骨关节综合征诊断的困惑与对策

本文分析了骨关节病综合征诊断的困难,提出获得正确诊断的几种方法与思路,包括:(1)查找目录与对照图谱;(2)通过实验室特异检查进行病因诊断;(3)掌握构成该综合征的必备条件;(4)利用发散性思维想到其可能性。

关节镜联合肘管扩大成型术治疗肘关节骨性关节炎伴肘管综合征疗效观察

目的探讨关节镜联合肘管扩大成型术治疗肘关节骨性关节炎伴肘管综合征的临床疗效。方法选择2020年9月至2023年8月河北省沧州中西医结合医院骨外科收治的101例肘关节骨性关节炎伴肘管综合征患者为研究对象,按照手术方式不同将患者分为观察组(n=51)和对照组(n=50)。观察组患者采用关节镜联合肘管扩大成型术,对照组患者采用常规肘管扩大成型术。观察并记录2组患者的手术时间、术中出血量、住院时间、并发症发生情况。分别于术前、术后6个月时,采用Mayo肘关节功能评分(MEPS)评估2组患者的肘关节功能,采用日常生活活动能力评定表(ADL)评估2组患者的日常生活能力,采用视觉模拟评分(VAS)评估2组患者的疼痛程度;使用关节量角器测量肘关节旋前度数、旋后度数、屈伸度数,评估2组患者的肘关节活动度;使用Keypoint型肌电图仪检测小指展肌的复合肌肉动作电位(CMAP)、尺神经的神经传导速度(NCV)、运动诱发电位潜伏期(MEPLP),评估2组患者神经恢复情况。结果观察组患者的手术时间、住院时间显著短于对照组,术中出血量、并发症显著少于对照组(P<0.05)。术前,观察组和对照组患者的MEPS、ADL、VAS评分比较差异无统计学意义(P>0.05);术后6个月,观察组患者的MEPS、ADL评分显著高于对照组,VAS评分显著低于对照组(P<0.05)。术前,观察组和对照组患者的旋前度数、旋后度数、屈伸度数比较差异无统计学意义(P>0.05);术后6个月,2组患者的旋前度数、旋后度数、屈伸度数显著高于术前(P<0.05),观察组和对照组患者的旋前度数、旋后度数、屈伸度数比较差异无统计学意义(P>0.05)。术前,观察组和对照组患者的CMAP、NCV、MEPLP比较差异无统计学意义(P>0.05);术后6个月,观察组患者的CMAP、NCV显著高于对照组,MEPLP显著低于对照组(P<0.05)。结论常规肘管扩大成型术、关节镜联合肘关节扩大成型术均可改善肘关节骨性关节炎伴肘管综合征患者的肘关节活动度,但后者损伤更小,恢复更快,在提升肘关节功能及日常生活能力、减轻疼痛程度、调节肌电图检查指标等方面效果更佳,且并发症更少。

倪康裕老师治疗骨关节固定综合征的临床经验解析

[目的]总结倪康裕老中医治疗骨关节固定综合征的临床经验。[方法]通过验案分析,阐述倪康裕老师从肝脾肾及痰湿瘀血论治骨关节固定综合征的经验和常用方药。[结果]倪康裕老师根据骨关节固定综合征的病机特点,擅长运用利水通经补肾法治疗,疗效甚佳,并提出以预防为主的治疗原则。[结论]倪康裕老师对骨关节固定综合征的治疗特色鲜明,疗效显著,具有临床实践的指导意义。

MPR及X线测量股骨头颈比的对比研究

目的对比MPR及X线测量股骨头颈比,为临床治疗提供参考。方法 MPR组为150例行髋关节CT检查患者,X线组为同期行骨盆正位片检查的患者,分别测量股骨头最大直径和股骨颈最小直径,并计算头颈比例。结果MPR组的股骨头颈直径比例为1.48±0.17;X线组的股骨头颈直径比例为1.45±0.12。MPR组的股骨头最大直径为(42.98±6.18)mm,X线组的股骨头最大直径为(42.76±3.98)mm。MPR组的股骨颈最小直径为(27.15±6.12)mm,X线组的股骨颈最小直径为(29.16±2.67)mm。结论股骨头颈比例的测量在髋关节撞击综合征的诊断、分型以及异常影像征象的量化方面有一定指导意义。

