氨甲环酸不同给药方式对髋关节置换 围手术期出血的影响研究

目的 探讨3 种不同给药方式应用氨甲环酸减少单侧全髋关节置换（THA）围手术期失血效率和 安全性。方法 选取2015 年1 月-2017 年3 月该院初次接受单侧THA 的患者40 例,将其随机分为3 组。A 组（12 例）：氨甲环酸（TXA）关节腔局部注射给药;B 组（14 例）：TXA 静脉滴注给药联合关节腔局部注射给药; C 组（14 例）：术中喷洒和浸药纱布覆盖创面联合关节腔局部注射给药。比较3 组围手术期显性失血量、隐 性失血量、输血率、平均输血量、凝血功能及血栓性并发症的发生率。结果 3 组间术前一般资料、住院时 间、输血率、术前血红蛋白（HGB）含量及并发症发生率比较,差异无统计学意义（P >0.05）。C 组失血量 和平均输血量低于A、B 组（P <0.05）,A、B 组间比较差异无统计学意义（P >0.05）;3 组术后HGB 水平较 术前降低（P <0.05）,C 组HGB 高于A、B 组（P <0.05）;手术前后3 组间D- 二聚体（DD）、纤维蛋白素 （FIB）、凝血酶原时间（PT）及活化部分凝血活酶时间（APTT）比较,差异无统计学意义（P >0.05）,3 组术 后的FIB 含量较术前降低（P <0.05）,APTT 较术前延长（P <0.05）。结论 局部用药优于静脉给药,可安全有 效减少THA 围手术期出血。     

关节腔注射塞来昔布微球对大鼠类风湿性关节炎的治疗作用

考察关节腔注射塞来昔布（CEL）聚乳酸-羟基乙酸共聚物（PLGA）微球对大鼠类风湿性关节炎的治疗作用。以PLGA为载体,采用O/W乳化溶剂挥发法制备塞来昔布微球（CEL-MS）。采用完全弗氏佐剂诱导佐剂型关节炎（AA）大鼠模型,以大鼠足跖肿胀度、关节炎指数、脾脏指数和关节滑膜组织病理学检查作为治疗效果的指标,考察关节腔注射CEL-MS对大鼠类风湿性关节炎的治疗作用。结果显示,微球的形态圆整、表面光滑,平均粒径为（2.1 ± 0.3）μm、载药量为（20.8 ± 0.6）%。体内药效实验结果显示,与灌胃给予塞来昔布混悬液和关节腔注射塞来昔布混悬液相比,在关节炎大鼠关节腔中注射CEL-MS可显著降低关节肿胀和关节炎指数,有效抑制滑膜炎症。以上结果表明,关节腔注射CEL-MS对大鼠类风湿性关节炎具有良好的治疗作用。     

关节腔注射右美托咪定对膝关节镜术后镇痛的效果

目的 观察关节腔内注射右美托咪定对膝关节镜术后镇痛的效果.方法 择期行膝关节镜手术患者40例,随机分为生理盐水组（关节腔注射生理盐水20 ml）和右美托咪定组（关节腔注射右美托咪定1 μg/kg加生理盐水配置成20 ml）,每组各20例.于术后1、2、4、6、10、12、24 h时以视觉模拟评分（VAS）评价术后镇痛效果,术后当患者VAS评分≥4时静脉注射氯诺昔康8 mg镇痛,每8小时可重复注射1次.记录术后首次需要氯诺昔康镇痛的时间、术后24 h内氯诺昔康的用量及用药后的不良反应.结果 术后6h内右美托咪定组镇痛效果优于生理盐水组（P＜0.05）,右美托咪定组术后首次需要氯诺昔康镇痛的时间（320±115 min）较生理盐水组（69±46 min）延迟,24 h内总用量（8.7±1.9 mg）低于生理盐水组（16.8±2.5mg）（P＜0.05）.结论 关节腔内注射右美托咪定用于膝关节镜术后镇痛能够产生良好的镇痛效果,延长术后首次需要镇痛药辅助的时间.     

