严重骨质疏松患者全膝关节置换术疗效分析

目的：探讨严重骨质疏松患者在进行人工全膝关节置换术时的特点和围手术期处理方法。方法：2005年至2007年期间,我科进行伴有严重骨质疏松症的人工全膝关节置换术患者共计36例41膝,其中单膝关节置换31例,双膝置换5例。所有病例入院前均采用双光能X线骨密度仪（DEXA）检测骨密度。所有病例均采用后稳定型膝关节假体。患者在术前给予钙尔奇D片及鲑鱼降钙素等抗骨质疏松治疗1月,术后继续给予抗骨质疏松治疗2~3月。结果：术后切口均一期愈合,无并发症。所有病例随访时间36~60个月,平均49个月。膝关节功能评分（HSS评分法）术前平均为37.2±6.4分,术后平均评分94.6±8.8分,随访期间未见假体早期松动影像学改变,骨密度复查较术前有明显改善。结论：对于伴有严重骨质疏松的病例,骨质已受到不同程度的破坏,进行假体选择的个体化,手术操作的精细化以及术后康复治疗具体化等对临床疗效至关重要。     

骨保留型短柄假体行全髋关节置换手术早期疗效观察

目的:探讨骨保留型股骨短柄假体行全髋关节置换手术的近期疗效及临床体会。方法:自2013年1月~2015年3月,首次接受人工全髋关节置换术共30例患者(38髋),年龄38~70岁,均采用后外侧入路。通过比较术前、术后髋关节Harris评分、骨性关节炎指数可视化量表(WOMAC),评价手术疗效。结果:术后所有患者均获得随访,最少6月,最长33月,平均19.5月。术后髋关节疼痛均明显好转,随访期内无严重并发症发生。髋关节Harris评分:术前45.3±4.3,术后末次随访94.1±5.4。术后末次随访Harris评分较术前改善明显,差异有统计学意义(P0.05),术后3~4个月所有患者可以全负重行走。1例术中股骨近端骨折,术后愈合良好,未留后遗症。所有病例未发现假体松动或感染。结论:骨保留型股骨短柄假体行全髋关节置换手术近期临床效果满意,无严重并发症。新型短柄假体设计符合人体解剖特征,骨量保留多,术后疗效好,为髋关节置换提供了一种新的选择。     

全膝关节置换术治疗晚期类风湿性关节炎的早期临床随访研究

目的:探讨全膝关节置换术(TKA)治疗晚期类风湿性膝关节炎(RA)的早期临床疗效和安全性。方法:回顾性分析2006年~2011年接受TKA治疗的69例(102膝)晚期膝关节RA患者的临床资料,术后及随访时分析患者的影像学资料,末次随访时进行膝关节HSS评分,采用英国矫形外科协会标准评定患者满意度,SF-36健康量表评定患者的生活质量。结果:54例(81膝)患者术后获得2~7年(平均4.3年)随访;6例(7膝)死亡,6例(10膝)失访,3例(4膝)翻修,获得随访患者中1例(1膝)发生下肢深静脉血栓,经介入放置滤网治疗康复后出院,1例(1膝)感染。末次随访时,膝关节活动度(ROM)从术前平均(71.03°±29.51°)提高至(92.26°±10.29°),膝关节HSS评分从术前平均(47.30±10.06)分提高至(75.93±9.17)分;疼痛发生率和疼痛评分均较术前显著降低;冠状面和矢状面畸形率均较术前显著降低;身体健康(PCS)平均(47.98±6.96)分,心理健康(MCS)平均(41.45±5.67)分,均较术前显著增加,差异均有统计学意义(P0.05)。患者的治疗满意率为96.30%,膝关节假体X线片采用膝关节学会的X线评价与计分系统评价未见假体松动。结论:TKA治疗晚期膝关节RA患者2~7年的临床及影像学效果良好,未发现骨溶解、假体松动及严重衬垫磨损等并发症。     

