[目的]评估髋关节镜术治疗股骨髋臼撞击综合征(femoroacetabular impingement syndrome,FAI)合并外侧弹响髋(external snapping hip,ESH)的临床疗效.[方法]回顾性分析2014年1月—2019年6月本院行髋关节镜术患者,25例FAI合并ESH的患者列入观察组,行镜下关节内病变处理和镜下髂胫束松解;另外25例单纯FAI患者列为对照组,仅行镜下FAI病变处理.比较两组围手术期、随访与影像资料.[结果]两组患者均顺利手术,均未发生严重并发症.观察组手术时间显著长于对照组(P＜0.05),但两组术后完全脱拐行走时间、切口愈合等级和住院时间的差异均无统计学意义(P＞0.05).所有患者均随访12个月以上,与术前相比,末次随访时,两组患者疼痛视觉模拟评分(visual analogue scale,VAS)显著降低(P＜0.05),而改良 Harris 髋关节评分(modified Harris Hip Scores,mHHS)和国际髋关节结果工具评分(International Hip Outcome Tool,iHOT-33)显著增加(P＜0.05);观察组伸直位髋内收活动度(range of motion,ROM)显著增加(P＜0.05).术前,观察组VAS评分显著高于对照组(P＜0.05),观察组iHOT-33评分显著低于对照组(P＜0.05),观察组下肢伸直位内收ROM显著小于对照组(P＜0.05);末次随访时,两组上述指标的差异均无统计学意义(P＞0.05).影像方面,与术前相比,末次随访时两组患者α角显著减小(P＜0.05),股骨头颈偏矩(femoral head neck offset,FHNO)显著增加(P＜0.05).相应时间点,两组间α角、FHON、LCE角和T?nnis分级的差异均无统计学意义(P＞0.05).[结论]关节镜同时处理FAI和ESH病变具有创伤小、操作简单的优点,其临效床果与单纯FAI患者相近.

OBJECTIVE:To assess the mid-term effectiveness of anterior cruciate ligament (ACL) revision and to analyze the relevant factors that may affect the surgical outcomes. METHODS:The clinical data of 24 patients who underwent ACL revision surgery between April 2009 and July 2018 and were followed up for more than 2 years were retrospectively analyzed. There were 20 males and 4 females with a median age of 30 years [interquartile distance (IQR) was (25, 36) years]. The median body mass index was 24.45 kg/m 2 and IQR was (22.93, 25.93) kg/m 2. The median time between ACL revision and reconstruction was 41 months and IQR was (15, 85) months. The direct cause of the failure of reconstruction surgery included 14 cases of trauma, 8 cases of no obvious cause, and 2 cases of infection. During the revision operation, 14 patients had a poor bone tunnel position, all of which were drilled with new tunnels, the remaining 10 patients were freshly modified on the basis of the original bone tunnel. Seventeen patients used autogenous tendon revision, 7 patients used LARS ligament; 16 patients had cartilage injury. The Lysholm score, the International Knee Documentation Committee (IKDC) score, and the Tegner sports rating score were used for functional evaluation before operation, at 1 year after operation, and at last follow-up. The Likert satisfaction score was recorded at last follow-up. RESULTS:Patients were followed up with a median time of 47 months and IQR was (32, 61) months. The Lysholm score, IKDC score, and Tegner sports rating score were significantly improved at 1 year after operation and at last follow-up when compared with preoperative scores ( P<0.05). There was no significant difference between at last follow-up and at 1 year after operation ( P>0.05). At last follow-up, the median Likert satisfaction score was 4.0 and IQR was (3.0, 4.5). According to the presence or absence of cartilage damage and the type of graft, the above scores at last follow-up were compared between the groups, and the differences were not significant ( P>0.05). At last follow-up, 2 patients had graft fractures due to trauma again, and autogenous iliac bones were taken to fill the bone tunnel, and the second stage was revised; the rest of the patients recovered satisfactorily. CONCLUSION:With preoperative identification of the cause of ACL reconstruction failure, the stability and function of knee joint can be significantly improved by selecting appropriate bone tunnels and grafts during the revision and by active rehabilitation exercises.