跟骨关节内骨折的新术式及疗效分析

目的探讨切开复位内固定治疗跟骨关节内骨折的新方法及临床疗效。方法我中心利用微创技术,跟骨外侧小切口,用自行研制的跟骨解剖钢板及螺栓内固定治疗跟骨关节内骨折共150例183侧,单侧117例,双侧33例。术前根据跟骨X线片及Cr扫描结果进行分型,其中Sander’sⅡ型62侧,Ⅲ型87侧,IV型34侧。结果术后X线片显示跟骨高度、宽度、长度、以及BShler’s角和Gissane’s角均已恢复,无1例切口感染。术后获8～28个月（平均16．3个月）随访。根据美国足踝外科协会跟骨骨折的评分标准：其中优86侧（47．543％）,良81侧（43．72％）,可16侧（8．74％）,优良率为91．3％。结论微创小切口跟骨解剖钢板螺栓内固定治疗跟骨关节内骨折可获得满意的临床疗效。     

Impact of the numbers of injections of platelet rich plasma on the clinical outcomes in patients with knee osteoarthritis: A protocol for an updated network meta-analysis

Background:Two published meta-analyses have investigated the effects of the number of injections of platelet rich plasma (PRP) on clinical outcomes in knee osteoarthritis patients, however conflicting findings were generated.Methods:We will systematically search PubMed, Embase, and China National Knowledgement Infrastructure (CNKI) to capture additional eligible studies. After screening citations, extracting essential data, assessing the risk of bias, we will use RevMan software and Open BUGS to perform head-to-head and network meta-analysis of pain alleviation and improvement of joint functionality, respectively.Discussion:Knee joint osteoarthritis (KOA) is the main cause of joint degeneration in elderly, which seriously reduces patients quality of life. Although intra-articular PRP has been extensively prescribed to treat KOA, a definitive conclusion about the appropriate number of injections has not yet been generated in published meta-analyses. The present updated network meta-analysis will comprehensively answer this question.Ethics and dissemination:We will communicate our findings through participating in academic conferences or submiting it to be considered for publication in peer reviewed scholar journal.INPLASY registration number:We registered this protocol in International Plateform of Registered Systematic Review and Meta-Analysis Protocols (INPLASY) platform and obtained an identifier of INPLASY2020110043 (https://inplasy.com/inplasy-2020-11-0043/).     

跗骨窦微创小切口治疗移位关节内跟骨骨折

目的研究L形入路和跗骨窦微创小切口入路切开复位内固定运用于移位关节内跟骨骨折中的价值。方法选择本院2016年1月-2018年12月纳入的96例移位关节内跟骨骨折患者,按照随机双盲法分成两组各48例,A组采取跗骨窦微创小切口入路,B组采取L形入路,对比两组治疗结果。结果 A组优良率87.50%高于B组75.00%(P<0.05)。治疗前两组的Bohler角、AOFAS评分差异无统计学意义(P> 0.05),治疗后A组各项指标高于B组(P <0.05)。A组并发症发生率4.17%低于B组14.58%(P <0.05)。结论跗骨窦微创小切口入路切开复位内固定运用于移位关节内跟骨骨折中效果显著,有效改善关节功能,减少并发症发生率。     

Intra-articular glucocorticoids in early juvenile chronic arthritis

The efficacy of intra-articular glucocorticoid injections in the early phase of knee joint synovitis was studied in 79 children with juvenile chronic arthritis (42 girls and 37 boys). Half of the injections were given within the first six months from the onset of the disease. The probability of a patient staying in remission was much higher in triamcinolone-treated patients than in patients receiving methylprcdni-solone ( p <0.0005, Breslow statistics). Using multivariate analysis there was a significant association between the length of remission and the synovial fluid polymorphonuclcar leucocyte proportion (SF-PMN%. Patients with a high SF-PMN% tended to have shorter remissions than those with a low SF-PMN% (improvement of the fit in stcpwise model: chi-square = 8.81, p <0.005). The difference between triamcinolone and methylprednisolone groups was still clearly evident two years after injection.     

Conservative Treatment of Ankle Osteoarthritis: Can Platelet-Rich Plasma Effectively Postpone Surgery?

