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.     

Surgically treated reactive arthritis of the ankle after COVID-19 infection: A case report

A 37-year-old man developed right ankle pain and swelling six days after being diagnosed with coronavirus disease (COVID-19). Despite conservative treatment, his ankle symptoms persisted. Magnetic resonance imaging and computed tomography showed synovial hypertrophy and bone erosion in the ankle. Following arthroscopic synovectomy, performed 69 days after the COVID-19 diagnosis, the pain improved significantly. The clinical course was consistent with that of reactive arthritis following severe acute respiratory syndrome coronavirus 2 infection. The pathological findings resembled rheumatoid nodules. The bone erosion may have originated from the inflammatory pathway, which resembles the mechanism of rheumatoid arthritis.     

关节镜辅助下球囊扩张成形术治疗中重度营养不良跟骨关节内骨折

目的 分析关节镜辅助下球囊扩张成形术治疗中重度营养不良跟骨关节内骨折的临床疗效。方法 回顾性分析2014年3月至2017年2月中国人民解放军联勤保障部队第910医院骨科收治的跟骨关节内骨折患者55例。其中，男14例，女41例; 年龄47 ～ 76岁，平均（61.2±8.7）岁; 骨折Sanders分型: Ⅱ型12例，Ⅲ型17例，Ⅳ型26例。营养不良程度：中度40例，重度15例; 跟骨骨密度T值-5.2 ～ -2.7，平均-（4.1±0.6）。根据手术方式分为“关节镜+球囊”组15例、单纯球囊组12例、螺钉组8例和钢板组20例。记录手术时间、术中术后出血量、住院时间、术后B?hler角和Gissane角、各时间点关节面塌陷高度及各时间点VAS评分和AOFAS评分。结果 “关节镜+球囊”组手术时间长于单纯球囊组和螺钉组（P<0.01），但低于钢板组（P<0.01）；而术中、术后出血量和住院时间方面，与单纯球囊组、螺钉组差异无统计学意义（P>0.05），但低于钢板组（P<0.01）。“关节镜+球囊”组和单纯球囊组各时间点的VAS评分和AOFAS评分比较，差异无统计学意义（P>0.05）; 但“关节镜+球囊组”、单纯球囊组与螺钉组、钢板组比较，差异有统计学意义（P<0.01）。四组间术后B?hler角和Gissane角比较，差异无统计学意义（P>0.05）。在术后6、12、24个月时“关节镜+球囊”组和单纯球囊组比较关节面塌陷高度比较，差异无统计学意义（P>0.05）; 螺钉组和钢板组关节面塌陷高度比较，差异也无统计学意义（P>0.05）; 但“关节镜+球囊”组与螺钉组、钢板组，单纯球囊组与螺钉组、钢板组关节面塌陷高度比较，差异有统计学意义（P<0.01）。结论 关节镜辅助下球囊扩张成形术治疗中重度营养不良跟骨关节内骨折，具有操作简单、安全、康复期短的优点，值得临床推广。     

应用Fast-fix 360全内缝合技术修复半月板Ramp区损伤的临床研究

目的探讨应用Fast-fix 360全关节内缝合技术修补半月板Ramp区损伤的方法和疗效。方法2016年10月至2018年4月,中部战区总医院骨科足踝与运动医学中心使用Fast-fix 360缝合技术修补经镜下确诊为内侧半月板Ramp区损伤病人15例,其中男14例,女1例,平均年龄为23.6岁,病人均合并前交叉韧带(anterior cruciate ligament,ACL)断裂,均予以一期行ACL自体腘绳肌单束重建,6例合并外侧半月板损伤亦同期处理。术后行膝关节标准化功能康复。收集病例手术时间、术中出血量、术后并发症情况;术前、术后半年、术后1年的Lysholm膝关节评分、国际膝关节评分委员会(International Knee Documentation Committee,IKDC)评分;术后半年、1年分别复查患膝关节MRI,评估Ramp区损伤修复情况。结果病人随访13~26个月(平均17.8个月)。手术时间为(90.8±21.4)min,术中出血量为(50.5±10.6)ml。术后2例病人移植肌腱供区伤口浅表感染,经延长换药后均愈合;无伤口深部感染及膝关节感染;未出现腘窝血管神经损伤情况。术后半年及1年的Lysholm膝关节评分、IKDC评分均显著高于术前,差异均有统计学意义(P均<0.05)。术后半年MRI评估Ramp区的愈合率为73.3%,术后1年其愈合率提高至86.7%。结论使用Fast-fix 360全关节内缝合技术修补半月板Ramp区损伤,同时一期重建ACL,可获得较满意的临床疗效,方法简单、手术时间短,可作为半月板Ramp区损伤的一种常规修复方法。     

关节镜联合关节牵张成形术治疗踝关节创伤性关节炎

目的对比分析单纯关节镜手术与关节镜手术联合Ilizarov外固定架关节牵张术治疗踝关节创伤性关节炎的临床疗效。 方法纳入2016年10月至2018年4月聊城市中医医院收治的早中期踝关节创伤性关节炎患者30例，排除非创伤性关节炎和终末期踝关节炎。其中接受单纯踝关节镜手术者纳入对照组(n＝15)，接受关节镜手术联合Ilizarov外固定架关节牵张成形术者纳入研究组(n＝15)，术后随访6个月，对比分析两组患者的治疗效果：疼痛视觉模拟评分(VAS)、踝关节功能评分(Kofoed评分)以及生活质量的变化。计数资料比较采用卡方或Fisher精确检验，计量资料比较采用独立样本t检验。 结果研究组治疗有效率大于对照组(χ²＝7.214，P<0.05)，术后疼痛视觉模拟评分明显低于对照组(t ＝10.342，P<0.05)，Kofoed评分高于对照组(t ＝10.452，P<0.05)；研究组生活质量显著高于对照组(P<0.05)。 结论关节镜手术联合关节牵张成形术对早中期踝关节创伤性关节炎较单纯关节镜手术短期效果更好，可成为临床治疗中的一种选择，但远期效果尚需进一步研究。