强化髋关节周围肌肉力量训练对髌股关节疼痛综合征的疗效观察

［摘要］　目的　观察强化髋关节周围肌肉力量训练对髌股关节疼痛综合征（PFPS）的疗效。方法　选择2018年6月至2019年6月该院收治的PFPS患者60例,采用抽签法将其分为观察组和对照组,每组30例。对照组予常规物理治疗,观察组在对照组治疗方案的基础上增加髋关节周围肌肉力量训练。比较两组治疗前后的膝前痛量表（AKPS）评分、视觉模拟量表（VAS）评分以及屈膝、伸膝的最大峰力矩（PT）。结果　治疗后,两组AKPS评分均提高,VAS评分均降低,与治疗前比较差异均有统计学意义（P<0.05）。与对照组比较,观察组治疗后AKPS评分更高、VAS评分更低,差异有统计学意义（P<0.05）。治疗后,两组伸膝、屈膝PT值均提高,与治疗前比较差异均有统计学意义（P<0.05）。与对照组比较,观察组治疗后的伸膝、屈膝PT值更高,差异有统计学意义（P<0.05）。结论　强化髋关节周围肌肉力量训练有利于改善PFPS患者的膝关节活动功能,减轻膝关节疼痛症状,疗效显著。     

联合术式治疗儿童习惯性髌骨脱位的疗效评价

习惯性髌骨脱位又称复发性髌骨脱位，其病因复杂，手术治疗方法较多，若治疗不当极易复发。1985～2002年，我们采用髌骨外侧软组织广泛松解、内侧关节囊紧缩及动力性加强、半侧髌韧带移位的联合手术方式，治疗习惯性髌骨脱位57例，效果满意。现报告如下。     

慢性精神分裂症患者脑结构异常的MRI线性测量研究

［摘要］　目的　探究慢性精神分裂症患者的脑结构异常情况。方法　选取自贡市精神卫生中心2017-01～2019-08收治的50例慢性精神分裂症患者作为研究组,另选择50名健康志愿者作为对照组,均行脑部磁共振成像（MRI）扫描。采用线性测量法测量第三脑室宽度、尾状核头部宽度、脑室前角间距、三角区域间距、外侧裂宽度、海马高度、胼胝体厚度等指标,并进行组间比较。结果　研究组第三脑室宽度、左侧尾状核头部宽度、右侧尾状核头部宽度、左侧外侧裂宽度、右侧外侧裂宽度显著大于对照组（P<0.05）。两组在脑室前角间距、三角区域间距、左侧海马高度、右侧海马高度及胼胝体厚度方面比较差异无统计学意义（P>0.05）。结论　慢性精神分裂症患者存在脑结构异常,MRI线性测量对慢性精神分裂症的诊断和鉴别诊断有一定意义。     

数字化术前规划在腰椎重度退变椎弓根螺钉置入手术中的应用效果研究

［摘要］　目的　探讨数字化术前规划在腰椎重度退变椎弓根螺钉置入手术中的应用效果。方法　选择2018年5月至2020年5月在武汉中西医结合骨科医院接受腰椎椎弓根螺钉置入手术的患者47例,其中腰椎管狭窄症24例,退行性腰椎滑脱症23例。根据患者是否采用数字化术前规划将其分为观察组（采用数字化术前规划,22例）和对照组（未采用数字化术前规划,25例）,均行经椎间孔入路椎间植骨融合术（TLIF）。比较两组置钉时间、置钉出血量、术中透视时间以及置钉精确度。结果　两组患者手术均顺利完成,术后均未发生神经损伤、脑脊液漏及切口感染等并发症。观察组22例共置钉152枚,对照组25例共置钉172枚。观察组单枚置钉时间、术中透视时间均短于对照组,单枚置钉出血量少于对照组,差异有统计学意义（P<0.05）。观察组总体置钉精确度显著优于对照组（P<0.05）。结论　对于腰椎关节重度退变患者,数字化术前规划可为置钉提供参考,有助于缩短置钉时间,减少术中出血量和透视时间,提高置钉精准度。     

穴位埋线治疗失眠症30例临床观察

［摘要］　目的　观察穴位埋线治疗失眠症的临床疗效。方法　将60例失眠患者按就诊顺序半随机分为两组,治疗组（n=30）给予穴位埋线治疗,对照组（n=30）给予阿普唑仑治疗。比较两组睡眠改善情况。结果　治疗组治愈18例,好转9例,未愈3例。对照组治愈13例,好转7例,未愈10例。两组疗效比较差异有统计学意义（P<0.05）。结论　穴位埋线治疗失眠症疗效良好,复发率低,值得临床推广。     