Objective To determine the effectiveness of hip arthroscopy combined with endoscopic iliotibial band (ITB) release in patients with both femoroacetabular impingement (FAI) syndrome and external snapping hip (ESH). Methods Retrospectively review the preoperative and minimum of 2‐year follow‐up data of patients with both FAI syndrome and ESH who underwent endoscopic ITB release during hip arthroscopy (FAI + ESH group) from January 2014 to December 2018. The same number of age‐ and gender‐matched FAI syndrome patients without ESH undergoing hip arthroscopy were enrolled in the control group (FAI group). Patient‐reported outcomes (PROs) including international Hip Outcome Tool (iHOT‐33), modified Harris Hip Score (mHHS), visual analog scale for pain (VAS‐pain), and abductive force of affected hip at 3 month and 2 years postoperatively were comparatively analyzed. The VAS‐satisfaction score of two groups at 2 years postoperatively were also analyzed. Results The prevalence of ESH in FAI syndrome patients undergoing hip arthroscopy in our institution was 5.5% (39 of 715 hips), including nine males (10 hips) and 29 females (29 hips). The mean age at the time of surgery was 32.1 ± 6.9 years (range, 22–48 years). According to inclusion and exclusion criteria, 23 patients were enrolled in FAI + ITB group. Twenty‐three age‐ and sex‐matched FAI syndrome patients were enrolled in FAI group. At 24 months postoperatively, no patient still suffered ESH symptoms and painful palpation at lateral region in FAI + ITB group. The iHOT‐33, mHHS, and VAS‐pain score of patients in FAI + ESH group were significantly severer than patients in FAI group preoperatively (41.6 ± 7.5 vs 48.8 ± 7.2, 54.8 ± 7.2 vs 59.2 ± 6.9, 5.5 ± 0.9 vs 4.7 ± 1.0; P < 0.05), while there was no significant difference in these scores between the patients in FAI + ESH group and FAI group at 3‐month and 24‐month follow‐up (73.6 ± 8.5 vs 76.1 ± 6.9, 85.3 ± 7.8 vs 84.2 ± 6.6, 0.8 ± 0.9 vs 0.6 ± 0.9; P > 0.05). At 3 months after surgery, the abductive force of operated hip was significantly smaller than that in FAI group (82.4 ± 12.4 N vs 91.9 ± 16.1 N, P < 0.05), whereas there was no significant difference at 24 months after surgery (101.6 ± 14.9 N vs 106.5 ± 13.7 N, P > 0.05). The VAS‐satisfaction scores of patients in the two groups were at a similarly high level (90.5 ± 6.8 vs 88.8 ± 7.3, P > 0.05). There was no complication and no arthroscopic revision in either group until 2‐year follow‐up. Conclusion Although abductive force recovery of the hip was delayed, hip arthroscopy combined with endoscopic ITB release addressed hip snapping in patients with both FAI syndrome and ESH, and could get similar functional improvement, pain relief, recovery speed, as well as patient satisfaction compared with the pure hip arthroscopy in FAI syndrome patients without ESH.

ObjectiveTo analyze the learning curve experience of hip arthroscopy based on patient demographics, surgical time, portal setup time, and postoperative complications and to find the key point in the learning curve.MethodsFrom May 2016 to February 2019, a prospective study on the learning curve experience of hip arthroscopy was performed in our hospital. We evaluated the first 50 consecutive hip arthroscopy procedures performed by a single surgeon. There were nine females and 41 males with a mean age of 30.8 years. We divide the patients into early group and late group according to the date of their operation, with each group including 25 patients. Data on patient demographics, types of procedure, surgical time, portal setup time, and postoperative complications were collected. Functional scores were assessed with the modified Harris Hip Score (mHHS).ResultsPatients were followed up for 16.4 months on average (range, 13–27 months). The early group of patients had a mean age of 35.2 years and the late group a mean age of 26.5 years. The most common procedures performed for the early group were debridement (17 patients, 68%), and in the late group, most patients underwent labral repair (18 patients, 72%). Mean total surgical time was 168 min for the early group and 143 min for the late group, and there was no statistically significant difference between two groups. The portal setup time in the early group and late group was 40.2 ± 12.4 min and 18.5 ± 6.2 min, respectively (P < 0.001), and the portal setup time was significantly longer in the early group. Further analysis of the learning curve of portal setup showed that the average portal setup time was not statistically significant changed after 30 cases. There were six complications including iatrogenic cartilage injury and iatrogenic labrum injury in the early group and five complications including perineal crush injury and nerve stretch injury in the late group. The functional score of patients in the late group was significantly higher than that in the early group during follow‐up.ConclusionThe steep learning curve of hip arthroscopy is mainly caused by the challenge of portal setup and portalrelated complications were more common in the early group than in the late group. Surgical time is not an effective indicator for evaluating progress on the learning curve of hip arthroscopy.

