Current status of surgical treatment for traumatic arthritis / 解放军医学杂志

Traumatic arthritis (TA) is one of the common diseases of bone and joint caused by trauma. The main pathological changes are degeneration of articular cartilage and secondary hyperplasia and ossification of cartilage. The main clinical manifestations are joint pain and dysfunction of movement. Its pathogenesis is still unclear. At present, the treatment of TA is based mainly on symptoms rather than etiology, including physical therapy, drug treatment, surgical treatment, etc. Conservative treatment (physical therapy, drug treatment) can only alleviate short-term pain, and the long-term effect is not satisfactory. Thus, patients with middle and late TA tend to choose surgical treatment. At present, the surgical treatment of TA includes arthroscopic debridement, arthrodesis, cartilage repair, osteotomy, artificial joint replacement, 3D printing technology, etc. There are differences in the postoperative efficacy. This article reviews the current situation of surgical treatment for TA.

Outcomes of endobutton and rigidfix femoral fixation methods with hamstring autograft in anterior Cruciate ligament reconstruction / 中国组织工程研究

BACKGROUND: The choice of fixation is an important factor affecting the prognosis of anterior cruciate ligament reconstruction. Endobutton and Rigidfix are two kinds of femoral end suspension fixators which are widely used at present. Their advantages are high fixation strength, large contact area between tendon and bone tunnel, and conducive to tendon-bone healing. However, it is still controversial whether there are differences in clinical efficacy and bone tunnel enlargement between the two fixation methods. OBJECTIVE: To analyze the outcomes of two different femoral fixation methods (Endobutton and Rigidfix) with hamstring autograft in anterior cruciate ligament reconstruction. METHODS: A retrospective analysis was performed on the data of 270 cases which accepted the anterior cruciate ligament reconstruction and second arthroscopic look from June 2015 to December 2017. All patients signed the informed consent. This study was approved by the Hospital Ethics Committee. The patients were divided into two groups according to the method of femoral end fixation. The Endobutton femoral fixed reconstruction was performed in Endobutton group (150 cases). The Rigidfix femoral fixed reconstruction was performed in Rigidfix group (120 cases). Reconstruction of anterior cruciate ligament was done using autologous semitendinosus and gracilis tendon. All cases were fixed with Bioabsorbable Interference Screw and AO hollow nail bolt pile fixing screw at the tibial tunnel. The diameter of bone tunnel was also measured by MRI. The knee joint function recovery and stability were evaluated by Lysholm score, International Knee Documentation Committee score, Tenger score table, drawer test, Lachman test, axle shift test, and KT-1000 joint measuring instrument. Second-look arthroscopic evaluation was performed in all patients, focusing on continuity of the reconstructed anterior cruciate ligament, the synovial coverage and the prevalence of abnormal structure at 1 year after surgery. RESULTS AND CONCLUSION: (1) All patients were followed up for 14 to 44 months. (2) Tunnel widening was significantly increased in the Endobutton group than in the Rigidfix group at 1 year after surgery (P 0.05). (4) At 1 year after surgery, the range of motion of knee joint was not significantly different between the two groups (P > 0.05). (5) There was no significant difference between the two groups in drawer test, Lachman test and axle shift test (P > 0.05). The side-to-side difference of KT-1000 in the Endobutton group was (1.12±1.20) mm, while that of KT-1000 in Rigidfix group was (1.23±0.91) mm. There was no significant difference between the two groups (P > 0.05). (6) Secondary arthroscopic examination showed that there were 1 case of complete graft absorption, 11 cases of graft wear in Endobutton group, 2 cases of complete graft absorption and 15 cases of graft wear in Rigidfix group. There was no significant difference between the two groups (P > 0.05). (7) There were 59 excellent cases, 61 good cases, 30 poor cases in Endobutton group, 47 excellent cases, 49 good cases and 24 poor cases in Rigidfix group. There was no significant difference between the two groups (P > 0.05). (8) The incidence of complication was 2.6% in the Endobutton group and 6.6% in the Rigidfix group, and no significant difference was found between the two groups (P > 0.05). (9) The results suggested that Endobutton and Rigidfix had the same clinical outcome. There was no significant difference in the coverage and continuity of synovial synovial membrane between the second look grafts. However, compared with Rigidfix transverse screw system, Endobutton fixation at the femoral end is more likely to cause bone tunnel enlargement.

