发育性髋关节发育不良的早期筛查及保守治疗现状

发育性髋关节发育不良(developmental dysplasia of the hip,DDH)是小儿最常见的髋关节疾病。早期筛查是发育性髋关节发育不良诊治的重要环节,在日益成熟的筛查体系下,通过体格检查、超声检查及X线检查等方法可尽早明确诊断,为早期治疗提供条件。保守治疗适用于1.5岁以内的DDH患儿,包括佩戴髋关节外展支具和闭合复位。本文将围绕发育性髋关节发育不良的早期筛查和保守治疗的近期研究成果进行综述。     

重型血友病A患儿关节出血与关节评估的相关性研究

目的了解血友病患儿出血与关节病变之间的关系,为临床治疗和预后判断提供理论依据。方法选取2016年6月至2017年1月于首都医科大学附属北京儿童医院及成都市新世纪妇女儿童医院就诊的1~7岁重型血友病A且有关节出血记录的患儿,以患儿关节出血为研究关节,收集前3个月研究关节的出血次数,应用超声、X线、磁共振成像(MRI)和血友病关节健康评分(HJHS)评分系统对关节进行评估。将关节出血次数与超声、X线、MRI和HJHS评分进行相关性分析,并对超声、X线、MRI和HJHS评分间的相关性进行分析。结果1.共收集重型血友病A患儿18例,年龄(5.6±1.8)岁,共30个出血关节,中位年关节出血次数为4次(4~16次),中位年靶关节出血次数为8次(4~16次)。2.关节出血次数与超声、X线评估有相关性(r=0.390,P=0.033;r=0.517,P=0.008),与HJHS评估、MRI评估均无相关性(均P>0.05)。3.超声、X射线、HJHS和MRI两两之间均呈极显著正相关[r=0.815(超声与X线),r=0.510(超声与HJHS),r=0.812(超声与MRI),r=0.666(X线与HJHS),r=0.911(X线与MRI),r=0.781(HJHS与MRI),均P<0.01]。4.关节超声和/或MRI评估异常的关节中,出血次数与关节评估间均无相关性(P>0.05)。结论关节出血与关节评估获得的关节病变程度结果不一致,因此准确判断关节病变情况需综合评估关节结构、功能等,以便更加全面地指导血友病患儿的治疗。     

The prevalence of joint hypermobility among high school students

Objective The aim of this study was to determine the prevalence of joint hypermobility among high school students and to define the characteristics of patients with joint hypermobility.Methods The students underwent complete history and physical examination. In order to designate marfanoid habitus, body weight, height, and span/height and upper/lower segment ratios were recorded. The degree of joint hypermobility was scored by the Beighton scoring system. The following features were also examined: arthralgia, myalgia, low back pain, sciatica, spinal deformities, temporomandibular joint pain and crepitus, effusion, swan neck deformity, arachnodactyly, joint dislocation, joint sprain, Raynauds phenomenon, stria, varicose veins, abdominal and inguinal hernia, heart disease history, myopia, dropping eyelids, and antimongoloid slant.Results Eight hundred sixty-one students (433 females and 428 males) with a mean age of 15.4±1.1 years (range 13–19) were examined. Joint hypermobility was observed in 101 (11.7%) of the students. According to the Beighton scoring system, the majority of these (61.4%) were observed to score 4. Our results show that phenotype has no relation with joint mobility. Of the total number of students, there were 31 male (7.2%) and 70 female (16.2%) hypermobile subjects. The difference between sexes was highly significant (P=0.00005). Joint sprain was detected in 14 of hypermobile students (13.9%) and 50 of nonhypermobile students (6.6%). Its presence was the only significant parameter between hypermobile and nonhypermobile students (P=0.0094).Conclusions Joint hypermobility was found in 11.7% of the students in our study, and the results are in harmony with the previous studies on Western populations. Although hypermobility does not seem to be very problematic in young people, as in our focus group, we believe that it is important for physicians to recognize this problem to ensure correct diagnosis and treatment, since it may lead to mimic rheumatic diseases in the future.     

透明质酸钠治疗老年膝骨性关节炎对患者关节滑液白介素-1β的影响分析

目的分析透明质酸钠（Sodium hyaluronate,SH）治疗老年膝骨性关节炎（Knee Osteoarthritis,KOA）对患者关节滑液白介素-1β（Interleukin-1β,IL-1β）的影响,探讨其临床治疗机制。方法选取我院2013年1月~2013年8月收治的136例老年KOA患者,按照随机数字表分为观察组及对照组,在常规治疗基础上分别实施SH及生理盐水注射治疗,比较两组患者临床疗效及治疗前后关节滑液IL变化。结果观察组治疗5周后ISOA评分显著降低,且显著低于对照组（P〈0.05）,对照组治疗5周后ISOA评分无显著变化（P〉0.05）;观察组临床改善32例,显效23例,有效9例,总有效率94.1%,对照组临床改善7例,显效10例,有效18例,总有效率51.5%,观察组总有效率显著高于对照组;观察组治疗1周后即见关节滑液IL-1β显著降低,且治疗期间呈显著降低趋势,治疗3个月后IL-1β仍显著低于治疗前含量（P〈0.05）;对照组治疗期间关节滑液IL-1β水平无明显变化（P〉0.05）。结论 SH可有效降低老年KOA患者关节滑液IL-1β水平,在降低关节软骨破坏、促进关节软骨修复、减轻炎性介质水平方面具有良好效果,可有效改善患者临床症状,保证其生活质量,可作为无手术指征的老年KOA患者的有效保守治疗方案加以推广。     

