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
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
目的:比较连续股神经阻滞(continuous femoral nerve block,CFNB)和CFNB联合关节周围浸润镇痛(periarticular local infiltration analgesia,PLIA)对膝关节置换术后镇痛及早期功能恢复的影响。方法:选择择期行膝关节置换手术患者100例,...目的:比较连续股神经阻滞(continuous femoral nerve block,CFNB)和CFNB联合关节周围浸润镇痛(periarticular local infiltration analgesia,PLIA)对膝关节置换术后镇痛及早期功能恢复的影响。方法:选择择期行膝关节置换手术患者100例,随机分为CFNB组(n=50)和CFNB联合PLIA组(简称PLIA组,n=50),以视觉模拟评分(visual analogue score,VAS)评价患者疼痛程度,在术后各时点记录静息及被动运动时患侧膝关节前、后部VAS评分。记录术后患者被动屈膝90°时间、主动直腿抬高时间,记录患者术前及术后72 h美国特种外科医院膝关节评分(hospital for special surgery knee score,HSS)。结果:术后静息时膝关节前部VAS评分在各时点两组间差异均无统计学意义(P>0.05),但膝关节后部VAS评分在术后4、8、12、24 h时PLIA组明显低于CFNB组(P<0.05)。被动运动时PLIA组膝关节前部VAS评分在术后24 h明显低于CFNB组(P<0.05),膝关节后部VAS评分在术后12、24 h明显低于CFNB组(P<0.05)。两组术前及术后72 h HSS评分差异无统计学意义(P>0.05)。与CFNB组比较,PLIA组被动屈膝90°时间和主动直腿抬高时间均明显缩短(P<0.05)。结论:CFNB联合PLIA镇痛可以降低术后膝关节后部疼痛评分,减少被动运动疼痛,缩短被动屈膝90°时间,改善患者术后早期康复效果。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.
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.
文摘目的:比较连续股神经阻滞(continuous femoral nerve block,CFNB)和CFNB联合关节周围浸润镇痛(periarticular local infiltration analgesia,PLIA)对膝关节置换术后镇痛及早期功能恢复的影响。方法:选择择期行膝关节置换手术患者100例,随机分为CFNB组(n=50)和CFNB联合PLIA组(简称PLIA组,n=50),以视觉模拟评分(visual analogue score,VAS)评价患者疼痛程度,在术后各时点记录静息及被动运动时患侧膝关节前、后部VAS评分。记录术后患者被动屈膝90°时间、主动直腿抬高时间,记录患者术前及术后72 h美国特种外科医院膝关节评分(hospital for special surgery knee score,HSS)。结果:术后静息时膝关节前部VAS评分在各时点两组间差异均无统计学意义(P>0.05),但膝关节后部VAS评分在术后4、8、12、24 h时PLIA组明显低于CFNB组(P<0.05)。被动运动时PLIA组膝关节前部VAS评分在术后24 h明显低于CFNB组(P<0.05),膝关节后部VAS评分在术后12、24 h明显低于CFNB组(P<0.05)。两组术前及术后72 h HSS评分差异无统计学意义(P>0.05)。与CFNB组比较,PLIA组被动屈膝90°时间和主动直腿抬高时间均明显缩短(P<0.05)。结论:CFNB联合PLIA镇痛可以降低术后膝关节后部疼痛评分,减少被动运动疼痛,缩短被动屈膝90°时间,改善患者术后早期康复效果。
