CPM机在骨科术后关节功能锻炼的应用

目的探讨下肢关节功能恢复器(CPM)在骨科术后关节功能锻炼的应用,改善膝关节的活动度。方法对照组采用传统的康复方法,实验组采有早期使用CPM机进行康复训练。结果实验组膝关节活动度明显优于对照组(P<0.05)。结论CPM机在骨科术后关节功能锻炼的早期应用,膝关节功能改善明显,具有广阔的临床应用价值。     

全髋置换术和空心钉内固定术治疗股骨颈骨折的疗效比较

目的比较全髋置换术和空心钉内固定术治疗老年有移位新鲜股骨颈骨折的临床疗效。方法回顾性分析68例老年股骨颈骨折患者的临床资料,分为全髋置换组33例,空心钉内固定组35例,比较两种术式的临床疗效。结果68例随访12～72个月,平均36个月。经统计学分析两组在住院时间、手术时间、出血量、输血量和术后平均下地时间方面差异有统计学意义(P<0.05);在髋关节功能方面差异也有统计学意义(P<0.05);在术后并发症上差异无显著性(P>0.05)。最终随访时Harris评分全髋置换术组平均为(86.7±6.4)分,空心钉内固定术组平均(81.3±5.8)分,差异有统计学意义(P<0.05)。结论空心钉内固定术治疗老年股骨颈骨折的患者在住院时间、手术时间、出血量和输血量优于全髋置换术,但全髋置换术具有卧床时间短,术后恢复快,并发症少,功能恢复好等优点。对于老年有移位的新鲜股骨颈骨骨折首选全髋置换术。     

人工全髋置换术治疗髋关节疾病的临床体会

目的 观察人工全髋置换术在治疗髋关节疾病中的效果,为进一步的临床应用提供临床依据。方法 本研究选我院骨科2008年6月至2011年6月3年期间的80例人工全髋置换术治疗髋关节疾病患者,术后患者随访l～4年,没有失脱患者,根据关节功能评分标准进行评分与观察并发症的发生情况,现察其效果,并对结果进行分析。结果 根据评分标准,80例患者中90～100分患者(A组)57例(71.25%),80～89分患者(B组)18例(22.50%),70～79分组患者(C组)5例(6.25%)。>80分的患者共75例(93.75%);并发症2例(2.5%)。结论 人工全髋置换术治疗髋关节疾病效果好。     

骨质疏松性股骨颈骨折的治疗效果观察

目的 观察分析骨质疏松性股骨颈骨折的治疗方法及临床疗效。方法 回顾性分析48例骨质疏松性股骨颈骨折患者为研究对象,根据手术方法分为半髋组27例行人工股骨头置换术治疗及全髋组21例行人工全髋关节置换术治疗,分析2组患者一般资料、手术方法及临床疗效。结果 2组患者优良率无差异(P>0.05),手术时间、术中输血、住院费用及并发症发生率差异有统计学差异(P<0.05)。结论 人工股骨头置换术对于老年骨质疏松性股骨颈骨折治疗效果满意,有效地缩短了手术时间,降低了术后早期并发症,安全性更高,值得临床推广使用。     

双侧髋关节同期置换比较优势的临床研究

目的比较双侧髋关节同期置换与分期置换的临床疗效,得出同期置换中存在的优势。方法回顾性研究自2005年7月至2009年7月期间我科行双侧髋关节置换术的54例患者分为2组:同期组33例(66髋),分期组21例(42髋)。比较2组住院费用,总住院时间,总出血量,总输血量,术前和术后Harris评分及手术后并发症等方面的差异(含术后关节活动度)。结果 2组在住院费用、总住院时间、总手术时间、总出血量方面差异有显著性(P<0.05),分期置换均要大于同期置换,在术后Harris评分,总输血量方面差异无显著性(P>0.05)。结论同期双侧髋关节置换具有明显的比较优势,值得推广。     

临床护理路径在普外科手术患者中的应用

目的探讨临床护理路径在普外科手术患者中应用效果。方法140例普外科胆囊切除患者随机分为2组:试验组和对照组。实验组采用临床护理路径,对照组采用常规护理。比较2组的知识掌握情况、满意度、住院时间及住院总费用。结果实验组的各项指标均明显好于对照组(P<0.05)。结论实施临床护理路径使患者对知识的掌握及满意程度提高,可以缩短住院时间,并减少住院总费用。     

