人工全膝关节置换术中髌骨置换的临床研究

目的探讨人工全膝关节置换术中髌骨置换之后的临床疗效,为临床上是否要进行髌骨置换提供参考依据。方法选择2009年12月—2012年2月于我院急诊科、骨科就诊并拟行人工全膝关节置换术的骨关节炎患者84例,按随机数字随机将所有入选患者分为对照组42例和研究组42例,研究组患者在关节置换术中接受髌骨置换的治疗,对照组则不进行髌骨置换,治疗后所有患者接受为期1年的随访,对两组疗效进行比较。结果两组术后2、3个月的美国膝关节协会评分系统(KSS)临床评分差异均无统计学意义(P>0.05),术后6、12个月KSS临床评分差异有统计学意义(P<0.05);两组术后2、3、6个月的Feller髌骨评分差异均无统计学意义(P>0.05),术后12个月Feller髌骨评分差异有统计学意义(P<0.05)。结论人工全膝关节置换术中行髌骨置换能在一定程度上改善膝关节功能评分和髌骨评分。     

快速康复理念在骨肉瘤人工膝关节置换术围术期中应用

目的探讨快速康复理念在骨肉瘤人工膝关节置换术围术期实施方法及效果观察。方法选取中国医科大学附属第四医院骨外科自2013年10月至2017年1月收治的15例采用人工膝关节置换术治疗的骨肉瘤患者设为快速康复组,围术期采用快速康复理念管理;18例采用人工膝关节置换术治疗的骨肉瘤患者设为常规组,实施常规治疗。比较两组的术后康复情况。结果快速康复组患者术后下床活动时间明显早于常规组,并发症明显少于常规组,术后膝关节活动度的优良率明显高于常规组,随访3个月时的膝关节功能评分明显高于常规组,两组间比较,差异均有统计学意义(P<0.05)。结论对骨肉瘤人工膝关节置换术的患者围术期实施快速康复管理,能够促进术后康复。     

滑膜切除对同期双侧全膝关节置换术后失血及功能恢复的影响

目的:探讨同期双侧全膝关节置换术(TKA)时行滑膜切除术对术后失血量及膝关节功能恢复的影响。方法:2014年11月至2017年12月间因患原发性膝骨关节炎在我院行同期双侧全膝关节置换的患者62例,其中32例术中进行滑膜切除(实验组),30例术中不进行滑膜切除(对照组)。对比两组患者手术时间、术中出血量、住院时间、术后第3天血色素较术前降低值、术后隐性出血量、术后输血率以及术后4周、12个月疼痛视觉模拟评分(VAS)和美国膝关节协会评分(KSS)。结果:两组患者均获得12个月随访。两组患者手术时间、术中出血量差异均无统计学意义(P>0.05);实验组术后输血率明显高于对照组(25%vs. 10%),但差异无统计学意义(P>0.05);实验组住院时间、术后第3天血色素较术前血色素降低值、隐性失血量均高于对照组,差异有统计学意义(P<0.05)。两组术后4周及术后12个月VAS评分、KSS评分(包括临床评分、功能评分)均较术前明显改善,差异有统计学意义(P<0.05)。两组间术前、术后4周及术后12个月VAS评分及KSS评分(包括临床评分、功能评分)差异无统计学意义(P>0.05)。结论:在行同期双侧全膝关节置换治疗骨性关节炎时,与保留滑膜相比,滑膜切除在缓解术后疼痛及改善膝关节功能方面未带来明显获益,且增加了隐性失血量及术后输血率。     

