中西医结合治疗急性痛风性关节炎临床疗效及对血清炎症因子影响研究

目的探讨中西医结合治疗急性痛风性关节炎临床疗效及对血清炎症因子的影响。方法选取本院收治的急性痛风性关节炎患者88例,随机分为中西医结合组与对照组,各44例。对照组予双氯芬酸钠治疗,中西医结合组在对照组治疗的基础上予中药内服外用治疗,两组治疗观察3个月。结果治疗后,中西医结合组的总有效率高于对照组(P<0.05)。治疗后,两组的关节疼痛视觉模拟评分法(VAS)评分低于治疗前(P<0.05),且中西医结合组低于对照组(P<0.05)。中西医结合组治疗期间不良反应发生率低于对照组(P<0.05)。治疗后,两组的血清肿瘤坏死因子-α(TNF-α)和C-反应蛋白(CRP)含量低于治疗前(P<0.05),且中西医结合组低于对照组(P<0.05)。结论中西医结合治疗急性痛风性关节炎能抑制炎症因子的释放,还可减少不良反应的发生,能促进改善患者的关节疗效,缓解关节疼痛。

探讨按动疗法治疗膝骨关节炎的临床疗效

目的探讨按动疗法治疗膝骨关节炎的临床疗效。方法选取本院2018年5月至2019年7月收治的膝骨关节炎患者74例,随机分为对照组与实验组,每组37例。对照组患者采用常规推拿治疗,实验组采用推拿联合按动疗法治疗,比较两组患者治疗前、治疗1个月后骨关节炎指数(WOMAC)、膝关节HHS评分、患者视觉模拟痛觉评分(VAS)及治疗有效率的情况。结果治疗后,两组患者骨关节炎指数评分均降低,膝关节HHS评分均升高,且实验组骨关节炎指数评分低于对照组,膝关节HHS评分高于对照组,视觉模拟痛觉评分(VAS)低于对照组,治疗有效率明显高于对照组,差异均具有统计学意义(P<0.05)。结论按动疗法治疗膝骨关节炎临床疗效显著,可更好的解决患者关节疼痛及关节僵直情况,提升患者关节日常活动能力,改善膝关节功能,临床效果优于单一传统推拿治疗,值得临床推广。

透明质酸钠治疗膝骨关节炎疗效及对血清肿瘤坏死因子-α白细胞介素-1β水平的影响

随着我国人口老龄化趋势的加重,膝骨关节炎(knee osteoarthritis,KOA)的发病率也出现逐年增长的趋势[1]。KOA的病因复杂,目前尚未完全明确,一般认为其发病是由多方面的因素如老龄化、超重或肥胖、创伤、长期疲劳损伤、关节异常畸形(先天或后天性)等共同参与引起的[2]。近年来,关于KOA发病机制有了更加深入的认识,肿瘤坏死因子-α(TNF-α)、白细胞介素-1β(IL-1β)等炎症因子对关节软骨细胞的破坏作用越来越受到临床重视[3]。

内固定与人工关节置换治疗老年股骨粗隆间骨折的疗效及安全性比较

目的对比老年股骨粗隆间骨折经内固定与人工关节置换治疗的临床疗效及安全性。方法选取104例我院于2015年1月—2016年3月收治的老年股骨粗隆间骨折患者,随机分为对照组(52例,经内固定治疗)和观察组(52例,经人工关节置换治疗)。比较2组患者的临床疗效和安全性。结果观察组的手术指标明显优于对照组,且骨折愈合时间显著短于对照组,组间差异均有统计学意义(P<0.05)。治疗前后2组患者的Harris评分均明显提高,差异有统计学意义(P<0.05);但组间Harris评分和并发症发生率差异均无统计学意义(P>0.05)。结论内固定和人工关节置换治疗老年股骨粗隆间骨折的临床疗效相当,均可有效改善髋关节功能,促进恢复;但后者的手术时间和术中出血量优于前者,安全性更高,更适用于老年患者。

