The purpose was to investigate the effect of different degrees of valgus deformity correction on patellar position and clinical outcome in patients with valgus knees after total knee arthroplasty (TKA). We retrospectively analyzed and followed 118 patients with valgus knees. Based on the post-operative hip–knee–ankle (HKA), patients were divided into three groups: neutral (±3°), mild (3–6°), and severe (> 6°). Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), range of motion (ROM), and Knee Society Score (KSS) were used to evaluate post-operative clinical efficacy. Also, the patellar tilt angle (ε-angle), congruence angle (θ-angle), and Insall–Salvati index (ISI) were used to represent the patellar position. Post-operative observation indicators included HKA, angle of the femur (α-angle), tibial angle (β-angle), femoral component flexion angle (γ-angle), and tibial component posterior slope angle (δ-angle). All patients showed significant improvements in HKA, ROM, WOMAC, and KSS after operation (P < 0.001). Regarding patellar position, the ISI values decreased to varying degrees (P < 0.05). The patellar tilt angle was significantly increased in the severe valgus group compared to that in the mild valgus and neutral groups (P < 0.001). Univariate analysis showed that the degree of post-operative residual valgus was significantly affected by WOMAC, KSS, α-, ε-, and θ-angles. Minor valgus undercorrection did not affect the short-term outcome after TKA; however, when the residual valgus angle was > 6°, the post-operative scores were significantly reduced. Inadequate valgus correction does not result in significant changes in patellar height but may increase the risk of poor patellar tracking.

目的 观察亚低温联合星状神经节阻滞对脑动脉瘤患者介入术后脑功能的影响.方法 选取河南大学淮河医院2019年3月至2021年6月择期或急诊接受脑动脉瘤介入治疗的80例患者作为研究对象.根据治疗方案分为4组:A组(接受传统治疗)、B组(接受神经阻滞)、C组[接受神经阻滞联合低温(35.0±0.5)℃治疗]、D组[神经阻滞联合低温(32.0±0.5)℃治疗],各20例.比较患者手术前后经颅多普勒大脑中动脉血流速度、局部脑氧饱和度(rSO2)、血内皮素-1(ET-1)、S100 β蛋白以及简易智力状态检查量表(MMSE)评分.结果 与A组比较,术后B、C、D组患者大脑中动脉血流速度、ET-1和S100 β降低,rSO2升高(P＜0.05).与B组比较,D组患者大脑中动脉血流速度、ET-1、S100 β水平降低,MMSE评分升高(P＜0.05).结论 星状神经节阻滞和其联合亚低温疗法均可减少ET-1释放,缓解脑血管痉挛,改善患者术后脑功能,其中星状神经节阻滞联合(32.0±0.5)℃亚低温疗法对于术后脑功能保护效果最为明显.

背景:目前已有研究将骨关节炎患者关节软骨及正常人关节软骨进行研究后发现,lncRNA HOTAIR较对照组明显上调,可能与骨关节炎的发生有一定关系.目的:探索lncRNA HOTAIR在白细胞介素1β介导的骨关节炎中的作用机制.方法:①临床样本分组:选取20例关节炎行全膝关节表面置换患者的内侧髁软骨作为骨关节炎组,选取7例行下肢截肢或因股骨颈骨折行全髋关节置换患者的关节软骨作为正常软骨组;②实验动物分组:取48只SD大鼠随机分为骨关节炎组(36只)和正常对照组(12只),骨关节炎组建立膝关节骨关节炎模型;③细胞实验分组及处理:将体外培养的大鼠关节软骨细胞(RCCs-1)分为对照组、白细胞介素1β组(筛选出最佳质量浓度10μg/L模拟骨关节炎环境)、siRNA组、白细胞介素1β+siRNA组,对照组不做特殊处理,其他各组分别加入相应的溶液进行处理,培养48 h;④检测指标:分别于造模后4,6,8周取大鼠股骨行苏木精-伊红染色观察病理变化;采用RT-PCR分析患者关节软骨、大鼠关节软骨及白细胞介素1β处理的大鼠软骨细胞中lncRNA HOTAIR的mRNA表达水平;采用CCK-8法检测白细胞介素1β处理的软骨细胞活力;Western blot检测软骨细胞Ⅱ型胶原蛋白表达;流式细胞技术检测软骨细胞凋亡情况.结果 与结论:①正常对照组大鼠软骨细胞排列整齐,软骨结构层次清晰,潮线完整;骨关节炎组随着造模时间的延长,软骨结构越紊乱,软骨细胞数量明显减少,软骨基质失染,潮线严重紊乱;②lncRNA HOTAIR在骨关节炎患者和骨关节炎组大鼠软骨细胞中表达增高;③白细胞介素1β降低大鼠膝关节软骨细胞活力,且促进HOTAIR的表达增加;④HOTAIR抑制大鼠膝关节软骨细胞活力及Ⅱ型胶原蛋白的表达;⑤HOTAIR的表达促进软骨细胞凋亡;⑥结果提示,抑制HOTAIR介导的软骨细胞凋亡可能是膝骨关节炎基因治疗的潜在机制.

