【专题访谈】王晋东医生 “快速康复外科”让老年患者有更多获得感http://www.wtoutiao.com/p/209fhML.html“快速康复外科”让人工膝关节置换术患者有更多获得感
1、什么是“快速康复外科”? “快速康复外科”1997年由丹麦Henrik教授首次提出,之后加以推广,开始应用在普外泌外等其它外科领域,现在已经应用到关节外科。 “快速康复外科”在人工膝关节置换术中的应用,既是一种理念也是一种技术,其通过优化手术操作技能和围手术期管理,最终让患者有更多获得感,包括:获得最安全的治疗,最好的手术疗效,最快的康 复,最满意的就医体验和生活质量。提高患者满意度是“快速康复外科”的终极目标之一。 通过引入“快速康复外科”,目前我们的人工膝关节置换手术患者基本可 以做到以下几点:治疗康复全程无痛;术后第一天拨除尿管和引流管借助助行器下地活动,部分患者不放引流管;术后第二天在家属陪伴下可以蹲便,术后5-7天不借助任何辅助器具步态近乎正常地 自由行走;术后一周左右出院。2、详情请点击以下链接了解http://www.wtoutiao.com/p/209fhML.html
亲爱的患者朋友: 感谢您在此留言。感谢您的理解、信任、肯定,还有关心。很抱歉,不能一一回复所有患者的留言,但我都会细心体会,用心关注,并“感受您的就医感受”,以此来鼓励自己今后做得更好。祝大家开心、健康、平安!
直接前方入路(DAA)人工全髋关节置换手术让患者受益
许多患者询问如何预约挂号。1、电话:拨打0351-114,根据提示一步步完成即可。请各位患者就诊前一定携带以前的所有就诊资料,特别是影像学资料,有时候就不必要再花钱做检查了。
关节炎非常普遍,但我们对它的理解并不深刻。实际上,“关节炎”不是一种单一的疾病,它经常非正式地用来指关节疼痛或关节疾病。据统计,有超过100种不同类型的关节炎和相关的疾病,不同年龄,不同性别,不同种族的个体都可能也一定会患上关节炎。该疾病在女性中非常常见,随年龄增长更容易发生,是主要的致残因素。关节炎主要累及的部位有髋、膝、手指及脊柱,症状通常包括肿胀、疼痛、僵硬、活动受限和畸形。症状时轻时重,时好时坏,可能维持数年,但也可能进展加重。严重的关节炎能够导致慢性疼痛,日常活动受限,行走或者上下楼困难。关节炎可能引起永久的关节改变,这些变化可能是明显的,比如指关节结节性肿大,但经常这种破坏性变化只能在X光片检查时才能发现。某些类型的关节炎不仅影响关节,也会影响心脏、眼睛、肺、肾脏和皮肤。关节炎主要有以下几种类型退变性关节炎又叫骨性关节炎,是最常见的关节炎类型。当覆盖在骨质表面的平滑且有减震作用的软骨开始磨损,关节就会出现不适。软骨磨损严重,骨与骨摩擦的时候,就会引起疼痛,肿胀和僵硬。随病情进展,关节不再强壮有力,疼痛可能演变为慢性疼痛。风险因素包括超重、家族史、年龄增长、和曾经外伤史(比如半月板、前交叉韧带损伤等)。轻中度的关节炎可以尝试以下方法:注意休息;调整生活方式;物理治疗(冰敷或热敷);规律的锻炼;维持健康的体重;增强关节周围的肌肉力量;应用辅助装置(手杖、拐杖或助行器);服用止痛药物或抗炎药物;避免过度的重复动作(持续反复深蹲等)。如果关节症状严重,引起活动明显受限并且严重影响生活质量,以上治疗方法可能有帮助,但需要考虑人工关节置换手术。合理运动、维持健康的体重、避免外伤和重复的损伤性活动,以及规避不健康的生活方式,一定程度上能够预防骨性关节炎的发生。炎症性关节炎 健康的免疫系统有保护作用,它产生内在的炎性反应来去除感染,防止疾病。但是免疫系统可能会犯错,错误地攻击关节,引起无法控制的炎性反应,潜在地引起关节损害,有时也损害内在器官,眼睛和身体的其它部位。类风湿关节炎和牛皮癣关节炎就是例子。研究认为基因和环境因素综合作用能够激发自身免疫。在某些有遗传因素的个体中,吸烟就是激发类风湿性关节炎的一种环境风险因素。对于自身免疫性和炎症性关节炎,早期诊断和积极治疗至关重要。降低、延缓疾病的活动性能够帮助减少甚至阻止永久性的关节损害。可以通过服用一种或多种药物来达到缓解症状的目的。治疗该疾病的目标就是减轻疼痛,改善功能和阻止进一步的关节损害。感染性关节炎 细菌、病毒或真菌可以进入关节,激发炎性反应。比如,食物污染或食物中毒时,沙门氏菌或者志贺氏菌可能会引起关节感染;性传播性疾病,则关节感染可能会是衣原体或者淋病感染;共用针头或输血的血液间传播感染,则会引起关节丙型肝炎感染。许多病例,及时使用抗生素治疗可以清除关节感染,但有时关节炎会迁延为慢性。代谢性关节炎最常见的是痛风性关节炎。许多食物和人类细胞中存在嘌呤类物质,当嘌呤类物质代谢时,就会产生尿酸。一些人因为尿酸产生过多或者身体不能快速清除尿酸,体内尿酸水平较高。尿酸在体内聚集,在关节内形成针尖样结晶体,导致关节突然出现剧烈疼痛,引起痛风发作。痛风时好时坏,如果尿酸水平不能降低,痛风就会变为慢性,引起持续性关节疼痛和功能受限。关节炎的诊断关节炎的诊断往往从就诊初级医生开始。患者就诊后,医生开始体格检查,可能做相关的血液检查和影像学扫描来帮助确定关节炎的类型。如果诊断不明确,或者是炎症性关节炎,应该就诊关节炎专科医生或者风湿病学专家。骨科医生主要通过手术来治疗终末期关节疾病,包括应用人工关节置换手术。当关节炎影响到身体其它系统或其它部位,其他学科的专家,比如眼科、皮肤科或口腔科专家,应该参与到治疗中来。如何应对关节炎?关节炎是一种常见的不被准确理解的疾病。我们可以采取许多措施来保护关节功能,维持关节运动特性,享受高质量的生活。正确了解该疾病,选择合理的治疗方法,养成科学健康的生活方式和行为习惯,投入时间做合适的体育锻炼并维持健康的体重至关重要。如果你遭受关节疾病的困扰,不能收到理想的治疗效果,建议就诊关节专科医生。
We know that a diet low in processed foods and animal fats and high in colorful produce, whole grains and omega-3s can helpalleviate arthritis symptoms. Now promising new research suggests that allium vegetables and broccoli may one day play a rolein preventing or treating osteoarthritis, or OA.我们知道低加工、低动物脂肪、色彩亮丽、全谷类和富含欧米茄-3s食物有助于减缓关节炎症状。现在新的热点研究结果显示,葱属类蔬菜和椰菜花有朝一日在预防或治疗骨关节炎方面扮演重要角色。