Intra-articular use of hyaluronic acid in the treatment of osteoarthritis

Osteoarthritis is one of the leading causes of disability in the elderly. The changes in the lubricating properties of synovial fluid lead to significant pain and loss of function. More than ten years have passed from the first studies. Up till now many authors have supported intra-articular hyaluronan (HA) therapy as not only a symptom-modifying therapy but also a treatment which may significantly decrease the rate of deterioration of joint structure. In this review we report data relative to knee and hip treatment. The ongoing studies continue to further our understanding of the fundamental mechanisms that likely underlie the therapeutic benefits of this treatment but, despite recent progress, many unresolved issues require further study. Large scale double blind controlled studies must be carried out to confirm these promising data and produce meaningful guidelines.     

CT引导关节腔内注射施沛特配合松解术治疗肩关节周围炎的临床研究

为观察CT引导肩关节腔内注射的临床价值和施配特配合松解术治疗肩关节周围炎的临床效果。行肌间沟麻醉下手法松解术后，分别配合和不配合关节腔内注射施沛特治疗肩关节周围炎；统计分析了CT引导和不在CT引导下行肩关节腔内注射的成功率；观察了施沛特注射到关节腔内、外的CT征像。结果表明137例（治疗组）和46例（治疗对照组）松解术后配合和不配合关节腔内注射施沛特的疗效有显著差异（P〈0．01）；123个肩（引导组）和40个肩（引导对照组）肩关节腔内注射的成功率和有效率分别为1130％、52．50％，两者有显著差异（P〈0．01）；治疗组注射到关节腔内的施沛特弥散良好，5例（影像对照组）注射到关节腔外施沛特呈块状。表明，CT引导肩关节腔内注射具有定位准确，方法简单等优点；关节腔内注射施沛特配合松解术治疗肩关节周围炎，提高了肩关节松解术治疗肩关节周围炎的疗效。     

银针联合玻璃酸钠治疗膝骨关节炎的随机对照研究

目的观察陆氏银质针联合关节腔内注射玻璃酸钠治疗膝骨关节炎的疗效。方法 64例膝骨关节炎患者,随机分为治疗组32例（陆氏银质针治疗联合膝关节腔内注射玻璃酸钠）、对照组32例（膝关节腔内注射玻璃酸钠）进行治疗,比较两组疗效。结果治疗组总有效率为96.9%,对照组为84.4%,两组差异有统计学意义（P〈0.05）。结论陆氏银质针联合关节腔内注射玻璃酸钠治疗膝骨关节炎疗效显著。     

Combination of intra-articular tenoxicam, lidocaine, and pethidine for outpatient knee arthroscopy

BACKGROUND: Studies of intra-articular non-steroidal anti-inflammatory drugs have revealed an analgesic effect equivalent to that of intra-articular local anaesthetic agents and morphine. The aim of this study was to evaluate the analgesic effect of intra-articular lidocaine, pethidine and tenoxicam compared with that of lidocaine and pethidine on postoperative pain after arthroscopy. METHODS: After day-case knee arthroscopy, 60 patients were randomly allocated to one of three groups to receive 20 ml of a solution containing 0.9% saline (group S), 2% lidocaine and 10 mg preservative-free pethidine (group LP) and 2% lidocaine, 10 mg preservative-free pethidine and 20 mg tenoxicam (group LPT). Postoperative pain was assessed using a visual analogue scale and measuring analgesic requirements. RESULTS: Pain scores were significantly lower in the LP group than in the S group at 1 and 2 h after surgery. From 4 h until the end of the first postoperative day, pain scores were significantly lower in the LPT group of patients at rest and on knee flexion than in the other two groups; these patients also used less oral analgesics (P<0.05). CONCLUSION: The combination of 20 ml lidocaine 2%, 10 mg pethidine and 20 mg tenoxicam given intra-articularly provided superior analgesia and reduced oral analgesic requirement during the first day after arthroscopy compared with lidocaine and pethidine alone.     

