目的:分析术前静脉滴注高、低剂量氨甲环酸(tranexamic acid,TXA)对老年股骨颈骨折全髋置换术(total hip arthroplasty,THA)失血的影响.方法:选取THA患者87例,分为低剂量A组(43例,TXA 15 mg/kg)和高剂量B组(44例,TXA 50 mg/kg).比较两组围手术期失血量,术后血红蛋白减少量,输血量及下肢深静脉血栓形成.结果:两组间显性失血量(DBL)、总失血量(TBL)、术前与术后24 h测得的血红蛋白量差值的比较差异有统计学意义,而输血量及并发症差异无统计学意义.结论:术前0.5 h静脉滴注50 mg/kg高剂量TXA在减少手术失血量方面效果好,且不增加血栓等并发症形成风险.

[目的]评价麻醉下手法松解术(manipulation under anesthesia,MUA)结合等速肌力锻炼治疗冻结肩的临床疗效.[方法]回顾性分析2017年10月—2019年2月在本院采用MUA治疗的冻结肩60例患者的临床资料.依据医患沟通结果,30例的MUA治疗后行等速肌力锻炼(等速组),30例在MUA治疗后常规康复锻炼(常规组).比较两组治疗期、随访和ISOMED2000检查资料.[结果]所有患者均顺利完成治疗,无严重并发症发生.等速组治疗周期显著短于常规组[(84.6±8.3)d us(103.9±28.3)d,P＜0.05],但等速组治疗费用显著高于常规组[(2 760.7±134.2)元vs(2 355.2±401.9)元,P＜0.05].随时间推移,两组疼痛VAS评分均显著下降(P＜0.05);治疗后2、4周等速组VAS评分显著优于常规组(P＜0.05).治疗期间等速组止痛药物的使用强度显著低于常规组(P＜0.05).所有患者随访平均(34.5±5.9)个月,随时间推移,两组Constant-Murley评分,以及肩关节外展、前屈、后伸活动度(range of motion,ROM)均显著增加(P＜0.05).末次随访时等速组的Constant-Murley评分,以及外展、前屈、后伸 ROM 均显著优于常规组[(91.4±4.2)分vs(88.3±4.6)分;(165.8±9.6)°vs(149.7±14.8)°;(171.1±8.3)° vs(159.2± 12.6)°;(49.7±5.6)° vs(40.0±4.7)°,P＜0.05].ISOMED2000检测方面,与治疗前相比,末次随访时两组60°/s外展、60°/s前屈、60°/s后伸、120°/s外展、120°/s前屈、120°/s后伸、180°/s外展、180°/s前屈和180°/s后伸峰值扭矩(peak torque,PT)均显著增加(P＜0.05),治疗前两组间上述测量指标的差异无统计学意义,但末次随访时等速组均显著优于常规组(P＜0.05).[结论]MUA结合等速肌力锻炼治疗冻结肩可显著改善治疗效果,有效缓解肩关节疼痛、增加关节活动度和增强肩关节力量.

Background: While studies have indicated that total knee arthroplasty (TKA) is effective to treat the patients with advanced tuberculosis (TB) of the knee joint a consensus of views regarding surgical timing, prosthesis selection, and peri-operative antitubercular therapy has not been reached. The purpose of this study was to evaluate the safety of TKA in the patients with advanced active tuberculous arthritis of the knee. Methods: Eight patients with advanced active tuberculous arthritis of the knee were reviewed in this study from 2010 to 2017. The diagnosis of each patient was confirmed by postoperative histopathology revealing granulomatous lesions with epithelioid histiocytes surrounded by lymphocytes and positive acid-fast staining. Antitubercular medications and TKA with primary prosthesis were performed in all patients with one-stage TKA in six and two-stage in two. Local symptoms, erythrocyte sedimentation rate (ESR) values were used for detecting the recurrence of tuberculosis. The hospital for special surgery knee score (HSS) system was used to evaluate the function outcomes of the involved knees. Results: Within an average follow-up period of 48.8 months, no recurrence of tuberculous infection was found in any of the patients. The ESR became normal (below 20 mm/h) within six months after TKA in all patients. The average HSS score improved from 32.4 ± 8.6(18-42) points preoperatively to 85.6 ± 9.7(68-94) points 1.5-2.0 years after surgery (p<0.001). All knees showed good integrity and no loosening of prosthesis was found. Conclusions: TKA for advanced active tuberculosis of the knee is a safe procedure providing symptomatic relief and functional improvement. A long infection-free interval is not a prerequisite for TKA. Wide surgical debridement and adequate post-operative antitubercular chemotherapy are the mainstay to eradicate the infection.