股骨髋臼撞击综合征(FAI)是一种由于髋关节解剖结构异常，导致股骨与髋臼异常接触从而引起髋关节弹响或疼痛的疾病，是引起髋关节疼痛及活动受限的主要原因之一。若得不到及时治疗，可能会导致髋关节软骨及髋臼盂唇损伤，进而继发髋关节骨性关节炎或股骨头坏死，但FAI的发病较为隐匿，不易引起重视。因此，尽早发现对治疗FAI十分重要。超声、X线影像、CT、磁共振成像(MRI)等影像学检查可通过观察髋关节骨形态及周围软组织的情况，尽早诊断FAI并区分其分型，以便临床选择合适的治疗方法。基于此，本文将对FAI的最新的诊断与治疗方法作一综述，以期为FAI的临床诊断及治疗提供一定参考。

富血小板血浆(PRP)是全血通过离心后得到的血小板浓缩物，其中含有大量的生长因子及蛋白质，可以促进组织细胞的修复与再生，这使得PRP在促进伤口愈合，治疗肌肉骨骼疾病方面得到广泛的应用。膝关节是机体最容易损伤的关节之一，膝关节内注射PRP可以治疗或缓解多种关节病变。然而由于PRP的制备方式不同，使用的频率及剂量也有所不同，所以通过注射PRP治疗膝关节疾病的治疗效果尚未有统一的意见。本文将重点阐述PRP在几种常见膝关节疾病的研究及应用现状。

肿瘤样钙质沉积症(tumoral calcinosis,TC)又称为脂肪钙质肉芽肿病、臀石等,在临床上很少见[1].目前其发病机制仍未完全清楚.其好发于中年人,大部分患者无症状,部分患者表现为大关节附近,软组织肿胀酸痛不适,皮肤有溃疡、瘘道形成,局部有白垩样物质流出.X 射线是最基本的影像学检查,TC 表现为关节伸侧软组织内,钙化结节聚集行成分叶状、团块状,多呈"桑葚样""鹅卵石样".治疗主要以完整手术切除为主,有复发可能,注意随访.

骨关节炎是一种以关节软骨损伤为中心特征的老年退行性病变，随着人口老龄化的加重，骨关节炎的致残率也逐年上升。骨关节炎的发病机制尚不清楚，传统的治疗方案也无法阻止关节炎的进展，只能进行手术治疗。近年来，随着研究的深入，学者们发现，关节炎软骨细胞中长链非编码RNA(lncRNA)表达水平的变化与骨关节炎的发生和发展有很大关联，其中以HOTAIR的表达量差别较大。HOTAIR在关节软骨细胞中的表达上调，促进关节软骨基质的降解、软骨细胞的凋亡，相反，如果沉默HOTAIR可以控制基质的降解，减少细胞的凋亡，然而对于HOTAIR的研究目前仍不完善，仍需进一步研究。

