膝关节周围截骨术治疗膝外翻性骨关节炎研究进展北大核心CSCD

目的对近年膝关节周围截骨术治疗膝外翻性骨关节炎的手术方式研究进展进行综述。方法查阅近年国内外膝外翻性骨关节炎截骨手术治疗相关文献,对膝关节周围截骨术不同手术方式的优缺点、疗效进行总结。结果对于有症状且年轻、活动度大的膝外翻性骨关节炎患者,膝关节周围截骨术是一种安全、可靠的治疗选择。目前,临床应用的主要手术方式有股骨远端内侧闭合楔形截骨术、股骨远端外侧张开楔形截骨术、胫骨近端内侧闭合楔形截骨术、胫骨近端外侧张开楔形截骨术。不同截骨手术方式的适应证和优缺点不同,选择正确的截骨手术方式对取得良好的临床疗效至关重要。结论膝关节周围截骨术治疗膝外翻性骨关节炎有多种手术方式,为获得良好预后、提高生存率、减少并发症发生,需要根据不同情况制定最合理的手术策略。     

胫骨侧个性化髓外定位技术行人工全膝关节置换术后胫骨假体冠状位力线的评价研究

目的探讨人工全膝关节置换术(total knee arthroplasty,TKA)中应用胫骨侧个性化髓外定位技术截骨后胫骨假体冠状位力线情况。方法回顾分析2020年1月—2021年6月接受初次TKA且符合选择标准的170例(210膝)患者临床资料。其中,77例(96膝)胫骨侧采用传统髓外定位技术(传统定位组);93例(114膝)采用个性化髓外定位技术(个性化定位组),即结合胫骨解剖形态特点,在胫骨平台关节面选择个性化定位点作为髓外近端定位点。两组性别、年龄、身体质量指数、侧别、骨关节炎病程及Kellgren-Lawrence分级等一般资料比较,差异均无统计学意义(P>0.05),具有可比性。测量个性化定位组术前胫骨冠状位近、远端解剖轴形成的侧弓角(tibial bowing angle,TBA)并对胫骨轴线分型,分析个性化定位点位置分布规律。比较两组手术前后髋-膝-踝角(hip-knee-ankle angle,HKA)、胫骨远端外侧角(lateral distal tibial angle,LDTA),术后冠状位胫骨假体角(tibia component angle,TCA)及胫骨假体冠状位力线优良率。结果个性化定位组胫骨轴线分为直线型58膝(50.88%)、内弓型35膝(30.70%)、外弓型21膝(18.42%)。直线型者胫骨个性化定位点多位于外侧髁间棘高点(62.07%),内弓型者多位于内、外侧髁间棘之间区域(51.43%),外弓型者多位于外侧髁间棘外侧坡(57.14%)。两组组内手术前后HKA比较,差异均有统计学意义(P<0.05);手术前后LDTA比较,差异均无统计学意义(P>0.05)。两组间术前LDTA、HKA及手术前后差值比较,差异均无统计学意义(P>0.05);术后TCA比较,差异有统计学意义(P<0.05)。传统定位组术后胫骨平台假体较个性化定位组更倾向于内翻。术后个性化髓外定位组胫骨假体冠状位力线优良率为96.5%(110/114),传统定位组为87.5%(84/96),差异有统计学意义(χ²=7.652,P=0.006)。结论 TKA胫骨侧冠状位截骨时采用个性化髓外定位技术可行,与传统髓外定位技术相比胫骨假体冠状位力线优良率更高。     

Mid-term functional outcomes following reoperation after total ankle arthroplasty: A retrospective cohort study

BackgroundDespite a significant reported rate of non-revision reoperation after total ankle arthroplasty (TAA), it is uncertain if these subsequent procedures have an impact on the longer term outcomes. This study aimed to compare minimum five-year functional outcomes of patients who had undergone reoperation after TAA to those who did not require reoperation.MethodsSeventy-six ankles (74 patients) who underwent TAA with the Salto Talaris fixed bearing system between 2007 and 2014 were allocated into two groups based on presence (n = 16) or absence of reoperation (n = 60). Reoperations included all secondary procedures after index TAA, excluding revision surgeries requiring removal or exchange of the original prosthesis. The foot and ankle outcome score (FAOS) at preoperative and minimum five-year follow-up was compared between the groups. Additionally, improvements in FAOS subscales were compared. Preoperative deformity, postoperative implant alignment, number of periprosthetic cysts, and subsidence between groups were compared using standard weightbearing radiographs.ResultsThe most common cause of reoperation was gutter impingement (n = 11), followed by stress fracture of the medial malleolus (n = 2), tarsal tunnel syndrome (n = 1), periprosthetic cyst (n = 1), and infection (n = 1). In comparison to the non-reoperation group, all FAOS subscales except for the Sports and Recreational Activities subscale were significantly lower in the reoperation group at final follow-up. The reoperation group exhibited significantly less improvement in the Pain, Symptoms, and Quality of Life subscales at final follow-up (p < 0.05). There were no statistical differences in the radiographic parameters between both groups.ConclusionsPatients who underwent reoperation after TAA demonstrated inferior functional outcomes at mid-term follow-up. An emphasis should be placed on preventing possible causes of reoperations to achieve favorable patient outcomes. Additionally, if a reoperation is deemed necessary, a thorough evaluation and surgical correction of underlying causes should be achieved.     