T2-mapping quantitative imaging technique based on sequence optimization in the ankle talus osteochondral injury / 中国组织工程研究

BACKGROUND: At present, DWI, DTI, T1-mapping, T2-mapping, and T2*-mapping are commonly used in cartilage functional imaging sequences in both scientific research and clinic. T2-mapping is often used for the quantitative analysis of cartilage, but it was obviously limited due to the long scanning time and poor experience of the patient.OBJECTIVE: To quantitatively evaluate the talar cartilage injury degree of chronic lateral ankle instability patients by sequence optimized T2-mapping quantitative imaging technique. METHODS: Totally 53 cases of chronic ankle instability(case group) and 46 healthy subjects(control group) were from the Second Affiliated Hospital of Inner Mongolia Medical University. They underwent conventional Magnetic Resonance Imaging and optimal T2-mapping quantitative imaging scanning. The total talar cartilage was divided into six compartments: internal anterior, internal medial, internal posterior, lateral anterior, lateral center and lateral posterior. Six T2 values were totally taken as each partition had one T2 value. The experiment was approved by the Ethics Committee of Inner Mongolia Medical University. RESULTS AND CONCLUSION: The T2 values of internal anterior, internal medial, internal posterior areas of case group were higher than those of control group(P 0.05). The results showed that the talus cartilage injury mainly occurred in the internal talus in patients with chronic lateral ankle instability. The cartilage damage degree could be quantitatively evaluated by magnetic resonance T2-mapping imaging technique. It is possible that T2-mapping based on sequence optimization can be used in functional image routine scan.

Effectiveness of a modified posterior approach for arthroscopic resection on painful talocalcaneal coalition in adults / 中国修复重建外科杂志

Objective: To investigate the effectiveness of arthroscopic talocalcaneal coalition resection in painful adults via a modified posterior approach. Methods: Between January 2015 and December 2017, 9 patients with painful talocalcaneal coalition accepted arthroscopic resection via the posterior malleolus high lateral observation approach combined with the lower medial operation approach. Of them, 6 were male and 3 were female, aged from 19 to 30 years (mean, 24 years). Among them, 2 cases had no definite local trauma and 7 cases had a history of sprain of foot and ankle. The disease duration ranged from 6 to 30 months, with a median of 12 months. Rozansky classification of talocalcaneal coalition for the 9 patients: 5 cases (5 feet) were type Ⅰ, 2 cases (2 feet) type Ⅱ, and 2 cases (2 feet) type Ⅲ. The patients had no sequelae of limb dysfunction and no limb joint surgery in the past. All the patients received anteroposterior and lateral X-ray films and CT scans of the ankle joint during follow-up. The visual analogue scale (VAS) score and American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hind foot score were used to evaluate the effectiveness. Results: The operation time was 60-90 minutes (mean, 76 minutes). All patients were followed up 12-24 months (mean, 18 months). All the incisions healed by first intention, without infection, skin necrosis, lower extremity deep vein thrombosis, vascular nerve and tendon injury, bone bridge recurrence, and other complications. The ankle function recovered well and the pain was relieved obviously after operation, and the patients returned to work at 3-5 months after operation, with an average of 3.9 months. At last follow-up, the VAS score was 0.7±0.5, which was significantly improved ( t=20.239, P=0.000) when compared with preoperative score (4.2±0.5); the AOFAS ankle-hind foot score was 94±4, which was significantly improved ( t=-27.424, P=0.000) when compared with preoperative score (62±2). According to AOFAS ankle-hindfoot scoring system, the results were excellent in 7 cases and good in 2 cases at last follow-up. Conclusion: It is more intuitive, more space, and more flexibility for operation via the modified posterior malleolus high lateral observation approach combined with the lower medial operation approach in talocalcaneal coalition. It is feasible to remove talocalcaneal coalition programmatically according to the specific anatomic signs during the operation.

