[目的]介绍斜外侧椎间融合术治疗腰椎结核的手术技术和初步结果.[方法] 2018年10月—2020年6月,本院骨科收住腰椎结核患者13例,采用斜外侧椎间融合术治疗.取侧卧位,经腹外斜肌、腹内斜肌、腹横肌进入腹膜外间隙,抵达腰椎侧方,清除病灶,取髂骨植骨,最后行椎体钉内固定.[结果]手术时间平均(132.51±21.40) min,术中出血量(227.32±43.14)ml.术后7d,血沉(elythocyte sedimentation late,ESR)、C反应蛋白(C-reactive protein,CRP)、VAS评分(visual analogue scale,VAS)均较术前显著改善,差异均有统计学意义(P＜0.05).术后患者神经功能改善,无明显并发症.[结论]斜外侧椎间融合术治疗腰椎结核是一种新的微创手术方式,具有创伤小、手术时间短、出血量少、病灶清除彻底、安全有效的优点.

Objective To explore the clinical application value of intelligent wearable rehabilitation system in rehabilitation after total knee arthroplasty (TKA). Methods Prospective study. The 120 patients from Beijing Boai Hospital treated by TKA from October 2017 to April 2018 were enrolled, including 15 males and 69 females, aged from 55 to 78 years old, body mass index( BMI) from 19. 7 to 32. 6 kg/m2. Preoperative range of motion( ROM) from 84° to 117°, K-L grading Ⅲ 42 patients, Ⅳ 78 patients. The random number method was applied to divide 60 patients into control group and 60 patients into treatment group. During hospitalization and post-discharge, the control group was trained according to the doctor’s advice and on-time review, while the treatment group used the NEO-SMART system for postoperative training. The pain visual analogue scale (VAS), knee range of motion ( ROM) and knee HSS score of two groups were observed at different time points after surgery. Results There was no significant difference in gender, age, BMI and K-L grading between the two groups(all P values>0. 05). Among the 120 patients, 4 patients were lost in follow-up, others were followed up for 6 months. No significant differences in VAS were noted between two groups at 48 h after operation (P>0. 05). At 2 weeks and 1 month after surgery, VAS in the rehabilitation group was lower than that in the control group (2. 2 ± 0. 61) and (1. 2 ± 0. 37) scores in the rehabilitation group and ( 2. 5 ± 0. 82 ) and (1. 7 ± 0. 53 ) scores in the control group, respectively, with statistically significant differences (all P values<0. 05). The ROM scores of two groups were not significantly different at 48 h and 1 week after operation (P>0. 05), At 2 weeks, 1 month, and 3 months postoperatively, the knee joint ROM was higher in the treatment group(93. 1°± 3. 07°,103. 5°± 3. 47°,107. 3°± 4. 33°) than the control group (88. 7°± 3. 60°, 96. 8°± 3. 76°, 99. 8° ± 4. 05°), there were statistical differences(all P values<0. 01). The HSS scores of the treatment group were significantly higher than the control group at 1 month, 3 months and 6 months after surgery (all P values <0. 01). Conclusions Wearable rehabilitation system can significantly improve the effect of rehabilitation training for TKA patients after operation, which is worthy of clinical application.

目的 探讨伤后手术时机对前交叉韧带损伤术后膝关节活动度及稳定性的影响.方法 分析2012年1月-2015年6月在浙江省金华广福医院接受治疗的76例单侧前交叉韧带损伤患者的临床资料,观察组(35例)患者在入院后3周内进行手术,对照组(41例)患者在入院后超过3周进行手术.比较2组患者手术前后关节活动度、Tegner、Lysholm、IKDC评分的差异,术后采用Kt2000测量仪测量手术前后胫骨前后移动距离,并对2组患者术后并发症进行定期随访,比较术后并发症发生情况.结果 2组患者手术前后关节活动度、Tegner、Lysholm及IKDC评分比较,差异均无统计学意义(P＞0.05).观察组患者术后关节活动度、Tegner、Lysholm及IKDC评分明显高于对照组,差异均具有统计学意义(P＜0.05);2组患者手术前后Kt2000屈膝30°、90°133.32 N下胫骨前后移动距离明显小于术前,差异均具有统计学意义(P＜0.05).观察组患者术后屈膝30°、90°133.32 N下胫骨前后移动距离与对照组相比,差异均无统计学意义(P＞0.05).对照组患者术后并发症发生率明显高于观察组,差异具有统计学意义[2.86％ (1/35) vs.12.20％ (5/41);log-rank x2=3.891,P=0.048].结论 伤后3周内进行前交叉韧带重建术可以有效保护患者膝关节的活动度及稳定性,有效避免术后膝关节半月板损伤及膝关节粘连的发生.

