As compulsory content for orthopedic graduate students, total knee arthroplasty (TKA) is characterized by requirements of surgical accuracy and so is difficult to train since there is limited opportunity for young surgical trainees especially design of surgical operation and long term training to get experience. Traditional teaching of TKA for graduates is embarrassed by these barriers. Recent years, new techniques such as robotic-arm assisted surgery and 3D-printing technology have been extensively used in clinical training. For example the hybrid model with combined surgical design in virtue of robotic system and vivid simulation produced by 3D-printing for training. This paper reviewed is current situation in this field and evaluated the feasibility in clinical application

背景:超高龄(≥90岁)髋部骨折患者给骨科医师带来越来越大的挑战.目的:分析超高龄髋部骨折患者的合并症特点,探讨此类患者的围手术期安全性.方法:回顾性分析2006年1月至2020年12月我中心收治的髋部骨折病例,经筛选,纳入本研究1537例.以年龄分组:A组(≥90岁,139例)和B组(65～89岁,1398例).比较两组的性别、骨折诊断、合并症情况,然后进行匹配处理,比较匹配后两组(AP组和BP组)术前住院日、总住院日、围手术期死亡率和并发症发生率.结果:A组发生股骨转子间骨折的患者比例高于B组(χ2=16.471,P<0.01),合并糖尿病或其他代谢性疾病的患者比例低于B组(χ2=9.752,P=0.0028),而合并贫血的患者比例则高于B组(χ2=97.472,P=0.006).AP组和BP组的围手术期死亡率以及大部分并发症的发生率比较,差异无统计学意义;但肺部感染并发率差别具有统计学意义(χ2=4.187,P=0.041).结论:超高龄髋部骨折中有较多的转子间骨折;合并贫血的患者比例高,合并糖尿病等代谢疾病的患者比例低;围手术期较易并发肺部感染;死亡率和绝大多数并发症发生率并未升高.

背景:机器人辅助全膝关节置换系统可实现良好的假体定位和力线重建,但目前在国内的临床应用尚处于起步阶段.目的:评估一种国产膝关节手术机器人辅助用于全膝关节置换术的有效性和安全性.方法:本研究纳入24例严重膝骨关节炎患者,分为机器人手术组(11例)和传统对照组(13例),平均年龄(64.9±12.0)岁.比较患者术前术后HSS评分、KSS评分及WOMAC评分,并比较两组之间各项评分差异,统计并发症情况.结果:两组患者的年龄、性别、身高、体重、BMI、术前髋膝踝(hip knee ankle,HKA)角均无统计学差异(P<0.05).患者术前HSS评分、KSS评分及WOMAC评分与术后各项评分相比具有显著统计学差异(P<0.05),但是两组之间比较各项评分差异并无统计学意义(P>0.05).机器人手术组纠正合格率为63.6％,对照组为69.2％,两组无统计学差异(P=0.651).两组术后均无翻修病例,无感染、假体松动下沉、心脑血管意外等严重并发症发生.结论:该膝关节手术机器人辅助用于全膝关节置换术安全性良好,且可用于严重膝骨关节炎的治疗,具有临床应用前景.

背景:类风湿关节炎(RA)晚期常累及前足小关节,造成前足畸形.目前关于手术治疗RA前足畸形的中长期随访研究较少.目的:评估手术治疗RA前足畸形的中长期疗效.方法:回顾性分析2010年11月至2019年7月诊断为RA前足畸形并行手术治疗的15例患者(22足)的临床资料,其中男3例,女12例,平均年龄(60±12)岁.记录术前及术后即刻的外翻角(HVA)、第1～2跖骨间角(IMA),术前、术后3个月、术后6个月、术后1年及末次随访的美国足踝外科协会(AOFAS)评分,以及术后并发症.结果:15例患者获得2～11年随访,平均(5.6±2.8)年;术前及术后即刻HVA分别为49°±15°、17°±5°,IMA分别为17°±5°、10°±2°,术后较术前均有显著改善(P<0.05).AOFAS评分:术前、术后3个月、术后6个月、术后1年、末次随访分别为(28±25)分、(91±8)分、(92±9)分、(91±12)分、(82±15)分,术后各随访时间点较术前均显著升高(P<0.05),末次随访较术后3个月、6个月、1年有所下降(P<0.05),术后3个月、6个月、1年之间无显著差异(P>0.05).结论:手术治疗RA前足畸形的中长期临床效果确切.手术不能抑制RA的进展,远期存在畸形复发风险,需加强随访.