Clinical observation of arthroscopic all-inside combined with outside-in "suture loop" repair for meniscus bucket-handle tear / 中国修复重建外科杂志

Objective: To investigate the effectiveness of arthroscopic all-inside combined with outside-in "suture loop" repair for meniscus bucket-handle tear (BHT). Methods: Between August 2016 and May 2019, 44 case of meniscus BHT were treated with arthroscopic all-inside combined outside-in "suture loop". There were 29 males and 15 females with an average age of 26.6 years (range, 18-42 years). The causes of injury included sports injury in 31 cases, falling injury in 7 cases, and sprain in 6 cases. There were 32 cases of medial meniscus posterior horn tears and 12 cases of lateral meniscus posterior horn tears. The disease duration ranged from 6 weeks to 3 months. Thirty-three cases were complicated with anterior cruciate ligament rupture. All patients had normal lower limb alignment. The preoperative Lysholm score was 42.1±9.1. According to the evaluation criteria of MRI and Barrett et al., the healing of meniscus was evaluated, and the effectiveness was evaluated by Lysholm score. Results: All the 44 patients were followed up 8-36 months with an average of 16.8 months. At last follow-up, according to the evaluation criteria of Barrett et al., 39 cases were clinically healed, 5 cases were not healed, the clinical healing rate was 88.6%; according to MRI evaluation, 32 cases were completely healed, 7 cases were partially healed, and 5 cases were not healed, the total healing rate was 88.6%, and the complete healing rate was 72.7%. Lysholm score was 87.8±4.8, which was significantly different from that before operation ( t=31.060, P=0.000). Conclusion: Arthroscopic all-inside combined with outside-in "suture loop" repair is a reliable and effective method for the meniscus BHT, which can obtain good joint function.

Surgery treatment of Meyers-Mckeever-Zaricnyj type IV tibial eminence fracture patients under arthroscope: A report of 7 cases and literature review / 吉林大学学报(医学版)

Objective: To observe the efficacy of Endobutton combined with the suture in the treatment of Meyers-Mckeever-Zaricnyj type IV tibial eminence fracture, and to explore the characteristics and treatment methods of Meyers-Mckeever-Zaricnyj type IV fracture. Methods: The clinical data of seven patients with Meyers-Mckeever-Zaricnyj type IV tibial eminence fracture were collected; the literature review was performed, and the surgical treatment methods, key points of operation and precautions of the patients were analyzed. Results: After arthroscopic debridement, 3 kinds of main fractures were found: anterior cruciate ligament connected fragment (ACLCF), anterior horn of lateral meniscus connected fragment (ALMCF), and posterior-medial cartilage connected fragment (PMCCF). The PMCCF was first fixed after pre-reduction from back to front and from deep to shallow orders, then the ALMCF and ACLCF were fixed, avoiding the secondary displacement and bone cutting. The follow-up periods of 7 patients were 6-12 months, with an average followed-up period of 7 months. The front drawer test (-), Lachman test (-); the average Lysholm score of patients before operation was less than that in the last follow-up period (P<0. 05). The knee joint stability of patients was good, and the knee joint had no movement disorder and infection. Conclusion: The intra-operative reduction order is crucial during the operation of Meyers-Mckeever-Zaricnyj type IV tibial eminence fracture. Perfect fixation can be achieved by using Endobutton combined with suture.

Comparison of two surgical methods in the treatment of rotator cuff tendinopathy / 中国综合临床

