关节镜下滑膜切除术治疗膝类风湿性关节炎

[目的]探讨关节镜下滑膜切除术在治疗膝类风湿性关节炎中的价值.[方法]在关节镜下对32例43膝类风湿性关节炎患者行关节镜下滑膜切除术,术后给予正规内科治疗3个月.所有患者得到了6个月以上的随访.随访内容包括关节功能的评定和红细胞沉降率( ESR)、C反应蛋白(CRP)和类风湿因子(RF)的测定.[结果]术后6个月关节功能的优良率为90.7％上(43/39个). 术后3个月,ESR、CRP和RF较术前明显下降(P＜0.05). [结论]关节镜下滑膜切除术联合术后正规内科用药治疗膝类风湿性关节炎,对膝关节局部及全身症状均有明显改善作用.     

膝关节十分区法关节镜下滑膜切除术治疗类风湿性关节炎

目的评估膝关节十分区法关节镜下滑膜切除术治疗类风湿性关节炎的疗效。方法自2010-05—2014-01对16例类风湿性关节炎根据赵立恒等提出的膝关节十分区法行关节镜下膝关节滑膜组织切除术,并与2005-01—2009-12关节镜下行膝关节常规滑膜切除的19例进行比较。比较2组手术前后血沉(ESR)、C-反应蛋白(CRP)、膝关节功能Lysholm评分及复发率。结果常规组19例术后随访10~72个月,平均41.6个月;十分区组术后随访10~48个月,平均34.6个月。2组术后ESR、CRP值及Lysholm评分均较术前明显改善,差异有统计学意义(P0.05)。与常规组比较,十分区组Lysholm优良率更高(χ2=3.96,P0.05)和复发率更低(χ2=3.88,P0.05)。结论采用膝关节十分区法行关节镜下滑膜切除术治疗类风湿性关节炎疗效更确切,降低了复发率,关节功能改善更明显,预后良好。     

关节镜下滑膜切除术治疗类风湿性关节炎

目的:评价关节镜下滑膜切除术在治疗类风湿性关节炎中的价值。方法:对40例早中期类风湿性关节炎48个膝关节(男10个,女38个,平均年龄35岁)在关节镜下行滑膜切除术,并使用双极射频汽化仪对残留的滑膜进行处理。术后给予羟基氯喹、氨甲喋呤和柳氮磺胺吡啶等抗类风湿药治疗,疗程6~12个月。48个关节均得到了6个月的随访,34个关节得到2年的随访。随访包括近侧指间关节的疼痛、关节压痛及关节肿胀的改善率;Ishikawa关节功能的评分;术前术后血沉(ESR)、C反应蛋白(CRP)和类风湿因子(RF)的检测。结果:早期类风湿性关节炎以滑膜充血水肿为主要特点,中期类风湿性关节炎在镜下的表现是血管翳和肉芽肿的形成,术后6个月近侧指间关节的疼痛、关节压痛及关节肿胀的总改善率为83.3%,术后2年为55.9%。Ishikawa关节功能的评分术后6个月总优良率为93.8%,术后2年为73.5%。ESR、CRP和RF均较术前明显下降。结论:对早中期类风湿性关节炎患者应进行关节镜下滑膜切除术,同时术后给予正规的药物治疗。     

关节镜诊治膝关节滑膜软骨瘤病及其疗效分析

目的探讨关节镜微创手术对膝关节滑膜软骨瘤病的诊断和治疗价值。方法本组21例,23膝,男13例14膝,女8例9膝,其中左膝11侧,右膝12侧;年龄28～74岁,平均48.6岁;病史1月～66月,平均18月;初次就诊20例22膝,外院开放手术后复发1例。所有病例术前均行常规X线检查,部分病员行CT或MRI检查。手术行关节镜检,瘤体和病变滑膜切除,记录该病在关节镜下的表现形式（滑膜表面型、滑膜层包裹型、关节囊纤维层包裹型、游离体型）及关节内合并症,样本全部送病理检查。术后加压包扎、局部冰敷并按计划功能锻炼。结果本组21例23膝,其中滑膜表面型6膝、滑膜层包裹型4膝、关节囊纤维层包裹型2膝、游离体型11膝,术后病理检查确诊;所有病例获得了12～42月,平均28个月随访,未见复发,患肢功能良好;术前Lysholm评分（62.4±4.2）分;国际膝关节评分委员会（IKDC）膝关节功能主观评分（47.2±3.6）分;术后12月复查Lysholm评分（80.3±4.6）分;IKDC主观评分（87.4±4.1）分。结论关节镜手术创伤小,显露充分,病灶切除彻底,术后功能恢复理想,对膝关节滑膜软骨瘤病具有较高的诊治价值。     