GarlicIn a study published in BMC Musculoskeletal Disorders, researchers from King’s College in London compared X-rays and diets of 1,000 women. Those who ate plenty of fruits and vegetables had less early evidence of hip OA, but the evidence was most striking among those who regularly consumed garlic, onions, leeks and other vegetables in the allium family. The researchers also studied a compound in garlic, diallyl disulphide, and found that it limits the amount of cartilage-damaging enzymes in human cells in the laboratory. However, says Frances Williams, PhD, the study’s lead author, “I would recommend that all patients with OA eat a healthy diet, but I wouldn’t at this stage suggest adding more garlic or supplements.”大蒜 来自英国女王大学的研究者比较了1000名女性的饮食和X光片情况后, 在《BMC肌肉骨骼疾病》上发表了研究报告。那些食用大量蔬菜水果的受试者很少出现早期的髋关节骨关节炎迹象, 而且在那些规律食用大蒜、洋葱、韭菜以及其他葱属类蔬菜的受试者中表现更为明显。这些研究者在实验室里还研究了大蒜中的一种化合物-己二烯二硫化物,发现它能够限制人类细胞中的软骨损害酶的数量。但是,这项研究的带头人Frances Williams 博士说,“我建议所有的骨关节炎患者要健康饮食,但我不建议现在就食用更多的大蒜或大蒜补充剂”Broccoli Another study done in the U.K. found that a compound in broccoli,sulforaphane, may prevent cartilage from breaking down, possibly by blocking the action of cartilage-degrading enzymes,says Ian Clark, PhD, a professor in the University of East Anglia’s School of Biological Sciences.Clark conducted the work on cells in the lab and is about to lead a three-year study of some 30 people on the road to joint replacement. He hopes to learn whether, when broccoli is eaten regularly, “sulforaphane actually gets into the joint and cartilage at appropriate doses to display activity [in the body],” he says.Whatever the future findings of these veggies’ impact on arthritis, it’s a good idea to get more of them now – raw or cooked, alone or as ingredients in your favorite dishes. They’re loaded with flavor, fiber and antioxidants.椰菜花 英国的另一项研究发现椰菜花中的一种化合物-萝卜硫素可能能够预防软骨的破坏。东安格利亚大学生物科学学院教授、Ian Clark博士认为萝卜硫素可能通过抑制软骨降解酶的活动来预防软骨的破坏。他在实验室中开展了细胞方面的研究,并将对30名正考虑关节置换的患者进行为期3年的研究。通过这项研究,他希望知道规律食用椰菜花后,是否萝卜硫素真正地进入了关节和软骨里,以合理的浓度在体内发挥作用。不管以后这些蔬菜对关节炎的影响的研究结果如何,现在较多食用它们是一个好主意 —不管是生食还是熟用,单独食用还是只是你菜系中的一部分。他们可口,而且富含维生素和抗氧化剂。以上英文引自ARTHRITIS TODAY作者:Larry Lindner and Lori Solomon 本人翻译
Osteoarthritis (OA) was once considered a disorder in which joints simply wore out-- the unavoidable result of a long and active life. But recent research has shown that OA is a complex process with many causes and may even be more than one disease. It is not an inevitable part of aging experts say, but rather the result of a combination of factors, many of which can be modified or prevented. Here is what doctors recommend to reduce the risk of OA or delay its onset.骨性关节炎曾经被认为是一种不可避免的单纯的关节磨损性疾病,是长期积极活动的结果。但是,最近研究表明骨性关节炎是多因素影响的复杂过程,甚至可能不仅仅是单一的疾病。它不随年老而必然发生,而是多种因素综合作用的结果,其中的许多因素我们能够调节和预防。这里便是医生的一些建议,可以减少或者推迟骨性关节炎的发生。