Objective To investigate the outcomes of C‐shaped release around the greater trochanter in gluteal muscle contracture under arthroscopy. Methods From December 2016 to January 2018, 185 patients with gluteal muscle contracture who treated under arthroscopy were reviewed, including 69 males and 116 females. All patients had a history of repeated intramuscular injection into the buttocks. The follow signs were positive in all the patients before surgery: squatting and crouching disability, difficulty in crossing the leg, Ober's sign positive, clicking sound during rotation of the hip. The C‐shaped release around the greater trochanter under arthroscopy was performed in 96 cases (C‐shaped release group) with an average age of 24.6 ± 4.9 years old, and conventional gluteal muscle contracture release under arthroscopy was performed in 89 cases (conventional release group) with an average age of 25.1 ± 5.0 years. The released tissues in the C‐shaped release group: iliotibial band (ITB) about 5 cm distal to the proximal end of the greater trochanter, the contracture tissue near the posterior and superior of the greater trochanter, which depended on both intraoperative physical examination and arthroscopic observation. The released tissues in conventional release group: the contracture tissues in gluteal muscles according to observation under arthroscopy. The gluteal muscle contracture disability scale (GDS) and Visual analogue scale (VAS) were evaluated before surgery and at the last follow‐up. Results The average release time after making arthroscopic operation space for each lower limb were 12.2 ± 3.2 min in the C‐shaped release group, and 21.4 ± 6.1 min in the conventional release group (P = 0.000). All the patients were followed for at least of 2 years after operation. There was one case of wound hematoma in the C‐shaped release group and five cases in the conventional release group(P = 0.079), abductor weakness (IV level)occurred in two patients in the C‐shaped release group and five cases in the conventional release group (P = 0.208). GDS was 49.3 ± 17.3 (22 to 70) in theC‐shaped release group and 48.1 ± 15.6 (23 to 69) in the conventional release group before surgery (P = 0.622), 91.7 ± 5.2 (83 to 100) in the C‐shaped release group and 90.2 ± 6.1 (83 to 98) in the conventional release group (P = 0.073) with difference nearly significant at last follow‐up. Conclusion Arthroscopic C‐shaped release around the greater trochanter had less operation time, acceptable complication occurrence, and it has an optimistic outcome for gluteal muscle contracture under arthroscope.

Xenogeneic porcine fibrin sealant (PFS), derived from porcine blood, was used as a scaffold for cartilage tissue engineering. PFS has a porous microstructure, biocompatibility and degradation, and it provides a perfect extracellular matrix environment for the adhesion and proliferation of chondrocytes. Recently, PFS in combination with autologous chondrocytes (ACs) were used to study the microstructure of PFS scaffolds and promotion effect on the proliferation and migration of ACs. In this study, we investigated the effects of PFS in combination with ACs on the healing of cartilage defects in rabbits. A full-thickness cartilage defect was made in the femoral trochlear in rabbits, subsequently, three surgical procedures were used to repair the defect, namely: the defect was treated with microfracture (MF group); the defect was filled with PFS alone (PFS group) or in combination with ACs (PFS + ACs group); the unrepaired cartilage defects served as the control group (CD group). Three and 6 months after the operation, the reparative effect was evaluated using medical imaging, gross scoring, pathological staining, biomechanical testing and biochemical examination. The PFS group showed a limited effect on defect repair, this result was significantly worse than the MF group. The best reparative effect was observed in the PFS + ACs group. These results hinted that PFS in combination with autologous chondrocytes has broad prospects for clinical applications in cartilage tissue engineering.

[目的]探讨前交叉韧带(anterior cruciate ligament,ACL)重建失败后翻修进行翻修手术的主要原因.[方法]回顾性2009年3月-2020年3月解放军总医院骨科收治的因重建失败而行翻修术的36例患者的临床资料,其中男31例,女5例,年龄(29.39±6.63)岁;31例于外院行初次ACL重建术,5例于本院初次重建.结合患者临床病例及影像学资料研究分析ACL重建失败的原因.[结果]36例翻修患者中,33例初次重建术移植物使用自体肌腱,2例使用同种异体肌腱,1例使用LARS人工韧带.在患者初次ACL重建失败的因素中,19例为创伤导致的翻修;10例为单纯的技术原因;3例因生物学原因而翻修;7例为组合因素,其中6例同时存在创伤因素及技术因素,1例为生物学因素合并技术因素;另有3例为其他原因.翻修手术中,23例使用自体肌腱,10例使用LARS人工韧带,2例使用同种异体肌腱,1例患者因自体肌腱过细(≤6mm)而使用自体肌腱加同种异体肌腱进行翻修.[结论]导致前交叉韧带重建手术失败的因素包括骨隧道定位错误、移植物选择及合并损伤等,但主要与手术技术有关.