Objectives To evaluate the morphine-sparing effects of the sequential treatment versus placebo in subjects undergoing total knee arthroplasty (TKA), the effects on pain relief, inflammation control and functional rehabilitation after TKA and safety. Design Double-blind, pragmatic, randomised, placebo-controlled trial. Setting Four tertiary hospitals in China. Participants 246 consecutive patients who underwent elective unilateral TKA because of osteoarthritis (OA). Interventions Patients were randomised 1:1 to the parecoxib/celecoxib group or the control group. The patients in the parecoxib/celecoxib group were supplied sequential treatment with intravenous parecoxib 40 mg (every 12 hours) for the first 3 days after surgery, followed by oral celecoxib 200 mg (every 12 hours) for up to 6 weeks. The patients in the control group were supplied with the corresponding placebo under the same instructions. Primary and secondary outcome measures The primary endpoint was the cumulative opioid consumption at 2 weeks post operation (intention-to-treat analysis). Secondary endpoints included the Knee Society Score, patient-reported outcomes and the cumulative opioid consumption. Results The cumulative opioid consumption at 2 weeks was significantly smaller in the parecoxib/celecoxib group than in the control group (median difference, 57.31 (95% CI 34.66 to 110.33)). The parecoxib/celecoxib group achieving superior Knee Society Scores and EQ-5D scores and greater Visual Analogue Scale score reduction during 6 weeks. Interleukin 6, erythrocyte sedation rate and C-reactive protein levels were reduced at 72 hours, 2 weeks and 4 weeks and prostaglandin E2 levels were reduced at 48 hours and 72 hours in the parecoxib/celecoxib group compared with the placebo group. The occurrence of adverse events (AEs) was significantly lower in the parecoxib/celecoxib group. Conclusions The sequential intravenous parecoxib followed by oral celecoxib regimen reduces morphine consumption, achieves better pain control and functional recovery and leads to less AEs than placebo after TKA for OA. Trial registration number ClinicalTrials.gov (ID: NCT02198924 ).

Objective:To report our experience in treatment of patients with orthopaedic trauma during COVID-19 epidemic.Methods:We retrospectively analyzed the 67 patients with orthopedic trauma who had been treated at Department of Orthopaedics, Peking Union Medical College Hospital from February 1 to March 31, 2020. After screening for COVID-19 infection was performed under strict protection, the patients were diagnosed and assigned to outpatient emergency treatment or hospitalization according to their specific condition. Twenty-six patients were treated at the outpatient emergency department. They were 8 males and 18 females with an average age of 69.5 years. Of them, 6 with vertebral compression fracture were placed on bed brakes, 14 with limb fracture immobilized after close reduction, 2 with skin laceration treated with debridement and suture, and 4 with hip fracture immobilized in bed. In the 41 hospitalized patients, there were 14 males and 27 females with an average age of 68.5 years. In them, hemiarthroplasty was performed for 7 femoral neck fractures, kyphoplasty for 5 vertebral compression fractures, total elbow arthroplasty for one humeral intercondylar fracture, exploration and suture for one case of Achilles tendon rupture, and internal fixation surgery for the remaining 27 cases.Results:Most of the patients had osteoporotic fractures which accounted for 61.5% (16/26) of the outpatients and 68.3% (28/41) of the inpatients, respectively. The duration from injury to surgery averaged 2.3 days and the length of hospitalization 4.5 days for the 41 hospitalized patients, decreased compared with the corresponding data (3.1 days and 11.5 days) for the similar inpatients in the same period last year. In the 41 inpatients, fever was observed upon hospitalization in 4 cases and after operation in 26 cases, and related to their primary injury or surgical trauma in all. Acute pulmonary embolism happened during operation in one patient with femoral shaft fracture.Conclusions:The prevention and control of COVID-19 should be continued. The awareness and behavior of health care providers are expected to be enhanced by strict screening protocol, protection and supervision. The proportion of elderly patients with osteoporotic fracture increased during the COVID-19 pandemic. Shortage of blood was the major problem affecting the treatment. Timely surgical treatment should be indicated for the patients with orthopedic trauma, especially those with lower extremity fracture.