Maintain A Healthy Weight 保持健康的体重Excess weight is one of the biggest risk factors for OA – and for good reason. Extra pounds put additional pressure on weight-bearing joints, such as the hips and knees. Each pound you gain adds nearly four pounds of stress to your knees and increases pressure on your hips six-fold. Over time, the extra strain breaks down the cartilage that cushions these joints.有充分的理由说明,超重是骨性关节炎最大的风险因素之一。额外的体重给负重关节施加了多余的压力,比如髋关节和膝关节。体重每增加一磅就会给膝关节和髋关节分别增加接近四倍和六倍的应力。久而久之,超额的应力就会毁坏软骨,而软骨对关节有缓冲保护作用。But mechanical stress is not the only problem. Fat tissue produces proteins called cytokines that promote inflammation throughout the body. In the joints, cytokines destroy tissue by altering the function of cartilage cells. When you gain weight, your body makes and releases more of these destructive proteins. Unless you are very overweight, losing even a few pounds can reduce joint stress and inflammation, cutting your risk of OA in half.但是机械应力不是唯一的问题。脂肪组织产生细胞因子,会激发全身的炎症反应。在关节里,细胞因子通过改变软骨细胞的功能而破坏软骨。当你体重增加时,你的身体会产生和释放更多的这些破坏蛋白。除非你相当地超重,否则,即使体重减轻几磅也能减少关节应力和炎症反应,把发生骨性关节炎的风险减少一半。Control Blood Sugar 控制血糖The latest research suggests that diabetes, which affects the body's ability to regulate blood sugar (glucose), may be a significant risk factor for OA. That's because high glucose levels speed the formation of certain molecules that make cartilage stiffer and more sensitive to mechanical stress. Diabetes can also trigger systemic inflammation that leads to cartilage loss. The newly discovered connection between diabetes and joint damage may help explain why more than half of Americans diagnosed with diabetes also have arthritis.最近的研究显示糖尿病,由于影响身体调节血糖的能力,可能是骨性关节炎的一种显著风险因素。因为高血糖加速了某些化学分子的形成,这些分子会使软骨变硬,对机械应力就变得更为敏感。糖尿病还能够激发全身性炎症反应,从而导致软骨丢失。最新发现在糖尿病和关节损害之间的关系有助于解释为什么超过一半的美国糖尿病患者同时患有骨关节炎。Get Physical 善于锻炼Physical activity is the best available treatment for OA. It's also one of the best ways to keep joints healthy in the first place. As little as 30 minutes of moderately-intense exercise five times a week helps joints stay limber and strengthens the muscles that support and stabilize your hips and knees. Exercise also strengthens the heart and lungs, lowers diabetes risk and is a key factor in weight control.体育活动是骨性关节炎最为有效的治疗方法,也是保持关节健康首要的最好方法之一。每周五次,每次30分钟的中强度锻炼有助于保持关节的柔韧性,使肌肉变得强壮,而肌肉能支撑和稳定你的髋关节和膝关节。锻炼还能增强心肺功能,降低糖尿病风险,是控制体重的一个关键因素。You don't have to join a gym or have a formal workout plan to benefit. Walking, gardening – even scrubbing floors – count. But the greatest results come with a consistent and progressive exercise program adjusted for your age, fitness level and the activities you enjoy most.不是必须去健身房或者制定规范的健身计划才能受益。步行,园艺活儿甚至擦擦地板都有效。但是最好的运动效果与持续的渐进性的锻炼计划相伴而生,而且锻炼计划要与你的年龄、健康水平和你最喜欢的活动方式相适应。No matter what type of exercise you choose, listen to your body. If you have pain after a workout that persists more than an hour or two, do less next time and take more breaks. To avoid injury, go slow until you know how your body reacts to a new activity and don't repeat the same exercise every day.