保留股骨颈全髋关节置换术后程序性康复护理

目的探讨保留股骨颈型人工全髋关节置换术（CFP）的近期疗效及程序性康复护理。方法应用保留股骨颈型人工全髋关节置换治疗,对髋关节骨关节病14例18髋进行股骨颈全长保留的全髋置换术。结果经过6月～1年6月随访,14例18髋人工髋关节临床效果良好。人工髋关节的活动和关节功能良好,X线摄片示人工髋关节位置良好,假体无松动和下沉。结论保留股骨颈型人工全髋关节置换（CFP）符合股骨近端生理顺应性,使假体适应应力分布。防止股骨近端骨质疏松引起假体松动和下沉,髋关节病近期疗效较好,同时为今后需要假体翻修提供骨结构基础,尤其适用于可能需要行假体翻修的中青年患者,同时有利于髋关节康复。     

Protective effects of tumor necrosis factor-α blockade by adalimumab on articular cartilage and subchondral bone in a rat model of osteoarthritis

We aimed to investigate the effects of an anti-tumor necrosis factor-α antibody (ATNF) on cartilage and subchondral bone in a rat model of osteoarthritis. Twenty-four rats were randomly divided into three groups: sham-operated group (n=8); anterior cruciate ligament transection (ACLT)+normal saline (NS) group (n=8); and ACLT+ATNF group (n=8). The rats in the ACLT+ATNF group received subcutaneous injections of ATNF (20 μg/kg) for 12 weeks, while those in the ACLT+NS group received NS at the same dose for 12 weeks. All rats were euthanized at 12 weeks after surgery and specimens from the affected knees were harvested. Hematoxylin and eosin staining, Masson''s trichrome staining, and Mankin score assessment were carried out to evaluate the cartilage status and cartilage matrix degradation. Matrix metalloproteinase (MMP)-13 immunohistochemistry was performed to assess the cartilage molecular metabolism. Bone histomorphometry was used to observe the subchondral trabecular microstructure. Compared with the rats in the ACLT+NS group, histological and Mankin score analyses showed that ATNF treatment reduced the severity of the cartilage lesions and led to a lower Mankin score. Immunohistochemical and histomorphometric analyses revealed that ATNF treatment reduced the ACLT-induced destruction of the subchondral trabecular microstructure, and decreased MMP-13 expression. ATNF treatment may delay degradation of the extracellular matrix via a decrease in MMP-13 expression. ATNF treatment probably protects articular cartilage by improving the structure of the subchondral bone and reducing the degradation of the cartilage matrix.     

Primary stability of various implants in tibial opening wedge osteotomy: a biomechanical study

 High tibial osteotomy (HTO) is an established method for treating varus gonarthrosis. The opening wedge HTO has some advantages over the lateral closed wedge technique. In this biomechanical study various systems of internal fixation of medial HTO were compared using an animal cadaver model (lower leg specimens from 1-year-old female domestic pigs). The first osteotomy (10°) was carried out and stabilized with a C-plate, an Arthrex spacer plate, or an AO tibial plate with or without bone graft. The resistance to axial stress was tested in a mechanical testing machine. Under lower axial stress (25, 50, 75, 100 N) the axial displacement between the various specimens did not show any significant differences. Under maximal axial force, the specimen fixed with the C-plate (F _max 2042 N) showed significantly better stability than the Arthrex plate (F _max 1687 N); P < 0.05. The AO plate (F _max 1612 N without bone graft and F _max 1583 N with bone graft) showed the lowest axial exposure to stress. Moreover, the influence of the osteotomy angle (7.5°, 10°, 12.5°, 15°) on axial stress resistance (F _max 2548, 2090, 1975, and 1740, respectively) was evaluated, and a direct correlation was found (R = 0.794, P < 0.05). Received: April 12, 2002 / Accepted: July 8, 2002 Offprint requests to: G. Spahn     

Prevalence and clinical signs of degenerative temporomandibular joint changes validated by magnetic resonance imaging in a non-patient group