骨科手术病人术前排尿训练对手术后患者排尿影响的分析

目的探讨骨科手术前进行排尿训练对预防和减少术后排尿困难及尿潴留的效果。方法对70例骨科择期手术患者分为常规组和实验组。各35例,常规组在术前作常规护理,实验组在术前3d开始接受排尿训练,每天至少4次,直至患者感到排尿顺畅自然为止。结果常规组自行排尿10例,试验组26例;术后首次排尿时间,常规组2～5.14h,实验组2～3.25h,术后4h内自行排尿时2组血压均无明显变化,而超过4h自行排尿者,常规组患者收缩压明显升高。结论术前对患者进行排尿训练可预防和减少术后排尿困难和尿潴留的发生率。     

保留后瓣及瓣下结构的二尖瓣置换术19例分析

目的总结保留后瓣及瓣下结构的二尖瓣置换术19例的经验与治疗效果,并与常规不保留后瓣及瓣下结构的二尖瓣置换术比较,探讨其临床应用的安全性及有效性。方法2008年6月至2009年9月,我们对19例风湿性二尖瓣病变患者行保留后瓣及瓣下结构的二尖瓣置换术,并与21例行常规不保留后瓣及瓣下结构的患者进行比较,观察手术时间、术后呼吸机辅助时间、术后正性肌力药物辅助时间、ICU停留治疗时间差异。结果保留后瓣及瓣下结构的二尖瓣置换术并不加长手术时间,不加大手术难度,没有增加并发症及其它危险。结论术后与对照组比较,减少了术后呼吸机辅助时间、术后正性肌力药物辅助时间及ICU停留治疗时间,有利于患者病情恢复,是值得推广的手术方式。     

人工全膝关节置换术的围手术康复护理

人工全膝关节置换是采用假体关节代替严重受损关节的一种关节功能重建手术,其目的在于缓解膝关节疼痛,矫正关节畸形,改善患肢功能状态,提高生活质量。膝关节置换术的患者多为高龄人群,术后卧床限制了老年患者的呼吸运动,使低氧血症及下肢血栓形成发生率增高,所以术后早期康复训练对全膝关节置换术患者尤为重要。     

关节镜下膝关节盘状半月板损伤疗效分析

目的为进一步探讨了解关节镜下通过手术治疗膝关节盘状半月板损伤的临床治疗效果。方法选取我院在2009年10月至2010年10月期间收治的36例膝关节外侧盘状半月板损伤在关节镜下行手术的患者为研究对象,对其临床资料进行回顾性分析。根据患者盘状半月板损伤的情况实施不同的切除手术,观察所有患者在治疗后的膝关节功能恢复情况。结果术后均无感染、血管神经损伤、关节活动受限、下肢深静脉形成血栓等并发症的发生。术前Lysholm评分为(69.32±8.22)分,术后6个月提至(86.71±7.53)分,两者比较有显著性的统计学差异(P<0.05),取得满意效果。对患者随访6～28个月,平均随访13.5个月,患者手术治疗的效果均保持良好。结论膝关节外侧盘状半月板损伤手术结合关节镜具有创伤小、手术时间短、术后恢复较好等特点,值得在临床中推广应用。     

Ceramics for Prosthetic Hip and Knee Joint Replacement

The most commonly used bearing couple in prosthetic hip or knee joint replacements consists of a cobalt–chrome (CoCr) metal alloy articulating against ultrahigh-molecular-weight polyethylene. Ceramics have been used as an alternative to metal-on-polyethylene in joint replacement surgery of arthritic hips and knees since the 1970s. In prosthetic hip and knee bearings, ceramic surfaces offer a major benefit of drastically reduced wear rates and excellent long-term biocompatibility, which can increase the longevity of prosthetic hip and knee joints. This benefit is important clinically because hip and knee replacement has become a very common surgical procedure, particularly in the United States, and because these procedures are being increasingly performed in younger patients who place greater demands on the prosthetic bearings. However, ceramics are brittle and the risk of catastrophic bearing failure in vivo , while rare, is a major concern. Improvements in material quality, manufacturing methods, and implant design have resulted in a drastic reduction of the incidence of such failures, so that modern ceramic bearings are safe and reliable if used with components of proven design and durability. Future material improvements are actively being investigated to reduce the risk of ceramic-bearing failures even further. The purpose of this article is to review the structure, properties, applications, and limitations of the ceramics that have been used in orthopedic bearings, and to describe the new ceramic composite materials and surface treatments that will be available for joint replacement surgery in the near future.     

