Outcome of osteotomies for the treatment of haemophilic arthropathy of the knee

Background and aims The knee is one of the most commonly affected joints in haemophilic arthropathy leading to stiffness and disability. It is the aim of this study to investigate the outcome of corrective osteotomies around the knee.Patients and methods We report on the long-term results of ten osteotomies around the knee for severe haemophilic arthropathy and axial deviation at an average of 7.25±1.8 years postoperatively. Seven high tibial (preoperatively 7.2±2° varus) and three supracondylar osteotomies (preoperatively 7±3° valgus) were performed on seven patients (three of them bilateral).Results The clinical score of the Advisory Board of the World Federation of Haemophilia (average 7.4 points preoperatively) remained unchanged in two patients, improved in three patients and deteriorated in five patients. The radiological Pettersson score (average 8.2 points preoperatively) showed a worsening of 2.5 points over the time. Patients reported a subjective improvement for seven osteotomies, with sports activity in three patients, although the range of motion did not change significantly. Total knee arthroplasty was considered to be a failure, i.e. endpoint of follow-up. Six knees were replaced in four patients by total arthroplasty after a mean of 6.6 years.Conclusion Although survival of osteotomies around the knee in haemophilic arthropathy is lower than in non-haemophilic patients, we think that it is a choice of treatment, which, at least, postpones the indication for total knee arthroplasty in this young patient group.An equal contribution was made by K. Trieb and J. Panotopoulos     

Improvements in knee range and symptomatic and functional behavior after knee arthroplasty based on preoperative restriction in range

Recovery of knee range and Oxford Knee Score post knee arthroplasty based on preoperative knee range is described. A total of 191 patients recruited across 5 hospitals were assessed preoperatively, at 8 weeks postoperatively and 1 year. Preoperative knee range was categorized into "low" (≤ 109), "moderate" (> 109 to ≤ 120), and "high" (> 120°) flexion and "normal" (± -5) and "restricted" (> +5°) terminal extension. Recovery was analyzed using MIXED modeling procedures. The low-flexion group gained flexion across time. The moderate-flexion and high-flexion groups lost flexion initially then recovered, but 1-year flexion remained lower than preoperative values. The restricted terminal extension group gained extension across time. The normal terminal extension group lost extension initially then recovered to preoperative values at 1 year. Recovery in Oxford score was independent of preoperative knee range limitation. Improvement in knee range postoperatively, but not self-reported behavior, is highly dependent on the initial restriction in range.     

氨甲环酸减少膝关节周围骨折围手术期失血的临床研究

[目的]探讨氨甲环酸减少膝关节周围骨折围术期失血的有效性及安全性。[方法]选取徐州市中心医院2015年1月～2018年4月收治的膝关节周围骨折患者108例为研究对象。采用随机数字表法将108例患者分为A、B、C和D组,每组27例。A组为对照组,应用生理盐水。B组、C组和D组分别静脉应用、局部应用和联合应用氨甲环酸。记录各组止血带使用时间、术中失血量、总失血量、隐性失血量和术后24 h引流量;术后3 d血红蛋白减少量、平均红细胞比容下降最大值和术后24 h D-二聚体;并发症发生情况以及输血率。[结果] 4组手术均在3h内完成。4组术中止血带使用时间及术中失血量比较,差异无统计学意义(P0.05)。B、C、D组总失血量和隐性失血量组间均显著低于A组(P0.05),D组总失血量和隐性失血量显著低于B组和C组(P0.05)。A～D组血红蛋白减少量和平均红细胞比容下降最大值呈逐渐降低趋势,血红蛋白减少量各组间比较差异均无统计学意义(P0.05),平均红细胞比容下降最大值各组间比较差异具有统计学意义(P0.05)。C组和D组术后24 h D-二聚体水平显著低于A组和B组,且C组和D组比较差异有统计学意义(P0.05)。所有患者术后均无下肢深静脉血栓形成及肺栓塞发生。D组1例患者术后第3 d白蛋白为28 g/L,静脉输入人血白蛋白20 g;其余患者均未输血。[结论]静脉和局部应用氨甲环酸均可明显减少膝关节周围骨折患者围术期失血量,且不增加深静脉血栓的发生率,联合应用效果更佳。     