快速康复外科理念在达芬奇机器人肺癌根治手术中应用价值研究

目的探讨快速康复外科理念在达芬奇机器人肺癌根治手术中的应用价值。方法选取北部战区总医院自2018年10月至2019年4月收治的60例行达芬奇机器人肺癌根治手术的患者为研究对象。将患者随机分入常规组和ERAS组,每组各30例。常规组患者接受达芬奇机器人肺癌根治手术+胸外科常规围术期管理,ERAS组在常规组基础上结合快速康复外科治疗模式。比较两组患者的术后24、48 h视觉模拟评分,围术期相关指标(手术时间、引流时间、术后住院时间、术后住院费用),以及术后并发症发生率。结果两组患者均顺利完成手术,无死亡,无二次开胸,均于拔除引流管后痊愈出院。ERAS组术后24、48 h视觉模拟评分分别为(4.51±1.36)分、(3.12±1.26)分,均低于常规组的(6.10±1.37)分、(4.58±1.32)分,差异有统计学意义(P<0.05)。常规组和ERAS组手术时间分别为(118.73±50.46)min、(101.23±56.30)min,差异无统计学意义(P>0.05);引流时间分别为(6.84±2.61)d、(5.40±2.77)d,差异无统计学意义(P>0.05)。ERAS组术后住院时间为(6.75±2.43)d,短于常规组的(9.84±3.61)d,差异有统计学意义(P<0.05)。ERAS组术后住院费用为(7.46±0.42)万元,少于常规组的(8.04±0.96)万元,差异有统计学意义(P<0.05)。ERAS组术后并发症发生率为10.0%(3/30),低于常规组的33.3%(10/30),差异有统计学意义(P<0.05)。结论在达芬奇机器人肺癌根治手术中结合快速康复外科理念可有效缓解患者疼痛症状,降低术后并发症发生率,缩短术后住院时间,减轻经济负担。     

本体感觉强化训练对全膝关节置换术后膝关节功能的影响

目的:探讨本体感觉强化训练对全膝关节置换术后患者膝关节功能的影响。方法:120名全膝关节置换术后患者随机分为治疗组(60例)和对照组(60例),两组均给予膝关节置换术后常规康复锻炼,治疗组在此基础上增加本体感觉强化训练。分别于手术前、手术后3个月、6个月、12个月采用膝关节功能评分(HSS)评价临床疗效。结果:术前2组患者膝关节HSS评分组间无差异(P>0.05),术后3个月时2组患者膝关节HSS评分稍改善,两组间部分评分指标差异有统计学意义(P<0.05);术后6个月时2组患者膝关节HSS评分明显改善,部分评分指标组间差异有统计学意义(P<0.05);术后12个月时2组患者膝关节HSS评分显著改善,全部评分指标组间差异有统计学意义(P<0.05)。结论:全膝关节置换术后早期给予常规康复治疗的基础上辅助本体感觉强化训练,能进一步加速患者膝关节的功能恢复。     

胃癌围术期全营养联合目标营养支持治疗对胃肠功能恢复及预后影响

目的探讨给予胃癌围术期患者全营养联合目标营养支持治疗对胃肠功能恢复情况及预后的影响。方法选取自2010年1月至2017年1月十堰市郧西县人民医院收治的56例行根治性全胃切除术的胃癌围术期患者为研究对象,采用随机数字表法将患者分为常规组(n=28)与观察组(n=28)。常规组患者采用传统肠内营养支持治疗,观察组患者采用全营养联合目标营养支持治疗。比较两组患者术前及术后1、7 d的营养指标,包括前清蛋白、清蛋白及转铁蛋白水平;比较两组患者的术后胃肠功能指标,包括术后首次排便、排气时间。结果术后1 d,两组患者前清蛋白、清蛋白水平较术前降低,差异有统计学意义(P<0.05);转铁蛋白水平较术前比较,差异无统计学意义(P>0.05)。术后7 d,常规组患者前清蛋白、清蛋白水平与术后1 d比较,差异无统计学意义(P>0.05);观察组患者前清蛋白、清蛋白水平较术后1 d升高,且高于常规组,差异有统计学意义(P<0.05);两组患者转铁蛋白水平比较,差异无统计学意义(P>0.05)。观察组术后首次排气、排便时间均短于常规组,差异有统计学意义(P<0.05)。结论全营养联合目标营养支持治疗可加快胃癌患者围术期胃肠功能的恢复,改善患者预后。     

