体外震波在股骨头坏死中的应用研究进展

体外震波（extracorporealshockwave,ESW）作为声波的一种,是一种有效的力学刺激,通过解压缩和压缩（疏密）的交替介质传播,发挥空化作用、拉伸力以及剪切力而达到对组织细胞的无损伤机械刺激,激活组织细胞的自愈机制,按其不同的冲击波源分为液电式、电磁式和压电式[1]。20世纪80年代中期,一些学者在动物实验中,发现ESW可促进成骨细胞的成骨作用,于是开始将ESWT应用在治疗肌肉骨骼疾病中。     

股骨颈骨折全髋关节置换后异体血输注的影响

背景：人工髋关节置换成为目前治疗移位性股骨颈骨折效果较为肯定的方法,因其围手术期失血量较多,致使很多患者需要输血,而输血本身有一定的成本和风险。目的：探讨股骨颈骨折患者全髋关节置换后异体血输注的相关影响因素,进一步指导并完善在临床工作中血液管理。方法：对接受全髋关节置换的275例股骨颈骨折患者进行回顾性分析,比较不同性别、年龄、体质量指数、置换前血红蛋白水平、术中出血量、双下肢静脉血栓、置换后抗凝方式、手术时间、假体类型等对置换后异体血输注的影响,以及对异体血输注的预测价值。结果与结论：比较男性患者与女性患者全髋关节置换后的输血量时发现两者差异无显著性意义（P〉0.05）,而在输血率方面两者差异具有显著性意义（P〈0.05）。两组内体质量指数≤25kg/m2的患者和〉25kg/m2的患者在输血量及输血率上组间差异均无显著性意义（P〉0.05）。年龄、置换前血红蛋白水平和置换过程中出血量是股骨颈骨折患者全髋置换后异体血输注的影响因素,而性别、体质量指数、抗凝方式、双下肢静脉血栓、手术时间、假体类型及术后引流量对术后异体血输注的影响不大。提示,根据影响因素所建立的模型公式对临床上评估和预测置换后异体血输注的风险具有一定的应用价值。     

初次全膝关节置换术后肢体肿胀的影响因素研究

[目的] 探讨初次全膝关节置换术后肢体肿胀的相关影响因素,进一步指导并完善患者术后肢体康复训练.[方法] 对2007年10月~2009年8月接受全膝关节置换术的286例患者进行回顾性分析,比较不同性别、年龄、身高体重指数(BMI)、双下肢静脉血栓(DVT)、术后抗凝方式、手术时间、围手术期血红蛋白变化、假体类型等对术后...     

数字化骨科技术在骨科临床教学中的应用

骨科临床教学是骨科学生培养的关键过程。传统的教学方法和媒介存在诸多不足,而迅速发展的数字化骨科技术结合了计算机、图像处理、3D打印等多种新型医学处理技术,具有形象化、可视化、可重复性和可操作性等优点,在骨科临床教学中展现出广阔的应用前景。     

马栗种子提取物对全膝关节置换后早期隐性失血量与肢体周径变化的影响

背景：有研究表明,全膝关节置换后肢体肿胀主要还是与隐性失血有关.马栗种子提取物的主要成分是七叶皂苷,有保护血管,增加血管张力,降低毛细血管通透性,抗水肿,抗炎、抗渗出的作用,可有效预防和治疗创伤后肢体肿胀.目的：探讨马栗种子提取物对初次全膝关节置换后隐性失血量与肢体周径变化的影响及病理机制.方法：回顾性分析2013年1至9月接受全膝关节置换的150例患者,其中试验组85例置换后当日开始口服消肿药物马栗种子提取物0.3 g,3次/d,共14 d;对照组65例并未给予消肿药物.两组患者的年龄、身高及体质量指数等参数差异均无显著性意义（P＞0.05）,具有可比性.置换后1-3 d复查血常规.记录术中及置换后失血量和输血量,应用Gross方程计算置换后隐性失血量.观察并测量患者围手术期患膝髌上10 cm大腿周径的变化.两组间比较采用两独立样本t检验.结果与结论：试验组和对照组隐性失血量分别为（590.6±214.2）,（821.2±457.3） mL,差异有显著性意义（t=3.238,P=0.021）.试验组置换后失血总量、置换后第2,3天膝上10 cm大腿周径变化均明显小于对照组（P＜0.05）,而两组置换后第1天膝上10 cm大腿周径变化和引流量差异无显著性意义（P＞0.05）.提示早期应用马栗种子提取物可显著减少初次全膝关节置换后隐性失血,明显缓解置换后肢体肿胀,有利于促进肢体功能康复.其消肿的机制可能是减少置换后隐性失血,促进静脉回流.     

