初诊医生一般会根据患者的体征和症状怀疑RA,如果是这样,患者将被转介给风湿免疫科专医生 - 具有诊断和治疗RA的特定培训和技能的专家。在早期阶段,RA可能类似于其它形式的炎性关节炎。没有一项测试可以确认RA。为了做出正确的诊断,风湿病专家会询问有关个人和家庭病史的问题,进行体检并进行实验室检查。病史医生将询问个人和家庭病史以及近期和当前症状(疼痛,压痛,僵硬,移动困难)。体检医生将检查每个关节的肿胀,表温和疼痛,寻找压痛点,关节功能障碍的情况。疼痛、功能障碍的关节数量和部位也与RA诊断相关。例如,RA往往影响身体两侧对称性大关节。体检可能会发现其他症状,如类风湿结节或低热。血液测试血液测试将测量炎症水平并寻找与RA相关的生物标记物,例如抗体(血液蛋白)。炎症反应红细胞沉降率(ESR或“sed率”)和C-反应蛋白(CRP)水平是炎症的标志物。高ESR或CRP并非特异于RA,但当与其他线索(如抗体)结合使用时,有助于进行RA诊断。抗体类风湿因子(RF):疾病的过程中约80%的RA患者体内会发现的抗体。由于RF也有可能发生在其他炎症性疾病中,因此不能就此确诊RA。另一种抗体,抗-环瓜氨酸肽(anti-CCP) - 主要发现在RA患者身上。这使得anti-CCP 测试成为RA的更强有力的线索。但是只有60%到70%的RA患者可以发现抗CCP抗体,即使在症状出现之前也可以存在。影像学检查可以进行X射线,超声或磁共振成像扫描以寻找关节损伤,例如关节内侵蚀性损伤 - 关节内软骨、滑膜、骨的损失 - 以及关节间隙的变窄。但是,如果成像测试没有显示不排除RA的关节损伤,这可能意味着疾病处于早期阶段并且尚未损伤关节。本文系李军医生授权好大夫在线(www.haodf.com)发布,未经授权请勿转载。
类风湿性关节炎(RA)是一种自身免疫性疾病,其中身体的免疫系统 - 通常通过产生免疫蛋白攻击细菌和病毒等外来物质,保护机体健康,但是错误地攻击关节。自体免疫攻击错误主要发生在关节滑膜,产生关节炎症,导致关节内和周围的肿胀和疼痛。滑膜产生的液体润滑关节保护营养关节软骨。如果炎症不受控制,它会损伤软骨,覆盖关节骨骼末端的弹性组织,以及骨骼本身。随着时间的推移,软骨会丢失,骨骼之间的关节间隙会变小。关节可能变得松散,不稳定,疼痛并失去活动能力。也可能发生关节畸形。关节软骨一旦损伤不能逆转,所以医生建议早期诊断和积极治疗来控制RA。类风湿性关节炎最常影响手,足,手腕,肘部,膝和踝的关节。通常是对称性。这意味着如果一个膝盖或手受到影响,通常另一个也是。由于RA还可以影响身体系统,例如心血管或呼吸系统,因此它被称为全身性疾病。系统性意味着“整个身体。”谁受类风湿性关节炎的影响?美国约有150万人患有类风湿性关节炎(RA)。女性患病的几率是男性的近三倍。在女性中,RA最常见于30至60岁之间。在男性中,它通常发生在晚年。患有RA的家庭成员增加患RA的几率,但大多数RA患者并没有家族史。
类风湿性关节炎(RA)治疗的目标是:阻断炎症反应;缓解症状;预防关节和器官损伤;改善关节功能和维护机体整体健康;减少长期并发症。要实现这些目标,医生将遵循以下这些策略:积极早期的治疗(Early,aggressive treatment):尽快减少或阻止炎症-越早越好。目标缓解(Targeting remission):RA的炎症称为疾病活动期,治疗的最终目标是阻断炎症反应缓解症状,即达到疾病炎症期的最小或实现无症状。实现这一目标的治疗策略称为目标缓解(Targeting remission)。严密控制(Tight control):将疾病活动降低到最低水平并维持住。研究表明,严格控制可以预防或减缓关节损伤的速度。RA的药物有不同的药物用于治疗类风湿性关节炎。有些主要用于缓解RA的症状,其它用于减缓或阻止疾病的进程并减缓阻止器官损伤。缓解症状的药物非甾体类抗炎药(NSAIDs)可通过非处方药和处方药获得。它们用于帮助缓解关节炎疼痛和炎症。NSAID包括诸如布洛芬,酮洛芬和萘普生钠等药物。对于患有胃溃疡或有胃溃疡风险的人,医生可能会开COX-2抑制剂的NSAID(例如,塞来昔布),对胃肠道更安全。这些药物可以通过口服或直接应用于肿胀关节周围的皮肤(作为贴剂或霜剂)。减缓疾病活动的药物皮质类固醇。皮质类固醇药物,包括泼尼松,泼尼松龙和甲泼尼龙,是有效的速效抗炎药物。它们可用于RA以控制潜在的破坏性炎症,同时等待NSAID和DMARD(下文)的应用维持生效。由于这些药物存在副作用的风险,所以要遵循短期、低剂量应用原则。DMARDs治疗作为改善疾病的抗风湿药物的首字母缩写,DMARDs是用于改变疾病进程的药物。传统的DMARD包括甲氨蝶呤,羟氯喹,柳氮磺胺吡啶,来氟米特,环磷酰胺和硫唑嘌呤。这些药物可以通过口服,自我注射或门诊输液给药。生物制剂这些药物是DMARD的一个子集。生物制剂可能比传统的DMARD更快地起作用,并且通过在医生办公室输注注射或给予。因为它们针对炎症过程中的特定步骤,所以它们不会像其他一些RA治疗那样消除整个免疫反应。在许多RA患者中,生物制剂可以减缓,改变或阻止疾病-即使其他治疗方法没有多大帮助。本文系李军医生授权好大夫在线(www.haodf.com)发布,未经授权请勿转载。