关节镜下滑膜切除术治疗类风湿腕关节炎

目的总结类风湿腕关节炎行关节镜下滑膜切除术的疗效。方法对35例类风湿腕关节炎患者行关节镜下滑膜切除术治疗。术前1周及术后1年采用VAS评分对腕关节疼痛进行评价,测量患者腕关节屈伸活动度,检测患者类风湿因子(RF)、C-反应蛋白(CRP)、红细胞沉降率(ESR)水平。结果患者均获得随访,时间12~20个月。VAS评分术前(8.5±2.7)分,术后1年(3.5±1.3)分;腕关节屈伸活动度术前77.0°±17.0°,术后1年117.0°±19.0°;RF术前(58.1±12.2)U/ml,术后1年(23.1±8.6)U/ml;CRP术前(31.3±4.0)mg/L,术后1年(13.1±3.0)mg/L;ESR术前(52.4±4.5)mm/1h,术后1年(22.5±3.6)mm/1h。术后1年各项指标与术前比较差异均有统计学意义(P0.01)。术后1年疗效评价:优15例,良11例,可7例,差2例,优良率74.29%。结论类风湿腕关节炎患者实施关节镜下滑膜切除术治疗,可减轻患者疼痛,提升关节活动度,效果显著。     

关节镜联合万古霉素硫酸钙治疗膝关节感染

[目的]评价关节镜联合载药硫酸钙治疗膝关节感染的临床效果。[方法]回顾性分析2017年1月～2019年2月膝关节感染患者9例,均有侵袭性操作史,均采用关节镜清创灌洗联合万古霉素硫酸钙关节内置入治疗。总结临床与辅助检查结果。[结果] 9例患者均顺利完成手术。术后9例患者患膝肿痛逐渐消退,至末次随访时未发现感染复发病例。随时间推移,9例患者的VAS评分显著减少(P0.05),而Lysholm评分和Judet评分显著增加(P0.05)。辅助检查方面,细菌培养阳性9例,其中,金黄色葡萄球菌4例,表皮葡萄球菌5例,均对万古霉素敏感。病理检查显示滑膜组织增生,内可见多量中性粒细胞浸润。术后1周WBC、ESR和CPR均较术前显著下降(P0.05),术后1个月WBC、ESR和CPR较术后1周进一步下降(P0.05),接近正常值水平。9例患者术后即刻X线片检查可见关节腔内植入万古霉素硫酸钙颗粒影,术后1个月时X线片检查见载药颗粒影完全消失。至末次随访时,9例患者均未见膝关节明显退行性改变征象。[结论]运用关节镜清创联合万古霉素硫酸钙植入关节腔,可有效治疗膝关节感染,保留其功能。     

切除与不切除滑膜对人工全膝关节置换术后感染影响的比较

[目的]研究膝骨性关节炎患者行人工全膝关节置换术时进行滑膜切除与否对术后感染的影响。[方法]选择2008年~2012年860例符合原发性膝骨关节炎诊断标准的患者,年龄48~82岁,分为两组:420例关节置换同时进行滑膜切除,440例未进行滑膜切除。随访3~7年,平均4.8年。观察和测定手术时间,引流量,术前和术后1、3 d,2、6、12周和1年血沉(ESR)、C反应蛋白(CRP)、白细胞总数和感染率评价膝关节术后临床效果。采用VAS评分和AKSS评分评价手术效果。[结果]两组患者术前各项临床指标差异均无统计学意义,基线基本相同。手术时间滑膜切除组较长(76±15)min,非切除组(65±12)min,P0.001,伤口引流量滑膜切除组(285±105)ml,未切除组(245±103)ml,P0.001。术后滑膜未切除组患者血液中ESR、CRP水平高于切除组,术后2周CRP恢复到术前水平,而ESR缓慢降低直至术后6周接近正常水平。术后两组患者白细胞总数,未切除组偏高,但差异无统计学意义。术后两组患者VAS评分和AKSS评分差异无统计学意义。在平均4.8年的随访中,切除组出现表浅感染3例,深部感染4例,未切除组表浅感染2例,无深部感染患者。[结论]人工全膝关节置换术滑膜切除组手术时间及伤口引流量均高于未切除组,未切除组术后白细胞总数、ESR,CRP偏高,但感染率低,因此推测膝关节滑膜在抗感染中发挥作用。     