人工关节置换与加压螺钉内固定治疗高龄骨质疏松性股骨颈骨折的疗效观察

目的:探讨人工关节置换与加压螺钉内固定治疗高龄骨质疏松性股骨颈骨折的疗效。方法:选取2010年8月至2013年3月我院收治的120例高龄骨质疏松性股骨颈骨折患者,将所有患者随机分为人工置换组和内固定组两组,每组各60例,内固定组采用加压螺钉内固定术治疗,人工置换组采取人工关节置换术治疗,评定两组患者的手术时间、术中出血量、下地时间、术后并发症发生率及末次随访时Harris评分优良率。结果:人工置换组手术时间及术中出血量分别为(124.8±16.7)min、(369.2±99.7)ml,明显高于内固定组的(73.5±15.1)min、(78.4±25.6)ml;但人工置换组术后下地时间为(15.3±4.8)d,明显低于内固定组的(40.2±7.5)d;人工置换组与内固定组患者术后并发症的发生率分别为20%、66.7%,人工置换组明显低于内固定组,其中,泌尿系褥疮的组间差异最为显著;末次随访时Harris评分优良率,相比于内固定组的61.67%,人工置换组为78.33%,明显偏高。差异有统计学意义(P0.05)。结论:加压螺钉内固定术和人工关节置换术在治疗高龄骨质疏松性股骨颈骨折方面各有优劣,对于能够耐受人工关节置手术且经济条件好的的老年患者而言,采用人工关节置换术治疗,疗效更佳。     

膝关节人工单髁置换的近期疗效分析

目的:探讨膝关节人工单髁置换治疗晚期膝关节单间室骨性关节炎的近期疗效。方法:选择2007年3月至2011年9月我院采用膝关节人工单髁置换且随访超过2年的单间室病变的骨性关节炎的患者37例,采用膝关节人工单髁置换治疗,随访时行膝关节X线摄片检查,观察有无松动、下沉及另外一侧间室有无退变或是否加重,末次随访时评估HSS评分,比较与术前的疼痛及功能的差异。结果:37例患者均获得随访,随访时间22~38个月,平均29.8个月,所有患者均无松动、下沉及另外一侧间室退变或退变加重,末次随访时HSS评分(95.5±1.7)分,显著高于术前(68.5±2.1)分,差异有统计学意义(P=0.016)。结论:膝关节人工单髁置换手术治疗晚期膝关节单间室骨性关节炎创伤小,患者并发症少,术后功能恢复良好,近期疗效好。     

人工全膝关节置换术后假体周围感染的季节性分析

目的:探讨患者在不同季节进行人工全膝关节置换术,术后发生假体周围感染(PJI)的构成比差异,为积极预防人工全膝关节置换术后假体周围感染的发生提供理论依据。方法:对第四军医大学西京医院2005年12月到2014年12月间行人工全膝关节置换术并发生假体周围感染(PJI)的17例患者进行回顾性分析,分析患者术后假体周围感染发病率和季节的相关性。结果:人工全膝关节置换术患者假体周围感染发生率夏季(0.98%),明显高于冬季(0.30%),春季(0.25%),秋季(0.19%),夏季与秋季组之间、夏季与春季组之间差异存在统计学意义(P0.05)。患者翻修术后末次随访结果示夏季组PJI患者HSS评分低于其他三组,差异具有统计学差异(P0.05),夏季组感染患者的WOMAC评分高于其他三组,差异具有统计学差异(P0.05)。HSS评分及WOMAC评分结果表明,夏季组PJI患者预后及满意度均低于其他三组(P0.05)。结论:人工全膝关节置换术后假体周围感染发生率呈现周期性规律,且夏季感染发生率明显高于其他季节,这种差异可能与自身免疫及周围环境的的周期性变化有关。     

人工全膝关节置换术50例临床效果观察

目的:探讨人工全膝关节置换术临床效果。方法:选择我院2008年1月至2011年1月收治的行人工全膝关节置换术的患者50例53膝,对其临床资料进行回顾性分析。并作术前、术后HSS评分比较。结果:HSS术后评分,优47膝,占88.7%,良4膝,占7.5%,一般2膝,占3.7%。类风湿性关节炎4例HSS术前评分为35.24±1 1.78,术后评分为89.61±10.37;骨性关节炎44例HSS术前评分为44.37±10.29,术后评分为91.47±15.65;创伤性关节炎5例HSS术前评分为39.23±11.56,术后评分为90.61±13.2。术前、术后比较差异均有统计学意义(P<0.05)。术后整体优良率为96.2%。无严重并发症发生。结论:人工全膝关节置换术实施过程中,制订严密的手术计划,拥有高操作技术和理论基础,做好生命体征的密切观察及术后整体的康复功能训练,可取得较好疗效。     