单方狗骨酒治疗类风湿性关节炎疗效观察

笔者1975年研制出单方狗骨药酒治疗类风湿性关节炎,对降低抗“O”、血沉、促进类风湿因子转阴等具有显著疗效,通过238例临床观察取得了满意效果。1 临床资料与方法 1.1 一般资料 本组238例中,男50例,女188例,年龄19～50岁,平均年龄44岁。病史:最短者1年,最长者10年。其中轻型100例,重型138例。 1.2 诊断标准 按类风湿性关节炎的诊断标准诊断。 1.3

人工关节置换在四肢骨肿瘤保肢治疗的临床观察

目的:探讨人工关节置换在四肢恶性骨肿瘤或骨肿瘤复发保肢治疗后的疗效。方法:47例Ⅲ期以上长骨骨肿瘤实施瘤段完整切除+人工假体重建保肢治疗。结果:随访7～27个月。3例骨肉瘤患者术后局部复发,行截肢术;1例术后2周切口出现渗液,经局部换药后愈合。参照Enneking肢体肌肉骨骼系统肿瘤外科治疗重建术后功能评定标准,肢体功能优良率73%。结论:人工关节置换对四肢恶性骨肿瘤或骨肿瘤复发的治疗在功能重建方面,并发症少,功能恢复好,是一种保肢治疗的好方法。

有限元分析全膝关节置换股骨假体置入定位参数及临床优化验证

背景:三维有限元仿真分析在生物力学中有着广泛应用,但在膝关节置换中的研究不多,对股骨假体的研究也比较少。目的:有限元分析膝关节置换股骨假体置入的优化定位参数,并对Gemini-PS膝关节假体全膝关节置换进行临床验证。方法:1构建全膝关节置换膝关节有限元模型,对股骨假体截骨定位参数进行正交实验,选择股骨假体的平移量A、外旋度数B、外翻度数C 3个参数作为正交实验的相关因素,每个参数取3个值建立正交表,创建9个实验组合的全膝关节置换膝关节的有限元模型,对9个模型进行有限元分析,通过优化处理进行方差和极差分析。2纳入42例(47膝)中老年膝骨关节炎患者,采用Gemini-PS膝关节假体进行全膝关节置换,采用美国特种外科医院膝关节评分及美国膝关节协会评分评价置换前后膝关节功能,以疼痛目测类比评分评估置换前后膝关节疼痛程度。结果与结论:1聚乙烯衬底表面压应力峰值最小的为平移0 mm,外旋3°,外翻6°组合,压应力峰值为15.9 MPa;聚乙烯衬垫表面压应力的影响因素中,内外平移的影响大于外旋角度的影响大于外翻角度的影响;通过极差分析和方差分析发现股骨假体置入的最佳定位参数组合为平移0 mm,外旋3°,外翻6°;通过仿真计算证明正交实验是有效的;242例患者均得到随访,随访时间12-36个月,1例发生术口下段皮下脂肪液化;置换后末次随访患膝美国特种外科医院膝关节评分及美国膝关节协会评分均较置换前显著提高(P<0.05);置换后疼痛目测类比评分较置换前显著降低(P<0.05)。X射线检查未发现骨溶解、假体脱位及松动等并发症,置换后膝关节功能恢复良好;3结果提示,股骨假体置入位置的微小变化都会引起聚乙烯衬垫表面压应力峰值的异常分布,全膝关节置换术中对股骨假体进行准确定位可以取得良好的置换效果。

