Long-term outcome of surgical treatment for idiopathic spinal arachnoid web: A case series

ObjectiveSpinal arachnoid web (SAW) is a rare condition of the spine with limited long-term follow-up data in the literature. The longest reported follow-up period was an average  3.2 years. The objective of this study is to report our long-term results of patients who underwent surgical treatment for symptomatic idiopathic SAW.MethodsWe conducted a retrospective review of cases of idiopathic SAW that were operated between 2005–2020. We collected preoperative and last follow-up (LFU) data on motor force, sensory loss, pain, upper motor neuron (UMN) sign, gait disorder, sphincter dysfunction, syringomyelia, hyperintensity on T2-MRI, appearance of newer symptoms and number of reoperations.ResultsOur study included 9 patients with a mean follow-up period of 3.6 years (range 2–9.1 years). The surgical intervention involved a standard centered laminectomy, durotomy and arachnoid lysis. At presentation, motor weakness was present in 77.8% of patients, sensory loss in 66.7%, pain in 88.9%, sphincter dysfunction in 33.3%, UMN sign in 22%, gait disorder 55.6%, syringomyelia in 55.6% and MRI T2 hyperintensity in 55.6% of patients. At LFU, there was an improvement in all symptoms and signs to varying degrees. No new neurological symptoms appeared postoperatively, and there was no recurrence during the follow-up period.ConclusionOur results demonstrate that the reported immediate and short-term favorable outcomes following arachnoid lysis for symptomatic SAW persist over a long-term period and the risk of readhesion-correlated neurological deterioration following conventional surgical intervention is low.     

The influence of iliotibial tract thickness on clinical outcomes in women with patellofemoral pain

BackgroundThe assessment of iliotibial tract thickness by ultrasonography may help identify a key, previously unexplored factor that may contribute directly to the homeostasis imbalance of the femoropatellar joint in people with patellofemoral pain (PFP).ObjectivesTo compare the iliotibial tract thickness of people with PFP and asymptomatic people; and to correlate the iliotibial tract thickness with self-reported pain and function of people with PFP.MethodsEighty women, separated into two groups: PFP group (n = 40) and control group consisting of asymptomatic participants (CG; n = 40). The participants answered the Anterior Knee Pain Scale (AKPS) questionnaire, to identify the self-reported knee function; they evaluated the pain in millimeters by the Visual Analog Scale for pain (VAS). For the imaging evaluation, an ultrasound was used, with a linear transducer at the distal portion of the iliotibial tract (coronal plane), with the participants positioned in dorsal decubitus, with 20° of knee flexion. The iliotibial band was visualized in its long axis, and three sequential images were recorded between the lateral femoral condyle and the lateral tibial condyle. The measurements were normalized and correlated.ResultsThe groups had no differences (P > 0.001) between participants for: age/weight/height/IMC. Participants in the PFP group had moderate levels of pain (58 + 2.1 mm), considerable self-reported functional limitation (d = 3.05) and greater iliotibial tract thickness compared with the CG (d = 2.41).ConclusionThe iliotibial tract of women diagnosed with PFP have greater thickness compared with asymptomatic women. There was no association between iliotibial tract thickness and subjective measures of pain and function.     

A review of suture anchors

Suture anchors are designed to allow soft tissue to bone healing in cases where inadequate soft tissue stock on bone makes it impossible to perform a direct soft tissue-to-soft tissue repair. Suture anchor fixation is one of the most important innovations in arthroscopic glenohumeral shoulder surgery, optimizing the link between bone and soft tissue at the rotator cuff footprint. Newer developments and techniques have expanded the use of suture anchors to most other musculoskeletal tissues including the hip, elbow, hand, knee foot and ankle.Their success depends on having an understanding of the biology and biomechanics that affect their use and knowing the factors that may affect the clinical outcome. This review concentrates on the design, insertion technique, composition and evolution of suture anchors in orthopaedic surgery and the ways in which they are utilised in different tissues.     

PA-aO2、PaCO2和Lac水平与急性百草枯中毒患者的预后的相关性

目的探究肺泡-动脉氧分压差(PA-aO2)、动脉血二氧化碳分压(PaCO2)和血乳酸(Lac)水平与急性百草枯中毒(APP)患者的预后的相关性。方法选取2018年8月至2020年8月就诊于本院的126例APP患者,根据3个月随访情况,分为存活组57例和死亡组69例,另选取同期于本院进行健康体检的健康人群45例作为对照组,检测3组PA-aO2、PaCO2和Lac水平。结果与对照组比较,APP患者PA-aO2和Lac水平显著升高,PaCO2水平显著降低,且死亡组变化幅度显著大于存活组,差异有统计学意义(P<0.05);PA-aO2和Lac与存活组呈负相关,与死亡组呈正相关,PaCO2与存活组呈正相关,与死亡组呈负相关(P<0.05);PA-aO2、PaCO2和Lac联合检测对APP患者预后的预测价值显著高于单一指标,差异有统计学意义(P<0.05)。结论PA-aO2、PaCO2和Lac水平与APP患者预后密切相关,值得临床参考。     

