Recurrent hemarthrosis after total knee arthroplasty caused by the impingement of a remnant lateral meniscus: A case report

A case of recurrent hemarthrosis initially presenting after the fifth postoperative month is described. Because of recurrent pain and swelling, the patient underwent an arthroscopy 14 months after total knee arthroplasty (TKA). A remnant posterior lateral meniscus was found to be impinged between the femoral component and the tibial liner, and there was oozing from the hypertrophied synovium around the remnant meniscus. The remnant meniscus and the synovium were carefully cauterized and completely excised. Following the arthroscopy, hemarthrosis has not recurred. A remnant lateral meniscus may be a cause of recurrent hemarthrosis after TKA. Accordingly, in cases of recurrent hemarthrosis after TKA, exploration by arthroscopy should be considered.     

中-低恶性程度的孤立性颈胸段脊柱转移瘤的手术疗效及生存分析

背景　颈胸段脊柱（CTJS）转移瘤多伴发严重疼痛及神经症状，对患者的生存时间影响亦较大。当转移瘤生物学行为是中-低恶性程度，并且孤立存在时，其手术效果以及生存时间如何，目前国内外报道均较少。　目的　探讨孤立性、原发肿瘤中-低恶性程度CTJS转移瘤的手术疗效及生存情况。方法　选择北京大学第三医院2011年1月-2015年5月收治的10例CTJS转移瘤患者为研究对象，均为孤立性、原发肿瘤中-低恶性程度且原发灶控制良好。采用整块切除或分块切除的手术方法予以广泛或边缘的转移瘤完全切除。采用视觉模拟评分法（VAS）评分、神经功能评估按脊髓损伤功能评定（Frankel分级）、美国东部肿瘤协作组（ECOG）评分对疼痛、功能状况和脊髓功能进行评价，采用Kaplan-Meier法评估生存时间。结果　手术时间为160~410 min，平均（262.2±85.7）min；术中出血量为800~3 200 ml，平均（1 770.0±766.0）ml。1例患者术中胸膜破裂，1例患者术后脑脊液瘘，1例患者术后出现双下肢肌力下降。VAS评分〔（2.10±0.99）分〕低于术前〔（6.20±1.48）分〕（t配对=22.841，P<0.001）。10例患者中9例伴有不全截瘫或截瘫，术后7例神经功能Frankel分级至少改善一个等级，评分由术前（3.30±1.16）分提高到术后（4.20±0.63）分（t配对=3.857，P=0.004）。患者术后功能状态均较术前好转，ECOG评分由术前（2.60±0.97）分下降到术后（1.80±0.63）分（t配对=4.000，P=0.003）。除1例死于心脏疾病外，其余患者中位生存时间为54个月，两种手术方式的术后生存时间比较，差异无统计学意义（χ2=0.471，P=0.493）。结论　对孤立性、原发肿瘤中-低恶性程度、原发灶控制良好的CTJS转移瘤患者的手术治疗可以缓解其疼痛，改善其神经功能和提高其生活质量。无论是转移瘤整块还是分块切除，当切除范围达到广泛或边缘时，术后生存时间均令人满意。     

Usefulness of a combined approach of DIERS Formetric 4D® and QUINTIC gait analysis system to evaluate the clinical effects of different spinal diseases on spinal-pelvic-lower limb motor function

BackgroundTo investigate the alterations in body movement and their compensatory characteristics under different spinal diseases through an objective and quantitative analysis of the spinal-pelvic-lower limb motor function.MethodsA total of 120 subjects were recruited from October 2016 to April 2017. The patients were classified into 2 groups in which 65 patients with cervical spondylotic myelopathy (CSM) and 25 patients with idiopathic scoliosis (IS). The former group was evaluated with JOA score while those in the IS group underwent Lenke classification. A control group was set up with 30 healthy subjects. All the subjects were instructed to walk at a constant speed for one minute on a treadmill, and their spinal-pelvic-lower limb motions were monitored simultaneously with a DIERS Formetric 4D® grating system and a QUINTIC gait analysis system.ResultsThe rotation angle of thoracic and lumbar vertebrae in IS group were larger than those in the control group (P < 0.05), and the knee joint angle A in the CSM group and IS group were larger than the control group (P < 0.05). In the CSM group, the knee joint angular velocity and angular acceleration were both greater than the control group (P < 0.05). And there was a negative linear correlation between the JOA score for the lower extremity of CSM patients and their knee joint angular acceleration.ConclusionIS patients tend to demonstrate increased swing amplitude of the trunk. Those with CSM will also have larger knee joint angular velocity and angular acceleration.     

