人工髋关节置换术后翻修治疗体会

近年来,随着我国开展人工关节置换术,临床取得了较好的效果,为老年股骨颈骨折、股骨头无菌性坏死、成人先天性髋关节脱位等患者解除痛苦。随着人工髋关节置换术的广泛开展,因手术人员的技术原因,以及假体的长期使用,术后并发症也随之增多,翻修术也成为必然。针对我院30例人工髋关节术后翻修适应证选择及假体选择。谈一些治疗体会。     

全髋关节表面置换进展及若干问题的思考

全髋关节表面置换术与传统的全髋关节置换术相比有众多优点,然而随着研究的深入,全髋关节表面置换的缺点不断暴露,其中牵涉到很多矛盾的思想观点,如骨水泥在假体固定中的应用与否,髋臼臼杯变形与臼杯厚度、植入技术的复杂关系等。分析存在的矛盾且深入探索,从而发现解决矛盾的办法。     

全髋关节表面置换进展及若干问题的思考

全髋关节表面置换术与传统的全髋关节置换术相比有众多优点,然而随着研究的深入,全髋关节表面置换的缺点不断暴露,其中牵涉到很多矛盾的思想观点,如骨水泥在假体固定中的应用与否,髋臼臼杯变形与臼杯厚度、植入技术的复杂关系等.分析存在的矛盾且深入探索,从而发现解决矛盾的办法.     

锁定钢板联合骨水泥或异体骨在老年肱骨近端骨折治疗中的疗效对比分析

肱骨近端锁定钢板固定技术近年来广泛应用于年轻人高能量粉碎性骨折及老年人骨质疏松骨折。本研究对应用肱骨近端锁定钢板联合异体骨或骨水泥治疗老年性肱骨近端不稳定骨折的临床效果进行比较分析。本组25例老年性肱骨近端骨折患者行切开复位肱骨近端锁定钢板内固定联合异体骨植骨或骨水泥填塞治疗。术后均随访12个月以上。所有患者无感染、内固定松动断裂、骨折不愈合及肱骨头坏死等情况,骨折愈合时间平均3.8个月(3个月~7个月)。结果提示:肱骨近端锁定钢板联合异体骨植骨或骨水泥填塞治疗老年性肱骨近端骨折的临床效果均比较满意,使用骨水泥填塞远期功能恢复更好。     

骨膜移植诱导再生关节软骨研究与假说理论

由于关节软骨的再生和修复能力有限 ,较大的软骨缺损难以愈合 ,所以有必要通过其他材料来修复关节软骨缺损 ,虽然目前人工关节已成功地用来治疗严重的关节疾患 ,但人工关节置换术并发症多 ,且不适合于发育中的儿童青少年 ,因而研究自身组织修复关节软骨缺损 ,具有十分重要的意义。近年来 ,骨膜移植诱导再生关节软骨的研究 ,为解决这一难题开辟了一条新的途径。回顾这方面研究的历史过程 ,可以使我们充分理解假说理论在科学研究和临床医学中的重要作用 ,从中得到一些有益的启示。1　“骨膜移植诱导再生关节软骨”假说的提出骨膜属结缔组织 ,…     

人工膝关节置换术的演变及其最优选择

人工关节是指用生物相容性与机械性能良好的金属材料制成的一种类似人体骨关节的假体.近年的关节外科发展迅速,人工膝关节置换术每年都在改进,治疗效果已有明显的进步,各种形式的假体不断推出.随着生物医学模式向生物-心理-社会医学模式的转变,患者日益要求人工关节质量好、费用少、与术后生活质量并举.回顾膝关节假体发展的历史,剖析其各阶段的重大变革,骨科专业医务工作者从以下几个方面进行哲学思考:(1)人类对人工膝关节置换的认识受到主客观条件的限制,经过多次往复才得以完成到目前水平;(2)人工膝关节置换选择中既要理解它的共性原则,更要把握它的个性原则,才能达到人工与自然的协调;(3)最优化是人工膝关节置换发展中的最终目标.     