股骨颈骨折行人工髋关节置换45例的临床分析

目的探讨老年性股骨颈骨折行人工髋关节置换术的相关要点及临床效果。方法回顾性分析45例行人工髋关节置换术的老年性股骨颈骨折患者的临床资料。结果根据Harris评分标准评定:总优良率95.56%。随访期间出现髋关节脱位2例;髋关节疼痛2例;假体松动1例。无一例出现感染、骨折及神经损伤等并发症。结论老年性股骨颈骨折行人工髋关节置换术的优势在于术后可以早期下地活动并恢复功能锻炼,术后症状和功能恢复更加确切,再手术率较低,其手术成功的关键是重建股骨偏心距。     

E8002 Reduces Adhesion Formation and Improves Joint Mobility in a Rat Model of Knee Arthrofibrosis

Knee arthrofibrosis is a common complication of knee surgery, caused by excessive scar tissue, which results in functional disability. However, no curative treatment has been established. E8002 is an anti-adhesion material that contains L-ascorbic acid, an antioxidant. We aimed to evaluate the efficacy of E8002 for the prevention of knee arthrofibrosis in a rat model, comprising injury to the surface of the femur and quadriceps muscle 1 cm proximal to the patella. Sixteen male, 8-week-old Sprague Dawley rats were studied: in the Adhesion group, haemorrhagic injury was induced to the quadriceps and bone, and in the E8002 group, an adhesion-preventing film was implanted between the quadriceps and femur after injury. Six weeks following injury, the restriction of knee flexion owing to fibrotic scarring had not worsened in the E8002 group but had worsened in the Adhesion group. The area of fibrotic scarring was smaller in the E8002 group than in the Adhesion group (p < 0.05). In addition, the numbers of fibroblasts (p < 0.05) and myofibroblasts (p < 0.01) in the fibrotic scar were lower in the E8002 group. Thus, E8002 reduces myofibroblast proliferation and fibrotic scar formation and improves the range of motion of the joint in a model of knee injury.     

泌尿科手术侧卧位摆置方法分析与探讨

目的探索安全、舒适的泌尿科手术侧卧位摆置方法。方法改良方法108例为实验组,传统方法108例为对照组,在用时、医生满意度、并发症、体力之间进行对比。结果实验组节时、省力、医生满意度高、并发症少。结论此方法可安全有效的运用在泌尿科手术中。     

eNAMPT Is Localised to Areas of Cartilage Damage in Patients with Hip Osteoarthritis and Promotes Cartilage Catabolism and Inflammation

Obesity increases the risk of hip osteoarthritis (OA). Recent studies have shown that adipokine extracellular nicotinamide phosphoribosyltransferase (eNAMPT or visfatin) induces the production of IL-6 and matrix metalloproteases (MMPs) in chondrocytes, suggesting it may promote articular cartilage degradation. However, neither the functional effects of extracellular visfatin on human articular cartilage tissue, nor its expression in the joint of hip OA patients of varying BMI, have been reported. Hip OA joint tissues were collected from patients undergoing joint replacement surgery. Cartilage explants were stimulated with recombinant human visfatin. Pro-inflammatory cytokines and MMPs were measured by ELISA and Luminex. Localisation of visfatin expression in cartilage tissue was determined by immunohistochemistry. Cartilage matrix degradation was determined by quantifying proteoglycan release. Expression of visfatin was elevated in the synovial tissue of hip OA patients who were obese, and was co-localised with MMP-13 in areas of cartilage damage. Visfatin promoted the degradation of hip OA cartilage proteoglycan and induced the production of pro-inflammatory cytokines (IL-6, MCP-1, CCL20, and CCL4) and MMPs. The elevated expression of visfatin in the obese hip OA joint, and its functional effects on hip cartilage tissue, suggests it plays a central role in the loss of cartilage integrity in obese patients with hip OA.     

循证教学法在专业技术人员职业继续教育中的应用和效果评价

以2017年8月-2020年12月在中国化工学会培训中心接受专业技术培训的792名学员作为观察对象,通过与传统教学法比较来评价循证教学法在专业技术人员职业继续教育中的效果.研究期间,开设7期新材料领域的专题培训班,每期培训班举办2场,分别作为对照组和实验组,实验组采用循证教学法,对照组采用传统教学法.培训结束以后,通过...     

