关节镜下半月板部分切除术治疗膝关节半月板损伤的疗效观察

目的探讨关节镜下半月板部分切除术治疗膝关节半月板损伤疗效,并与半月板成形术、保守治疗比较。方法回顾性分析2012年9月-2015年9月该院95例膝关节半月板损伤患者的临床资料,根据治疗方案分为3组,半月板部分切除术组(37例)行关节镜下半月板部分切除术,半月板成形术组(30例)行关节镜下半月板成形术,保守治疗组(28例)拒绝手术患者给予保守治疗。治疗后6个月评估临床疗效;治疗后6个月和2年采用L-ROM测定评估膝关节活动度,发放视觉模拟评分(VAS)评估患者疼痛程度,发放Lysholm膝关节功能评分评估膝关节功能,记录3组远期并发症发生。结果半月板部分切除组治疗总有效率为97.30%和半月板成形术组的86.68%均高于保守治疗的53.57%(P0.05),半月板部分切除术组与半月板成形术组组间比较无差异(P0.05);与治疗前相比,3组患者治疗6个月、2年后膝关节活动度、Lysholm评分明显上升,VAS评分明显下降(P0.05),半月板部分切除术组、半月板成形术组治疗6个月、2年后膝关节活动度、VAS评分组间比较无差异(P0.05),但与保守治疗组比较差异明显(P0.05);半月板部分切除术组治疗6个月、2年后Lysholm评分明显高于半月板成形术组、保守治疗组(P0.05),半月板成形术组、保守治疗组组间比较有差异(P0.05)。结论关节镜手术治疗膝关节半月板损伤效果确切,且关节镜下半月板部分切除在改善膝关节功能上更具优势。     

关节镜下半月板部分切除及术后康复

目的研究膝关节镜下半月板部分切除及术后康复治疗半月板损伤的疗效。方法对膝关节单纯半月板损伤的110例病人,进行关节镜下半月板部分切除术,其中康复组56例术后早期进行康复治疗,包括下肢肌力和关节活动度练习,早期负重行走和下蹲练习;对照组术后未行系统康复治疗。术前和术后3个月分别进行膝关节功能的Lysholm评分。结果术前Lysholm评分,康复组为(61.3±5.7)分,对照组为(61.8±5.5)分;术后3个月时,康复组Lysholm评分为(93.6±3.8)分,对照组为(79.8±4.2)分。康复组与对照组比较,术前两组间Lysholm评分差异无显著性,术后3个月两组间Lysholm评分差异有显著性(P<0.01)。结论膝关节镜下半月板部分切除及术后早期康复,可有效恢复病人的膝关节功能。     

运动员膝关节半月板损伤微创术后的康复

目的：研究运动员膝关节半月板损伤微创术后康复的特点及其存在问题。方法：本组病例分为A组（运动员组）36例，B组（普通人群组）45例，经临床检查与MRI检查术前诊断为膝关节半月板损伤，并由一位关节镜专科医师用微创外科技术行损伤半月板部分切除术。术后采用康复计划，由一组治疗师实施康复训练。随访时采用临床症状、体征、Lyshlom评分法、膝关节百分法进行评估。结果：A组2例，B组1例剧烈活动后关节疼痛，A组2例分别于术后8个月和16个月损伤膝关节前交叉韧带再手术，其余病例临床症状消失，关节功能正常。Lyshlom评分：A组术前：51.85±18.65，术后93.00±7.00，B组术前：52.38±16.02，术后：92.00±6.00（P＜0.01）。膝关节百分法：A组术前：49.56±16.64，术后：92.00±5.00；B组术前：50.43±16.02，术后：94.00±6.00（P＜0.01）。两组术前、术后评分相互比较差异无显著性（P＞0.05）。结论：采用微创外科技术及其康复计划治疗膝关节半月板损伤，无论是运动员还是非运动员都取得满意的临床效果，但对竞技运动员来讲，存在术后早期康复中过度负荷和训练引起临床症状的倾向，康复中后期的肌力训练和本体感觉训练等显然达不到运动员竞技状态恢复的要求，相关的研究值得康复医学界的重视。     

关节镜下半月板成形术在膝关节半月板损伤治疗中的应用

目的探讨关节镜下半月板成形术在膝关节半月板损伤治疗中的应用效果。方法选取该院2012年2月至2016年7月收治的95例膝关节半月板损伤患者进行研究,按随机数字表法将其分为研究组和对照组。研究组采用关节镜下半月板成形术治疗,对照组采用半月板切除术治疗,比较两组患者膝关节功能、Lysholm膝关节评分及膝关节主观功能(IKDC)评分改善情况。结果研究组膝关节功能优于对照组,差异有统计学意义(χ~2=2.942,P0.05)。术前Lysholm膝关节评分组间比较差异无统计学意义(P0.05);术后两组患者Lysholm膝关节评分均增高,与术前比较差异均有统计学意义(P0.05),术后14d及末次随访时研究组Lysholm膝关节评分均高于对照组,差异有统计学意义(P0.05)。术前IKDC评分组间比较差异无统计学意义(P0.05);术后两组患者IKDC评分均增高,与术前比较差异均有统计学意义(P0.05),术后14d及末次随访时研究组IKDC评分均高于对照组,差异有统计学意义(P0.05)。结论关节镜下半月板成形术治疗膝关节半月板损伤的远期疗效优于半月板切除术,可作为治疗膝关节半月板损伤的首选手术方式。     

