Arthroscopic decompression of a ganglion cyst causing suprascapular nerve compression

Ganglion cysts causing suprascapular nerve compression are an uncommon cause of suprascapular nerve compression. The advent of magnetic resonance imaging (MRI) and its application in patients with shoulder pain has improved the ability to diagnose cystic lesions causing extrinsic compression of the suprascapular nerve. Traditionally, treatment of suprascapular nerve compression by a ganglion cyst has required open cyst excision through either a deltoid and infraspinatus muscle takedown or a muscle splitting approach. We present three cases of suprascapular nerve compression by a ganglion cyst in which the cyst was decompressed arthroscopically. In each case the patient's symptoms resolved after arthroscopic cyst decompression, and a postoperative MRI does not demonstrate reaccumulation of the cyst fluid. Arthroscopic ganglion cyst decompression is a well-tolerated approach to this problem that avoids the morbidity of an open surgical procedure. The absence of recurrent cyst formation combined with resolution of the symptoms attests to the success of this method.     

Is it possible to make an accurate diagnosis based only on a medical history? A pilot study on women's knee joints

The purpose of this pilot study was to determine if an accurate diagnosis could be made concerning the knee joint using only the patients' medical history information. Only women were chosen for this study because of existing unpublished data on a cohort of 100 women with normal knees to act as a control (group I). From the 2,266 knee surgical procedures in the database of one surgeon, two other groups were selected. Group II was those women with only a torn medial meniscus. Group III were those women with only a torn anterior cruciate ligament (ACL). The medical history data of one half of the database were statistically analyzed to determine the questions that were the best predictors of each group. The medical history questions discovered to be best predictors were different from what might be expected from an individual surgeon's experience, expert opinion, or a medical consensus opinion panel, but the predictors did have a foundation in fact and are substantiated by statistical analyses. Using these predictors, a validation was performed on the other half of the database. When the top 142 predicting questions were used, the diagnostic accuracy was 98%; 98 of 100 of the “normal” group, 57 of 59 cases classified as having a torn meniscus, whereas 128 of 129 cases classified as having a torn ACL were correctly identified. When the only the 30 strongest predictors were used, the diagnostic accuracy was 85%: 100 of 100 cases were correctly classified as normal, 45 of 59 cases were correctly classified as having a torn meniscus, and 101 of 129 cases were correctly classified as having a torn ACL. This study demonstrated that statistical methods applied to medical historical data can make a differential clinical diagnosis of an unknown knee joint problem with high degree of accuracy and with statistical significance. In the future, computerized medical diagnostic instruments can be constructed using these statistical methods.     

踝关节骨折的手术治疗和手法复位治疗效果比较分析

目的比较手法复位和手术治疗两种方法治疗踝关节骨折的临床疗效,为踝关节骨折治疗方法的选择提供依据。方法选取2007年12月至2013年6月北京密云县医院收治的踝关节骨折患者106例,根据患者自愿和病情情况,将106例踝关节骨折患者分为手术组(50例)和手法复位组(56例)。比较两组患者的复位情况。结果手法复位组骨折复位优良率和踝关节功能恢复优良率分别为82.14%和87.50%,均显著低于手术治疗组的96.00%和94.00%(Z=8.947,2.989,P均<0.05)。手法复位组平均住院天数为(5.5±3.4)d,平均住院费用为(2503.1±534.6)元,并发症发生率为3.57%,显著低于手术治疗组(P<0.05)。结论手术治疗和手法复位治疗踝关节骨折各有优缺点,在具体治疗中,需要根据患者情况和意愿选择合适的治疗方法。     

Treatment of intra-articular fractures of Os calcis with open reduction,internal fixation and bone graft