关节置换前后髌骨高度对膝关节功能的影响

目的:研究全膝关节置换术前、术后Insall-Salvati指数和改良Insall-Salvati指数与术后膝关节活动度的关系。方法:采用HSS评分系统对患者全膝关节置换术后半年至一年的关节功能、活动度、肌力、屈曲畸形、稳定性等进行评价。测量81例(106膝)患者术前、术后X线片Insall-salvati指数及改良Insall-salvati指数。结果:术后HSS评分为(89±10)分,术前Insall-salvati指数及改良Insall-salvati指数分别为(1.00±0.13)、(1.61±0.21),术后Insall-salvati指数及改良Insall-salvati指数分别为(0.94±0.19)、(1.67±0.34)。关节置换术后Insall-salvati指数较置换前显著降低(P0.05),改良Insall-salvati指数显著提高(P0.05)。术后低位髌骨组(Insall-salvati指数0.8)HSS评分、活动度和屈曲畸形分值均较正常髌骨组(0.8Insall-salvati指数1.5)显著降低(P0.05)(P0.05)。高位髌骨组(Insall-salvati指数1.5)和正常髌骨组各项评分均无显著差异(P0.05)。术前改良Insall-salvati指数小于1.8的患者术后膝关节HSS评分、功能、活动度、肌力、屈曲畸形、稳定性显著高于大于1.8的患者(P0.05)。结论:术前改良Insall-salvati指数和术后Insall-salvati指数可作为评价术后膝关节功能的参考指标。术前、术后的膝关节高度均会影响术后关节功能,全膝关节置换术中精确截骨对术后关节功能十分重要。     

新型非骨水泥柄设计特征及临床应用效果

目的:探讨一种新型的适合于儿童的非骨水泥固定型股骨柄设计特征,并通过随访获得其临床效果。方法:选取2010年9月~2013年4月在我科植入新型非骨水泥股骨柄的6名儿童患者,其中男1例,女5例;年龄8.5±3.2岁(5~11岁)。病理诊断结果骨肉瘤患者5例,恶性神经鞘瘤患者1例;右股骨下端患者5例,左股骨下端患者1例;其中一例患者术前有病理骨折。6例患者在我科行双动半膝关节置换术,其中股骨下端均采用了新型非骨水泥假体柄。采用Enneking骨肌肉肿瘤置换后下肢功能评定标准对患肢行功能评价,影像学重点评估股骨柄在髓腔放置位置是否得当、股骨柄假体有无松动、有无应力遮挡、骨溶解等现象,并测量术后患者患肢短缩畸形数据。结果:6例患者随访时间32个月(14~54个月),除1例5岁女童术前肢体条件较差在术后14个月行膝关节融合手术,其余无翻修病例,置换关节均无感染、折断等现象。MSTS评分21.33分;射线片示所有患者股骨髓腔内假体柄放置位置满意,股骨侧及胫腓骨侧假体周围未见骨溶解。结论:新型非骨水泥固定型股骨柄设计合理,早期稳定性可,后期可取得满意的生物固定效果。     

全膝关节置换术对膝关节骨关节炎患者关节功能的影响

目的:探讨全膝关节置换术(TKA)对膝关节骨关节炎患者术后关节功能的影响。方法:回顾性分析2013年8月-2015年8月我院收治的76例膝关节骨关节炎患者的临床资料,所有患者均采用全膝关节置换术治疗。观察并比较患者手术前后膝关节HSS评分、膝关节疼痛目测类比评分(VAS)、膝关节屈曲活动度(ROM)的变化情况。结果:患者术后膝关节HSS评分、膝关节疼痛评分VAS及ROM均明显高于术前,差异具有统计学意义(P0.05);术前HSS评分、膝关节疼痛VAS评分、膝关节ROM、胫骨平台后倾角(PSA)以及股骨前髁偏距(ACO)与术后膝关节HSS评分呈正相关关系,而内翻畸形角度与术后膝关节HSS评分呈负相关关系,差异具有统计学意义(P0.05)。结论:全髋关节置换术能够改善骨关节炎患者的膝关节功能,并且术前膝关节HSS评分、膝关节疼痛VAS评分及PSA与术后患者髋关节功能恢复程度有关。     

Compromission de la masse osseuse et de la motricité chez des malades traités par blocage androgénique