关节镜清理术治疗老年性膝骨关节炎

目的探讨关节镜对老年性膝骨关节炎的诊断价值及治疗效果。方法自2001年10月至2003年3月使用关节镜清理治疗膝关节骨关节炎患者37例,按照Lysholm膝关节功能评分,术前膝关节功能评分为(53.6±7.3)分。随访3～15个月,平均9个月。结果本组37例病人经关节镜检查均证实有骨关节炎存在,术前摄片,21例出现病理改变,16例未发现病理改变。本组病人术后3个月症状缓解明显,Lysholm膝关节功能评分平均提高到(92.7±1.5)分,统计学分析显示术后与术前评分相比差异有显著性意义。结论关节镜清理术可有效治疗膝骨关节炎;膝关节镜术可早期诊断膝骨关节炎;其损伤小、疗效好、并发症少,可重复手术治疗,能早期恢复关节的功能。     

初次TKA治疗伴AORIⅡa型胫骨缺损的严重膝内翻骨关节炎

目的探讨初次全膝关节置换术(total knee arthroplasty,TKA)治疗严重膝内翻骨关节炎并胫骨Anderson骨科研究所(Anderson orthopaedic research institute,AORI)骨缺损分型Ⅱa型骨缺损的手术技巧及短期疗效。方法8例(10膝)严重膝内翻骨关节炎并胫骨AORIⅡa型骨缺损患者,男2例(3膝),女6例(7膝);年龄61～79岁,平均(68.8±6.7)岁。均采用后稳定型假体,术中应用骨赘清理、胫骨平台外移截骨、内侧软组织松解等技术矫正膝内翻畸形,所有病例均采用胫骨内侧矩形金属垫块复合胫骨托延长杆,2例(2膝)联合应用自体骨移植重建胫骨缺损,定期复查X线片,检查膝关节活动度并行Lysholm评分。结果术后随访14～50个月,平均26个月。膝关节Lysholm评分术前(25.16±5.04)分,术后末次随访(85.4±10.3)分,手术前后比较差异有统计学意义(P0.05);复查X线片未见假体松动、下沉,末次随访膝关节活动度(86.1±11.4)°显著优于术前(61.37±10.24)°。结论全膝关节置换术中应用骨赘清理、胫骨平台外移截骨、内侧软组织松解等技术,并采用金属垫块联合延长杆重建胫骨AORIⅡa型骨缺损,能矫正膝内翻畸形,为胫骨假体提供良好的初始稳定性,随访膝关节功能较前明显改善,短期临床效果满意。     

SchatzkerⅡ型胫骨平台骨折的影像学评估及解剖钢板治疗

目的:探讨SchatzkerⅡ型胫骨平台骨折术前充分影像学评估的重要性及解剖钢板治疗的临床疗效。方法:SchatzkerⅡ型胫骨平台骨折患者67例,男48例,女19例;年龄16～69岁,平均45.4岁。开放性骨折10例,闭合性骨折57例。术前均行膝关节正、侧位X线摄片检查、螺旋CT薄层扫描和三维重建、MRI检查,根据影像学资料对患膝骨、软骨及软组织损伤进行评估。采用解剖钢板或结合关节镜进行治疗。结果:X线片、CT、MRI在明确诊断方面没有明显差异,在分型诊断中,CT、MRI明显优于X线片;经MRI检查均存在不同程度的软骨损伤,常多种表现并存;CT、MRI检查发现伴随的软组织损伤分别为17例、59例;参考CT、MRI扫描后手术方式发生改变21例(31.3%)。术后随访9～31个月,平均18.2个月,骨折均获临床愈合;Rasmussen影像学及临床评分优良率分别为86.7%(58例)、94.0%(63例),Resnick-Niwayama分级评价呈现骨性关节炎的患者21例(31.3%)。未出现切口不愈合或感染,无膝内、外翻畸形,无钢板、螺钉断裂。结论:结合X线片、CT、MRI能获得对手术方案制定及手术效果预测的重要图像信息;解剖钢板或结合关节镜治疗SchatzkerⅡ型胫骨平台骨折安全可靠、损伤小且疗效满意。     