通痹方内服加熏蒸治疗膝关节骨性关节炎38例

目的:观察通痹方内服加熏蒸治疗膝关节骨性关节炎的临床疗效。方法:将74例膝关节骨性关节炎患者,按照随机数字表法随机分为两组。对照组给予塞来昔布胶囊(辉瑞制药有限公司,批号H20120353)100 mg,1 d 2次,口服。治疗组给予通痹方(黄芪、赤芍、当归、川芎、地龙、生地黄、炙甘草、柴胡、桃仁、红花、乳香、五灵脂、羌活、秦艽、川牛膝)早、晚各1次,水煎服;晚间服药后水煮药渣,将患侧膝关节伸置于药盆上方进行熏蒸,每次治疗30 min,1 d 1次。两组均治疗2周为1个疗程,2个疗程后判定疗效。结果:治疗组临床治愈21例,显效10例,有效5例,无效2例,有效率为94.73%;对照组临床治愈13例,显效9例,有效4例,无效10例,有效率为72.2%。两组对比,差别有统计学意义(P<0.01)。结论:通痹方内服加熏蒸治疗膝关节骨性关节炎疗效确切。

42例理筋手法配合中药熏蒸治疗创伤性肘关节炎的临床观察

目的研究理筋手法配合中药熏蒸治疗创伤性肘关节炎的治疗效果。方法 2011年2月-2012年2月收治的42例创伤性肘关节炎患者实施理筋手法配合中药熏蒸的治疗方式,观察治疗效果,总结经验。结果上述42例患者中治愈6例,占14.29%,显效患者15例,占35.71%,有效患者19例,占45.24%,总有效率为95.24%。结论理筋手法配合中药熏蒸对于治疗创伤性肘关节炎效果较为明显,值得在临床中应用推广。

富血小板血浆在股骨颈骨折治疗中的应用

目的探讨应用富血小板血浆(PRP)对股骨颈骨折治疗效果的影响。方法选择2016年4月至2018年4月于揭阳市人民医院骨一科治疗的100例股骨颈骨折患者为研究对象,以随机数表法分为观察组和对照组,每组50例。对照组行单纯空心钉内固定手术,观察组在对照组基础上联合PRP治疗。持续注入PRP 5周后,比较两组患者的临床疗效、治疗前后的端骨密度、人工全髋关节疗效评分(Harris评分),以及住院时间、骨折愈合时间和并发症的发生情况。结果治疗后,观察组患者的治疗总有效率为94.0%,明显高于对照组的80.0%,差异有统计学意义(P<0.05);治疗前,两组患者的端骨密度比较差异无统计学意义(P>0.05);治疗后,两组患者的骨密度明显提高,且观察组的骨密度为(1.85±0.35)g/cm^2,明显高于对照组的(1.05±0.26)g/cm^2,差异均有统计学意义(P<0.05);治疗前,两组患者的Harris评分比较差异无统计学意义(P>0.05);治疗后,两组患者的Harris评分明显升高,且观察组的Harris评分为(80.55±7.14)分,明显高于对照组的(73.36±6.04)分,差异均有统计学意义(P<0.05);观察组患者的住院时间和骨折愈合时间分别为(23.78±9.15)d、(8.26±1.54)个月,明显短于对照组的(27.86±7.84)d、(9.17±2.14)个月,差异均有统计学意义(P<0.05);观察组患者的并发症总发生率为4.0%,明显低于对照组的18.0%,差异有统计学意义(P<0.05)。结论富血小板血浆能促进股骨颈骨折患者骨折端愈合,提高端骨密度,缩短恢复时间,减少并发症发生,值得临床推广应用。

Treatment of 60 Cases of Gouty Arthritis with Modified Simiao Tang

Objective:To observe the clinical effect of a modified Simiao Tang (加味四妙汤 Modified Decoction of Four Wonderful Drugs) for gouty arthritis and its influence on uric acid in blood. Methods: 120 cases of gouty arthritis were randomly divided into the treatment group and control group with 60 cases in each group. Modified Simiao Tang (MST) was orally administered to the patients in the treatment group and allopurinol tablet was orally administered to the patients in the control group. The clinical effects of two groups were evaluated after one-week treatment and uric acid (UA) and C-reactive protein (CRP) levels in blood were determined after 1-month treatment. Results: The total effective rate in the treatment group was significantly higher than in the control group, 86.7% vs. 68.3% (P< 0.01). And the treatment group was also significantly better than the control group in decreasing UA and CRP (P<0.05 or P<0.01). Conclusions: MST can significantly improve the symptoms and signs of gouty arthritis and decrease the levels of UA and CRP. It is good for gouty arthritis.

