Tratamiento del paciente con artrosis

The therapeutic management of patients with osteoarthritis aims to decrease pain and inflammation, improve physical function, and to apply safe and effective treatments. A patient-centered approach implies the active participation of the patient in the design of the treatment plan and in timely and informed decision-making at all stages of the disease. The nucleus of treatment is patient education, physical activity and therapeutic exercise, together with weight control in overweight or obese patients. Self-care by the individual and by the family is fundamental in day-to-day patient management. The use of physical therapies, technical aids (walking sticks, etc.) and simple analgesics, opium alkaloids, and antiinflammatory drugs have demonstrated effectiveness in controlling pain, improving physical function and quality of life and their use is clearly indicated in the treatment of osteoarthritis. Conservative surgery and joint replacement is indicated when treatment goals are not achieved in specific patients.     

重度脊柱畸形的截骨矫形原则

<正>对于重度脊柱畸形而言,单纯后路内固定术无法达到有效矫形的目的,而脊柱截骨矫形作为一种更加有效的治疗手段逐渐被广泛应用。截骨矫形术除了可以对僵硬的脊柱畸形进行有效矫正以外,对于存在冠状面及矢状面失平衡的重度脊柱畸形患者也有良好     

不对称经椎弓根截骨矫治成人先天性脊柱侧后凸畸形

【摘要】 目的：分析应用不对称经椎弓根截骨技术矫治成人先天性脊柱侧后凸畸形的临床疗效。方法：2009年9月~2013年10月采用不对称经椎弓根截骨矫治成人先天性脊柱侧后凸畸形患者16例,男9例,女7例。年龄18～42岁,平均23.6岁。均有腰背痛,无神经受压症状。16例患者脊柱侧凸Cobb角43°~97°,后凸Cobb角15°~70°。侧凸畸形和后凸畸形顶椎均位于同一节段,其中顶椎位于胸椎10例、腰椎6例。于术前、术后及末次随访时在X线片上测量脊柱冠状面主弯Cobb角、矢状面后凸角、冠状面平衡及矢状面平衡,比较术前、术后及末次随访时影像学参数评估手术矫形效果。于术前、末次随访时填写SRS-22问卷量表,评估患者术后的生活质量变化。结果：手术融合节段5~12个,平均7.23个节段。手术时间3~7h,平均4.26h。术中出血量700～2500ml,平均1265ml。1例L1部位截骨患者术后出现双下肢痛觉过敏,急诊手术探查发现截骨部位硬脊膜皱褶,脊髓受压,对截骨部位椎板切开减压,术后症状明显好转,术后3个月随访神经症状消失。2例患者术后出现一侧胸腔积血,紧急行胸腔闭式引流术,1周后拔除引流管。15例患者获得6～48个月（平均13.4个月）随访。获得随访的15例患者冠状位主弯Cobb角术前为58.67°±20.36°（43°～97°）,术后为20.32°±8.76°（8°～37°）,末次随访时为21.76°±8.34°（10°～41°）,术后与术前比较差异有统计学意义（P<0.01）,矫正率为50.76%~82.36%,平均为65.36%,末次随访时与术后比较丢失率为2.45%。术前矢状位后凸角度为45.62°±16.26°（15°～70°）,术后为16.35°±16.87°（-20°～40°）,末次随访时为18.27°±13.92°（-15°～40°）,术后与术前比较差异有统计学意义（P<0.01）,矫正率为50.97%~79.32%,平均为64.16%,末次随访时与术后比较丢失率为4.2%。15例患者中,6例术前存在冠状面失平衡,术后均恢复平衡;4例术前存在矢状面失平衡,术后3例恢复平衡,1例仍为失平衡。SRS-22问卷量表总得分由术前66.47±12.35分（49～79分）提高至末次随访时的84.13±6.42分（76～92分）（P<0.01）。15例患者均获得骨性融合,无假关节形成或内固定断裂。结论：应用不对称经椎弓根截骨技术矫治先天性脊柱侧后凸畸形,可获得较好的矫形效果,显著改善患者躯体外观及躯体平衡,同时明显改善患者的生活质量。     

椎板关节突截骨治疗中重度退行性脊柱侧凸近期疗效观察

目的：探讨中重度退行性脊柱侧凸的后路截骨术治疗方法和临床效果。方法2012年1月-2013年12月对9例中重度退行性脊柱侧凸患者采用了后路选择性经椎板关节突截骨、减压、椎弓根螺钉内固定去旋转矫形术治疗,对其近期疗效进行观察。结果与本组术前相比,JOA评分、Cobb角均有明显改善,差异有统计学意义( P<0．05),4例患者有轻度下肢疼痛、麻木,无其他并发症。结论后路选择性椎板关节突截骨椎弓根螺钉内固定旋转矫形手术治疗中重度退行性脊柱侧凸可起到减压、矫形、融合、重建脊柱稳定性的目的,近期效果满意。     

A comparative in vivo ultrasonometric evaluation of normal and delayed fracture healing in sheep tibiae

OBJECTIVE:

To compare normal and delayed bone healing by measuring ultrasound conduction velocity across the bone callus.

METHODS:

A model of transverse linear and 5 mm resection osteotomies of sheep tibiae was used. Fourteen sheep were operated on and were divided into two groups of seven according to osteotomy type. The procedure was performed on the right tibiae and the intact left tibiae were used as controls. The transverse and axial ultrasound velocities were measured at 30-day intervals for 90 days, after which the animals were killed and both the right and left tibiae were resected for in vitro biomechanical analysis.