OBJECTIVE:To investigate the diagnostic value of 6 conventional physical examination tests for the diagnosis of supraspinatus tendon tears, and how well they could tell the difference between partial-and full-thickness tears.METHODS:A total of 91 patients with different shoulder symptoms who received shoulder arthroscopic procedure were enrolled in the study from June 2017 to September 2020. The intraoperative findings were compared with the results of the preoperative physical examination of 6 clinical tests, including the Hug-up test, the Jobe test, the 0°abduction test, the drop arm test, the Neer test, and the Hawkins test, to determine the sensitivity, specificity, positive and negative predictive value, accuracy, positive and negative likelihood ratio of each test.RESULTS:By arthroscopy, a total of 44 full-thickness tears, 34 partial-thickness tears, and 13 intact supraspinatus tendons were found in all 91 cases. The Hug-up and the Jobe tests significantly correlated with the intraoperative findings. The sensitivity of the Hug-up test, the Jobe test, the 0° abduction test, the drop arm test, the Neer test, and the Hawkins test was 0.90, 0.79, 0.64, 0.42, 0.49, 0.24 respectively;the specificity was 0.61, 0.69, 0.54, 0.38, 0.31, 0.77;the positive predictive value was 0.93, 0.94, 0.89, 0.80, 0.81, 0.86;the negative predictive value was 0.50, 0.36, 0.20, 0.10, 0.09, 0.14;the accuracy was 0.86, 0.78, 0.63, 0.42, 0.46, 0.32;the positive likelihood ratio was 2.30, 2.58, 1.39, 0.69, 0.71, 1.06;and the negative likelihood ratio was 0.16, 0.30, 0.67, 1.50, 1.65, 0.98.CONCLUSION:The Jobe test and the Hug-up test are both effective at accurately diagnosing supraspinatus tendon tears, the Hug-up test detects supraspinatus tears with a high sensitivity, and similar specificity. The tests assessed in this study are not capable of distinguish between partial-and full thickness supraspinatus tendon tears.

目的 探讨临床医学PBL教学与传统教学模式下课堂创造氛围的对比.方法 2020年5—6月期间选择本校2016级临床医学学生51名作为研究对象,随机分为对照组(25名)和PBL组(26名).对照组接受传统教学模式按照课程设置常规教学,实验组按课程设置设计PBL教学措施,对比两组课堂创造氛围情况,并对比两组学生效果.结果 实验组干预后课堂创造氛围评分显示:学生团队合作度(3.56±0.37)分、学习趣味性(3.76±0.18)分、教学启发性(4.59±0.42)分、创新支持度(4.36±0.57)分和课堂民主性评分(4.45±0.34)分均高于对照组(2.21±0.57、2.13±0.57、2.38±0.86、2.41±0.69、2.45±0.54)分,差异均有统计学意义(P<0.05).实验组医学理论知识(42.03±7.12)分和操作技能考核得分(41.08±8.57)分及总分(84.16±14.03)分均高于对照组(34.03±6.57分、35.02±5.57分、70.25±11.59)分,差异均有统计学意义(P<0.05).结论 临床医学PBL教学模式可有效创设良好的课堂创造氛围,有助于提升教学效果,有利于创新性人才的培养,较传统教学模式优势显著,临床应用价值较高.