PAO髋臼周围截骨截骨的目的是更好地完善股骨头和髋臼窝的匹配。髋关节侧的截骨术称为“髋臼截骨术”。髋臼周围截骨术(PAO)是年轻成人最常采用的术式。也被称为Ganz截骨术或者Berness截骨,因为它是由Ganz教授在瑞士伯尔尼发明的术式。股骨侧的截骨术被称为“股骨截骨术”。复杂的髋关节畸形有时需要髋臼侧和股骨侧的双侧截骨。PAO髋臼周围截骨后,调整游离骨块到髋关节匹配更为良好的位置,扩大髋关节匹配度,减小髋关节软骨压力,延长髋关节寿命。截骨髋臼块重新定位后,螺钉固定,直到骨骼愈合,可以拆下螺丝,但这并非必需的。如同您想象的一样,这个手术技术很复杂,一般只在非常专业的髋关节中心,由有经验的髋关节医生亲自操作。手术后肢体的恢复锻炼过程需要3月,一般术后3-5日开始双拐或者助行器辅助行走锻炼,术后6周开始单拐锻炼,术后12周骨质稳定愈合后恢复正常生活工作。手术的成功率除了手术的技术外,PAO手术长期稳定的疗效还取决于:(1)35岁以下的患者。(2)虽然髋臼浅而且小,但股骨头和髋臼的匹配性好,也就是说股骨头曲率与股骨头的曲率相同时(通过髋关节外展内旋位X片确定),手术成功率高。(3)关节间隙窄于2mm厚(普通厚度约4毫米)时,做PAO软骨磨损可能过多了。MRI有助于更好地判断关节软骨的损害程度,对于PAO手术适应症有更好的指导。dGEMRICScan 和 T2 Mapping 是目前较为先进的关节软骨损伤及退变程度的无创检查手段,dGEMRIC全称为软骨延迟钆增强MRI,当dGEMRIC指数低时,PAO保持疗效的几率降低。dGEMERIC指数不是预测疗效的决定性因素,但可能有助于揭示何时关节表面软骨开始损害退变以及严重程度。半脱位的病例,因为头臼匹配度往往较差,术后疗效不必单纯的髋臼发育不良病例,但PAO截骨任然可能是减轻症状延长关节寿命的唯一选择。股骨侧截骨术股骨侧近端进行截骨,改变股骨头与髋臼软骨面的负重立线,使得股骨头和髋臼侧完好的软骨负重。美国的文献较少单独应用这一技术,担心影响将来的假体置换,但在欧洲较多有希望的报告。我们也有单独应用的病例,多是儿童少年患者,成人病例多与髋臼截骨结合应用,处理严重髋关节发育不良及股骨近端畸形病例。其它骨盆截骨术世界各地尚有一些其它类型的截骨方法处理不同类型的成人髋臼发育不良。在日本有较多的ROA髋臼周围截骨术式的报告,这是一种髋臼周围旋转或者半球途径的截骨方式。“三联截骨术”,“Chiari截骨术”,以及“Colonna手术”目前在国内都有医院在尝试应用。风险任何手术都有风险,PAO 截骨术也不例外存在如感染,出血,骨不完全愈合,神经或动脉损伤的潜在风险。此外,即使手术成功,髋关节还有随着时间推移逐渐发展为关节炎的可能。然而这个术式从GANZ教授1982年首次报道至今,已经有20-30年的大量实践和随访报告,已经被证实是青少年髋臼发育不良患者解除疼痛、延长挽救自体髋关节寿命,避免或者推迟假体髋关节置换,最为有效和安全的方法,没有其它。
群英荟萃 携手共论——第五届唐都创伤骨科论坛研讨会圆满成功2016年5月8日,由第四军医大学附属唐都骨科医院承办的第五届唐都创伤骨科论坛研讨会在西安成功举办,已连续举办四届的创伤骨科研讨会吸引了西部地区众多专家学者踊跃参与,会议由李军教授主持。本次大会邀请了上海第六人民医院副院长、中国医师协会骨科医师分会副会长、中华医学会骨科分会创伤学组副组长、中国医师协会创伤委员会副主任张长青教授,第四军医大学西京骨科医院院长、国际著名骨科及组织工程研究专家裴国献教授莅临并做大会致辞、演讲。西北地区如西京医院、红会医院、交大附属医院等十多位著名专家参与比例讨论及交流指导,三百余名来自西北各地区的代表参会讨论学习。会议一改往日的专家授课模式,结合第一、二、三、四届唐都创伤骨科论坛办会经验及研讨会广大参会同仁的反馈议建,本届论坛以病例讨论指导理论实践学习为主线,结合专题综述阐明诊疗新进展,与会专家、代表各抒己见,共同交流探讨。搭建省内、西北和全国的创伤骨科医生知识经验交流平台,共同推动创伤骨科事业的蓬勃发展。第四军医大学西京骨科医院院长、国际著名骨科及组织工程研究专家裴国献教授莅临并做大会致辞、演讲上海第六人民医院副院长、中国医师协会骨科医师分会副会长、中华医学会骨科分会创伤学组副组长、中国医师协会创伤委员会副主任张长青教授授课。会议围绕肱骨髓钉技术、髋部髓钉技术、股骨髓钉技术、 胫骨髓钉技术等四个专题进行病例讨论,内容涉及四肢骨折髓内钉技术的热点问题及新技术、新理论,强调临床实战操作经验分享。30余位来自西北各地区不同单位的代表参与病例分享,讨论专家自由提问,交流病例处理原则、技巧、经验、疗效评价及对策。会议现场李军教授组织会议讨论,现场气氛热烈,发言踊跃王海鹏医生病例分享汇报 专家自由提问与交流发言Workshop环节由唐都医院骨三科王海鹏、陈祝峰主治医师进行演示并结合临床实践工作经验悉心介绍,操作包括股骨顺行/逆行髓钉、胫骨髓钉、股骨近端髓钉和肱骨顺行髓钉,各地区医院代表积极操作、踊跃提问,受益匪浅。 现场Workshop手术模拟操作本次唐都创伤骨科论坛研讨会旨在通过病例讨论普及提高省内各骨科医生的临床规范操作技能及理论水平,系统学习近年创伤骨科热点问题的诊治理念及最新进展,全面提高西北创伤骨科医生自身业务技能,突出实用性及可操作性。会后唐都骨科医院表示将定期举办唐都骨科论坛暨规范化创伤骨科学习班,介绍现代创伤骨科理论和技术,为西北地区和全国的创伤骨科医生提供分享知识和经验的平台,并设想逐步将唐都创伤骨科论坛建设成一个国际骨科交流平台。为中国创伤骨科事业的蓬勃发展敬献绵薄之力! 撰稿人:王海鹏 高珊