大转子延长截骨在THR术后感染一期翻修中的临床应用

评价大转子延长截骨并行单纯钢丝捆扎在人工髋关节置换（THR）术后感染一期翻修中的作用及对翻修假体的影响.选取2010年10月~2013年10月期间30例髋关节置换术后假体感染性松动并行一期翻修术的患者,随访时间（34.8＆#177;13.2）月,对患者手术时间、截骨长度和愈合时间、术前术后Harris评分及术后感染控制情况进行统计.30例患者髋关节术后评分明显高于术前,手术时间为（132.4＆#177;23.6）min,经大转子截骨长度为（11.4＆#177;2.6）cm,截骨愈合时间（3.8＆#177;1.3）个月.术后感染未见复发.因此THR术后感染的一期翻修术中应用大转子延长截骨方法能缩短手术时间,髋关节功能较术前明显改善.     

经皮肾镜取石术前测定血清降钙素原和尿细菌学培养的临床价值

探讨在经皮肾镜取石术前测定降钙素原和尿细菌学培养在临床中的应用价值。根据全身炎症反应综合征诊断标准将患者分为全身炎症反应组36例和非全身炎症反应组49例,用统计学方法分析各因素对经皮肾镜取石术术后发生全身炎症反应综合征的影响。单因素分析结果显示第一时间血清PCT水平高、术前尿培养阳性与尿源性全身炎症反应综合征的发生有关(P均0.05)。多因素分析结果显示第一时间血清PCT值阳性、术前尿培养阳性与全身炎症反应综合征的发生相关(P均0.05)。经皮肾镜取石术术后出现全身炎症反应综合征受诸多因素影响,术前测定降钙素原和尿细菌学培养对术前病情评估及预防全身炎症反应综合征方面具有较高的临床应用价值。     

糖皮质激素治疗脓毒血症的策略

脓毒症是由感染所致的破坏性的全身炎症反应综合征,进一步发展可导致多器官功能障碍综合征,甚至休克,成为危重患者最主要的死亡原因之一。糖皮质激素是脓毒症的重要辅助药物,其治疗机制在于其抑制机体的炎症反应,但其使用剂量、疗程、时间一直存在争议。本文通过回顾糖皮质激素在治疗脓毒症的发展历程,深入探讨糖皮质激素治疗脓毒血症的治疗策略。     

从系统论视角看全身炎症反应综合征

全身炎症反应综合征已经成为当前危重病医学所面临重大挑战。本文从系统论的角度出发,通过阐述全身炎症反应综合征的发病机制、病理过程及治疗进展,浅谈系统论在全身炎症反应综合征基础研究和临床治疗中的指导作用。     

腰-硬联合麻醉在高海拔高龄患者髋关节置换术中的应用

探讨腰-硬联合麻醉及全身麻醉用于高海拔高龄低氧患者行人工髋关节置换的临床优势。分析2010年1月～2013年11月来我院进行人工髋关节置换术的高龄（年龄＞69岁）低氧患者86例,其中全麻31例,腰-硬联合麻醉55例,记录麻醉后5min、15min、30min及术毕血压、心率,术中低血压发生率,术后转ICU比例等指标。与全麻相比,腰-硬联合麻醉组血流动力学稳定、术中低血压发生率降低（P＜0．05）、入住ICU几率显著降低（P＜0．05）。在高海拔高龄低氧患者行人工髋关节置换术中采用腰-硬联合麻醉可以使患者麻醉效果突出,血流动力学平稳,安全有效,比全麻更有临床应用优势。     

Serotonin syndrome in elderly patients treated for psychotic depression with atypical antipsychotics and antidepressants: two case reports