背景:目前髋臼盂唇损伤的手术治疗方法包括清创、修复、再固定以及髋臼盂唇重建.盂唇重建是最近兴起的一种手术方式,采用自体或异体移植物进行修补盂唇缺损,目前用于修补的移植物选择有很多,其近期的随访也表明该方法可以很好地恢复盂唇结构和功能,而且与清创切除、修复等方法相比具有一定的优势,但还没有证据表明重建的长期效果如何,哪种情况、哪种移植物更适合.目的:综述关节镜下髋臼盂唇重建的移植物选择.方法:在PubMed、GeenMedica等数据库中检索2000至2019年发表与髋臼盂唇重建相关的文献,关键词为“labrum,reconstruction,graft,hip,acetabulum,尤以近10年文章为主.结果 与结论:①目前用于修补髋臼盂唇的移植物有很多,包括自体移植物(髂胫束、股薄肌和半腱肌、股四头肌肌腱、股直肌肌腱、关节囊)和同种异体移植物(腓骨短肌、阔筋膜张肌),其近期的随访表明这些移植物可以很好地恢复盂唇结构,使髋关节恢复运动;②但作为一种新兴手术方式,所以目前缺乏长期随访和前瞻性比较研究来证明髋臼盂唇重建的长期效果如何,哪种情况、哪种移植物更适合;③在今后的研究中,需要对不同移植物的中远期疗效进行比较,以供临床选择.而且随着科学技术的发展,人工复合材料的问题不断得以解决,也将成为更有前景的替代物.

Objective To explore the effect of local application of tranexamic acid (TXA) without drainage on blood loss in elderly patients with hip hemiarthroplasty. Methods A retrospective study was performed in 50 elderly cases of femoral neck fractures who had underwent hip hemiarthroplasty in department of Bone and Joint Surgery of Affiliated Hospital of Jining Medical University. Patients were randomly divided into the TXA group (n=25) and the control group (n=25). The TXA group received the intra-articular injection of 2 g TXA dissolved in 50 ml of normal saline, the control group received the intra-articular injection of the same volume of normal saline before closing the incision. The drainage tube was not used in both groups. The intraoperative blood loss, external blood loss, hidden blood loss, total blood loss, transfusion rate, postoperative hemoglobin concentration and complications were compared between the two groups. Results The postoperative hemoglobin concentrations in the TXA group were higher than those in the control group (t=7.473, t=7.226, t=7.572, P 0.05). Conclusion Local application of tranexamic acid (TXA) without drainage can effectively reduce perioperative blood loss and transfusion rate, and does not increase the incidence of complications in the elderly patients with hip hemiarthroplasty. Key words: Femoral neck fractures; Arthroplasty, replacement, hip; Tranexamic acid; Blood loss, sugical; Venous thrombosis

笔者于2018-07采用全膝关节置换术治疗双膝关节类风湿性关节炎1例,术后发生多发动脉栓塞导致死亡,报道如下. 1病例报道 患者,女,55岁,因“双膝关节疼痛9年,加重半年”入院.“脑梗塞”病史5年(未留后遗症),“类风湿关节炎”病史15年,长期服用类固醇激素.查体:双膝关节肿胀、畸形,关节间隙压痛,麦氏征(+),过伸过屈试验(+),多处指、趾间关节畸形明显.实验室检查示:类风湿因子78.3 IU/ml,血沉117 mm/h,血小板765×109/L,活化部分凝血活酶时间(APTT):20.6 s,血浆纤维蛋白原6.6 g/L.双膝X线片示:双膝关节退行性变.初步诊断为双膝关节类风湿性关节炎.患者日常活动受限,要求行全膝关节置换术(TKA).术前评估静脉血栓栓塞症(VTE)评分1分,经科室讨论后7月13日予以手术,手术进行顺利.7月19日患者右下肢疼痛、麻木,给予盐酸曲马多注射液75 mg肌注,疼痛仍不缓解,急查床旁彩超见:双下肢动脉内膜回声增强,右侧胫前动脉、足背动脉未探及,左侧胫前动脉探及稀疏血流信号,疑双侧下肢动脉粥样硬化或栓塞.血管外科会诊,查动脉CTA示:多发动脉栓塞,尤以双下肢动脉闭塞为重.