Therapeutic androgen suppression induces hypogonadism with effects on the patient’s locomotor system. We tried to verify these effects on a group of patients with prostate cancer presenting a prolonged life expectancy. Thirty six patients treated by radical prostatectomy (mean PSA: 7.2±1.3 ng/ml) had stage pT3 cancer in 24 cases and pT2c in 12 cases. The first group was treated by radiotherapy and androgen suppression and the second group was treated by androgen suppression alone after surgery. After 24–36 months (mean=28.4 months), staging was performed by CT scan, bone scintigraphy, PSA and testosterone assays, and bone densitometry. An identical assessment was repeated an average of 53.1 months after starting treatment. Staging never demonstrated disease recurrence; PSA was between 0.01 and 0.4 ng/ml (mean: 0.11 ± 0.96 ng/ml) and the mean plasma testosterone was 0.4 ng/ml. The first bone densitometry revealed osteopenia: T score =?1.71±0.91; Ward score=?2.22±0.917; BMD (bone density) =0.879±0.126. The second bone densitometry showed progression to osteoporosis and a significant 6% reduction of the BMD: T Score=?1.95±0.84; Ward score=?2.4±0.87; BMD=0.819±0.12. During this time interval, 3 patients developed a fracture of the femur and a fourth patient fractured two ribs after physical exertion. All patients compalined of decreased physical strength and very marked fatigability. We can conclude that androgen suppression causes an alteration of locomotor function and quality of life of patients treated for prostate cancer and presenting a long life expectancy.     

Correlation Between Bone Markers and Bone Mineral Density in Postmenopausal Women with Osteoporosis

ObjectiveTo study the relationship between bone markers and bone mineral density (BMD) in an effort to identify their utility in postmenopausal women with osteoporosis.MethodsEighty-two consecutive postmenopausal women with untreated osteoporosis were included in the study. Forearm, spinal, and femoral BMD by dual-energy x-ray absorptiometry and markers of bone formation (serum osteocalcin and bone-specific alkaline phosphatase) and bone resorption (urinary free deoxypyridinoline) were measured in all patients. Patients with low serum vitamin D levels, secondary osteoporosis, or clinically significant systemic disease were excluded from the study. The patients were classified on the basis of BMD of the lumbar spine into the following 3 groups: mild (n = 23) (T score -2.5 through -3), moderate (n = 42) (T score -3.1 through -4), or severe (n = 17) (T score ≤-4.1) osteoporosis. One-way analysis of variance and Pearson correlation were used for statistical analysis, with a P value < .05 being considered significant.ResultsSerum osteocalcin was significantly different among the 3 study groups (4.1 ± 2.7, 4.5 ± 3.1, and 6.7 ± 5.6 ng/mL, respectively; P = .0349) and had a significant negative correlation with BMD (r² = -0.0779; P = .0168). Other bone markers such as bone-specific alkaline phosphatase and urinary free deoxypyridinoline did not correlate with the underlying BMD.ConclusionIn our study, osteocalcin was significantly correlated with BMD in postmenopausal women with osteoporosis. Other bone markers did not correlate with BMD. Further large-scale population data and analyses are needed to confirm these findings. (Endocr Pract. 2008;14:1102-1107)     

膝关节镜下有限清理与广泛清理术治疗膝关节骨关节炎的临床疗效

目的:研究膝关节镜下有限清理与广泛清理术治疗膝关节骨关节炎的临床疗效。方法:选择2012年2月至2013年2月我院收治的80例膝关节骨关节炎患者,按随机数字表法平均分为研究组及对照组各40例,研究组行膝关节镜下有限清理术,对照组行广泛清理术;比较两组患者治疗优良率、手术前及术后1年膝关节功能评分及手术时间、住院时间等。结果:研究组患者治疗优良率为80.00%(32/40)高于对照组的75.00%(30/40),但差异无统计学意义(P0.05);研究组手术时间及住院时间分别为(30.4±14.8)h及(8.9±4.3)d,明显低于对照组的(60.6±16.9)h及(15.6±6.8)d,比较差异具有统计学意义(P0.05);两组术后1年膝关节功能评分较治疗前均明显改善,研究组术后Lysholm评分为(73.2±12.3)分,与对照组的(73.7±11.9)分比较差异无统计学意义(P0.05);两组患者均未出现术后感染等并发症,对照组2例出现术后下肢静脉血栓,研究组无严重并发症发生,两组比较差异无统计学意义(P0.05)。结论:膝关节镜下有限清理术治疗膝关节骨关节炎与广泛清理术疗效相当,但可明显缩短手术时间及住院时间,患者恢复快,值得推广应用。     

Measurement of bone mineral density (BMD) with quantitative computed tomography (QCT) in postmenopausal osteoporosis: effect of estrogen.

