目的 探讨后稳定型全膝关节置换术患者术后股骨后髁偏距变化对早期功能的影响。方法 选取2013年1月—2016年1月我院收治的121例骨关节炎接受单侧后稳定型膝关节置换患者,记录所有患者术前与术后股骨后髁偏距,根据股骨后髁偏距变化情况分为A组(股骨后髁偏距不变或增加)与B组(股骨后髁偏距减小)。对两组患者进行至少12个月的随访,比较其骨关节炎指数评分(WOMAC)、美国膝关节协会评分(KS)、美国膝关节外科学会评分系统(HSS)及膝关节功能之间的差异。结果 术后,2组患者在前髁偏距变化、股骨假体屈曲角、胫骨后倾角、胫骨角方面差异无统计学意义(P＞0.05)。但术后1年A组患者在WOMAC评分、HSS评分和负重主动屈曲范围方面改善优于B组患者,差异有统计学意义(P＜0.05)。结论 重建股骨后髁偏距能够改善后稳定型全膝关节置换术患者术后早期的骨关节炎症状,并提升患者负重位主动屈曲范围,有一定临床价值。

Objective To explore the stabilized total knee arthroplasty effects on early functional changes of condylar offset. Methods 121 cases of posterior stabilized total knee arthroplasty in our hospital from Jan.2013 to Jan.2016 were enrolled in the study. All patients with preoperative and postoperative posterior condylar offset records, according to the changes of femoral condylar offset were divided into A group and B group. The patients in the two groups were followed for at least 12 months, and the differences in the Osteoarthritis Index score (WOMAC), the American Knee association score (KS), HSS score and knee function were compared. Results After surgery, two patients in the anterior condylar offset changes, femoral prosthesis flexion angle, tibial angle, tibial angle difference was not statistically significant (P > 0.05). But after 1 years, the improvement of WOMAC score, HSS score and weight-bearing active flexion range in group A was better than that in group B, the difference was statistically significant (P < 0.05). Conclusions The reconstruction of the posterior condylar offset can improve the stability after total knee arthroplasty in patients with early osteoarthritis symptoms, and enhance the active flexion range of patients with weight-bearing, which has some clinical value.

目的 观察关节镜下清理术联合中药熏洗治疗痛风性膝关节炎的临床疗效。方法 收集2013年7月—2016年7月期间收治于我院骨科的痛风性膝关节炎患者,根据纳入及排除标准,获得44例患者,共44个膝关节。根据术后是否采用中药熏洗治疗,将其分为治疗组25例及对照组19例。观察内容:术后1周及术后3月的WBC、BUA、ESR、CRP、膝关节疼痛VAS、Lysholm关节功能评分;2组患者术后6月、12月随访时的膝关节疼痛VAS、Lysholm关节功能评分。结果 ①2组患者术前与术后1周的膝关节疼痛VAS、 Lysholm关节功能评分组内比较差异有统计学意义(P＜0.05),术后1周的膝关节疼痛VAS、 Lysholm关节功能评分组间比较差异无统计学意义(P＞0.05)。②2组患者术前与术后3月随访的WBC、BUA、ESR、CRP组内比较差异有统计学意义(P＜0.05),术后3月随访的WBC、BUA、ESR、CRP组间比较差异无统计学意义(P＞0.05)。③2组患者术后3月、6月、12月随访的膝关节疼痛VAS、Lysholm关节功能评分组间比较,差异有统计学意义(P＜0.05)。结论 关节镜下清理术结合中药治疗痛风性膝关节炎能有效减轻患者膝关节疼痛,值得临床使用。

Objective Retrospective evaluation of the curative effect of the arthroscopic debridement combined with Chinese medicine fumes in the treatment of the gouty arthritis of knee joint.Methods We analyzed 44 patients (from July 2013 to July 2016 in the orthopaedic department of the Sichuan Second T.C.M.Hospital)with gouty arthritis of knee joint. The all 44 patients were divided into treatment group and control group according to postoperative management that whether or not to apply Chinese medicine fumes.The treatment group,25 patients, were all treated by arthroscopic debridement combined with Chinese medicine fumes,and the control group,19 patients, were all treated by arthroscopic debridement only.The observation targets were as follows: VAS、Lysholm、WBC、BUA、ESR、CRP of postoperative after 1 week, 3 months,and VAS、Lysholm. postoperative VAS、Lysholm after 6months、12months.Results Compared the preoperative contents with postoperative contents after1 week,there was statistically significant difference in VAS、Lysholm of both groups(P＜0.05).There was no statistically significant difference in VAS、Lysholm in postoperative 1 week between two groups (P＞0.05). Compared the preoperative contents with postoperative contents after 3 month,there was statistically significant difference in WBC、BUA、ESR、CRP of both groups(P＜0.05).There was no statistically significant difference in WBC、BUA、ESR、CRP of postoperative 3 months between two groups(P＞0.05). There was statistically significant difference in VAS、Lysholm of postoperative 3 months and 6 months between two groups(P＜0.05).Conclusion Arthroscopic debridement combined with Chinese medicine fumes may improve the quality of life in the treatment of gouty arthritis of knee joint,and it is worthy of wide clinical application.