Alveolar ridge preservation in beagle dogs using carbonate apatite bone substitute

Granular-shaped carbonate apatite (CO₃Ap) bone substitute has demonstrated good clinical results, especially in the bone augmentation procedure, because it has high osteoconductivity and can be replaced by a new bone. This study aimed to evaluate the potential usefulness of CO₃Ap bone substitute for alveolar ridge preservation of beagle dogs during the 9-week follow-up period after surgery. Reconstruction of extraction sockets with CO₃Ap granules (CO₃Ap group) allowed approximately 1.0 mm higher alveolar bone height than that with a blood clot (control group) at 4 and 9 weeks after surgery. Additionally, the measured area at the buccal aspect of the alveolar bone in the CO₃Ap group was approximately 2 mm² larger than that in the control group at 4 and 9 weeks after surgery. Continuity from the buccal side to palatal side of the alveolar bone was restored, maintaining its contour at 4 weeks after surgery. The amount of bony tissue, especially the amount of mature bone, in the alveolar part was statistically larger than that of control group at 9 weeks after surgery even though complete replacement of CO₃Ap granules with new bone was not observed within 9 weeks. In conclusion, CO₃Ap granules have good potential for alveolar ridge preservation.     

Mitochondrial Dysfunction Affects the Synovium of Patients with Rheumatoid Arthritis and Osteoarthritis Differently

There is growing evidence regarding the role of mitochondrial dysfunction in osteoarthritis (OA) and rheumatoid arthritis (RA). However, quantitative comparison of synovial mitochondrial derangements in these main arthritis forms is missing. A prospective clinical study was conducted on adult patients undergoing knee surgery. Patients were allocated into RA and OA groups based on disease-specific clinical scores, while patients without arthritis served as controls. Synovial samples were subjected to high-resolution respirometry to analyze mitochondrial functions. From the total of 814 patients, 109 cases were enrolled into the study (24 RA, 47 OA, and 38 control patients) between 1 September 2019 and 31 December 2021. The decrease in complex I-linked respiration and dyscoupling of mitochondria were characteristics of RA patients, while both arthritis groups displayed reduced OxPhos activity compared to the control group. However, no significant difference was found in complex II-related activity between the OA and RA groups. The cytochrome C release and H₂O₂ formation were increased in both arthritis groups. Mitochondrial dysfunction was present in both arthritis groups; however, to a different extent. Consequently, mitochondrial protective agents may have major benefits for arthritis patients. Based on our current study, we recommend focusing on respiratory complex I in rheumatoid arthritis research.     

Methotrexate Ameliorates Systemic Inflammation and Septic Associated-Lung Damage in a Cecal Ligation and Puncture Septic Rat Model

Background: Sepsis is a serious, heterogeneous clinical entity produced by a severe and systemic host inflammatory response to infection. Methotrexate (MTX) is a folate-antagonist that induces the generation of adenosine and also inhibits JAK/STAT pathway; MTX it is widely used as an anti-inflammatory drug to control the immune system. Objective: The aim of this study was to assess the beneficial effects of a single and low dose of MTX in the systemic response and acute lung injury (ALI) induced by sepsis. As in the clinics, we treated our animals with antibiotics and fluids and performed the source control to mimic the current clinic treatment. Methods and main results: Sepsis was induced in rats by a cecal ligation puncture (CLP) procedure. Six hours after induction of sepsis, we proceeded to the source control; fluids and antibiotics were administered at 6 h and 24 h after CLP. MTX (2.5 mg/Kg) was administered 6 h after the first surgery in one CLP experimental group and to one Sham group. A protective effect of MTX was observed through a significant reduction of pro-inflammatory cytokines and a decrease infiltration of inflammatory cells in the lung. In addition, we found a regulation in adenosine receptor A2aR and the metalloproteinases by MTX. Conclusion: A single, low dose of MTX attenuates sepsis lung-associated damage by decreasing pro-inflammatory response, infiltration of pro-inflammatory cells and avoiding defective tissue lung remodeling.     

白内障青光眼联合手术的临床护理研究

目的：探究白内障青光眼联合手术的护理情况及临床效果。方法：将64例行白内障青光眼联合手术患者随机分为干预组（给予综合性护理干预）和对照组（给予一般性护理）,各32例,比较两组临床护理效果。结果：干预组并发症总发生率（18.8%）低于对照组（46.9%）,护理总满意率（90.6%）高于对照组（78.1%）,比较差异显著（P＜0.05）。结论：对白内障青光眼联合手术患者加强护理干预,可减少相关并发症的发生,更好地改善其预后。