Treatment of spinal cord compression caused by C2 osteochondroma with reconstruction and fusion after total resection: Case report and literature review

Context: Osteochondroma is the most common benign tumor of the bone, but spinal osteochondroma is rare. We report a case of cervical osteochondroma in multiple exostoses arising from the lamina of the C2 vertebra, presenting with features of compressive myelopathy in a 22-year-old male. Total resection of the tumor and atlantoaxial fixation and fusion after reconstruction of the C1 posterior arch were performed.Findings: The patient recovered significantly. He was asymptomatic and no sign of recurrence was observed after one-year follow-up.Conclusions: Osteochondroma should be considered as a rare cause of spinal cord compression. Entire removal of the tumor will result in complete decompression and can reduce the risk of recurrence. We provide a new approach to reconstruct after resection.     

Range of motion of foot joints following total ankle replacement and subtalar fusion

BackgroundIn severe cases of ankle and subtalar arthritis, arthrodesis of the subtalar joint is performed in combination with ankle arthroplasty. In these special cases gait analysis reveals real motion at the replaced tibiotalar joint.MethodsTwenty-three patients affected by ankle and subtalar arthritis, treated either with a 3-component or a 2-component prosthesis in combination with subtalar arthrodesis, were clinically evaluated preoperatively and at a minimum of 1-year follow-up. Gait analysis was performed postoperatively using a multi-segment foot protocol. Foot kinematics were compared to corresponding data from a healthy control group.ResultsClinical scores significantly improved from preoperative to follow-up. The clinically measured passive ankle dorsiflexion/plantarflexion significantly improved at the follow-up. Patients’ normalized walking speed and stride length were significantly lower than those in control. With exception of the ankle frontal-plane motion, sagittal-plane mobility of foot joints was about 50% than that in healthy joints.ConclusionsImprovement in clinical scores was found for both prostheses. Normal spatio-temporal parameters were not restored. In these patients, fusion of the subtalar joint appeared to be compensated by larger frontal-plane motion at the tibiotalar joint.Level of evidenceLevel III- retrospective comparative study.The study was approved by the local Ethics Committee as protocol MAT (protocol registration at clinicaltrials.gov NCT03356951).     

Computer assisted total knee arthroplasty: 2.5 years follow-up of 200 cases

IntroductionComputer assisted surgery in total knee arthroplasty (TKA) should improve accuracy of both femoral and tibial components placement. This study evaluated the functional outcomes of computer navigated total knee arthroplasty through the Knee Society Score (KSS) and Tegner Lysholm Knee Scoring Scale (TLKSS).Materials and methodsBetween September 2007 and February 2013, 180 patients (200 knees; 109 females and 71 males; mean age: 64 years) undergoing computer-assisted TKA were recruited. Plain radiographs and CT scans were performed post-operatively to evaluate alignment. The clinical outcomes were measured using the KSS and TLKSS pre-operatively and after 6, 12 and 36 months.ResultsThe mean follow-up duration was 2.5 years. The mean tourniquet time was 72 ± 13.4 min, and patients received an average of 0.6 ± 0.82 units of blood after surgery. The average preoperative KSS functional score of 44.6 ± 13.7 improved to 80.4 ± 16.4 after 2 years. The average preoperative TLKSS improved to 71.4 ± 13.5 after 2 years. The mechanical axis was within ±3° in all patients. No axial malalignments were observed on TC Scan. Three patients (1.6% of cases) required revision.ConclusionComputer assisted TKA allows reproducible alignment and kinematics, reducing outliers, provides ligament balancing and ensures good short term outcomes in terms of KSS functional score and TLKSS.     

人文医疗在阴式全子宫切除术联合阴道后壁修补术治疗子宫脱垂合并肠疝患者中的应用

目的探究人文医疗在阴式全子宫切除术联合阴道后壁修补术治疗老年子宫脱垂合并肠疝(阴道后壁膨出)患者中的应用效果。方法选择2018年1月至2019年12月期间天长市中医院收治子宫脱垂合并肠疝患者120例作为研究对象。全部入选病例均行阴式全子宫切除术联合阴道后壁修补术治疗,采用随机数字表法将病例分为对照组和观察组,各60例。对照组给予常规护理,观察组给予人文医疗护理。对比2组患者中文版知觉压力量表(CPSS)评分、抑郁自评量表(SDS)、焦虑自评量表(SAS)评分、心理弹性量表-简表(RS-14)、护理服务满意度、皮质醇(Cor)、心率及平均动脉压。结果护理前,2组CPSS、SDS、SAS及RS-14评分组间比较的差异无统计学意义(P>0.05);护理7 d后,2组CPSS、SDS、SAS及RS-14评分均较护理前降低,且观察组均低于对照组,差异有统计学意义(P<0.05)。观察组患者的满意度(96.67%)较对照组高(80.00%),差异有统计学意义(P<0.05)。观察组手术结束时2组患者的Cor、心率及平均动脉压较对照组低,差异有统计学意义(P<0.05)。结论人文医疗应用于子宫脱垂合并肠疝患者护理中,能够改善其不良情绪,缓解心理压力,减少手术的应激反应,提高患者对护理满意度。     