Effect of proximal femoral osteoporosis on cementless hip arthroplasty: A short-term clinical analysis

Objective： The aim of this retrospective investigation was to explore the influence of femoral osteoporosis on short-term curative effects ofcementless hip arthroplasty and to evaluate the femoral metaphyseal bone mineral density （BMD） for femoral osteoporosis in order to guide prosthesis choice and rehabilitation. Methods： We performed 127 total arthroplasty operations between June 1999 to February 2003 and investigated 49 cementless hip replacements with the Metalcancellous cementless Lubeck Ⅱ system being used in all hips. There were twenty men and twenty-nine women whose mean age at the time of the operation was 60 years （range, 52-81 years）. The patients were divided into osteoporosis or normal groups according to the femoral metaphyseal BMD measured preoperatively. The average duration of follow-up was 30 months （range, 8-52 months）. We evaluated all of the patients from a clinical standpoint with use of a standard-terminology questionnaire with respect to the short-term curative effects and patients＇ satisfaction. Hip pain status and functional ability were important indicators of treatment efficacy. Results： Harris hip score and patients＇ satisfaction in femoral osteoporosis patients who underwent noncemented hip arthroplasty were lower （P=0.004, P=0.03） while the incidence of thigh pain was higher （P=0.03） than the patients with non-osteoporosis. Conclusion： The higher incidence of pain, as well as the decrease in function experienced by the patients in osteoporosis group, supports the case that cementless arthroplasty is not a better choice for those patients and that we had better select prosthesis based on the femoral metaphyseal BMD.

Clinical Observation on Treatment of Rheumatoid Arthritis with Fengshi Xiandan in 53 Cases

We have successfully developed Fengshi Xiandan (风湿仙丹) and used it to treat 53 cases of rheumatoid arthritis (RA),with indomethacin used to treat another 53 cases of RA as the controls.The results showed that the rate of cure and obvious effect was 54.7% and the total effective rate was 92.4% in the treatment group,as compared to 26.4% and 66.0% respectively in the control group,with an obvious difference in curative effect between the two groups (P<0.01).The improvement of all the main clinical symptoms and signs except arthralgia in the treatment group was superior to that in the control group (P<0.05 or P<0.01). The improvement of erythrocyte sedimentation rate (ESR),rheumatoid factor (RF),C-reaction protein (CRP), immunoglobulin (Ig),T-lymphocyte subgroups,micro-circulation in nail fold,and red blood cell (RBC) and hemoglobin (Hb) of anemia patients in the treatment group was superior to that in the control group (P<0.05 or P<0.01).There was an obvious difference (P<0.05 or P<0.01) in superoxide dismutase (SOD) of RBC and lipid peroxide (LPO) of plasma before treatment in the two groups as compared to normal group (P<0.05 or P<0.01).The level of SOD and LPO after treatment in the treatment group obviously tended to normal as compared to that befbre treatment (P<0.05 or P<0.01).The reduction of LPO in the treatment group was obviously superior to that in the control group (P<0.01).The result shows that Fengshi Xiandan (风湿仙丹) with an obvious curative effect on RA can not only control the symptoms of RA but also improve its pathologic damage and prevent its development.

