Objective:To analyse the efficacy of arthroscopic minimally invasive surgery in patients with knee joint gouty arthritis.Methods:A retrospective analysis method was carried out on randomly selected 56 patients with kn...Objective:To analyse the efficacy of arthroscopic minimally invasive surgery in patients with knee joint gouty arthritis.Methods:A retrospective analysis method was carried out on randomly selected 56 patients with knee gouty arthritis from early July 2018 to the end of June 2019.All patients underwent arthroscopic minimally invasive surgery.Results:In this study,the patients were followed for 10 months.The Lysholm score of knee function was found to be significantly higher after treatment compared to the scores before treatment(P<0.05).Conclusion:Arthroscopic minimally invasive surgery is a promising method to treat for knee joint gouty arthritis.展开更多
Minimally invasive surgery(MIS) for arthroplasty of the knee began with surgery for unicondylar knee arthroplasty(UKA).Partial knee replacements were designed in the 1970 s and were amenable to a more limited exposure...Minimally invasive surgery(MIS) for arthroplasty of the knee began with surgery for unicondylar knee arthroplasty(UKA).Partial knee replacements were designed in the 1970 s and were amenable to a more limited exposure.In the 1990 s Repicci popularized the MIS for UKA.Surgeons began to apply his concepts to total knee arthroplasty.Four MIS surgical techniques were developed: quadriceps sparing,mini-mid vastus,mini-subvastus,and minimedial parapatellar.The quadriceps sparing technique is the most limited one and is also the most difficult.However,it is the least invasive and allows rapid recovery.The mini-midvastus is the most common technique because it affords slightly better exposure and can be extended.The mini-subvastus technique entirely avoids incising the quadriceps extensor mechanism but is time consuming and difficult in the obese and in the muscular male patient.The mini-parapatellar technique is most familiar to surgeons and represents a good starting point for surgeons who are learning the techniques.The surgeries are easier with smaller instruments but can be performed with standard ones.The techniques are accurate and do lead to a more rapid recovery,with less pain,less blood loss,and greater motion if they are appropriately performed.展开更多
The Minimal Invasive Surgery (MIS) technique used for knee arthroplasty implantation implies a less aggressive surgery and reduces the aesthetic impact. Its most notable disadvantage is the poor visualization of bone ...The Minimal Invasive Surgery (MIS) technique used for knee arthroplasty implantation implies a less aggressive surgery and reduces the aesthetic impact. Its most notable disadvantage is the poor visualization of bone structures, which may lead to alterations in the correct placement of the prosthetic components. Navigation-assisted surgery may help avoid such mistakes, and thus navigation coupled with the MIS technique may be an alternative for the future. This is a prospective randomized study of 50 patients who received a total knee arthroplasty. In 25 cases the MIS technique was used, whereas in the other 25 navigation was also employed. Mean age of the patients was 71.63 years, and the mean body mass index was 31.19. Results were assessed based on the definitive radiographic position of the femoral, tibial, and limb axis prosthetic components, as well as according to the Visual Analogue Scale (VAS), the Knee Society Score (KSS), Western Ontarioand McMaster Universities Arthritis Index (WOMAC), Short Form version 12 (SF-12) questionnaires, and the “up-and-go” test. Differences were found between both groups for duration of the procedure (p = 0.0005). No differences were found in the need for analgesics, amount of drained blood, or mean stay time. There were differences regarding the best radiographic position of the tibial component in the navigation group, but not in the final mechanical axis of the limb, even though out-of-range cases were more abundant in the standard-MIS group. At one year after surgery, clinical, functional and quality of life outcomes were similar in both groups. The combined use of surgical navigation and the MIS technique does not yield advantages in terms of limb alignment nor clinical results at one year after surgery.展开更多