RESULTS:

Both the transverse and axial ultrasound velocities progressively increased, but the increase was smaller for the delayed union that resulted from the resection osteotomy. The mechanical resistance was higher for the normally healed tibiae that resulted from a linear osteotomy; this result closely correlated with the ultrasound velocity results. Significant differences were found for the comparisons between the intact and operated tibiae in both groups and between the groups for both the transverse and axial ultrasound velocities, but the differences were greater for the latter.

CONCLUSION:

We conclude that in vivo transverse and axial ultrasound velocities provide highly precise information about the healing state of both linear and resection diaphyseal osteotomies, but the axial ultrasound velocity most likely has greater discriminatory power. This method has the potential for clinical application in humans.     

Osteotomy in the vertical ramus outside the mandibular foramen for tumours in the parapharyngeal space

IntroductionAlthough several techniques have been described to access the parapharyngeal space, tumour surgery in this area remains a challenge. This study investigated a simple and safe technique to access parapharyngeal space tumours.Material and methodsEight primary parapharyngeal space tumours were treated with osteotomy of the vertical ramus outside the mandibular foramen. The primary tumours were pleomorphic adenoma, schwannoma, Warthin's tumour, lipoma, chordoma, and adenoid cystic carcinoma. Tumour size ranged from 4 × 4 cm to 6 × 7 cm. Patients with malignant tumours who underwent surgical resection also received adjuvant dose-fractionated stereotactic radiotherapy.ResultsAll tumours were removed completely without rupture. No patient exhibited any permanent postoperative complication, malocclusion, or other dental complications from this surgical approach. One patient had slight transient postoperative facial paresis, which resolved spontaneously within 4 weeks. The patients were followed for 7–26 months, during which no recurrence was encountered.ConclusionsOsteotomy of the vertical ramus outside the mandibular foramen achieved good exposure and satisfactory aesthetic and functional results. This simple and safe technique facilitates the removal of infratemporal fossa tumours while preserving the inferior alveolar nerve.     

Scarf截骨联合软组织平衡松解治疗重度拇外翻

目的：探讨Scarf截骨联合软组织平衡治疗重度拇外翻的手术疗效。方法：回顾性分析2019年6月至2021年6月采用Scarf截骨联合软组织平衡手术治疗的38例（50足）重度拇外翻患者的临床资料,男6例（8足）,女32例（42足）;年龄29～64(54.7±6.8)岁;左侧26足,右侧24足;病程5～23(12.4±3.9)年。比较手术前后拇外翻角（hallux valgus angle,HVA）、第1、2跖骨间角（intermetatarsal angle,IMA）、跖骨远端关节面角（distal metatarsal articular angle,DMAA）,观察术后并发症发生情况。术前和末次随访时采用美国足与踝关节协会（American orthopedic foot ankle society,AOFAS）评分评价前足功能恢复情况,采用视觉模拟评分法（visual analogue scale,VAS）评价患者疼痛缓解程度。结果：38例患者（50足）均获随访,时间15～23(18.3±3.2)个月。HVA、IMA、DMAA术前分别为（44.61±3.92）°、（18.74±2....     

微创与传统Chevron截骨治疗轻中度拇外翻的疗效比较

目的:比较微创与传统Chevron截骨法治疗轻中度拇外翻的临床疗效。方法:回顾性分析2019年1月至2021年月2月收治的36例(36足)轻中度拇外翻患者的临床资料,按照手术方法不同分为微创截骨组(微创组)和传统Chevron截骨组(传统组)。微创组16例(16足),男1例,女15例,年龄36～60(49.0±9.5)岁;按照Mann分型标准,轻度9例,中度7例;采用微创截骨结合空心钉固定治疗。传统组20例(20足),男2例,女18例,年龄38～65(50.0±9.2)岁;按照Mann分型标准,轻度11例,中度9例;采用传统Chevron截骨治疗。观察并比较两组患者术前和术后12个月拇外翻角(hallux valgus angle,HVA),第1、2跖骨间角(intermetatarsal angle,IMA),比较术前、术后6周和12个月美国矫形足踝外科协会(American Orthopedic Foot and Ankle Society,AOFAS)前足评分和视觉模拟评分(visual analogue scale,VAS)。结果:36例(36足)患者获得随访,时间14～30(...     

微创Chevron合并外侧软组织松解治疗轻中度拇外翻畸形的短期疗效分析

目的:探讨微创Chevron合并外侧软组织松解治疗轻中度拇外翻畸形的短期疗效。方法:自2019年1月至2021年12月,采用微创Chevron截骨加外侧软组织松解术式治疗67例(80足)轻中度拇外翻患者,男5例(6足),女62例(74足);年龄20～60(47.2±9.7)岁;轻度(拇外翻角≤20°)54例(64足),中度(20°<拇外翻角≤40°)13例(16足)。比较术前与末次随访时拇外翻角(hallux valugs angle,HVA),Ⅰ-Ⅱ跖骨间角(Ⅰ-Ⅱ intermetatarsal anlge,Ⅰ-Ⅱ IMA),远端跖骨关节角(distal metatarsal articular angle,DMAA),籽骨Hardy评分变化,并采用北美足踝外科协会拇趾-跖趾关节(American Orthopaedic Foot and Ankle Society’s Hallux Metatarsophalanged-Interphalangeal,AOFAS Hallux MTP-IP)评分进行疗效评价。结果:67例患者获得随访,时间6～23(13.7±6.5)个月。术...     

微创跖骨近端截骨联合Akin截骨术治疗重度 外翻

目的:探讨微创跖骨近端闭合楔形截骨术（proximal closing wedge osteotomy,PCWO）联合Akin截骨术治疗重度 外翻的临床疗效。 方法:选取2016年8月至2018年8月重度 外翻患者45例（50足）,其中男14例,女31例;年龄（40.1±13.0）岁（...