目的 探讨对初次膝关节置换术贫血患者采用重组人促红细胞生成素+铁剂进行治疗的临床效果.方法 50例初次膝关节置换术贫血患者,随机分为治疗组与常规组,各25例.治疗组术前采用重组人促红细胞生成素+铁剂治疗,常规组术前采用氨甲环酸治疗.对比两组治疗前后血红蛋白水平、输血率及住院时间.结果 治疗后,治疗组血红蛋白(102.42±12.49)g/L高于常规组的(94.79±8.03)g/L,差异有统计学意义(P<0.05).治疗组患者输血率低于常规组,差异有统计学意义(P<0.05).治疗组患者住院时间(6.07±1.59)d短于常规组的(9.12±1.49)d,差异有统计学意义(P<0.05).结论 术前重组人促红细胞生成素+铁剂有效应用,可使初次膝关节置换术贫血患者血红蛋白水平获得显著改善,就术前贫血情况进行有效纠正,从而对患者病情康复发挥明显促进作用,最终促进初次膝关节置换术贫血患者有效预后.

目的 探讨全髋关节置换术与半髋关节置换术治疗老年股骨颈骨折患者的临床疗效.方法 62例股骨颈骨折老年患者,依据信封随机法分为全髋组与半髋组,各31例.全髋组采用全髋关节置换术治疗,半髋组采用半髋关节置换术治疗.对比两组手术优良率、并发症发生率、围手术期失血量及术后住院天数.结果 全髋组患者手术优良率83.9％高于半髋组的54.8％,差异具有统计学意义(P<0.05).两组并发症发生率对比,差异无统计学意义(P>0.05).全髋组围手术期失血量(413.5±71.7)ml多于半髋组的(257.3±53.6)ml,差异具有统计学意义(P<0.05).两组术后住院天数对比,差异无统计学意义(P>0.05).结论 全髋关节置换术同半髋关节置换术相比,全髋关节置换术治疗老年股骨颈骨折患者优良率明显较高,但围手术期失血量较多,两种方法的手术并发症及住院天数无明显区别,临床上需依据股骨颈骨折老年患者具体情况选择相应手术方式,以达到治疗的最优疗效.

目的 探讨关节置换治疗老年膝关节退行性骨关节炎的临床效果及患者的生活质量改善情况.方法 选取2018年7月-2019年6月在我院接受治疗的66例老年膝关节退行性骨关节炎患者,对其关节置换治疗疗效及治疗前后患者的生活质量水平进行了分析.结果 通过对66例患者实施关节置换术进行治疗,HSS评分优良率达到了90.91％;而且治疗后,MMSE评分以及ADL评分显著低于治疗前,治疗前后患者的生活质量水平对比差异显著(P<0.05).结论 针对老年膝关节退行性骨关节炎患者,通过采用关节置换术进行治疗临床疗效显著,能够有效改善老人的生活质量,值得临床推广应用.

Objective To investigate the social function defect and risk behavior in troublemaking home-lessness patients with mental disorders ,and provide reference for community prevention and rehabilitation of patients .Methods Patients with stray mental disorders who were treated in our hospital were sampled by random number table ,95 cases of troublemaking homelessness patients were seen as the study group , and 121 cases of non-troublemaking homelessness patients were seen as the control group .The disease type distribution and risk behavior incidence during hospitalization of the two groups were compared .The social function and risk of the two groups of patients were assessed using the SSFPI scale and risk rating before treatment and at the end of 3 months of treatment .Results There was no significant difference in the distribution of disease between the two groups (P＞0 .05).During the hospitalization period ,the inci-dence of quarrel ,provocation ,wounding others ,destruction ,escape ,self-injury ,theft ,looting ,and erot-ic behavior was significantly higher in the study group than that in the control group (P＜0 .05 or 0 .01). At the end of 3 months ,the total scores of SSFPI in the two groups were significantly higher than those before treatment (P＜0 .01) ,and the study group elevated more significantly than the control group (P＜0 .05).The proportion of patients with risk level 2 ,3 ,4 ,5 in the study group before treatment was sig-nificantly higher than that in the control group (P＜0 .05 or 0 .01).The risk of both groups was reduced after treatment ,and there was no significant difference between the two groups (P＞0 .05).Conclusion Troublemaking homelessness patients with mental disorders have obvious social function defect and dan-gerous act .Systemic treatment and rehabilitation ,timely risk assessment ,dynamic monitoring and con-trol were needed to promote patients to return to society

