观察循经通络穴位按摩疗法对缓解膝关节置换术患者围手术期负性情绪的临床疗效.将2018年10月～2019年10月的80例行膝关节置换术并伴有围手术期负性情绪的患者随机分为干预组和对照组,每组40例.对照组采用常规护理,干预组在常规护理的基础上加用循经通络穴位按摩,干预措施持续至术后3d,观察比较两组患者焦虑、疼痛、自理能力及膝关节活动度的情况.干预组焦虑、疼痛、自理能力以及膝关节活动度情况均优于对照组,差异有统计学意义(P＜0.05).循经通络穴位按摩疗法能有效改善膝关节置换术患者围手术期的负性情绪状况,减轻患者疼痛、提高自理能力,有利于麻醉、手术的顺利进行和术后的康复锻炼的实施,同时可以减轻医护人员以及陪护人员的工作量,提高患者住院期间的满意度.

目的 探讨单次及两次静脉滴注氨甲环酸对老年股骨转子间骨折患者围术期隐性失血和凝血功能的影响.方法 老年股骨转子间骨折患者100例根据随机数字表法分为研究组和对照组,两组在术前静脉滴注氨甲环酸;研究组术后7 h再次给药.比较两组手术时间、切口长度、住院时间、失血情况、凝血功能及双下肢深静脉血栓的发生率.结果 两组手术时间、切口长度、住院时间无明显差异(P>0.05),研究组总失血量、隐性出血量及输血率均显著低于对照组(P<0.05);术前、术后3 d,两组凝血酶原时间(PT)、活化部分凝血酶时间(APTT)、纤维蛋白原(FIB)、D-二聚体(D-D)水平无明显差异(P>0.05),两组双下肢深静脉血栓发生率无明显差异(P>0.05).结论 术前及术后7 h两次静脉滴注氨甲环酸可更有效减少老年股骨转子间骨折患者隐性失血量,且不会对患者的凝血功能造成明显影响.

目的 消肿止痛合剂联合氨甲环酸对膝关节置换术患者失血量及纤维蛋白原降解产物(FDP)、D-二聚体(D-D)的影响.方法 选取甘肃省中医院2018年7月至2019年6月收治的60例需行膝关节置换术的膝骨关节炎患者,按照随机数字表法分为观察组和对照组,各30例.对照组给予氨甲环酸治疗,观察组则联合消肿止痛合剂治疗,两组均治疗7 d.比较两组失血及输血情况,术前、术后1 d、3 d、5 d、7 d血红蛋白与红细胞水平,术后1 d、3 d、5 d、7 d血浆FDP、D-D水平以及术后7 d VAS及HSS评分.结果 与对照组相比,观察组的术中出血量、隐性失血量、总失血量及输血比例明显减少(P<0.05);与术前相比,术后1～7 d两组红细胞及血红蛋白水平呈先降低后升高趋势,且术后7 d水平最高,观察组术后1～7 d的红细胞及血红蛋白水平均较高(P<0.05);术后1～7 d两组血清FDP、D-D呈先升后降趋势,术后1 d水平最高,且观察组低于对照组(P<0.05),两组术后3～7d水平无明显差异(P>0.05);与术前1 d相比,术后7 d两组VAS评分均降低,且观察组低于对照组;两组HSS评分均升高,且观察组高于对照组(均P<0.05).结论 消肿止痛合剂联合氨甲环酸可明显减少膝关节置换术患者的术中失血量,改善血红蛋白、红细胞以及凝血和纤溶系统,降低疼痛程度,促进膝关节功能的恢复.

Objective:To observe the effects of oral administration of QuHan ZhuFeng mixture on the contents of hyaluronic acid(HA)in joint fluid and the serum of the patients with knee osteoarthritis(KOA)of Y ang deficiency pattern. Methods: Ninety patients were randomized into the groups of A, B and C. Group A adopted QuHan ZhuFeng mixture,50 mL each time,three times per day,group B received sodium hyaluronate by intraarticular injec-tion,2 mL each time,once per week, and group C adopted therapeutic methods in the group A and B.Three groups were treated for five weeks consecutively.The contents of HA in joint fluid and the serum were observed before and after treating.Results:The difference showed no statistical meaning in the comparisons of the levels of HA in joint fluid before treating among three groups (P>0.05);the difference had statistical meaning in the comparisons within three groups before and after treating(P<0.05),the difference was statistically significant in the comparisons among three groups in five weeks after treating (P<0.05).The difference had no statistical meaning in the comparisons of HA contents in the serum before treating among three groups(P>0.05);the difference presented statistical meaning in the comparison between before and after treating within three groups (P<0.05),when group A and C were com-pared with group B in five weeks after treating,there was a significant difference (P<0.05).Conclusion:QuHan ZhuFeng mixture could raise HA contents in knee joint synovia and decrease HA contents in the serum in the treat-ment of the patients with KOA of Y ang deficiency pattern,its effects are more obvious when it is combined with sodium hyaluronate.

