重症臀肌挛缩症的手术治疗

目的：探讨重症臀肌挛缩症的手术方式及并发症的防治。方法：根据刘国辉等制定的臀肌挛缩症的分度方法和重症诊断标准，对确诊的287例重症患者进行手术治疗及结合术后功能锻炼，并随访其疗效。结果：随访11个月～8年，有效率100.0％，治愈率97．5％，并发症少，无复发。结论：手术彻底松解挛缩组织，减少创伤，结合术后有效的功能锻炼，可以明显提高重症臀肌挛缩症疗效，减少并发症的发生。

臀肌挛缩症手术治疗34例分析

目的 :总结各种术式治疗臀肌挛缩症的疗效。方法 :1996～ 2 0 0 2年共手术治疗臀肌挛缩症患者 34例 ,手术初期沿用小切口、直切口、“S”形大切口 ,后改做股骨大转子上后方 2cm弧形切口。随访时间 6个月～ 2年 ,对其中随访资料完整的 2 8例进行分析、评定。结果 :2 8例中 ,疗效优 2 3例 ,良 3例 ,可 2例 ,手术优良率为 92 .8%。结论 :手术方式影响预后 ,经临床应用 ,大转子上后方弧形切口优于小切口、直切口、“S”形大切口 ,随访结果满意。

带旋髂深血管缝匠肌肌骨瓣治疗股骨头缺血性坏死疗效观察

目的探讨带旋髂深血管缝匠肌肌骨瓣治疗股骨头缺血性坏死疗效。方法收集成人股骨头缺血坏死86例（86髋），并按照髋关节Harris评分系统进行评价；对所有患者实行带旋髂深血管缝匠肌肌骨瓣治疗股骨头缺血性坏死术，所有患者均得到随访，随访时间1．2～11年，平均6．2年，以1．2年数据为评价依据。所获数据采用方差分析、t检验和x^2。结果患者术后的Harris评分均较术前明显提高，差异有显著性（P〈0．05），优良率91．86％。结论采用带旋髂深血管缝匠肌肌骨瓣治疗股骨头缺血性坏死可取得良好效果，髋关节功能恢复好，对预防股骨头进一步塌陷具有更好的效果。

共同性斜视临床分析98例

目的 探讨眼外肌悬吊徙后术治疗共同性斜视的临床应用。方法 将眼肌断端缝线根据所测徙后手术量悬吊后徙 ,缝于肌附着点巩膜浅层 ,先打活结 ,调整眼位 ,正位后结扎。结果 98例共同性斜视采用眼外肌悬吊徙后术者 ,术后眼位正位或偏斜 5°以内者 89例 ,与对照组有显著差异 (P <0 .0 5 ) ,6～ 10°残余斜视度 9例 ,全部病例矫正眼位满意 ,无并发症发生。结论 手术方法简单 ,效果可靠 ,避免了眼心反射 ,巩膜穿孔 ,玻璃体脱出及垂直性斜视的发生。

康复护理对膝关节交叉韧带重建术后下肢功能恢复的影响

目的探讨康复护理对膝关节交叉韧带重建术后下肢功能恢复的影响。方法对本院2013年1月—2014年1月关节镜下膝关节交叉韧带重建术后患者125例给予早期康复护理和后期康复锻炼,随访3~6个月,观察患者术后膝关节活动度、lysholm评分及膝关节疼痛肿胀情况。结果与康复护理前比较,术后康复锻炼3个月的膝关节活动度和lysholm评分分别为（96.33±10.41）°和（86.12±11.57）分,而术后6个月患者膝关节活动度和lysholm评分均明显升高,为（116.37±16.78）°和（91.10±12.35）分,差异有统计学意义（P〈0.05）;术后6个月患者发生膝关节疼痛和肿胀的发生率分别为7.69%和12.31%。结论精心的康复护理有助于改善膝关节交叉韧带重建术患者的膝关节活动度,减少不良反应,促进膝关节功能的恢复。

Comparative study on early period of recovery between minimally invasive surgery total knee arthroplasty and minimally invasive surgery-quadriceps sparing total knee arthroplasty in Chinese patients

Background Different kinds of minimally invasive surgery （MIS） procedures have now been used in total knee arthroplasty （TKA）. Compared with traditional TKA procedure with a long skin incision, clinical studies showed MIS procedures had some advantages. Quadriceps sparing （QS） procedures are the most minimally invasive MIS procedure until now. This study was aimed to find the insertion types for Chinese patients＇ vastus medialis and if the QS procedure had some advantages in patients＇ early recovery. Methods Between February 2006 and May 2007, 120 consecutive patients underwent unilateral primary TKA under general anesthesia, among whom 14 patients were lost to follow-up, the remaining 106 cases were enrolled in this study. Among the 106 cases there were 85 right knees, 21 left knees （15 men and 91 women, with a mean age of 65.1±7.4 years）; osteoarthritis in 97 patients （91.5%） and rheumatoid arthritis in 9 patients （8.5%）. MIS TKA was performed in 49 cases （MIS TKA group）, while MIS-QS TKA in 57 cases （MIS-QS TKA group）. During the operation, the type Ⅰ, Ⅱ and Ⅲ insertions of the vastus medialis for all patients were recorded. Each knee was rated post-operatively according to the Hospital of Special Surgery （HSS） scoring system. Clinical follow-up was undertaken at 1 week, 2, 6, 12 and 24 weeks. Operating time and complications were recorded. Results There was no statistically significant difference between the two groups for gender distribution, age, left or right knee incidence, pre-operative diagnosis, incidence of varus or valgus deformity. Of the 106 cases there was 1 （0.9%） case with a type Ⅰ insertion of the vastus medialis, 4 （3.8%） cases with type Ⅱ insertions, 101 （95.3%） cases with type Ⅲ insertions. The HSS scoring was significantly different between the MIS-QS TKA group and MIS TKA group within the first two weeks post operation. From 2 weeks later to 24 weeks, no significant difference was found. The average operating time was （53.3±12.4） minutes in the MIS TKA group and （64.1±15.1） minutes in the MIS-QS TKA group （P 〈0.001）. In the MIS-QS TKA group, 1 patient had delayed healing of the partial skin incision （1.8%）. No other complications were found in either group. Conclusions Although most of the Chinese patients had type Ⅲ insertions of the vastus medialis, the MIS-QS TKA procedure showed less injury to the quadriceps than the standard MIS TKA and this could contribute to the earlier recovery of of the patients. But a shorter-skin incision and more tension on the skin may also lead to more skin complications.