目的 探讨合并慢性肺部疾病影像学表现的高龄髋部骨折患者的临床特点及手术治疗的安全性.方法 对2019年1月至2021年12月首都医科大学附属北京世纪坛医院关节外科骨肿瘤科收治的高龄(年龄≥80岁)髋部骨折患者148例的临床资料进行回顾性分析.其中男36例,女112例,年龄(86.4±4.6)(80～99)岁.根据入院时肺部X线或CT检查结果,将全部患者分为合并慢性肺部疾病组(简称为肺疾病组,89例)和不合并慢性肺部疾病组(简称无肺疾病组,59例).对两组患者的年龄、性别构成、骨折类型和合并症等基线资料进行比较;对两组患者住院日、围手术期病死率、是否转入ICU治疗以及肺部感染、心肌梗死、心力衰竭、脑梗死、静脉血栓形成、消化道出血和尿路感染等并发症发生情况进行比较.P<0.05为差异有统计学意义.结果 两组患者的年龄、性别构成、骨折类型和合并症等基线数据差异均无统计学意义(均P>0.05),有可比性.肺疾病组患者围手术期肺部感染和尿路感染发病率显著高于无肺疾病组(χ2=5.531,8.275;P=0.019,0.004);两组患者围手术期病死率、住院日和其他并发症差异均无统计学意义(均P>0.05).结论 影像学提示合并慢性肺部疾病的高龄髋部骨折患者围手术期更易发生肺部感染和尿路感染,但围手术期病死率、住院时间及大多数术后并发症发生率无显著升高.

肩袖损伤是最常见的肌腱损伤之一,主要表现为肩关节疼痛、僵硬和活动受限 [1] 。据统计,在60 ～ 69岁人群中,肩袖损伤发病率可达31%,而在80岁以上人群中预计高达65% [2] 。肩袖撕裂是严重的肩袖损伤,巨大肩袖撕裂是指撕裂范围＞5 cm或者累及≥2条肌腱的撕裂 [3-4] 。修复肩袖的解剖结构是恢复盂肱关节正常生物力学的基础。肩袖撕裂的治疗经历了开放式手术修补、关节镜辅助下小切口修补和全关节镜下修补几个历史阶段。

Background:Rotator cuff injury, also known as rotator cuff tear (RCT) , is a common shoulder joint injury. Currently there is no unified standard for arthroscopic rehabilitation for RCT injury in terms of improving shoulder function, relieving pain and improving quality of life.Objective:To explore the effect of medical care patient integration with enhanced recovery after surgery (ERAS) rehabilitation model on self-efficacy and rehabilitation effect of functional rehabilitation training of affected limbs after shoulder arthroscopy in patients with RCT.Methods:From April 2020 to April 2021, a randomized controlled study with 60 patients was completed, and the follow-up period was 3 months (daily-nursing group: n=29; ERAS rehabilitation group: n=31) . Postoperative rehabilitation of patients in the two groups was carried out by daily nursing regimen and medical-patient integration ERAS protocol, respectively. The clinical effects of the two groups were evaluated by physical examination, self-efficacy for rehabilitation outcome scale (SER) , Constant-Murley scale.Results:Three months after operation, the total scores of exercise self-efficacy, coping self-efficacy and rehabilitation self-efficacy in the two groups at last follow-up were higher than preoperatively, the experimental group was significantly higher than that in the control group (P < 0.05) ; in the score of Constant-Murley scale 1-week and 3-months after surgery, the ERAS rehabilitation group was significantly higher than that in the Daily-nursing group, and the difference was statistically significant (P < 0.05) ; the compliance of functional exercise in the experimental group was significantly higher than that in the control group 3 months after operation (P < 0.05) .Conclusion:The integrated ERAS rehabilitation model of medical care and patients is helpful to improve the self-efficacy level of upper limb rehabilitation training after arthroscopic treatment of rotator cuff injury, enhance the compliance of rehabilitation exercise, and quickly restore the function of affected limbs.

