Intraoperative complications in temporomandibular joint arthroscopy: A retrospective observational analysis of 899 arthroscopies

This study aims to describe intraoperative complications in temporomandibular joint arthroscopy in patients with Wilkes stage II, III y IV. An analytic observational retrospective study. Inclusion criteria were patients who had no improvement with conservative treatment diagnosed as Wilkes II stage to Wilkes stage IV, and no previous TMJ surgery. Exclusion criteria were disc perforation observed by arthroscopy. Data collected from 458 patients (899 arthroscopies). Of this population, 772 (85.8%) arthroscopies correspond to women, and 127 men (14.1%). Of the sample evaluated, 368 (40.9%) were arthroscopic without discopexy, and 531 (59%) were arthroscopic with discopexy using resorbable pins. In total, 330 complications (36.7%) were found, of which 293 (32.5%) were implicated with iatrogenic damage to the anatomy, and 36 (4%) were associated with some instrument failure. Of this total number of complications, 191 (51.9%) of 386 corresponded to the arthroscopy without discopexy group and 138 (25.9%) of 531 corresponded to the arthroscopy with discopexy group. These study data suggest that the main complications were irrigation fluid extravasation (p = 0.000), and intra-articular bleeding (p = 0.001) followed by pin problems (p = 0.001) in cases of arthroscopies with discopexy. Within the limitations of the study it seems that the learning curve has an important influence on the occurrence of complications. At the beginning of the learning curve, complications are more related to anatomy. Afterwards, the rate of complications decreases but they are more related to the instruments used in advanced techniques. Therefore, proper training and a wide learning curve can reduce the risk of complications and if any occur, more timely management could be given.     

会阴保护方法在预防髋关节镜术中压力性损伤的应用效果

目的 对比新型泡沫敷料联合常规棉垫和单纯采用常规棉垫两种会阴保护方法预防髋关节镜术中压力性损伤的应用效果。方法 选取2017年7月至2018年7月在我科行髋关节镜手术的80例股骨髋臼撞击综合征病人，采用随机数字表法分为观察组和对照组，每组40例。观察组病人会阴部在使用手术室常规棉垫的基础上加用新型泡沫敷料预防压力性损伤，对照组病人会阴部位仅采用手术室常规棉垫预防压力性损伤。观察两组病人术后即刻、24 h和72 h的压力性损伤发生情况。结果 观察组仅术后即刻发生压力性损伤1例（2.5%）；对照组术后即刻和术后24 h共发生压力性损伤9例（22.5%）；两组压力性损伤发生情况比较，差异具有统计学意义（χ²=12.489，P=0.015）。结论 对仰卧牵引位行髋关节镜手术的病人，会阴部加用新型泡沫敷料与仅采用手术室常规棉垫相比，可有效减少术后压力性损伤的发生，对临床护理工作有一定的指导意义。     

Arthroscopically Assisted Anterior Treatment of Symptomatic Large Talar Bone Cyst

Symptomatic cystic lesions of the talus are rare. The traditional operations usually do not provide visualization to reveal the deep structure of the lesion and could cause cartilage damage or other severe traumatic injury. We report an operative technique to reach the cystic lesion without talar cartilage damage, remove the lesion, and fill defect with a bone graft assisted by anterior arthroscopy and evaluate its safety and reliability for future study. Seven cases of talar bone cyst were included. The patients were placed in the supine position after anesthesia induction and noninvasive ankle traction was applied. Standard anteromedial and anterolateral portals were established to observe the ankle; the distal end of the medial approach was moderately enlarged to 2 to 3 cm. The biopsy specimen of the cyst was obtained under arthroscopic guidance; the cyst wall was abraded and the sclerotic rim drilled. Arthrocare radiofrequency ablation was performed to prevent recurrence. The defect was tightly impacted with autologous or allograft cancellous bone. All cysts in these cases were located in the medial talus; anteroposterior radiographs and computed tomographic coronary scan showed a cyst diameter of >1?cm. Intraoperative inspection showed a tiny chondral gap on the talar dome in 1 case and on the medial wall of talus in 1 case; no cartilage injury was found in the remainder. Two cases were impacted with grafted autogenous iliac bone into the talar defect and 5 cases with allograft cancellous bone. Computed tomography confirmed that the cysts had healed, with no signs of recurrence found in any patient at 1 year postoperatively. The mean American Orthopaedic Foot and Ankle Society ankle-hindfoot scale score increased from 65 preoperatively to 91 points postoperatively, a statistically significant difference (p?<?.01). No complications developed and no reoperations were required postoperatively. Arthroscopically assisted anterior treatment with autologous or allograft bone graft is an effective method for symptomatic large talar bone cysts.     