Arthroscopic hip surgery has become an established diagnostic and therapeutic method for addressing different hip pathologies. This paper focuses on hip arthroscopy for treating hip disorders in children under the age...Arthroscopic hip surgery has become an established diagnostic and therapeutic method for addressing different hip pathologies. This paper focuses on hip arthroscopy for treating hip disorders in children under the age of 10. Arthroscopic hip surgery was performed 30 times on 24 children to address various hip pathologies. Indications were septic arthritis, benign soft tissue tumors, traumatic and congenital hip dislocation, juvenile idiopathic arthritis and osteochondroma of the acetabulum. Diagnostic arthroscopy was technically feasible in all cases. All cases of septic arthritis were successful treated using arthroscopic lavage and antibiotics. In the miscellaneous cases (benign fibrous tumor, juvenile idiopathic arthritis, osteochondroma congenital hip dislocations and traumatic hip dislocation) 4 hips had additional open surgery including surgical dislocation with synovectomy, open reduction and stabilization of the fractured posterior rim of the acetabulum, acetabulopasty and open resection of an osteochondroma with acetabuloplasty. In conclusion arthroscopic hip surgery is an additional diagnostic and therapeutic method that is suitable for treating different hip pathologies in children under the age of 10. Primary treatment of septic arthritis can be done easy by hip arthroscopy. Using cannulated mini arthroscopic hip instruments (2.7 mm), the range of application can be expanded to include treatment of very young infants. Hip arthroscopy can reduce the need of open surgery but cannot replace bony procedures in hip surgery.展开更多
BACKGROUND Gout and seronegative rheumatoid arthritis(SNRA)are two distinct inflammatory joint diseases whose co-occurrence is relatively infrequently reported.Limited information is available regarding the clinical m...BACKGROUND Gout and seronegative rheumatoid arthritis(SNRA)are two distinct inflammatory joint diseases whose co-occurrence is relatively infrequently reported.Limited information is available regarding the clinical management and prognosis of these combined diseases.CASE SUMMARY A 57-year-old woman with a 20-year history of joint swelling,tenderness,and morning stiffness who was negative for rheumatoid factor and had a normal uric acid level was diagnosed with SNRA.The initial regimen of methotrexate,leflunomide,and celecoxib alleviated her symptoms,except for those associated with the knee.After symptom recurrence after medication cessation,her regimen was updated to include iguratimod,methotrexate,methylprednisolone,and folic acid,but her knee issues persisted.Minimally invasive needle-knife scope therapy revealed proliferating pannus and needle-shaped crystals in the knee,indicating coexistent SNRA and atypical knee gout.After postarthroscopic surgery to remove the synovium and urate crystals,and following a tailored regimen of methotrexate,leflunomide,celecoxib,benzbromarone,and allopurinol,her knee symptoms were significantly alleviated with no recurrence observed over a period of more than one year,indicating successful management of both conditions.CONCLUSION This study reports the case of a patient concurrently afflicted with atypical gout of the knee and SNRA and underscores the significance of minimally invasive joint techniques as effective diagnostic and therapeutic tools in the field of rheumatology and immunology.展开更多
目的:探讨温针灸联合关节镜微创手术治疗膝骨关节炎(knee osteoarthritis,KOA)的临床效果。方法:选取2022年1—10月马鞍山市人民医院收治的60例膝骨关节炎患者为研究对象,根据治疗方式分为两组,其中治疗组30例,应用温针灸联合关节镜微...目的:探讨温针灸联合关节镜微创手术治疗膝骨关节炎(knee osteoarthritis,KOA)的临床效果。方法:选取2022年1—10月马鞍山市人民医院收治的60例膝骨关节炎患者为研究对象,根据治疗方式分为两组,其中治疗组30例,应用温针灸联合关节镜微创手术治疗,对照组30例,应用单纯关节镜微创手术治疗。对比两组Lequesne疗效、Lysholm膝关节评分、美国西安大略和麦克马斯特大学骨关节炎指数(Western Ontario and McMaster University osteoarthritis index,WOMAC)功能评分。结果:治疗后,治疗组患者总有效率显著高于对照组,差异有统计学意义(P<0.05)。治疗前,两组Lysholm膝关节功能评分比较,差异无统计学意义(P>0.05);治疗后3个月、6个月,治疗组Lysholm膝关节功能评分显著高于对照组,差异有统计学意义(P<0.05)。治疗前,两组WOMAC评分比较,差异无统计学意义(P>0.05);治疗后3个月、6个月,治疗组WOMAC评分显著低于对照组,差异有统计学意义(P<0.05)。结论:温针灸联合关节镜微创手术治疗KOA较单纯关节镜微创手术效果更好。展开更多