2016年4月17日由解放军第四军医大学唐都骨科医院骨三科主办的第一届唐都足踝外科研讨会圆满落幕。会议邀请了南佛罗里达足踝矫形研究中心副教授Dr. Steinlauf给大家做专题演讲。来自西京医院、521医院、西安市中医医院、大兴医院等30余位医生参加会议,踊跃发言、积极讨论,会议现场学术气氛浓郁。Dr. Steinlauf在骨科15楼会议室学术讲Dr. Steinlauf讲演李军教授翻译。本次唐都足踝外科研讨会主要包括科室参观、专题演讲和病例讨论三个方面。参观科室过程中,李军主任与Dr. Steinlauf就距骨坏死、陈旧跟骨骨折病例查体、手术方案进行多次沟通讨论,科室医生全程认真学习。Dr. Steinlauf,梅玉峰,李军医生查房讨论手术方案。Dr. Steinlauf与梅玉峰、王波、张信医生观片。参观科室结束后,在会议室Dr. Steven D. Steinlauf就跟骨骨折手术的演变:外侧入路-经皮微创、跟骨关节粉碎骨折的一期距下融合、踝关节损伤的热点问题(下胫腓韧带、三角韧带、后踝损伤修复的时机)踝关节骨折病例做了专题演讲,讲授自己在使用施乐辉带袢钛板手术过程中的经验,并通过提问与回答环节帮助参会医生解决的疑惑与问题。病例讨论围绕跟骨骨折、距骨骨折、踝关节骨折展开,各医院医生代表积极分享,总结经验并提出问题,与Dr. Steven D. Steinlauf、李军主任进行讨论。会议结束,各参会医生纷纷表示受益匪浅,不仅学习到了足踝外科领域新的知识,同时还解决自己在手术过程中遇到的问题与困惑。梅玉峰医生主持病例讨论环节。 唐都医院骨三科在唐都骨科医院几代领导范清宇教授,马保安教授和钱济先院长培养下,已经形成以创伤骨科为基础,髋关节外科,足踝外科为特色的临床服务、基础研究、教育培训中心。此次会议旨在借Dr. Steven D. Steinlauf路演讲学的机会,通过跟骨骨折和踝关节骨折这两个交叉在创伤骨科和足踝外科的常见而又热点的论题,聚集陕西和西安的对足踝关节周围创伤和足踝外科专业医生,特别是年轻一代的创伤、足踝外科医生,欢聚一堂,积极直面国际专家,了解国际创伤骨折和足踝外科的进步发展,在陕西省足踝外科主委梁晓军主任的领导下,希望能够为陕西省足踝外科的发展尽一份微薄之力。
2015-06-18中国医师协会骨科分会中国医师协会骨科分会中国医师协会骨科分会微信号CAOS_China功能介绍中国医师协会骨科医师分会(CAOS)官方公众平台,骨科医师的港湾。骨科界最新官方信息,骨科界最全的继续教育,骨科界最大的交流社区。共享骨科一手资讯,同看医师喜怒哀乐。投稿联系邮箱:secretary@caos-china.org。导语美国骨科医师协会(AAOS,American Academy of Orthopaedic Surgeons)2016年国际手术技能奖学金项目报名活动现已启动。下文由2010年度此项目获奖者李军医师根据游学期间的所闻所感总结得出,这位来自第四军医大学唐都医院的骨科副主任将所获奖学金应用于关节置换技术尸体操作学习和手术观摩之中,通过在学习后的出色工作和技术传播,于2014年再次获得AAOS设立的IEL奖项奖学金。李军医师希望通过此次总结能帮助大家更多的了解这个项目,鼓励我们的中青年骨科精英积极申报,让更多的中国医生成为这个项目的ALUMNI,为中国骨科积极融入世界骨科增添人气。 Hello, AAOS International Scholarship alumni, colleagues and friends, My name is Jun Li.It was great honor to be a 2010 International Scholarship recipient, and a 2014 IEL Scholarship recipient. I am very happy to share my AAOS International scholarship visiting experiences which brought great inspirations to my future career.The first visit of my 2010 program took place in the AAOS-AAHKS Hip & Knee Replacement Orthopaedic Learning Center at Rosemont, IL. The two-day cadaver practicing course with lectures offered by experts provided excellent opportunities for me to learn about developments in Hip & Knee primary and revision replacement. I remember that Dr. William A. Jiranek, the director of the course, kindly presented the reading and CD materials to me. Then I observed at Kaiser Permanente, Oakland Medical