中药熏洗治疗膝关节骨性关节炎的Meta分析

为运用循证医学方法对中药熏洗治疗膝骨性关节炎（OA）的临床疗效及安全性进行系统评价和Meta分析。全面收集了中药熏洗治疗OA的文献资料。在严格质量评价基础上，对研究结果进行定性分析。合并各篇优、良为阳性结果，中、差为阴性结果。利用RevMan4．1软件对多个研究结果的总体疗效进行固定效应模型的Meta分析，并进行敏感性分析。用漏斗图表示发表性偏倚。结果显示，中药熏洗治疗OA的效应值OR=2．68.95％可信区间为[1．82，3．95]；敏感性分析显示效应值稳定；漏斗图图形不对称；无中药熏洗不良反应的报道。表明中药熏洗治疗OA有一定的疗效，由于漏斗图提示存在发表性偏倚，加上现有临床研究存在的方法学问题，现在的研究结论有一定的局限性，欲得出公认的结论，尚有待进行设计严谨的多中心、随机对照试验。     

创伤性浮膝伴血管损伤的早期诊治

目的 探讨创伤性浮膝同时伴同侧血管损伤患者的早期诊断及救治.方法 总结1996年6月～2002年12月收治28例30个浮膝的手术固定方法、血管修复情况及术后治疗和恢复情况.结果 术后伤口一期愈合5例,17例伤口二期行植皮修复,4例胫前骨折部外露二期行皮瓣转移术,截肢2例,保肢成功率92.9%.术后26例经18个月～8年随访,骨折均愈合,下肢功能恢复优良率64.3%.结论 对浮膝损伤患者应高度重视伴有血管损伤可能,早期作出诊断,积极合理治疗,对患者预后至关重要.     

治疗时机对创伤性漂浮膝预后的影响

目的:探讨不同的手术时机对于创伤性漂浮膝术后功能恢复的影响。方法:回顾性分析42例接受手术治疗并获得随访的漂浮膝患者术后膝关节功能恢复情况,将患者按接受手术的时间分为72h内（23例）和72h后（19例）手术组,根据Karlstrom标准对两组患者术后膝关节功能恢复情况进行评定,将评定结果使用SPSS10·0软件进行统计学分析。结果:随访11个月⁶年,平均26个月,72h内接受手术者膝关节功能恢复情况优10例,良7例,中5例,差1例;72h后接受手术者优2例,良5例,中4例,差8例,两组结果差异有显著性统计学意义（P<0·01）。结论:早期手术坚强内固定、早期进行功能锻炼对于漂浮膝损伤远期功能的恢复具有重要的意义。     

Midterm results of mobile-bearing knee replacements

We examined the clinical and radiographic results of 93 patients affected by knee arthritis or osteonecrosis subjected to unilateral cementless mobile-bearing total knee arthroplasty with the LCS prothesis (Depuy/Johnson & Johnson). The mean follow-up was 9.5 years (range, 7–12 years). Clinical evaluation was performed using the Knee Society rating system, while radiographic evaluation was done according to the Knee Society roentgenographic system. At the latest follow-up, the mean knee score was 87 points: the functional score improved from 40 to 90. Radiolucent lines were small and not progressive. The implant survival at 12 years was 88%. Six knees (7%) required revision for implant-related problems. We conclude that the mobile-bearing prosthesis is a successful device even at long-term follow-up.     

云南白药对全髋关节置换术出血量的影响

目的研究云南白药在围术期对全髋关节置换术术中出血量及术后引流量的影响。方法2006至2008年我科收治的股骨颈骨折行全髋关节置换术60例,随机分成两组,分别服用云南白药胶囊和空胶囊;术前术后测定凝血酶原时间(PT),记录全部病人术中出血量及术后24 h引流量。结果实验组和对照组病人的凝血酶原时间(PT)差异有统计学意义(P<0.01);试验组的术中出血量、术后24 h引流量分别为(380±78)ml(、336±77)ml,较对照组(481±77)ml(、418±68)ml明显减少,差异具有统计学意义(P<0.01)。结论云南白药胶囊能够明显减少全髋关节置换术围术期出血量。     

Planning for minimally invasive unicompartmental knee arthroplasty

Unicompartmental knee arthroplasty (UKA) is considered the treatment of choice in patients with single compartment arthritis of the knee at early stages or with osteonecrosis limited to one compartment. However, results in the literature are still controversial and it is a technically difficult procedure. The main goal of UKA is to restore the articular space of the afflicted compartment, without influencing the limb alignment. Selection of patients and pre-operative planning are crucial. The necessity to improve functional results and to reduce immobilization of the patients has led to the development of minimally invasive surgery. Applied to UKA, this approach reduces blood loss and surgical time, causes fewer symptomatic postoperative complications, and permits earlier recovery compared to the traditional incision. The shorter incision makes careful pre-operative planning essential. We briefly review the indications for UKA, the pre-operative clinical and radiological assessment, and the surgical procedure. Proocedings of the Consensus Conference “TSS in hip and knee replacement” (Rapallo, Italy 22–24 June 2006)     

Osteotomy of the tibial tubercle in complex primary total knee replacement

Objective  Stiffness and severe deformity pose a major challenge in total knee arthroplasty. Numerous techniques have been described to gain exposure and improve knee flexion. Tibial tubercle osteotomy provides excellent and safe exposure of the joint, although mechanical and wound complications have been reported. Materials and methods  We present a series of 32 consecutive complex primary total replacements where an osteotomy of the tibial tubercle was utilised. Results  The patients had a mean follow-up of 2 years and 11 months. Following the procedure, with the exception of one case complicated with deep infection, all of the patients had improved clinically. The mean postoperative range of motion had increased to 102° (give P value < 0.005) and there were no cases of delayed union or non-union. A mechanical complication related to technique occurred in one patient; there were no other cases with a postoperative extension lag. Conclusion  In this challenging population group, we have found a tibial tubercle tuberosity osteotomy to greatly facilitate exposure without compromising the clinical and radiographic outcome.     

28 mm Metasul™ bearings in primary total hip arthroplasty

Assessment of possible low-wear with some former metal-on-metal (MoM) total hip arthroplasties (THA) led to the reintroduction of metallic bearings in the late 80’s. The author reports on two studies of Metasul-28 mm cementless THA. In the first one in a general population, impingement has been the main cause of osteolysis and Co level survey has been a good indicator of Metasul bearing behaviour. In the second study, in a group of 83 less than 50-year-old and active patients, Metasul bearings showed good wear resistance at 7.2 years mean follow-up. In both studies, no general toxic effect could have been detected thus far. According to the current knowledge, it is always reasonable to expect low-wear and better THA longevity with use of MoM bearings under the following conditions: 1) use of a CoCr alloy with high carbide concentration; 2) reduce impingement risk (head without sleeve, slimmer as possible neck, perfectly adapted Morse cone from the same manufacturer, well — oriented components); and 3) prefer cementless acetabular fixation.