Surgical Principles The subtalar joint is a major weight bearing joint in the lower limb. Displaced intra-articular fractures of the os calcis should be treated with anatomical reduction and stable internal fixation to allow early mobilization. Intra-articular fractures of the os calcis lead to loss of joint congruity, and impaction of the cancellous bone. Bone grafting, together with stable internal fixation, allow early mobilization and weight bearing after surgery. The operation is done with the lateral approach which allows direct access to the fracture site. The subchondral bone, the sustentaculum tali and the medio-inferior part of the os calcis provide good bone stock for the purchase of screws. After reduction and fixation of the depressed fragments, the space is filled with cortico-cancellous grafts. The lateral wall of the os calcis is buttressed with a plate. Postoperatively, passive mobilization is started early, walking with a weight relieving calliper lasts for the first six weeks and graduated weight bearing is started on the seventh week.     

Type 4 median nerve entrapment in a child after elbow dislocation

Case studied Median nerve entrapment is a rare, serious complication of elbow dislocation. We report a Type 4 median nerve entrapment after elbow dislocation in a 10-year-old boy. Radiologically Matev's sign and a new radiological finding—a sclerotic tunnel at the lateral side of the olecranon—were seen.Treatment The patient was treated by excising the damaged segment and reanastomosing the nerve 13 months after the injury.     

Fungal periprosthetic joint infection: Rare but challenging problem

Periprosthetic joint infection (PJI) is the most difficult complication following total joint arthroplasty. Most of the etiological strains, accounting for over 98% of PJI, are bacterial species, with Staphylococcus aureus and Coagulase-negative staphylococci present in between 50% and 60% of all PJIs. Fungi, though rare, can also cause PJI in 1%–2% of cases and can be challenging to manage. The management of this uncommon but complex condition is challenging due to the absence of a consistent algorithm. Diagnosis of fungal PJI is difficult as isolation of the organisms by traditional culture may take a long time, and some of the culture-negative PJI can be caused by fungal organisms. In recent years, the introduction of next-generation sequencing has provided opportunity for isolation of the infective organisms in culture-negative PJI cases. The suggested treatment is based on consensus and includes operative and non-operative measures. Two-stage revision surgery is the most reliable surgical option for chronic PJI caused by fungi. Pharmacological therapy with antifungal agents is required for a long period of time with antibiotics and included to cover superinfections with bacterial species. The aim of this review article is to report the most up-to-date information on the diagnosis and treatment of fungal PJI with the intention of providing clear guidance to clinicians, researchers and surgeons.     

Arthroscopic subacromial decompression: Results according to the degree of rotator cuff tear

We evaluated the results of arthroscopic subacromial decompression according to the degree of rotator cuff tear in 71 patients, available for follow-up for at least 1 year (average 19 months). Of the patients with stage II disease, 82% were satisfied regardless of whether they had no rotator cuff tear (nine of 11) or had a partial tear (28 of 34) of the rotator cuff. Of patients with stage III disease (complete rotator cuff tear), 88% (23 of 26) were satisfied. An acceptable objective UCLA shoulder rating greater than or equal to 28 points was seen in 82% (nine of 11) of the patients without a rotator cuff tear, 76% (26 of 34) with a partial tear, and 77% (20 of 26) with a complete tear. All four of the patients with complete tears less than 1 cm obtained excellent results. Three of the six failures were in patients with complete tears who had a narrowed acromial-humeral distance of less than 7 mm. The average UCLA pain score showed significant improvement from 2.8 (constant pain) to 8.6 (occasional pain) at 1-2 years postoperatively. The function, strength, and active forward flexion scores also increased at 1-2 years from their preoperative values. The overall patient satisfaction rate of 85% and the objective success rate of 77% are within the range of that seen with open rotator cuff repair.     