目的:分析微创经皮钢板固定术治疗胫骨远端关节外骨折的疗效和安全性.方法:选择2016年3月至2018年3月佛山市第一人民医院收治的100例胫骨远端关节外骨折患者为研究对象,按照随机数表法划分为对照组与观察组;对照组实施交锁髓内钉治疗;观察组实施微创经皮钢板固定术治疗,比较两组患者的临床疗效.结果:两组患者的临床治疗优良率、术中出血量、感染发生率、断钉发生率、延迟愈合发生率、治疗前的生活质量评分比较,差异均无统计学意义(P＞0.05);观察组患者的手术时间、伤口愈合时间、住院时间、骨折愈合时间均较对照组更短,畸形愈合发生率、膝关节疼痛发生率均较对照组更低,治疗后的生活质量评分较对照组更高,差异均具有统计学意义(P＜0.05).结论:胫骨远端关节外骨折应用微创经皮钢板固定术治疗的疗效显著,而且安全性高.

Objective To prospectively evaluate the postoperative hemostatic effect of using tourniquet with different way during total knee arthroplasty(TKA) in patients with high coagulation condition.Methods In the prospective study,92 cases of patients received TKA with different tourniquet applications were enrolled (D-Dimer ＞ 1 000 μg/L) and randomly divided into group A (half-course group,n =46)using tourniquet only during cementation and group B (whole-course group,n =46) using tourniquet from incision to wound closure.The operation duration,wound drainage,hidden blood loss,total blood loss,hemoglobin loss,blood transfusion rate,average transfusion volume,pain score,range of motion,limb-swelling and complication were recorded and analyzed by t test and x2 test using SPSS 19.0.Results The wound drainage,hidden blood loss,total blood loss,hemoglobin loss,pain score,limb-swelling and complications in group A were significantly lower than those in group B (t =-7.432,-15.72,-2.205,-2.746,-3.070,-5.525,all P ＜ 0.05).The operation duration and range of motion were significantly higher in group A than those in group B (t =8.098,2.290,both P ＜ 0.05),there was no significant difference in blood transfusion rate and average transfusion volume between two groups (x2 =0.956,t =-0.329,both P ＞ 0.0 5).Conclusion Using half-course tourniquet has a better hemostatic effect and a lower complication suffering rate than using whole-course tourniquet after TKA in the patients with high coagulation condition.

[Objective] To explore the hemostatic effect of intermittent clamping drainage and knee-flexing position after total knee arthroplasty.[Methods] From July 2014 to November 2015,96 patients receiving total knee arthroplasty were randomly divided into the trial group (n=48 cases) and control group (n=48 cases).After operation,patients in the the trial group received high vacuum suction drainage with intermittent damping drainage tube in a 90 degrees of flexion position of their knee and hip in a flexible bed,and intermittent damping drainage for 24 h.While in the control group,patients were operated with traditional suction and had their limbs placed in full extension for the first 24h post-operatively.Relevant indicators were recorded and compared between two groups,including the wound drainage volume over 24 h,haemoglobin loss,blood transfusion,pain,arc of motion,swelling,length of hospital stay and complications,respectively.[Results] The 24 h wound drainage,haemoglobin loss and mean volume of blood transfusion in the trial group were less than in the control group,with significant difference (P＜0.05).No difference was observed in other observation indexes.[Conclusions] Intermittent clamping drainage and knee-flexing position is effective in reducing blood loss and blood transfusion after total knee arthroplasty.

Objective To evaluate a 3-year mid-term clinical results of FAST-FIX suture system in arthroscopic meniscal posterior horn repair. Methods Clinical results of 46 patients with meniscal tear who underwent posterior horn of the meniscus repair using the FAST-FIX suture system from January 201 1 to April 2013 were retrospectively analyzed. There were 27 males and 19 females,age 17~42 years old,average 23. 5 ±8. 22 years old. There were 25 left knee and 21 right knee and 33 red zone injury and 13 red-white zone injury,8 of which were accompanied by anterior cruciate ligament injury. Clinical healing of the meniscus was assessed by Lysholm scores (35. 73 ±11. 28)points,IKDC scores (37. 26 ±13. 17) points and Tegner scores (3. 3 ±1. 7 ) points before operation. Results The average follow-up period was 46. 3 months (range:36-59 months). The clinical healing rate was 91. 3%. Healing failure occurred to 4 patients and 2 of which had a meniscus noose after operation and were confirmed surgical failure in reoperation. Mean Lysholm scores were (86. 3 1 ± 11. 89),IKDC scores (82. 9 ±13. 44)and Tegner scores (5. 9 ±1. 9)in 3 years after operation for all 46 cases. The differences between the preoperative and postoperative scores in three type scores were statistically significant (P<0. 05 ). Conclusion Arthroscopic posterior horn of the meniscus repair with the FAST-FIX suture system may provide good 3-year mid-term clinical results after operation.