Centre for four days following Dr. Stefano Bini. I was very impressed with Dr. Bini’s broad view of world orthopaedics. Dr. Bini was also my first mentor leading me to Joint Arthroplasty practicing. Short Presentation to Colleagues about “Orthopaedics in China”Great experiences and memories with Dr. Bini and colleagues at Kaiser Permanente, Oakland Medical Centre2012 AAOS International Scholarship Program Alumni Meeting2015 AAOS International Scholarship Program Alumni MeetingAfter the AAOS Surgical Skill Scholarship program, I invited Dr. Stefano Bini and Dr. Ronald Wyatte to 1st Tang Du Orthopaedic Joint Symposia to perform arthroplasty surgeries. They also presented their publications at the 2011 Shaanxi Provincial Orthopaedic Association Annual Meeting, offering international elements to the conference. Moreover, I invited Dr. Andrew Park (Resident in San Francisco Orthopaedic Residency Program, CA, USA) to visit Tang Du Hospital, Feb. 8-28, 2011. We organized multiple meetings which allowed Chinese medical students and young orthoapedic surgeons to practice their oral English with Dr. Park by exchanging ideas on a wide range of topics, including the differences between being orthopaedic professionals in China and that in the US. Dr. Domagoi Delimar, one of the AAOS International alumni attended our 2nd Tang Du Orthopaedic Joint Symposia, as published on the AAOS International Blog and AAOS International Facebook .The 1st Tang Du Orthopaedic Joint Symposia. I really love the idea of presenting the symbols of the host and guest cities on the manual. (Chang An Tower and the Golden Gate Bridge).English salon for young orthopaedic surgeons in Xi’an community, (Dr. Park, left six; Dr. Jun Li, left seven)The 2nd Tang Du Orthopaedic Joint Symposia, (Dr. Domagoi Delimar, left six; Professor Hari Reddi, left seven; Dr. Jun Li, right three)My research mentor, Professor Hari Reddi from UC Davis, lecturing on "Today's basic research is the final treatment solution of DDH"The two orthopaedic educational programs in Tang Du Orthopaedic Joint Symposia and Tang Du Orthopaedic Trauma Symposia have been held annually since 2011. Both conferences have become high-ranking national orthopaedic educational programs. Over 500 orthopaedic surgeons attended