两种不同麻醉和镇痛方法对糖耐量减低的老年高血压患者全膝置换术后糖代谢的影响

目的两种不同麻醉和镇痛方法对糖耐量减低的老年患者全膝置换术后糖代谢的影响。方法60例择期行全膝置换术的糖耐量减低患者随机分成腰硬联合麻醉联合术后硬膜外镇痛组（腰硬组）和全身麻醉联合术后静脉镇痛组（全麻组）各30例,分别测定入手术室后,术后30min、1、3、7d的空腹血糖和胰岛素浓度;术后10d空腹和口服糖耐量试验（OGTT）2h的血糖和胰岛素浓度,并计算相应胰岛素抵抗指数,以视觉模糊疼痛评分（VAS）评估术后1h、1、3、7d的疼痛评分,并记录围手术期相关不良事件发生率。结果腰硬组术后30min、1、3d的空腹血糖相比全麻组明显较低（均P＜0.05）;腰硬组在术后30min、1、3、7d的胰岛素浓度和胰岛素抵抗指数相比全麻组明显较低（均P＜0.05）。腰硬组在术后1d和3d的中餐后2h血糖浓度相比全麻组明显较低（均P＜0.05）。全麻组术后10d空腹、OGTT2h的胰岛素浓度和胰岛素抵抗指数相比术前均明显升高（均P＜0.05）,且相比腰硬组明显更高（均P＜0.05）。术后1h和术后1d腰硬组VAS评分明显小于全麻组（均P＜0.05）。结论腰硬联合麻醉和硬膜外镇痛能减轻糖耐量减低的老年高血压患者的全膝置换术后糖代谢紊乱。     

Thermal analysis of the osteoarthritic human hyaline cartilage

Summary Arthritis of major joints, especially osteoarthritis of the knee is a very frequent disease of human beings mainly in the developed countries. The pathology of osteoarthritis has been subject of many publications before, using a wide spectrum of different methods to evaluate degenerative changes of hyaline cartilage. The authors examined osteoarthritic human knee joint hyaline cartilage with differential scanning calorimetry. The different stages of cartilage degeneration have been verified by histological examinations. The research group demonstrated thermal differences between various stages of osteoarthritis. Besides explaining possible causes for experienced thermodynamic effects, the authors reflect upon future research ways and the possibilities of applying the method in practice.     

用于SAR估计的基于U-Net网络的快速膝关节模型重建

膝关节高场磁共振成像（MRI）时,射频功率沉积（SAR）是一个关键的安全指标.目前对于局部SAR的准确估计只能通过电磁仿真实现,这就要求得到每一个个体的膝关节模型.本文提出一种针对低场磁共振图像的基于卷积神经网络的分割方法,以实现膝关节磁共振图像的快速重建.数据集来自于矢位T₁加权自旋回波图像,将膝关节组织按照"肌肉-脂肪-骨骼"模型进行简化,除脂肪与骨骼之外的其他组织归类为肌肉.采用一种全卷积的神经网络,即U-Net进行逐层的图像分割,卷积层数为4,训练采用交叉熵函数.本文对图像的自动分割结果与手动标注结果进行了定量的比较.此外,采用3 T正交鸟笼线圈进行了SAR仿真,结果验证了组织简化对于SAR估计的可行性,并且所提方法构建的模型可以得到较为精准的局部SAR分布.     

前交叉韧带损伤的继发性生物力学影响

前交叉韧带(anterior cruciate ligament, ACL)损伤往往会导致半月板及周边韧带的继发性损伤. 由于离体实验和临床研究的局限性,损伤的机理仍未得到清晰的认识. 基于核磁共振断层扫面图像重建了一个比较完整和精确的膝关节三维有限元模型. 采用文献报道的解剖测量数据对关节的解剖尺寸进行了检验,证明模型在几何上比较准确. 并且对文献报道的膝关节实验作了模拟,得出的计算结果与实验比较吻合,证明模型能够在一定程度上再现膝关节真实的运动情况. 然后利用该模型对ACL损伤前后的膝关节进行模拟,分别在屈膝0$^\circ$和30$^\circ$的姿态下对胫骨施加前后方向和竖直方向的载荷. 结果表明, ACL的损伤改变了关节组织上的应力分布:内侧半月板后段的应力显著增加;外侧半月板、后交叉韧带以及侧副韧带上的应力改变程度则取决于载荷的类型和屈膝的角度. 该研究有助于认识ACL损伤之后周边组织的继发性损伤现象,并对容易诱发损伤的高危动作进行分析和预防,对研究ACL的损伤和治疗具有重要的意义.      

High-resolution ICP–MS determination of Ti,V, Cr,Co, Ni,and Mo in human blood and urine of patients implanted with a hip or knee prosthesis

The main components (Ti, V, Cr, Co, Ni, and Mo) of metallic alloys currently used in hip and knee articular prostheses have been simultaneously determined in human whole blood and urine of implanted people by a (HR)-ICP–MS method previously developed in our laboratory. The determination of those elements has been carried out in patients with knee and hip prosthesis and in a group of pre-operation patients without any metallic device in their bodies, used as controls, demonstrating the usefulness of this technique to perform multielement analysis at ppt levels in complex matrices. The concentrations of V, Cr, Co, Ni, and Mo in urine and blood of implanted people turned out to be very similar to those obtained in control patients. However, raised Ti levels could be found both in urine and blood of patients with articular prostheses made or coated with a titanium alloy (Ti₆Al₄V).     