术中关节腔内注射氨甲环酸对老年人工全膝关节置换术后引流量及血清白细胞计数、血红蛋白水平变化影响

目的探讨术中关节腔内氨甲环酸注射对老年膝关节骨性关节炎进行人工全膝关节置换术(TKA)术后引流量及血清白细胞计数(WBC)、血红蛋白(Hb)水平变化的影响。方法选取2014年12月至2016年11月首都医科大学附属北京潞河医院收治的101例老年膝关节骨性关节炎患者,按照随机数字表法将患者分为常规组(n=50)与观察组(n=51)。常规组患者于TKA术中注射0.9%氯化钠溶液,观察组患者于TKA术中关节腔内注射氨甲环酸治疗。观察并比较两组患者术后引流量、总失血量、膝关节功能(HSS)评分及血清WBC、Hb水平变化情况,并统计两组活化部分凝血活酶时间、凝血酶原时间及并发症发生情况。结果观察组患者总失血量及术后引流量均低于常规组,组间比较,差异有统计学意义(P<0.05);术后血清Hb水平高于常规组,血清WBC低于常规组,组间比较,差异有统计学意义(P<0.05);术后,观察组HSS评分高于常规组,组间比较,差异有统计学意义(P<0.05);术中、术后两组活化部分凝血活酶及凝血酶原时间比较,差异无统计学意义(P>0.05)。观察组并发症发生率为3.9%(2/51),低于常规组的18.0%(9/50),组间比较,差异有统计学意义(P<0.05)。结论对行TKA术后的老年膝关节骨性关节炎患者给予氨甲环酸关节腔内注射治疗,效果显著,并发症发生率低,可改善患者膝关节功能及血清学各指标水平,减少术后引流量及总失血量。     

加速康复外科理念在军事训练伤致前交叉韧带断裂围术期临床应用

目的探讨在军事训练伤致前交叉韧带断裂围术期应用加速康复(ERAS)外科理念的临床效果。方法选取58例军事训练伤致前交叉韧带断裂需行韧带重建患者,按围术期处理方法的不同分为加速康复组和传统康复组,每组29例。比较两组患者术后不同时间疼痛的程度、并发症、活动量、膝关节Lysholm评分、膝关节活动度恢复时间及住院时间的差异。结果加速康复组术后1、24、48 h和3~7 d的疼痛视觉模拟评分分别为(1.65±0.94)分、(2.41±1.45)分、(2.09±0.80)分、(1.35±0.73)分,明显低于传统康复组的(6.83±1.02)分、(6.87±1.95)分、(6.39±0.70)分、(5.69±0.63)分,差异均有统计学意义(P<0.05)。与传统康复组相比,加速康复组术后并发症发生率降低、活动量增加、膝关节Lysholm评分增高、膝关节活动度恢复时间及住院时间明显缩短,差异均有统计学意义(P<0.05)。结论 ERAS理念在军事训练伤致前交叉韧带断裂围术期中的应用是安全可行的,可以有效地减少并发症的发生、提高患者的术后生存质量、促进膝关节功能恢复、缩短住院时间。     

氨甲环酸给药途径对初次单侧全膝关节置换术后出血量影响

目的探讨氨甲环酸给药途径对初次单侧全膝关节置换术患者术后出血量的影响。方法选取冀中能源邢台矿业集团总医院2016年1—12月收治的接受初次单侧全膝关节置换术治疗的146例患者作为研究对象,采用随机数字表法分为A组(n=73)与B组(n=73)。A组患者术中给予氨甲环酸关节腔内注射,B组患者给予氨甲环酸静脉滴注、关节腔内注射联合治疗。比较两组患者失血量、血红蛋白水平及膝关节功能变化情况。结果 B组患者术后显性失血量、隐性失血量、总失血量均低于A组,组间比较,差异有统计学意义(P<0.05);术后1、3、5 d,两组患者血红蛋白水平均低于术前,且B组低于A组,差异有统计学意义(P<0.05);术后3、6个月两组患者美国特种外科医院膝关节评分均高于术前,且B组高于A组,差异有统计学意义(P<0.05)。结论氨甲环酸静脉滴注、关节腔内注射联合应用,可更好的减少初次单侧全膝关节置换术患者术后出血量,有效调节血红蛋白水平,促进患者膝关节功能恢复。     