关节腔注射A型肉毒毒素治疗卒中后肩痛的疗效观察

目的:比较关节腔注射A型肉毒毒素(botulinum toxin type A,BTA)与类固醇治疗卒中后肩痛的疗效。方法:46例卒中后肩痛患者随机分为治疗组和对照组,超声引导下行关节腔注射,治疗组注射A型肉毒毒素和利多卡因,对照组注射曲安耐德和利多卡因。治疗前、治疗后即刻、1周后、4周后对患者进行评定。内容包括视觉模拟评分(VAS);Fugl-Meyer简式运动功能评定上肢部分;肩关节屈、外展、外旋被动关节活动度(ROM)。结果:治疗后即刻和1周后,两组VAS降低,与治疗前差异均有显著性意义(P0.05);4周后治疗组仍有差异(P0.05),对照组与治疗前无差异。两组的Fugl-Meyer简式运动功能评定在治疗后即刻和1周后均无改善,4周后两组评分均提高,与治疗前差异有显著性意义(P0.05)。治疗后即刻,两组外旋ROM改善,与治疗前差异均有显著性意义(P0.05),治疗组4周后仍有差异(P0.05),对照组1周后和治疗前差异无显著性意义。治疗1周后,对照组屈曲ROM改善,与治疗前差异有显著性意义(P0.05);4周后治疗组屈曲ROM改善,与治疗前差异有显著性意义(P0.05),对照组与治疗前无差异。两组外展ROM较治疗前无明显改善。结论:关节腔注射BTA能减轻卒中后肩痛的疼痛程度,并改善肩关节ROM,疗效可能优于曲安耐德。     

液压扩张结合小针刀疗法治疗肩周炎的临床观察

2000年2月-2006年1月采用液压扩张配合小针刀疗法治疗肩周炎187例,疗效满意,现报告如下.     

可吸收螺钉在关节内骨折中的应用

目的评价可吸收螺钉在关节内骨折中的临床应用效果。方法采用超高分子聚-DL-乳酸(PDLLA)自膨胀可吸收螺钉治疗关节内骨折162例,术后石膏托固定3～4周。定期随访,了解骨折愈合及关节功能情况。结果术后随访3—24个月,按王伟敦等疗效评定标准,优126例,良31例,差5例。优良率96．9％。结论PDLLA自膨胀可吸收螺钉是关节内骨折理想的内固定物,其操作简单,固定确切,生物相容性好。     

水针刀靶向三点松解注射技术在冻结肩治疗中的应用

目的:观察水针刀靶向三点松解注射微创技术治疗冻结肩的临床效果。方法:自2017年3月至2018年11月,将140例冻结肩患者分为观察组与对照组。观察组70例,男30例,女40例;年龄(59.2±11.5)岁;病程(6.76±4.14)个月;采用水针刀靶向三点松解注射治疗。对照组70例,男29例,女41例;年龄(58.9±11.8)岁;病程(6.65±3.98)个月;采用小针刀治疗。在治疗前和疗程结束1个月后分别采用简化麦吉尔疼痛问卷表对两组患者的疼痛程度进行评估,采用Constant-Murley肩关节评分系统对两组患者的肩关节功能进行评估,并比较治疗后两组临床疗效,最后采用疼痛程度的改善率来评定患者的治疗效果。结果:疗程结束1个月后,两组冻结肩患者SF-MPQ中的分类疼痛评估指数、视觉模拟评分、现时疼痛强度及总的疼痛评分均较治疗前下降(P0.01),观察组的疼痛程度评分低于对照组(P0.01);两组肩关节疼痛、功能活动、肌力评分、活动度及Constant-Murley总评分均较治疗前提高(P0.01),观察组的肩关节疼痛、功能活动、活动度及Constant-Murley总评分优于对照组(P0.01),但肌力评分与对照组相比差异无统计学意义(P0.05);观察组疼痛程度改善愈显率为70.0%,优于对照组(45.7%),P=0.003;观察组疼痛程度改善总有效率为97.1%,优于对照组(84.3%),P=0.009。结论:采用水针刀靶向三点松解注射技术治疗冻结肩疗效确切,操作简单,患者痛苦小,安全性高,是一种较好的微创治疗方法。     

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。