目的:探究个性化全膝关节置换术对膝关节骨性关节炎初次手术患者的影像学及近期临床效果。方法:本研究为回顾性队列研究,选取299例济宁医学院附属医院关节与运动医学科的膝关节骨性关节炎患者作为研究对象,根据接受手术方式不同将患者...目的:探究个性化全膝关节置换术对膝关节骨性关节炎初次手术患者的影像学及近期临床效果。方法:本研究为回顾性队列研究,选取299例济宁医学院附属医院关节与运动医学科的膝关节骨性关节炎患者作为研究对象,根据接受手术方式不同将患者分为常规组(n = 152)与个性化组(n = 147)。常规组患者采用传统全膝关节置换术式治疗,个性化组患者采用个性化全膝关节置换术式治疗。对比分析两组患者手术前后下肢力线、假体位置、术中无拇指实验合格率、术中胫骨试模抬离阳性率、手术时间、血红蛋白、美国纽约特种外科医院(Hospital for Special Surgery, HSS)评分等多项指标。结果:较常规组,个性化组术后平片提示有着更优良的下肢力线和假体位置。个性化组无拇指实验合格率明显优于常规组,差异有统计学意义(P Objective: To investigate the imaging and recent clinical outcomes of personalized total knee arthroplasty in patients undergoing primary surgery for osteoarthritis of the knee. Methods: This study was a retrospective cohort study, 299 patients with knee osteoarthritis in the Department of Joint and Sports Medicine, Affiliated Hospital of Jining Medical College were selected as the study objects, and the patients were divided into the conventional group (n = 152) and the personalized group (n = 147) according to the different ways of receiving surgery. Patients in the conventional group were treated with traditional total knee replacement, and patients in the personalized group were treated with personalized total knee replacement. Comparative analysis of the two groups of patients before and after the operation of the lower limb force line, the prosthesis position, intraoperative thumbless experiment pass rate, intraoperative tibial trial mold lifting off the positive rate, the operation time, hemoglobin, the United States of America, New York Hospital for Special Surgery score and other indicators. Results: Compared with the conventional group, the postoperative plain radiographs of the personalized group suggested a better lower limb line of force and prosthesis position. The pass rate of thumbless test in the personalized group was significantly better than that in the conventional group, and the difference was statistically significant (P < 0.05). The positive rate of tibial trial lifting in the conventional group was higher than that in the personalized group, and the difference was statistically significant (P < 0.05). The HSS score in the 3rd postoperative month was better in the personalized group than in the conventional group, and the difference in knee function score between the two groups was statistically significant (P < 0.05). Postoperative Hemoglobin in the personalized group was significantly higher than Hemoglobin in the conventional group, and the difference in postoperative Hemoglobin between the two groups was statistically significant (P < 0.01). For the remaining indicators, the difference between the personalized group and the conventional group was not statistically significant. Conclusion: Compared to conventional total knee replacement, personalized total knee replacement achieves a more optimal lower extremity line of force and prosthesis placement, and demonstrates better short-term clinical outcomes. Personalized total knee arthroplasty is a viable surgical option in primary total knee replacement.展开更多
目的探讨应用Wagner Cone生物型股骨柄假体联合转子下横行截骨治疗CroweⅣ型成人髋关节发育不良(developmental dysplasia of the hip,DDH)的临床疗效。方法回顾性分析2021年1月至2024年1月济宁医学院附属医院收治的15例(20髋)CroweⅣ型...目的探讨应用Wagner Cone生物型股骨柄假体联合转子下横行截骨治疗CroweⅣ型成人髋关节发育不良(developmental dysplasia of the hip,DDH)的临床疗效。方法回顾性分析2021年1月至2024年1月济宁医学院附属医院收治的15例(20髋)CroweⅣ型DDH患者资料,其中女13例(17髋),男2例(3髋);年龄32~67岁,平均(51.7±10.5)岁。所有患者均采用改良髋关节Hardinge入路,选择股骨小转子下横行截骨技术结合Wagner Cone生物型股骨柄假体进行人工髋关节置换。应用Harris髋关节评分评价患者临床功能恢复情况,疼痛视觉模拟评分(visual analogue scale,VAS)评估患者疼痛程度;收集手术时间、术中出血量、患者手术前后下肢长度等临床资料并进行分析比较。随访期间观察截骨处的愈合及并发症情况。结果患者均获随访7~36个月,平均(19.7±8.7)个月。手术时间72~235 min,平均(142.2±44.1)min;术中出血量为200~1800 mL。术后即刻X线片示股骨柄与髓腔均紧密压配,假体髓腔填充良好。Harris髋关节评分由术前(49.9±6.3)分提高至末次随访时的(91.1±2.7)分,手术前后比较差异有统计学意义(P<0.05);VAS评分由术前(5.1±1.0)分改善至术后(1.6±0.5)分,手术前后比较差异有统计学意义(P<0.05)。末次随访时患者双下肢不等长相差(0.4±0.3)cm,与术前(4.0±0.6)cm比较,差异有统计学意义(P<0.05)。术后截骨端不愈合患者1例,无感染、神经损伤和假体松动、下沉患者。结论Wagner Cone生物型股骨柄联合转子下横形截骨治疗CroweⅣ型髋关节发育不良,能获得满意临床疗效,术后并发症少,可有效平衡双下肢长度,减轻患者髋关节疼痛,并且能简化手术流程,值得临床推广使用。展开更多
