Comparison of the efficacy of total arthroscopy and traditional surgical treatment for the treatment of popliteal cyst / 中国骨伤

OBJECTIVE@#To compare the clinical efficacy of total arthroscopic surgery and traditional surgery for popliteal cyst.@*METHODS@#From August 2014 to July 2017, 60 cases of popliteal cyst were treated with total arthroscopy or traditional surgery respectively. In total arthroscopy group, there were 30 patients including 7 males and 23 females with an average age of (55.81±8.53) years old; the duration of the disease was (3.52±1.12) years;according to Rauschning-Lingdgren grading, 7 cases were grade I, 19 cases were grade II, 4 cases were grade III. In traditional surgical group, there were 30 patients including 5 males and 25 females with an average age of (57.93±9.84) years old; the duration of the disease was (3.48±1.34) years; according to Rauschning-Lingdgren grading, 5 cases were grade I, 21 cases were grade II, 4 cases were grade III. Preoperative symptoms involved such as arthralgia and swelling after knee joint and limited mobility. MRI confirmed a popliteal cyst. Arthroscopic surgery and traditional surgical was used respectively. Incision length, operation time, average stay, total hospital cost and Lysholm score of two groups were compared.@*RESULTS@#In the total arthroscopic group, 1 case suffered from nerve injury, and all cases' incision healed well. In the traditional surgical group, there was 1 case of incision infection, 2 cases of poor healing, 1 case of nerve injury and 1 case of recurrence. All 60 cases were followed up for 6 to 30 months with an average of (13.3±6.5) months. After operation, the symptoms of knee joint arthralgia and swelling, discomfort were significantly improved in the two groups. There were statistically significant differences in incision length, operation time, average stay, total hospitalcost and Lysholm score 6 months after surgery(<0.05).@*CONCLUSIONS@#The total arthroscopic resection of popliteal cyst, via anterior approach to having a knee joint cavity exploration and treatment of meniscus and bursa, while combined with posteromedial approach for cyst excision would promise a minimal surgery and less pain for patients. Patients will have a rapider recovery, lower recurrence rate and less complication. The total arthroscopic resection easy to accepting for the patient and having a better clinical curative effect is obviously superior to the traditional surgery.

Diagnosis and therapy of popliteal cyst / 中国骨伤

Popliteal cyst is a common peri-knee cyst, also known as a Baker's cyst. With the current development of popliteal cysts, the pathogenesis is mainly due to increased pressure in the knee joint caused by various reasons, leading to a fluid-filled sac that can form behind the knee as a result of enlargement of the gastrocnemius-semimembranosus bursa. The current diagnostic methods include X-ray computed, ultrasound, and magnetic resonance. Among them, magnetic resonance imaging is considered the gold standard for the diagnosis of popliteal cysts. There are various treatments, including conservative treatment, traditional surgical resection and arthroscopic surgery. In recent years, the focus of the treatment of popliteal cysts has gradually shifted from the simple removal of cysts to arthroscopic treatment of intra-articular lesions and the treatment of joint-cyst communication, and achieved a good effect. However, there are still controversies about the most effective treatment, and the best surgery method is still uncertained. It is hoped that high quality prospective studies will be able to directly compare different surgery methods, so as to select the best treatment for popliteal cyst. This article reviews past literature research and describes in detail the epidemiology, pathological mechanism, clinical manifestations and signs, auxiliary examination, diagnosis and differential diagnosis and clinical treatment of popliteal cysts. Different diagnosis methods and treatment methods are compared and summarized to provide basis for clinical diagnosis and treatment.