Objective To research the tourniquet effect on cement mantle thickness in total knee arthroplasty.Methods From June 2013 to June 2014,112 cases of patients were received total knee arthroplasty in the First People's Hospital of Foshan and 94 cases of which received primary operation,82 cases were recruited of the research and randomly divided into experimental group(n=41) without tourniquet and control group(n =41)with tourniquet.The radiological cement mantle thickness was evaluated postoperatively in 2 zones (tibia) on anteroposterior and 4 zones (tibia 2;femur 2) on lateral radiographs,and values were cumulated.Additionally,the calculated blood loss,haemoglobin loss,blood transfusion rate,average transfusion volume,VAS pain score,arc of motion,swelling,ecchymosis and micro thrombus in venules were recorded.Results The study showed that (3.57± 0.62) mm on without tourniquet group and(3.74 ±0.71)mm on tourniquet group in tibia (P=0.240).However,the cement mantle thickness of mm on without tourniquet group(2.00±0.43) mm on tourniquet group(2.19±0.48) in femur (P=0.053),there was no statistically significant difference between two groups.The tourniquet group were reduced on the calculated blood loss,haemoglobin loss,blood transfusion rate and average transfusion volume compared with without tourniquet group(P＜0.05).But VAS pain score,arc of motion,swelling,ecchymosis and micro thrombus in venules were slightly increased in tourniquet group compared with without tourniquet group (P＜0.05).Conclusion The use of a tourniquet in total knee arthroplasty can reduce the calculated blood loss,haemoglobin loss,blood transfusion rate,average transfusion volume,but without using a tourniquet has a better clinical results.

Objective To investigate the blood management strategy methods in the perioperative period of arthroplasty. Methods From July 2010 to July 2015,132 cases of patients underwent arthroplasty in our hospital were randomly divided into four groups:the experimental group(32 cases)received preoperative autologous blood donation(PAD)combined with acute nor-movolemic hemodihtion(ANH),control group one(30 cases)received simple adoption PAD,40 cases in the control group two only received ANH,30 cases in the control group three only received closed suction drainage(CSD),the postoperative blood loss and allogeneic blood infusion amount of the four groups were compared. Results 1 d after surgery,the RBC,Hb and HCT of the experimental group and control group had no significant change(P >0. 05),while the control group two and control group three were significantly lower(P <0. 05);The hospital stay times of the four groups were not significantly different(P > 0. 05),but the anemia and the total complication rate of experimental group were significantly lower than those in the control group( P <0. 05);acute blood loss and allogeneic blood transfusions in the experimental group was significantly lower than the control group (P <0. 05). Conclusion PAD and ANH applied in joint arthroplasty perioperative blood management helps to reduce the a-mount of postoperative allogeneic blood transfusion and acute blood loss after surgery,and the patient′s vital signs remain stable. The method is worthy of promotion in clinical applications.

Objective To study the effects of intermittent clamping drainage (ICD) for 4 hours after total&nbsp;knee arthroplasty (TKA) in the female patients with different hemoglobin (Hb) levels. Methods A total of 88 female patients who received TKA in the First People's Hospital of Foshan from September 2012 to August 2015 were selected. There were 44 patients with mild anemia (90 g/L<Hb≤110 g/L) and 44 non-anemic patients (Hb>110 g/L) in this study, then they were further divided into continuous drainage and ICD groups randomly, thus there were 4 groups subsequently, group A (90 g/L<Hb≤110 g/L, continuous drainage), group B (90 g/L<Hb≤110 g/L, ICD), group C (Hb>110 g/L, continuous drainage) and group D (Hb>110 g/L, ICD). ICD method was to clamp all time but 5 min every 2 h for the first 4 h after TKA with the affected limb at extension position, then open the drainage until it was removed 24 h after the operation. Postoperative drainage volume, total hemorrhage volume, hidden hemorrhage volume, calculated Hb loss, blood transfusion rate, average volume of blood transfusion, range of motion (ROM) of knee joint and surgical complications such as infection, skin necrosis of wounds, ecchymosis were recorded and compared among the groups. Results For patients with the same Hb levels, differences of postoperative drainage volume, total hemorrhage volume, hidden hemorrhage volume and calculated Hb loss had statistical significance between different drainage groups (P <0.05); But their blood transfusion rate, ROM of knee joint, incidence of ecchymosis and limb swelling showed no statistical differences (P>0.05). For average blood transfusion volume, there were statistical differences between continuous drainage and ICD groups of patients with mild anemia (P <0.05), while there was no statistical differences for non-anemic patients (P >0.05). No infection or skin necrosis of wounds happened in all groups. Conclusions Compared to the routine continuous drainage, four hours' intermittent clamping drainage after TKA could reduce postoperative drainage volume, total hemorrhage volume, hidden hemorrhage volume and calculated Hb loss effectively, and lower average blood transfusion volume obviously for mild anemia patients. Due to the limitation of blood transfusion rate, average volume of blood transfusion seems to be more suitable indicator in evaluation of hemorrhage after TKA.