胸腰椎骨折椎弓根内固定断裂与植骨融合方式的相关性分析

[目的]探讨胸腰椎骨折椎弓根螺钉内固定系统内固定术后,椎弓根螺钉断裂与植骨融合方式之间的关系,以探讨胸腰椎骨折植骨融合的最佳方式。[方法]回顾性研究1995年5月~2005年12月本院脊柱外科收治的胸腰椎骨折病人197例,其中A组单纯内固定(不植骨)患者14例,B组“H”形椎板植骨21例,C组横突间植骨67例,D组椎间、椎内联合横突间植骨95例。[结果]术后随访6~32个月,内固定断裂12例,其中A组4例,B组3例,C组5例,D组0例,4组中D组内固定断裂率显著低于其他3组(P<0.05)。[结论]椎间、椎体内联合横突间植骨重建脊柱三柱的稳定性,符合人体生物力学原理,能有效降低内固定断裂的发生。     

On the measurement of the functional properties of the CFTR

A number of methods are currently employed to assess the functional properties of CFTR channels and their response to pharmacological potentiators, correction of the defective CFTR trafficking, and vectorial introduction of new proteins. Here we review the most common methods used to assess CFTR channel function. The suitability of each technique to various experimental conditions is discussed.     

Preservation of the pylorus and resection of the head of the pancreas

The historical evolution of the pylorus-preservation resection of the head of the pancreas is traced from the first resections early in this century to relative standardization of the operation, to a lowering of the operative mortality, and to an interest in improving nutritional status after resection. There are many theoretical advantages for the function of the upper gastrointestinal tract after pylorus and gastric preservation, such as maintenance of gastric capacitance and equilibration of osmotic pressure in gastric digestants, foodstuff digestion and absorption, and bowel motility. After the pylorus-preserving resection, gastric emptying is normal, pyloric function to prevent duodenal reflux is often normal, and gastric acids and serum levels of duodenal hormones are at normal levels, whereas after standard pancreatoduodenectomy, all of these are often abnormal. No prospective blinded studies have been published comparing nutritional values after the two operative procedures, but evidence is presented of a satisfactory result with regard to gastric capacitance, body weight gain, and lack of postgastrectomy symptoms. An undoubted advantage of the pylorus-preserving feature is a simplification of the operation. These gains are achieved without increase in operative mortality, without increase in the incidence of jejunal ulcer, and without theoretical or actual decrease in value of the procedure as a cancer operation, except in patients with duodenal carcinoma proximal to the ampulla of Vater.     

下颌全牙弓后移量及最后界的测量

目的：研究下颌牙弓的有效后移量及找寻下颌牙弓移动的后界。方法：选取涉及拔除下颌第三磨牙或下颌第三磨牙缺失的病例18例（男6例,女12例）。采用种植支抗牵引下牙弓向远中,治疗完成时所有病例均明确到达下颌牙弓后界,即下颌第二磨牙远中到达下颌升支前缘软组织交界处。应用治疗前后的曲断片测量下颌第二磨牙远中到升支前缘的距离。结果：下颌第二磨牙后移量为（3.49±1.21）mm;治疗后磨牙后间隙的长度为（4.43±0.97）mm。结论：下颌牙弓可确定性地实现整体后移;最大后移量由磨牙后间隙的长度决定;其最后界止于下颌第二磨牙远中与下颌升支前缘软组织交界处。     