Arthroscopy in the diagnosis of acute injuries to the knee joint

Summary This study evaluates the role of arthroscopy in the diagnosis of acute injuries to the knee. One hundred and fifty four patients with a suspected ligament injury or effusion of the knee joint underwent arthroscopy. A haemarthrosis was present in 82% and a bloodless effusion in 10%. Meniscal tears were found in 19% of the knees. Fresh ligament ruptures were present in 71% and an associated haemarthrosis in 95% of these; 65% were partial tears. The commonest isolated lesion was a complete or partial tear of the anterior cruciate, which occurred in 15% of cases. More than one ligament injury occurred in 56%, the commonest combination being tears of the anterior cruciate and medial collateral ligaments. In a high percentage of cases, arthroscopy revealed unsuspected injuries of significance in management. In 39%, an open or closed procedure followed arthroscopy. There were no complications from the diagnostic arthroscopy. We conclude that arthroscopy provides a more accurate diagnosis than clinical examination alone, and is especially valuable for assessing the patient with a haemarthrosis of the knee.

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Résumé Le but cette étude est d'évaleur le rôle de l'arthroscopie dans le diagnostic des lésions traumatiques récentes du genou. Cent cinquante et un sujets chez lesquels on pouvait soupçonner une lésion ligamentaire ou un épanchement du genou ont subi une arthroscopie. Il existait une hémarthrose dans 82% des cas et une hydarthrose dans 10%. On a découvert une déchirure d'un ménisque dans 19% des genoux. Il y avait une rupture ligamentaire récente dans 71% des cas, et chez 95% d'entre eux une hémarthrose y était associée. La lésion isolée la plus fréquente était la rupture, partielle ou complète du ligament croisé antérieur, qui existait dans 15% des cas. On notait l'atteinte de plus d'un seul ligament dans 56% des cas, l'association la plus habituelle étant la déchirure des ligaments croisé et latéral interne. Dans une importante proportion de cas l'arthrose a mis en évidence des lésions inattendues, nécessitant des mesures thérapeutiques particulières. Chez 39% des patients l'arthroscopie a ét suivie d'un traitement chirurgical, à ciel ouvert ou non. L'arthroscopie à visée diagnostique n'a entraîné aucune complication. Les auteurs concluent que l'arthroscopie permet un diagnostic lésionnel plus précis que le simple examen clinique et qu'elle est particuliérement utile chez les sujets qui présentent une hémarthrose du genou.

     

人工髋关节表面置换术19例

目的总结人工髋关节表面置换术的初步经验与疗效。方法 2007年8月～2009年6月对19例(19髋)髋关节疾病行人工髋关节表面置换术,假体均为金属对金属髋关节表面假体。取髋关节后外侧入路,直视下或定位器下钻入导向钉,根据股骨颈直径确定股骨头假体的大小,髋臼假体使用生物型压配技术固定,股骨头假体骨水泥固定。结果 1例术后复查X线片时发现髋臼假体脱位再次手术复位成功;1例在股骨颈定位时发现导针严重偏差,重新定位定向后获得良好位置,术后X线位置良好;其余17例手术顺利和术后X线显示位置良好,出院时均屈髋达90°,步行出院。19例随访3～25个月,平均9.2月,末次随访HSS评分为(91±11)分,较术前(43±10)分明显增高(t=14.465,P=0.000);UCLA髋关节活动评分(7.4±1.6)分,较术前(4.4±1.3)分明显升高(t=8.364,P=0.000)。结论金属对金属髋关节表面置换术治疗某些髋关节疾病近期疗效优良,特别适合于年轻患者;但该术式有更长学习曲线,有一定的适用范围,且在行髋关节表面置换时需要准备全髋置换的器械。     

胫、股骨内压与膝关节疼痛关系的研究和治疗方法探讨

作者对膝关节痛和休息痛的病人21例测量了股、胫骨内压和关节镜检查,其均值股骨髁0.143±0.011kpa,16例(76.19％)超过对照组0.130kpa(P<0.01);胫骨髁0.180±0.022kpa,18例(85.7％),超过对照组0.105kpa。同时测量膝关节腔内压21例,均值为0.135±0.035kpa,18例(85.7％),高于对照组0.120kpa。认为骨内压增高是引起膝关节痛的原因之一。