Objective:To explore multidisciplinary team (MDT) for the treatment of hip fracture in the elderly.Methods:A retrospective analysis was done of the 196 elderly patients who had been admitted to Department of Joint Surgery, Beijing Shijitan Hospital from September 2017 to December 2018 for hip fractures. They were divided into 2 groups depending on whether MDT had been applied or not. In the MDT group of 102 patients, there were 43 males and 59 females with an age of 81.9±8.4 years, and 63 femoral neck fractures and 39 intertrochanteric fractures. In the traditional treatment group of 94 patients, there were 37 males and 57 females with an age of 81.3±8.6 years, and 55 femoral neck fractures and 39 intertrochanteric fractures. The 2 groups were compared in terms of complications and mortality during hospitalization, interval from admission to surgery, total hospital stay, and Harris hip scores at 6 months after surgery.Results:There were no statistically significant differences in general data before surgery between the 2 groups, indicating comparability ( P>0.05). Eighty-four patients (89.4%) in the traditional treatment group and 98 patients (96.1%) in the MDT group underwent surgery, showing no significant difference between the groups ( χ2=3.327, P=0.068). In the patients undergoing surgery in the MDT group, the incidences of postoperative delirium [12.2% (12/98)], pulmonary infection [11.2% (11/98)], cardiogenic disease [13.3%(13/98)], electrolyte disturbance[12.2%(12/98)] and deep venous thrombosis of lower extremity [6.1% (6/98)] were significantly lower, the interval from admission to surgery (1.9 d±0.9 d) and total hospital stay (10.2 d±0.9 d) significantly shorter, and Harris hip scores (81.3±6.2) at 6 months after surgery significantly higher than those in the patients undergoing surgery in the traditional treatment group [31.0%(26/84), 22.6% (19/84), 25.0% (21/84), 28.6% (24/84), 16.7%(14/84); 3.1 d±1.6 d and 14.1 d±6.2 d; 75.4±7.8; respectively] (all P<0.05). Conclusion:In the treatment of hip fracture in the elderly, multidisciplinary team is effective in reducing complications during hospitalization, shortening the interval from admission to surgery and total hospital stay, and promoting functional recovery of the hip.

背景:由于金属锚钉作为永久性异物不易被患者接受,近年来生物型可吸收锚钉在骨科应用增多.目的:观察带缝线可吸收锚钉修复股骨髋臼撞击综合征合并盂唇损伤的临床疗效.方法:选取首都医科大学附属北京世纪坛医院2014年2月至2016年2月收治的股骨髋臼撞击综合征合并盂唇损伤患者80例,均在关节镜下采用带缝线可吸收锚钉修复.术后1,3年评估患者的髋关节功能评分、疼痛目测类比评分,并与术前对比,评估治疗效果,同时记录并发症和材料宿主反应,并进行患者治疗满意度评价.试验方案获得北京世纪坛医院医学伦理委员会审核批准,所有患者及家属签署书面知情同意书.结果与结论:①80例股骨髋臼撞击综合征合并盂唇损伤患者术后1,3年时的Harris评分高于术前,目测类比评分低于术前,差异均有统计学意义(P<0.05);②患者术后1,3年时的治疗优良率达90.0％,95.0％;治疗满意度分别为87.4％,93.8％,随着时间的延长,治疗优良率和患者满意度有增高的趋势,但统计学分析差异均不显著(P>0.05);③未出现锚钉脱落、软骨损伤等并发症,也未发生材料宿主反应.提示:在股骨髋臼撞击综合征合并盂唇损伤关节镜下手术中应用带缝线可吸收锚钉,具有微创、固定可靠、无金属植入物、临床疗效显著等优点.

目的 探讨距腓前韧带损伤在踝关节前外侧撞击时对关节软骨磨损的影响,及踝关节镜撞击物清理+自体骨软骨移植+距腓前韧带修复术治疗效果分析.方法 自2016年8月～2018年12月,共收治前外侧踝关节撞击综合征患者42例,对所有患者进行踝关节镜探查并观察软骨磨损情况.术中清除撞击组织及增生骨赘,修复(移植)磨损软骨及距腓前韧带.采用AOFAS评分进行疗效评估.结果 术后获得随访26例,(随访时间6～26个月,平均17.1个月),AOFAS评分由术前(56.69±6.3)分提高到末次随访时(88.80±3.94)分.手术前后差异具有统计学意义(P<0.05).在42例前外侧踝关节撞击患者中.无韧带损伤5例,单纯距腓前韧带损伤26例,踝关节外侧三角韧带不同程度损伤11例.22例存在软骨损伤,其中单纯距腓前韧带损伤占14例,外踝三角韧带不同程度损伤8例,无韧带损伤0例.撞击部位软骨损伤5例,距骨顶内侧软骨损伤12例,距骨顶内侧对应面软骨损伤3例.距骨顶内侧与其对应面均软骨损伤2例.撞击部位与软骨损伤部位符合不显著,不存在统计学意义(P>0.05).结论 当距腓前韧带损伤后,在踝关节运动时,距骨发生内翻、前移,产生踝关节半脱位.距骨顶内侧与踝顶发生撞击,进而导致距骨顶内侧软骨磨损.踝关节镜并韧带修复可有效治疗踝关节前外侧撞击,缓解疼痛,增强踝关节稳定性,良好保护踝关节软骨.