We report two cases of serotonin syndrome in elderly patients during treatment of psychotic depression with atypical antipsychotics and antidepressants. The first case is a 69-year-old man who was admitted for depression with psychosis and treated with trazodone, risperidone, and sertraline. Subsequently, he developed myoclonus, tremor, cogwheel rigidity, and diaphoresis. The second case is a 72-year-old female initially admitted to a medical inpatient unit for a change in mental status that presented as increased confusion, lethargy, slurred speech, and a fever of 101.5 degrees. She had been on phenelzine and quetiapine. In both cases, all symptoms resolved within 24 hours of the psychotropics being stopped. In both cases, we believe that serotonin syndrome was produced by a combination of an antidepressant and an atypical antipsychotic. There have been several case reports of serotonin syndrome from similar combinations of antidepressant and atypical antipsychotic treatment. Clinicians treating elderly patients with a combination of serotonergic antidepressants and atypical antipsychotics for psychotic depression should be aware of the potential for serotonin syndrome.     

Effects of visual center of pressure feedback on postural control in young and elderly healthy adults and in stroke patients

The goal of this study was to compare young and elderly healthy individuals and elderly stroke patients in their capacity to use visual CP feedback (VF) in controlling both quiet standing and weight shifting and to assess their sensory re-weighing when this VF is withdrawn. A total of 40 participants were involved in this study. Participants were asked to either quietly stand on a force platform for a period of 45 s with eyes open (EO), using visual feedback (VF) or without visual feedback (No VF) or to perform a dynamic weight shifting task while using VF or No VF. During the quiet standing trials with VF, only the young (YO) were able to decrease the amplitude and increase the frequency of their sway in either plane. Removal of the VF resulted in a 'destabilizing' effect in both healthy elderly (EL) and stroke patients (ST) in the sagittal plane. With regard to the dynamic task, both the YO and EL were generally more successful at weight shifting in terms of speed and control when compared to the ST. Yet, when VF was removed, only the YO were able to largely maintain speed and precision of control. Hence, providing or removing visual CP feedback during quiet standing or removing VF during visually controlled weight shifting can discriminate healthy young participants from healthy elderly, but does not clearly discriminate healthy elderly from stroke patients in the same age group. Results revealed that sagittal plane imbalance in healthy elderly and stroke patients may be largely due to the effects of aging, whereas frontal plane imbalance is much more specific for the postural problems associated with stroke.     

Pr?diktoren tumorassoziierter Fatigue

Fatigue is a serious cancer-related syndrome reported by cancer patients during and after treatment. Especially the impact of chronic fatigue on quality of life is substantial. The aim of this study was to identify predictors of fatigue after finishing treatment from an early stage of the cancer treatment. A sample of 551 cancer patients with heterogeneous diagnoses completed questionnaires assessing fatigue, psychological and psychosomatic data plus treatment data. The patients were recruited from an acute care hospital (t1) and the participants completed the questionnaire 2?C2.5 years after treatment (t2). Regression analysis showed that the strongest predictor of later fatigue was fatigue during the therapy. Other impact factors are radiotherapy and pain. The results suggest that the diagnosis and treatment of acute fatigue should be carried out at an early stage of cancer treatment to prevent chronic fatigue. Suitable diagnostic methods and treatment options will be presented.     

Age-related differences in postural reaction time and coordination during voluntary sway movements

The elderly are known to exhibit declines in postural control during standing and walking, however little is known about how the elderly react under time-critical and challenging postural situations. The purpose of this study was to examine age-related differences in reaction time (RT) and the pattern of temporal coordination between center of pressure (COP), trunk and head motion during voluntary postural sway movements. Healthy young (n=10; mean=24 years; SD=5 years) and elderly men (n=8; mean=75 years; SD=2 years) stood on a force plate with tri-axial accelerometers attached to the head and lower trunk. Participants were required to generate sway in the anterior-posterior (AP) or medial-lateral (ML) direction in response to an auditory cue during two different testing conditions called Static reaction and Dynamic reaction. Static reactions involved the initiation of voluntary sway in either the AP or ML direction from quiet stance. Dynamic reactions involved an orthogonal switch of voluntary sway between the AP and ML directions. Compared to the young, elderly individuals exhibited slower RT during both Static and Dynamic reaction, and smaller differences in RT and phasing between COP, trunk, and head motion. The results of this study suggest that the elderly adopted more rigid coordination strategies compared to the young when executing a rapid change in direction of whole body motion. The rigid movement strategy of the elderly was presumably generated in an effort to compensate for increased challenge to the maintenance of stability.     