骨水泥封堵股骨髓腔对全膝关节置换术围手术期失血量的影响

目的探讨骨水泥封堵股骨髓腔对全膝关节置换术(TKA)围手术期失血量的影响。 方法回顾性分析陕西省人民医院2014年1月至2016年12月因骨关节炎行单侧初次TKA的患者173例,具有完整的影像学资料、血液学检验报告且伴发疾病不影响凝血或血流动力学的患者共116例,其中男53例,女63例,年龄平均(64±5)岁。65例患者使用自体截骨块制成的塞子填塞股骨髓腔口(A组),51例患者在使用自体骨塞的基础上采用面团期骨水泥封堵残存的股骨髓腔裂隙(B组)。采用卡方检验比较两组患者的性别、麻醉方式、异体输血率及深静脉血栓(DVT)发生率,采用独立样本t检验比较两组患者的年龄、身体质量指数(BMI)、手术时间、术中出血量、截骨厚度、术后引流量及围手术期显性出血量及隐性出血量。 结果所有患者均顺利完成手术,两组患者在性别(χ²＝0.161,P >0.05)、年龄(t＝－8.38,P >0.05)、BMI(t＝1.837, P >0.05)、麻醉方式(χ²＝0.91,P >0.05)、手术时间(t＝1.714,P >0.05)及截骨厚度(t＝0.448,P >0.05)方面差异无统计学意义。A组的显性出血量为(237.7±58.7)ml,B组的显性出血量为(225.5±68.1)ml,2组之间差异无统计学意义(P >0.05);A组的隐性出血量为(624.6±77.1)ml,B组的隐性出血量为(543.1±63.3 )ml, A组的隐性出血量明显高于B组(t ＝6.104,P <0.05)。A组的异体输血率为35%,B组的异体输血率为21%,经比较二者之间差异有统计学意义(χ²＝4.861,P <0.05)。A组和B组下肢DVT的发生率分别为6.1%与3.9%,差异无统计学意义(P >0.05)。 结论使用骨水泥封堵股骨髓腔可有效减少TKA围手术期隐性失血量。     

The effect of epidural anesthesia on reducing blood loss during upper abdominal surgery

We examined the advantage of the combined epidural anesthesia with general anesthesia for the upper abdominal surgery One hundred and thirty-five gastric cancer patients were subjected to the study. They were divided into four groups. Group A (n = 46) and B (n = 44) received distal gastrectomy, and group C (n = 27) and D (n = 18) received total gastrectomy. In group A and C, anesthesia was maintained with combined epidural and general anesthesia. In group B and D, only general anesthesia was administered. We compared group A versus B and groups C versus D. The parameters for the comparisons were intraoperative blood loss, averaged mean blood pressure, surgical operation time, etc. The patient background was not different between group A and B, and also between group C and D. The blood loss and mean blood pressure were significantly lower in groups A and C than in groups B and D. But there was no correlation between the blood loss and mean blood pressure. The results suggest that the fall of the mean blood pressure is one of the causes of reduced blood loss, but the causes may include other complicated parameters. We conclude that the combined use of epidural anesthesia with general anesthesia is useful for reducing the amount of blood loss for upper abdominal surgery.     

优质化护理在膝关节病变非手术治疗中的应用

目的：探讨膝关节病变非手术治疗中优质护理的效果。方法将本院2013年5月~2014年2月收治的60例膝关节病变非手术治疗（药物、理疗等）患者随机分为A、B两组,对照组（A组）行常规护理,护理组（B组）在A组的基础上采取优质护理。结果护理组30位患者在优质护理期内,17位痊愈,12位明显好转,1位无效,护理有效率达96.67%;对照组30位患者在其护理期内,10位痊愈,16位好转,4位无效,护理有效率达86.67%。结论加大心理护理力度,重视康复治疗期的护理,鼓励患者适当的减轻体重、加强户外运动都可以提高护理质量。     