Targeted postoperative care improves discharge outcome after hip or knee arthroplasty

OBJECTIVE: To determine whether targeted postoperative care, based on preoperative risk assessment, can increase the number of patients who are discharged home directly from acute care after elective hip or knee arthroplasty. DESIGN: Quasiexperimental with historical control. SETTING: A public university teaching hospital. PARTICIPANTS: One hundred patients who had an elective hip or knee arthroplasty. INTERVENTIONS: Between January and July 2001, 50 patients had their risk of discharge to extended inpatient rehabilitation assessed preoperatively with a newly developed Risk Assessment and Prediction Tool (RAPT). Postoperative management was targeted on the basis of the identified level of risk. Results were compared with those of a similar group of 50 patients treated between January and July 2000. MAIN OUTCOME MEASURES: Discharge destination, length of stay (LOS), and readmission rates. RESULTS: The percentage of patients discharged directly home increased significantly, from 34% during 2000 to 64% in 2001 (P=.002), with no increase in readmission rates in the 12 months postdischarge. In addition, the mean acute hospital LOS decreased by 1.1 days to 7.5 days in 2001 (P=.02). CONCLUSIONS: Use of the RAPT and targeted postoperative care resulted in more patients being discharged directly home after hip or knee arthroplasty while hospital LOS further decreased.     

CPM在膝关节强直松解术后的应用

１４例膝关节强直患者于松解术后第２天至第１０天应用持续被动关节活动器（ＣＰＭ）和微波治疗，每日二次，每次１小时。１０例对照，只用微波治疗。结果显示：切口拆线时ＣＰＭ治疗组膝关节主动活动度（ＡＲＯＭ）为６７．４±９．６，显著大于对照组４８．３±１２．１（Ｐ＜０．０１），住院天数、患膝关节水肿消除时间均比对照组缩短，但无统计差异，ＣＰＭ治疗组无一例发生切口延期愈合，且疼痛感比对照组轻。     

痹祺胶囊联合刃针治疗膝骨性关节炎的疗效观察

目的 探究痹祺胶囊联合刃针治疗早期膝骨性关节炎（knee osteoarthritis,KOA）的疗效。方法 采用随机数字表法将70例KOA患者随机分成2组,各35例。2组患者均用刃针治疗,1次/周,共2次;对照组患者联合口服塞来昔布胶囊200 mg/次,1次/d;试验组患者联合口服痹祺胶囊1.2 g/次,3次/d;治疗14 d。比较治疗前后及3个月随访的视觉模拟评分（visual analogue scale,VAS）及西安大略和麦克马斯特大学（Western Ontario and McMaster University,WOMAC）骨关节炎指数量表评分来判定疗效。结果 纳入研究的70例KOA患者中有8例脱落,共有62例纳入分析。2组治疗后VAS及WOMAC评分较治疗前均显著降低（P<0.01）,但对照组比试验组的VAS分值降低更明显（P<0.05）,WOMAC评分在治疗2周后和3个月随访均为试验组降低更明显（P<0.05）。治疗2周后,2组有效率较接近（试验组96.9%,对照组90%）,3个月随访试验组有效率（93.8%）优于对照组（63.3%）（P<0.01）。结论 采用痹祺胶囊联合刃针与塞来昔布联合刃针治疗KOA均疗效显著,但痹祺胶囊联合刃针改善关节功能更明显,且疗效更稳定持久。     

全膝关节置换术后个性化系统康复的疗效观察

目的:探讨个性化系统康复对仝膝关节置换术(TKR)后功能恢复的作用,以及对术后住院时间的影响.方法:选择TKR手术患者44例,随机分成系统康复训练组(22例)和对照组(22例).两组均接受骨科常规治疗、护理和功能锻炼指导.康复组除接受骨科常规治疗外,入院后根据患者情况由康复医学科制定个性化系统的康复治疗方案,康复治疗方案分为4个阶段:第一阶段(术前第4天)、第二阶段(术后第0-3天)、第三阶段(术后第4-14天)、第四阶段(术后第15-60天).康复治疗内容包括呼吸训练、肌力训练、关节活动度训练、平衡功能、本体感觉、步态和独立转移能力训练.于手术治疗前4d,手术后第14天及第60天进行评价,指标包括:美国膝关节学会评分(AKSS)、膝关节活动范围(ROM)、手术后住院天数.结果:康复组和对照组手术前各项观察指标经统计学分析差异无显著性意义(P＞0.05),康复组在第14天AKSS关节和功能评分值优于对照组(P＜0.05),第60天AKSS关节和功能评分值明显优于对照组(P＜0.01),ROM测定值均优于对照组(P＜0.01),手术后住院天数短于对照组(P＜0.05).结论:个性化系统康复治疗町促进TKR术后患者的功能恢复;增加手术后膝关节的关节活动范围;缩短患者手术后的住院天数.     

