目的 探讨关节镜下外侧韧带增强固定修复术治疗慢性踝关节不稳定的护理和康复方案。方法 回顾性分析2023年1月–2023年8月广州市正骨医院收治的31例采用关节镜下外侧韧带增强固定修复术治疗的慢性踝关节不稳定患者的围术期护理措施和康复指导措施。结果 31例患者均随访无脱落,于术后3、6、12个月返院复查随访,患者手术后患足美国矫形外科足踝协会（AOFAS）踝-后足评分均较前次随访评分提高（均P<0.05）。患者术后3个月Zung焦虑评分和Zung抑郁评分较术前均明显下降（均P<0.05）。31例患者术后无1例发生踝关节不稳定复发、腓肠神经损伤和感染等并发症。结论 关节镜下外侧韧带增强固定修复术的方法治疗慢性踝关节不稳定患者,加强术前术后的护理措施、康复指导,对恢复踝关节稳定性和灵活性有重要作用,有利于提高患者生活质量和满意度。

Objective To investigate the nursing and rehabilitation of chronic ankle instability with reinforcement fixation and repair of lateral ligament under arthroscopy．Methods The perioperative nursing measures and rehabilitation guidance of 31 patients with chronic ankle instability treated with lateral ligament reinforcement fixation under arthroscopy from January 2023 to August 2023 were analyzed retrospectively．Results None of the 31 patients was disassociated during follow-up．The American Orthopaedic Foot and Ankle Society（AOFAS）scores of the patients were significantly higher and higher at 3,6 and 12 months after surgery（all P<0.05）．The Zung anxiety score and Zung depression score at 3 months after operation were significantly lower than those before operation（all P<0.05）．None of the 31 patients had postoperative complications such as ankle instability recurrence,sural nerve injury,peroneal tendinitis and infection．Conclusions In arthroscopic reinforcement fixation of lateral ligament in the treatment of patients with chronic ankle instability,strengthening the perioperative nursing measures and rehabilitation guidance,plays an important role in restoring the stability and flexibility of the ankle,and is conducive to improving the quality of life and satisfaction of patients．

目的 探讨臂丛神经阻滞和关节腔内注射局麻药联合应用在肩关节镜手术中的应用价值。方法 对肩关节镜手术患者100例进行研究,2018年8月—2020年8月入组,根据随机数字表法分组处理,对照组和观察组各为50例,前者用臂丛神经阻滞,后者与关节腔内注射局麻药联合,比较2组麻醉效果、不同阶段疼痛程度、肩关节功能。另对比2组不良反应。结果 观察组麻醉起效时间、苏醒时间和拔管时间分别为(10.72±2.45)min、(8.21±1.32)min和(9.52±1.12)min,与对照组对应指标有差异(P<0.05);2组术前疼痛程度和肩关节功能对比无差异(P>0.05),观察组术后6 h、术后24 h和术后48 h疼痛评分依次为(1.31±0.27)分、(2.87±0.52)分和(3.44±0.42)分,术后6 h、术后12 h、术后24 h和术后48 h镇静评分分别为(2.92±0.32)分、(2.54±0.24)分、(2.38±0.12)分和(2.27±0.15)分,术后1周、1个月和3个月的肩关节功能评分分别为(50.12±4.54)分、(56.18±4.12)分和(73.16±4.78)分,较之于对照组有差异(P<0.05);对照组和观察组出现不良反应的概率分别为18.00%和4.00%(P<0.05)。 结论 在肩关节镜手术中联合应用臂丛神经阻滞联合关节腔内注射局麻药麻醉方式,可提高麻醉效果,术后镇痛和镇静效果明显,也可减少不良反应,对患者肩关节功能改善作用明显,存在广泛应用价值。

目的 探讨在关节镜下膝关节前交叉韧带损伤重建术治疗的临床效果。方法 选取2018年3月—2020年3月之间我院接受住院治疗的80名膝关节前交叉韧带损伤患者作为研究对象。根据手术方式的不同,常规手术进行交叉韧带损伤的重建术治疗为常规组,关节镜下膝关节前交叉韧带损伤重建术治疗为研究组,每组各40名患者,比对两组的治疗效果。结果 通过数据得出常规组的膝功能评分(71.8±12.6)及膝功能不稳评分(13.2±1.6)要低于研究组膝功能评分(83.9±12.9)及膝功能不稳评分(19.3±2.3),差异有统计学意义(P＜0.05)。在术后疼痛评分上研究组(3.35±0.23)各项数据均优于常规组(4.35±1.69),差异有统计学意义(P＜0.05)。研究组并发症发生率仅为5%,常规组并发症发生率有17.5%,研究组数据远要低于常规组,差异有统计学意义(χ^<sup>2=5.178,P=0.023)。结论 在膝关节镜下前交叉韧带损伤重建术治疗可有效改善膝关节活动性、稳定性、有效减轻患者的疼痛感,减少并发症的发生,促进膝关节功能的康复。关节镜下进行膝关节前交叉韧带损伤重建术治疗具有临床推广和采纳的价值。

Objective To investigate the clinical effect of arthroscopic anterior cruciate ligament (ACL) reconstruction. Methods 80 patients with ACL injury in our hospital from March 2018 to March 2020 were selected as the research objects. According to the different surgical methods, patients underwent the traditional open surgery for cruciate ligament injury reconstruction treatment were selected as the control group,patients underwent arthroscopic anterior cruciate ligament injury reconstruction treatment were as the study group, 40 patients in each group, the treatment effect of the two groups were compared. Results The Lysholm score (71.8±12.6) and and Lysholm instability score (13.2±1.6) of the control group were lower than those of the study group (83.9±12.9 and 19.3±2.3), the differences were statistically significant (P <0.05). In the postoperative pain score, the study group (3.35±0.23) data was better than the control group (4.35±1.69), the difference was statistically significant (P <0.05). The incidence of complications in the study group was only 2.5%, and that in the control group was 17.5%, which was significantly lower than the control group, and the difference was statistically significant (χ²= 5.178, P= 0.023). Conclusion Arthroscopic anterior cruciate ligament reconstruction can effectively improve the activity and stability of knee joint, effectively reduce the pain of patients, reduce the occurrence of complications, and promote the rehabilitation of knee joint function. Arthroscopic anterior cruciate ligament reconstruction has the value of clinical promotion and adoption.

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 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 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。