不管你选择何种运动方式,要视你的身体反应而为。如果运动后出现疼痛,持续时间超过一小时或者两小时,下次就要减少运动量,多休息。为了避免损伤,行动要慢直到你明白你的身体对一项新的运动的反应如何;不要每天重复同样的运动。Play It Safe 注意安全,小心行事Because cartilage doesn't heal well, an injured joint is nearly seven times more likely to develop arthritis than one that was never injured. Fractures, dislocations – even ligament tears and strains – can significantly increase the risk of OA, which occurs in about 50 percent of people who experience a traumatic injury.因为软骨损伤后愈合不好,(软骨)损伤的关节可能发生关节炎的概率是没有损伤关节的将近七倍。骨折、脱位,甚至韧带撕裂和拉伤都能显著增加骨性关节炎发生的风险,有过创伤的患者大约50%会发生骨性关节炎。Although injuries aren't always avoidable, it pays to protect your joints. If you play sports, wear protective gear, such as joint padding for soccer or hockey. And make sure any baseball field you use has break-away bases. At home or work, use your largest, strongest joints for lifting and carrying and take breaks when you need to. After an injury, maintaining a healthy weight can help guard against further joint damage.尽管损伤不是总能避免,保护你的关节却很值得。如果你体育运动,要穿戴上保护性装置,比如踢足球或者玩冰球时,配戴上关节衬垫。确信你在棒球场上有挣脱装置。在家里或工作中,抬举东西时会使用你最大的、最强壮的关节,如果需要休息时就要注意休息。关节损伤后维持健康的体重能够帮你保护关节避免进一步损伤。Choose A Healthy Lifestyle 选择健康的生活方式Some risk factors for OA can't be changed. For instance, OA becomes more common as people age, though why this occurs isn't clear. One idea is that the number of cartilage cells simply diminishes over time. Because more women than men develop OA, especially after age 50, lower estrogen levels after menopause may also play a role.一些骨性关节炎的风险因素不能改变。比如,随着年龄增长,骨性关节炎会变得更为普遍, 尽管并不清楚它为什么会发生。 一种观点认为是因为随着时间推移,软骨细胞的数量会减少。因为更多的女性比男性容易患骨性关节炎,特别是50岁以后,因此,更年期后较低的雌激素水平可能也起一定的作用。In addition, some people inherit genes that make them more susceptible to OA. In one study, variations in the gene for a cytokine associated with inflammation and cartilage loss doubled the risk of severe arthritis. It's important to remember, though, that arthritis is a multifactorial disorder and simply inheriting a gene doesn't mean you will develop it.另外,一些人由于遗传了基因片段,使他们更易患上骨性关节炎。一项研究表明,与炎症和软骨丢失相关的细胞因子基因的变异会使患上严重关节炎的风险翻倍。但是,明白关节炎是多因素决定的疾病非常重要,单纯遗传基因并不意味着你就会患上关节炎。Ultimately, the best defense against any disease, including OA, is a healthy lifestyle. The way you eat, exercise, sleep, manage stress and interact with others, and whether you smoke or drink can have a tremendous influence not just on overall health, but also on the health of your joints.最后,预防任何疾病,包括骨性关节炎,的最好方法是养成健康的生活方式。 你的饮食习惯、锻炼方式、睡眠情况、处理压力和与人相处的能力、以及是否吸烟或饮酒不仅对你的整体健康,而且对你的关节健康都有巨大的影响力。以上英文原文引自Arthritis Foundation 作者 Linda Rath 本人翻译