目的 探讨中药熏洗与膝关节自我锻炼管理对改善老年骨性膝关节炎功能康复效果。方法 选择90例在本院就诊的老年骨性关节炎患者,按数字表法分为观察组和对照组各45例,对照组采用膝关节康复护理知识教育、膝部中药熏洗与揉搓按摩等治疗,观察组在此治疗护理上加强对患者进行膝关节功能训炼和自我活动行为管理;随访6周,评价两组患者膝关节肿胀、疼痛、训练依从性、膝关节功能。结果 膝关节疼痛缓解、肿胀消退观察组优于对照组;膝关节功能康复效果观察组优于对照组,活动训练依从性观察组高于对照组。结论 应用中药熏洗与加强患者膝关节自我活动训炼管理,可缓解膝关节疼痛、减轻膝关节肿胀,改善患者膝关节功能,提高患者自我功能训练的依从性和生活质量。

Objective To explore the effect of traditional Chinese medicine fumigation and knee joint exercise management on the rehabilitation of senile osteoarthritis of the knee. Methods 90 cases in our hospital for treatment of senile osteoarthritis were randomly divided into observation group and control group with 45 cases in each group, the control group used the knee joint rehabilitation nursing knowledge education, herbal fumigation and massage knee treatment; the observation group on the treatment and nursingwith strengthening the function of knee joint training and self behavior management for the patients; 6 weeks of follow-up, we have evaluation of two groups of patients with knee joint swelling, pain, and knee joint function training compliance. Results The knee joint pain, swelling, knee joint function rehabilitation effect in the observation group were better than that of control group; training compliance in the observation group was better than that of control group. Conclusion The application of herbal fumigation and strengthen the self training of patients with knee joint activity management, may relieve the pain of knee joint, swelling and improve knee function. Theirtraining compliance and quality of life have been increased.

目的 探讨 FAST-FIX全内缝合系统治疗膝关节半月板后角损伤的3年中期疗效。方法 2011年1月—2013年4月采用FAST-FIX全内缝合系统治疗膝关节半月板后角损伤并均得到满意随访的患者46例,其中男27例,女19例,年龄17～42 a,平均(23.5±8.22)a。左膝25例,右膝21例,损伤类型:红区损伤33例,红白区损伤13例,其中8例伴交叉韧带损伤。根据Barrett标准评价半月板愈合情况,并用Lysholm评分、IKDC评分、Tegner评分分别评估术后关节功能改善情况。术前Lysholm评分为:(35.73±11.28)分,IKDC评分为:(37.26±13.17)分,Tegner评分为(3.3±1.7)。结果 随访时间36~59个月,平均随访46.3个月,随访3年显示42例患者半月板愈合良好,手术成功率91.3%。术后4例患者出现疼痛,其中2例出现绞索,二次手术证实缝合失败并行半月板成形术。术后3年Lysholm评分为:(86.31±11.89)分,IKDC评分为:(82.9±13.44)分,Tegner评分为(5.9±1.9)。术前与术后3年随访评分相比均有统计学意义(P<0.05)。结论 FAST-FIX全内缝合系统治疗膝关节半月板后角损伤3年中期疗效良好。

Objective To evaluate a 3-year mid-term clinical results of FAST-FIX suture system in arthroscopic meniscal posterior horn repair. Methods Clinical results of 46 patients with meniscal tear who underwent posterior horn of the meniscus repair using the FAST-FIX suture system from January 2011 to April 2013 were retrospectively analyzed. There were 27 males and 19 females,age 17~42 years old,average 23.5±8.22 years old. There were 25 left knee and 21 right knee and 33 red zone injury and 13 red-white zone injury, 8 of which were accompanied by anterior cruciate ligament injury. Clinical healing of the meniscus was assessed by Lysholm scores(35.73±11.28)points,IKDC scores(37.26±13.17)points and Tegner scores(3.3±1.7)points before operation. Results The average follow-up period was 46.3 months (range: 36-59 months). The clinical healing rate was 91.3%. Healing failure occurred to 4 patients and 2 of which had a meniscus noose after operation and were confirmed surgical failure in reoperation. Mean Lysholm scores were (86.31±11.89),IKDC scores(82.9±13.44)and Tegner scores(5.9±1.9)in 3 years after operation for all 46 cases. The differences between the preoperative and postoperative scores in three type scores were statistically significant (P<0.05). Conclusion Arthroscopic posterior horn of the meniscus repair with the FAST-FIX suture system may provide good 3-year mid-term clinical results after operation.