目的探讨课题研究型品管圈在构建基于加速康复外科(enhanced recovery after surgery,ERAS)理念下膝关节置换围手术期管理模式中的应用。方法成立“膝望圈”及圈外专家咨询团,依据课题研究型品管圈操作步骤,从人员、制度、方法、信息、...目的探讨课题研究型品管圈在构建基于加速康复外科(enhanced recovery after surgery,ERAS)理念下膝关节置换围手术期管理模式中的应用。方法成立“膝望圈”及圈外专家咨询团,依据课题研究型品管圈操作步骤,从人员、制度、方法、信息、设备5个层面分析现状,明确6大攻坚点,多方拟定对策并加以筛选判断,从组建多学科“环抱式”围手术期安全管理模式、建立五位一体“动无忧”康复安全策略、建立“智信行”膝关节置换临床路径信息化管理网络等方面改进。结果构建了基于ERAS理念下膝关节置换围手术期管理模式,优化了膝关节置换术临床路径。与改善前相比,康复风险评估落实率(41%提升至100%)及术后屈曲功能相关指标显著提升,患者术后首次下床时间[(16.5±0.41)h降至(9.6±1.11)h]、膝关节屈曲达标时间[(147.4±17.6)h降至(86.9±10.1)h]、改善后临床路径完成时间、均次康复费用以及均次住院费用均显著下降。结论课题研究型品管圈活动可有效推进基于ERAS理念下膝关节置换围手术期管理模式的构建,对规范临床诊疗行为,提高医疗质量,有积极促进作用,值得在医疗服务的现代化发展中推广应用。展开更多
文摘目的:探究个性化全膝关节置换术对膝关节骨性关节炎初次手术患者的影像学及近期临床效果。方法:本研究为回顾性队列研究,选取299例济宁医学院附属医院关节与运动医学科的膝关节骨性关节炎患者作为研究对象,根据接受手术方式不同将患者分为常规组(n = 152)与个性化组(n = 147)。常规组患者采用传统全膝关节置换术式治疗,个性化组患者采用个性化全膝关节置换术式治疗。对比分析两组患者手术前后下肢力线、假体位置、术中无拇指实验合格率、术中胫骨试模抬离阳性率、手术时间、血红蛋白、美国纽约特种外科医院(Hospital for Special Surgery, HSS)评分等多项指标。结果:较常规组,个性化组术后平片提示有着更优良的下肢力线和假体位置。个性化组无拇指实验合格率明显优于常规组,差异有统计学意义(P Objective: To investigate the imaging and recent clinical outcomes of personalized total knee arthroplasty in patients undergoing primary surgery for osteoarthritis of the knee. Methods: This study was a retrospective cohort study, 299 patients with knee osteoarthritis in the Department of Joint and Sports Medicine, Affiliated Hospital of Jining Medical College were selected as the study objects, and the patients were divided into the conventional group (n = 152) and the personalized group (n = 147) according to the different ways of receiving surgery. Patients in the conventional group were treated with traditional total knee replacement, and patients in the personalized group were treated with personalized total knee replacement. Comparative analysis of the two groups of patients before and after the operation of the lower limb force line, the prosthesis position, intraoperative thumbless experiment pass rate, intraoperative tibial trial mold lifting off the positive rate, the operation time, hemoglobin, the United States of America, New York Hospital for Special Surgery score and other indicators. Results: Compared with the conventional group, the postoperative plain radiographs of the personalized group suggested a better lower limb line of force and prosthesis position. The pass rate of thumbless test in the personalized group was significantly better than that in the conventional group, and the difference was statistically significant (P < 0.05). The positive rate of tibial trial lifting in the conventional group was higher than that in the personalized group, and the difference was statistically significant (P < 0.05). The HSS score in the 3rd postoperative month was better in the personalized group than in the conventional group, and the difference in knee function score between the two groups was statistically significant (P < 0.05). Postoperative Hemoglobin in the personalized group was significantly higher than Hemoglobin in the conventional group, and the difference in postoperative Hemoglobin between the two groups was statistically significant (P < 0.01). For the remaining indicators, the difference between the personalized group and the conventional group was not statistically significant. Conclusion: Compared to conventional total knee replacement, personalized total knee replacement achieves a more optimal lower extremity line of force and prosthesis placement, and demonstrates better short-term clinical outcomes. Personalized total knee arthroplasty is a viable surgical option in primary total knee replacement.
文摘目的探讨课题研究型品管圈在构建基于加速康复外科(enhanced recovery after surgery,ERAS)理念下膝关节置换围手术期管理模式中的应用。方法成立“膝望圈”及圈外专家咨询团,依据课题研究型品管圈操作步骤,从人员、制度、方法、信息、设备5个层面分析现状,明确6大攻坚点,多方拟定对策并加以筛选判断,从组建多学科“环抱式”围手术期安全管理模式、建立五位一体“动无忧”康复安全策略、建立“智信行”膝关节置换临床路径信息化管理网络等方面改进。结果构建了基于ERAS理念下膝关节置换围手术期管理模式,优化了膝关节置换术临床路径。与改善前相比,康复风险评估落实率(41%提升至100%)及术后屈曲功能相关指标显著提升,患者术后首次下床时间[(16.5±0.41)h降至(9.6±1.11)h]、膝关节屈曲达标时间[(147.4±17.6)h降至(86.9±10.1)h]、改善后临床路径完成时间、均次康复费用以及均次住院费用均显著下降。结论课题研究型品管圈活动可有效推进基于ERAS理念下膝关节置换围手术期管理模式的构建,对规范临床诊疗行为,提高医疗质量,有积极促进作用,值得在医疗服务的现代化发展中推广应用。
