Die laterale OSG Instabilität- Wann und Wie operieren?

Ligamentous injuries of the ankle joint are one of the most common injuries. Mostly the lateral ligament complex is injured. A conservative functional therapy is initial recommended in most patients. Despite the generally good results 10 to 30% have residual symptoms after a sprain and often show a chronic ankle instability. Ligamentous instabilities should be treated operatively. The anatomic primary reconstruction of the ligaments with local tissue, possibly with augmentation with local tissues, allografts or suture tapes might be indicated in selected cases. Arthroscopic techniques for chronic ankle instability are still evolving but did not show superiority to open techniques, yet.     

Orbital Granular Cell Tumor in a Patient with Churg Strauss Syndrome: The Importance of Biopsy

A 65-year-old woman presented with a long standing, progressive exophthalmos of the right eye. Her medical history was significant for Churg Strauss syndrome, and was treated with immunosuppressive therapy. She had undergone two previous orbital biopsies showing inflammatory reactive lymphoid hyperplasia. A diagnosis of orbital inflammation in Churg-Strauss syndrome was suspected, and the immunosuppressive therapy was increased. Because of the lack of response to therapy, a further biopsy was performed, by lateral orbitotomy approach. Biopsy of the mass revealed a granular cell tumor composed of S-100 positive cells with an acidophilic granular cytoplasm and peripheral lymphocytic infiltration. A granular cell tumor, which is very rare in the orbit, should be considered in the differential diagnosis of orbital tumors, and if suspected, an excisional biopsy must be undertaken. Typical hystopathological aspect of the granular cell tumor is characterized by the presence of S-100 positive closely packed polygonal cells with a granular cytoplasm.     

蛛网膜下腔麻醉正中穿刺与侧入穿刺对患者术后腰痛发生情况影响的临床研究

目的:研究蛛网膜下腔麻醉正中穿刺与侧入穿刺对患者术后腰痛发生情况的影响。方法:选择在我院接受椎管内麻醉的患者作为研究对象,随机分为给予侧入穿刺椎管内麻醉的观察组和给予正中穿刺椎管内麻醉的对照组,观察麻醉后腰痛发生例数、疼痛程度。结果:观察组发生腰痛的例数、中国整脊颈腰痛评分、JOA下腰痛评分以及NRS疼痛评分均明显低于对照组。结论:侧入穿刺入路椎管内麻醉能够有效减少腰痛发生率、缓解腰痛程度,具有临床价值。     

跟骨骨折术后切口不愈的原因分析

目的：分析闭合性跟骨骨折切开复位内固定术后切口愈合不良的原因。方法2009年5月～2013年5月间，我科有61例（78侧足）跟骨骨折患者行跟骨外侧L型切口，其中53例男性（67侧足），8例女性（11侧足），年龄21～57岁（平均39岁）。56例（71足）是高处坠落伤，5例（7足）是交通伤。手术时间为伤后3h～22d，平均9d。骨折根据Sanders分型，Ⅱ型34足，Ⅲ型31足，Ⅳ型13足。对这些患者的全身状况、手术时机、手术方法、内固定物的选择、手术后处理等情况进行回顾性分析，并对患者进行术后随访，随访0.5～3年，平均随访时间20个月。结果有7例患者（9侧足）发生切口边缘坏死或裂开，占11.5%。经相应治疗，均获得愈合。结论跟骨骨折术后切口愈合不良的发生与患者全身状况、合并的基础疾病、跟骨的解剖特点、手术的时机选择、内固定物的选择、手术操作及术后处理等多种因素相关。     

Clinical usefulness of multiplex PCR-lateral flow for the diagnosis of orthopedic-related infections

Abstract

Objectives: Polymerase chain reaction (PCR)-based assays are being increasingly used for the diagnosis of orthopedic-related infections. Unfortunately, classical PCR requires imaging devices that are expensive and complex. We previously developed the PCR-lateral flow (PCR-LF) method, which does not require any additional imaging device. In the present study, the objective was to determine whether PCR-LF tests could be used to effectively diagnose orthopedic-related infections.

Methods: In this study, we used PCR-LF to diagnose common causes of orthopedic-related infections and compared the results to those from conventional bacterial cultures of the same samples.

Results: Notably, for 228 synovial fluid or pus specimens, the sensitivity and specificity of bacterial cultures were 53.5% and 97.7%, respectively, compared to 61.6% and 89.9% for PCR-LF. Although the difference in sensitivity between bacterial cultures and PCR-LF was not significant, when our analysis was limited to cases with suspected periprosthetic joint infection, the sensitivity of PCR-LF (66.1%) was superior to that of bacterial cultures (42.9%).

Conclusion: This study indicates that PCR-LF is a useful method for diagnosing orthopedic-related infections.