壮筋养血汤治疗晚期跟骨关节内骨折临床观察

目的 探讨壮筋养血汤治疗晚期跟骨关节内骨折患者的效果及安全性.方法 选择2018年6月—2020年11月大同大学附属医院收治的88例晚期跟骨关节内骨折患者为研究对象,以随机数字表法分为对照组(44例)和研究组(44例).2组均接受切开复位内固定术治疗,对照组术后接受抗感染等西医治疗,研究组在对照组的基础上采用壮筋养血汤...     

盐酸青藤碱关节腔注射用纳米粒温敏凝胶的制备及其性质考察

目的 制备关节腔注射用盐酸青藤碱固体脂质纳米粒(盐酸青藤碱-SLN)温敏凝胶并考察其体外释放特征.方法 以泊洛沙姆407 (P-407)和泊洛沙姆188 (P-188)为凝胶基质,以凝胶胶凝温度为考察对象对处方进行优化;微乳液法制备盐酸青藤碱-SLN,冷溶法制备盐酸青藤碱-SLN温敏凝胶;用HPLC法测定盐酸青藤碱的量,透析法研究盐酸青藤碱-SLN温敏凝胶的体外释放特性.结果 最佳处方为18％P-407、5％ P-188和0.6％羟丙基甲基纤维素(HPMC),所制盐酸青藤碱-SLN温敏凝胶胶凝温度为(34.5±0.2)℃.体外释放结果显示盐酸青藤碱-SLN温敏凝胶24 h内累积释放率为(57.79±0.36)％,48 h内累积释放率为(75.16±0.12)％,具有明显的缓释作用.结论 所制盐酸青藤碱-SLN温敏凝胶具有温敏特性和明显的缓释作用,纳米载体和温度敏感凝胶的组合有望成为新的关节腔给药传递系统.     

Dynamic and Functional Gait Analysis of Severely Displaced Intra-Articular Calcaneus Fractures Treated with a Hinged External Fixator or Internal Stabilization

The purpose of this article was to assess functional gait outcome. Fifty-five patients with severely displaced intra-articular calcaneus fractures and soft tissue damage were evaluated prospectively with computerized dynamic pedography and a clinical scoring scale. The treatment protocol assigned 30 patients to open reduction and internal fixation (ORIF) and 25 to closed reduction and stabilization with a biomechanically tested hinged external fixator. Gait parameter was evaluated by measuring plantar pressure distribution, length of a double-step, double-step duration, standing duration, effective foot length, and width of gait. Pedographic measurements were performed with a custom-made gait analysis system (medilogic Gangas, Berlin, Germany). Results were graded by an extended protocol of questionnaires and the American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot scales. Radiographs were reviewed according to the Sanders classification at the time of follow-up (7.3 years). All measurements were statistically analyzed (t test; Mann-Whitney U test). Aberrations were associated with all calcaneal fractures in both groups. Dynamic gait analysis showed gait asymmetry in all patients. The type of treatment (ORIF or a hinged fixator) of severely displaced calcaneus fractures did not affect gait analysis nor result in significantly different (P > .05) patient outcome scores. The gait analysis system allows a valid dynamic pedographic measurement. The hinged external fixator can be recommended in displaced intra-articular calcaneal fractures with severe soft tissue damage to reduce complications associated with ORIF. ACFAS Level of Clinical Evidence: 2c.     

(iii) Principles of acetabular fractures

Acetabular fractures are rare, significant injuries involving the articular surface of the acetabulum. They are typically associated with a high-energy mechanism of injury, though fragility type fractures are now increasingly seen. Associated injuries to another organ system are seen in half of all cases. Radiographic assessment is performed using antero-posterior pelvic radiographs and Judet views, as well as computerized tomography (CT). Classification is based on the column theory and describes fracture anatomy in relation to the anterior and posterior columns. Non-operative treatment is indicated when there is less than 2 mm of articular displacement or when patient factors (such as associated injuries/co-morbidities) or soft tissue injury are incompatible with surgery. Open reduction and internal fixation is indicated in displaced fractures, total hip arthroplasty being used in unreconstructable injuries. Operative treatment involves difficult exposures and technically demanding reduction and fixation techniques. Significant associated injuries include neurovascular injury, bleeding, open fracture wounds, soft tissue injury, hip dislocation and femoral fractures. Late complications include post-traumatic osteoarthritis, avascular necrosis and heterotopic ossification. The goals of treatment should be to give the patient a congruent, functional hip whilst minimizing the complications from both the injury and surgery. Poor results are more likely if the reduction is non-anatomical.     

透明质酸钠关节内注射治疗踝关节骨性关节炎疗效观察

目的观察透明质酸钠注射液（SH）关节内注射治疗踝关节骨性关节炎的临床疗效.方法对25例踝关节骨性关节炎患者（36踝关节）常规关节腔穿刺注入SH,每周给药1次,每次2 ml,连续给药5周后评定踝关节疼痛、肿胀及功能障碍改善情况.结果患者的踝关节疼痛、关节肿胀及功能障碍等均有改善（P＜0.05～0.01）,总有效率91.61%.结论SH对踝关节骨性关节炎是一种安全、理想、有效的治疗药物.     