The aim of this study is to investigate associations between degenerative bony changes of the temporomandibular joint (TMJ) evaluated by magnetic resonance imaging (MRI) and signs and symptoms of temporomandibular disorders (TMD) in a non-patient group. A total of 307 subjects (140 males and 167 females) were selected from the cross-sectional epidemiological study "Study of Health in Pomerania" (SHIP) for this evaluation. A clinical functional examination of the masticatory muscles and the TMJs was performed as well as an MRI examination of the TMJs. Another 77 subjects (25%) exhibited degenerative changes of one or both TMJs in the MRI. Clinical analysis revealed pain on palpation of the masticatory muscles in 113 subjects. Some 39 subjects had pain during palpation of the TMJs. There were significant associations between the MRI confirmed diagnosis of osteoarthrosis and some clinical signs (joint noises, joint palpation pain, reduced mouth opening) and symptoms (reported pain in the jaw and masticatory muscles) of TMD as well as further MRI diagnoses (disc displacement with and without reduction, fibrosis of the posterior ligament). Although there were some associations, clinical examination alone is not sufficient for diagnosing degenerative joint diseases. MRI is a necessary diagnostic adjunct for estimating the prevalence of TMD subgroups in non-patient populations.     

颞颌关节盘前移与颞颌关节骨关节病相互关系初探

本研究对２５例经临床检查及ＴＭＪ关节造影检查诊断为关节盘前移的患者（其中可复性１１例，不可复性１４例）进行了关节内窥镜检观察。结果发现，２５例患者均见有ＴＭＪ骨关节病（０Ａ）改变，其中以不可复性盘前移患者关节腔中ＯＡ改变较为严重。作者对关节盘前移与ＴＭＪＯＡ的相互关系进行了初步讨论。     

Surgical treatment of degenerative osteoarthritis of the fingers

Degenerative osteoarthritis of the long fingers is rare and surgical management is often necessary if there is joint pain, however this indication should not only be based on radiographic imaging. The specific anatomical problems of the metacarpophalangeal (MCP), proximal interphalangeal (PIP) and distal interphalangeal (DIP) joints are described. The surgical approach for each joint is described as well as functional management, in particular that of the extensor apparatus. Mobility should always be preserved for the MCP, arthroplasties are recommended for the PIP except for the index, and arthrodesis for the DIP. The different and most frequently used implants are described as well as the indications and expected results. The indications are discussed in relation to the limited results in the literature as well as the preferences of a panel of French hand surgeons.     

2007～2009年我院骨关节疾病用药分析

目的：了解我院骨关节疾病用药情况,为合理用药提供参考。方法：应用我院处方用药数量、销售金额和采用用药频度排序的方法计算我院药品应用趋势和频度,并参考国内文献,进行分析。结果：由3年数量份额上分析,我院用药呈上升趋势,非甾体抗炎药中销售数量和销售金额最多的排序前3位品种为双氯芬酸、布洛芬、吲哚美辛。结论：我院骨关节疾病用药基本合理,但尚需进一步规范。     

A survey to determine current practice patterns in the surgical treatment of advanced thumb carpometacarpal osteoarthrosis

Background  

The purpose of this study was to determine current practice patterns and examine the influence of recent evidence in the surgical treatment of advanced thumb carpometacarpal (CMC) osteoarthrosis.     

不同关节腔给药方法治疗KOA的临床疗效观察

目的:探讨关节腔给药方法治疗探讨膝关节骨性关节炎的临床疗效,阐明其可能存在的作用机制。方法:抽取我科2005年以来的住院病例,在1年后进行随访,根据不同治疗方法分为复方丹参注射液冲洗组、生理盐水冲洗组、玻璃酸钠注射组、复方丹参注射液冲洗+玻璃酸钠注射组、生理盐水冲洗+玻璃酸钠注射组,每组病例各30例,对其近期及远期疗效分别进行分析。结果:复方丹参注射液冲洗+玻璃酸钠注射治疗KOA的近远期疗效优于其他各组。结论:关节腔冲洗与关节内HA注射的治疗方法,用于治疗膝骨关节炎时具有协同作用。可能是通过减少炎症反应、润滑关节软骨、改善临床症状等途径来实现的。