四神煎治疗膝骨关节炎急性期30例临床观察

目的观察四神煎治疗膝骨关节炎急性期的临床疗效。方法将60例膝骨关节炎急性期患者随机分为治疗组与对照组,每组各30例。治疗组予以四神煎合用英太青(双氯芬酸钠缓释胶囊)治疗,对照组单以英太青口服,疗程2周。治疗前后观察晨僵、关节肿胀、关节发热、关节压痛4项症状、体征和血沉、C-反应蛋白。结果治疗组的总有效率为96.66%,对照组的总有效率为73.33%,两组比较差异具有显著性意义(P<0.05);治疗组在改善患者晨僵、关节肿胀、关节发热、关节压痛和降低C-反应蛋白方面均优于对照组。结论四神煎治疗膝骨关节炎急性期疗效明显,是临床有效方剂。     

Multiple floppy valves with all cardiac valves prolapsing: Clinical course and treatment

Summary Two cases with prolapse of all four cardiac valves are described and compared with two similar ones previously reported. The severity and progression of regurgitation of each of the valves differed by case, despite having similar echocardiographic findings consistent with the diagnosis of multiple floppy valves. Two of the four patients had their aortic valve replaced because of severe regurgitation: the excised valves revealed myxomatous degeneration. None of the patients had any stigmata of Marfan or Ehlers-Danlos syndrome, except for the presence of hyperextensive joints. There may be an unknown collagen disorder that caused floppiness in all the valves.     

膝关节粘连性功能障碍的手术和康复治疗：附20例病例分析

20例因创伤或某些病变后致膝关节纤维性僵直的住院患者,关节活动范围平均40°,影响工作及生活.采用手术分离膝关节内粘连及术后康复治疗,结果,膝关节活动范围平均达110°,较术前增加 70°.15例经平均27个月的随访,优者10例,良者3例,可者2例.     

Costs and outcomes associated with alternative discharge strategies following joint replacement surgery: analysis of an observational study using a propensity score

We estimated the impact of alternative discharge strategies, following joint replacement (JR) surgery, on acute care readmission rates and the total cost of a continuum of care. Following surgery, patients were discharged to one of four destinations. Propensity scores were used to adjust costs and outcomes for potential bias in the assignment of discharge destinations. We demonstrated that the use of rehabilitation hospitals may lower readmission rates, but at a prohibitive incremental cost of each saved readmission, that patients discharged with home care had longer acute care stays than other patients, that the provision of home care services increased health system costs, and that acute care readmission rates were greatest among patients discharged with home care. Our study should be seen as one important stepping stone towards a full economic evaluation of the continuum of care for patients.     

The imaging spectrum of Baker's (Popliteal) cysts

Baker's (Popliteal) cysts are frequently encountered on cross-sectional imaging of the knee. These consist of enlarged gastrocnemius semimembranosus bursa which typically communicate with the knee. They may be imaged with a variety of techniques including arthopgraphy, CT, ultrasound and MRI, with the latter two being more commonly used. Examples of bursa imaged with all of the above techniques are demonstrated in the essay, as well as variance of normal appearance and pathological entities including ruptured bursa, abnormally positioned bursa, osteochondromatosis, septic complications of the bursa and pigmented villonodular synovitis.     

Tranexamic acid given intraoperatively reduces blood loss after total knee replacement: a randomized,controlled study

BACKGROUND: Extensive blood loss in total knee replacement (TKR) surgery is well known and is associated with a high transfusion rate of allogenic blood. Tranexamic acid (TXA) has been shown to reduce blood loss by 50% in this patient group, but only in cases with a perioperative loss of 1400-1800 ml. This study was performed to see if TXA offers any advantages in knee replacement surgery with blood loss at 800 ml. METHODS: Thirty consecutive patients scheduled for TKR in spinal anesthesia with the use of a tourniquet, were randomized to TXA or non-TXA. Tranexamic acid 10 mg kg-1 was given at conclusion of surgery and again 3 h later. Blood loss was registered. RESULTS: Total blood loss was at all times significantly lower in the TXA group compared to the non-TXA group (409.7+/-174.9 ml vs. 761.7+/-313.1 ml; P<0.001). There were no differences in coagulation parameters. No patients in the TXA group had a blood transfusion vs. 13% in the non-TXA group (NS). No complications were registered in the two groups. CONCLUSION: We conclude that TXA significantly reduces blood loss after total knee replacement surgery.     

氯胺酮与氟哌啶复合麻醉用于兔膝骨性关节炎模型

目的探索氯胺酮、氟哌啶应用于兔麻醉后对呼吸系统的影响并进行麻醉效果评价。方法32只健康新西兰兔随机分为两组,氯胺酮、氟哌啶组(KD组);氯胺酮组(K组)。KD组以(100 mg氯胺酮 5 mg氟哌啶)/kg体重肌内注射;K组以100 mg氯胺酮/kg体重肌内注射,均进行兔膝骨性关节炎模型的建立。于麻醉后15 min时抽取耳中央动脉血做血气分析,评价麻醉效果、记录持续时间、死亡率。结果KD组麻醉前与麻醉后15 min时比较:酸碱度(pH)、碱剩余(BE(B))差异有显著性(P<0.01);标准碳酸氢盐(SB)、细胞外液缓冲碱(Beecf)、氧饱和度(SO2)差异有显著性(P<0.05)。K组麻醉前与麻醉后15 min时比较:pH、二氧化碳分压(PaCO2)差异有显著性(P<0.01);SB、Beecf、BE(B)差异有显著性(P<0.05)。KD组与K组在麻醉后15 min时比较:实际碳酸氢盐(HCO3ˉ)、总二氧化碳(TCO2)差异有显著性(P<0.01);Beecf BE(B)总血红蛋白(THBc)差异有显著性(P<0.05)。KD组的麻醉效果为优75%、良25%、差0%,死亡率0%,麻醉有效时间(45±5)min。K组的麻醉效果为优0%、良31%、差69%,死亡率0%,麻醉有效时间(20±5)min。结论用氯胺酮、氟哌啶联合应用于兔麻醉效果优于单纯氯胺酮麻醉。     