两种不同类型包皮环切缝合器行包皮环切术的临床效果比较

［摘要］　目的　比较两种不同类型包皮环切缝合器行包皮环切术的临床效果。方法　回顾性分析青岛滨海学院附属医院及青岛市第三人民医院泌尿外科2019年8月至2021年10月230例使用一次性包皮环切缝合器（DCSD）行包皮环切术患者的临床资料。根据患者自身意愿,以使用DCSD类型不同分为观察组129例和对照组101例。观察组采用单纯宽吻合钉缝合的DCSD;对照组采用吻合钉联合硅胶垫片缝合的DCSD。比较两组手术时间、术中出血量、术后2 h疼痛评分、术后第一次换药疼痛评分、术后10 d水肿程度、完全脱钉时间、术后1个月未完全脱钉例数、术后血肿发生率、术后感染发生率、切口裂开率以及术后3个月患者满意度。结果　两组手术时间、术中出血量、术后2 h疼痛评分结果比较差异无统计学意义（P>0.05）。观察组术后第一次换药疼痛评分及术后10 d水肿程度评分显著低于对照组（P<0.05）。对照组完全脱钉时间及术后1个月未完全脱钉例数结果显著优于观察组（P<0.05）。两组术后血肿发生率及切口裂开率比较差异无统计学意义（P>0.05）。观察组术后感染发生率显著低于对照组（P<0.05）。两组术后3个月患者满意度比较差异无统计学意义（P>0.05）。结论　与单纯宽吻合钉缝合的DCSD相比,吻合钉联合硅胶垫片缝合的DCSD显著改善了脱钉情况,不足之处在于其近期水肿及感染率更高,换药时疼痛评分更高,但两组患者的远期效果相似。     

阴式全子宫切除术中骶主韧带不同缝线的对比研究

［摘要］　目的　探讨阴式全子宫切除术中骶主韧带残端缝线对阴道残端愈合的影响。方法　回顾分析阴式全子宫切除术并回访的病例140例,按时间段分为观察组和对照组各70例。对照组时间段为2010-01～2011-06,骶主韧带残端缝合的缝线用10号丝线。观察组时间段为2011-07～2013-01,骶主韧带残端缝合的缝线用7号丝线。术后1个月观察阴道排液,术后3个月观察阴道残端息肉（肉芽）、线头排异情况。结果　对照组出院后阴道排液42例,其中阴道残端息肉（肉芽）、线头排异各22例;观察组出院后阴道排液7例,阴道残端息肉（肉芽）、线头排异各3例。两组比较差异有统计学意义（P<0.01）。结论　阴式全子宫切除术术后残端愈合与骶主韧带缝合的缝线粗细有密切关系。     

关节镜下射频消融治疗髌股轨迹不正疗效观察

目的观察关节镜下射频消融治疗髌股轨迹不正的效果。方法对17例22膝髌股轨迹不正患者,常规行关节镜检查后,将镜头置于髌股关节下部近髁间窝处,动态观察髌股轨迹。用射频汽化仪进行髌骨外侧支持带的切割、松解。在髌骨内侧支持带松弛处,行组织紧缩术,调整髌骨运动轨迹。结果患者麻醉消退后,行患膝屈伸功能锻炼,无关节积血,术前疼痛症状消失,关节活动正常,X线摄片显示髌股关节对合良好。结论关节镜下射频消融术治疗髌股轨迹不正疗效满意。     

急诊介入与择期介入对左室急性心肌梗死治疗的影响分析

［摘要］　目的　探讨急诊介入与择期介入对左室急性心肌梗死治疗的影响。方法　选取86例左室急性心肌梗死患者,根据患者出现相应临床症状到行经皮冠脉介入治疗（PCI）的时间分为急诊组（n=29）、延迟1组（n=27）及延迟2组（n=30）,测定住院期间及治疗后6个月的左室射血分数（LVEF）及左室舒张末期内径（LVEDD）。结果　急诊及延迟1组LVEF及LVEDD改善明显,差异有统计学意义（P<0.05）,而延迟2组改善无明显差异。结论　左室急性心肌梗死的急诊介入及2周前延迟介入对心脏功能均有所改善。     

关节镜辅助治疗复发性髌骨脱位的术后护理及康复锻炼

习惯性髌骨脱位局部表现为膝内侧支持带松弛薄弱,外侧支持带紧张,病史较长,可导致髌股关节软骨损伤,产生髌骨周围疼痛、膝关节无力、“打软腿”、突然活动不灵和摩擦等症状,严重影响了患者的日常活动。传统的治疗方法有切开进行髌骨外侧支持带松解、内侦4支持带紧缩缝合、胫骨结节内移、股内侧肌止点移位术,但这些方法创伤大、恢复慢。     

Acute traumatic lateral patellar dislocation

An unusual case of acute extra-articular patellar dislocation is described in which the patella dislocated laterally, rotated 90 degrees about its vertical axis, and wedged against the lateral femoral condyle. Closed reduction in the emergency department failed and operative intervention was required.     