体外震波对骨微血管内皮细胞生理功能的影响

BACKGROUND: Extracorporeal shock wave has been shown to influence the physiological function of endothelial cells via the activation of mechanoreceptors and specific signal transduction system, and gene expression regulation. OBJECTIVE:To explore the impact of different energy flow densities and numbers of shots of extracorporeal shock waves on the new vessel formation ability, migration capability and apoptosis of bone microvascular endothelial cells. METHODS: Bone microvascular endothelial cells isolated from the femoral head of patients undergoing arthroplasty were subcultured in vitro, and then were immunofluorescently evaluated with endothelial cell marker antibodies to CD31 and von Willebrand factor (vWF), and grouped according to different energy flow densities (low, 0.03 mJ/mm2; high, 0.11 mJ/mm2) and numbers of shots (400 and 800). Capillary-like tube formation, migration capability and apoptosis of bone microvascular endothelial cells were determined by 3-D culture in vitro, scratch test, and flow cytometry, respectively. RESULTS AND CONCLUSION: vWF and CD31 were positively expressed in approximately 100% of bone microvascular endothelial cells, which indicates the cultured cells had characterization of microvascular endothelial cells. Extracorporeal shock wave enhanced angiogenesis and migration capability of bone microvascular endothelial cells derived from the femoral head, and especially low-energy flow density of extracorporeal shock wave exerted more superior effects. Angiogenesis of bone microvascular endothelial cells was decreased with the increased shot number in the low-energy flow density group. In addition, extracorporeal shock wave inhibited bone microvascular endothelial cell apoptosis induced by steroids. Our results suggest that energy flow density and number of shots of extracorporeal shock waves impact the physiological function of bone microvascular endothelial cells derived from the femoral head. 中国组织工程研究杂志出版内容重点：组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程     

鸡尾酒疗法减少全髋关节置换后的隐性失血

BACKGROUND: Epinephrine solution, tranexamic acid, hemostatic gels and powders have been used to reduce topical blood loss after total hip arthroplasty; however, none of these methods alone is sufficient.     

体外震波治疗骨质疏松的研究进展

<正>骨质疏松症已成为严重影响老年人生存质量的疾病之一,药物并辅以物理、营养治疗等是目前治疗骨质疏松的主要方法。但是药物治疗周期长、费用高、患者依从性较差,很难在短时间内迅速提高骨密度及骨强度,而且还存在不良反应及安全问题。目前研究比较多的非药物治疗方法包括训练和生物物理学干预,如机械振动疗法、超声疗法以及低频脉冲电磁场疗法等,但是这些方法对促进骨重建以及改善骨微结构的作用十分有限,治疗骨质疏松的临床效果并不明显~([1—4])。体     

人工关节置换术患者术后血氧饱和度的监测与护理干预

目的：探讨人工关节置换术后低氧血症的发生规律,提出护理对策。方法监测2013年1—4月行人工关节置换术患者100例的围术期指尖血氧饱和度（ SpO2）,进行曲线描记,对不同手术类型患者围术期SpO2变化进行对比研究。结果人工关节置换术患者围术期SpO2变化曲线几近一致, SpO2最低值主要集中在手术当日,术后第1～2天表现为明显的低氧血症,在第3～5天表现出平稳上升恢复的趋势;单侧膝关节置换术患者在手术当日及术后第1天SpO2检测值分别为（91．9±2．5）％和（92．9±2．0）％,均低于单侧髋关节置换术患者[（93．3±2．2）％、（93．7±2．0）％],差异有统计学意义（t值分别为－2．789,－2．231;P＜0．05）。结论人工关节置换术患者围术期SpO2的变化有一定的规律,术后1d容易发生无症状性低氧血症,尤以膝关节置换术为著,应加强护理干预,预防低氧血症的发生。     

氨甲环酸在人工关节外科领域的应用

Tranexamic acid （ TXA ） is economical and safe, with good hemostatic effects in joint surgery. The intravenous route is most commonly used. TXA can also be administrated orally or intra-articularly but not intrathecally or intra-cerebrally. Better hemostatic effects can be achieved both in spinal surgery and total hip arthroplasty （ THA ） with the use of TXA. TXA is generally injected intra-articularly in total knee arthroplasty （ TKA ） before the tourniquet was released and after the capsule was sutured. The patients who underwent TKA were divided into 2 groups, including one group receiving 1.5% TXA intra-articularly and the other group receiving 3.0% TXA intra-articularly. The postoperative blood loss volume was 1295 ml in the 1.5% TXA group, and 1208 ml in the 3.0% TXA group. Statistically signiifcant differences were observed between the 2 groups, and the patients receiving more TXA had less blood loss. Only the articular cavity is affected with the intra-articular administration of TXA. Such advantages as minimal systemic absorption, less intra-articular bleeding and reduced risk of deep venous thrombosis （ DVT ） and pulmonary embolism （ PE ） can be found with the intra-articular administration of TXA when compared with the intravenous administration. The intra-articular administration of TXA is superior to the intravenous administration. （ 1 ） Potential complications related to the intravenous administration of TXA can be avoided or decreased, particularly in high-risk patients, such as the patients with cardiovascular diseases, venous thromboembolism, renal dysfunction and so on. （ 2 ） The blood loss, blood transfusion and transfusion rate after TKA can be reduced with the intra-articular administration of TXA. TXA is contraindicated in the patients with a history of arterial or venous thrombosis, hematological system diseases, acute renal failure, seizures and/or hypersensitivity. Postoperative hemorrhage is caused by many factors, and the physicians should take comprehensive