Management of knee rheumatoid arthritis and tibia nonunion with one-stage total knee arthroplasty and intramedullary nailing: A report of two cases

Total knee arthroplasty (TKA) is a surgical procedure which is widely used in the treatment of gonarthrosis secondary to rheumatoid arthritis (RA). The incidence of stress fractures in tibia in the patients with RA is higher compared to normal patients. In this study, we report two cases of TKA and intramedullary nailing in RA patients with severe knee arthritis and tibial nonunion. Both patients had a satisfactory clinical outcome with radiological healing of the tibial fracture.     

华北地区成人正常胫骨内侧平台后倾角的测量及临床意义

目的测量华北地区成人正常胫骨内侧平台后倾角数据,为改进及设计适合中国人的膝关节假体和在全膝关节置换术中行合理的胫骨截骨,提供参考数据和理论依据。方法428例(450膝,男∶女=252∶198)胫骨无疾病和畸形的华北地区成人,年龄18～79岁,平均43.9岁。按不同年龄段分成三组,A组:18～39岁,B组:40～59岁,C组:≥60岁。用CRX线机摄胫腓骨标准侧位像,并按照Danzig测量方法,在计算机上测量胫骨内侧平台后倾角。结果男252膝,左侧113膝,右侧139膝;胫骨内侧平台后倾角度,左侧13.2°±4.4°,右侧10.5°±5.1°,平均11.7°±4.9°。女198膝,左侧85膝,右侧113膝;胫骨内侧平台后倾角度,左侧11.2°±3.5°,右侧10.6°±4.4°,平均10.8°±4.0°。胫骨内侧平台后倾角度:A组平均11.7°±4.4°,B组平均10.4°±4.7°,C组平均12.3°±4.4°。经统计学分析证实胫骨内侧平台后倾角在不同性别、侧别及年龄间比较,差异无显著性意义。结论华北地区成人正常胫骨内侧平台后倾角大多在9°～13°,平均11.3°±4.5°,最大角度为21°,大于西方人。     

膝关节单髁置换术的并发症及防治

膝关节单髁置换术(UKA)是一种治疗膝关节单侧间室退行性骨关节炎的外科手术,起步于自上世纪70年代。最初,手术效果并不理想,然而随着植入物设计进步和手术技术的改进,UKA逐渐产生令人满意的效果,现在已越来越多被应用。不过UKA仍然面临着诸多问题有待解决。本文综述了膝关节UKA后常见的并发症及其防治。     

Medial unicompartmental knee arthroplasty in the ACL-deficient knee

Symptomatic osteoarthritis (OA) of the knee develops often in association with anterior cruciate ligament (ACL) deficiency. Two distinct pathologies should be recognised while considering treatment options in patients with end-stage medial compartment OA and ACL deficiency. Patients with primary ACL deficiency (usually traumatic ACL rupture) can develop secondary OA (typically presenting with symptoms of instability and pain) and these patients are typically young and active. Patients with primary end stage medial compartment OA can develop secondary ACL deficiency (usually degenerate ACL rupture) and these patients tend to be older. Treatment options in either of these patient groups include arthroscopic debridement, reconstruction of the ACL, high tibial osteotomy (HTO) with or without ACL reconstruction, unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA). General opinion is that a functionally intact ACL is a fundamental prerequisite to perform a UKA. This is because previous reports showed higher failure rates when ACL was deficient, probably secondary to wear and tibial loosening. Nevertheless in some cases of ACL deficiency with end-stage medial compartment OA, UKA has been performed in isolation and recent papers confirm good short- to mid-term outcome without increased risk of implant failure. Shorter hospital stay, fewer blood transfusions, faster recovery and significantly lower risk of developing major complications like death, myocardial infarction, stroke, deep vein thrombosis (as compared to TKA) make the UKA an attractive option, especially in the older patients. On the other hand, younger patients with higher functional demands are likely to benefit from a simultaneous or staged ACL reconstruction in addition to UKA to regain knee stability. These procedures tend to be technically demanding. The main aim of this review was to provide a synopsis of the existing literature and outline an evidence-based treatment algorithm.     

3D打印技术在复杂型髋臼假体翻修术中应用1例报告

正患者,男,63岁,10年前因左髋关节发育不良、股骨头坏死,在我院行左侧人工全髋置换手术,术后恢复满意,正常参加农村重体力劳动。近2年出现左髋疼痛、跛行,并进行性加重。左下肢短缩4 cm左右,左髋外展、外旋及屈曲功能均明显受限,肢端血管、神经功能均正常。右髋关节发育不良、股骨头坏     

血小板CD36与膝关节置换术后发生急性肺栓塞的相关因素

目的探讨血小板CD36的表达与行全膝关节置换术(TKA)患者术后发生急性肺栓塞(APE)的关系。方法选取50例TKA术后发生APE患者和同期150例TKA术后未发生APE和血栓患者进行基本资料比较。结果两组患者年龄、抗凝剂使用、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、甘油三酯(TG)以及D-二聚体(D-D)比较差异均有统计学意义(P0.05)。血小板CD36在APE患者中明显高表达,差异有统计学意义(P0.05)。在Logistic回归分析中,年龄、抗凝剂的使用、D-D以及血小板CD36的异常表达与APE发生密切相关。ROC曲线分析结果显示,血小板CD36的高表达在对于TKA术后发生APE具有较好的诊断价值,曲线下面积为0.821(95%CI 0.749~0.892,P0.001),敏感性为81.6%,特异性为71.5%。结论血小板CD36在TKA术后发生APE的患者中升高,CD36在血小板的异常表达是TKA患者发生APE的危险因素。TKA后行血小板CD36检测对于预防APE发生有一定临床意义。