OBJECTIVE:Both ligament-advanced reinforcement system (LARS) and hamstring tendon autograft can serve as grafts for posterior cruciate ligament (PCL) reconstruction. However, few studies have compared the effectiveness of these two approaches. This study therefore aimed to compare the clinical efficacy of arthroscopic reconstruction of the PCL using either the LARS or hamstring tendon autograft. METHODS:A total of 36 patients who underwent PCL reconstruction were retrospectively analyzed. Within this cohort, 15 patients received a reconstruction using the LARS (LARS group) and 21 using the hamstring tendon autograft (HT group). RESULTS:The pre- and post-operative subjective scores and knee stability were evaluated and the patients were followed up for a period of 2 to 10.5 years (4.11±2.0 years on average). The last follow-up showed that functional scores and knee stability were significantly improved in both groups (P<0.05). Six months after operation, Lysholm scores and IKDC subjective scores were higher in the LARS group than in the HT group (P<0.05). Nonetheless, the last follow-up showed no significant differences in the functional scores or the posterior drawer test between the two groups (P>0.05). In the LARS and HT groups, 12 and 9 patients, respectively exhibited KT1000 values <3 mm, with the difference being statistically significant (P<0.05). In the HT group, the diameter of the four-strand hamstring tendon was positively correlated with height (P<0.05), which was 7.37±0.52 mm in males and 6.50±0.77 mm in females (P<0.05). CONCLUSION:Both LARS and hamstring tendon approaches achieved good efficacy for PCL reconstruction, but patients in the LARS group exhibited faster functional recovery and better knee stability in the long term. LARS is especially suitable for those who hope to resume activities as early as possible.

Purpose: To compare patient-reported outcomes (PROs) in patients with femoroacetabular impingement (FAI) syndrome and external snapping hip (ESH) treated with hip arthroscopy with or without endoscopic iliotibial band (ITB) release. Methods: Retrospective review case series with both FAI syndrome and ESH who underwent surgical treatment under same indications. According to the primary operation that was determined by patients themselves, the patients undergoing ITB release during hip arthroscopy for FAI syndrome were enrolled in the ITB-R group, and patients undergoing hip arthroscopy without ITB release were enrolled in non-ITB-R group. Patients with dysplasia, severe osteoarthritis, revision, and bilateral surgery were excluded. PROs including international Hip Outcome Tool (iHOT-33), modified Harris Hip Score (mHHS), visual analog scale for pain (VAS-pain) and VAS-satisfaction, and the rates of achieving minimal clinically important difference, patient acceptable symptomatic state (PASS), and substantial clinical benefit for the PROs at 2 years operatively were comparative analyzed. Results: The prevalence of ESH in patients with FAI syndrome who underwent hip arthroscopy in our institution was 4.9% (30 of 612 hips). The mean age at the time of surgery was 33.1 +/- 6.9 years (range 22-48 years). After exclusion, 16 patients (16 hips) were enrolled into ITB-R group and 11 patients (11 hips) enrolled into non-ITB-R group. PROs including iHOT-33, mHHS, VAS-pain, and VAS-satisfaction in patients in ITB-R group were better than that in non-ITB-R group at 2 years postoperatively (P = .013, .016, .002, and .005, respectively). The rates of achieving PASS for mHHS, PASS for VAS-pain, and substantial clinical benefit for iHOT-33 of patients in ITB-R group were significantly better than that in non-ITB-R group (P = .009, .006, and .027, respectively). Conclusions: Patients with both FAI syndrome and ESH undergoing ITB release during hip arthroscopy had better PROs than those undergoing hip arthroscopy without ITB release. Level of Evidence: Level III, retrospective comparative study.