氨甲环酸对全膝关节置换术失血量影响的系统评价

[目的]评价氨甲环酸对全膝关节置换术后失血量等指标的影响及其安全性。[方法]利用互联网检索数据库The Cochrane Library(2011年第4期)、Ovid(1948年～2011年12月)、PubMed(1966年～2011年12月)、EM-BASE(1966年～2011年12月)、中国期刊全文数据库(CNKI,1994年～2011年12月),检出氨甲环酸在全膝关节置换术中应用的相关文献,筛选出符合纳入标准的随机对照试验。提取数据,采用RevMan 5.0软件进行Meta分析,比较氨甲环酸组与对照组在失血量、输血率、术后并发症等方面的差异。[结果]共纳入随机对照研究15篇。Meta分析结果显示,使用氨甲环酸可以减少病人平均总失血量513.03 ml[95%置信区间(-678.26,-347.81),P<0.01]、平均术中出血量94.03 ml[95%置信区间(-297.97,91.92),P=0.32]、平均术后出血量297.22 ml[95%置信区间(-772.50,178.05),P=0.22];氨甲环酸可以显著降低输血率[危险度差值0.29,95%置信区间(-0.40,-0.17),P<0.01]、平均输血量0.99个单位[95%置信区间(-1.48,-0.49),P<0.01];两组间深静脉血栓、肺栓塞发生率的差异无统计学意义(P>0.1)。[结论]氨甲环酸能有效减少全膝关节置换术的失血量,降低输血率和输血量,且并未增加术后DVT及PE的发生率。     

多模式止血方案对减少单膝关节置换术围手术期失血的有效性

目的探讨多模式止血方案对减少单侧全膝关节置换术(TKA)围手术期失血量及减低术后输血率的有效性。方法分析95例行TKA患者围手术期失血及输血量等相关资料,59例患者采用多模式止血方案为A组,36例患者未采用多模式止血方案为B组。多模式止血方案包括:术前血红蛋白浓度的优化,术前补充循环容量,尽量减小手术创伤,术中关节内外鸡尾酒混合剂的应用,止血带压力的设置,术中关节内注射氨甲环酸联合引流管夹闭3h等。记录两组患者术中出血量、术后引流量及手术前后血常规相关数值,同时观察患者术后深静脉血栓形成等严重并发症情况。结果 A组患者引流量、总失血量、隐性失血量显著低于B组,术后第1、3天血红蛋白浓度和红细胞比容均明显优于B组,两组比较差异均有统计学意义(P0.05)。术后输血:A组0例,B组10例(27.77%),差异有统计学意义(P0.05)。两组患者均未发现深静脉血栓及相关并发症。结论多模式止血方案对减少单膝TKA术后血液丢失效果显著,达到零输血率的目标,该方案安全、有效。     

肝细胞生长因子对膝关节软骨影响的临床意义

目的 研究前列腺素Ｅ２（ＰＧＥ２）参与关节软骨退变的进程机理,以及肝细胞生长因子（ＨＧＦ）对膝关节软骨损伤修复的作用机理。方法 对符合临床诊断标准的３０个膝关节,分别给予膝关节腔注射肝细胞生长因子,每天１次,每次２ｍｌ,观察ＰＧＥ２、尿中１型胶原（ｃｒｏｓｓｌａｐｓ）、碱性磷酸酶（ＡＫＰ）以及临床症状的改善程度,并做了给药６周后与给药有的对比研究。结果 给药６周后ｃｒｏｓｓｌａｐｓ和ＰＧＥ２与给药     

The effect of tourniquet use on hidden blood loss in total knee arthroplasty

The objective of this study was to examine the characteristics of hidden blood loss and assess the effects of using a tourniquet on postoperative hidden loss in patients undergoing primary total knee arthroplasty. Eighty patients were randomised into two groups: one group underwent operation with a tourniquet and one without. Operating time, perioperative blood loss, hidden blood loss, free haemoglobin, swelling, ecchymosis, straight leg raising action and knee flexion were measured. There were significant differences in the hidden blood loss, free haemoglobin, postoperative swelling, extent of ecchymosis, straight leg raising and postoperative knee flexion in the early period after operation between the two groups. Our results indicate that knee arthroplasty operations with a tourniquet might promote postoperative hidden blood loss and hinder patients’ in early postoperative rehabilitation exercises.     