背景:臀肌挛缩症十分常见,常会导致不同程度的髋关节功能受限,目前常用的手术矫正方法有两种:传统开放松解和关节镜下松解.目的:比较关节镜下双侧一期松解与传统开放松解治疗臀肌挛缩的效果.方法:回顾性研究北京协和医院1995年1月至2018年12月收治的双侧臀肌挛缩患者,其中应用传统开放松解治疗的患者19例,关节镜下臀肌挛缩松解的患者21例.收集患者手术时间、切口长度、术中出血量、术后疼痛、并发症发生率、复发率、髋关节内收活动度、Harris髋关节评分(HHS)等治疗指标.结果:术后随访6～24个月,平均14.8个月.与传统开放手术组相比,关节镜治疗组的平均手术时间更长(P<0.05),但手术切口更小、术中出血量更少、术后疼痛明显减轻(P<0.05).术后并发症发生率、臀肌挛缩复发率及末次随访时的髋关节内收活动度、HHS评分,两组比较无明显统计学差异(P>0.05).结论:关节镜下臀肌挛缩松解术安全、有效,相对于传统开放松解手术在保证治疗疗效的基础上在许多明显的优势,值得推广.

背景:随着人口老龄化、手术技术及理念的更新、人们对生活质量要求的不断提升,因骨质疏松性骨折行手术治疗的患者不断增加,骨质疏松性骨折给患者及其家庭,甚至整个社会都带来了沉重的经济负担.目的:分析骨质疏松性骨折手术患者住院费用组成及其相关影响因素,为后续研究或医疗政策制定提供相关依据.方法:回顾性分析2018年9月至2019年8月收治的骨质疏松性骨折手术患者233例次.从病历系统提取相关信息并进行统计学分析,包括性别、年龄、身高、体重、术前血红蛋白及白蛋白水平、相关基础病、骨折部位、手术及麻醉方式、重症监护室天数、并发症和住院费用等方面.住院费用主要包含检查费、化验费、手术费、药费和材料费.结果:研究共纳入233例次骨质疏松性骨折患者,其中椎体压缩骨折138例,股骨颈骨折43例,股骨转子间骨折25例,桡骨远端骨折18例,肱骨近端骨折9例.233例次的住院总费用为15,119,297元,平均住院天数为(6.6±7.9)d,平均住院费用为(64,890±38,250)元.统计学分析结果显示,骨折部位数、手术方式、住院天数、术后转重症监护病房及术后出现并发症是影响患者住院费用的主要因素.结论:本研究更新了骨质疏松性骨折住院费用等相关资料,并提出了影响患者住院费用的主要因素,对后续研究具有一定的参考性.