壮元扶骨逍遥汤对膝关节液SOD的影响

目的：观察壮元扶骨逍遥汤治疗膝骨关节炎的疗效及其对膝关节液SOD的影响。方法：将120例膝骨关节炎患者随机分为治疗组和对照组各60例，分别采用口服壮元扶骨逍遥汤和膝关节腔注射玻璃酸钠治疗，观察两组临床疗效及膝关节液SOD含量的变化。结果：治疗组临床疗效及膝关节液SOD含量改善程度均显著优于对照组（P〈0．05、P〈O．01）。结论：壮元扶骨逍遥汤治疗膝骨关节炎充分发挥了祖国医学标本兼治的特点，疗效显著且作用持久，值得临床推广应用。

Preparation and characterization of nanosized ethosomes loaded with tetrandrine and their in vivo efficacy in arthritis treatment

The purpose of this work was to explore the feasibility of ethosomes for improving the anti-arthritic efficacy of topically administered tetrandrine, a bisbenzylisoquinoline alkaloid. Ethosomes were prepared by using the transmembrane pH-gradient loading method and characterized by mean diameter, morphology and entrapment efficiency. The prepared tetrandrine-loaded ethosomes exhibited spherical shape with about 78 nm of average diameter and entrapment efficiency of （52.87±3.81）%, whereas the liposomes had bigger size （99 nm） and higher entrapment efficiency （98.80±0.01）%. In addition, ethosomes exhibited favorable and enhanced penetration behavior as compared with liposomes. More importantly, tetrandrine-loaded ethosomes had a significantly better anti-adjuvant arthritis efficacy in rats compared to liposomes formulation, but no significant difference in the anti-arthritic efficacy between tetrandrine-loaded ethosomes and commercial dexamethasone ointment was observed. These results suggest that ethosomes would be a promising nanocarrier for topical delivery of tetrandrine across skin.

Efficacy of acupuncture during post-acute phase of rehabilitation after total knee arthroplasty

OBJECTIVE:The purpose of this study was to determine whether acupuncture is effective in reducing pain and swelling around the knee and improving range of motion(ROM) during the post-acute phase of rehabilitation after total knee arthroplasty(TKA).METHODS:Following TKA,80 knees in 80 patients were randomly assigned to either an acupuncture treatment group(Group A) or a control group(Group C).In Group A,the complementary treatment of acupuncture was performed three times/week from postoperative day 7 until postoperative day 21.Outcome measures were:i) pain as assessed by a visual analog scale;ii) reduction of swelling around the knee as indicated by its circumference at the center of the patella;and iii) ROM of the affected knee.RESULTS:Group A patients had significantly reduced pain and swelling around the knees and earlier recovery of ROM than did those in Group C.CONCLUSION:Acupuncture provides effective treatment during the post-acute phase of rehabilitation after TKA with respect to pain relief,reduction of swelling around the knee,and early recovery of ROM.

Tuina for Leg Length Discrepancy and Lumbosacral Pain Due to Sacroiliac Joint Subluxation

Objective： To observe theclinical effect of tuina reduction manipulation on leg length discrepancy and lumbosacral pain due to sacroiliac joint subluxation. Methods： A total of 60eligible cases were randomly allocated into an observation group and a control group, 30 in each group. Cases in the observation group were treated with conventional tuina plus reduction manipulation of sacroiliac joint subluxation; whereas cases in the control group were treated with conventional tuina plus acupuncture. The clinical effects were observed after 10 times of treatment. In addition, the relapse rates were observed 2 months after treatment. Results： The total effective rate in the observation group was 80.0%, versus 50.0% in the control group, showing a statistically significant difference （P＆lt;0.05）. The relapse rate of lumbosacral pain in the observation group was 12.5%, versus 66.7% in the control group, showing a statistically significant difference （P＆lt;0.01）. The relapse rate of leg length discrepancy in the observation group was 16.7%, versus 80.0% in the control group, showing a statistically significant difference （P＆lt;0.01）. Conclusion： Tuina reduction manipulation can obtain substantial therapeutic effect for leg length discrepancy and lumbosacral pain due to sacroiliac joint subluxation, coupled with a low relapse rate.