笔者于2018-01-09诊治脊髓空洞症合并Charcot关节病1例,报道如下. 1 病例报道 患者,女,57岁.因“右肩疼痛伴活动受限5个月”人院.查体:体温正常,右肩下垂,肩周压痛,活动受限明显,被动活动中可触及肱骨近端前后滑动,有半脱位感觉,关节不稳定.既往无糖尿病史.X线片显示右肱骨头部分缺如,内上移位.MRI显示C2～T4水平脊髓增粗,脊髓中央管扩张,内可见一纵行条索状、串珠状T1WI低信号,T2WI高信号影.诊断:右肩关节Charcot关节病;Chiari畸形并脊髓空洞症.由于患者脊髓空洞范围较大,在后颅窝减压术的基础上松解蛛网膜下腔,开放第4脑室正中孔,保证脑脊液流出;去除脑干的骨性束缚和解除疝出物导致的硬膜压迫,重建枕骨大孔的正常脑脊液动力学,消除脊髓空洞症;Charcot关节病采用非手术治疗,给予非甾体抗炎药并用支具固定肩关节,避免关节活动,应用抗生素预防和控制感染.术后随访3个月,未出现脊髓空洞症进展及其他神经性关节病变迹象.

Objective To investigate the effects of early minimally invasive intracranial hematoma removal on hypertensive intracerebral hemorrhage and the levels of C-reactive protein (CRP),interleukin-4 (IL-4) and interleukin-10 (IL-10).Methods Eighty-four patients with hypertensive cerebral hemorrhage were analyzed retrospectively.Patients were randomly divided into control group and study group according to treatment methods,with 42 cases in each group.The control group was treated with scavenging of bone window hematoma,and the study group was treated with early minimally invasive intracranial hematoma removal,all patients were followed up for two weeks.The clinical effects of two groups were compared,the levels of serum CRP,IL-4,IL-10 before and after treatment,the condition of nerve function defect and the incidence of complications before and after treatment were compared between the two groups.Results The total effective rate of treatment in study group was 95.24％ (40/42),which was significantly higher than that of control group [(78.57％ (33/42)],and the difference was statistically significant (P ＜ 0.05).After treatment,serum CRP,IL-4,IL-10 levels in study group were (13.7 ±3.5) mg/L,(15.4 ±3.6)ng/L,(10.1 ±2.2)ng/L,which were significantly lower than those in control group (16.8 ±4.1)mg/L,(18.2 ±4.0) ng/L,(14.3 ±2.6) ng/L,there was a statistically significant difference (P ＜ 0.05).At 1 and 2 weeks after treatment,the NIHSS scores in study group were (24.4 ± 3.4) and (9.4 ± 2.2) respectively,which were significantly lower than those in control group (33.2 ± 4.1,14.5 ± 3.1),the difference was statistically significant (P ＜0.05).The incidence of complications in study group (4.76％) was significantly lower than that of control group (21.43％),the difference was statistically significant (P ＜ 0.05).Conclusions Early minimally invasive intracranial hematoma is effective in the treatment of hypertensive intracerebral hemorrhage,and it can effectively control the levels of CRP,IL-4 and IL-10,promote the recovery of neurological function,and reduce the incidence of complications.It is worth popularizing in clinical application.