目的:评价应用髋关节镜下滑膜切削联合关节松解术治疗早期强直性脊柱炎髋关节病变的效果.方法:研究2013年5月到2018年5月48例因早期强直性脊柱炎髋关节病变在我科行关节镜治疗的患者的临床资料并随访,随访时间10～52月,平均28.25±17.16月.将48例患者以不同的治疗方案作为分组依据,分为对照组、观察组,每组样本均24例.对照组应用传统开放手术,观察组采用髋关节镜下滑膜切削联合关节松解术治疗.对比两种治疗方案对治疗总有效率、临床观察指标、疼痛程度、不良反应发生率的影响.结果:观察组治疗总有效率为95.83％,明显高于对照组(70.83％),差异具有统计学意义(P<0.05);治疗前,两组患者的Harris评分、Oxford评分、屈曲角度、外展角度、C反应蛋白以及ESR无统计学意义(P>0.05),治疗后两组患者的Harris评分、Oxford评分、外展角度均明显升高(P<0.01),屈曲角度明显升高(P<0.05),C反应蛋白和ESR均明显降低(P<0.01),其中观察组临床观察指标变化幅度明显优于对照组,差异具有统计学意义(P<0.05);治疗前两组患者的疼痛程度评分无统计学意义(P>0.05),治疗后两组患者的疼痛评分均明显降低(P<0.05),其中观察组疼痛程度评分明显低于对照组,差异具有统计学意义(P<0.05);观察组不良反应发生率8.33％(2/24),对照组不良反应发生率41.67％(10/24),组间对比观察组低于对照组,差异具有统计学意义(χ2=7.111,P<0.05).结论:应用髋关节镜下滑膜切削联合关节松解术治疗早期强直性脊柱炎髋关节病变,不仅可以改善临床观察指标、改善疼痛程度,还可以减少不良反应发生率、提高治疗总有效率.

Background As a degenerative disease, osteoarthritis (OA) greatly affects aged population. The human chondrocyte cell line CHON-001, derived from normal human articular cartilage, has been widely used in vitro in osteoarthritis models. In order to better understand the underlying mechanism of OA pathogenesis, this study was conducted to explore the effects of LncRNA dynamin 3 opposite strand (DNM3OS) on CHON-001 cells. Methods The expression levels of and correlation between DNM3OS and miR-126 that derived from OA and non-OA tissues were determined by quantitative real time (qRT)-PCR and Spearman's correlation analysis. Cell viability, clone, migration, invasion and apoptosis were respectively determined by cell counting kit-8, colony formation, wound healing assay, transwell and flow cytometry. The target genes were predicted by starbase V2 and targetscan 7.2 and confirmed by luciferase reporter assay. The expressions of apoptosis-related factors were detected by Western blot. Results The expression of DNM3OS was down-regulated in OA patients. Functional assays demonstrated that ectopic expression of DNM3OS promoted the proliferation and inhibited apoptosis of CHON-001 cells, and that knocking down DNM3OS suppressed cell proliferation and induced apoptosis. Mechanistic investigation revealed that DNM3OS physically bound to the promoter of miR-126 and suppressed miR-126 expression. Decreased expression of DNM3OS was negatively correlated with miR-126 in OA patients. Furthermore, the effects of siDNM3OS on inhibiting cell proliferation and promoting apoptosis were partially reversed by miR-126 inhibitor. Meanwhile, type insulin-like growth factor-1 (IGF1) was identified as a target gene for miR-126 and was negatively associated with the miR-126 expression. Overexpressed IGF1 restored the effects of miR-126 mimic in suppressing cell proliferation and promoting apoptosis. Conclusion Our results showed that DNM3OS could affect the CHON-001 cell proliferation and apoptosis by regulating IGF1 by sponging miR-126.

随着我国人口老龄化的逐步到来,骨质疏松症患者也将越来越多.WHO将其与糖尿病、心血管病共同列为影响中老年人身体健康的三大杀手.骨折是骨质疏松最常见、最严重的并发症.骨质疏松性椎体压缩骨折会引起腰背痛、后凸畸形、功能障碍等后遗症,严重影响患者的生活质量[1-3].髋关节周围骨折的高病死率及致残率,给患者及其家庭带来严重影响.随着原发性骨质疏松症诊治指南的不断推广,临床医师及广大群众逐步意识到了骨质疏松症预防及治疗的重要性.2011年3月至2015年6月首都医科大学附属北京世纪坛医院关节外科对62例骨质疏松症患者进行唑来膦酸静脉注射治疗,同时观察该药的疗效和不良反应,并分组进行预防性研究,报告如下.