In order to provide theoretical evidence for the medical workers'researches in the field,the related pathogenesis of steroid-induced osteonecrosis femoral head was elucidated from the aspect of TCM,and the research status of TCM constitutions were summed up.

经皮椎体成形术(Percutaneous Vertebroplasty,PVP)是目前治疗骨质疏松性骨折和病理性骨折常用的脊柱微创技术.因其创伤小、费用低、疼痛缓解迅速等优点,在临床上得到了广泛应用.而其并发症大多与骨水泥渗漏存在直接或间接的关系[1],血管源性骨水泥渗漏因无明显临床症状往往被人们忽视[2],若发现不及时,会出现肺栓塞、脑栓塞等致命性并发症.目前,国内未见对血管源性骨水泥渗漏的系统性总结文献,国内外骨水泥渗漏判定标准主要基于X线或CT检查,较少介入MRI、MRA、CTA血管造影等手段[3].血管源性骨水泥渗漏主要是Yeom分型S型渗漏[4～5].在齐氏分型属线状渗出[6].为了引起广大临床医师对该并发症的重视并提供一定的临产参考,本文对该并发症进行了综述.

Essex-Lopresti损伤(Essex-Lopresti Injury,ELI)常因高能量暴力作用于前臂导致桡骨头骨折合并前臂骨间膜破坏及下尺桡关节脱位,是肘、前臂、腕同时受累的三联损伤,也可称之为前臂纵向分离.因Essex-Lopresti在1951年较详细报道而得名,其发生率约占桡骨头骨折的1％[1].由于临床上对该损伤认识不足,就诊时约有75％的患者因忽视三角纤维软骨复合体与骨间膜损伤而漏诊,而在延迟治疗的患者中仅20％能取得相对满意的疗效[2].因此,早期的诊断是提高该病疗效的关键[3].

Objective:To explore the influence ofXiaoZhong ZhiTong mixture combined with tramadol on the patients after total knee arthroplasty (TKA).Methods:Sixty patients who accepted TKA in our hospital were chosen as the objects of the study,and allocated to the observation group and the control group according to random method,30 cases in each group,the control group accepted tramadol after the operation,and the observation group took XiaoZhong ZhiTong mixture combined with tramadol after the operation,after treating for one week,VAS and HSS scales of the knee in both groups were compared in 12 hours,24 hours,48 hours and seven days after the operation.The contents ofMMP-1,TNF-α and IL-1 in the serum of the patients in both groups were detected by ELISA method before the surgery,after the surgery,in one week and four weeks after the surgery.Results:The observation group was lower than the control group in VAS scales when the patients rested and moved in seven days and 48 hours after the surgery,simultaneously higher than the control group in HSS scales of the knee in seven days and 48 hours after the surgery,and the difference had statistical meaning (P＜0.05).The observation group was lower than the control group in the contents of MMP-1,TNF-α and IL-1 in one week and four weeks after the surgery,and the difference showed statistical meaning (P＜0.05).The observation group was lower than the control group in the incidence of adverse reaction,and the difference had statistical meaning (P＜0.05).Conclusion:XiaoZhong ZhiTong mixture combined with tramadol is applied to the analgesia of the patients after TKA,and effective in improve knee joint movement,decrease the contents of MMP-1,TNF-α and IL-1 in the serum of the patients,and its mechanism is worth further studying.

探究消肿止痛合剂配合曲马多对人工膝关节置换术后的影响.方法:选取60例在甘肃省中医院接受人工膝关节置换术的患者为研究对象,按随机法分为观察组和对照组,对照组术后给曲马多治疗,观察组术后给予消肿止痛剂配合曲马多治疗,治疗1周后,比较两组患者在术后第12 h、24 h、48 h、7 d的VAS评分和膝关节HSS评分.结果:观察组患者在术后第48 h和7 d静息疼痛和活动时疼痛VAS评分明显低于对照组,同时观察组患者在术后第48 h和7 d膝关节HSS评分明显高于对照组,差异均具有统计学意义(p<0.05).结论:消肿止痛合剂配合曲马多用于膝关节置换术后患者的镇痛和改善膝关节活动疗效显著,其机制值得进一步探讨研究.