To the Editor: Rheumatoid arthritis (RA) is a chronic inflammatory disorder characterized by synovial hyperplasia and joint destruction. The knee is the most commonly affected joint in patients with RA, and approximately 25% of patients with RA will undergo joint replacement within 22 years.[1] Total-knee arthroplasty (TKA) is a successful treatment for patients with severe joint pain due to osteoarthritis or RA. Concerns regarding increased loosening rates and potential need for multiple revision surgeries have traditionally discouraged the use of TKA in patients under 60 years old.[2] Although results in young patients are encouraging,[3] little mid-term follow-up data are available. Other researchers focus on the controversial subject of resurfacing in TKA. Comparisons of the results in resurfaced and non-resurfaced arthroplasties have found no significant differences between the two groups, while others have argued that resurfacing of the patella should be performed routinely. Therefore, we reported the mid-term survival of a successful knee arthroplasty design in patients with RA under 60 years old and compared the difference between resurfacing group and non-resurfacing group. The criteria for patient inclusion in the study were as follows: (1) age <60 years, (2) RA diagnosis, (3) cemented condylar prosthesis, and (4) follow-up ≥2 years. A total of 47 patients with RA (68 knees) who met the study criteria were evaluated post-operatively (47 patients underwent cemented TKA in the Orthopaedics Department of the Peking Union Medical College Hospital and were hospitalized during January 2003 to January 2008). Two patients were lost to follow-up. All patients received cemented condylar prosthesis (16 knees: cruciate-retaining prostheses; 52 knees: posterior stabilized prostheses; 27 knees: patellar resurfacing at initial surgery and Knee Society score >20). The same protocol for post-operative management was utilized which included low molecular weight heparin, three doses of a second-generation cephalosporin, bedside continuous passive motion machine therapy, physical therapy with partial weight-bearing, and quadriceps and hamstring strengthening exercises starting on the second post-operative day. The radiographs were evaluated according to the Knee Society radiographic evaluation system.[4] The anteroposterior and lateral radiographs were analyzed for the presence and progression of radiolucency lines at the bone-cement interfaces and the prosthesis-cement interfaces according to the Knee Society guidelines.[4] The clinical outcome was assessed with the passive range of motion, Hospital for Special Surgery (HSS) score, and the visual analog scale (VAS) of anterior knee joint pain during stair climbing pre-operatively and at last follow-up. The greatest value of the motion arc was measured in the supine position without weight-bearing to compare the range of motion. Patients with at least one abnormally high value of these indexes received surgical therapy. Median disease activity level according to Disease Activity Score 28 was 5.8 (range, 3.9–6.9), which represented moderately or extremely active RA. The stratification analysis according to patellar resurfacing was further performed. There was no significant difference between resurfacing and non-resurfacing group on the above assessment. The median HSS score improved from 43.4 (range, 10–79) pre-operatively to 95.5 (range, 49 –124) at the time of the last follow-up (P < 0.01). The median VAS score decreased from 7.59 (range, 6–8) pre-operatively to 0.25 (range, 0–2) (P < 0.001). The overall arc of flexion improved from a median of 101.62° (range, 25°–150°) pre-operatively to 110.96° (range, 70°–150°), the extension of the knee decreased from a median of 14.78° (range, 0°–54°) preoperatively to 2.53° (range, 0°–10°). The stratification analysis according to patellar resurfacing was further performed. There was no significant difference observed between resurfacing and non-resurfacing group on HSS score, VAS score, and range of motion. However, both subgroups showed significantly improved post-operative HSS score compared with the pre-operative score (P < 0.05). The radiographic follow-up lasted 8.3 years (range, 2–33 years), with radiolucency at the bone-cement and prosthesis-cement interfaces of each component examined. The median femorotibial angle was 0.03° varus (range, −10° to 15°) pre-operatively and 1.65° varus (range, −11° to 30°) at the last follow-up. On the anteroposterior views, the average femoral component flexion angle and tibial component angle were 97.9° (range, 94°–115°) and 89.1° (range, 82°–92°), respectively. On the lateral views, the average femoral component flexion angle and tibial component angle were 2.2° (range, −10° to 15°) and 87.0° (range, 80°–95°), respectively. Two complications occurred during the follow-up. One knee (1.5%) suffered from post-operative infection in the 13th month after surgery. The implant was removed and antibiotic-impregnated cement was filled. Revision surgery was performed 6 months later. One knee (1.5%) had transient peroneal nerve palsy but recovered after conservative therapy. No wound-related complications were reported.[5–9] In conclusion, TKA achieved favorable clinical and radiological outcome for RA patients with age younger than 60 years. Furthermore, there was no relationship between patellar resurfacing and HSS score improvement, indicating that patellar resurfacing and denervation may have a similar effect in improving knee function. There was no significant difference in HSS score, VAS score, and range of motion between the two groups. We suggest that TKA need to be performed without delay in younger patients with RA if the surgery is necessary. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form the patients have given their consent for their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Conflicts of interest None.

背景:良好的围手术期镇痛是加速康复外科(ERAS)理念的重要组成部分.前足截骨矫形手术是足踝外科常见手术,尚无针对此类手术的规范化围手术期镇痛方案.目的:比较喉罩全麻结合踝周神经阻滞与喉罩全麻结合术后患者自控镇痛(PCA)两种方法在前足截骨矫形术后镇痛方面的疗效.方法:本研究纳入2015年1月至2019年6月间收治的中重度外翻并接受单足前足截骨矫形患者86例,其中男8例,女78例,年龄53～83岁,平均(68.1±8.4)岁.术式采用收肌腱及外侧关节囊松解+改良Chevron截骨±Weil截骨±Akin截骨.患者随机分为两组,PCA组:采用喉罩全麻+术后PCA;踝周阻滞组:采用喉罩麻醉后、切开手术前行踝周神经阻滞.收集两组手术时间,术前及术后即刻、6 h、12 h、24 h、48 h及3 d、7 d时切口疼痛VAS评分等指标.结果:两组患者年龄、性别无统计学差异(P>0.05).PCA组的平均手术时间为(56±6)min,踝周阻滞组为(58±7)min,组间比较无统计学差异(P>0.05).PCA组术后即刻、6 h、12 h、24 h的VAS评分分别为(4.5±1.0)分、(5.1±1.5)分、(4.8±1.7)分、(4.0±1.4)分,踝周阻滞组分别为0分、(1.0±0.9)分、(3.5±1.1)分、(3.0±1.8)分,踝周阻滞组显著低于PCA组(P<0.05).术后48 h、3 d及7 d的VAS评分,两组比较无统计学差异(P>0.05).术后注射阿片类镇痛药物者,PCA组(10例,23.3％)明显多于踝周阻滞组(2例,4.7％).结论:踝周神经阻滞可有效控制前足截骨矫形术后疼痛,减少非PCA途径阿片类镇痛药物使用,提高患者手术体验,值得临床应用.