关节镜下两种手术方式治疗老年膝关节半月板损伤的疗效比较

目的对比关节镜下两种手术方式治疗老年膝关节半月板损伤的临床疗效。方法选取我院于2017年9月～2018年10月收治的90例老年膝关节半月板损伤患者,随机数表法分为两组各45例,观察组患者选择关节镜下半月板成形术进行治疗,对照组患者选择关节镜下半月板缝合术进行治疗,对比两种治疗方法的临床效果。结果观察组治疗总优良率(88.89%)比对照组(71.11%)高(P<0.05);观察组患者治疗后Lysholm评分和功能改善评分均比对照组高(P<0.05)。结论将关节镜下半月板成形术应用于老年膝关节半月板损伤治疗中效果确切,可将患者的膝关节功能改善。     

中药熏蒸配合功能锻炼对膝关节镜下半月板手术患者功能恢复的影响

目的:探讨中药熏蒸配合功能锻炼对膝关节镜下半月板手术患者功能恢复的影响。方法:将100例行膝关节镜手术的半月板损伤患者随机分为治疗组与对照组,各50例。对照组给予常规功能锻炼;治疗组采用中药熏蒸配合功能锻炼的分期康复训练的方法。术前和术后3个月分别进行膝关节功能的Lysholm评分。结果:治疗组膝关节功能改善程度明显优于对照组(P<0.01)。结论:中药熏蒸配合功能锻炼对膝关节镜下半月板手术患者膝关节功能恢复有积极意义。     

半月板部分切除和非手术治疗膝内侧半月板退行性损伤的对比研究

目的比较关节镜下半月板部分切除和系统非手术治疗退行性膝关节内侧半月板损伤的临床疗效。方法采用前瞻性研究方法,选取2016年8月至2017年6月首都医科大学附属北京友谊医院骨科收治的退行性膝关节内侧半月板损伤患者62例,所有患者均接受膝关节磁共振检查证实为退行性膝关节内侧半月板损伤。按照单纯随机抽样法将患者分为手术治疗组和非手术治疗组,每组各31例。手术治疗组患者接受关节镜下膝关节内侧半月板部分切除,非手术治疗组患者采用口服非甾体抗生素、冲击波和运动疗法治疗。治疗前和治疗后6个月分别使用膝关节损伤和骨关节炎结果评分(KOOS评分)、Tegner活动度评定量表(Tegner评分)和Lysholm膝关节评分(Lysholm评分)评价膝关节功能和疼痛程度,并且比较两种方法的治疗效果。结果截止到2018年1月,除3例患者失访外,59例患者获得完整门诊随访,其中手术治疗组30例,非手术治疗组29例。手术组治疗前KOOS评分、Tegner活动度评定量表评分和Lysholm膝关节评分分别为(308.8±11.2)分,(3.3±1.2)分和(65.2±9.6)分;而非手术治疗组治疗前上述指标分别为(306.7±10.3)分,(3.4±1.3)分和(64.8±8.1)分;两组各评分比较差异无统计学意义(P>0.05)。治疗6个月后,手术组患者KOOS评分、Tegner活动度评定量表评分和Lysholm膝关节评分分别为(310.6±10.8)分、(3.5±1.3)分、(65.2±9.6)分,非手术治疗组上述指标分别为(359.1±18.4)分、(4.6±1.7)分、(73.2±10.1)分,非手术组各评分均明显优于手术组,差异有统计学意义(P<0.05)。非手术组优良率(72.4%)明显高于手术组(46.7%),差异具有统计学意义(P<0.05)。结论对于退行性膝关节内侧半月板损伤,系统非手术治疗的效果优于关节镜下半月板部分切除的临床疗效,所以首选推荐使用系统的非手术治疗方法。     

关节镜全内缝合法治疗外侧半月板腘肌腱裂孔处撕裂的临床疗效分析

目的 评估在半月板缝合器辅助下关节镜全内缝合法治疗膝关节外侧腘肌腱裂孔处半月板撕裂的临床疗效。方法 选择2018年1月－2019年6月该院确诊为腘肌腱处半月板撕裂并行关节镜下全内缝合的患者32例。患者年龄20～47岁，平均（33.75±8.21）岁；男21例，女11例；左膝损伤14例，右膝损伤18例。术前及术后6个月随访时，采用Lysholm膝关节评分、Tegner膝关节运动评分和美国膝关节协会评分（KSS）评估患者膝关节功能恢复情况；术前及术后6个月，采用视觉模拟评分（VAS）及关节活动度评估患者疼痛及关节活动度改善情况。结果 术后患者均得到6个月的随访，Lysholm评分由术前的（56.80±10.34）分提高至（89.56±5.71）分，Tegner评分由（2.47±0.78）分提高至（5.63±1.21）分，KSS由（42.28±4.75）分提高至（89.28±3.95）分，VAS由（5.03±1.77）分降至（1.85±0.54）分，关节活动度由（51.34±16.19）°扩大至（126.38±6.03）°，术前术后比较，差异均有统计学意义（P < 0.05）。结论 腘肌腱裂孔处半月板较松弛，采用缝合器辅助下关节镜全内缝合法，在缝合过程中将腘肌腱与半月板同时缝合，能够较大程度地改善患者术后临床症状，提高稳定性，加大关节活动度，值得临床推广应用。     

