目的:观察膝关节脱位多发韧带损伤一期同时重建并修复内侧不稳,中医药辅助治疗的临床疗效.方法:回顾性分析2017 年6月至2020年12 月我科收治的膝关节脱位多发韧带损伤患者 25 例,诊断为前十字韧带损伤和后十字韧带损伤合并内侧副韧带Ⅲ度°损伤.患者均一期行自体腘绳肌腱、腓骨长肌腱移植膝关节镜下重建前后十字韧带,联合有限切开修复内侧稳定结构,联合中医药辅助治疗.末次随访采用Lysholm评分、IKDC评分系统评价膝关节功能,并通过Lachman试验、PDT试验、外翻应力试验评价膝关节稳定性.结果:所有患者均全部获得随访,平均随访(25.61±8.62)个月.末次随访时,Lysholm、IKDC评分和膝关节活动度均明显恢复.Lachman试验:23例阴性,2例I度阳性,阴性率为92.0％(22/25).PDT试验:21例阴性,4例I度阳性,阴性率为84.0％(21/25).侧方(内翻)应力试验:阴性24例,阳性1例(I°),阴性率为96.0％(24/25).结论:对于合并膝关节内侧不稳定的多发韧带损伤患者,关节镜下行一期重建前后十字韧带并修复内侧损伤,联合中医药辅助治疗,可取得优良的初期临床疗效.

目的:观察关节镜下Bankart损伤修复术联合Remplissage术治疗合并Hill-Sachs损伤的复发性肩关节前脱位的临床疗效.方法:2015年4月至2018年4月,采用关节镜下Bankart损伤修复术联合Remplissage术治疗复发性肩关节前脱位患者18例.男13例,女5例.年龄18～43岁,中位数31岁.均合并Hill-Sachs损伤,骨缺损体积均小于肱骨头体积的20％.合并肩胛骨关节盂骨缺损14例,骨缺损直径均小于关节盂直径的20％;合并肱二头肌肌腱炎4例、上盂唇损伤3例;均不合并盂肱韧带肱骨侧撕脱损伤、肱骨大小结节骨折及肩袖损伤.采用美国肩肘关节外科医师协会(American Shoulder and Elbow Surgeons,ASES)评分标准、美国加州大学洛杉矶分校(the University of California at Los Angeles,UCLA)肩关节评分标准评价临床疗效,记录手术前后肩关节屈曲活动度、外旋活动度.结果:所有患者均获随访,随访时间12～17个月,中位数15个月.ASES评分,术前(84.4±4.7)分,术后12个月(97.4±6.3)分;UCLA评分,术前(21.8±4.4)分,术后12个月(28.9±3.1)分;肩关节屈曲活动度,术前168.1° ±2.7°,术后167.8° ±2.9°;外旋活动度,术前71.0° ±9.4°,术后72.7° ±8.7°.末次随访时,所有患者均未发生肩关节再脱位.结论:关节镜下Bankart损伤修复术联合Remplissage术治疗合并Hill-Sachs损伤的复发性肩关节前脱位,有利于改善肩关节功能、维持肩关节正常活动,避免肩关节再脱位.

Objective: To discuss the effects of integrative medicine rehabilitation therapy in the recovery of proprioceptive sense of the patients after knee anterior cruciate ligament (ACL) reconstruction. Methods: Sixty pa-tients were randomly divided into the observation group and the control group, 30 cases each group, the control group received common rehabilitation training method, and the observation group accepted TCM general therapy on the basis of the treatment the control group received. Proprioceptive senses of knee joints of the patients in both groups were detected in three months, six months and twelve months after the operation. Results: The difference had statistical meaning in the comparisons of Lysholm scales in three months after treating within two groups (P<0.05);the difference had statistical meaning in the comparison between both groups(P<0.05). The difference had no statis-tical meaning in the comparisons of bending knees in three months after the operation between both groups (P>0.05); the difference had statistical meaning in the comparisons between both groups in six months and twelve months after the operation (P<0.05). Conclusion: The mode of common rehabilitation method and TCM rehabilitation therapy could promote the recovery of proprioceptive sense of the patients after the surgery of ACL reconstruction obviously.