膝关节屈曲90°连续缝合切口对全膝关节置换术治疗效果的影响

目的 比较膝关节屈曲90°连续缝合切口和膝关节伸直位连续缝合切口在全膝关节置换术（total knee arthroplasty,TKA）中的应用效果。方法 选择2017年1月至2019年1月我院收治的122例拟行TKA手术的病人,采用随机数字表法将病人分为两组,对照组（61例）采用膝关节伸直位连续缝合切口,观察组（61例）采用膝关节屈曲90°连续缝合切口。比较两组病人切口长度、缝合时间、手术时间、术后失血量、直腿抬高活动时间、屈膝90°活动时间、拆线时间、住院时间、Hollander切口愈合（Hollander wound evaluation scale,HWES）评分、美国纽约特种外科医院（American hospital for special surgery,HSS）膝关节评分、Rasmussen评分、膝关节活动范围（ROM）、疼痛视觉模拟量表（visual analogue scale,VAS）以及术后并发症差异。结果 两组切口长度、缝合时间、手术时间、术后失血量、直腿抬高活动时间、拆线时间、住院时间、HWES评分、并发症发生率比较,差异均无统计学意义（P均＞0.05）。观察组屈膝90°活动时间短于对照组,术后24 h、48 h的HSS评分、Rasmussen评分高于对照组,膝关节ROM大于对照组,术后24 h、48 h、72 h的VAS评分均低于对照组,差异均有统计学意义（P均＜0.05）。结论 膝关节屈曲90°连续缝合切口可减轻术后早期疼痛程度,利于膝关节功能恢复,且不增加并发症发生风险。     

Analgesic Effects of Ultrasound‐Guided Iliohypogastric/Ilioinguinal Nerve Block Combined with Lateral Femoral Cutaneous Nerve Block in Total Hip Arthroplasty via Direct Anterior Approach: A Retrospective Cohort Study

ObjectiveThis study aimed to explore the efficacy and safety of the combination of lateral femoral cutaneous nerve blocks (LFCNB) and iliohypogastric/ilioinguinal nerve blocks (IHINB) on postoperative pain and functional outcomes after total hip arthroplasty (THA) via the direct anterior approach (DAA).MethodsIn this retrospective cohort study, patients undergoing THA via the DAA between January 2019 and November 2019 were stratified into two groups based on their date of admission. Sixty‐seven patients received LFCNB and IHINB along with periarticular infiltration analgesia (PIA) (nerve block group), and 75 patients received PIA alone (control group). The outcomes included postoperative morphine consumption, postoperative pain assessed using the visual analogue scale (VAS), the QoR‐15 score, and functional recovery measured as quadriceps strength, time to first straight leg rise, daily ambulation distance, and duration of hospitalization. The Oxford hip score and the UCLA activity level rating were assessed at 1 and 3 months after surgery. In addition, postoperative complications were recorded. Patients were also compared based on the type of incision used during surgery (traditional longitudinal or “bikini” incision).ResultsPatients in the nerve block group showed significantly lower postoperative morphine consumption, lower resting VAS scores within 12 h postoperatively, lower VAS scores during motion within 24 h postoperatively, and better QoR‐15 scores on postoperative day 1. These patients also showed significantly better functional recovery during hospitalization. At 1‐month and 3‐month outpatient follow up, the two groups showed no significant differences in Oxford hip score or UCLA activity level rating. There were no significant differences in the incidence of postoperative complications. Similar results were observed when patients were stratified by type of incision, except that the duration of hospitalization was similar.ConclusionCompared to PIA alone, a combination of LFCNB and IHINB along with PIA can improve early pain relief, reduce morphine consumption, and accelerate functional recovery, without increasing complications after THA via the DAA.     