局部松解对膝关节退行性变模型滑液中IL-1β、IL-6及TNF-α变化的影响

膝关节退行性变引起的老年性膝痛是临床上常见的病症。为寻求更好的治疗方法,本文通过膝周软组织松解疗法,观察实验性膝关节退变动物模型治疗前、后关节液中IL1β、IL6及TNFα水平变化,探讨松解膝周软组织对膝关节退行性变的影响。1材料与方法1.1实验动物采用10～14个月龄,体质     

A prospective comparison of clamping the drain or post-operative salvage of blood in reducing blood loss after total knee arthroplasty

We undertook a prospective, randomised study in order to evaluate the efficacy of clamping the drains after intra-articular injection of saline with 1:500 000 adrenaline compared with post-operative blood salvage in reducing blood loss in 212 total knee arthroplasties. The mean post-operative drained blood volume after drain clamping was 352.1 ml compared to 662.3 ml after blood salvage (p < 0.0001). Allogenic blood transfusion was needed in one patient in the drain group and for three in the blood salvage group. Drain clamping with intra-articular injection of saline with adrenaline is more effective than post-operative autologous blood transfusion in reducing blood loss during total knee arthroplasty.     

Complete anterior cruciate ligament tear and the risk for cartilage loss and progression of symptoms in men and women with knee osteoarthritis

OBJECTIVE: To determine whether a complete anterior cruciate ligament (ACL) tear, a frequent incidental finding on magnetic resonance imagings (MRIs) of individuals with established knee osteoarthritis (OA), increases the risk for further knee OA progression. METHODS: We examined 265 participants (43% women) with symptomatic knee OA in a 30-month, prospective, natural history study of knee OA. The more symptomatic knee was imaged using MRI at baseline, 15 and 30 months. Cartilage was scored at the medial and lateral tibiofemoral joint and at the patellofemoral joint using the Whole-Organ MRI Score (WORMS) semi-quantitative method. Complete ACL tear was determined on baseline MRI. At each visit, knee pain was assessed using a knee-specific visual analog scale and physical function was assessed using the Western Ontario and McMaster Universities (WOMAC) physical function subscale. RESULTS: There were 49 participants (19%) with complete ACL tear at baseline. Adjusting for age, body mass index, gender and baseline cartilage scores, complete ACL tear increased the risk for cartilage loss at the medial tibiofemoral compartment [odds ratio (OR): 1.8, 95% confidence interval (CI): 1.1, 3.2]. However, following adjustment for the presence of medial meniscal tears, no increased risk for cartilage loss was further seen (OR: 1.1, 95% CI: 0.6, 1.8). Knee pain and physical function were similar over follow-up between those with and without a complete ACL tear. CONCLUSIONS: Individuals with knee OA and incidental complete ACL tear have an increased risk for cartilage loss that appears to be mediated by concurrent meniscal pathology. The presence of a complete ACL tear did not influence the level of knee pain or physical function over short-term follow-up.     

氨甲环酸的局部应用对减少腰椎后路融合术术后出血量效果及安全性研究

目的评估氨甲环酸切口内局部应用对减少腰椎后路融合术术后出血量的有效性及安全性。方法回顾2015年1月~2017年2月81例因退行性腰椎管狭窄初次行腰椎后路单节段及双节段融合手术的患者。根据术中是否使用氨甲环酸分为氨甲环酸组(A组)39例,对照组(B组)42例,所有患者均行腰椎后路椎弓根螺钉固定、椎间盘切除植骨融合术,A组术毕后切口内注射氨甲环酸注射液(100 m L:1 g),B组不使用,术后夹闭引流管2 h。比较术后24小时及总引流量,观察下肢深静脉血栓形成、肺栓塞发病率。结果两组在年龄、性别、腰椎融合节段数、术前血液学、手术时间以及术中失血量无统计学差异(P0.05),但是A组术后引流量明显低于B组,结果具有统计学意义(P0.05)。两组均无并发下肢深静脉血栓形成及肺栓塞的病例。结论术毕切口局部应用氨甲环酸可显著减少腰椎后路融合术后失血量,且不增加肺栓塞及下肢深静脉血栓形成的风险。     

