全膝关节置换中鸡尾酒与股神经阻滞镇痛疗效早期对比：单中心随机双盲对照

文题释义：全膝关节置换：根据人体膝关节解剖及功能,采用钴铬钼合金等材料制成膝关节表面假体,通过手术方式植入体内,以达到纠正下肢力线、减少患者膝关节疼痛和改善长期功能为目的的一种手术方式。 鸡尾酒镇痛：将盐酸罗哌卡因、肾上腺素、阿片类药物及激素类药物等配成混合物,注射于膝关节周围起到一定术后镇痛的一种方法。 背景：全膝关节置换中关节周围鸡尾酒注射镇痛模式的早期镇痛效果及患者满意度能否达到甚至超越股神经阻滞一直饱受争论。 目的：比较全膝关节置换术中鸡尾酒镇痛与股神经阻滞镇痛的早期临床疗效。 方法：选择2019年3至12月徐州医科大学附属医院收治的70例慢性膝关节骨性关节炎患者,采用计算机随机列表分为2组：观察组(n=35)接受全膝关节置换治疗,关闭切口前分别于关节囊后部及两侧副韧带区域、切口皮下组织注射鸡尾酒混合溶液,切口关闭后通过引流管注入鸡尾酒混合溶液;对照组(n=35)接受全膝关节置换治疗,关闭切口后注射麻醉药物进行股神经阻滞。术后14 d内评估患者活动后的目测类比评分、膝关节主动活动度与患者镇痛满意度。试验获得徐州医科大学附属医院伦理委员会批准。结果与结论：①观察组术后2,3,5 d的目测类比评分低于对照组(P < 0.05),其余时间点比较差异无显著性意义(P > 0.05);②观察组术后2,3 d的膝关节屈曲活动度大于对照组(P < 0.05),其余时间点比较差异无显著性意义(P > 0.05);③观察中35例中23例对镇痛效果满意,对照组35例中10例对镇痛效果满意,组间比较差异有显著性意义(P < 0.05);④观察组术后急性镇痛20次,对照组术后急性镇痛36次;⑤结果表明,膝关节置换中鸡尾酒关节腔内注射镇痛优于股神经阻滞镇痛,其术后早期可提高患者膝关节主动活动度与满意度,有利于术后患者膝关节早期康复。ORCID: 0000-0002-4802-6811(张野) 中国组织工程研究杂志出版内容重点：人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程     

外侧排筏钢板结合Jail螺钉固定治疗累及后外侧柱的胫骨平台塌陷骨折近期疗效

目的 比较外侧排筏钢板结合Jail螺钉固定与单独外侧排筏钢板固定治疗累及后外侧柱的胫骨外侧平台塌陷骨折的近期临床疗效。方法 回顾分析2016年1月—2021年1月收治的106例(106膝)累及后外侧柱的胫骨外侧平台塌陷骨折患者。根据是否联合Jail螺钉固定,分为对照组(单纯采用外侧排筏钢板固定,52例)和研究组(外侧排筏钢板联合Jail螺钉固定,54例)。两组患者性别、年龄、患膝侧别、致伤原因、Schatzker分型、Tscherne-Gotzen分度、受伤至手术时间及术前外侧胫骨平台后倾角(posterior slope angle,PSA)、胫骨平台内翻角(tibial plateau varus angle,TPVA)、Rasmussen解剖评分等一般资料比较差异无统计学意义(P>0.05)。记录并比较两组患者手术时间、累计透视时间、术中出血量、住院时间、骨折愈合时间及并发症发生情况;术前及术后1年X线片、CT所示PSA、TPVA、Rasmussen解剖评分;记录术后1年两组关节面塌陷例数,采用美国特种外科医院(HSS)评分评价疗效。结果 两组患者均获随访,随访时间12～3...     

Comparison of minimally invasive reduction through a bone tunnel combined with Jail screwing and posterolateral locking plating for simple posterolateral tibial plateau fractures北大核心CSCD