the 4th Tang Du Orthopaedic Trauma Symposia held in Xi’an, China on April 24, 2015. The 4th Tang Du Orthopaedic Trauma Symposia held in Xi’an, China on April 24, 2015. Lecturers were sharing clinical casesThe 4th Tang Du Orthopaedic Trauma Symposia held in Xi’an, China on April 24, 2015. Audiences were involved in the case discussion. I was honored to be selected as the AAOS 2014 IEL scholarship recipient. Ms. Anna Gurevich designed the excellent visiting program for me from 10 May to 18 May at Midwest Orthopaedics at Rush University Medical Center with Dr. Craig Della Valle. From 20 May to 22 May, my observership shifted to be with Dr. John Clohisy at Barnes Jewish Hospital/Washinton Universiry Orthopeadics at St. Louis, and then with Dr. Hany S. Bedair at Department of Orthopaedic Surgery, Massachusette General Hospital/Harvard Medical School. Finally, from Tuesday to Wednesday, 26-27 May. My observership was with Dr. Hany S. Bedair and Dr. William Healy at Newton Wellesley Hospital.This observership program was designed based on my professional needs and clinical interests, focusing on the cutting-edge techniques in Hip & Knee Joint surgery. My OR observation included partial knee replacement, hip resurfacing arthroplasty, mini-incision hip & knee replacement, revision surgery of hip & knee, PAO Osteotomy, Surgical Dislocation, hip arthroscopy for hip labrum repairing, and arthroscopic surgical technique for hip impingement.My mentors and hosts were Dr. Della Valle, Dr. Clohisy, and Dr. Bedair. They are all well-known hip & knee specialists who established pioneering research programs such as long survivorship of arthroplasty, preservation hip surgery. During the eighteen-day program, I took part in 30 cases of surgical observation and discussion. I observed the detailed surgical techniques, and learned solutions to the technical traps which I encountered during my practice. This 18-day observation was totally accomplished, and went beyond my expectation as I got training on those cutting edged surgical techniques and became familiar with US post-medical-education training system, learned about the U.S. healthcare system, hospital administration and protocols, operating room teamwork, and clinical research program establishment. We