Osteoarthritis (OA) is the utmost commonly arising joint disease. Knee condyles play an essential role during OA progression. Circular RNA (or circRNA) is a novel kind of RNA, which, unlike the well-known linear RNA, plays an important regulatory role in OA on the basis of a previous research. In our study, expression of circRNAs in OA knee condyle was measured by illumine sequencing platform. A total of 197 differentially expressed circRNAs, such as hg38_circ_0007474 and hg38_circ_0000118 were identified, and 21 target miRNAs, 2466 source genes and 166 394 circRNA-miRNA-mRNA pairs were predicted. Further analysis was applied on three OA-related circRNAs (hsa_circ_0045714, hsa_circ_0002485, and hsa_circ_0005567). The results were partly verified by previous studies. Further biological research is needed to unfold the possible pathway and therapeutic target of OA.

Background: Osteogenesis imperfecta is a rare disease caused by the decrease and structural abnormality of bone type I collagen. It can lead to the decrease of bone strength, repeated fractures and malunion. Osteotomy can improve limbs fuctions and increase the survival rate of the patients. Objective: To explore the perioperative management, surgical methods and short and mid-term clinical outcomes of multi-segmental osteotomy for severe deformity of lower limbs caused by os-teogenesis imperfecta. Methods: Seven patients with severe deformity of lower limbs caused by osteogenesis imperfecta ad-mitted to our hospital between January 2015 and October 2017 were retrospectively analyzed. There were 5 males and 2 fe-males with a mean age of 14.7 years (range: 9-27 years). Deformity was found in 24 long bones. Of them, 18 bones were conducted multi-segmental osteotomy and intramedullary nail fixation. Preoperative angulation of the deformity of the fe-mur and tibia was 63°on average (range: 20°-120°). Results: The osteotomy was performed in 3.4 sites of one bone on aver-age (range: 3-4 sites). The mean operation time of the femur and tibia was 1.7 h (range: 1-2.5 h) and 1.2 h (range: 1-1.5 h), respectively. The amount of bleeding of one femur was 223 ml (range: 150-600 ml). All the patients were followed up for 17.7 months (range: 6-40 months). The patients began to take partial weight training at 4.3 months postoperatively (range: 4-6 months). The mean healing time was 5.4 months (range: 4-8 months). No nonunion or refracture occurred. Fat liquefac-tion was found in one incision which was healed by wound dressing. Barthel score increased from 45.7 (range: 24-80) preop-eratively to 85.7 (range: 78-96) after surgery (P＜0.01). WeeFIM score increased from 50.8 (range: 36-70) preoperatively to 74.0 (range: 60-90) after surgery (P＜0.01). Conclusions: One-stage multi-segmental osteotomy and intramedullary nail fix-ation of the femur and tibia can effectively correct lower limb alignment, maximize the correction of severe lower limb de-formity, reduce operation frequency and shorten treatment period, and also recover the motor function of lower limbs and improve the quality of life in combination with rehabilitation training.