急性等容量血液稀释用于老年膝关节表面置换术的可行性研究

目的 评估老年膝关节表面置换术使用急性等容量血液稀释（ANH）的有效性及安全性。方法 30例择期行膝关节表面置换术的老年患者，年龄65～75岁，ASAⅠ～Ⅱ级，随机分为两组，Ⅰ组为ANH组，Ⅱ组为急性高容量血液稀释（AHH）组。记录各组麻醉前（T1）、麻醉后（T2）、血液稀释后（T3）、手术开始（T4）、手术结束（T5）、术后24h（T6）、术后48h（T7）时的血流动力学、凝血功能、动脉血气、红细胞比容。结果 Ⅱ组中心静脉压（CVP）在血液稀释后、手术开始后较Ⅰ组显著升高（P〈0．01）。两组患者凝血酶原时间（PT）、国际标准化比值（INR）在血液稀释后显著延长（P〈0．05），但仍在正常值范围内。纤维蛋白原含量（FIB）在血液稀释后显著降低（P〈0．05），但仍在正常值范围内。部分活化凝血活酶时间（APTT）在血液稀释后显著延长（P〈0．01）。结论 ANH的稀释效率高，容量负荷干扰小，红细胞保护程度高，较急性高容量血液稀释有更多的安全性和有效性，适用于老年膝关节表面置换术。     

应用关节镜诊治膝关节骨关节炎

目的：探讨关节镜对膝关节骨关节炎的诊断及治疗价值。方法：自1999年3月-2004年3月，对69例(77膝)膝关节骨关节炎(OA)患者进行关节镜检及镜下清理术。结果：22例(24膝)获得早期诊断，关节镜分级与临床表现呈正相关。与X线改变程度的符合率较低(48．1％)，随访2～5年，平均3．6年，术后综合评估：1～2年，优良率78．9％；2年以上，优良率61．2％。软骨退变程度与疗效关系：术后1-2年优良率：软骨Ⅰ度退变100％；Ⅱ度退变72．8％；Ⅲ度退变61％。2年以上优良率：Ⅰ度92．6％：Ⅱ度62．3％；Ⅲ度48．4％。结论：关节镜检有利于膝关节OA的早期诊断，并对诊断和治疗提供较为全面的信息。镜下清理术对早期OA有良好疗效．而且具有创伤小、恢复快、并发症少、可重复等优点，是治疗膝关节OA较理想的手术方法之一。     

手法为主治疗儿童髋关节急性软组织损伤

儿童髋关节急性软组织损伤多见“髋关节急性滑膜炎”或“髋关节软组织嵌顿症”。其临床特点是,患儿因运动后跌碰损伤或急性扁桃体炎等出现下肢跛行。早期多以膝痛为主诉,伴髋关节疼痛,腹股沟深压痛,髋内旋、外展活动受限,X线片检查发现髋关节间隙增宽,部分患者可见关节囊阴影增大。笔者运用手法加外用活血止痛中药制剂治疗30例(治疗组)与用患肢皮牵引和活血止痛中药内服治疗15例(对照组)。结果:两组愈显率比较,(治疗组96.7%,对照组73.3%),有显著差异P<0.05。经治疗2天内膝痛消失,治疗组29例(96.7%),对照组14例(93.3%),无显著差异,(P<0.05)。治疗1周内髋关节疼痛消失,治疗组28例,(93.3%),对照组7例(46.7%),有显著差异,(P<0.05)。故笔者认为以手法与外用药治疗优于下肢皮牵引和内服中药之法。膝痛是儿童髋关节软组织损伤早期的主诉之一,但临床检查膝部无阳性体征,经早期处理,膝痛症状消失较快,探其机理,认为与闭孔神经其分枝所支配区有关。当髋关节损伤或炎症反应刺激影响到闭孔神经或其分支时,闭孔神经所行经的膝关节因反射或放射等因素影响而出现疼痛。再者,患儿神经系统发育未成熟、对疼痛来源分辩定位能力差,诉说膝痛而不说髋关节疼痛,如忽视对髋关节的必要检查,会因漏诊而延误治疗。儿童髋关节暂时性滑膜炎与髋关节软组织嵌顿,发病机理多与运动损伤或急性炎症有关。临床表现大致相同,但其病理改变有轻重之别,故临床检查须细致加以分辩。手法治疗可根据其病理机制不同而灵活运用,通过手法可达到松解关节滑膜嵌顿与软组织痉挛,改善血液循环,增加组织新陈代谢而收到活血、消肿止痛的功效。手法治疗比传统患肢皮牵引疗法更直接、快速产生治疗效果,且方法简便,时间短、手法轻柔使患儿感觉舒适而易于接受。