Objective To investigate the effect and safety of different regimens of tranexamic acid on perioperative blood loss in patients with total knee arthroplasty(TKA).Methods A prospective study was carried out in 90 patients who had unilateral TKA for end-stage knee osteoarthritis from March 2016 to February 2017 in Beijing Shijitan Hospital,Capital Medical University.The patients were randomly divided into 3 groups;the single-use group had 15 mg/kg tranexamic acid by intravenous infusion 10 rmin before the end of operation;the repeated-use group had 15 mg/kg tranexamic acid by intravenous infusion 1 h before operation and 10 min before the end of operation;the control group had no special drug administration.Hemoglobin concentration and hematocrit before and on the 3rd day after operation,postoperative drainage,blood transfusion volume and adverse manifestations of deep venous thrombosis (DVT) were observed.Doppler ultrasonography on lower limb vessels was performed before and 14 d after operation.Results Postoperative drainage volume and total blood loss in singleuse group and repeated-use group were significantly less than those in control group [(253 ± 79),(165 ± 83) ml vs (463 ± 174) ml;(865 ± 241),(742 ± 213) ml vs (1 132 ± 319) ml];there were differences between single-use group and repeated-use group(P ＜ 0.01 or P ＜ 0.05).There was no significant difference of hidden blood loss among groups(P ＞0.05).The blood transfusion rate was 23.3％ (7/30) in single-use group,13.3％ (4/30) in repeated-use group and 43.3％ (13/30) in control group;there were differences among 3 group (P ＜ 0.05).No symptomatic DVT was observed within 14 d after operation.Conclusion Intravenous infusion of tranexamic acid can decrease postoperative drainage,blood loss and blood transfusion without increasing risk of DVT in patients with TKA.

OBJECTIVE:To study the impact of sclerostin single chain Fv on osteoporotic fracture healing in ovariectomized rats. METHODS:24 SD rats were ovariectomized. One week later,the middle shaft transverse fractures model of the femur of left lower extremity was established. Model rats were randomly divided into model group and treatment group with 12 rats in each group. Model group was given intrathecal injection of phosphate buffer 0.2 ml,and treatment group was given intrathecal injection of sclerostin single chain Fv 2.5 mg/kg,twice a week,for consecutive 12 weeks. The contents of calcium,phosphorus,alkaline phosphatise and osteocalcin in serum were determined. BMD,Tb.Th,Tb.Sp,BVF,SMI and morphologic change of left femur were also determined. RESULTS:The contents of calcium,phosphorus,alkaline phosphatise and osteocalcin in serum of model group were(1.92±0.54)mmol/L,(1.54±0.61)mmol/L,(64.43±13.92)U/L and(9.04±0.71)ng/ml;above index of treatment group were(2.43±0.28)mmol/L,(1.58±0.26)mmol/L,(79.25±12.49)U/L and(9.57±0.83)ng/ml. BMD,Tb.Th,Tb.Sp,BVF and SMI of model group were(91.51±12.33)mg/cc,(0.09±0.02)mm,(0.47±0.22)mm,0.18±0.03 and 1.42±0.31;above index of treatment group were(135.15±11.12)mg/cc,(0.01±0.03)mm,(0.34±0.11)mm,0.29±0.01 and 0.65±0.34,respectively. Compared with model group,the contents of calcium and alkaline phosphatise,BMD and BVF were increased significantly in treatment group(P<0.05),and SMI was decreased significantly(P<0.05);there was no statistical significance in other index(P>0.05). The amount of osteoblast in treatment group was more than in model group under microscope. CONCLUSIONS:sclerostin single chain Fv promotes osteoporotic fracture healing in ovariectomized rats.

