Objective:To explore the early clinical effect of synchronous total and unicompartmental knee arthroplasty in the treatment of bilateral knee osteoarthritis in the same patient.Methods:From January 2018 to December 2020, 16 patients with bilateral knee osteoarthritis who underwent total and unicompartmental knee arthroplasty at the same time were analyzed retrospectively. The operation time, tourniquet time, hospitalization time and blood transfusion rate were recorded. The hip-knee-ankle (HKA) angle and lower limb length of patients after bilateral surgery were compared, and the leg length discrepancy (LLD) was calculated. Knee society score-function (KSS-f), Oxford knee score (OKS), EuroQol Five Dimensions Questionnaire (EQ-5D) and Forgotten joint score (FJS) at 2 years after operation were counted, and Knee society score-clinic (KSS-c) on both sides were recorded.Results:All patients were followed up for an average of (34.81±6.01) months. The average operation time was (118.63±5.54) minutes, the total tourniquet time was (84.88±5.63) minutes, and the hospital stay was (7.25±1.65) days. No patient needed blood transfusion. The HKA angle and lower limb length on TKA side were similar to those on UKA side, with no significant difference. The change of HKA on TKA side was (7.25±4.33)°, and that on UKA side was (4.17±4.20)°. The change of HKA angle on TKA side was more significant (Z=2.275, P=0.023). The length variation of lower limb on TKA side was (12.66±6.29)mm, while that on UKA side was (5.30±3.05)mm. The length of lower limb on TKA side increased more, with a statistically significant difference (Z=3.103, P=0.002). Two years after operation, the KSS-f score was (82.63±4.70) points, the OKS score was (17.31±3.70) points, the KSS-c score on the TKA side was (78.94±7.41) points, and the UKA side was (83.88±5.77) points, both of which were significantly higher than those before operation (P<0.001). The FJS score was (69.81±4.64), and the EO-5D score was (73.88±8.21). None of the patients had occurred complications, as pulmonary embolism, symptomatic deep vein thrombosis, knee stiffness, joint infection, and the progression of reserved compartmental osteoarthritis.Conclusions:At the same time, one side of TKA and the other side of UKA are effective methods for the treatment of knee osteoarthritis, which can achieve satisfactory clinical effects, and will not lead to differences in the length of lower limbs after surgery.

Objective:To understand the acoustic profiles of vertebral cancellous bone in ultrasonography using data of Micro-CT scanning as the reference, so as to lay a theoretical foundation for ultrasound-guided posterior pedicle screw fixation in spinal fusion surgery.Methods:Two cancellous bovine spinal bone blocks and two human cancellous allogeneic spinal bone blocks were used to simulate the cancellous bones along the pedicle screw channel. Each bone specimen was obtained of CT parameters on Micro-CT scanning, then subjected to ultrasound transmission measurement using an unfocused broadband transducer with central frequencies of 2.2 MHz, 2.5 MHz, 3 MHz, and 12 MHz, respectively. The acoustic amplitude, attenuation, and velocity of the ultrasound penetrating each bone specimen were captured by a hydrophone. Then the attenuation and impact on acoustic velocity of ultrasound by the bone specimens under different ultrasonic frequencies were calculated.Results:High-density human allogeneic bone blocks presented higher bone volume fraction (BV/TV) and greater trabecular number (TB. N) (both P<0.05), lower trabecular separation and structural model index (both P<0.05), compared with the low-density human allogeneic ones. For each of the 4 bone specimens under the 4 different frequencies, the ultrasound amplitudes decreased (all P<0.05) and the acoustic attenuation in creased (all P<0.05) with greater bone thickness. With rising frequency, a downward reduction in acoustic attenuation of low-frequency ultrasound (2.2 MHz, 2.5 MHz and 3 MHz) was noted inside the 2 mm thin cancellous bovine bone ( r=0.95 for bovine bone block #1, r=0.89 for bovine bone block #2, both P<0.05), and an upward increase in acoustic velocity was noted inside all of the 4 bone blocks ( r=0.71 for bovine bone block #1, r=0.81 for bovine bone block #2, r=0.35 for the high-density human allogeneic bone block, r=0.61 for the low density human allogeneic bone block, all P<0.05). In cancellous bovine bone blocks tested with any given low frequency of the ultrasound (2.2 MHz, 2.5 MHz, and 3 MHz), the acoustic velocity increased with greater bone thickness (all P<0.05) . Conclusion:There is a correlation between CT parameter features of cancellous bone blocks and their acoustic profiles with ultrasound transmission at varying frequencies. This finding theoretically implies a foundation for development of ultrasound navigation systems.

单髁置换术(UKA)是指治疗单一间室膝骨关节炎(KOA)的一种微创手术,因其具有手术切口小、术中出血少、术后恢复快等优势,逐渐成为膝骨关节炎阶梯化治疗中的重要环节.临床上应用的UKA假体主要有活动平台(MB)和固定平台(FB)两种,MB-UKA可使膝关节的运动更接近自然生物力学且磨损率低,但易发生垫片脱位及假体撞击等并发症.FB-UKA较稳定,无脱位风险,并发症少但磨损率高.目前国内外文献对两者的孰优孰劣尚未形成统一的标准.本文就MB-UKA和FB-UKA的最新临床应用进展进行综述.

目的 探讨全膝关节置换术中超声引导收肌管阻滞与膝关节后囊间隙阻滞联合关节腔注射混合镇痛药物的镇痛效果.方法 纳入自2018-01-2020-12采用全膝关节置换术治疗的120例单侧膝关节骨性关节炎,60例术中进行超声引导收肌管阻滞与膝关节后囊间隙阻滞联合混合镇痛药物关节腔注射镇痛(观察组),60例术中单纯进行超声引导收肌管阻滞与膝关节后囊间隙阻滞镇痛(对照组).结果 120例均获得至少6个月随访,术中未出现重要神经、血管损伤,术后切口一期愈合,随访期间未出现感染、假体松动、膝前疼痛等并发症.观察组术后12、24、48、72h静息状态下与运动状态下疼痛VAS评分低于对照组,术后12、24、48、72 h膝关节活动度高于对照组,术后1、3个月膝关节功能KSS评分均高于对照组,差异有统计学意义(P＜0.05).但两组术后并发症发生率比较差异无统计学意义(x2=0.370,P=0.543).结论 全膝关节置换术中在超声引导收肌管阻滞与膝关节后囊间隙阻滞的基础上于关节腔注射混合镇痛药物能明显提高术后镇痛效果,改善患者膝关节活动度,促进膝关节功能恢复,并且安全性较高.