Just because the trees are bare and there’s a chill in the air doesn’t mean you have to forgo your daily walks outside for the dreaded treadmill. Anything but! In fact, outdoor walking during winter may have surprising benefits for people with arthritis. Walking in winter air can:只是因为光秃秃的树木,空中弥漫着一丝寒意,并不意味着你就一定要放弃日常的户外漫步,而转向单调乏味的跑步机运动。 一定不要!事实上,冬日里户外漫步对于关节炎患者而言,可能会有惊人的益处。冬日里户外漫步能有以下功效:Keep bones strong. Like bears, people tend to hibernate during the winter and, as a result, get too little sunlight, explains Lynn Millar, PhD, a physical therapist and professor at Andrews University in Barrien Springs, Mich. That's too bad for bones. Sun exposure triggers vitamin D production in the skin, and bones need the “sunshine vitamin” to make the body absorb bone-strengthening calcium properly. Not getting outside during winter months slows down production and decreases the body’s store of vitamin D.保持骨骼强壮。 Andrews大学教授,理疗专家Lynn Millar博士解释说,冬日里人们象熊一样倾向于避寒,结果就是几乎得不到阳光。这对于骨骼来说,糟糕透了。晒太阳能够激发皮肤里维生素D的产生,骨骼需要这样的“阳光维生素”,来使身体合理吸收令骨骼强壮的钙元素。冬日里几个月足不出户会减缓维生素D的产生,并减少身体里维生素D的储存。“Vitamin D is important for keeping bones strong; it’s particularly important for people with arthritis who take corticosteroids because they have an increased risk of brittle bones,” says Millar. Going for a winter walk and getting 15 minutes of sun on your face and hands two to three times per week should suffice for getting enough sun for vitamin D production.Millar 说:“维生素D对维持骨骼强壮非常重要;由于增加了骨折的风险,对于服用皮质激素的关节炎患者尤为重要。”冬日户外漫步,每周两到三次,每次15分钟,让你的面部和双手日光浴,应该能够获得足够的阳光以便产生维生素D。Improve mood. Sunlight and just being outdoors can do wonders for lifting your mood, says Millar. Spending time with friends walking can have positive effects on mood and decrease pain. A University of Washington in Seattle study of 112 women aged 19 to 78 shows that women who took a brisk, outdoor walk for 20 minutes daily had better mood, higher self-esteem and an improved sense of well-being at the end of the eight-week study. Winter walking could provide an effective, easy-to-stick-with therapy for mild-to moderate depression, say the researchers, especially for those who experience side effects from prescription treatment options.愉悦心境。呆在户外,享受阳光,能够让你出奇地情绪高昂,精神振奋,Millar说。和朋友一起散步对心情有积极的影响,还能够减轻疼痛。华盛顿的一所大学在西雅图对112名19岁至78岁的女性进行研究,8周末的研究结果表明每天精神饱满地户外散步20分钟的女性心情较好,有更高的自尊心,幸福感提升。研究人员说,冬日漫步为轻度到中度抑郁症的患者,特别是那些由于处方药物治疗带来副作用的人,能够提供一种易于维持治疗的有效方法。Motivate. You are more likely to complete a workout on a walking route if you walk outdoors, simply because you need to return home or to your car, says Millar. On a treadmill, however, you can hit ‘stop’ as soon as boredom strikes.激励作用。 Millar说,如果你户外散步,仅仅是因为你需要返回家或者你的车里,因此,你更容易完成散步路线的锻炼。但是,如果是跑步机的话,厌倦情绪一产生,你就有可能随时停下来。Burn calories. Outdoor walking through the park or around the neighborhood on a cold day won’t burn any more calories than walking on a warm summer day, but walking in the snow will. “You expend more energy because it’s harder to move your feet in the snow, and you lift your legs a little higher,” she explains.消耗热量。 寒冷的日子里,在公园或街坊周围散步不会比在温暖的夏日里消耗更多的热量,但是在下雪天却会。“因为在雪中移动你的脚步会很艰难,你会把腿抬的更高,你就需要消耗更多的能量,”Millar 解释说。以上英文原文引自Arthritis Foundation,作者:Denise Lynn Mann. 本人翻译。
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