High-resolution Sonographic Measurements of Lower Extremity Bursae in Chinese Healthy Young Men / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Lower extremity bursae are very vulnerable to injury during strenuous physical exercises. Understanding the imaging characteristics of normal bursae is essential for early diagnosis of morphological abnormalities. Therefore, we evaluated the normal range of lower extremity bursae in healthy young men using high-resolution ultrasound (HR-US) imaging.</p><p><b>METHODS</b>Bursae in the lower extremities were examined by HR-US in 290 Chinese healthy young men with a median age of 18 years (range, 18-23 years). The bilateral suprapatellar bursa (SPB), deep infrapatellar bursa (DIPB), popliteal bursa (PB), and retrocalcaneal bursa (RCB) were imaged and measured for analysis.</p><p><b>RESULTS</b>The HR-US identification rates of the SPB, DIPB, PB, and RCB were 89.0% (517/580), 55.0% (319/580), 29.4% (171/580), and 49.5% (287/580), respectively. With the assumption that the bursae were normal in 95% of the study participants, the length and width values at the maximal cross-section of the SPB, DIPB, PB, and RCB were ≤18.00 and 6.09 mm, 8.10 and 2.11 mm, 7.67 and 3.93 mm, and 7.82 and 2.04 mm, respectively.</p><p><b>CONCLUSIONS</b>Using HR-US imaging, we were able to analyze lower extremity bursae with high detection rates in healthy young men. The normal ranges of lower extremity bursa dimensions in healthy young men measured by HR-US in this study could be used as reference values for evaluation of bursa abnormalities in the lower extremity.</p>

Analysis of effects of arthroscopic treatment for recurrent patellar dislocation by lateral patellar retinacular release outside the synovial bursa of knee joint combined with reconstruction of medial patellofemoral ligament / 中国骨伤

<p><b>OBJECTIVE</b>To introduce an arthroscopic technique in managing recurrent dislocation of the patella and its clinical results.</p><p><b>METHODS</b>Sixteen patients with recurrent patellar dislocation were reviewed, including 3 males and 13 females. The average age was 17.6 years old (ranged from 14 to 32 years). The patients suffering from patellar sub-luxation averaged 18.5 months (ranged from 6 to 23 months)before operation. These patients were treated with lateral patellar retinacular release outside the synovial bursa of knee joint and medial patellofemoral ligament reconstruction using the semitendinosus tendon free autograft. The Lyshohm scores before and after operation were used to evaluate outcomes at the final follow-up.</p><p><b>RESULTS</b>All the patients were followed up, and the duration ranged from 6 to 48 months, with an average of 12 months. There was no recurrence. The Q angle decreased from (16.4 ± 3.7)° to (10.1 ± 1.4)°; insall index decreased from 1.37 ± 0.25 to 1.28 ± 0.23; congruence angle decreased from (21.3 ± 2.6)° to (5.86 ± 2.23)°; Lysholm score improved from 76.1 ± 5.2 to 89.8 ± 4.1 at 6 months after operation.</p><p><b>CONCLUSION</b>Compared with conventional procedure, arthroscopic surgery for recurrent dislocation of the patella achieves excellent outcomes with minimum invasion.</p>

Ethyl acetate fraction from Angelica sinensis inhibits IL-1ß-induced rheumatoid synovial fibroblast proliferation and COX-2, PGE2, and MMPs production

BACKGROUND: The root of Angelica sinensis (AS), also known as "Dang-gui," was a popular herbal medicine widely used in the treatment of gynecological diseases in China, Korea, and Japan for a long time. This study aimed to determine the effects of ethyl acetate fraction from Angelica sinensis (EAAS) on the interleukin-1ß (IL-1ß)-induced proliferation of rheumatoid arthritis synovial fibroblasts (RASFs), and production of matrix metalloproteinases (MMPs), cyclooxygenase (COX) 2, and prostaglandin E2 (PGE2), involved in articular bone and cartilage destruction, by RASFs. RESULTS: RASF proliferation was evaluated with cholecystokinin octapeptide (CCK-8) reagent in the presence of IL-1ß with/without EAAS. Expression of MMPs, tissue inhibitor of metalloproteinases-1 (TIMP-1), COXs, PGE2, and intracellular mitogen-activated protein kinase (MAPK) signaling molecules, including p-ERK, p-p38, p-JNK, and NF-κB, were examined using immunoblotting or semi-quantitative reverse transcription-polymerase chain reaction and enzyme-linked immunosorbent assay. EAAS inhibited IL-1ß-induced RASF proliferation; MMP-1, MMP-3, and COX-2 mRNA and protein expressions; and PGE2 production. EAAS also inhibits the phosphorylation of ERK-1/2, p38, and JNK, and activation of NF-κB by IL-1ß. CONCLUSION: EAAS might be a new therapeutic modality for rheumatoid arthritis management.