目的探讨关节镜辅助复位内固定(arthroscopically-assisted reduction and internal fixation,ARIF)结合加速康复外科(enhanced recovery after surgery,ERAS)理念与开放复位内固定(open reduction and internal fixation,ORIF)治疗胫...目的探讨关节镜辅助复位内固定(arthroscopically-assisted reduction and internal fixation,ARIF)结合加速康复外科(enhanced recovery after surgery,ERAS)理念与开放复位内固定(open reduction and internal fixation,ORIF)治疗胫骨平台后外侧骨折的临床疗效差异。方法回顾性选择2020年1月至2022年11月徐州市中心医院骨科胫骨平台后外侧骨折患者70例,根据治疗方法分为ARIF组(结合ERAS,n=32)和ORIF组(未结合ERAS,n=38)。所有患者住院后均通过影像学检查评估骨折类型,比较两组患者的手术时间、住院时间,采用视觉模拟量表(visual analogue scale,VAS)评估患者术后早期疼痛,美国特种外科医院(hospital for special surgery,HSS)评分评估患者术后3个月膝关节功能,比较两组患者术后6个月双侧大腿周径差值。结果ARIF组患者的手术时间显著短于ORIF组[(67.84±9.89)min vs(85.16±9.18)min,P<0.001],住院时间显著短于ORIF组[(7.13±1.41)d vs(8.74±1.84)d,P<0.001]。术后第3天,ARIF组的VAS评分显著低于ORIF组[(4.00±1.44)分vs(5.39±1.24)分,P<0.001]。术后3个月,ARIF组患者的膝关节功能显著优于ORIF组,术后6个月髌骨上10 cm大腿周径差值显著小于ORIF组(P<0.001)。结论与ORIF相比,接受ARIF结合ERAS治疗胫骨平台后外侧骨折的患者术后恢复更快、住院时间更短、临床疗效更确切。展开更多
Background： Although the early clinical outcomes of total knee arthroplasty （TKA） using minimally invasive surgery techniques have been widely described, data on the mid- to long-term outcomes are limited. We desig...Background： Although the early clinical outcomes of total knee arthroplasty （TKA） using minimally invasive surgery techniques have been widely described, data on the mid- to long-term outcomes are limited. We designed a retrospective study to compare the two most common TKA techniques - The modified quadriceps-sparing （m-QS） approach and the mini-medial parapatellar （MMP） approach - In terms of the clinical and radiographic parameters, over a minimum follow-up period of 5 years. Methods： The m-QS approach was used in 31 knees and the MMP approach, in 36 knees. Knees in both groups were compared for component position and alignment, knee alignment, length of the skin incision, range of motion, Visual Analog Scale score, muscle torques, Knee Society Score, Western Ontario and McMaster Universities Osteoarthritis Index, and number of complications. Results： There were no major intergroup differences in any of the clinical and radiographic outcomes assessed at the final follow-up examination. Conclusions： On the basis of numbers studied, the m-QS group, which requires more technique, showed equivalent results with the MMP group in the postoperative 5 years. Preservation of the extensor mechanism in the m-QS approach could not ensure any improvement in the clinical outcomes during the mid-term follow-up duration.展开更多
文摘Objective:To analyse the efficacy of arthroscopic minimally invasive surgery in patients with knee joint gouty arthritis.Methods:A retrospective analysis method was carried out on randomly selected 56 patients with knee gouty arthritis from early July 2018 to the end of June 2019.All patients underwent arthroscopic minimally invasive surgery.Results:In this study,the patients were followed for 10 months.The Lysholm score of knee function was found to be significantly higher after treatment compared to the scores before treatment(P<0.05).Conclusion:Arthroscopic minimally invasive surgery is a promising method to treat for knee joint gouty arthritis.
文摘Minimally invasive surgery(MIS) for arthroplasty of the knee began with surgery for unicondylar knee arthroplasty(UKA).Partial knee replacements were designed in the 1970 s and were amenable to a more limited exposure.In the 1990 s Repicci popularized the MIS for UKA.Surgeons began to apply his concepts to total knee arthroplasty.Four MIS surgical techniques were developed: quadriceps sparing,mini-mid vastus,mini-subvastus,and minimedial parapatellar.The quadriceps sparing technique is the most limited one and is also the most difficult.However,it is the least invasive and allows rapid recovery.The mini-midvastus is the most common technique because it affords slightly better exposure and can be extended.The mini-subvastus technique entirely avoids incising the quadriceps extensor mechanism but is time consuming and difficult in the obese and in the muscular male patient.The mini-parapatellar technique is most familiar to surgeons and represents a good starting point for surgeons who are learning the techniques.The surgeries are easier with smaller instruments but can be performed with standard ones.The techniques are accurate and do lead to a more rapid recovery,with less pain,less blood loss,and greater motion if they are appropriately performed.