Objective To compare the effect of whether rotator cuff pathological tissue cleaning and tendon insertion reconstruction or not under shoulder arthroscopy on the surgical treatment of rotator cuff tendinopathy. Methods From September 2015 to January 2017,the clinical data of forty-one patients with rotator cuff tendinopathy treated by surgical medicine ward in Shengjing Hospital of China Medical University were retrospectively analyzed. According to different surgical methods,41 patients were divided into A group and B group. In group A,21 patients were treated with shoulder arthroscopic bursa debridement combined with selective acromioplasty. In group B,20 patients were treated with cleanup of pathological changes tissue and reconstruction of tendon insertion on the basis of A. All patients were followed up for one year. Constant-Murley shoulder function score,visual analog scale (VAS),University of California Los Angeles (UCLA) and Hawkins sign,arc of pain sign and infraspinatus muscle test were used as the evaluation indexes. The shoulder joint function was evaluated so as to compare the efficacy of two surgical methods for rotator cuff disease. Results Compared with the preoperative,the postoperative VAS score,UCLA score and Constant-Murley score in both groups were significantly improved. In group A,the preoperative in group A (5. 0±1. 3) points,(15.5±1.4) points,(65.1±5.7) points) were increased to (0.7±0.4) points,(33.0±1.7) points,(90. 9±3. 1) points. The preoperative scores of group B were (5. 2±1. 0)points,(15. 6±2. 0) points, (65. 4±5. 9) points, and increased to ( 0. 4 ± 0. 5) points, ( 34. 3 ± 0. 9) points, ( 93. 3 ± 2. 3) points respectively,and the differences were statistically significant (group A: t＝14. 77,P＜0. 001; t＝－ 74. 44,P＜0. 001; t＝－ 29. 19,P＜0. 001; group B: t＝23. 13,P＜0. 001; t＝－ 61. 52,P＜0. 001; t＝－ 26. 38,P＜0. 001). The UCLA score and Constant-Murley score of shoulder joint in group B were higher than those in group A (t＝－3. 27,P＝0. 003; t＝－2. 90,P＝0. 007). Postoperative positive rates of Hawkins sign,pain arc sign and infraspinatus muscle test in group A decreased from 90%(18/20),90%(18/20),95%(19/20) to 15%( 3/20),10%( 2/20) and 15%( 3/20) respectively. There was a significant difference between preoperative and postoperative (χ2＝13. 067,P＜0. 001) . χ2＝14. 063,P＜0. 001; χ2＝14. 063,P＜0. 001), group B decreased from 90. 5%( 19/21), 85. 6%( 18/21), 90. 5%( 19/21) to 9. 5%( 2/21), 4. 8%(1/21),9.5%(2/21).There were significant differences between preoperative and postoperative (χ2＝15. 059,P＜0. 001;χ2＝12. 500,P＜0. 001;χ2＝15. 059,P＜0. 001) . Conclusion Both group A and group B are effective in the treatment of rotator cuff tendon disease,and group B is more effective than group A in the treatment of rotator cuff tendon disease.

Structure and component analysis of uratoma around joint / 局解手术学杂志

Objective To analyze the structure and component of gouty tophus around joint, and provide basis to select solvent of gouty tophus and surgical cleaning method.Methods The sample of gouty tophus were obtained from 6 patients in 187 hospital of PLA from January2016 to December 2017, which were rinsed by distilled water, and then dried and accepted other dispose.The sample were analyzed by Fourier Transform Infrared Spectroscopy (FTIR), scanning electron microscope and thermal gravimetric analyzer.Results Sodium urate was the main component of the uratoma, the proportion was 56％;the organic component was about 14％of the uratoma.The microstructure of the uratoma under scanning electron microscope have two forms, the one looks like column crystal and the other like granules head up to lump.Conclusion The main component of the gouty tophus are sodium urate and organic tissues, the possible solvent should react on the both of them.

Preliminary effectiveness of carpal arthroscopic adjuvant treatment of intra-articular fractures of distal radius / 中国修复重建外科杂志

Objective: To investigate the early-term effectiveness of carpal arthroscopy in the treatment of intra-articular fractures of distal radius. Methods: The clinical data of 50 cases of intra-articular fractures of distal radius between January 2015 and December 2017 were retrospectively analyzed. According to the different methods of intraoperative assisted treatment, the patients were divided into the trial group (11 cases with carpal arthroscopy assisted treatment) and the control group (39 cases with traditional open reduction). There was no significant difference between the two groups in general data such as gender, age, affected side, cause of injury, time from injury to operation, and preoperative displacement ( P>0.05), which were comparable. Six patients in the trial group had triangular fibrocartilage complex (TFCC) injury and received one-stage repair. Postoperative X-ray films were taken to estimate the fracture reduction. Patient-Rated Wrist Evaluation (PRWE) wrist function score and modified Mayo score were used at 3 months after operation to evaluate the function of the wrist. The range of wrist flexion, extension, pronation, and supination motion of the two groups were recorded and compared at 3 months after operation. Patients in the trial group were further divided into the reduction group after arthroscopic exploration (group A, 6 cases) and the simple cleaning group after arthroscopic exploration (group B, 5 cases), and their wrist motions were compared. Results: The operation time of the trial group was greater than that of the control group ( t=11.08, P=0.00). There was no significant difference in intraoperative blood loss and fracture reduction between the two group ( P>0.05). X-ray film at 1 day after operation showed that the degree of fracture displacement was significantly decreased when compared with preoperative one in each group ( P0.05). Conclusion: Carpal arthroscope assisted treatment of intra-articular fractures of distal radius can achieve good reduction and postoperative function. Meanwhile, TFCC, ligament, articular cartilage, and other injuries can be repaired in one stage.