The chopstick-noodle twist: an easy technique of percutaneous patellar fixation in minimally displaced patellar fractures

We report six cases of minimally displaced two-part patellar fractures with skin injury over the patella that were treated with percutaneous K wire fixation and compression applied using stainless steel (SS) wire. This technique makes it possible to perform early operative treatment in cases where unhealthy skin is not amenable to conventional tension band wiring. The technique employs two K wires inserted through the two fracture fragments under local or regional anaesthesia. They are then compressed using simple SS wire knots at the two ends - making it look like noodles at the end of two chopsticks. The fixation is subsequently augmented with a cylindrical plaster-of-Paris cast. The technique is simple, cheap and does not cause soft tissue injury.     

Rehabilitation of Achilles and patellar tendinopathies

Achilles and patellar tendinopathies affect a broad range of the population and are difficult conditions to manage clinically. The pathology is persistent in the chronic tendon and can be considered to be failed healing. The exact cause of tendinopathy pain is unclear but may be related to changes in neurovascular structures. Rehabilitation for Achilles and patellar tendinopathies is based on an exercise programme that aims to improve muscle-tendon function and normalise the pelvic/lower limb kinetic chain. This incorporates a programme for restoring and improving muscle strength, endurance and power and retraining sport-specific function. Rehabilitation may take a prolonged period of time, both the athlete and clinician must be patient and persistent to maximise results from an exercise-based treatment.     

Functional results after patellar fractures in elderly patients

Elderly patients tend to fracture the patella because of a simple fall. In this group of patients restoration of primary functional level is crucial. Sixty-eight patients more than 65 years of age with patellar fractures, who were treated in our institution between January 1990 and December 1999 were evaluated. There were 43 females and 25 males. The ages ranged from 65 to 88 years (17 patients>80). We focus on the mechanism, which led to the fracture, the pre-morbid and post-morbid state of the patients and the various aspects of treatment in this group of patients. The majority (82%) had a simple fall. Half of the patients had background diseases. Forty-five patients (66%) had comminuted patellar fracture. In 58 patients (85%) the extensor mechanism was disrupted, which therefore, necessitated an operation (group I). The rest, ten patients, were treated conservatively (group II). Follow-up time ranged between 0.5 and 10.5 years (mean 4.5 years). Minor complications were noted in five patients. Sixty patients (88%) had intact extensor mechanism, while five patients in group I (9%) and three in group II (30%) had extension-lag of 10-30 degrees (P<0.05). None of the patients had non-union, cosmetic disturbances or developed osteoarthritis. Fifty-six patients (82%) (41 patients in group I and five in group II, P<0.05) achieved the same independence mobility status post-fracture. In elderly patients the cause of the fracture is a direct blow by simple fall to the patella causing comminuted fractures; however, with these patients excellent or good results were eventually achieved. Surgical treatment yielded better results than non-surgical.     

Changes in articular cartilage in experimentally induced patellar subluxation

OBJECTIVES—Patellar subluxation was experimentally induced in young rabbits and the resulting cartilaginous changes were observed over a prolonged period of time to determine histological changes in the subluxated patellar cartilage.
METHODS—The tibial tuberosity in 12 week old rabbits was laterally displaced and fixed to the tibia with wire to induce lateral patellar subluxation. Pathological changes in patellar cartilage were examined for 120 weeks after surgery using computed tomography and stereoscopic microscopy.
RESULTS—Eight weeks after surgery, changes in articular cartilage consisting of horizontal splitting of the matrix were observed in the intermediate zone and were presumed to have been caused by shearing stress applied to the patellar cartilage. The cartilaginous changes caused by patellar subluxation progressed very little over the 120 weeks. Very few rabbits presented with osteoarthritic changes in the patellofemoral joint, most probably because the stress resulting from the malalignment of the patellofemoral joint was mild enough to permit recovery.
CONCLUSION—The mild, non-progressive pathological changes, in particular, basal degeneration, induced in this experiment in patellar cartilage were quite similar to the changes in articular cartilage seen in human chondromalacia patellae.

     

急性创伤性髌骨脱位的早期手术治疗

目的探讨急性创伤性髌骨脱位早期手术治疗的效果,评价异体肌腱重建的治疗效果。方法对27例急性创伤性髌骨脱位患者行关节镜下内侧髌骨股骨韧带（MPFL）修补或重建,部分病例同时行关节镜下髌外侧支持带松解和（或）胫骨结节内移截骨。结果术后平均随访19.2个月,术后均未出现髌骨再次脱位,无髌骨错动或半脱位。患者主观Kujala评分、Lysholm评分、Tegner运动等级评分与受伤前比较差异无统计学意义（P〉0.05）。结论急性创伤性髌骨脱位的早期手术治疗能够明显改善髌骨稳定性,术后主观评分和运动等级均达到受伤前水平,有利于患者术后膝关节功能和运动水平的恢复。