BACKGROUND: Total knee arthroplasty (TKA) is an effective method for the end-stage knee osteoarthritis, which can obviously relieve pain and improve function. But a large amount of postoperative blood loss is a serious complication, how to reduce postoperative blood loss is still a difficulty. OBJECTIVE: To explore the efficacy of local application of different doses of tranexamic acid without drainage on the METHODS: 150 patients with osteoarthritis who underwent TKA were randomly divided into three groups (n=50 per group). Group A received the intra-articular injection of tranexamic acid (2 g) plus 50 mL of normal saline; group B received the intra-articular injection of tranexamic acid (1 g) 50 mL of normal saline; group C received the intra-articular injection of 50 mL of normal saline. The drainage tube was not used in all patients. The number of hemoglobin, the number of patients undergoing blood transfusion, intraoperative blood loss, external blood loss, hidden blood loss, total blood loss and postoperative 3 hour-related blood coagulation indexes were recorded and compared among groups. Additionally, the incision infection and deep vein thrombosis were observed. RESULTS AND CONCLUSION: (1) The difference of hemoglobin among groups was significant (F=7.218-7.516, P=0.000).(2)The number of blood transfusion in the groups A,B and C was 2,5 and 9,respectively,which had significant differences (χ2=25.753, P=0.000). (3) The intraoperative blood loss had no significant difference among groups (F=1.206, P=5.283). The difference in the postoperative external blood loss, postoperative hidden blood loss and total postoperative blood loss among groups was significant (F=14.389, P=0.000; F=7.158, P=0.009; F=6.752, P=0.012). Moreover, the hemostatic effect was in a dose-dependent manner. (4) There were no significant differences in the postoperative 3-hour-related blood coagulation indexes among groups (P > 0.05). (5) There was no deep vein thrombosis at 1 week postoperatively, and no deep vein thrombosis or pulmonary embolism occurred within postoperative 3 months in the three groups. (6) To conclude, topical application of tranexamic acid without drainage can significantly reduce perioperative blood loss, blood transfusion rate, and does not increase the incidence of complications, and the hemostatic effect is in a dose-dependent manner.

Objective To investigate the clinical effect of microsurgical treatment of basal ganglia cerebral hemorrhage by lateral fissure approach.Methods 79 cases of cerebral hemorrhage of basal ganglia in Huaihe Hospital of Henan University from November 2013 to March 2016 were randomly divided into groups,39 cases in the control group and 40 cases in the observation group.The control group was treated by the temporal lobe cortex approach.The observation group was treated by microfracticular surgery.The situation of hematoma clearance,complication rate and activity of daily living between the two groups were observed and compared.Results The postoperative 24h observation group>90%,the hematoma clearance rate was 85% (34/40),higher than that in the control group 51.28% (20/39),the difference was statistically significant (P <0.05).The complication rate of the observation group was 5% (2/40),which was lower than that of the control group 23.08% (9/39),the difference was statistically significant (P <0.05).The scores of activities of daily living in the observation group were higher than those in the control group, the difference was statistically significant (P <0.05).Conclusion Microsurgical treatment of basal ganglia cerebral hemorrhage with lateral fissure approach can effectively improve the clinical symptoms,promote the prognosis and improve the hematoma clearance rate and activities of daily living.

Objective:To investigate the clinical characteristics and clinical outcomes of different operative approaches for patients with sellar region meningiomas in order to provide theoretical basis for clinical treatment.Methods:The data of 56 patients with sellar region meningiomas admitted from October 2011 to October 2016 in our hospital were selected.The clinical features of sellar region meningiomas were observed.The clinical outcomes of patients treatment of unilateral subfrontal approach or pterional approach were compared in order to find a good treatment for patients with meningiomas in sellar region.Results:In 56 cases,Simpson grade I and II were 39 cases and the total resection rate was 69.64%.The grade III and IV were 13 cases and 4 cases.The suprasellar meningioma was 24 cases and sellar meningioma 32 cases.The ratio of visual acuity decreased,pituitary compression,visual field defects,optic nerve or the optic chiasm compression in suprasellar meningiomas patients were higher than that in the parasellar meningiomas(P<0.05).The amount of bleeding,operation time and hospitalization time were no difference between two operative approach(P>0.05).Conclusion:The clinical characteristics of suprasellar meningiomas and suprasellar meningiomas are different.The effects of suprasellar meningiomas on vision,visual field,pituitary compression and optic nerve compression were greater than those of the suprasellar meningiomas.In clinical treatment,there are no differences between the two ways,both can get better clinical efficacy,it was worthy of clinical promotion.