目的 分析PBL教学法结合3D打印在脊柱外科临床教学中的应用效果.方法 选择2019年4月—2020年4月滨州医学院烟台附属医院所接收的60名对口五年制本科医学院临床本科实习生为研究对象.现将学生分为对照组30名以及观察组30名.对照组学生接受PBL教学法,观察组接受PBL联合3D打印教学法,比较2组学生的学习成绩、教学质量评分及自主学习时间.结果 相较于对照组,观察组学生各项脊柱外科学考试成绩明显更高(P<0.05),且和对照组相比,观察组学生对于课堂趣味性、课堂互动性、学习积极性、疾病认知情况、相关操作掌握情况以及教学满意度得分更高(P<0.05),从2组学生自主学习时间对比情况来看,观察组明显比对照组自主学习时间更长(P<0.05).结论 在开展脊柱外科临床教学工作过程中,运用3D打印联合PBL教学法完成该项工作,有助于提升实习生实际操作能力水平以及理论知识掌握度,同时也可强化学生学习自主性.

目的 分析3D打印技术在运动医学骨科临床教学中的应用效果,旨在为相关人员的研究工作提供参考.方法 试验选择2019年6月—2020年6月滨州医学院烟台附属医院所接收的运动医学骨科实习本科生60名为研究对象,现按照所接受的临床带教方法不同,将其分为对照组30名以及观察组30名.对照组学生沿用传统带教方案,以此为基础,观察组学生应用3D打印模型方案学习,分析两组学生综合能力问卷评分以及考试成绩对比情况.结果 与对照组相比,观察组学生教学满意度、理解能力水平、自学能力水平以及学习兴趣得分明显更高,差异有统计学意义(P<0.05).和对照组相比,观察组学生的理论知识以及操作技能考试成绩得分明显更高,差异有统计学意义(P<0.05).结论 将3D打印技术全面运用于运动医学骨科实习带教工作之中,可以在极大程度上提升学生对于实习带教工作的满意度,同时可提升学生们的成绩,帮助实习生创建立体化思维,增强学习兴趣,值得进一步推广及应用.

假体脱位是全髋关节置换(total hip arthroplasty,TH A)术后常见的并发症之一,目前仍然是关节外科医生面临的主要挑战.而在术后假体前脱位发生后,有些医师甚至会错误地判断为后脱位,在闭合复位时牵引及复位方向错误,导致手法复位失败,甚至出现假体周围骨折、假体松动,需要翻修手术的可能.本文从假体前脱位的影像评估、影响因素、正确的术前规划以及术后良好的体位管理方面进行讲述,以期为指导临床医师提高患者THA术后疗效提供参考.

目的 评估静脉应用氨甲环酸减少膝关节镜下前交叉韧带重建术后关节失血量的临床效果.方法 选择自2019年至2020年期间在滨州医学院烟台附院接受膝关节镜下前交叉韧带重建手术治疗的80例患者作为研究对象,其中男55例,女25例;年龄19～49岁,平均(31.4±10.7)岁.患者被随机分成氨甲环酸组和对照组,氨甲环酸组的患者于止血带充气前按体重15 mg/kg静滴应用氨甲环酸,术后按体重每小时10 mg/kg持续应用氨甲环酸3h,对照组不使用氨甲环酸.术后24 h评估膝关节引流血量,术后1d、7d、14 d评估膝关节膝关节髌骨周径、膝关节活动度及疼痛视觉模拟评分(visual analogue scale,VAS).结果 与对照组相比,术后24 h氨甲环酸组的膝关节引流血量明显减少(P＜0.05);术后7d,氨甲环酸组的VAS、膝关节活动度和髌骨周径更优势(P＜0.05);术后14 d,氨甲环酸组的VAS和髌骨周径更优势(P＜0.05),膝关节活动度无明显差异(P＞0.05).结论 关节镜下前交叉韧带重建术后静脉应用氨甲环酸可以有效减少失血量,减轻术后早期膝关节肿胀及疼痛.