文摘The Minimal Invasive Surgery (MIS) technique used for knee arthroplasty implantation implies a less aggressive surgery and reduces the aesthetic impact. Its most notable disadvantage is the poor visualization of bone structures, which may lead to alterations in the correct placement of the prosthetic components. Navigation-assisted surgery may help avoid such mistakes, and thus navigation coupled with the MIS technique may be an alternative for the future. This is a prospective randomized study of 50 patients who received a total knee arthroplasty. In 25 cases the MIS technique was used, whereas in the other 25 navigation was also employed. Mean age of the patients was 71.63 years, and the mean body mass index was 31.19. Results were assessed based on the definitive radiographic position of the femoral, tibial, and limb axis prosthetic components, as well as according to the Visual Analogue Scale (VAS), the Knee Society Score (KSS), Western Ontarioand McMaster Universities Arthritis Index (WOMAC), Short Form version 12 (SF-12) questionnaires, and the “up-and-go” test. Differences were found between both groups for duration of the procedure (p = 0.0005). No differences were found in the need for analgesics, amount of drained blood, or mean stay time. There were differences regarding the best radiographic position of the tibial component in the navigation group, but not in the final mechanical axis of the limb, even though out-of-range cases were more abundant in the standard-MIS group. At one year after surgery, clinical, functional and quality of life outcomes were similar in both groups. The combined use of surgical navigation and the MIS technique does not yield advantages in terms of limb alignment nor clinical results at one year after surgery.
文摘Arthroscopic hip surgery has become an established diagnostic and therapeutic method for addressing different hip pathologies. This paper focuses on hip arthroscopy for treating hip disorders in children under the age of 10. Arthroscopic hip surgery was performed 30 times on 24 children to address various hip pathologies. Indications were septic arthritis, benign soft tissue tumors, traumatic and congenital hip dislocation, juvenile idiopathic arthritis and osteochondroma of the acetabulum. Diagnostic arthroscopy was technically feasible in all cases. All cases of septic arthritis were successful treated using arthroscopic lavage and antibiotics. In the miscellaneous cases (benign fibrous tumor, juvenile idiopathic arthritis, osteochondroma congenital hip dislocations and traumatic hip dislocation) 4 hips had additional open surgery including surgical dislocation with synovectomy, open reduction and stabilization of the fractured posterior rim of the acetabulum, acetabulopasty and open resection of an osteochondroma with acetabuloplasty. In conclusion arthroscopic hip surgery is an additional diagnostic and therapeutic method that is suitable for treating different hip pathologies in children under the age of 10. Primary treatment of septic arthritis can be done easy by hip arthroscopy. Using cannulated mini arthroscopic hip instruments (2.7 mm), the range of application can be expanded to include treatment of very young infants. Hip arthroscopy can reduce the need of open surgery but cannot replace bony procedures in hip surgery.
基金Supported by Natural Science Foundation of Guangdong Province,No.2023A1515011213。
文摘BACKGROUND Gout and seronegative rheumatoid arthritis(SNRA)are two distinct inflammatory joint diseases whose co-occurrence is relatively infrequently reported.Limited information is available regarding the clinical management and prognosis of these combined diseases.CASE SUMMARY A 57-year-old woman with a 20-year history of joint swelling,tenderness,and morning stiffness who was negative for rheumatoid factor and had a normal uric acid level was diagnosed with SNRA.The initial regimen of methotrexate,leflunomide,and celecoxib alleviated her symptoms,except for those associated with the knee.After symptom recurrence after medication cessation,her regimen was updated to include iguratimod,methotrexate,methylprednisolone,and folic acid,but her knee issues persisted.Minimally invasive needle-knife scope therapy revealed proliferating pannus and needle-shaped crystals in the knee,indicating coexistent SNRA and atypical knee gout.After postarthroscopic surgery to remove the synovium and urate crystals,and following a tailored regimen of methotrexate,leflunomide,celecoxib,benzbromarone,and allopurinol,her knee symptoms were significantly alleviated with no recurrence observed over a period of more than one year,indicating successful management of both conditions.CONCLUSION This study reports the case of a patient concurrently afflicted with atypical gout of the knee and SNRA and underscores the significance of minimally invasive joint techniques as effective diagnostic and therapeutic tools in the field of rheumatology and immunology.