背景:踝关节是血友病最常侵犯的关节之一,对于双侧出现严重关节面破坏的血友病性踝关节病患者,一直未能有很好的治疗方案.目的:探讨应用逆行交锁髓内钉行一期双侧胫距跟融合术治疗双侧终末期血友病性踝关节病的围术期处理方法、手术方法及短中期临床疗效.方法:回顾性分析2012年1月至2016年6月收治的5例双侧终末期血友病性踝关节病患者,甲型血友病3例,乙型血友病2例,均为男性;年龄为22,～42岁,平均27.6岁.术前根据美国矫形足踝协会(AOFAS)评分为19～31分,平均25分.入院后由血液内科会诊,通过凝血因子预实验确定围手术期凝血因子替代方案,应用逆行交锁髓内钉行一期双侧胫距跟融合术.结果:单侧融合术用时为60～90min,平均73 min;术中出血量为10～60 ml,平均24ml.术后双足完全负重时间为3.5～6.0个月,平均4.2个月.5例患者全部获得随访,随访时间为20～61个月,平均37个月.术后1年随访时X线片示踝关节完全融合,AOFAS评分为83～92分,平均87分.l例术中发生双侧胫骨下段骨折,1足踝前正中切口皮缘愈合不良,l足因l枚交锁螺钉刺激皮肤于术后5周时局部麻醉下取出.结论:在良好的围术期凝血因子替代治疗方案下,采用逆行交锁髓内钉行一期双侧胫距跟融合术治疗双侧终末期血友病性踝关节病变安全有效、医疗费用低、康复周期短.

OBJECTIVESOsteoarthritis (OA) is a common degenerative disease of the synovial joints. Although numerous studies have been performed, the aetiology of OA remains unclear. Evidence suggests that DNA methylation plays important roles in OA.METHODSIntegrated analysis of five gene expression and one methylation profilings in OA was performed to identify differentially expressed genes (DEGs) and differentially methylated genes (DMGs), respectively. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment were then conducted to reveal the biological functions of DEGs and DMGs. The protein-protein interaction network was finally constructed.RESULTSA set of 500 DEGs and 1219 DMGs in OA was found when compared with normal tissues. Function analysis of DEGs and DMGs revealed 3 critical OA-related pathways. A total of 20 DEGs were screened whose expressions showed strongly negative correlations with DNA methylation levels. Among them, 4 up-regulated DEGs (BST2, HDAC4, ITGB2 and VCAM1) may be closely related to the pathogenesis of OA.CONCLUSIONSThe results of integrated analysis explored 3 OA-related pathways (rheumatoid arthritis, osteoclast differentiation and ECM-receptor interaction) and 4 candidate genes of OA (BST2, HDAC4, ITGB2 and VCAM1) that may be therapeutic targets.

目的 探讨人工关节外科非计划二次手术的发生概率及原因,为人工关节外科非计划二次手术的预防提供参考依据.方法 通过住院电子病案系统对2012年1月至2016年6月北京协和医院骨科关节病房住院患者的病例信息进行检索,对其中非计划二次手术的病例进行全面分析.结果 本研究入选人工关节外科开展手术病例2 941例,其中发生非计划二次手术24例,发生率为0.81%.发生非计划二次手术患者的平均年龄为61.67岁,其中男9例,女15例.患者平均住院天数为44.58d.经描述性分析发现,术后感染、切口愈合不良、假体脱位是发生非计划二次手术的主要原因,分别占29.2%(7/24)、20.8%(5/24)、25.0%(6/24).结论 高血压、糖尿病、血友病或者因类风湿性关节炎等免疫系统疾病长期服用免疫抑制剂或者糖皮质激素是发生非计划二次手术的高危因素.建议在完善术前检查和相关科室会诊的同时,术前应当与患者及家属充分宣教及沟通,告知可能出现的非计划二次手术的风险.

RATIONALE:Arterial injuries during total knee arthroplasty (TKA) though rare may occur. Hemophilia may further challenge the management of such injury.PATIENT CONCERNS:A 48-year-old male patient with severe hemophilia type A and stiff knee arthropathy underwent bilateral TKAs. Left popliteal artery injury was detected at the end of the left TKA.DIAGNOSES:Urgent angiography confirmed the diagnosis of the left popliteal artery transection.INTERVENTIONS:With clotting factor VIII replacement treatment, open repair was performed by end-to-end vascular bypass with the autograft of the large saphenous vein. No anticoagulant and antiplatelet treatment was administered postoperatively. Doses of the factor VIII were decreased step by step postoperatively.OUTCOMES:Left lower limb was reperfused 4 hours after the onset of the ischemia. The patient recovered uneventfully. Postoperative Doppler examination showed the left popliteal artery remained patent.LESSONS:The hemophilia may endanger the patients to higher risk of arterial injury during TKA because of the severe deformity and fibrosis around knee joint. For the hemophilia patients, with rational coagulation factor replacement therapy, open repair with autograft was an effective revascularization procedure for artery injury.