目的 探讨关节镜下髌骨支持带调整术与Fulkerson胫骨结节内移抬高术治疗复发性髌骨脱位的临床疗效.方法 将36例复发性髌骨脱位的患者分为观察组和对照组.观察组在关节镜下行髌骨支持带调整术,同时行Fulkerson胫骨结节内移抬高术联合髌股韧带重建术;对照组行前两种手术方式联合的二联术.术后对两组患者进行随访,对比分析两组患者治疗前后患肢功能恢复的情况.结果 两组患者的髌骨活动功能在术后6周基本恢复正常,较术前髌骨活动功能的各项指标有了明显改善(P<0.05),两组患者术后6周与术后3个月髌骨活动功能各项指标比较,也有显著性差异(P<0.05),观察组患者的改善情况优于对照组(P<0.05).两组患者的Lysholm综合评分与IKDC主观评分在术前比较,无显著性差异(P>0.05);两组患者这两项评分术后不同时期比较,有显著性差异(P<0.05),观察组患者的评分均高于对照组(P<0.05).结论 关节镜下髌骨支持带调整术联合Fulkerson胫骨结节内移抬高术与髌股韧带重建术对于复发性髌骨脱位有较好的疗效,适合临床推广应用.

2009年6月～ 2012年1月,我科手术治疗35例髌骨骨折合并对侧髌股外侧高压综合征患者,疗效满意,报道如下. 1 材料与方法 1.1 病例资料 本组35例,男12例,女23例,年龄30～65岁.患者均为一侧的单纯闭合新鲜髌骨骨折,伴有对侧髌股外侧高压症状.

目的：观察消肿止痛合剂配合依托考昔对膝关节前交叉韧带（ACL）重建术后的镇痛效果。方法将50例ACL重建患者随机分为研究组及对照组，研究组术后采用消肿止痛合剂配合依托考昔镇痛消肿，对照组术后口服依托考昔片镇痛，两组患者均维持镇痛3天。记录患者静息时不同时点的VAS评分（视觉模拟评分法）、3 d内吗啡类镇痛药物用量和不良反应的发生情况。结果研究组与对照组在术后72 h内各时点VAS评分和3 d内吗啡类镇痛药物用量上有显著性差异（P＜0.05），不良反应发生率有显著性差异（P<0.05）。结论消肿止痛合剂配合依托考昔对ACL重建术后的镇痛效果肯定，值得临床推广。

膝关节外伤手术治疗后的粘连所导致的活动功能障碍一直是关节外科关注的焦点.其原因既有高能量损伤后关节内及周围骨折创伤的系列反应,又和膝关节术后长时间固定而不及时锻炼相关.各种因素使膝关节组织病理反应加重,软骨退行性改变,组织修复能力严重受限,最终导致功能障碍.因此,术后有计划、有步骤的进行康复治疗尤为重要.

Objective To assess single ropivacaine local infiltration for postoperative analgesia and early postoperative rehabilitation in total knee arthroplasty (TKA ).Methods Fifty patients with TKA were divided into two equal groups;Ropivacaine group (25 cases):surgery incision infiltration 0.25% ropivacaine 20 ml,and postoperative in-travenous analgesia(PCIA);Control group (25 cases):invasive surgery incision saline 20 ml,and PCIA.Visual ana-log scale(VAS)assessed at different time points using the analgesic effect,assessed at different times after rehabilita-tion training compliance,active knee ROM and knee function.Results At postoperative 4,6,8,12h VAS scores of ropivacaine group were 1.28 ±1.03,2.17 ±1.67,2.13 ±1.76,2.38 ±0.34;Control group were 2.75 ±1.09, 3.25 ±1.29,4.50 ±1.51,4.62 ±1.60,differences were statistically significant (P<0.01),but differences were not statistically significant postoperative 24,48 h (P>0.05):ropivacaine group were 3.20 ±1.21,3.17 ±0.84;control group were 3.28 ±1.21,3.56 ±1.19.Ropivacaine group and the control group after rehabilitation training compliance,knee ROM and HSS scores were statistically significant differences (P<0.01 ).Conclusions Ropiva-caine local infiltration combined with PCIA for analgesia after TKA is a safe and effective method.