Objective To compare the clinical effects of minimally invasive reduction through a bone tunnel combined with Jail screwing and those of posterolateral locking plating in the treatment of simple posterolateral tibial plateau fractures. Methods A retrospective analysis was conducted of the data of 48 patients who had been operatively treated and completely followed up at Department of Orthopedics, Suqian Hospital of Nanjing Drum Tower Hospital Group for simple posterolateral tibial plateau fractures from October 2016 to October 2020. There were 26 males and 22 females, aged from 35 to 68 years. They were divided into a minimally invasive group (25 cases subjected to minimally invasive reduction through a bone tunnel combined with Jail screwing) and an incision group (23 cases subjected to posterolateral locking plating) according to their surgical methods. The operation time, incision length, intraoperative blood loss, fracture healing time, cumulative fluoroscopy time, hospital stay and posterior inclination angles of the tibial plateau and Hospital for Special Surgery (HSS) knee function scores at 1, 3, 6, 9, and 12 months after operation were compared between the 2 groups. Complications in the 2 groups of patients were recorded. Results There was no significant difference in the preoperative general data between the 2 groups, showing comparability (P>0.05). The 48 patients were followed up for 12 to 36 months (average 16.5 months). The minimally invasive group was significantly better than the incision group in operation time [(42.6±9.1) min versus (65.7±11.5) min], incision length [(4.0±0.4) cm versus (15.0±1.5) cm], intraoperative blood loss[(22.6±5.8) mL versus (31.5±8.8) mL], hospital stay [(7.6±1.4) d versus (11.1±2.4) d], and HSS score one month after operation [(84.8±1.9) points versus (72.9±4.1) points], but the cumulative fluoroscopy time in the incision group [(4.1±1.4) s]was significantly less than that in the minimally invasive group [(22.3±4.2) s] (P<0.05). There were no significant differences in fracture healing time, HSS scores at 3, 6, 9, or 12 months after operation, or posterior inclination angle of the tibial plateau between the 2 groups (P>0.05). There were no such complications as wound infection, vascular injury, internal fixation failure, nonunion or malunion of fractures in either of the 2 groups. Two cases in the incision group presented with symptoms of common peroneal nerve injury but recovered 3 months after operation. Conclusions Although both minimally invasive reduction through a bone tunnel combined with Jail screwing and posterolateral locking plating can achieve satisfactory outcomes in the treatment of simple posterolateral tibial plateau fractures, the minimally invasive technique is preferable because it shows the advantages of a smaller incision, less bleeding, shorter operation time, a lower operation risk, quicker postoperative recovery and shorter hospital stay. © 2022 Chinese Journal of Orthopaedic Trauma. All rights reserved.     

An applied research on precise sustentacular screw placement based on anatomical division of the anterior lateral wall of calcaneus and the sustentaculum tali北大核心CSCD

Objective To evaluate our novel path based on anatomical division of the anterior lateral wall of calcaneus and the sustentaculum tali for precise sustentacular screw placement in the surgical treatment of calcaneal fractures of Sanders types Ⅱ and Ⅲ. Methods The anterior lateral wall of the calcaneus was divided into the anterior-superior zone S1, the anterior-inferior zone S2, the posterior-superior zone S3 and the posterior-inferior zone S4 for demarcation of the screw insertion points by our method of Four Zones, and into the front, middle and rear sections by our method of Three Sections for demarcation of the screw target points. The specimens were scanned by CT and modeled by Mimics. On the 3D virtual model of the calcaneus, one screw was placed from each zone of the anterior lateral wall of the calcaneus to the sustentaculum tali body. The screw placement target for S1 and S2 was the medial intersection point P1 of the front and middle sections of the sustentaculum tali, and that for S3 and S4 was the medial intersection point P2 of the middle and rear sections of the sustentaculum tali. It was observed whether the screws were placed in the bone channel. A total of 72 patients were included who had been admitted to Department of Orthopaedics, Suqian Hospital Affiliated to Xuzhou Medical University for calcaneal fractures of Sanders types Ⅱ and Ⅲ from January 2017 to January 2021. They were divided into an anatomical division group and a 3D printing group according to their screw placement method for the sustentaculum tali. In the anatomical division group of 32 patients subjected to screw placement based on our anatomical division, there were 25 males and 7 females, aged from 24 to 60 years; in the 3D printing group of 40 patients subjected to screw placement assisted by 3D printing, there were 31 males and 9 females, aged from 25 to 58 years. The disparities between the parameters of sustentacular screw placement and the actual values were compared in the anatomical division group, and the total number of screws, screws on average, distribution of screws, and accuracy of screw placement were compared between the 2 groups. Results All the screws which were virtually placed in the specimens of the calcaneus from S1 and S2 to P1 and from S3 and S4 to P2 passed through the bony channel, with no perforation into the tarsal sinus. There was no significant difference in the general date between the anatomical division group and the 3D printing group, showing they were comparable (P > 0.05). In the anatomical division group, a total of 52 screws were placed to the sustentaculum tali with an average of (1.63 ± 0.48) screws per patient, and 2 screws were placed in 20 patients, yielding an accuracy rate of screw placement of 92.3% (48/52). There were no statistically significant differences between the parameters and the actual values of screw placement in the anatomical division group (P > 0.05). In the 3D printing group, a total of 63 screws were placed to the sustentaculum tali with an average of (1.58 ± 0.49) screws per patient, and 2 screws were placed in 23 patients, yielding an accuracy rate of screw placement of 93.7% (59/63). There were no significant differences in the above comparisons between the anatomical division group and the 3D printing group (P > 0.05). Conclusion In the surgical treatment of calcaneal fractures of Sanders types Ⅱ and Ⅲ, the sustentacular screw placement based on our anatomical division of the anterior lateral wall of the calcaneus and the sustentaculum tali can lead to similar clinical accuracy as 3D printing-assisted screw placement does. © 2022 Chinese Journal of Orthopaedic Trauma. All rights reserved.