目的 研究中药熏洗、中药离子导入加CPM综合疗法对膝关节功能障碍患者的作用效果。方法 从2014年4月—2016年4月,于我院共有78例膝关节功能障碍病患就诊。以数字法随机分成观察组(39例)和对照组(39例)。观察组给予中药熏洗以及中药离子导入再加以CPM综合疗法进行护理,对照组仅给予CPM综合疗法护理。观察两组患者护理后膝关节疼痛程度以及活动范围。结果 观察组患者膝关节功能优者占比51.28%,总有良率为84.62%,均高于对照组的25.64%,51.28%;观察组患者膝关节活动范围优者占比51.28%,总优良率为89.74%,均高于对照组的28.21%,66.67%;观察组患者WOMAC评分中膝关节疼痛以及膝关节僵硬和膝关节功能得分均低于对照组,WOMAC总分也低于对照组,差异均有统计学意义(P均＜0.05)。结论 中药熏洗、中药离子导入加CPM综合疗法能显著改善患者膝关节功能,增加活动度数,减轻疼痛等级,值得临床推广使用。

Objective To study the effect of traditional Chinese medicine fumigation, traditional Chinese medicine iontophoresis combined with CPM combined therapy on patients with knee joint dysfunction. Methods From April 2014 to April 2016, in our hospital there were a total of 78 cases of knee joint dysfunction disease patient treatment. With digital method they were randomly divided into observation group (39 cases) and control group (39 cases). The observation group was treated with Chinese herbal fumigation and washing and Chinese medicine iontophoresis and CPM combined therapy nursing, control group only received CPM combined therapy nursing. Observation of nursing care of the patients in the two groups were knee pain and range of motion. Results The observation group of patients with knee joint function was accounted for than 51.28%. The total yield was 84.62%. They were significantly higher than those in the control group of 25.64%, 51.28%; Observation group of patients with knee joint range of motion was accounted for than 51.28%. The total excellent and good rate was 89.74%, were significantly higher than those in the control group of 28.21%, 66.67%; Observation group, WOMAC score of knee pain and knee stiffness and knee joint function score were significantly lower than those of the control group. WOMAC score was significantly lower than that of the control group. The differences were statistically significant (P<0.05). Conclusion Traditional Chinese medicine fumigation, traditional Chinese medicine iontophoresis combined with CPM therapy could significantly improve the patient's knee function, increase the degree of activity, reduce the pain level. It is worth to have clinical application.

目的 对比观察海桐皮汤熏洗应用于膝骨性关节炎关节镜清理术后的临床疗效。方法 于2012年1月—2014年1月,从我院骨科住院患者中选取因膝骨性关节炎行关节镜清理术病例60例,随机分为两组,对照组术后给予常规康复治疗措施,治疗组在常规康复治疗的基础上于术后2周拆线后配合海桐皮汤熏洗治疗,治疗周期4周。对比两组患者治疗前后的WOMAC评分,分析其疗效差异。结果 两组患者WOMAC评分术后2周比较无差异P＞0.5;治疗4周后,两组患者较术后2周有所降低(P＜0.5),但治疗组疗效优于对照组(P＜0.5)。结论 海桐皮汤熏洗疗法可改善膝骨性关节炎关节镜清理术后膝关节功能,操作简便,成本低廉,无副作用,值得临床推广应用。

目的 通过比较利伐沙班、依若肝素和非抗凝治疗对全膝关节表面置换术后的疗效,分析全膝关节置换术后抗凝治疗的必要性、有效性及安全性。方法 选取2010年1月—2013年8月我科收治的全膝关节表面置换术的患者154例,按治疗方式分成利伐沙班组(A组)、依若肝素钠组(B组)及非抗凝组(C组)。观察各组术后静脉血栓栓塞发生率;术前及用药后凝血功能指标的变化;术后总失血量、显性失血量、隐性失血量;伤口情况;膝关节功能HSS评分。结果 A组与B组术后无静脉栓塞症发生,C组出现静脉栓塞症3例;A、B、C三组术前与术后凝血功能指标差异均无统计学意义(P>0.05);B组术后显性失血量高于A组(P<0.05);三组患者术前及术后各回访时间点膝关节功能HSS评分差异无统计学意义(P>0.05)。结论 抗凝药物预防全膝关节置换术后静脉血栓栓塞症的效果确切,利伐沙班与依若肝素疗效相当;抗凝治疗不会增加术后失血量及伤口并发症的发生率,且对术后膝关节中期功能恢复无影响。全膝关节表面置换术后使用抗凝治疗效果良好,安全性可。