Insulin Dependence Increases the Risk of Complications and Death in Total Joint Arthroplasty: A Systematic Review and Meta‐(Regression) Analysis

ObjectivesTo investigate the proportion of insulin‐dependent diabetes mellitus (IDDM) patients among diabetic patients undergoing total joint arthroplasty (TJA) and whether insulin dependence is associated with postoperative complications.MethodsA systematic literature search was performed in EMBASE, PubMed, Ovid, Medline, the Cochrane Library, Web of Science, the China Science and Technology Journal Database, and China National Knowledge Infrastructure from the inception dates to 10 September 2019. Observational studies reporting adverse events with IDDM following TJA were included. Primary outcomes were cardiovascular complications, pulmonary complications, kidney complications, wound complications, infection, and other complications within 30 days of surgery. Secondary outcomes were the proportion of IDDM patients among diabetic patients undergoing TJA and its time trend.ResultsA total of 19 studies involving 85,689 participants were included. Among patients undergoing TJA, 26% of diabetic patients had IDDM. Compared with non‐insulin‐dependent diabetes (NIDDM), the incidences of cardiac arrest (risk ratio [RR], 2.346; 95% confidence interval [CI], 1.553 to 3.546), renal failure (relative risk [RR], 2.758; 95% CI, 1.830 to 4.156), deep incisional surgical site infection (RR, 1.968; 95% CI, 1.107 to 3.533), wound dehiscence (RR, 2.209; 95% CI, 1.830 to 4.156), and death (RR, 2.292; 95% CI, 1.568 to 3.349) were all significantly increased in IDDM. A significant time trend was witnessed for the prevalence of IDDM (P = 0.014). There was no statistical significance for organ/space surgical site infection, thrombotic events (deep venous thrombosis/ pulmonary embolism), and revision rates.ConclusionInsulin‐dependent diabetes is an independent high‐risk factor for increased adverse outcomes relative to NIDDM, suggesting that hierarchical and optimal blood glucose management may contribute to reducing the adverse complications after surgery for these patients. In addition, because the risk of sepsis, deep wound infection, organ/space surgical site infection, urinary tract infection, renal insufficiency, and renal failure significantly increase after TJA in IDDM patients, more active postoperative antimicrobial prophylaxis may be needed on the premise of protecting renal function.     

Mid‐ to Long‐Term Outcomes of Cementless Modular,Fluted, Tapered Stem for Massive Femoral Bone Loss in Revision Total Hip Arthroplasty

ObjectiveTo evaluate mid‐ to long‐term results of revision total hip arthroplasty for massive femoral bone loss using a cementless modular, fluted, tapered stem.MethodsThis is a retrospective study performed at a single hospital. During the period of January 2007 to January 2015, 33 patients (34 hips) underwent primary revision surgery with cementless modular, fluted, tapered stems due to femoral bone loss. Sixteen men and 17 women were included in the study, with an average age of 63.9 ± 11.7 years (range, 27 to 88 years). Operative data including operative duration, length of incision, drainage volume and duration, blood loss and transfusion, cases of bone graft and extended trochanteric osteotomy were recorded. Clinical evaluation was performed using Harris hip score (HHS), visual analogue scale (VAS), and patients'' satisfaction. Radiographic data including femoral stem fixation, subsidence, integrin of allograft bone, and leg length discrepancy were assessed. Complications and survivorship were evaluated using Kaplan–Meier survival rate.ResultsThe mean follow‐up was 9.1 ± 2.5 years (range, 5–13 years). The Harris hip score was 43.6 ± 11.5 preoperatively and maintained at 86.5 ± 6.6 at the time of latest follow‐up (P < 0. 05). The X‐ray showed bone ingrowth fixation in 30 hips (88%), fibrous stable fixation in three hips (9%), and instability in one hip (3%). The average stem subsidence was 3.9 ± 2.2 mm (range, 1 to 10 mm). The mean difference in leg length in our study was 3.3 ± 2.7 mm (range, 0 to 10 mm), and the leg length discrepancy in 28 (82%) patients was within 5 mm. No case of junction fracture was observed. Seven (21%) intraoperative fractures occurred in our study. Three (9%) cases with infection were observed after revision. Six (18%) patients had lower limb vein thrombosis. The survivorship of prostheses with re‐revision for any reason was 95% (95% CI, 12.0 to 13.0) at the 10‐year follow‐up. Three (9%) re‐revisions were needed, including one for aseptic loosening, one for dislocation, and one for infection.ConclusionThe mid‐ to long‐term results of revision total hip arthroplasty with the cementless modular, fluted, tapered stems are encouraging for massive femoral bone loss.