The Measurement of the Inclination Angle of the Hamate and Analysis of the Inclination Angle for the Rotation Deformity of the Little Finger in the Fixation of the Carpometacarpal Joint

ObjectiveComplex base fractures of the fifth metacarpal bone and dislocation of the fifth carpometacarpal joint are more prone to internal rotation deformity of the little finger sequence after fixation with a transarticular plate. In the past, we have neglected that there is actually a certain angle of external rotation in the hamate surface of transarticular fixation. This study measured the inclination angle of the hamate surface relative to the fifth metacarpal surface for clinical reference.MethodsIn a prospective single‐center study, we investigated the tilt angle of 60 normal hamates. The study included thin‐layer computed tomography (CT) data from 60 patients from the orthopaedic clinic and inpatient unit from January 2017 to March 2020, including 34 men and 26 women who were 15~59 years old, average 35 years old. The CT data of 60 cases in Dicom format of the hand was input into Mimics and 3‐Matics software for three‐dimensional (3D) reconstruction and measuring the angle α between hamate surface and the fifth metacarpal surface. According to the possible placement of the transarticular plate on the fifth metacarpal surface, we measured the angle β between the hamate surface 1 and the fifth metacarpal surface and the angle γ between the hamate surface 2 and the fifth metacarpal surface.ResultsThe average angle between the hamate surface and the fifth metacarpal surface was 11.66°. The hamate surfaces 1 and 2 have an external rotation angle of 7.30° and 7.51° on average with respect to the fifth metacarpal surface, respectively. There is no statistically significant difference in the angles between the two groups (P > 0.05).ConclusionsThe horizontal angle of the dorsal side of the hamate is different from the back of the fifth metacarpal surface, and the hamate has a certain external rotation angle with respect to the fifth metacarpal surface. No matter how the transarticular plate is placed, the plate always has a certain external rotation angle relative to the fifth metacarpal surface. When the fixation is across the fifth carpometacarpal joint, if the plate does not twist and shape, it will inevitably cause internal rotation of the fifth metacarpal, resulting in internal rotation deformity of the little finger sequence.     

静脉输注甘露醇开放血脑屏障对抗生素透过血脑屏障的影响

目的　通过快速静脉输注甘露醇可逆性开放血脑屏障 (BBB) ,探知此方法能否增加抗生素透过BBB的量 ,在何时达到最高峰 ,其通透量增加后临床上有无不良反应。方法　采用自身配伍设计 ,共 6个样本组。对照组仅使用抗生素 ;其余 5组分别在使用甘露醇前 60、3 0min ,同时使用甘露醇后 3 0、60min使用抗生素 ,各组皆取使用抗生素后 1h的脑脊液测其抗生素浓度。抗生素选用头孢三嗪。结果　测量值经过q检验 ,经 2 0 %甘露醇处理前后的CSF中的头孢三嗪浓度差异有非常显著性。全组患者经临床观察未出现神经系统的不良反应。结论　经静脉快速输注2 0 %甘露醇后可以使透过BBB的水溶性抗生素的量增加 ,两者使用的顺序是在抗生素使用 3 0min内即给予甘露醇快速滴注。该方法不会增加低神经毒性抗生素在中枢神经系统的不良反应。     

Preservation of the pylorus in resection of the head of the pancreas

Whipple's pancreatoduodenectomy was the standard operation for diseases of the head of the pancreas for more than 40 years, but the results were vitiated in part by poor gastrointestinal function and malnutrition. Reintroduced in 1978, pylorus-preserving proximal pancreatoduodenectomy (PPPP) has had an increasing impact on pancreatic surgery as its benefits have been recognized: improved nutritional status, decreased incidence of postgastrectomy syndromes, and a technically easier operation. Postoperative mortality rates and 5-year survival rates are comparable with those of the classic Whipple procedure. PPPP is indicated for most patients with chronic pancreatitis of the pancreatic head. It is also appropriate for patients with periampullary cancer and for those with pancreatic cancer arising from the lower part of ‘the head and the uncinate process. More than 650 patients have now undergone PPPP: 31% for chronic pancreatitis and 66% for periampullary and pancreatic cancers. We assess the indications for PPPP, outline the operation, and review the results.