踝关节镜微创治疗踝关节骨性撞击综合征的疗效分析

目的分析踝关节骨性撞击综合征患者采用踝关节镜微创治疗的临床治疗效果。方法选取踝关节前方骨性撞击综合征患者54例。均有踝关节前方疼痛感,踝关节活动受限、关节肿胀、撞击试验阳性。入院后完善相关检查,积极行术前准备,均采用踝关节镜微创手术治疗。关节镜微创治疗以清除瘢痕组织、滑膜组织、骨赘、骨软骨碎片为主,同时治疗过程中药对已损伤的关节软骨面进行修整。结果入组治疗的54例患者均手术成功,术后随访12~18个月,通过美国足踝外科协会拟定的踝关节评分(AOFAS评分)进行评定:优31例,良18例,可5例,优良率90.7%。术后4例出现足背麻木症状,并发症发生率为7.4%。结论对于踝关节骨性撞击综合征患者采用踝关节镜微创治疗临床疗效好,术后并发症少。

Electroacupuncture plus external application of Chinese medicine for knee osteoarthritis

Objective： To reveal the action mechanism and efficacy of electroacupuncture（EA） plus external application of Wei Ling Xian（Radix Clematidis） extract in treating knee osteoarthritis（KOA）, for providing theoretical evidence and novel plan for the treatment of KOA. Methods： Totally 284 inpatients were divided into an EA group and an observation group by the random number table, 142 cases in each group. The EA group was intervened by EA, ultrashort waves, and oral administration of Glucosamine Hydrochloride capsules; while the observation group was by external application of Wei Ling Xian（Radix Clematidis） extract at topical area in addition to the treatment given to the EA group. The intervention lasted 14 d in both groups. X-ray examination of knee joint was ordered before and after treatment, as well as the detection of positive expression of matrix metalloproteinase-1（MMP-1） in cartilage of knee joint, hyaluronic acid（HA） and interleukin-1β（IL-1β） in the inflammatory effusion; the Western Ontario and McM aster Universities osteoarthritis index（WOMAC） and visual analogue scale（VAS） were adopted to evaluate the clinical efficacy. Results： In the observation group, the X-ray examination result of knee joint was significantly improved, the positive expressions of MMP-1 and IL-1β content were significantly decreased, the level of HA was increased, WOMAC and VAS scores dropped, and the total effective rate was 91.5%, which were significantly different from those in the EA group（P〈0.05）. Conclusion： EA plus external application of Wei Ling Xian（Radix Clematidis） extract can produce a more significant efficacy in treating KOA compared to ordinary EA treatment.

Clinical research on the short-term efficacy of massaging quadriceps for knee osteoarthritis

Objective： To observe the short-term efficacy of massaging quadriceps on knee osteoarthritis （KOA）. Methods： Totally 30 KOA patients were enrolled and treated mainly with massaging quadriceps, 20 min for each session, once a day, 2 weeks as a treatment course, and for 2 courses in total. After treatment, the changes of visual analogue scale （VAS） and Western Ontario and McMaster Universities osteoarthritis index （WOMAC） were observed. Result： The VAS and WOMAC scores dropped after treatment, with a statistically significant difference （P〈0.01）. After a course of treatment, the recovery rate was 33.3% and the total effective rate was 86.7%; after 2 courses, the recovery rate was 60.0% and the total effect rate was 96.7%. Conclusion： Massaging quadriceps can alleviate pain, improve the function of knee joint, and produce a significant short-term efficacy in treating KOA.

Observation on clinical effects of herbal cake-partitioned moxibustion for knee osteoarthritis

Objective： To observe the clinical effects of herbal cake-partitioned moxibustion in the treatment of knee osteoarthritis （KOA）. Methods： A total of 120 cases with KOA were randomly divided into two groups by the random digital table, 60 cases in each group. The herbal cake-partitioned moxibustion （HCPM） group was treated by herbal cake-partitioned moxibustion, once per day and five days per week, with ten sessions as one course. The Western medication （WM） group was treated by the oral administration of Diclofenac Sodium Sustained-release Tablets. The knee functions of the patients were assessed by Western Ontario and McMaster Universities osteoarthritis index （WOMAC） before and after the treatment. The clinical effects were observed in the two groups after four-week continuous treatment. Results： The total effective rate was 86.7% in the HCPM group and 73.3% in the WM group. The difference in the total effective rate between the two groups was statistically significant （P〈0.05）. After treatment, WOMAC scores in the two groups were statistically different than those of the same group before the treatment （both P〈0.05）; the difference between the two groups were statistically significant （P〈0.05）. Conclusion： Herbal cake-partitioned moxibustion and oral administration of Didofenac Sodium Sustained-re;ease Tablets can improve the knee functions of KOA patients, but the therapeutic effect was better by herbal cake-partitioned moxibustion than by oral administration of Diclofenac Sodium Sustained-release Tablets.