Objective To analyze the clinical effect of stereotactic targeting minimally invasive surgery in the treatment of brain glioma. Methods 70 patients with brain glioma admitted in our hospital from June 2012 to October 2014 were select-ed and randomly divided into control group and observation group with 35 cases in each. The control group were treated by the conventional tumor resection by craniotomy. The observation group were treated by stereotactic targeting minimally inva-sive surgery. And the treatment effect of the two groups was observed. Results After treatment, compared with the control group, the observation group had higher 2-year survival rate(88.6% vs 71.4%) and lower recurrence rate(14.3% vs 40.0%) with statistically significant differences (P<0.05). In addition, the ADL scores and nerve function score in the observation group were significantly better than those in the control group with statistically significant differences (P<0.05). Conclusion For the treatment of brain glioma, stereotactic targeting minimally invasive surgery is easy to operate with minimal invasion, low cost, good effect and high clinical application value.

目的：观察神经节苷脂联合高压氧治疗颅脑损伤后认知功能障碍的临床疗效，为临床治疗提供理论依据。方法选取2011-06—2014-06我院收治的颅脑损伤后存在认知功能障碍患者98例，将其分为观察组与对照组，每组49例。对照组给予神经节苷脂治疗，观察组在对照组基础上给予高压氧治疗。对2组患者临床疗效进行观察与比较。结果观察组总有效率83.7%高于对照组的61.2%，差异有统计学意义(P <0.05)；2组治疗前 MMSE 评分及 Barthel 评分比较差异均无统计学意义(P >0.05)；与治疗前比较，治疗后2组 MMSE 评分及 Barthel 评分均明显提高，差异均具有统计学意义(P <0.05)；与对照组比较，观察组治疗后 MMSE 评分及 Barthel 评分改善情况更显著，差异有统计学意义(P <0.05)。结论神经节苷脂联合高压氧治疗颅脑损伤后认知功能障碍具有显著临床疗效，能使患者认知功能及日常生活活动能力有效改善，值得临床进一步推广应用。

Objective: The aim of this study was to investigate differences in the gait patterns of patients with ceramicon- ceramic large-diameter-femoral-head hip arthroplasty (LHA) and those with standard-diameter-femoral-head hip arthroplasty (SHA) within one year after surgery. Methods: Between October 2012 and March 2014, 30 patients who had undergone LHA (36 mm) and 30 patients who had undergone SHA (28 mm) were selected. One year after surgery, postoperative gait analysis of each patient was performed with the Tecnobody gait analysis system, and gait parameters (ipsilateral/contralateral ratios for each patient) were measured. Results: Ipsilateral/contralateral ratios of step cadence, step time, proportions of the gait cycle accounted for by the single-leg stance phase and the swinging phase and the Harris score of the hip joint did not differ significantly between the two groups. However, ipsilateral/contralateral ratios of step length, gait velocity, hip flexion/extension, adduction/abduction, rotation, and knee flexion/extension were significantly higher in the LHA group than in the SHA group (P < 0.05). Conclusion: One year after surgery, gait parameters and joint range of motion were superior in patients who underwent LHA compared to those who underwent SHA. A large-diameter-femoral-head prosthesis may be more effective in the recovery of joint function in patients after surgery.

目的：探究大骨瓣减压术对重型颅脑外伤患者脑血流及脑代谢的影响效果。方法：资料随机选取2009年6月～2014年6月本院收治的102例重型颅脑外伤患者，随机分为研究组与对照组，每组51例。对照组予以常规药物治疗，研究组行大骨瓣减压术治疗，分析2组治疗效果。结果：治疗后研究组ICP低于对照组，CPP高于对照组，≤50岁患者脑摄氧率高于对照组，＞50岁患者低于对照组，≤50岁患者颈内静脉—动脉乳酸差低于对照组，＞50岁患者高于对照组（ P＜0．05）。结论：大骨瓣减压术对重型颅脑外伤患者脑血流及脑代谢具有积极影响，具有临床应用价值。