Associative learning over trials activates the hippocampus in healthy elderly but not mild cognitive impairment

The ability to form associations between choice alternatives and their contingent outcomes is an important aspect of learning that may be sensitive to hippocampal dysfunction in memory disorders of aging such as amnestic mild cognitive impairment (MCIa), or early Alzheimer disease. In this preliminary study we examined brain activation using functional magnetic resonance imaging (fMRI) in 12 healthy elderly participants and nine patients with MCIa during an associative learning task. Using a high-field 3.0-Tesla MRI scanner, we examined the dynamic neural response during associative learning over trials. The slope of signal attenuation associated with learning was analyzed for differences between groups within an a priori defined hippocampal region. Results indicated dynamic signal attenuation associated with learning in the healthy elderly sample, but not in MCIa. The absence of an associative learning effect in the MCIa sample reaffirms an important link between the learning difficulties that are commonly encountered in MCIa and the mesial temporal region.     

Depressive symptoms and one year mortality among elderly patients discharged from a rehabilitation ward after orthopaedic surgery of the lower limbs

The objective of the present prospective observational study is to evaluate the effect of depressive symptoms on 1-year mortality in a population of elderly patients discharged from a rehabilitation unit after orthopaedic surgery of the lower limbs. A total of 222 elderly inpatients were included, and stratified according to 12-months survival. 14 (6.3%) of the patients who were eligible for this study died during the 12-months period after discharge. As expected, patients who died were significantly older, lower cognitive performance, more depressive symptoms, poorer nutritional status and higher comorbidity in comparison to those who survived. Furthermore, they were generally more functionally dependent on admission to the Department, had worse functional recovery and were more disable at discharge, although a longer length of stay comparing to survived patients. In the adjusted logistic regression model, after adjustment for possible confounders and covariates, the presence of severe depressive symptoms significantly predicted a four-fold risk of death at 12 months. The only other factor associated poor 12-months survival was comorbidity, that predicted a 6-fold risk of death. In conclusions this study suggests that severe depressive symptoms on admission predicts 1-year mortality in elderly patients discharged from a post-acute care unit after orthopaedic rehabilitation.     

Emotional Distress Associated with Surgical Treatment and its Relationship with Coping Profiles Among Chronically ill Older Patients

The study determines the patterns of coping styles among older patients with hip osteoarthritis and assesses the derived profiles in terms of perceived stress and anxiety before and after arthroplasty. Sixty-one hospital patients (mean age 70.3 years) were analysed one day before arthroplasty and three months after. The participants were assessed with the Brief-COPE (coping style), PSS-10 (perceived stress) and STAI (anxiety) psychometric tests. Four coping patterns were yielded using data clustering: rational, enterprising (resourceful), potentially maladaptive and flexible. Repeated measures ANOVA indicated a main effect within subjects but did not indicate that decreases of stress and anxiety varied differently between groups. Cluster 1 (a coping profile characterised by high helplessness, low active coping, high avoidance) reported significantly greater stress and anxiety than all other groups before and after hip replacement, while clusters 2 (flexible), 3 (resourceful) and 4 (rational) were characterised by similar levels of anxiety and stress. Older patients with osteoarthritis might differ in terms of emotional response to surgical treatment. Screening for coping styles at admission to hospital may indicate more vulnerable individuals.