Osteoarthritis is the most common and disabling of the orthopedic diseases. Currently, the conservative treatment of osteoarthritis is limited to symptomatic treatment, whose goal is to improve function and pain control. Ankle osteoarthritis is relatively uncommon, in contrast to osteoarthritis of the hip and knee, and the therapeutic options (both pharmacologic and surgical) are limited, with surgery providing poorer and less predictable results. The effectiveness of platelet-rich plasma injections for osteoarthritis is still controversial, especially so for ankle arthritis, owing to the lack of evidence in the present data. We retrospectively evaluated the mid- to long-term clinical results (mean follow-up of 17.7 months) for platelet-rich plasma injections in 20 patients (20 ankles) with ankle osteoarthritis. We evaluated the presence of pain using the visual analog scale, function using the Foot and Ankle Disability Index, and subjective satisfaction. The pre- and post-treatment scores, obtained from the clinical records and from telephone interviews during the follow-up period, were compared using the Student t test. We found a strong positive effect for 4 platelet-rich plasma injections (injected once a week) on pain (p = .0001) and function (p = .001), with 80% of patients very satisfied and satisfied, and only 2 patients (10%) required surgery because of early treatment failure. These results suggest that the use of platelet-rich plasma injection is a valid and safe alternative to postpone the need for surgery.     

跟骨关节内骨折合并腓骨肌腱脱位的多层螺旋CT诊断

目的：探讨多层螺旋CT(multi-slice computed tomography,MSCT)诊断跟骨关节内骨折合并腓骨肌腱脱位的临床价值。方法：选择新乐市中医医院2013年1月至2015年6月收治的跟骨关节内骨折患者142例,共154足,对所有患者进行MSCT扫描,并进行附带肌腱的容积再现(virtual reality, VR)和多平面重组(multiple planar reconstruction,MPR),测量足跟骨结节外侧突后缘至载距突内侧面的距离、载距突后缘的跟骨宽度。结果：128只足不存在腓骨肌腱脱位(未脱位组),轴位及冠状位MPR及VR图显示腓骨肌腱位于腓骨肌腱沟内;26只足存在腓骨肌腱脱位(脱位组),MSCT显示腓骨肌腱从腓骨肌腱沟内脱出,并向外侧移位。脱位组跟骨结节外侧突后缘至载距突内侧面的距离、载距突后缘的跟骨宽度均大于未脱位组[(5.08±0.61) vs.(4.78±0.59) cm;(4.18±0.47) vs.(3.83±0.50) cm;P<0.05]。脱位组均行骨折切开复位、钢板内固定治疗,未对腓骨肌腱脱位进行处理。术后对15只足随访12个月,其中3只足腓骨肌腱复位,另外12只仍处于脱位状态。结论：MSCT可多角度观察腓骨肌腱和腓骨肌腱沟的位置,准确判断跟骨关节内骨折是否合并腓骨肌腱脱位,对于腓骨肌腱脱位的临床诊断和治疗具有重要意义。     

掌侧锁定板内固定和外固定支架治疗桡骨远端关节内骨折的疗效比较

目的比较采用掌侧锁定板内固定与外固定架外固定治疗桡骨远端关节内骨折的疗效。方法 43例桡骨远端关节内骨折患者,其中男性31例,女性12例;年龄18～68岁,平均年龄35.16岁。分为2组,即内固定术组（采用掌侧锁定板）和外固定支架术组。回顾分析采用切开复位掌侧锁定板内固定术和采用闭合复位或者有限切开外固定支架术（其中11例结合克式针内固定）治疗情况。通过术后不同时期（术后2～3d、1个月、2个月、3个月、6个月、12个月）X射线片测量、关节活动度、握持力量等进行比较;对患者主观功能评估使用上肢、肩、腕伤残（DASH）评分。平均随访时间15个月（8～18个月）。结果放射学评价方面,内固定术组较外固定支架术组掌倾角恢复好,桡骨长度丢失情况内固定术组好于外固定支架术组,差异有统计学意义（P〈0.05）;术后末次随访内固定术组握力和关节屈伸活动度较外固定支架术组恢复更好,差异有统计学意义（P〈0.05）;末次随访DASH评分,内固定术组为7.9±6.1,外固定支架术组为14.1±5.4。内固定术组无明显术后并发症;外固定支架术组再手术1例,第二掌骨骨折1例,术后钉道感染2例。结论相比较来说,掌侧锁定钢板治疗桡骨远端关节内骨折效果更好。