目的:观察消肿止痛合剂对软组织损伤患者血清肿瘤坏死因子-a（tumor necrosis factor alpha,TNF-a）、白细胞介素-6（interleukin 6,IL-6）的影响,探讨其活血化瘀、消肿止痛作用产生的机制。方法:以2010年1月-2011年12月在我院治疗的骨科患者为研究对象,分为治疗组45例,对照组43例。2组患者入院后治疗组内服消肿止痛合剂,每次50mL,每日2次;对照组口服草木犀流浸液片2片/次,2次/d。2组患者均以7d为1个疗程,共治疗2个疗程,分别于入院第2、7、14天运用免疫度量法测定促炎症细胞因子TNF-a、IL-6于血清中的含量,并进行分析。结果:入院第2天,2组患者血清TNF-a、IL-6的含量比较,差异无统计学意义（P＞0.05）;第7、14天2组血清TNF-a、IL-6的含量比较,差异有统计学意义（P＜0.05）。入院第7、14天与入院第2天血清TNF-a、IL-6含量比较,差异有统计学意义（P＜0.01）。结论:消肿止痛合剂能抑制创伤后致炎症因子释放。

Objective:To observe the effects of XiaoZhong ZhiTong mixture on the changes of tumor necrosis factor alpha(TNF-ɑ) and interleukin 6(IL-6) in the serum of patients with soft tissue injury in the early and middle stages,to explore its mechanism of activating blood and eliminating stasis,alleviating edema and pain.Method:Orthopedic patients admitted to our hospital from January,2010 to December,2011 were allocated into the control group and the treatment group.Patients of the treatment group took XiaoZhong ZhiTong mixture,50mL each time,twice per day;the control group received melilotus extract tablets,three tablets each time,twice per day.Seven days were one course of treatment and contents of TNF-ɑ and IL-6 in the serum were detected with immune measurement after two courses of treatment at the 2nd,7th and 14th day after admission.Result:The difference between both groups showed no statistical meaning in the contents of TNF-ɑ and IL-6 at the 2nd day after admission(P0.05);it showed statistical meaning at the 7th and 14th day(P0.05).Conclusion:XiaoZhong ZhiTong mixture could inhibit the release of inflammatory factors after trauma.

Objective:To detect the clinical effect of herbal lotion of Longzhong brand with arthroscopic for treating knee osteoarthritis.Methods:All 60 cases were randomly divided into control group and treatment group from March 2010 to March 2011,30 patients in each group.The VAS score and lysholm score were observed in the two groups 1,3,6,and 12 months before and after operation.Results:The VAS score and lysholm score was not difference between the two groups before surgery(P0.05),but there was significant difference between the two groups 1,3,6,and 12 months after operation(P0.05).Conclusion:The herbal lotion combined with arthroscopic is effective for relieving pain of knee osteoarthritis.

Objective:to observe the analgesic effects of oxycodone and acetaminophen tablets and mixture of alleviating swelling and relieving pain on the patients after TKA.Method:50 TKA patients are randomly divided into research group and control group.The postoperative patients in research group receive oxycodone and acetaminophen tablets and mixture of alleviating swelling and relieving pain,while the ones in the control group orally take naproxen sustained release capsule.Both of the groups maintain analgesia for three days.The postoperative visual analog scale(VAS) at rest and movement are recorded.Result:There are significant differences when VAS of research group and control group are compared in the same group at different hours(P0.05),which shows there are certain efficacy of both groups' treatment.72 h VAS of research group is lower than control groupP0.05,which illustrates there is significant difference on analgesia after TKA between research group and control group.7 days after the operation,there is no significant difference between two groups.Conclusion:the analgesic efficacy of oxycodone and acetaminophen tablets and mixture of alleviating swelling and relieving pain after TKA is significant and they deserve further clinical application.