Objective Contract the clinical efficacy of treatment of Zero - P cervical fixation in cervical spondylotic myelopathy(CSM) and cervical spondylotic radiculopathy(CSR)with that of traditional anterior cervical spine surgery. Methods 56 patients with cervical discecto-my in our hospital from December 2010 to December 2014 were retrospectively analyzed. 28 cases(control group)performed traditional anterior cervical fixation,row traditional anterior discectomy and interbody Fusion(ACD)fixed with the inner plate;28 cases(observation group)accept-ed anterior discectomy fixed with Zero - P. Patients′cervical lordosis before and after treatment,VAS(visual analogue scale)pain scores were as-sessed. Operation time,incision drainage,bleeding volume,Cobb′s angle and vertebral height were observed. After six months′follow - up,neu-rological evaluation was performed using neural function score according to ASIA case of recovery. Results The operative time,blood loss,wound&nbsp;drainage,perioperative hemoglobin loss and other aspects of indicators in observation group were supervisor than these of the control group,and the differences were statistically significant( P < 0. 05). Patients′ cervical lordosis values after treatment in both groups were significantly improved than before treatment,and the improvement of the observation group cervical lordosis is better than the control group( P < 0. 05). VAS scores in observation group after treatment were significantly lower than the control group( P < 0. 05). In a month after treatment,results of the observation group patients′ Cobb′s angle and vertebral height,neurological function and other indicators are better than those of the control group,which was statistically significantly different between the two groups( P < 0. 05). Conclusion The performance of Zero - P system operation is simple. It can short operation time,decrease incision drainage and the loss of blood loss. Cervical lordosis and analgesic efficacy have been greatly improved.

Objective Fuction study on effect of Zero-P System on anterior cervical fusion in treatment of cervical spondylosis. Methods Retrospective analysis and summary were performed in eight patients with cervical spondylosis who were treated with Zero-P System from December 2010 to now. Results The mean operation time was 120 min an.d the mean blood loss was 80 mL. Dyspepsia abdominal pain was present in 2 patients and shoulder pain was present in 3 patients 3 days after operation,there were no patients feel foreign body sensation or dysphagia,and no complations of Zero-P System were occurred. The mean fusion time is 4 months. Conclusion Zero-P System can Individual used in treatment of cervical spondylosis on anterior cervical fusion.The operation steps were simple.The compliations such as foreign body sensation and dysphagia decreased significantly.

目的分析和研究他克莫司软膏与帕罗西汀联合应用治疗神经性皮炎的效果.方法选取2009年4月-2011年4月神经性皮炎患者86例,按双盲随机方法将其分为两组:对照组43例患者临床治疗时使用药物0.1%他克莫司软膏,观察组43例患者临床治疗在对照组治疗的基础上加用药物帕罗西汀,两组患者治疗结束后,将其治疗效果进行对比.结果观察组的治疗总有效率与对照组相比没有明显的差异(P>0.05),无统计学意义.观察组患者的复发率明显低于对照组(P<0.05),具有统计学意义.结论应用药物0.1%他克莫司软膏治疗神经性皮炎效果比较明显,并且患者在用药治疗期间不良反应较轻微,安全可靠,药物帕罗西汀与之联合应用,明显降低了神经性皮炎的复发率,提高了患者的睡眠质量,值得临床推广与应用.