Application of internal and external lysis combined with Ilizarov external fixation technology for severe knee pathological flexion contracture deformity in children / 中国修复重建外科杂志

Objective: To investigate the effectiveness of internal and external lysis combined with Ilizarov external fixation technology for severe knee pathological flexion contracture deformity in children. Methods: A retrospective analysis was made on 12 children (12 knees) with severe knee pathological flexion contracture deformity who were treated with internal and external lysis and Ilizarov external fixation between August 2012 and January 2017. There were 9 boys and 3 girls with an age of 3-12 years (mean, 8.4 years). There were 8 cases of tuberculosis, 3 cases of haemophilia A, and 1 case of residual deformity after extensive hemangioma drug injection. The disease duration ranged from 5 months to 4 years, with an average of 20.3 months. The degree of knee contracture was (67.42±23.30)°, and the range of motion of knee was (38.33±14.98)°. The preoperative Western Ontario and McMaster University Osteoarthritis Index (WOMAC) score was 78.42±15.57. The complication was observed after operation, and the degree of knee contracture, range of motion, and WOMAC score at 3 months and 1 year after operation were recorded and compared with those before operation. Results: The operations completed successfully in all children. All the 12 cases were followed up 9-24 months (mean, 14.5 months). All incisions healed by first intention after operation. The knee function of all children improved significantly and the weight-bearing walking function of the lower limbs restored. The degree of knee contracture, range of motion, and WOMAC score were significantly improved at 3 months and 1 year after operation (P0.05). Conclusion: For severe knee pathological flexion contracture deformity in children, application of internal and external lysis combined with Ilizarov external fixation has advantages, such as small trauma, rapid recovery, and early postoperative knee function training, and good effectiveness.

Unilateral Biportal Endoscopic Spinal Surgery Using a 30° Arthroscope for L5–S1 Foraminal Decompression

Foraminal decompression using a minimally invasive technique to preserve facet joint stability and function without fusion reportedly improves the radicular symptoms in approximately 80% of patients and is considered one of the good surgical treatment choices for lumbar foraminal or extraforaminal stenosis. However, proper decompression was not possible because of the inability to access the foramen at the L5–S1 level due to prominence of the iliac crest. To overcome this challenge, endoscopy-based minimally invasive spine surgery has recently gained attention. Here, we report the technical skills required in unilateral extraforaminal biportal endoscopic spinal surgery using a 30° arthroscope to enable foraminal decompression at the L5–S1 level. Two 0.8-cm portals were created 2 cm lateral from the lateral border of the pedicles at the L5–S1 level. After sufficient working space was made, half of the superior articular process (SAP) in the hypertrophied facet joint was removed using a high-speed burr and a 5-mm wide osteotome, whereas the remaining inside part of the SAP was removed using a Kerrison punch and pituitary punch. The foraminal ligamentum flavum should be removed to inspect the conditions of the L5 exiting root and disc. Removing of the extruded disc could decompress the L5 root. The extraforaminal approach using a 30° arthroscope is considered a minimally invasive alternative technique for decompressing foraminal stenosis at the L5–S1 level that preserves facet stability and provides symptomatic relief.

Clinical observation of arthroscope treating traumatic omarthralgia with Bankart injury / 中国医学装备