Rare Cause of Knee Pain after Martial Arts Demonstration: A Case Report

Background

Patellar dislocations are a commonly treated injury in the Emergency Department (ED), with a majority of cases involving lateral subluxation of the patella outside of the joint space. Intra-condylar dislocations of the patella are rare. Of the two types of axis rotation, vertical and horizontal, the vertical occurs five times less frequently. These injuries most often undergo open reduction or, at best, closed reduction under general anesthesia.

Objectives

To remind Emergency Physicians to consider this injury in any patient with severe knee pain and limited mobility, even with a history that is lacking significant trauma.

Case Report

We present a case of intra-condylar patellar dislocation with vertical axis rotation.

Conclusion

This injury is no longer primarily attributed to the young and, barring fracture, closed reduction in the ED should be considered.     

膝关节镜微创术后臭氧配合玻璃酸钠关节腔内注射治疗中重度单膝关节骨性关节炎78＇f~lJ短期疗效观察

目的 观察膝关节镜微创术后臭氧（O3）配合玻璃酸钠（SH）关节腔内注射治疗中重度单膝关节骨性关节炎（OA）的临床疗效并探讨其机理.方法 回顾性分析216例行膝关节镜微创术后中重度单膝关节OA患者的临床资料,按术后辅助治疗策略分为联合治疗组 （O3 ＋SH） 78例、O3组66例及SH组72例.采用WOMAC骨关节炎指数评分评估三组治疗前及治疗后30d、90d及180d的临床疗效.结果 治疗30d后,与O3组和SH组比较,联合治疗组WOMAC总分、疼痛评分均显著降低（P均〈0.01）;O3组僵直评分较SH组显著降低（P〈0.01）,但与联合治疗组比较无显著差异（P〉0.05）;而三组间功能丧失评分无显著差异（P〉0.05）.治疗90d后,与O3组和SH组比较,联合治疗组WOMAC总分、疼痛评分、功能丧失评分均显著降低（P均〈0.01）;与SH组比较,O3组疼痛评分、僵直评分显著降低（P均〈0.01）;联合治疗组僵直评分也较SH组显著降低（P〈0.01）,但联合治疗组和O3组僵直评分无显著差异;而SH组功能丧失评分较O3组显著降低（P〈0.05）.治疗180d后,与O3组和SH组比较,联合治疗组WOMAC总分、疼痛评分、僵直评分、功能丧失评分均显著降低（P均〈0.01）;与SH组比较,O3组僵直评分显著降低（P〈0.01）.结论 膝关节镜微创术后对中重度单膝关节OA患者进行关节腔内O3配合SH注射治疗能尽早显著减轻患者膝部疼痛、改善膝关节整体功能,提高关节活动度,改善预后,远期获益显著.     

106例跟骨关节内骨折的手术治疗

目的 探讨跟骨关节内骨折的手术治疗效果及其并发症防治措施.方法 对106例(135足)跟骨关节内骨折患者采用切开复位跟骨钢板内固定治疗,骨折按Sanders 分型,Ⅱ型51足,Ⅲ型62足,Ⅳ型22足,术后随访5～20个月,观察有无并发症发生,术后功能恢复情况等,对治疗效果进行总结评价.结果 106例患者骨折均愈合,功能恢复良好,其中优58例,良38例,优良率为90.57%.4例切口愈合延迟,2例伤口发生感染,4例术后持续性疼痛,并发症发生率为9.43%.结论 切开复位跟骨钢板内固定术是治疗跟骨关节内骨折的有效治疗方法.     

两种方法治疗 Sanders Ⅱ～Ⅳ型跟骨关节内塌陷骨折的疗效观察

目的：探讨克氏针撬拨顺序复位联合接骨板内固定治疗SandersⅡ～Ⅳ型跟骨关节内塌陷骨折的疗效。方法应用克氏针联合接骨板内固定术式治疗SandersⅡ、Ⅲ、Ⅳ型42例50足跟骨关节内骨折。结果所有患者均获随访,随访时间6～24个月,平均（14±9．5）个月。实验组手术时间、手术出血量和VAS评分均小于对照组,差异有统计学意义（ P＜0．05）。两组患者术后B？hler′s角、Gissane角、跟骨长度和丘部高度相比差异有统计学意义（P＜0．05）。两组跟骨宽度和结节部高度相比差异无统计学意义（P＞0．05）。对照组Fernandez跟骨骨折功能组优良率69．05％,实验组92．86％,两组优良率相比差异有统计学意义（ P＜0．05）。结论克氏针撬拨顺序复位联合接骨板内固定是治疗SandersⅡ～Ⅳ型跟骨关节内塌陷骨折的有效方法。     

Comparative Efficacy of Intra-Articular Steroid Injection and Distension in Patients With Frozen Shoulder: A Systematic Review and Network Meta-Analysis

Objective

To compare the efficacy of intra-articular (IA) steroid injection and distension in patients with frozen shoulder.