目的探讨锁定板治疗不稳定股骨粗隆间骨折的临床效果。方法对2005年10月至2010年10月在我院骨科住院治疗的58例不稳定股骨粗隆间骨折患者进行锁定板治疗,采用髋关节功能Harris评分系统评定患者的临床疗效。结果 58例不稳定股骨粗隆间骨折的患者经过锁定板进行治疗后53例达解剖复位,有效率为91.38%。进行为期12个月的随访结果所有患者骨折均愈合。根据髋关节功能Harris评分标准:优34例,良17例,可5例,差2例,优良率87.93%。所有患者均无内固定松动断裂、髋关节不稳、关节强直等并发症发生。结论锁定板治疗不稳定股骨粗隆间骨折患者的一种安全有效的方法,值得在临床中推广应用。

目的探讨同种异体骨移植在胸腰椎结核手术中的应用价值。方法对35例胸腰椎结核患者采用一期前路病灶清除、同种异体骨椎间移植植骨、侧前方内固定。结果术后随访18～60个月,平均24个月。1例患者原窦道不能愈合,需要再次行窦道切除后愈合。所有患者症状均明显改善,术后神经功能均有不同程度恢复。影像学检查示异体骨和内固定物位置良好,椎体序列恢复良好,椎间高度恢复。异体骨植骨均获骨性融合,愈合时间8～36个月,平均11.4个月。术前平均Cobb角为37.8°,术后1周平均Cobb角为10.6°,平均矫正27.2°,末次随访平均Cobb角为16.8°,平均丢失6.2°。无1例结核复发。结论胸、腰椎结核手术中采用同种异体骨移植,可以减轻患者取自体骨的疼痛,椎间融合率高,稳定性好,手术方便快捷。

【Objective】To summarize the key points of diagnosis and treatment of Gluteus Minimus Contracture.【Methods】 43 cases,all performed surgery.35 of them simply released the contracture in the long leg side and with rehabilitation after surgery.【Results】 The different length of two legs was corrected.The pace return normal.【Conclusion】Gluteus Minimus Contracture could diagnosed with some criteria such as incline pelvis,claudication,the same length of both legs absolutely and relatively,negative ober test,no flip in hip.Also standards like patients can squat when knees hold together and them can site with crossing legs.In physiological examination,hip get restricted adduction in 0° position,but a sudden release in flexion hip.An operation can correct the longer side of the low extremity.

[Objective]To observed Lingshen composition treatment insomnia side effects of ssris antidepressant efficacy.[Method]The use of SSRIs antidepressants cause insomnia were randomly divided into two groups,treatment group,40 cases of oral spiritual reference mixture;control group of 40 patients treated using nitrazepam tablets.Pittsburgh Sleep Quality Index (PSQI) evaluated.[Results]Two groups 2 weeks,4 weeks treatment group sleep latency,sleep time and other indicators,the difference was not significant ( P 0.05 ). Treatment group 27 cases,markedly effective 9 cases,improve 2 cases,ineffective 2 cases,the total effective rate was 95%,effective rate 90% ;control group 26 cases,markedly effective 8 cases,improve 3 cases,ineffective 3 cases,the control group rate was 92.5%,effective rate is 85%.Rather two groups,the difference was not significant ( P 0.05 ).[Conclusion]Lingshen composition on the efficacy of SSRIs antidepressants insomnia due to the exact.

目的:观察中西医结合治疗抗精神病药所致闭经的临床疗效。方法:将70例因服用抗精神病药出现闭经3～7个月的女性分裂症患者列为观察对象,随机分为治疗组、对照组各35例,分别用中西医、单纯西医治疗,进行疗效对比。结果:治疗组痊愈20例,有效12例,无效3例,总有效率为91.42%。对照组痊愈15例,有效11例,无效9例,总有效率为74.28%。两组总有效率比较,差异有非常显著性意义(P<0.05)。结论:中西医结合治疗抗精神病药所致闭经疗效显著。

目的观察白虎承气汤联合丙戊酸镁缓释片治疗复发性躁狂症的临床疗效。方法将60例失眠症患者随机分为2组。治疗组32例,给予白虎承气汤联合丙戊酸镁缓释片治疗;对照组28例,单用丙戊酸镁缓释片治疗。2组疗程均为6周。采用BRMS躁狂量表和TESS副反应量表进行评定。结果治疗组的总有效率为91%,显效率为81%;对照组的总有效率为79%,显效率为64%。2组显效率比较有显著性差异(P<0.05)。结论白虎承气汤联合丙戊酸镁缓释片治疗复发性躁狂症疗效好,可减少丙戊酸镁缓释片的用药剂量,不良反应明显减少,患者的耐受性提高。