稳定型内侧半月板ramp损伤采用全内缝合修复手术对关节活动度和愈合效果的影响

目的探讨关节镜下前交叉韧带重建术+全内缝合修复术治疗稳定型内侧半月板ramp损伤对患者关节活动度和愈合效果的影响。方法选取自2016年3月至2018年3月山东第一医科大学附属成武医院收治的稳定型内侧半月板ramp损伤患者85例,按照手术方式分成两组,对照组42例做关节镜下前交叉韧带重建术治疗,观察组43例采用关节镜下前交叉韧带重建术+全内缝合修复术治疗,对比两组患者术后末次随访时韧带愈合情况,于术前、术后6个月时分别采用国际膝关节文献委员会膝关节评估量表(international knee documentation committee,IKDC)评估膝关节功能改善情况,采用Lysholm膝关节评分(Lysholmknee scale,LKS)进行膝关节功能评估。结果术后随访6个月时观察组半月板撕裂完全愈合率为95.35%,高于对照组的78.52%(χ2=5.308,P=0.021),末次随访时组间愈合率差异无显著性(P>0.05)。术前两组患者IKDC、Lysholm膝关节评分差异无显著性(P>0.05),术后6个月时、末次随访时观察组患者IKDC评分、Lysholm膝关节评分均优于对照组(P<0.05);相较术前,两组患者术后6个月时、末次随访时Lachman实验差值逐渐减小,术后各时段组间差异有显著性(t=4.919,P=0.000)。结论关节镜下前交叉韧带重建术+全内缝合修复术治疗稳定型内侧半月板ramp损伤可缩短愈合时间,更好地改善膝关节活动度。     

玻璃酸钠用于膝关节半月板损伤关节镜治疗术后近期疗效评价

目的评价玻璃酸钠应用于膝关节半月板损伤行关节镜半月板修整成型术后患者的近期疗效。方法 2008年9月-2009年3月,共收治50例膝关节半月板损伤患者,男29例,女21例,年龄18～65岁。采用随机、对照方法将患者分为两组:试验组25例,为关节镜术后应用玻璃酸钠组;对照组25例,为关节镜术后空白对照组。随访时间3～6个月,无失访患者。两组治疗前后采用Lysholm评分对膝关节功能进行评定。结果随访发现两组术后关节症状均好转。两组术前和术后1周Lysholm评分差异无统计学意义(P≥0.05),两组术后2、3、4、5周Lysholm评分差异有统计学意义(P<0.05)。结论膝关节半月板损伤患者,行关节镜手术后应用玻璃酸钠,有利于其术后的康复。     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Modified micro-superior percutaneously-assisted total hip: early experiences & case reports

Because of the extensile nature and familiarity of the standard posterior-lateral approach to the hip, a family of "micro-posterior" approaches has been developed. This family includes the Percutaneously-Assisted Total Hip (PATH) approach, the Supercapsular (SuperCap) approach and a newer hybrid approach, the Supercapsular Percutaneously-Assisted Total Hip (SuperPATH) approach. Such approaches should ideally provide a continuum for the surgeon: from a "micro" (external rotator sparing) posterior approach, to a "mini" (external rotator sacrificing) posterior approach, to a standard posterior approach. This could keep a surgeon within his comfort zone during the learning curve of the procedure, while leaving options for complicated reconstructions for the more practiced micro-posterior surgeons. This paper details one author's experiences utilizing this combined approach, as well as permutations of this entire micro-posterior family of approaches as applied to more complex hip reconstructions.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.     

Structure and function of "metalloantibiotics"

Although most antibiotics do not need metal ions for their biological activities, there are a number of antibiotics that require metal ions to function properly, such as bleomycin (BLM), streptonigrin (SN), and bacitracin. The coordinated metal ions in these antibiotics play an important role in maintaining proper structure and/or function of these antibiotics. Removal of the metal ions from these antibiotics can cause changes in structure and/or function of these antibiotics. Similar to the case of "metalloproteins," these antibiotics are dubbed "metalloantibiotics" which are the title subjects of this review. Metalloantibiotics can interact with several different kinds of biomolecules, including DNA, RNA, proteins, receptors, and lipids, rendering their unique and specific bioactivities. In addition to the microbial-originated metalloantibiotics, many metalloantibiotic derivatives and metal complexes of synthetic ligands also show antibacterial, antiviral, and anti-neoplastic activities which are also briefly discussed to provide a broad sense of the term "metalloantibiotics."