膝关节红外热像图的多尺度熵算法分析研究

随着红外热成像技术的在医学领域日趋广泛的应用,传统的医学红外影像处理技术是通过医生观察胶片或者图像来进行诊断,需要医生具有足够的知识积累和临床经验.针对上述问题,提出了利用计算机图像处理技术对膝关节红外图像进行处理,形成图像信号序列,再通过多尺度熵算法进行数据信息分析,最终得出当机体膝关节出现病变时,其熵值在多个尺度上均低于健康机体熵值,且熵值越低,病变程度越大.     

Assessment of the Effectiveness of Rehabilitation after Total Knee Replacement Surgery Using Sample Entropy and Classical Measures of Body Balance

Exercises in virtual reality (VR) have recently become a popular form of rehabilitation and are reported to be more effective than a standard rehabilitation protocol alone. The aim of this study was to assess the efficacy of adjunct VR training in improving postural control in patients after total knee replacement surgery (TKR). Forty-two patients within 7–14 days of TKR were enrolled and divided into a VR group and a control group (C). The C group underwent standard postoperative rehabilitation. The VR group additionally attended twelve 30-min exercise sessions using the Virtual Balance Clinic prototype system. Balance was assessed on the AMTI plate in bipedal standing with and without visual feedback before and after the four-week rehabilitation. Linear measures and sample entropy of CoP data were analyzed. After four weeks of rehabilitation, a significant reduction in parameters in the sagittal plane and ellipse area was noted while the eyes remained open. Regression analysis showed that sample entropy depended on sex, body weight, visual feedback and age. Based on the sample entropy results, it was concluded that the complexity of the body reaction had not improved. The standing-with-eyes-closed test activates automatic balance mechanisms and offers better possibilities as a diagnostic tool.     

Quantitative assessment of mobile protein levels in human knee synovial fluid: feasibility of chemical exchange saturation transfer (proteinCEST) MRI of osteoarthritis

Purpose

To establish the feasibility of chemical exchange saturation transfer (proteinCEST) MRI in the differentiation of osteoarthritis (OA) knee joints from non-OA joints by detecting mobile protein and peptide levels in synovial fluid by determining their relative distribution.

Materials and Methods

A total of 25 knees in 11 men and 12 women with knee injuries were imaged using whole knee joint proteinCEST MRI sequence at 3 T. The joint synovial fluid was segmented and the asymmetric magnetization transfer ratio at 3.5 ppm MTR_asym (3.5 ppm) was calculated to assess protein content in the synovial fluid. The 85th percentile of synovial fluid MTR_asym (3.5 ppm) distribution profile was compared using the independent Student's t test. The diagnostic performance of the 85th percentile of synovial fluid MTR_asym (3.5 ppm) in differentiating OA and non-OA knee joints was evaluated.

Results

The 85th percentile of synovial fluid MTR_asym (3.5 ppm) in knee joints with OA was 8.6%±3.4% and significantly higher than that in the knee joints without OA (6.3%±1.4%, P<.05). A knee joint with an 85th percentile of synovial fluid MTR_asym (3.5 ppm) greater than 7.7% was considered to be an OA knee joint. With the threshold, the sensitivity, specificity and overall accuracy for differentiating knee joints with OA from the joints without OA were 54% (7/13), 92% (11/12) and 72% (18/25), respectively.

Conclusion

proteinCEST MRI appears feasible as a quantitative methodology to determine mobile protein levels in synovial fluid and identify patterns characteristic for OA disease.     

超声引导下连续腰交感神经节阻滞联合全麻对膝关节置换术患者镇痛及苏醒质量的影响

本文对超声引导下连续腰交感神经节阻滞联合全麻对膝关节置换术患者镇痛及苏醒质量的影响进行了分析和探讨。选取2017年1月～2019年1月本院膝关节置换术患者100例,依据随机数字表分为滞麻组和单麻组,每组50例,单麻组给予单纯全麻,滞麻组在此基础上给予超声引导下连续腰交感神经节阻滞,比较两组镇痛及苏醒质量、不良反应。结果显示,滞麻组切皮时（T1）、关节置换时（T2）、术毕（T3）的平均动脉压（MAP）、心率（HR）明显低于单麻组,滞麻组镇痛优良率明显高于单麻组,有统计学差异（P<0.05）;滞麻组呼之睁眼、呼之握拳、拔管、苏醒时间和苏醒并发症率明显低于单麻组,有统计学差异（P<0.05）;滞麻组和单麻组不良反应率比较,无统计学差异（P>0.05）。本文认为,超声引导下连续腰交感神经节阻滞联合全麻可有效改善膝关节置换术患者镇痛及苏醒质量,且安全性好,值得临床推广。