Observations on Curative Effect of High-frequency Electric Sparkle and Point-injection Therapy on Knee Osteoarthritis

Objective: To observe the curative effect of high-frequency electric sparkle and point-injection therapy (HESPT) on knee osteoarthritis (KOA). Methods: Two hundred and five patients were randomly divided into a warming needle moxibustion group (68 cases), a HESPT group (68 cases) and a point-injection group (69 cases). In the warming needle moxibustion group, the main points of Xuehai (SP 10), Neixiyan (EX-LE4), Waixiyan (EX-LE5), Dubi (ST 35), Zusanli (ST 36) and Yanglingquan (GB 34), and the adjunct points of Yinlingquan (SP 9) and Sanyinjiao (SP 6), on the affected side, were chosen for stimulation. In the HESPT group, tenderness points, the main points of Liangqiu (ST 34), Xuehai (SP 10), Neixiyan (EX-LE4), Waixiyan (EX-LE5) and Zusanli (ST 36), and the adjunct points of Yinlingquan (SP 9), Weizhong (BL 40) and Chengshan (BL 57), were chosen. After proper manipulation, Corydalis decumbens Pers. liquid was injected into the points and a high-frequency electric sparkle was applied to stimulate the needles for 30 seconds. In the point-injection group, point injection was performed with the same method, but the patients did not receive electric stimulation. The Western Ontario and McMaster University Osteoarthritis Index (WOMAC), the Lysholm Knee Score Scale (LKSS) and the ROM (Range of Motion) scale were used to evaluate the severity of KOA and the function of knee joints before treatment and 4 weeks after treatment. Finally, the Nimodipine method was used to assess the total curative effect. Results: After HESPT treatment, the scores for pain, morning stiffness and swelling were significantly lower (P<0.01) and LKSS index and ROM were much higher (P<0.01 and P<0.05 respectively) compared to the two other groups. The obviously effective rate and total effective rate were also significantly higher in the HESPT group than in the two other groups (P<0.01 or P<0.05). Conclusion: HESPT can improve joint function in KOA patients, and the curative effect is better than for warming needle moxibustion or point-injection only.

Treatment of Acute Gouty Arthritis by Blood-letting Cupping plus Herbal Medicine

Objective:To observe the therapeutic effect of blood-letting cupping plus herbal medicine for acute gouty arthritis.Methods:The 34 cases of acute gouty arthritis were treated by blood-letting cupping plus herbal medicine.Results:21 cases were cured and 13 cases improved.Conclusion:The therapeutic effect of this therapy was satisfactory for gouty arthritis.

Effect of Huqian Wan on liver-Yin and kidney-Yin deficiency patterns in patients with knee osteoarthritis

OBJECTIVE: To observe the curative effect of Huqian Wan on liver and kidney-Yin deficiency knee osteoarthritis(KOA).METHODS: One hundred patients were randomly divided into a treatment(50 patients) and control group(50 patients). In the treatment group, patients orally took the Chinese medicine Huqian Wan. Control group patients orally took Votalin, 75 mg, once a day, for 8 weeks. The visual analog scale(VAS), Western Ontario and Mc Master University Osteoarthritis Index(WOMAC), and Medical Outcomes Study Short Form 36-Item Health Survey(SF36) were used to evaluate the curative effect before treatment and after 8 and 16 weeks of treatment.RESULTS: VAS and WOMAC scores significantly decreased and SF 36 scores significantly increased after treatment in both groups compared with before treatment(P < 0.05). There were significant differences in VAS, WOMAC, and SF 36 score changes between the two groups at week 16(P < 0.05).There was a significant increase in VAS and WOMAC scores in the control groups(P < 0.05) between weeks 8 and 16, but no significant difference was found in the treatment group(P > 0.05).CONCLUSION: Huqian Wan could effectively improve the clinical symptoms and quality of life in patients with KOA. It could also have a better and longer lasting curative effect without obvious adverse events compared with Votalin.