膝关节骨关节炎患者术前等速肌力测试研究

目的研究将要接受全膝关节置换的膝关节骨关节炎患者的肌力状况。方法正常人34例,需要进行手术治疗的膝关节骨性关节炎患者21例进行等速肌力测试,对其结果进行比较分析。结果膝关节骨关节炎患者肌力与正常人相比有显著下降(P<0.01)。患者健患侧肢体肌力无显著差异(P>0.05)。结论膝关节骨关节炎患者一侧肢体患病引起活动受限,病程较长时,导致对侧肢体肌力亦显著下降。     

山药多糖关节腔注射对兔膝关节骨性关节炎炎症因子及关节软骨代谢的影响

目的 探讨山药多糖关节腔注射对兔膝关节骨性关节炎模型软骨退变的保护机制及抑制炎症因子表达水平的影响,为山药多糖的开发及研究提供相关证据,同时为进一步研究奠定基础。方法 将55只新西兰白兔,用随机数字表法分为5组,每组11只,采用改良Hulth法制备膝关节骨性关节炎兔模型,分别为模型组、山药多糖低、中、高剂量（0.7,1.43,2.15 mg·kg^-1）组、玻璃酸钠（1.00 mg·kg^-1）组。造模成功1周后模型组不干预治疗,各组使用相应药物干预5周,1次/周。5周后通过肉眼观察关节大体标本,光镜下观察关节软骨组织苏木素-伊红（HE）染色和甲苯胺蓝（TB）染色病理切片及评分,使用酶联免疫吸附测定法（ELISA）检测兔膝关节液白细胞介素-6（IL-6）,白细胞介素-1β（IL-1β）,肿瘤坏死因子-α（TNF-α）表达水平,采用免疫组化法检测关节软骨基质金属蛋白酶-13（MMP-13）,转化生长因子-β₁（TGF-β₁）,Ⅱ型胶原（Col-Ⅱ）的表达。结果 山药多糖干预5周后,与模型组比较,山药多糖各组关节液中IL-6,IL-1β,TNF-α的含量均明显降低（P<0.05）,关节软骨中MMP-13的表达水平均也明显低于模型组（P<0.05）,而TGF-β₁和Col-Ⅱ的含量明显升高（P<0.05）;与山药多糖低、高剂量组比较,山药多糖中剂量组兔膝关节炎症因子IL-6,IL-1β,TNF-α含量明显降低（P<0.05）,软骨组织中TGF-β₁和Col-Ⅱ的含量明显升高（P<0.05）,MMP-13的含量明显降低（P<0.05）。与玻璃酸钠组比较,山药多糖中剂量组兔膝关节炎症因子IL-6,IL-1β,TNF-α含量,软骨组织中TGF-β₁,Col-Ⅱ和MMP-13含量差异无统计学意义。结论 山药多糖关节腔注射可明显降低兔膝关节液中IL-6,IL-1β,TNF-α的表达,并能有效抑制关节软骨中MMP-13表达,使关节软骨胶原的降解得到抑制,促进TGF-β₁,Col-Ⅱ的合成,对关节软骨起到保护及修复作用,从而延缓关节软骨的退变。     

连续腰大肌间沟阻滞用于全膝关节置换术后镇痛的临床观察

目的 :观察连续腰大肌间沟阻滞用于全膝关节置换术后镇痛的疗效 ,并与硬膜外镇痛进行对比研究。方法 :选择ASAⅠ～Ⅱ级行全膝关节置换手术病人 2 0例 ,随机分为 2组 ,EA组 :硬膜外术后镇痛 ,采用 0 .12 5 %罗吡卡因 芬太尼 2 μg/ml,5ml/小时 ;PA组 :腰丛神经阻滞术后镇痛 ,采用 0 .12 5 %罗吡卡因 ,5ml/小时 ,两组维持镇痛 3～ 5天。记录静息和持续被动运动时的VAS疼痛评分 ,肌力分级 ,镇静程度和并发症发生率。结果 :在术后 12小时 ,2 4小时患膝持续被动活动(CPM ) ,4 8小时 (CPM )时PA组VAS评分明显小于EA组 ;肌力分级在术后 12小时和 2 4小时PA组高于EA组 ;PA组无并发症发生 ,EA组术后恶心发生率明显高于PA组 ;两组病人镇静程度无差异。结论 :腰大肌间沟阻滞用于全膝关节置换术后镇痛较之硬膜外镇痛明显减轻静息和运动时的疼痛 ,减少并发症发生 ,对下肢肌力影响更小 ,因此是一种令人满意的术后镇痛方法。