The objective was to study the effects of ropivacaine combined with lumbar epidural anesthesia (LEA) on immune and cognitive functions of elderly patients undergoing joint replacement. A total of 153 elderly patients undergoing joint replacement in our hospital from January 2014 to February 2015 were prospectively analyzed. They were divided into a LEA group and a ropivacaine + LEA group (a Rop+LEA group) based on therapeutic methods. Efficacy, adverse reactions, recurrence, the incidence of postoperative cognitive dysfunction (POCD), immune function, and cognitive function were compared between the two groups. Compared with those in the LEA group, patients in the Rop+LEA group had the best efficacy and 3-year survival, the lowest incidence of adverse reactions, recurrence rate, and incidence of POCD, the highest IL-10 level, the lowest TNF-alpha and IL-6 levels, and the highest MMSE score, Barthel index, and SF-36 score. In addition, there was no significant difference in CD8+ level between the two groups, but CD4+ level and CD4+/CD8+ratio in the Rop+LEA group were lower than those in the LEA group. Ropivacaine combined with LEA can promote the recovery of cognitive and immune functions and reduce inflammatory responses in elderly patients undergoing joint replacement, so the combination is expected to be widely popularized in clinical practice.

Background: Osteosarcoma (OS) is a complex cancer and depends on multiple biological processes and pathways. Therefore, there is an urgent need to identify reliable prognostic biomarkers for predicting clinical outcomes and helping personalize treatment of OS. Results: An expression Quantitative Trait Methylations (eQTMs)-based risk score model was developed to infer the prognostic efficacy for OS based on gene expression and methylation level. Some OS-specific eQTMs were identified and divided to positive and negative eQTMs. We found that some OS-specific eQTMs were significantly associated with survival in OS according to the eQTM-based risk score. The global characteristics for these prognosis-associated eQTMS were depicted and analyzed. These prognosis-associated eQTMS are stable in multiple experiments and showed better performance in predicting survival than single gene expression, age and gender of OS. Functional analysis indicated that the genes in prognosis-associated eQTMS were associated with essential biology processes of cancer development. In addition, these genes were also drug targets for many kinds of drugs and may provide assistance for studying drug repurposing of OS. Conclusion: These results highlight the potential of eQTMs as novel diagnostic, prognostic and therapeutic targets for OS.

[目的]探讨膝关节镜下内引流技术治疗成人腘窝囊肿的临床疗效.[方法]选择2017年3月～2019年3月在滨州医学院烟台附院接受膝关节镜下内引流术治疗的腘窝囊肿患者24例,术后采用Rauschning和Lindgren分级标准对手术疗效进行分析.[结果]术中镜下探查证实腘窝囊肿合并膝关节骨性关节炎22例,风湿性关节炎1例,痛风性关节炎1例,手术顺利,无血管、神经损伤等并发症.患者平均随访(16.63±4.36)个月,1例患者于术后2周复发,其余患者症状明显缓解,术后无感染等并发症.末次随访时Rauschning和Lindgren分级2级1例,1级2例,0级21例.[结论]作为一种治疗腘窝囊肿的微刨手术技术,膝关节镜下内引流技术安全有效.

目的 探讨加长柄人工关节置换术治疗复杂性转子间骨折的临床疗效.方法 选取本院2016年5月～2017年9月行加长柄人工关节置换术治疗的复杂性转子间骨折病例38例进行回顾性分析,观察、记录术后首次下床时间、完全负重时间、术后并发症及住院时间,术前及术后Harris评分评价髋关节功能.结果 所有患者手术顺利,首次下床时间平均为1.5d(1d-2d),平均完全负重时间为3d(2d-5d),平均住院时间10d(7d-14d),髋关节功能Harris术后1年平均(91.43±3.7).结论 加长柄人工关节置换术是治疗复杂性转子间骨折的有效方法,手术效果显著,术后髋关节功能恢复良好.

Objective To investigate the incidence of osteodystrophy induced by diving decompression in Yantai.Methods One hundred and seventy-one dive fishing personnel,who were hospitalized in our hospital,were selected as our research subjects.Paranasal sinuses,both shoulders,hips and knees had routine X-ray detection for study.Results Of all the patients,166 had a history of different degrees of joint pain and muscle pain.X-rays detection revealed that most divers were suffering from decompressed osteodystrophy.Conclusions With the extension of diving service,the incidence of decompressed osteodystrophy was increased gradually year by year.