Objective:To investigate the clinical effect of arthroscope treating traumatic omarthralgia with Bankart injury.Methods: 69 patients with traumatic omarthralgia with Bankart injury were divided into observation group (38 cases) and control group (31cases). And patients of observation group received the treatment of arthroscopic while those of control group received routine treatment. And then the shoulder joint score and visual analogue scale (VAS) of the two groups at post-treatment 1 week and post-treatment 1 month were compared, respectively.Results: At post-treatment 1 week, series of shoulder joint scores, included of pain, functional activity, activity degree of shoulder joint, muscle force and total score, of observation group were significantly higher than those of control group, respectively (t=5.27,t=6.02,t=6.81,t=3.37,t=8.22,P<0.05). While at post-treatment 1 month, all of above shoulder joint scores between the two groups were no significantly (t=1.02,t=1.73,t=2.85,t=2.46,t=4.01,P>0.05), respectively. And for all of these scores, post-treatment 1 month were higher than that of post-treatment 1 week. Besides, for both of the two groups, the VASs of post-treatment were lower than that of pre-treatment, and the VAS of observation group was significantly lower than that of control group(t=6.88,P<0.05).Conclusions: In the process of arthroscopic treating traumatic omarthralgia with Bankart injury, the recovery of shoulder joint function and the alleviating of painful of patients achieve better effect, and post-operative recovery is faster. Therefore, the therapy method is worthy in the popularization and application of clinical practice.

A Treatment Effect Study of Arthroscope Combined Proximal Humerus Osteotomy in Knee Inversion Osteoarthritis / 昆明医科大学学报

Objective To discover the treatment effect of arthroscope combined with proximal humerus osteotomy in Knee inversion osteoarthritis.Methods From April 2012 to December 2016, 126 cases were diagnosed with knee inversion osteoarthritis in our deparment, then we divided them into two groups randomly, 63 in each group, the control group operated with arthroscope, and the observation group operated with arthroscope combined with proximal humerus osteotomy. The treatment effects of the two groups were compared. Results Two groups of patients'HSS score,VAS score,KSS score before surgery have no statistical significance (P＞0.05) . 6 months post-operation, the HSS score and KSS score have significant increase in both groups, while the VAS score has an obviously reduction. The differences between the two groups have statistical significance (P＜0.05), the treatment effects in two groups have statistical significance (P＜0.05), the observation group has better treatment effect than the control group, and in the case of adverse reactions in both groups, there were no statistical significance (P＞0.05) . Conclusion The treatment of middle-aged and elderly people knee inversion osteoarthritis by arthroscope combined with proximal humerus osteotomy could improve the treatment,soit is worth promoting in clinics.

Inadvertent thermal injury following knee arthroscopic surgery in a pediatric patient / 대한마취과학회지

Inadvertent thermal injury can occur in pediatric patients under general anesthesia during knee arthroscopic surgery. Here, we report the case of a 10-year-old boy who underwent knee arthroscopic surgery under general anesthesia. After the surgery, he complained of pain in the left lower part of his chin and was diagnosed as having a thermal burn. At three-month follow-up, he recovered without any abnormalities except mild hypertrophy of the wound area. Although rare, arthroscopic surgery has the potential to cause thermal injury from the light source. We recommend that the light source should be connected to the arthroscope before switching the power on and disconnected after a considerable time of switching the power off when not in use.

Arthroscopic treatment of anterior cruciate ligament tibial eminence avulsion fracture with double heads compressive cannulated screw fixation in adolescents / 中国修复重建外科杂志

Objective: To discuss the effectiveness of arthroscopic treatment of anterior cruciate ligament (ACL) tibial eminence avulsion fracture in adolescents by using double heads compressive cannulated screw fixation. Methods: Twenty-four patients with ACL tibial eminence avulsion fractures were treated by arthroscopic reduction and internal fixation with double heads compressive cannulated screw fixation between June 2014 and June 2017. There were 15 males and 9 females with an average age of 12.3 years (range, 5-18 years). The body mass index was 19.3-26.4 kg/m 2 (mean, 23.3 kg/m 2). The injury causes included traffic accident injury in 10 cases, sports injury in 8 cases, and falling injury in 6 cases. According to the Meyers-McKeever classification, there were 19 cases of type Ⅱ and 5 cases of type Ⅲa. All patients’ drawer test and pivot shift test were positive. The interval between injury and operation was 3-14 days (mean, 6.2 days). During the follow-up period, the fracture healing condition of patients were determined by X-ray examination; Lysholm score, International Knee literature Committee (IKDC) score, and Tegner score were used to evaluate the knee function. Results: Primary healing of incision was obtained in all patients after operation. All the 24 patients were followed up 6-32 months (mean, 16.4 months). At 6 weeks after operation, 3 patients had difficulty in knee flexion. After the release of the knee joint by manipulation, the knee joint function recovered normally at 6 months after operation. At last follow-up, the X-ray films showed that all the fractures healed and no epiphyseal dysplasia, knee joint deformity, or leg length discrepancy occurred. The Lysholm score, IKDC score, and Tegner score were improved from preoperative 44.3±5.4, 43.7±4.4, and 3.0±1.3 to postoperative 93.1±4.3, 94.6±3.3, and 8.1±1.2, the differences were all significant ( t=25.152, P=0.000; t=28.634, P=0.000; t=13.226, P=0.000). Conclusion: The arthroscopic reduction and internal fixation with double heads compressive cannulated screw in treatment of ACL tibial avulsion fracture (Meyers-McKeever type Ⅱ and Ⅲ) in adolescents has so many advantages, such as minimal trauma, simple operation, firm fixation, little effect on the epiphyseal plate, and has a good joint function recovery.