To determine the efficacy of the estrogen replacement therapy (ERT) on the bone mineral density (BMD) measured with quantitative computed tomography (QCT) in postmenopausal osteoporosis 16 women aged 46-72 were examined. They were divided into two groups: 8 women treated with conjugated estrogens (Group I) and 8 who did not received ERT (Group II). In all 16 patients the serum hormonal concentrations (LH, FSH and estradiol) were measured with radioimmunological methods. The bone densitometry was performed in all of them using the single-energy computed tomography (QCT) with the computer Picker 1200. Bone mineral density was measured in three lumbar vertebra (L1-L3) and expressed in milligrams K2HPO4 per ml. The bone mineral density (BMD) was statistically significantly higher in the estrogen treated group (Group I) in every vertebra compared with that of controls (Group II). The serum FSH concentration was statistically significantly lower in the ERT group (Group I) and a statistically significant correlation between FSH level and average BMD (Lmean) was present. In conclusion: 1. the ERT is very efficacious in preventing bone loss in postmenopausal women; 2. measurement of BMD in lumbar vertebra L1 or L3 may be a sufficiently reliable and accurate, cost-effective and time-saving method of screening for osteoporosis; 3. the serum FSH determination seems to be useful in monitoring of the estrogen therapy for postmenopausal osteoporosis.     

UKA与TKA治疗膝关节内侧单间室骨性关节炎的临床对比

目的:探究膝关节单髁置换术(UKA)与全膝关节置换术(TKA)治疗膝关节内侧单间室骨性关节炎的临床治疗效果。方法:将2011年4月-2015年7月期间因膝关节单间室骨性关节炎入院接受治疗的89例患者纳入本研究,随机分为研究组和对照组,研究组44例,行UKA手术,对照组45例,采用TKA手术方式治疗。对两组患者进行术后随访,对比临床治疗效果。结果:两组术前均有明显膝关节疼痛,术后膝关节疼痛均明显改善,组间差别无显著统计学意义(X2=1.323,P=0.2500.05);术后膝关节屈曲角度、HSS评分相对于术前均显著改善,研究组术后膝关节屈曲角度(111.2±18.8)度高于对照组的(98.6±14.7)度,差异有统计学意义(P0.05);HSS评分(87.6±13.7)分高于对照组的(73.2±16.8)分,差异有统计学意义(P0.05);研究组膝关节屈曲至90度时间比对照组短,数据差异有统计学差异(t=-2.303,P=0.0240.05)。结论:膝关节内侧单间室骨性关节炎采用UKA与TKA均能取得一定临床效果,减轻患者痛苦,改善膝关节功能,但UKA临床疗效较好,手术创伤较小,术后恢复较快。     

Efectos del tratamiento con ácido zoledrónico en pacientes adultos con osteogénesis imperfecta

Background and objectiveOsteogenesis imperfecta (OI) is a genetic disorder that results in bone fragility. Several studies have demonstrated the effectiveness of bisphosphonate therapy. The aim of this study was to evaluate the effects of intravenous zoledronic acid on bone mineral density (BMD) and biochemical markers of bone turnover in adults with OI.Material and methodsWe carried out a prospective non-randomized study in patients with osteoporosis or severe osteopenia (T score <?2) related to OI and intolerance or contraindication to oral bisphosphonates. The patients were treated with a zoledronic acid infusion every 6 months. Densitometry was carried out annually. Calcium (Ca), phosphate (P), intact parathormone (PTH), 25 hydroxyvitamin D and biochemical markers of bone turnover [bone alkaline phosphatase (BAP), beta-cross-laps (CTX) and urinary deoxypyridoxine (DOP)] were measured every year. Adverse events and new fractures were registered.ResultsTen patients (2 men and 8 women) were treated. Treatment increased BMD measured in the lumbar spine after 24 (0.738±0.141 vs 0.788±0.144 g/cm²; p=0.048) and 36 months (0.720±0.139 vs 0.820±0.128; p=0.01). Significant increases in BMD were also observed after 24 months in the femoral neck (0.677±0.121 vs 0.703±0.122 g/cm²; p<0.016). Serum Ca, P, BAP and CTX concentrations remained unchanged. PTH concentrations increased and vitamin D concentrations decreased after 36 months of treatment. DOP excretion decreased significantly after 24 months. Seven patients had mild influenza-like symptoms occurring within the first 24 h after the first infusion. No severe adverse events were observed. None of the patients had new fractures.ConclusionZoledronic acid seems to be a safe and effective treatment option in adults with osteoporosis related to OI.