Gram stains have limited application in the diagnosis of infected total knee arthroplasty

Background

The diagnosis of periprosthetic knee infections can present a challenge to surgeons, especially in the case of chronic presentation. Gram stains are regularly performed as part of the microbiological evaluation of suspected infected total knee arthroplasties. Recently, the utility of this test in diagnosing infections has been questioned. The purpose of this study was to assess the effectiveness of Gram stains performed from surgical site samples by comparing their results to the final diagnosis of infection.

Methods

The results of 347 Gram stains performed at a single center at the time of revision total knee arthroplasty for both septic and aseptic reasons were compared to the final diagnosis based on intra-operative findings and histological evaluation.

Results

Gram staining demonstrated a low sensitivity of 7% (95% confidence interval 4–12%), a specificity of 99% (95% confidence interval 97–100%), and positive and negative predictive values of 92% and 57%, respectively.

Conclusions

This study confirmed previous findings of the poor utility of this test for the diagnosis of periprosthetic knee infections. The authors recommend that Gram staining no longer be performed at the time of suspected periprosthetic knee arthroplasty infection.     

第四代Oxford单髁置换术对膝关节内侧间室骨关节炎患者的疗效评估及步态分析

目的探讨第四代Oxford单髁置换术对膝关节内侧间室骨关节炎患者的临床疗效及对患者步态恢复的影响。方法将2016年1月至2018年1月收治并符合标准的30例(30膝)膝关节内侧间室骨关节炎患者纳入研究并作为试验组,另外再纳入20例(20膝)膝关节正常的志愿者作为本研究的正常组。试验组患者接受第四代Oxford单髁置换术,正常组研究对象不做任何治疗干预,仅作为观测指标对照。本研究观测指标主要包括疼痛视觉模拟评分(VAS评分)、膝关节学会评分系统(KSS)、美国WOMAC骨关节炎指数评分、美国特种外科医院膝关节评分(HSS评分)和步态分析运动学参数。比较试验组在术前、术后6个月及术后12个月的观测指标的差异,并分别与正常组作比较。结果试验组患者术前、术后6个月及术后12个月3个时间段两两之间的VAS评分、HSS评分、WOMAC评分以及KSS评分比较,差异均具有统计学意义(0.05)。试验组患者术前、术后6个月及术后12个月的步态分析各运动学参数的差异均具有统计学意义(0.05)。其中除最大前位移和最大内位移在术后6个月及术后12个月两个时间段差异无统计学意义之外,其他步态分析各运动学参数在3个时间段两两之间差异均具有统计学意义(0.05);试验组患者在术后12个月与正常组步态分析各运动学参数相比,最大伸直角、最大内位移和最大外位移比较,差异无统计学意义(0.05),但其余各步态分析各运动学参数差异仍然存在统计学意义(0.05)。结论在选择适当的病例和严格掌握手术适应证的前提下,第四代Oxford单髁置换术对膝关节内侧间室骨关节炎患者的近、中期疗效满意,术后患者关节功能更接近生理状态。     

新型撑开器结合微创内固定系统内固定治疗胫骨近端骨折

背景:传统手术治疗方法治疗胫骨近端骨折对骨折部位剥离广泛,且影响局部血液循环,增加骨折延迟愈合和不愈合的发生率。近年来兴起的微创内固定系统,可以最大限度地保护局部软组织以及血液循环,为骨折愈合提供更好的条件,而新型撑开器的应用也解决了传统人手牵引复位稳定性、持久性的问题,两者的结合应用逐渐受到关注。目的:探讨新型撑开器辅助复位、微创内固定系统治疗胫骨近端骨折的疗效。方法:以2016年5月至2019年10月收治的22例胫骨近端骨折患者为研究,随机分为对照组和观察组,各11例。对照组采用传统手法复位、常规切口钢板内固定;观察组以新型撑开器辅助复位、微创内固定系统钢板内固定。试验经广州医科大学附属第五医院伦理委员会批准。结果与结论:与对照组相比,观察组患者末次随访时Rasmussen膝关节功能评分较优,术中失血量、手术用时、住院天数、开始负重时间较少,出现关节受限、骨折延迟愈合等术后并发症患者数量较少,但骨折愈合时间与对照组接近,且切口感染、内固定松动断裂等术后并发症患者数量与对照组接近。提示应用新型撑开器结合微创内固定系统内固定治疗胫骨近端骨折,可以减少手术复位时间、降低局部软组织损伤,有利于患者早期功能锻炼,减少手术后并发症。