Osteoarthritis(OA)is a complex"whole joint"disease pursued by inflammatory mediators,rather than purely a process of"wear and tear".Besides cartilage degradation,synovitis,subchondral bone remodeli...Osteoarthritis(OA)is a complex"whole joint"disease pursued by inflammatory mediators,rather than purely a process of"wear and tear".Besides cartilage degradation,synovitis,subchondral bone remodeling,degeneration of ligaments and menisci,and hypertrophy of the joint capsule take parts in the pathogenesis.Pain is the hallmark symptom of OA,but the extent to which structural pathology in OA contributes to the pain experience is still not well known.For the knee OA,intraarticular(IA)injection(corticosteroids,viscosupplements,blood-derived products)is preferred as the last nonoperative modality,if the other conservative treatment modalities are ineffective.IA corticosteroid injections provide short term reduction in OA pain and can be considered as an adjunct to core treatment for the relief of moderate to severe pain in people with OA.IA hyaluronic acid(HA)injections might have efficacy and might provide pain reduction in mild OA of knee up to 24 wk.But for HA injections,the costeffectiveness is an important concern that patients must be informed about the efficacy of these preparations.Although more high-quality evidence is needed,recent studies indicate that IA platelet rich plasma injections are promising for relieving pain,improving knee function and quality of life,especially in younger patients,and in mild OA cases.The current literature and our experience indicate that IA injections are safe and have positive effects for patient satisfaction.But,there is no data that any of the IA injections will cause osteophytes to regress or cartilage and meniscus to regenerate in patients with substantial and irreversible bone and cartilage damage.展开更多
[目的]探讨全髋关节置换术(total hip arthroplasty,THA)关节腔灌注止血麻药激素药物混合液的作用。[方法]回顾性分析2022年10月—2024年3月初次单侧THA的92例患者的临床资料。依据术前医患沟通结果,46例患者为药物组,THA完成后给予关节...[目的]探讨全髋关节置换术(total hip arthroplasty,THA)关节腔灌注止血麻药激素药物混合液的作用。[方法]回顾性分析2022年10月—2024年3月初次单侧THA的92例患者的临床资料。依据术前医患沟通结果,46例患者为药物组,THA完成后给予关节内120 m L混合药物灌注;另外46例患者为对照组,关节内未使用药物。比较两组患者围手术期临床与检验资料。[结果]患者均顺利完成手术,无神经及血管损伤的并发症。两组在手术时间、切口长度、术中出血量和切口愈合等级的差异均无统计学意义(P>0.05)。但是,药物组的术后引流量[(216.3±32.4) mL vs (387.4±45.9) mL,P<0.001]和总显性失血量[(451.6±54.1) mL vs (625.5±63.3) mL,P<0.001]均显著低于对照组。此外,药物组术后DVT的发生率显著低于对照组(2.2%vs15.2%,P=0.026)。随术后时间推移,两组患者VAS评分均显著下降(P<0.05),而6 min步行距离均显著增加(P<0.05)。术后1 d和2 d,药物组的VAS评分显著低于对照组[(4.0±1.3) vs (6.7±1.4),P<0.001;(4.1±1.2) vs (7.3±1.3),P<0.001]。术后3 d和7 d,药物组6 min步行距离均显著大于对照组[(53.4±7.2) m vs (36.7±2.5) m,P<0.001;(154.0±14.1) m vs (124.8±14.0) m,P<0.001]。检验方面,术前两组Hct和D-D的差异均无统计学意义(P>0.05)。与术前比较,术后3 d两组的Hct均显著降低(P<0.05),而两组的D-D均显著升高(P<0.05)。术后3 d,药物组的Hct显著高于对照组[(38.1±1.3)%vs (36.2±0.5)%,P<0.001],而药物组的D-D显著低于对照组[(325.8±42.9)μg/L vs (377.8±53.3)μg/L,P<0.001]。[结论]关节腔灌注氨甲环酸联合罗哌卡因、地塞米松混合液能减轻THA术后疼痛,降低术后失血量,减少DVT的发生,有利于患肢功能恢复。展开更多
Fracture of the lateral process of the talus(FLPT)is uncommon in clinical practice and can be easily missed or misdiagnosed.In recent years,as researchers from all over the world have further deepened their research o...Fracture of the lateral process of the talus(FLPT)is uncommon in clinical practice and can be easily missed or misdiagnosed.In recent years,as researchers from all over the world have further deepened their research on FLPT,there has been a breakthrough in the classification,and the methods and principles of clinical management have changed accordingly;however,there is still no standardized guideline for the diagnosis and management of FLPT,and there have been few relevant literature review articles related to this kind of fracture in the past at least 5 years.In this article,we review the clinical classification,classification-based therapeutic recommendations,and prognosis of FLPT,with the aim of providing a reference for the clinical diagnosis and management of this infrequent fracture.展开更多
Fractures of the lateral process of the talus(FLPT)are uncommon fractures that represent a clinical challenge.Traditional radiological classification systems rely predominantly on radiographic findings.However,due to ...Fractures of the lateral process of the talus(FLPT)are uncommon fractures that represent a clinical challenge.Traditional radiological classification systems rely predominantly on radiographic findings.However,due to the high rate of FLPT misdiagnosis and the limited accuracy in evaluating concomitant talar injuries through plain radiographs,novel imaging classification systems have been developed that aim to enhance the diagnosis of concomitant talar injuries,thereby optimizing patient management and reducing the incidence of long-term complications.展开更多