目的:探讨同期双膝关节置换治疗膝骨关节病的临床疗效.方法:接收在我院患有膝骨关节病的患者一共有50例,对50例病人采取同期双膝关节置换进行治疗,对其手术效果给予分析研究.结果:手术时间为176±21.4min,术中出血量为520±55ml,引流量为650±40ml.50例患者都获得随访,时间为26±18.1个月.术前,膝关节活动范围平均为600±12.50,关节功能HSS评分为44±5.5分,术后,膝关节活动范围平均为1050±7.10,关节功能HSS评分为88.1±6.2分,其中优一共有36例,良一共有8例,可一共有4例,差一共有2例.结论:对膝骨关节病采取同期双膝置换术进行治疗的效果可靠,预后良好,具有临床推广价值.

Objective:To observe the clinical effect of oral cold-removing and wind-dispelling mixture in the treatment of Yang deficiency type knee osteoarthritis.Methods:All 90 cases were randomly divided into A,B and C three groups,and there were 30 cases in each group.A group was given cold-removing and wind-dispelling mixture orally,50 mL each time and three times per day.B group was treated by intra-articular injection with Sodium Hyaluronate,2 mL/time,once / week.C group was given cold-removing and wind-dispelling mixture orally,50 mL each time and three times per day,and also treated by intra-articular injection with Sodium Hyaluronate,2 mL/time,once / week at the same time.Three groups were treated for five week,continuously.Index severity of osteoarthritis (ISOA) score before and after treatment and clinical effects were observed.Results:Compared the scores of joint pain or discomfort,maximum walking distance,daily living ability within three groups before and after treatment,the differences were significant (P＜0.05),and the differences among three groups after treatment were also significant (P＜0.05).About the total effective rate,A group was 86.7％,B group was 90.0％,C group was 96.7％,there was significant difference between the three groups (P ＜0.05).Conclusion:cold-removing and wind-dispelling mixture has good clinical curative effect in the treatment of Yang deficiency type knee osteoarthritis,and it can effectively relieve pain,improve joints functions.

Objective To investigate the effect of artificial femoral head replacement for senile intertrochanteric frac-tures.Methods Hemiarthroplasty was used in treatment of 15 cases of intertrochanteric fracture.Results All pa-tients were followed up for 12 to 24 months.X-ray showed fractures reduced;hip function recovered well without loos-ening,dislocation.No deep vein thrombosis and other complications were found.According to Harris hip score:ex-cellent in 11 cases,good in 3,and fair in 1.Conclusions Intertrochanteric fractures with poor physical fitness can be treated with hemiarthroplasty with advantages of less trauma,short bed time and early ambulation,fewer complica-tions,and clinical efficacy is good.

近年来随着社会的发展,交通事故、高坠伤及其他意外情况引起的青壮年股骨颈骨折日渐增多.青壮年的股骨颈骨折一般均伴有高能量损伤,而股骨头、颈的薄弱血供在高能量损伤后极易遭受严重的甚至是不可逆的破坏,骨折部位及其周围的软组织承受较大的直接或间接暴力,极易发生股骨头的坏死或骨折的不愈合,这将严重影响青壮年患者后期的生活质量[1].青壮年股骨颈骨折目前临床上有多种治疗方案,但其后期治疗效果仍不能让人满意,如何恰当地选择治疗方案使患者术后恢复正常的生活成为所有骨科医生所不能回避的难题[2].我科2003年至2006年采取闭合复位经皮空心加压螺钉治疗青壮年股骨颈骨折32例,取得了比较满意的治疗效果,现报道如下.

目的:探讨分析应用经皮空心螺钉内固定术治疗青壮年股骨颈骨折的临床疗效.方法:选取2003年1月～2006年12月间我院收治的青壮年股骨颈骨折患者32例作为研究对象,应用经皮空心螺钉内固定术对其进行治疗,依据相关临床疗效判定标准对这32例患者的髋关节功能进行评分和比较,并将所得结果及所有患者的临床资料进行回顾性的分析.结果:得到完全性随访的患者有32例,随访的时间为12～72个月,平均随访时间为42个月.这32例患者的住院时间为7～15d,平均住院时间为11d,骨折的愈合时间为4～11个月,平均愈合时间为7.5个月,其中骨折愈合良好的患者有29例,骨折不愈合的患者有3例,骨折的愈合率为90.06%.结论:应用经皮空心螺钉内固定术治疗青壮年股骨颈骨折的临床疗效显著,具有操作简单、安全可靠等优点,值得在临床上推广应用.