两种膝关节假体置换治疗绝经后类风湿关节炎合并骨质疏松症效果对比研究

目的比较进口GEMINI MKⅡ旋转平台膝关节假体与国产后稳定型TC-Dynamic人工膝关节系统置换术治疗绝经后类风湿关节炎合并骨质疏松症的效果。方法选取自2014年2月至2018年8月在沈阳市第四人民医院骨科行全膝关节置换的绝经后类风湿关节炎合并骨质疏松症的34例患者为研究对象,根据患者意愿分为GEMINI MKⅡ旋转平台膝关节假体置换组(GEMINI MKⅡ组,n=18)及TC-Dynamic人工膝关节系统置换组(TC-Dynamic组,n=16)。比较两组患者治疗前及治疗后6、60个月的膝关节功能、疾病活动性指标及骨密度。结果 GEMINI MKⅡ组与TC-Dynamic组患者治疗后6、60个月的类风湿性关节炎疾病活动性指标较治疗前明显降低,膝关节功能明显改善,差异有统计学意义(P<0.05);但治疗后两组间上述各指标比较,差异无统计学意义(P>0.05)。治疗后6个月时,两组骨密度与治疗前比较,差异无统计学意义(P>0.05)。治疗后60个月时,两组骨密度较治疗前明显改善,差异有统计学意义(P<0.05);但两组间比较,差异无统计学意义(P>0.05)。结论 GEMINI MKⅡ旋转平台膝关节假体与国产后稳定型TC-Dynamic人工膝关节系统置换在改善绝经后类风湿关节炎合并骨质疏松症患者膝关节功能、降低类风湿性关节炎疾病活动性、增加骨量方面的作用相近。但国产假体更为经济,是临床治疗此类患者的良好选择。     

Knee injury and Osteoarthritis Outcome Score (KOOS) - validation of a Swedish version

The Knee injury and Osteoarthritis Outcome Score (KOOS) is a self-administered instrument measuring outcome after knee injury at impairment, disability, and handicap level in five subscales. Reliability, validity, and responsiveness of a Swedish version was assessed in 142 patients who underwent arthroscopy because of injury to the menisci, anterior cruciate ligament, or cartilage of the knee. The clinimetric properties were found to be good and comparable to the American version of the KOOS. Comparison to the Short Form-36 and the Lysholm knee scoring scale revealed expected correlations and construct validity. Item by item, symptoms and functional limitations were compared between diagnostic groups. High responsiveness was found three months after arthroscopic partial meniscectomy for all subscales but Activities of Daily Living.     

Endovascular management of carotid-cavernous fistulas

Objective To investigate endovascular treatment of traumatic direct carotid-cavernous fistulas （CCF） and their complications such as pseudoaneurysms. Methods： Over a five-year period, 22 patients with traumatic direct CCFs were treated endovascularly in our institution. Thirteen patients were treated once with the result of CCF occluded, 8 twice and 1 three times. Treatment modalities included balloon occlusion of the CCF, sacrifice of the ipsilateral internal carotid artery with detachable balloon, coll embolization of the cavernous sinus and secondary pseudoaneurysms, and covered-stem management of the pseudoaneurysms. Results All the direct CCFs were successfully managed endovascularly. Four patients developed a pseudoaneurysm after the occlusion of the CCF with an incidence of pseudoaneurysm formation of 18.2% （4/22）. A total number of 8 patients experienced permanent occlusion of the ICA with a rate of ICA occlusion reaching 36.4% （8/22）. Followed up through telephone consultation from 6 months to 5 years, all did well with no recurrence of CCF symptoms and signs. Conclusion Traumatic direct CCFs can be successfully managed with endovascular means. The pseudoaneurysms secondary to the occlusion of the CCFs can be occluded with stent-assisted coiling and implantation of covered stents.     