OBJECTIVE:To explore the therapeutic effects of Xiaozhong Zhitong mixture preventing heterotopic ossification (HO) after total hip arthroplasty. METHODS:From July 2006 to October 2009, 154 patients underwent total hip replacement surgery were randomly divided into sham group (group A, 50 cases), indomethacin group (group B, 55 cases) and Xiaozhong Zhitong mixture group (group C, 49 cases). Among 154 patients, 9 cases were primary osteoarthris, 34 cases osteoarthritis secondary to acetabular dysplasia, 98 cases osteoarthritis secondary to avascular necrosis of the femoral head, 2 cases rheumatoid arthritis, 5 cases femoral neck fracture, 6 cases other diseases. Modified Gibson approach was used during the operation. After operation, group A was no preventing treatment, group B was treated by indomethacin 50 mg every time, twice a day; group C was treated by Xiaozhong Zhitong mixture 50 ml every time, twice a day for 4 weeks. Eighteen months after operation was study termination point and X-ray (including the double hip anteroposterior,obturator oblique and iliac oblique film) was used to observe whether heterotopic ossification was formed (Brooker classification was used to evaluate ossification degree); Harris scoring was used to evaluate the function of hip joint,including PAHSS 80 scores and IAHSS 20 scores. RESULTS:All the patients were followed up,with the average of duration of 21.2 months. The condition of heterotopic ossification: for group A,there were 27 cases with heterotopic ossification(54%) ,and Brooker I in 8 cases, II in 9 cases, III in 8 cases and IVin 2 cases; for group B, there were 12 cases heterotopic ossification (21.82%), and Brooker I in 10 cases, II in 2 cases; for group C, there were 11 cases heterotopic ossification(22.45%), and Brooker I in 9 cases, I in 2 cases. There was significant difference among three group in heterotopic ossification by rank test (P<0.05), but no difference between group B and C (P>0.05); there were no significant difference among three groups before treatment in Harris, PAHSS and IAHSS by analysis of variance (one-way ANOVA) (P>0.05), and has significant difference at 18 months after treatment (P<0.01). There were significant difference in Harris, PAHSS and IAHSS before and after treatment at 18 months (P<0.01). LSD-t was used to analyzed the scoring of Harris, PAHSS and IAHSS, there was significant difference among group A and group B and group C (P>0.05), but no difference between group B and C (P<0.01). There were gastrointestinal reaction in 5 of group A, 35 in group B and 4 in group C. CONCLUSION:The effect of Xiaozhong Zhitong mixture on the prevention of heterotopic ossification after total hip arthroplasty is similar to indomethacin, but Xiaozhong Zhitong mixture has the advantages of less side effects and easily acceptance by patients.

<正>髌股关节不稳是骨科临床常见疾患。回顾我院近年来治疗髌股关节不稳、临床资料完整病例39例(45膝)。分别采用传统的Krogius开放式手术和膝关节镜下髌骨外侧支持带松解、紧缩重建内侧髌股韧带手术,两种术式比较,后者损伤小,

Objective:To observe clinical effects of XiaoDingGao in the treatment of knee traumatic synovitis.Method:80 patients with knee traumatic synovitis were randomly divided into treatment group(40 cases) and control group(40 cases).The treatment group was given XiaoDingGao by external use,and XiaoDingGao must be replaced every 48 hours,4 times as a course of treatment.The control group was given diclofenac acid emulsion by external use,4 times/d,20 min/times.The efficacy and adverse reactions were observed after a course of treatment.Result:The analgesic effects in the two groups was no significant difference(P0.05),but XiaoDingGao can eliminate knee swelling(P0.05).There were no adverse reactions in the two groups of patients.Conclusion:XiaoDingGao and diclofenac acid emulsion have the same of analgesic effects,but XiaoDingGao can better reduce knee swelling.

Objective To investigate the effect of the minimally invasive internal fixation with arthroscopy to treat tib-ial plateau fracture.Methods The clinical data of42 cases of closed tibial plateau fractures were analysed retrospec-tively.All cases were examined and reduced under arthroscopy,and treated by minimally invasive internal fixation.Results All cases were followed up for 14 ~32 months.All fractures were unitied after 4 ~9 postoperative months,and no infection or ankylosis occurred.The X-ray findings showed 37 cases got anatomic reduction,5 cases got col-lapse fracture of tibial poateau within 2mm.According to Rasmussen′s knee rating system,27 cases had excellent re-sults,11 good,and 4 fair.The excellent and good rate was 90.5%.Conclusions It is good way to treat tibial frac-ture with arthroscopy,which requires minimal trauma and provides quick recovery.

<正>髌股关节外侧高压综合症是由于髌骨外侧支持带张力增高,导致髌骨倾斜,引起髌股关节软骨损害的病理过程。它可表现为膝部疼痛,目前已越来越引起临床重视。我科自2007年5月~2010年8月,诊治髌股关节外侧高压综合症患者17例,采用膝关节镜检查、镜下清理、髌骨外侧支持带松解治疗,临床效果满意,现报告如下。

胫骨高位截骨手术是临床治疗膝关节骨性关节炎并膝内翻较常使用的、有效的治疗方法.有学者报导患者体重超标可以影响该手术的临床疗效[1].本研究通过根据体重指数(BMI)分组:BMI≤24组与BMI＞24组,共110例(136膝)膝关节骨性关节炎并膝内翻行胫骨高位截骨手术的疗效对照研究,探讨体重指数对该手术疗效的影响.

自2001年5月～2003年3月,作者采用胫骨高位截骨Giebel槽式钢板内固定术,治疗膝关节骨性关节炎合并膝内翻27例(36膝),效果满意.现报告如下.