Arthroscopic medial retinaculum plication in treatment of traumatic patellar instability / 中国内镜杂志

Objective To explore the short-term results of arthroscopic medial retinaculum placation (MRP) and lateral retinaculum release (LRR) in treatment of patients with traumatic patellar dislocation. Methods 17 cases (6 male, 11 female) with traumatic patellar instability from March 2012 to December 2015, with an average age of 16.8 years old (range from 14 to 37 years old). All of the patients had a clear history of trauma and experienced patellar dislocation for the first time, the patients experienced patellar dislocation 1 to 4 times preoperatively. The arthroscopic examination was undertaken before the repairing to observe the injured site of the medial retinaculum and the patellar track, as well as the dynamic patellofemoral congruence. All patients underwent arthroscopic MRP and LRR minimally invasive procedure. Results All patients were followed up for 9 to 28 months averaging (19.7 ± 1.3) months. The fear test was negative after operation. There was no redislocation during follow-up and their ranges of motion returned to normal. Postoperative CT images showed 15 cases regained normal anatomical relation of patellofemoral joint. 2 cases had mild semi-dislocation. Lysholm's score averaging (51.8 ± 4.5) points preoperatively and (92.4 ± 2.8) points postoperatively. According to Insall scale, the results were excellent in 11 knees, good in 5 knees, and fair in 1 knee at 1 year after operation with an excellent and good rate of 94.1％. Conclusions Arthroscopic MRP and LRR showed satisfactory results with limited morbidity in the short-term follow-up. This method can make the patients smaller wound,quicker recovered and lower recurrence rate.

Comparison of therapeutic effect and postoperative recovery of arthroscopy assisted percutaneous internal fixation and traditional surgery for tibial plateau fractures / 中国内镜杂志

Objective To compare the effectiveness of arthroscopy assisted percutaneous internal fixation and open reduction of traditional surgery for tibial plateau fractures. Methods Between January 2012 and January 2015, 178 patients with tibial plateau fractures were treated with arthroscopy assisted percutaneous internal fixation (arthroscopy group, n = 99), and control group (n = 79) with traditional surgery for the treatment of tibial plateau fractures. The operation time, fracture healing time, intraoperative and postoperative blood loss and complications were compared between the two groups. Knee function score and the range of motion were measured according to American Hospital for Special Surgery (HSS) score standard. Results Compared with control group, the amount of blood loss in arthroscopic group was less than that in control group (P < 0.05), and there was no significant difference in the operation time compared with control group. After 18～24 months follow-up, the HSS score of the arthroscopic group was higher, the wound healing time was shorter and the complication occurred less, the difference was statistically significant (P < 0.05). Conclusion The two treatment methods can achieve good clinical results, but after arthroscopic microscopic examination of the tibial plateau fractures with benefits such as: less blood loss, not increased the operation time, shorter healing time and less complications, higher HSS score while reduced the suffering of patients and improved the efficacy.