Objective To compare the influence of anticoagulant therapy on the curative effect after total knee arthroplasty and evaluate the necessity, effectiveness and safety of anticoagulant therapy. Methods 154 patients after total knee arthroplastyfrom January 2010 to August 2013 in our department were divided into the rivaroxaban group (group A), the enoxaparin group (B group) and non anticoagulation group (group C) according to the treatments. It was observed that the postoperative venous thromboembolism incidence; changes of blood coagulation indexes before and after the operation; the total blood loss、dominant blood loss and hidden hemorrhage; the wound; the HSS score of knee function. Results None of postoperative venous thromboembolism occurred in group A and B, three cases of venous thromboembolism in group C;The differences of between preoperative and postoperative coagulation indexes in three groups had no statistical significance (P>0.05); Dominant blood loss in group B was significantly higher than that of group A (P<0.05); No statistical significance in the HSS scores of knee function of three group (P>0.05). Conclusion The effect of anticoagulant drugs on the prevention of venous thromboembolism after total knee arthroplasty is effective, same efficacy in the treatment with rivaroxaban or enoxaparin; anticoagulant therapy does not significantly increase the postoperative blood loss and the incidence of wound complications, does not influence the recovery of postoperative mid-term knee function. The use of anticoagulation therapy after total knee arthroplasty has good effect and be safety.

KOA是临床上最常见,发病起源于关节软骨的慢性退行性关节疾病。近年来,应用黄芪治疗KOA的报道不断增多,并且开展了大量的机制研究。本文综述了黄芪在KOA治疗中的应用现状及研究进展,同时指出从PPAR-γ信号通路探索黄芪干预KOA的具体分子机制具有积极的理论和实践意义。

       目的   基于Nomogram初步构建膝骨关节炎（KOA）患者术前衰弱的风险预测模型。方法   便利选取172例于2021年12月—2022年8月在广州市某三甲医院关节外科接受择期膝关节置换术的KOA患者为研究对象，依据衰弱的发生与否分为衰弱组（n=111）和非衰弱组（n=61），通过单因素分析筛选变量，纳入Logistic回归分析，并构建列线图模型。结果   单因素分析结果显示年龄、BMI、膝关节疼痛年限、合并症、抑郁、焦虑、疼痛、睡眠障碍、营养状况等在不同组间比较差异存在统计学的意义（P＜0.05）。多因素Logistic回归分析表明，BMI异常（OR=3.360）、膝关节疼痛年限＞5年（OR=14.188）、抑郁（OR=5.608）、睡眠障碍（OR=25.480）是KOA患者术前衰弱的独立危险因素（P＜0.05）。基于此，建立了预测膝骨关节炎患者术前衰弱风险的列线图预测模型。结果显示C-index为0.915，校正曲线接近理想曲线，ROC曲线下面积（AUC）为0.919（95%CI：0.878~0.961），可见该预测模型具有较好的区分度和准确度。结论   根据BMI、膝关节疼痛年限、抑郁以及睡眠障碍这四个独立危险因素，可以准确地预测膝骨关节炎患者术前衰弱的风险。

    Objective  To develop a nomogram for predicting the risk of preoperative frailty in knee osteoarthritis patients．Methods  A convenience sample of 172 patients who underwent elective knee arthroplasty at a Grade-A hospital in Guangzhou from December 2021 to August 2022 was selected．The patients were divided into two groups based on the presence of preoperative frailty：frailty group（n=111）and non-frailty group（n=61）．The variables with statistical differences were screened by univariate analysis for multivariate logistic regression analysis，and the nomogram prediction model was established．Results  Univariate analysis identified significant differences between the groups in age，BMI，years of knee pain，complications，depression，anxiety，pain，sleep disturbance，and nutrition（P＜0.05）．Multivariate logistic regression showed that abnormal BMI（OR=3.360），years of knee pain ＞ 5（OR=14.188），depression（OR=5.608），and sleep disorders（OR=25.480）were independent  risk factors for preoperative frailty in knee osteoarthritis patients（P＜0.05）．Based on these findings，a nomogram prediction model was established．Model verification results demonstrated that the nomogram had good differentiation and accuracy in predicting the risk of preoperative frailty，with a C-index of 0.915，an area under the ROC curve of 0.919（95% CI：0.878~0.961），and a calibration curve slope close to 1．Conclusions  The nomogram，based on four independent risk factors（BMI，years of knee pain，depression，and sleep disturbance），effectively predicts the risk of preoperative frailty in knee osteoarthritis patients．