关节镜下经髌腱入路空心拉力螺钉复位固定治疗胫骨髁间嵴撕脱骨折*

目的探讨在关节镜下经髌腱入路,利用空心拉力螺钉复位固定胫骨髁间嵴撕脱骨折(TEFx)的安全性和有效性。方法选取2014年1月-2015年12月23例TEFx的患者,均在关节镜下经髌腱入路,用空心拉力螺钉复位固定。术前Meyers-McKeever分型:Ⅱ型8例,Ⅲ型10例,Ⅳ型5例;男17例,女6例;年龄16～53岁,平均27.8岁。术前前抽屉试验、Lachman试验均阳性。比较术前术后的视觉模拟评分(VAS)、Lysholm、Tegner和国际膝关节文献委员会(IKDC)评分评价患侧膝关节功能。结果 23例患者均得到随访,随访时间30～40个月,平均36个月。术后即刻X线片示TEFx均复位良好,术后3个月骨折均愈合。无1例感染、关节僵硬、伸直受限、复位丢失及神经血管损伤等并发症。最终随访患侧膝关节活动度均恢复正常,前抽屉试验、Lachman试验均阴性。VAS评分术前(4.8±1.2)分,最终随访为(1.2±0.8)分,术前术后比较,差异有统计学意义(t=18.72,P=0.003);Lysholm评分术前为(50.8±6.2)分,最终随访为(90.8±5.4)分,术前术后比较,差异有统计学意义(t=-42.64,P=0.000);Tegner评分术前为(4.0±1.0)分,最终随访为(5.1±1.2)分,术前术后比较,差异有统计学意义(t=-16.82,P=0.005);IKDC主观评分术前为(52.5±7.4)分,最终随访为(91.5±5.7)分,术前术后比较,差异有统计学意义(t=-40.58,P=0.000)。结论膝关节镜下经髌腱入路空心拉力螺钉内固定治疗TEFx具有微创、操作简捷、固定可靠和恢复快的优点。     

Concealed cosmetic closure in total knee replacement surgery – A prospective audit assessing appearance and patient satisfaction

ObjectiveWith the trend towards accelerated rehabilitation, the method of skin closure has become increasingly important in orthopedic surgery. It is imperative to evaluate a technique that provides superior clinical and cosmetic results specifically for TKA, due to relatively thin skin anterior to the knee making poor wound healing an issue of concern. We conducted a prospective, single-arm audit evaluating the patient assessments of incision cosmesis for a novel technique in TKA wound closure called Concealed Cosmetic Closure (CCC).Methods570 knees were included in the study whose wound was closed with concealed cosmetic subcuticular interrupted sutures (CCCIS) between January 2014 and May 2016. A validated, ordinal questionnaire, Stony Brooks Scar Evaluation Scale (SBSES) designed to elicit a score evaluating scar satisfaction was interviewed by the investigators to patients 6 months to 3 years postoperatively.ResultsCCC is a simple and relatively rapid single-operator technique that takes about 7–10 min to close 11–17 cm knee incision. In our study, the mean score for Stony Brook Scar Evaluation Scale (SBSES) was 4.4 (SD of 0.73) (range 3–5). The scar was rated highly in terms of cosmesis, patient satisfaction and appearance of the wound.ConclusionCCC is an effective modality for skin closure in total knee arthroplasty providing superior cosmetic healing with minimal complications leading to improved long term patient satisfaction.     

胆道手术缝合技术与缝合材料选择中国专家共识（2018版）

正胆道缝合重建是肝胆胰外科手术的最基本操作之一,建立胆汁引流通畅、无张力、血供充足的黏膜对黏膜吻合是胆道重建的基本要求。目前,胆道重建方式繁多,但根据所须重建胆道的病理生理状况选择合适的胆道缝合方法及缝合材料是保障胆道重建成功的关键因素。随着手术技术的进步及各种缝合材料的发展,胆道缝合技术越来越精细,高质量的胆道缝合重建是病人顺利康复及减少多次手术的关键。基于此,中华医学会外科学分会组织国内部分专家结合最新文献及胆道外科的最新进     

Hook plating in patella fractures

PurposeTension band wiring is considered the standard treatment for patella fractures. However, it is limited for fractures with marginal involvement, comminution, and osteoporotic bone. Our experience indicates that these limitations can be overcome with the hook plate. We evaluated the radiographic and clinical outcomes in patients with patella fracture treated with hook plating.MethodsWe enrolled 30 patients who underwent hook plating for patella fracture at two institutions between 2013 and 2017. Fracture classification and surgical options were reviewed. Postoperative fracture gap and time to union as radiographic measurements, and complications, range of motion, and functional outcome with the Lysholm score as clinical outcomes, were evaluated retrospectively.ResultsNine fractures were AO/OTA 34A1, three B1, one B2, two C1, nine C2, and six C3. All were closed fractures. There were 3 cases of revision, 4 with lateral or medial marginal fracture, 9 with isolated inferior pole fracture, and 14 with comminuted fracture. The average postoperative fracture gap was 0.4 (range, 0–2.0) mm, and bone union was achieved without additional intervention. The average time to union was 11.6 (range, 7–24) weeks. There were no complications, and no extension lag except in one case (10°). The average flexion was 138.5° (range, 110–145°). For functional outcomes, the average Lysholm score was 89.5 (range, 74–95), with 13 excellent, 14 good, 3 fair, and no poor cases.ConclusionThis study suggests that hook plating can result in good bone union and restored knee function in marginal or comminuted fractures of the patella.