[目的]研究人工全膝关节置换术后,患者应用智能可穿戴辅助康复系统进行辅助康复的治疗效果.[方法]按照标准筛选TKA手术患者120例,所有患者住院期间以相同的康复方案进行早期康复.患者出院后随机分为试验组和对照组各60例.试验组患者应用智能可穿戴辅助康复系统辅助,根据医生远程推送的康复方案和康复动作3D视频演示进行康复,同时由医生进行远程监测和沟通指导;对照组出院后继续按照住院期间的康复方案自行进行居家康复.记录比较两组患者手术前、出院时、术后1、3个月的关节活动度(ROM)、WOMAC评分和HSS膝关节功能评分.[结果]两组患者术后的主被动ROM、WOMAC及HSS评分均较术前有显著增加,差异有统计学意义(P＜0.05).术前和出院时主、被动ROM两组间的差异均无统计意义(P＞0.05);术后1、3个月时试验组的主、被动ROM的改善情况优于对照组,差异具有统计学意义(P＜0.05).两组患者术前和出院时的WOMAC和HSS评分比较差异无统计学意义(P＞0.05),术后1、3个月时试验组WOMAC和HSS评分优于对照组,差异有统计学意义(P＜0.05).[结论]与传统家庭康复模式相比,应用智能可穿戴辅助康复系统进行远程康复指导可在TKA术后短期内提高康复效果,并能够将康复宣教、智能预警和数据分析集为一体,值得进一步研究和推广.

目的 探究膝关节镜下膝关节前交叉韧带(ACL)重建术中胫骨端加强固定方式的临床疗效及意义.方法 选择73例本院行膝关节镜下ACL重建术的患者,对照组(37例)胫骨端应用单纯固定方式,而观察组(36例)胫骨端应用加强固定方式.比较手术前后膝关节功能恢复情况及并发症发生率.结果 术后1年两组患者的膝关节活动度及Tegner评分均较术前增加,KT-2000平移距离及国际膝关节文献委员会膝关节评估表(IKDC)评分均较术前下降(P<0.05);术后观察组膝关节活动度及IKDC评分大于对照组(P<0.05),优良率高于对照组(χ2=4.356,P=0.037),观察组并发症发生率小于对照组(Log-rankχ2=4.142,P=0.041).结论 胫骨端应用加强固定方式有助于改善膝关节功能恢复,同时提高了膝关节活动度,降低了并发症的发生率,值得临床治疗参考.

[目的]建立膝关节胫骨基座力学测试的有限元模型,并预测平台假体胫骨基座的疲劳特性和不同屈曲角度下聚乙烯衬垫的磨损.[方法]选用一款后稳定型(posterior stabilized,PS)固定平台膝关节假体,将模型设为连续、均匀和各项同性的材料,根据IS0 14879-1的要求,建立胫骨基座力学测试的有限元模型,试验测试基座在500万次载荷循环下的存活率.建立股骨假体和聚乙烯衬垫的三维有限元模型,测试不同屈曲角度下聚乙烯衬垫的磨损.[结果]胫骨基座的Von Mises应力峰值出现在基座固定柱和防旋翼的相接处,约为254.6 MPa.聚乙烯衬垫的接触面积在屈曲0°～60°时逐渐增加,屈曲60°～135°的过程中接触面积则开始迅速减少;而聚乙烯衬垫的平均接触应力则随着屈曲角度的增加而增加.[结论]有限元方法提供了一个可用于评估膝关节假体力学性能的虚拟平台,具有经济、可信度高的特点.本文建立的有限元模型能够快速、有效的预测膝关节假体的力学性能,为膝关节假体的设计改进奠定了基础.