OBJECTIVE:The aim was to assess the clinical, laboratory and radiological features of SAPHO syndrome.METHODS:We recruited all patients presenting to Peking Union Medical College Hospital from 2004 to 2015 diagnosed with SAPHO syndrome. The medical data, laboratory test results and imaging were collected for all patients.RESULTS:One hundred and sixty-four patients (111 women and 53 men) were recruited to our cohort. The mean age of the patients was 40.71 years. Nine patients had osteoarticular symptoms without skin involvement. One hundred and forty-three and 25 patients had palmoplantar pustulosis and severe acne, respectively. Psoriasis vulgaris was accompanied by palmoplantar pustulosis or severe acne in 24 patients. One hundred and sixty-four patients suffered from pain in the anterior chest wall, followed by spine (12 in the cervical region, 36 in the thoracic region and 111 in the lumbosacral region) and peripheral joint (136 patients) involvement. None of the patients had IBD. The hs-CRP level was increased in 70.8% patients. Only 2.4% were HLA-B27 positive. CT scan indicated osteolysis, sclerosis and hyperostosis in the anterior chest wall and spine in SAPHO syndrome patients. The bull-horn sign was the typical characteristic of SAPHO syndrome seen in bone scintigraphy images. One hundred and thirty-one (79.9%), 85 (51.8%), 100 (61%) and 54 (32.9%) patients took NSAIDs, CSs, DMARDs and oral bisphosphonates, respectively.CONCLUSION:SAPHO syndrome is predominant in middle-age women, characterized by dermatological and osteoarticular manifestations with unknown aetiology. CT scan and bone scintigraphy are useful for diagnosis. There is still no standard treatment to control the disease.

The timing of surgical intervention is important for ambulatory patients with metastatic epidural spinal cord compression (MESCC), while limited studies have focused on non-ambulant patients. The aim of this study was to investigate the proper timing of surgical intervention for paraplegic patients with MESCC.

Surgical fixation of humeral shaft fractures generally involves plating or nailing. It is unclear whether one method is more effective than the other. The aim of this study was to compare the results of the intramedullary nail and locking compression plate for the treatment of humeral shaft fractures. A total of 60 patients with humeral shaft fractures were randomized to undergo surgery with an intramedullary interlocking nail (n=30) or locking compression plate (n=30). The outcome was assessed in terms of intraoperative blood loss, operative time, hospital stay, union time, union rate, functional outcome, and incidence of complications. Functional outcome was assessed using the Constant score and the American Shoulder and Elbow Surgeons (ASES) score. Intraoperative blood loss, operative time, and hospital stay in group A (intramedullary interlocking nail) were significantly lower than those in group B (locking compression plate). No statistically significant difference was found regarding the union rate, mean Constant score, and mean ASES score between the groups. The average union time was found to be significantly lower for the intramedullary interlocking nail compared with the locking compression plate. The incidence of complications such as radial nerve palsy was found to be higher with the locking compression plate compared with the intramedullary interlocking nail. The intramedullary interlocking nail can be considered a better surgical option for the management of humeral shaft fractures because it offers decreased intraoperative blood loss; shorter operative times, hospital stays, and union times; and a lower incidence of serious complications such as radial nerve palsy.

Background: Total knee arthroplasty (TKA) is commonly performed using a tourniquet. However, some studies have reported that several complications were associated with the use of a tourniquet in TKA. In this study we investigate whether the limited use of a tourniquet in TKA would reduce complications and facilitate postoperative recovery.Methods: Sixty patients were randomly divided into two groups (30 cases/group): group A using the tourniquet throughout the surgical procedure, and group B using the tourniquet starting from the cementation to the completion of the procedure. Operation time, total measured blood loss, and incidence of complications were all recorded.Results: There was no significant difference in operation time, total measured blood loss, and hemoglobin concentration between the two groups. Incidence of postoperative complications in group B was significantly decreased in comparison to that in group A. The limb circumference at 10 cm above the superior patellar pole or below the inferior patellar pole and the pain score in group B were significantly decreased compared with that in group A at any time point. Range of motion in group B was significantly increased at three and 5 days postoperatively in comparison to that in group A.Conclusions: The limited use of a tourniquet in TKA provides the benefit of decreased limb swelling and knee joint pain while not compromising the operation time or blood loss and recovery. Level of evidence: Level I (Therapeutic). (C) 2014 Elsevier B.V. All rights reserved.