Medial patellofemoral ligament reconstruction with autologous gracilis tendon: Clinical and radiological outcomes at a mean 6 years of follow up

BackgroundThe medial patellofemoral ligament (MPFL) is considered the primary soft tissue restrain to lateral translation of the patella during the first 15–30 degrees of knee flexion. The primary restraint thereafter is the slope of the lateral wall of the trochlea. A plenty of procedures are described in literature for MPFL reconstruction with different types of graft, angle of knee flexion for fixation and rehabilitation protocols. In this study we used MPFL reconstruction with doubled autologous gracilis tendon with the Schottle’s technique. The aim of our study is to evaluate outcomes at medium-long term follow up of MPFL reconstruction.MethodsPatients who underwent arthroscopic MPFL reconstruction for recurrent patellar dislocation were followed up for a minimum of 2 to 10 years. Patient-reported outcomes including the Kujala, Visual Analogue Scale (VAS) score were collected preoperatively and postoperatively. Clinical complications such as loss of ROM, recurrent sub-luxation or dislocation were recorded.ResultsA total of 38 patients with recurrent patellar dislocation were treated with MPFL reconstruction and data were available for final follow up (mean 72.3 months, SD 33.6). Mean age at time of surgery was 23.4 (SD 7.8). Mean number of dislocations before surgery was 7.1 (SD 10.5). Recurrent dislocations were not observed in any of the patients treated at last follow-up. Significant clinical improvements were also noted with Kujala and VAS score. Patellar tilt angle decreased significantly from pre to post-operative.ConclusionOur study demonstrated that MPFL reconstruction with patellar suture anchors fixation using autologous gracilis tendon is an effective, safe and reliable method for treating recurrent patellar dislocation.     

外侧锁定接骨板治疗股骨远端骨折术后翻修的相关影响因素

目的：分析外侧锁定接骨板治疗股骨远端骨折术后因骨折不愈合或内固定断裂需要进行翻修手术的相关因素。方法：回顾性分析了北京大学第三医院2005年3月至2019年3月诊治的股骨远端骨折患者的临床资料,共有130例患者纳入该研究,翻修组12例,未翻修组118例。利用SPSS 17.0软件对患者的一般情况[性别、年龄、体重指数(body mass index, BMI)、合并基础疾病、吸烟史]、损伤相关因素(受伤原因、开放或闭合性损伤、骨折AO/OTA分型、骨折累及区域分布)、手术相关因素(手术时间、复位质量、是否出现术后感染)及内固定结构等临床资料进行单因素比较及Logistic回归分析。结果：130例纳入该研究的患者中12例进行了翻修手术,翻修率为9.2%。单因素分析发现年龄、BMI、骨折AO/OTA分型、骨折累及区域、手术时间、复位质量、接骨板长度/骨折区长度及髁螺钉上方的接骨板长度/骨折区长度在翻修组和未翻修组的差异具有统计学意义(P<0.05);Logistic回归分析发现骨折AO/OTA分型中A3型骨折、骨折累及髁上区域、手术时间、复位质量和髁螺钉上方的接骨板长度/骨折区长度是...     

全膝关节置换术髌骨置换与否的比较

目的回顾性分析、比较全膝关节置换术髌骨置换与否的疗效及优缺点,为临床治疗提供参考。方法自1994年1月～2000年12月间住院治疗的骨关节炎及类风湿性关节炎患者86例(109膝)。对髌骨置换和未置换的两组患者进行随访,膝关节评分采用美国HSS评分系统,髌骨评分采用Feller等的髌骨评分标准。随访时拍摄膝关节正、侧位及髌骨30°、90°轴位X线片。结果使用SPSS统计软件进行统计学分析。结果置换组与未置换组术后疗效及并发症的发生率无明显差异,髌骨功能评分差异有非常显著性意义(P<0.01)。置换组部分功能(上下楼梯及从椅子上坐起)略好于未置换组,未置换组术后膝前痛的发生率高于置换组,但多为轻度,差异有显著性意义(P<0.05)。术后髌骨不稳定和半脱位的发生率无统计学差异。结论髌骨不稳定的发生与术前畸形明显及术前髌骨外侧偏移倾向有关,是造成未置换组膝前痛的因素之一。未置换组髌骨不稳定与髌骨分型有关,建议如果术前拍摄髌骨轴位X线片时发现髌骨属于Ⅲ型者应置换髌骨。