Candida Septic Arthritis with Rice Body Formation: A Case Report and Review of Literature

Rice body formation in a joint or bursa is a rare condition, and is usually associated with rheumatoid arthritis or tuberculous arthritis. Here we describe a case of multiple rice body formation in a shoulder joint and in adjacent bursae, which was confirmed to be due to septic arthritis by Candida species. To the best of our knowledge, rice body formation in Candida septic arthritis in an immune-competent patient has not been previously reported.

Arthroscopic treatment of painful heel syndrome with radio-frequency / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate therapy effect of radiofrequency in the treatment of painful heel syndrome under arthroscopy.</p><p><b>METHODS</b>From January 2006 to December 2011, 13 patients with painful heel syndrome being admitted into our hospital were studied. There were 5 males and 8 femals, ranging in age from 35 to 68 years. All these surgeries were performed under local anesthesia. After constructing a man-made lacouna in the subcutaneous tissue above plantar fascia, a medial and a lateral portal were established on both sides of plantar fascia and at the anterior edge of calcaneal tuberosity. Hyperplasia and torn fiber tissue of plantar fascia, and plantar calcaneal bursa were removed with radiofrequency probe under arthroscopy. Then penetration of the plantar fascia was carried out in a reticulation-shaped pattern with a special radiofrequency probe TOPAZ. Each patient was assessed with VAS pain evaluation criteria and AOFAS ankle-hindfoot score system (AOFAS-AH) before and after operation. All the patients were followed up, and the duration ranged from 6 to 12 months.</p><p><b>RESULTS</b>All the 13 patients got excellent recovery with their heel pain relieved significantly. VAS score was 8.71 +/- 1.64 before operation, 6.27 +/- 2.53 at the 1st month after operation, and 2.30 +/- 2.69 at the 6th month after operation. AOFAS-AH score was 56.43 +/- 3.72 preoperation, 68.15 +/- 7.38 at 1st month post operation, and 84.51 +/- 2.93 at 6th month after operation. There were no perioperative and postoperative complications related to the procedure, such as blood vessel and nerve injury, and infection.</p><p><b>CONCLUSION</b>Plantar fasciitis and plantar calcaneal bursitis are main factors of painful heel syndrome. Due to advantages of being easy to operate, having definite effect and no use to do spur removal or plantar fasciotomy. Endoscopy assisted plantar calcaneal bursa removal and plantar fascia penetration by radiofrequency technique can be a satisfactory treatment method for painful heel syndrome.</p>

Operative Management in a Patient with Scapulothoracic Bursitis

Scapulothoracic bursitis, an uncommon lesion, has been reported to be a painful disorder of scapulothoracic articulation. The articulation may become inflamed secondary to trauma when overused because of sports or work that requires repetitive or constant movement of the scapula against the posterior chest wall. The bursitis usually appears as a growing mass at the scapulothoracic interface and is often confused with a soft tissue tumor. We report on a patient with scapulothoracic bursitis who underwent surgical excision.