目的 探讨差分自回归移动平均模型(ARIMA)用于巴基斯坦新冠疫情发展趋势的预测效果,为新冠疫情预测提供实践经验.方法 使用SPSS20.0软件,对巴基斯坦2020年3月10日至5月14日新冠疫情日新增确诊病例数时间序列构建ARIMA拟合模型,用以对未来日新增病例数进行预测,并与观察值进行比较.结果 ARIMA(2,1,0)模型很好地拟合了前期的日新增病例数序列,其平稳R2=0.50,模型各参数均具有统计学意义,且残差白噪声检验Ljung-Box Q=10.45,P=0.84.用该模型对5月15日-6月30日的新增病例数进行预测,显示疫情趋势总体上将继续上升,与截至5月31日的观察结果相一致,15天的预测误差仅为4.96％,17天则增加到9.62％,预计6月新增病例总数44015～103202例.将5月15日-31日的实际日新增病例数加入时间序列后重新使用该模型预测,6月新增病例总数68546～140886例.结论 可以运用ARIMA模型进行巴基斯坦新冠疫情短期趋势预测,巴基斯坦新冠疫情在六月仍将持续上升.

Purpose ：This retrospective study summarized the clinical, radiographic and arthroscopic manifestation of synovial chondromatosis (SC) of the hip, along with the post-operative effect to discuss the curative effect of arthroscopic management of hip SC. Methods : 21 patients underwent arthroscopic surgery from the same surgeon for hip SC were followed up for an average of 45 months. T-shaped capsulotomy was routinely performed in each case. Visual analog scale, range of motion, modified Harris Hip score and International Hip Outcome Tool score were collected preoperatively and at the time of the latest follow-up. All patients’ demographics, radiographs and arthroscopic images were collected to summarize and conclude the similarities and differences of their manifestation. Results : Large wedged-clumps of loose bodies demonstrated distinguishable radiographic, arthroscopic appearance and demanded different surgical strategy. Postoperative scores were all significantly improved. One case of residual pain and two cases of residual loose bodies with no symptom related were reported at the final follow up. All but one patients were satisfied with the outcome. Conclusion : Arthroscopy treatment of hip SC with T-shaped capsulotomy has demonstrated good result in terms of clinical outcome score, recurrence rate and complication rate. On the basis of this study, we concluded the clinical performance of large wedged-clumps of loose bodies of hip SC.

Objective To compare clinical outcomes of arthroscopic therapy for tibial eminence avulsion fracture with loop ligature suture and absorbable suture anchor. Methods From June 2012 to February 2018 62 patients with avulsion fractures of the anterior cruciate ligament injured within three weeks in First Medical Center of PLA General Hospital were selected in the study. All the affected knees have normal function before injury. The patients with open fracture, multiple fracture, tibial plateau fracture, meniscus and ligament injury were excluded in the study. All the patients were divided into two groups according to different operation methods: 30 patients were treated with arthroscopic reduction and fixation using loop ligature suture, as the suture group; 32 patients were treated with arthroscopic reduction and fixation using absorbable suture anchor, as the anchor group. The operation time and intraoperative blood loss of the two groups were compared. Knee joint stability of two groups was compared by front drawer test, Lachman test and axial shift test. Knee joint function of two groups was compared by Lysholm score and International Knee Documentation Committee (IKDC) 2000 subjective score. The independent sample t test was used to compare the quantitative data between two groups. The paired t test was used to compare the quantitative data within groups, and the chi-square test was used for compare the qualitative data between the two groups. Results All the incisions healed primarily. Radiographic evaluation showed bone union within three months postoperatively in both groups. The mean follow-up period after the operation was (22±8)months in suture group and (19±7)months in anchor group. The operation time in anchor group was lower than that in suture group, and the difference was statistically significant (t=2.491, P 0.05). The Lysholm score were both improved in two groups after operation for six months. The difference was statistically significant(suture group: t=26.265, P 0.05). Conclusion In the arthroscopic therapy for tibial eminence avulsion fracture, the loop ligature suture fixation and absorbable suture anchor fixation have their own characteristics but equivalent clinical effects, which could both provide satisfying reduction, rigid fixation, well healing of avulsed fragment and effective functional rehabilitation. Key words: Arthroscopy; Anterior cruciate ligament; Fractures, avulsion; Sutures