Objective To explore the curative effects of arthroscopic treatment of discoid meniscus injuries of the knee joints in different operative methods, and to provide references for the clinical choice of operative methods. Methods The complete data of 93 patients with discoid meniscus of the knee joints who were followed up for a mean period of 33 months were retrospectively analyzed. 48 cases of complete type of discoid meniscus were divided into 2 groups. Group A ( 26 cases ) was treated with total meniscectomy, and group B ( 22 cases ) was treated with partial meniscectomy. 45 cases of incomplete type of discoid meniscus were divided into 2 groups. Group C ( 21 cases ) was treated with total meniscectomy, and group D ( 24 cases ) was treated with partial meniscectomy. The surgical results were analyzed according to the Ikeuehi’s criteria of the knee joints and Lysholm knee score scale. Results Based on the scale of Ikeuehi’s criteria of the knee joints, 46 cases were excellent, 35 cases good, 8 cases fair and 4 cases poor, and the excellent and good rate was 87.1%. In the 48 cases of complete type of discoid meniscus, the excellent and good rate in the 26 patients who were treated with total meniscectomy was 92.3%, which was 72.7%in the 22 patients who were treated with partial meniscectomy. The differences between the total and partial meniscectomy were statistically significant according to the Lysholm knee score scale ( P<0.05 ). In the 45 cases of incomplete type of discoid meniscus, the excellent and good rate in the 21 patients who were treated with total meniscectomy was 90.5%, which was 91.7%in the 24 patients who were treated with partial meniscectomy. There were no statistically significant differences between the total and partial meniscectomy ( P>0.05 ). Conclusions ( 1 ) Satisfactory curative effects can be achieved in the treatment of discoid meniscus injuries with total and partial meniscectomy under arthroscopy;( 2 ) Similar curative effects can be achieved in total and partial meniscectomy for the incomplete type of discoid meniscus. However, the total meniscectomy is superior to the partial meniscectomy for the complete type of discoid meniscus.

OBJECTIVE To analyze the clinical outcomes of percutaneous kyphoplasty under local anesthesia for osteoporotic vertebral compression fractures. METHODS In this study, 76 elderly patients with osteoporotic vertebral compression fractures undergoing percutaneous kyphoplasty were followed up for 2-3.1 years. They were divided into 3 groups according to different ages: 60-69 yrs (A group), 70-79 yrs (B group) and 80- 91 yrs (C group). Pre- and post-operative and last follow-up evaluations were conducted. And the parameters of bone mineral density (BMD), kyphotic angle, change of visual analog scale (VAS), Oswestry disability index, average vertebral body height, complications and costs of hospitalization were recorded and analyzed. RESULTS BMD decreased with advancing age and had statistical significance between three groups (P < 0.05). Three thoracic spine fractures and 6 lumbar spine fractures could not be detected with digital radiography and were observed only on magnetic resonance imaging (MRI). The pre-operative levels of visual analogue scale and Oswestry disability index increased in all groups.No statistical significance existed between A and B groups. But there was statistical significance between A or B and C groups (P < 0.05). Pre- and post-operative assessments showed that statistically significant improvements were found in visual analogue scale and Oswestry disability index in all groups (P < 0.05). And statistically significant improvements were found for the pre- and post-operative kyphotic angles and vertebral body heights in A, C group and B groups (P < 0.05). The sites for symptomatic leakage of cement included paravertebral vein (n = 2), intervertebral disc (n = 1) and paravertebral space (n = 2). Adjacent vertebral fracture occurred in 1 patient at 17 months and underwent percutaneous kyphoplasty. The mean operative duration was 28 minutes per vertebrae and the mean cost of hospitalization at RMB yuan 33 778. CONCLUSION As a simple and safe procedure for osteoporotic vertebrae compression fractures, percutaneous kyphoplasty may relieve pain quickly, restore vertebral height, prevent further fractures and improve the patient's quality-of-life.

Objective To evaluate the preliminary outcome of cannulated screw internal fixation in treatment of the tarsometatarsal joint injuries.Methods From January 2005 to October 2010,21 patients(14 males and 7 females)with the tarsometatarsal joint injuries were treated.Their age ranged from 21 to 62 years(average 38.2 years).According to anatomical three-column classification,there were four patients with single medial column injury,four with medial and middle column injuries,three with middle and lateral column injuries,two with single lateral column injury and eight with three column injuries.The injury causes included traffic injury in nine patients,machine injury in eight and fall from height injury in four.The period from injury to admission was 2-15 hours(mean 5 hours).During operation,open reduction was performed,followed by internal fixation with the cannulated screw.X-ray examination was done in the regular follow-up and function was evaluated by using Maryland scoring system.Results Of all,19 patients were followed up for 4-47 months(mean 20 months),which showed no infection,loosing or breakage of the internal fixation.According to the Maryland scoring system,the clinical outcome was rated as excellent in eight patients,good in seven,fair in two and poor in two,with excellence rate of 79％.Conclusions The three-column theory plays an important role in clinical diagnosis and therapy of the tarsometatarsal joint injuries.Open reduction and cannulated screw internal fixation may attain satisfactory clinical results in treatment of the tarsometatarsal joint injuries.