文摘Osteoarthritis(OA)is a complex"whole joint"disease pursued by inflammatory mediators,rather than purely a process of"wear and tear".Besides cartilage degradation,synovitis,subchondral bone remodeling,degeneration of ligaments and menisci,and hypertrophy of the joint capsule take parts in the pathogenesis.Pain is the hallmark symptom of OA,but the extent to which structural pathology in OA contributes to the pain experience is still not well known.For the knee OA,intraarticular(IA)injection(corticosteroids,viscosupplements,blood-derived products)is preferred as the last nonoperative modality,if the other conservative treatment modalities are ineffective.IA corticosteroid injections provide short term reduction in OA pain and can be considered as an adjunct to core treatment for the relief of moderate to severe pain in people with OA.IA hyaluronic acid(HA)injections might have efficacy and might provide pain reduction in mild OA of knee up to 24 wk.But for HA injections,the costeffectiveness is an important concern that patients must be informed about the efficacy of these preparations.Although more high-quality evidence is needed,recent studies indicate that IA platelet rich plasma injections are promising for relieving pain,improving knee function and quality of life,especially in younger patients,and in mild OA cases.The current literature and our experience indicate that IA injections are safe and have positive effects for patient satisfaction.But,there is no data that any of the IA injections will cause osteophytes to regress or cartilage and meniscus to regenerate in patients with substantial and irreversible bone and cartilage damage.
文摘[目的]探讨全髋关节置换术(total hip arthroplasty,THA)关节腔灌注止血麻药激素药物混合液的作用。[方法]回顾性分析2022年10月—2024年3月初次单侧THA的92例患者的临床资料。依据术前医患沟通结果,46例患者为药物组,THA完成后给予关节内120 m L混合药物灌注;另外46例患者为对照组,关节内未使用药物。比较两组患者围手术期临床与检验资料。[结果]患者均顺利完成手术,无神经及血管损伤的并发症。两组在手术时间、切口长度、术中出血量和切口愈合等级的差异均无统计学意义(P>0.05)。但是,药物组的术后引流量[(216.3±32.4) mL vs (387.4±45.9) mL,P<0.001]和总显性失血量[(451.6±54.1) mL vs (625.5±63.3) mL,P<0.001]均显著低于对照组。此外,药物组术后DVT的发生率显著低于对照组(2.2%vs15.2%,P=0.026)。随术后时间推移,两组患者VAS评分均显著下降(P<0.05),而6 min步行距离均显著增加(P<0.05)。术后1 d和2 d,药物组的VAS评分显著低于对照组[(4.0±1.3) vs (6.7±1.4),P<0.001;(4.1±1.2) vs (7.3±1.3),P<0.001]。术后3 d和7 d,药物组6 min步行距离均显著大于对照组[(53.4±7.2) m vs (36.7±2.5) m,P<0.001;(154.0±14.1) m vs (124.8±14.0) m,P<0.001]。检验方面,术前两组Hct和D-D的差异均无统计学意义(P>0.05)。与术前比较,术后3 d两组的Hct均显著降低(P<0.05),而两组的D-D均显著升高(P<0.05)。术后3 d,药物组的Hct显著高于对照组[(38.1±1.3)%vs (36.2±0.5)%,P<0.001],而药物组的D-D显著低于对照组[(325.8±42.9)μg/L vs (377.8±53.3)μg/L,P<0.001]。[结论]关节腔灌注氨甲环酸联合罗哌卡因、地塞米松混合液能减轻THA术后疼痛,降低术后失血量,减少DVT的发生,有利于患肢功能恢复。
基金Supported by The China Scholarship Council,No.202308420035.
文摘Fracture of the lateral process of the talus(FLPT)is uncommon in clinical practice and can be easily missed or misdiagnosed.In recent years,as researchers from all over the world have further deepened their research on FLPT,there has been a breakthrough in the classification,and the methods and principles of clinical management have changed accordingly;however,there is still no standardized guideline for the diagnosis and management of FLPT,and there have been few relevant literature review articles related to this kind of fracture in the past at least 5 years.In this article,we review the clinical classification,classification-based therapeutic recommendations,and prognosis of FLPT,with the aim of providing a reference for the clinical diagnosis and management of this infrequent fracture.
文摘Fractures of the lateral process of the talus(FLPT)are uncommon fractures that represent a clinical challenge.Traditional radiological classification systems rely predominantly on radiographic findings.However,due to the high rate of FLPT misdiagnosis and the limited accuracy in evaluating concomitant talar injuries through plain radiographs,novel imaging classification systems have been developed that aim to enhance the diagnosis of concomitant talar injuries,thereby optimizing patient management and reducing the incidence of long-term complications.