文摘目的:探讨温针灸联合关节镜微创手术治疗膝骨关节炎(knee osteoarthritis,KOA)的临床效果。方法:选取2022年1—10月马鞍山市人民医院收治的60例膝骨关节炎患者为研究对象,根据治疗方式分为两组,其中治疗组30例,应用温针灸联合关节镜微创手术治疗,对照组30例,应用单纯关节镜微创手术治疗。对比两组Lequesne疗效、Lysholm膝关节评分、美国西安大略和麦克马斯特大学骨关节炎指数(Western Ontario and McMaster University osteoarthritis index,WOMAC)功能评分。结果:治疗后,治疗组患者总有效率显著高于对照组,差异有统计学意义(P<0.05)。治疗前,两组Lysholm膝关节功能评分比较,差异无统计学意义(P>0.05);治疗后3个月、6个月,治疗组Lysholm膝关节功能评分显著高于对照组,差异有统计学意义(P<0.05)。治疗前,两组WOMAC评分比较,差异无统计学意义(P>0.05);治疗后3个月、6个月,治疗组WOMAC评分显著低于对照组,差异有统计学意义(P<0.05)。结论:温针灸联合关节镜微创手术治疗KOA较单纯关节镜微创手术效果更好。
文摘目的探讨关节镜辅助复位内固定(arthroscopically-assisted reduction and internal fixation,ARIF)结合加速康复外科(enhanced recovery after surgery,ERAS)理念与开放复位内固定(open reduction and internal fixation,ORIF)治疗胫骨平台后外侧骨折的临床疗效差异。方法回顾性选择2020年1月至2022年11月徐州市中心医院骨科胫骨平台后外侧骨折患者70例,根据治疗方法分为ARIF组(结合ERAS,n=32)和ORIF组(未结合ERAS,n=38)。所有患者住院后均通过影像学检查评估骨折类型,比较两组患者的手术时间、住院时间,采用视觉模拟量表(visual analogue scale,VAS)评估患者术后早期疼痛,美国特种外科医院(hospital for special surgery,HSS)评分评估患者术后3个月膝关节功能,比较两组患者术后6个月双侧大腿周径差值。结果ARIF组患者的手术时间显著短于ORIF组[(67.84±9.89)min vs(85.16±9.18)min,P<0.001],住院时间显著短于ORIF组[(7.13±1.41)d vs(8.74±1.84)d,P<0.001]。术后第3天,ARIF组的VAS评分显著低于ORIF组[(4.00±1.44)分vs(5.39±1.24)分,P<0.001]。术后3个月,ARIF组患者的膝关节功能显著优于ORIF组,术后6个月髌骨上10 cm大腿周径差值显著小于ORIF组(P<0.001)。结论与ORIF相比,接受ARIF结合ERAS治疗胫骨平台后外侧骨折的患者术后恢复更快、住院时间更短、临床疗效更确切。
基金Source of Support： This Study was funded by the Beijing Science and Technology Planning Projects of Beijing Science and Technology Committee （No. Z131100005213004）, Instrument Research Project of the National Natural Science Foundation （No. 81327001 ）. Conflict of Interest： None declared.ACKNOWLEDGMENTS We thank Medjaden Bioscience for their language editing which have greatly improved the manuscript.
文摘Background： Although the early clinical outcomes of total knee arthroplasty （TKA） using minimally invasive surgery techniques have been widely described, data on the mid- to long-term outcomes are limited. We designed a retrospective study to compare the two most common TKA techniques - The modified quadriceps-sparing （m-QS） approach and the mini-medial parapatellar （MMP） approach - In terms of the clinical and radiographic parameters, over a minimum follow-up period of 5 years. Methods： The m-QS approach was used in 31 knees and the MMP approach, in 36 knees. Knees in both groups were compared for component position and alignment, knee alignment, length of the skin incision, range of motion, Visual Analog Scale score, muscle torques, Knee Society Score, Western Ontario and McMaster Universities Osteoarthritis Index, and number of complications. Results： There were no major intergroup differences in any of the clinical and radiographic outcomes assessed at the final follow-up examination. Conclusions： On the basis of numbers studied, the m-QS group, which requires more technique, showed equivalent results with the MMP group in the postoperative 5 years. Preservation of the extensor mechanism in the m-QS approach could not ensure any improvement in the clinical outcomes during the mid-term follow-up duration.