Ganglionectomy without Repairing the Bursal Defect: Long-term Results in a Series of 124 Wrist Ganglia

BACKGROUND: Some surgeons consider the abscission of a part of the articular bursa around the point of the input of ganglion's nape (average 1-2 cm diameter) to be very important with excellent results. However, a literature search revealed disagreement as to whether it is essential to repair a bursa defect. This study examined the effectiveness of this method without repairing the articular defect. An attempt was made to identify the anatomical origin of wrist ganglia during the surgical procedure. METHODS: This study evaluated 124 wrist ganglia that had been treated surgically during 2004-2009 using this technique and without repairing the bursa defect (1-2 cm in diameter). The variables studied were age, gender, time from the occurrence till abscission of the ganglia, former surgical interventions, preoperative and postoperative pain, insertion of the ganglion's nape and complications. Sixty-six patients with a mean follow-up of 42 months and minimum 12 months were examined. RESULTS: At the time of the follow-up, 80.3% had no pain whereas 92.2% showed a remarkable improvement. Seven cases of recurrence (10.6%) were found 2 to 85 months after surgery, of which most appeared during the first year (71.4%). It is important to mention that the majority of the dorsal ganglia (42.8%) originated from the capitate-lunate joint. None of the patients presented with scapholunate or other instability. CONCLUSIONS: This surgical method is a simple and safe with excellent long-term results and a lower recurrence rate compared to other surgical approaches. Overall, repair of the articular bursa is unnecessary.

Arthroscopic treatment of bursal-side partial-thickness rotator cuff tears / 中华外科杂志

<p><b>OBJECTIVE</b>To study the surgical techniques and results of arthroscopic treatment of bursal-side partial-thickness rotator cuff tears.</p><p><b>METHODS</b>From June 2002 to December 2007, 57 patients with bursal-side partial-thickness rotator cuff tears underwent arthroscopic treatment. There were 34 male and 15 female patients, the average age was 49.7 years (25 - 71 years). Fifteen left shoulder and 34 right ones were involved. Seven cases were classified as degree I, 6 as II and 36 as III according to Ellman classification. The anterior-posterior and the supraspinatus outlet projection of the X-rays were obtained before surgery. Twenty-nine patients had been received by sonography and 36 patients had undergone MRI examinations. All the patients underwent subacromial bursectomy and acromioplasty, 13 cases underwent cuff debridement, 36 cases underwent cuff repair. Among them, 3 cases were treated by side to side suture of rotator cuff, 26 cases were treated by suture anchor, 7 cases were treated by side to side suture combined with suture anchor. UCLA scoring system was adopted before operation and at the final evaluation.</p><p><b>RESULTS</b>Forty-nine patients had been reviewed at least 2 years after the operation with an average of 48 months (2 to 7 years). The average score was 32.1 ± 3.8 postoperatively, and the mean pain score was 2.9 ± 1.0 vs 8.4 ± 1.7 (P = 0.000) for pre- vs. post-operation, the function score was 5.4 ± 1.2 vs. 9.1 ± 1.4 (P = 0.000), the mean forward flexion score was 4.3 ± 1.1 vs. 4.9 ± 0.2 (P = 0.000), the mean forward flexion strength was 4.0 ± 0.4 vs. 4.8 ± 0.4 (P = 0.000), the results were 16 excellent, 31 good and 2 bad. Forty-seven patients were satisfied with the operation.</p><p><b>CONCLUSIONS</b>Arthroscopy is an effective method for the treatment of bursal-side partial-thickness rotator cuff tears. The key to the operation lies in bleeding control, proper acromioplasty and correct suturing method. This surgery has many advantages such as mini-invasion and rapid recovery.</p>

Comparison of Analgesic Efficacy between Single Interscalene Block Combined with a Continuous Intra-bursal Infusion of Ropivacaine and Continuous Interscalene Block after Arthroscopic Rotator Cuff Repair

BACKGROUND: This study evaluated the effectiveness of a continuous interscalene block (CISB) by comparing it with that of a single interscalene block combined with a continuous intra-bursal infusion of ropivacaine (ISB-IB) after arthroscopic rotator cuff repair. METHODS: Patients who had undergone CISB (CISB group; n = 25) were compared with those who had undergone ISB-IB (ISB-IB group; n = 25) for more than 48 hours after surgery. The visual analog scale (VAS) for pain, motor and/or sensory deficit, supplementary analgesics and adverse effects were recorded. RESULTS: There were no significant differences between the postoperative VAS of the CISB and ISB-IB groups, except at 1 hour after surgery. Their supplementary analgesics of the two groups were similar. Transient motor weakness (52%) and sensory disturbance (40%) of the affected arm were observed in patients in the CISB group. The catheters came out accidentally in 22% of the CISB group but in only 4% of the ISB-IB group. CONCLUSIONS: ISB-IB provides similar analgesia to CISB. However, the ISB-IB group had a lower incidence of neurological deficits and better catheter retention.