The acutely limping child

Acute limping may be the result of multiple pathologies in children. The differential diagnosis varies based on the age of the child. Irrespective of age, the initial imaging work-up includes AP and frog leg radiographs of the pelvis and ultrasound; MRI may sometimes be helpful. In children less than 3 years, infections and trauma are most frequent. MRI is the imaging modality of choice when osteomyelitis is clinically suspected. Between the ages of 3 and 10 years, transient synovitis of the hip and Legg-Calvé-Perthes disease are main considerations but infection, inflammation and focal bony lesions are also considered. In children over 10 years, slipped capital femoral epiphysis also is considered.     

Do Balance Board Training Programs Reduce the Risk of Ankle Sprains in Athletes?

Introduction Ankle sprains are the most common musculo-skeletal injury that occurs in athletes,particularly in sports that require jumping and landing on one foot such as soccer,and basketball(1-4).These injuries often result in significant time loss from participation,long-term disability,and have a major impact on health care costs and resources(5-8).     

High Intensity Interval Training:New Insights

KEY POINTS ·High-intensity interval training(HIT)is characterized by repeated sessions of relatively brief，intermittent exercise.often performed with an“a11 out”effort or at an intensity close to that which elicits peak oxygen uptake(i.e.，≥90%of VO2 peak).     

Developmental validation of the PowerPlex(®) ESI 16 and PowerPlex(®) ESI 17 Systems: STR multiplexes for the new European standard

In response to the ENFSI and EDNAP groups’ call for new STR multiplexes for Europe, Promega^® developed a suite of four new DNA profiling kits. This paper describes the developmental validation study performed on the PowerPlex^® ESI 16 (European Standard Investigator 16) and the PowerPlex^® ESI 17 Systems. The PowerPlex^® ESI 16 System combines the 11 loci compatible with the UK National DNA Database^®, contained within the AmpFlSTR^® SGM Plus^® PCR Amplification Kit, with five additional loci: D2S441, D10S1248, D22S1045, D1S1656 and D12S391. The multiplex was designed to reduce the amplicon size of the loci found in the AmpFlSTR^® SGM Plus^® kit. This design facilitates increased robustness and amplification success for the loci used in the national DNA databases created in many countries, when analyzing degraded DNA samples. The PowerPlex^® ESI 17 System amplifies the same loci as the PowerPlex^® ESI 16 System, but with the addition of a primer pair for the SE33 locus. Tests were designed to address the developmental validation guidelines issued by the Scientific Working Group on DNA Analysis Methods (SWGDAM), and those of the DNA Advisory Board (DAB). Samples processed include DNA mixtures, PCR reactions spiked with inhibitors, a sensitivity series, and 306 United Kingdom donor samples to determine concordance with data generated with the AmpFlSTR^® SGM Plus^® kit. Allele frequencies from 242 white Caucasian samples collected in the United Kingdom are also presented. The PowerPlex^® ESI 16 and ESI 17 Systems are robust and sensitive tools, suitable for the analysis of forensic DNA samples. Full profiles were routinely observed with 62.5 pg of a fully heterozygous single source DNA template. This high level of sensitivity was found to impact on mixture analyses, where 54–86% of unique minor contributor alleles were routinely observed in a 1:19 mixture ratio. Improved sensitivity combined with the robustness afforded by smaller amplicons has substantially improved the quantity of data obtained from degraded samples, and the improved chemistry confers exceptional tolerance to high levels of laboratory prepared inhibitors.