臭氧与玻璃酸钠治疗膝骨性关节炎疗效的比较

目的比较臭氧、玻璃酸钠以及二者联合治疗膝关节骨性关节炎的临床疗效。方法膝关节骨性关节炎143例按随机数字表分为A组（48例）、B组（48例）和C组（47例）,分别以玻璃酸钠20mg、30μg/ml浓度的医用臭氧30ml和同剂量臭氧＋同剂量玻璃酸钠作患膝关节腔注射,每周1次,5次为一疗程。比较治疗前与治疗后3d、30d、60d、90d膝关节VAS疼痛评分和膝关节功能Lysaholm评分。治疗后90d,比较膝关节Leguesne评分有效率。结果VAS评分：A组治疗后30、60、90d较术前明显改善,B、C组治疗后3、30、60、90d均较术前明显改善;B组治疗后3、30d改善程度较A组大,差异有统计学意义（P〈0．05）,但治疗后60、90d2组差异无统计学意义（P〉0．05）;C组治疗后3、30、60、90d均较A、B组改善明显,差异有统计学意义（P〈0．05）。膝关节功能Lysholm评分：A、C组治疗后30、60、90d均较治疗前明显提高,差异有统计学意义（P〈0．05）;而B组治疗后30、60d均较治疗前明显提高,但治疗后90d时与治疗前比较差异无统计学意义（P〉0．05）;A组治疗后90d明显高于B组,差异有统计学意义（P〈0．05）;C组治疗后30、60、90d均明显高于A、B组,差异有统计学意义（P〈0．05）。A、B组Leguesne疗效评分有效率差异无统计学意义（P〉0．05）,C组Leguesne疗效评分有效率明显较A、B组高。差异有统计学意义（P〈0．05）。结论应用臭氧治疗膝关节骨性关节炎能减轻关节疼痛,改善膝关节功能;而单用玻璃酸钠则疗效起效慢,但较单用臭氧稳定;二者联用不仅起效快、效果好,而且疗效稳定。     

止血带的使用方式对膝关节置换术失血量和手术时间的影响

目的探讨不同止血带使用方式对全膝关节置换术中、术后失血量的影响及意义.方法 2006年5月至2009年4月行单侧全膝关节置换术的膝关节骨关节炎患者88例,排除凝血机制异常者,患者根据止血带使用方式不同分为手术开始时开始使用组和安装假体时开始使用组,手术开始时开始使用组46例,安装假体时开始使用组42例,其他操作两组相同,记录手术时间、止血带使用时间,记录术中失血量、术后引流量,计算总失血量和隐形失血量.用两独立样本t检验比较两组间的差异.结果 手术开始时开始使用组：手术时间75～140 min,平均95.9 min;止血带使用时间54～105 min,平均65.2 min.安装假体时开始使用组：手术时间85～150 min,平均98.2 min;止血带使用时间18～30 min,平均24.1 min.术中失血量：手术开始时开始使用组132～640 ml,平均251.8 ml;安装假体时开始使用组320～965 ml,平均570.5 ml,术中失血量有统计学意义（P＜0.01）.术后引流血量：手术开始时开始使用组560～1310 ml,平均630.3 ml;安装假体时开始使用组470～1 190 ml,平均576.9 ml,两组间比较有统计学意义（P＜0.05）.总失血量：手术开始时开始使用组平均1 371.7 ml,安装假体时开始使用组平均1 419.3 ml,两组比较总失血量无统计学意义（P＞0.05）.隐形失血量：手术开始时开始使用组574.7 ml,安装假体时开始使用组437.3 ml,隐形失血量比较有统计学意义（P＜0.05）.手术开始时开始使用组发生肌肉疼痛4例,神经麻痹1例,对照组未发生使用止血带发生的并发症.结论 手术开始时开始使用组可减少术中失血,提供良好的手术视野利于手术操作,但术后失血较多,尤其是隐形失血量较多,对总失血量无明显影响.止血带使用时机对手术时间无影响.