目的 研究微酸性次氯酸水气锤脉冲消毒法对口腔综合治疗台水路(DUWLs)的消毒效果.方法 采用现场消毒试验方法,对微酸性次氯酸水消毒DUWLs的效果进行观察.结果 消毒前口腔手机联接端水样合格率为0％,三用枪水样合格率为30.00％.采用含有效氯150 mg/L的微酸性次氯酸水对DUWLs浸泡12 h,口腔手机联接端水样合格率为71.67％,三用枪水样合格率为80％.采用含有效氯150 mg/L的微酸性次氯酸水以气锤脉冲冲洗机清洗DUWLs,口腔手机联接端水样合格率为98.33％,三用枪水样合格率为100.00％.结论 该医院DUWLs中存在微生物污染超标,采用微酸性次氯酸水气锤脉冲清洗消毒可对DUWLs进行有效的消毒.

目的 探讨小孔径、多孔道、低钻速扇形钻孔减压术治疗早期股骨头缺血坏死的长期疗效.方法 选择解放军总医院第一医学中心骨科2001年2月-2006年4月在C形臂监视下采用3.5 mm克氏针进行小孔径、多孔道、低钻速钻孔减压治疗的早期股骨头缺血性坏死226例(383髋).对所有患者在手术后进行持续临床随访,评估术后1年和术后10年的改良Harris髋关节评分(mHHS评分)变化和影像学结果.结果 226例(383髋)中完成术后10年随访164例(285髋),其中男性128例(221髋),女性36例(64髋);平均年龄14 ～ 64(36.5±8.3)岁;随访时间130～204(186±9.7)个月;术前mHHS评分56～78(66.5±5.7)分,术后约1年时随访评分增加到61 ～ 93(81.3±5.4)分,最后1次随访时评分为59 ～ 90(80.4±5.9)分.最后1次随访时197髋(69.1％)疗效优良(mHHS评分＞80),患者无疼痛或轻微疼痛,能胜任日常工作,X线片显示股骨头无明显塌陷;61髋(21.4％)疗效为中(mHHS评分70～79分),患者轻度或中度疼痛,可以生活自理,股骨头塌陷＜2mm;27髋(9.5％)疗效差(mHHS评分＜69分),严重疼痛,生活不能自理,股骨头塌陷,其中23髋已经施行髋关节置换.结论 小孔径、多孔道、扇形低钻速钻孔减压术能够有效治疗早期股骨头坏死,减少对股骨头的骨质破坏,有助于延迟股骨头塌陷,可推迟或避免髋关节置换.

本文报道1例髋关节囊肿压迫股静脉导致下肢肿胀病例的诊疗过程。完善单侧髋关节核磁等检查后明确诊断,行髋关节镜检查,证实了术前诊断,通过髋关节镜微创手术部分切除囊肿行内引流,同时处理股骨髋臼撞击,盂唇损伤等关节内原发病因。术后患者腹股沟区包块消失,疼痛及下肢肿胀症状明显缓解,且术后随访未见复发。通过总结此病例诊治思路及治疗策略的选择并回顾文献,可见髋关节镜手术治疗此类疾病,在切除囊肿的同时可一期处理关节内原发病因,具有创伤小,安全,疗效显著,术后恢复快,不易复发等优点。

目的 观察膝关节髌股关节间隙和膝眼两个部位注射玻璃酸钠对膝关节髌股关节炎的疗效及应用特点.方法 选择2017年2月-2018年4月在武警特色医学中心骨科接受关节腔玻璃酸钠注射治疗的膝关节髌股关节炎患者64例,根据注射位点不同,依据就诊顺序按随机数字表法分为髌股关节间隙注射组(34例)和膝眼注射组(30例).两组均接受剂量为2.5 ml/次,1次/周,连续5周的膝关节腔玻璃酸钠注射治疗.比较两组患者治疗前后的VAS评分、Lysholm评分及治疗后优良率.结果 两组治疗后VAS评分均较治疗前降低,Lysholm评分均较治疗前升高(P＜0.05).首次注射后和注射3周后,髌股关节间隙注射组VAS评分显著低于膝眼注射组(P＜0.05).注射3周后及注射后3个月,髌股间隙注射组Lysholm评分高于膝眼注射组(P＜0.05).注射5周后及注射后3个月髌股间隙注射组优良率略高于膝眼注射组(85.29％vs76.67％;85.29％vs 80.00％,P＞0.05).结论 髌股关节间隙注射玻璃酸钠治疗膝关节髌股关节炎早期和长期临床效果优于膝眼注射法.