关节镜引导下复位内固定治疗胫骨平台骨折的疗效和对患者膝关节功能恢复及生活质量的影响

目的研究关节镜引导下复位内固定对胫骨平台骨折(FTP)患者的疗效和膝关节功能恢复及生活质量的影响。方法选取该院2016年8月-2018年3月收治的FTP患者104例,采用随机数字法将其分为观察组和对照组,每组52例。观察组行膝关节镜辅助切开复位内固定术,对照组患者行传统切开复位内固定术。比较两组患者的手术指标(切口长度、出血量、手术用时、术后引流量及下床时间)、骨生化指标[Ca~(2+)、降钙素(CT)、骨形态发生蛋白(BMP)和骨特异性碱性磷酸酶(NBAP)]、治疗疗效、膝关节功能Lysholm评分、生活质量SF-36评分和并发症发生情况。结果治疗前,两组患者骨生化指标、膝关节功能Lysholm评分、生活质量SF-36评分均无明显差异(P0.05)。治疗后,观察组切口长度、出血量、术后引流量、下床时间、NBAP明显少于对照组(P 0.01),观察组手术时间、Ca~(2+)、CT、BMP水平、Lysholm评分和SF-36评分均明显高于对照组(P 0.01)。观察组治疗有效率为90.38%,明显高于对照组80.77%(P 0.01)。观察组并发症发生率为11.54%,明显低于对照组28.84%(χ~2=4.69,P=0.002)。结论关节镜引导下复位内固定能够明显提升FTP患者的疗效,促进膝关节功能恢复,改善患者骨代谢指标,提高患者的生活质量,值得向临床推广应用。     

膝关节镜术后结合活血祛瘀汤内服对膝关节炎患者骨代谢指标及炎性指标的影响

目的:研究膝关节镜术后结合活血祛瘀汤内服对膝关节炎患者骨代谢指标及炎性指标的影响。方法:选取2013年6月至2016年5月抚顺市中医院骨科住院部收治的进行关节镜清理术的膝骨关节炎患者68例进行回顾性分析,按照术后治疗方法的不同分为观察组和对照组,每组34例。观察组内服活血祛瘀汤(58膝),对照组行单纯关节镜清理术(62膝)。将2组患者术后6个月随访疗效结果进行比较。结果:6个月治疗结束后,观察组总有效率81. 02%,显著高于对照组的48. 55%,差异有统计学意义(P 0. 05),观察组治疗后夜间卧床休息时疼痛、晨僵或起床后疼痛加重、绞锁、肿胀以及跛行优于对照组,差异有统计学意义(P 0. 05)。观察组治疗后TNF-α、IL-6改善显著,与对照组比较,差异有统计学意义(P 0. 05),观察组与对照组治疗后COMP、CTX-Ⅱ、CTX-Ⅰ、MMP-3治疗后效果显著,且观察组优于对照组,差异有统计学意义(P 0. 05)。结论:活血祛瘀汤可明显降低膝关节术后患者炎性反应递质水平,患者COMP,CTX-Ⅱ,CTX-Ⅰ和MMP-3指标亦有显著改善,患者综合治疗疗效优于患者单纯使用关节镜下清理术疗效。     

The Presence of a Psychiatric Condition is Associated With Undergoing Hip Arthroscopy for Femoroacetabular Impingement: A Matched Case-Controlled Study

Background

We sought to examine the association between having a psychiatric condition and undergoing hip arthroscopy for femoroacetabular impingement (FAI).

Efeitos de tramadol,magnésio e cetamina por via intra‐articular sobre a dor pós‐operatória em meniscectomia artroscópica

Objective

Postoperative pain control is important in terms of early recovery and rehabilitation in arthroscopic meniscectomy. For this purpose, we aimed to compare the effects of intraarticular tramadol, magnesium, and ketamine with combinations of pericapsular bupivacaine on postoperative pain and recovery in arthroscopic meniscectomy.

髋关节镜下盂唇修补术治疗髋臼盂唇损伤的疗效评价

目的:探讨髋关节镜下盂唇修补术治疗髋臼盂唇损伤的临床疗效。方法:选择2018年11月至2019年5月在广东省中医院诊断为髋臼盂唇损伤并在髋关节镜下行盂唇修复术的患者,所有患者术前术后采用X线片、三维CT和核磁共振等检查,选择改良Harris髋关节评分(mHHS)、体育运动专用髋关节评分(HOS-SSS)、日常活动的髋关节功能评分(HOS-ADL)和VAS疼痛评分,评定患者的临床疗效。结果:共纳入患者30例,其中男10例,女20例,年龄(37.8±10.6)岁(17~55岁)。所有患者均获随访,随访时间为6~12个月,平均8.2个月。患者术前H0S-ADL,HOS-SSS,mHHs评分分别为53.8±10.6,44.2±9.6,62.2±11.6;术后6个月时分别为77.6±10.2,72.8±7.3,79.3±9.1,均较术前显著提高(P<0.01);术前VAS评分为6.5±2.3,术后6个月时为2.6±1.3,较术前显著降低,差异有统计学意义(P<0.01)。结论:髋关节镜下盂唇修补术治疗髋臼盂唇损伤,能缓解症状,其近期临床疗效良好。