also talked about the future conference visiting and clinical research co-operation possibilities. Thanks to AAOS International Scholars Program, thanks to Ms. Anna Gurevich and Ms. Amanda Decker about all the visiting programs, travel information, accommodation and daily tentative which made my IEL scholarship visiting accomplishment comfortable and enjoyable.With my mentor & host, Dr. Dr. Craig Della Valle at Rush University Medical CenterWith Dr. Erdan Kayupov at motion analysis lab at Rush University Medical University.With my mentor & host, Dr. John Clohisy at Barnes Jewish Hospital/Washinton Universiry Orthopeadics at St. LouisWith my mentor & host, Dr. Hany S. Bedair, at Ether Dome. William T.G. Morton made history on October 16, 1846 in Massachusetts General Hospital’s surgical amphitheater, now known as the Ether Dome, as he demonstrated the first public surgery using anesthetic (ether)With my mentor & host, Dr. William Healy at Newton Wellesley HospitalWith Dr. Neil Dion who offered me lots of personal assistance at MGH Joint Arthroplasty.I love my career as an orthopaedic surgeon, and I like traveling, bicycling, and jogging in my spare time. I drove from Boston to Los Angles as a vacation tour with my wife after my Scholarship observation. Along the journey I witnessed the beauty of nature and experienced different lifestyles in the US, which was exciting and nourishing.In China I lead a young orthopaedic team group with 45 beds, 13 Orthopaedic faculty and Staffs, and 25 members in the Nursery Unit. Over 1000 surgeries are performed annually, and about 70% of them are trauma and 30% are joint replacement. My clinical practice focuses on joint arthroplasty and hip preservation surgery. I will continue to host the Tang Du Orthopaedic Joint Symposia and Tang Du Orthopaedic Trauma Symposia annually as I love international communication. Moreover, I am an active committee member of Chinese Orthopaedic Association (COA), Chinese Association of Orthopaedic Surgeon (CAOS), and SICOT China. If you are interested in international programs, please do not hesitate to contact me. I will be very happy to assist and to be the bridge between you and Chinese orthopaedics surgeons.作为AAOS的国际合作伙伴,中国医师协会骨科医师分会(CAOS)诚挚的希望各位国内的骨科医师可以积极参会、参与国际交流。