目的提高骨科住院医师规范化培训效果,提升关节镜手术的临床及教学工作质量与效率。方法将60名规范化培训学员,随机分为实验组和对照组,每组各30人。实验组采用骨科关节镜影像临床教学系统进行授课,对照组采用传统方法授课;按照计划完成培训后,对两组学员分别进行理论知识和技能的考核,同时问卷调查所有学员对教学方式的评价。结果实验组的理论及技能考核成绩均高于对照组;问卷调查结果显示,实验组学员在知识接受程度、学习主动性、兴趣、教学生动性评价等方面评分均优于对照组。结论该系统适用于住院医师规范化培训中骨科关节镜手术及相关临床教学,具有良好的实用性和临床及教学应用价值。

OBJECTIVE:To study the clinical outcome of manipulation release combined with arthroscopic debridement and synovia resection under general anesthesia for early hip involvment in patients with ankylosing spondylitis.METHODS:Manipulation release combined with arthroscpic debridement and synovium resection were performed for hip lesion in 22 patients with ankylosing spondylitis from June 2011 to June 2013, incuding 6 males and 16 females with anverage age of 24.7 years ranging from 17 to 23 years. The course of the diseases was from 10 to 41 months(22.1 months on average). After 6 months of conservative treatment, hip pain and other symptoms were no relief. The preoperative and postoperative follow-up evaluation was performed and compared by the hip movement, VAS pain score, mHHS score and NAHS score.RESULTS:All the patients were followed up for 26 to 44 months with an average of 30.2 months. The range of motion in active flexion-extension, abduction-adduction, internal-external rotation in 0° flexion and 90° flexion increased from (78.2±10.2)°, (36.3±6.4)°, (31.1±9.2)° and (37.3±10.5)° before operation to (113.5±8.4)°, (55.7±8.4)°, (58.7±2.1)° and (60.1±9.8)° after operation, respectively. The VAS scores decreased from 8.5±9.4 before operation to 5.5±7.1 after operation. The modified Harris and NAHS scores increased from 60.8±6.9 and 56.9±6.25 before operation to 88.1±10.4 and 84.6±5.4 after operation, respectively.CONCLUSIONS:Manipulation release combined with arthroscopic debridement and synovium resection under general anesthesia could effectively control the progression of hip lesion in patients with ankylosing spondylitis restoring the ROM, relieve pain symptoms, delay joint deformity and ankylosis with less bleeding, faster recovery, and significantly improve patients' quality of life.

人工单髁关节置换在治疗单间室骨关节炎已经有超过30年的历史,尽管早期的报告不尽如人意,但目前是可靠并安全的治疗关节炎的方法.单髁置换术的成功关键在于合适的患者的选择、细致的手术技术和避免对畸形的过度矫正.本文对人工单髁置换手术的发展历史作了简单回顾,然后分别对膝关节内、外侧单髁置换术患者的选择、手术要点、临床疗效、失败原因作一综述,并对其未来研究进行展望.

BACKGROUNDWe sought to compare clinical efficacy among endoscopy-assisted radio-frequency ablation under local anesthesia, extracorporeal shockwaves (ESWs), and eccentric exercises in treating insertional Achilles tendinosis.METHODSIn this retrospective study, 78 patients diagnosed as having unilateral insertional Achilles tendinosis were enrolled. These participants underwent endoscopy-assisted radio-frequency ablation, ESWs, and eccentric calf muscle exercises between March 1, 2006, and February 28, 2011. Clinical efficacy was evaluated by the visual analog scale (VAS), the American Orthopaedic Foot and Ankle Society (AOFAS) ankle/hindfoot scale, and the Victorian Institute of Sport Assessment-Achilles (VISA-A) scale before and after treatment.RESULTSBefore treatment, there were no statistically significant differences in VAS, AOFAS ankle/hindfoot scale, and VISA-A scale scores among the different groups (all P > .05). For the endoscopy and ESW groups, VAS, AOFAS ankle/hindfoot scale, and VISA-A scale scores were significantly improved after 18 months of treatment (all P < .05). The VAS, AOFAS ankle/hindfoot scale, and VISA-A scale scores in the endoscopy group were significantly higher than those in the ESW and eccentric exercise groups after 18 months of therapy (all P < .05).CONCLUSIONSCombined with synovectomy and tendon debridement, endoscopy-assisted radio-frequency ablation yields better clinical efficacy compared with ESWs in treating insertional Achilles tendinosis.