolol and CPPV8 depressed CO by 50%. The circulatory effects of verapamil were less evident but myocardial perfusion tended to increase.
Conclusions : The combination of propranolol or verapamil with CPPV does not result in any specific hemodynamic interaction in anesthetized pigs, except that the combined effect of propranolol and CPPV may severely reduce CO.     

Bariatric Surgery in Some "Central and East-European (former Eastern bloc)"Countries - Current Status and Prediction for the Next Millennium

Background: Obesity is increasing globallly, including in the formerly "Eastern Bloc" countries. Methods: A survey was made of obesity and bariatric surgery. Results: In the 8 East and Central European countries studied, with total population 300 million, roughly 43% of the population was overweight (BMI 25-30), 23% obese (BMI > 30), with about 15 million people morbidly obese (BMI > 40). From 0-10 morbidly obese individuals/100,000/year undergo bariatric surgery. Conclusion: Most countries were found to provide inadequate treatment for obesity.The majority of the morbidly obese are not treated effectively. However, health-care awareness of obesity and bariatric surgeons are slowly increasing.     

Volatile anaesthetics reduce adhesion of blood platelets under low-flow conditions in the coronary system of isolated guinea pig hearts

Background : Inhibitory effects of volatile anaesthetics on platelet aggregation have been demonstrated in several studies. However, the influence of volatile anaesthetics on intracoronary platelet adhesion has not been elucidated so far.
Methods : Isolated hearts of guinea pigs were perfused with buffer in the absence or presence of volatile anaesthetics (0.5 and 1 MAC) at constant coronary flow rates of 5 ml/min for 25 min, then 1 ml/min for 30 min and again 5 ml/min for 10 min. Before, during and after low-flow perfusion, a bolus of human platelets was applied into the coronary system. To simulate thrombogenic conditions, 0.3 U/ml human thrombin was infused during low-flow perfusion and reperfusion. The number of platelets sequestered to the endothelium was calculated from the difference between coronary in- and output of platelets. The myocardial production of lactate and consumption of pyruvate and coronary perfusion pressure were also determined.
Results : At a flow rate of 5 ml/min only about 3% of the applied platelets did not emerge from the coronary system, in any group. In contrast, 13.1±1.2% (mean±SEM) of infused platelets became adherent in low-flow perfusion in the control group without anaesthetic. The adherence was reduced with each 1 MAC isoflurane (to 6.2±1.2%), sevoflurane (to 4.4±0.9%) or halothane (to 3.2±1.5%) (each P <0.05 vs. control). Volatile anaesthetic, 0.5 MAC, did not inhibit platelet adhesion to a statistically significant extent in any case. Perfusion pressure and metabolic parameters were not statistically different between the control and the hearts exposed to anaesthetics.
Conclusion : Volatile anaesthetics in a concentration of 1 MAC can reduce the adhesion of platelets in the coronary system under reduced flow conditions. This action does not arise from vasodilation or inhibition of ischaemic stress.     

Synergistic interaction between the effects of propofol and midazolam with fentanyl on phrenic nerve activity in rabbits

Background: It has been shown that the depressive effects of both propofol and midazolam on consciousness are synergistic with opioids, but the nature of their interactions on other physiological systems, e. g. respiration, has not been fully investigated. The present study examined the effect of propofol and midazolam alone and in combination with fentanyl on phrenic nerve activity (PNA) and whether such interactions are additive or synergistic. Methods: PNA was recorded in 27 anaesthetised and artificially ventilated rabbits. In three groups, propofol, fentanyl and midazolam were administered intravenously in incremental doses to construct dose-response curves for the depressant effects of each one on PNA. In another two groups, the effect of pretreatment with either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. on the effects of propofol and fentanyl respectively on PNA were studied. Results: Propofol and fentanyl caused a dose-dependent depression of PNA with complete abolition at the highest total doses of 16 mg · kg^?1 i. v. and 32 μg · kg^?1 i. v., respectively. In contrast, midazolam in incremental doses to a total of 0.8 mg · kg^?1 reduced mean PNA by 63%, but approximately 12% of PNA remained at a total dose as high as 6.4 mg · kg^?1. The mean ED₅₀s, calculated from dose-response curves, were 5.4 mg · kg^?1, 3.9 μg · kg^?1 and 0.4 mg · kg^?1 for propofol, fentanyl and midazolam, respectively. Initial doses of either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. acted synergistically with subsequent doses of either propofol or fentanyl to abolish PNA at total doses of 8 mg · kg^?1 and 8 μg · kg^?1, respectively. Conclusion: Fentanyl has a synergistic interaction with both propofol and midazolam on PNA and hence potentially on respiration.     

Influence of dopexamine hydrochloride on haemodynamics and regulators of circulation in patients undergoing major abdominal surgery

Background: Catecholaminergic support is often used to improve haemodynamics in patients undergoing major abdominal surgery. Dopexamine is a synthetic vasoactive catecholamine with beneficial microcirculatory properties. Methods: The influence of perioperative administration of dopexamine on cardiorespiratory data and important regulators of macro- and microcirculation were studied in 30 patients undergoing Whipple pancreaticduodenectomy. The patients received randomized and blinded either 2 μg · kg^?1 · min^?1 of dopexamine (n=15) or placebo (n=15, control group). The infusion was started after induction of anaesthesia and continued until the morning of the first postoperative day. Endothelin-1 (ET-1), vasopressin, atrial natriuretic peptide (ANP), and catecholamine plasma levels were measured from arterial blood samples. Measurements were carried out after induction of anaesthesia, 2 h after onset of surgery, at the end of surgery, 2 h after surgery, and on the morning of the first postoperative day. Results: Cardiac index (CI) increased significantly in the dopexamine group (from 2.61±0.41 to 4.57±0.78 1 · min^?1 · m^?2) and remained elevated until the morning of the first postoperative day. Oxygen delivery index (DO₂I) and oxygen consumption index (VO₂I) were also significantly increased in the dopexamine group (DO₂I: from 416±91 to 717±110 ml/m² · m²; VO₂I: from 98±25 to 157±22 ml/m² · m²), being significantly higher than in the control group. pHi remained stable only in the dopexamine patients, indicating adequate splanchnic perfusion. Vasopressive regulators of circulation increased significantly only in the untreated control patients (vasopressin: from 4.37±1.1 to 35.9±12.1 pg/ml; ET-1: from 2.88±0.91 to 6.91±1.20 pg/ml). Conclusion: Patients undergoing major abdominal surgery may profit from prophylactic perioperative administration of dopexamine hydrochloride in the form of improved haemodynamics and oxygenation as well as beneficial influence on important regulators of organ blood flow.     

Systemic analgesia adapted to the children's condition

A concept of balanced analgesia using nonsteroidal anti-inflammatory drugs (NSAIDs), paracetamol (acetaminophen), opioids, and corticosteroids can also be used in patients with pre-existing illnesses. NSAIDs are the most effective treatment for acute pain of moderate intensity in children; however, these drugs should be avoided in patients at increased risk for serious side effects, e.g. patients with renal impairment, bleeding tendency, or extreme prematurity. NSAIDs can be given with minimal risks to the younger child with mild to moderate asthma, and, in these patients, the use of steroids can be encouraged; in addition to their antiemetic and analgesic action, a beneficial effect on asthma symptoms can be expected. In the non-intubated child with cerebral trauma, exaggerated sedation caused by opioids and increased bleeding tendency caused by NSAIDs must be avoided. In neonates and small infants, the oral administration of sucrose or glucose is helpful to minimize pain reaction during short uncomfortable interventions.