Curative effect of arthroscopic surgery on knee joint disease in children / 中华实用儿科临床杂志

Objective To analyze the clinical characteristics of children with knee joint diseases and discuss the curative effect of arthroscopy.Methods Eighty-nine children with knee joint diseases in Department of Orthopedics,the First Affiliated Hospital of Xinxiang Medical University from October 2012 to October 2015 were selected,and they were given knee arthroscopic surgery according to the disease types and characteristics,such as meniscal suture,suture plus angioplasty and synovectomy etc.All the symptoms,signs and the joint functions were recorded preoperatively and postoperatively.At the end of follow-up,surgical results were analyzed according to Lysholm score and International Knee Documentation Committee Knee evaluation form (IKDC) classification standard.Results The patients with discoid meniscus tear were the most,accounting for 55.55％ (55/99 knees).All patients were followed up for 6-30 months(the average time was 21 months) to find that all symptoms were relieved or disappeared within 1 year after operation.The outcome was evaluated according to the Tegner knee function:76 knees (76.76％) were markedly effective,16 knees (16.16％) were effective,6 knees (6.06％) were invalid and 1 knee (1.01％) was poor,and the excellent rate was 92.92％.The curative effect was evaluated according to Lysholm knee function score and IKDC score at the last follow-up.The Lysholm score in preoperation [(52.46 ± 4.79) scores] improved to (96.52 ± 3.97) scores in postoperation,and the difference was significant (t =-36.24,P ＜ 0.05);the IKDC score in preoperation [(46.52 ± 10.25) scores] improved to (90.67-± 5.89) scores in postoperation,and the difference was significant (t =-50.69,P ＜ 0.05).There was no joint infection,blood vessel or nerve damage and so on.Conclusions Meniscus tear is common in children with knee joint diseases,and most common is discoid lateral meniscus tear,and arthroscopy can have satisfactory outcome,with no obvious complications.Therefore,arthroscopic surgery is an ideal method for surgical treatment of children with knee joint disease.

Comparative study of unilateral or bilateral arthroscopic examination of traditional open surgery and drawed reset sac surgery tibial plateau fractures / 中国内镜杂志

Objective To compare the effectiveness of arthroscopy assisted percutaneous internal fixation and open reduction and traditional surgery tibial plateau fractures.Methods From August 2013 to April 2014, 78 patients with tibial plateau fractures according to random number table were divided into group A and group B, 39 cases in each. A group of traction using arthroscopic surgery, group B with traditional open bag reduction surgery.Results The operation time, intraoperative and postoperative bleeding less and wound lesion area was shorter and less in group A than that in group B; while the healing time and HSS score was faster and higher than that in group B. The difference was statistically significant (P 0.05); postoperative complication rate in group A was lower than that in group B, and there is significant difference (P < 0.05).Conclusion Both treatment methods can achieve good clinical results, but arthroscopically assisted treatment of tibial plateau fractures reset shorter operative time, less blood loss, healing time is shorter, less complications, but higher HSS score, etc., which reduced the suffering of patients and improved the outcome.

Clinical Effect of Arthroscopic Circumpatellar Denervation in Anterior Knee Pain of Patellofemoral Osteoarthritis and its Correlation with Cartilage Degeneration / 医学研究杂志

Objective To explore clinical effect of arthroscopic circumpatellar denervation in anterior knee pain of patellofemoral osteoarthritis and its correlation with cartilage degeneration.Methods Totally 104 patients with anterior knee pain of patellofemoral osteoarthritis were randomly divided into two groups.Patients in control group(n =52) were treated with arthroscopic debridement,and those in combined group(n =52) were treated with arthroscopic debridement plus circumpatellar denervation.All the patients were followed-up for 6 months.The WOMAC scores,knee function recovery were compared between two groups,and the changes of WOMAC score among different degrees of cartilage degeneration were analyzed.Results The WOMAC score of pain,morning stiffness and joint function were significantly improved in combined group than those in control group at 6 months after surgery(P ＜ 0.05).At 6 months after surgery,the score of range of activity and walking distance in both groups were all increased,and combined group had more remarkable increase than that of control group(P ＜ 0.05).Compared with before surgery,the total WOMAC score in patients with grade Ⅰ-m at 6 months after surgery significantly decreased (P ＜ 0.05),while there was no significant difference in patients with grade Ⅳ level between before surgery and 6 months after surgery (P ＞ 0.05).Conclusion Arthroscopic debridement plus circumpatellar denervation for anterior knee pain of patellofemoral osteoarthritis can effectively relieve pain symptom,promote the recovery of knee joint function,especially suitable for patients with cartilage degeneration of Ⅰ ～ Ⅲ.