Intrabursal vein abrasion and thrombosis: an unusual complication of femoral osteochondroma

A 21-year-old female with right distal femoral pedunculated osteochondroma is presented. She was admitted for severe lower limb pain, and swelling of one week duration. Clinical findings supported deep vein thrombosis [DVT] but Doppler ultrasound, and venography were normal. Surgical exploration revealed a large bursa around the tumor with a big vein abraded and thrombosed inside the bursa

Efficacy and pathogenicity of three live infectious bursal disease vaccines [intermediate plus strains] in commercial native chickens breed in Egypt

In this study, three of live intermediate plus IBDV vaccines [A, B, and C] which are commonly used in Egypt were selected and their pathogenicity and efficacy were investigated. Groups of native breed chicks were vaccinated at 14 days of age with each vaccine by eye drop route and in drinking water then challenged with virulent field IBDV 14 days post vaccination [PV]. The efficacy and pathogenicity of each vaccine were evaluated based on clinical signs, mortalities, gross lesion, Bursa/ body weight ratio [BF/BW], and histopathological lesions of the bursa. It was found that these vaccines are efficient as they conferred 100% protection in all vaccinated and challenged groups compared with 20% mortality in unvaccinated challenged group. However, they did not prevent bursal atrophy or histological lesions. The bursal atrophy was observed at 7days PV in groups vaccinated with vaccine [A] while it was observed at 10 days PV in groups vaccinated with vaccines [B] and [C]. Vaccine [A] was proved to be more invasive compared with vaccines [B] and [C] as evidenced by higher bursal lesion scores and lower relative BF/BW ratios at certain intervals PV. When vaccine B and C were given in drinking water, moderate to severe bursal changes were observed. Meanwhile, when these vaccines [B and C] were given by eye drop route, mild to moderate changes in the bursa were observed indicating that vaccination by eye drop route would be better than in drinking water. It would be concluded that, all studied vaccines are efficacious and they vary in invasiveness and pathogenicity. Vaccines [B] and [C] are less pathogenic than vaccines [A] and the vaccination by eye drop route will result in less severe bursal lesions and better immune response than in drinking water

Primary chondromatosis of subacromial bursa; A case report

Synovial chondromatosis is a rare disease. It occurs as primary or secondary lesion with involvement of joint, tendon and bursa [extra articular] or combined. We present a case of subacromial chondromatosis with presentation of a large cystic lesion with rapid growth and containing numerous chondral particles. The patient was a 16 year old boy admitted with a huge mass at right shoulder which was begun since 3 months. Sonography and CT scan showed a mass of 7 x 10 x 4 cm, which contained small particles. The patient was operated and a very large cystic mass with numerous rice bodies in it was removed. Pathologic examinations revealed primary synovial chondromatosis. Synovial chondromatosis should be considered in differential diagnosis of cystic masses around the joints especially shoulder

Osteochondroma of the scapula associated with winging and large bursa formation

To report a case of scapular osteochondroma associated with pain and winging that is rarely reported in the medical literature. A 19-year-old male presented with pain and winging of the right scapula. CT scan revealed an osteochondroma of the medial border of the scapula with a large bursa between the chest wall and the tumour. Excision of the tumour relieved the symptoms. Pathological study showed osteochondroma of the scapula. In a follow-up 1 year later he was free of pain with no clinical or radiological sign of recurrence. A case of scapular osteochondroma associated with pain and winging treated by excision and follow-up showed no sign of clinical or radiological recurrence

Morphological changes of roof of subacromial bursa in patients with rotator cuff tear / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To investigate the morphological changes of the roof of the subacromial bursa (SAB) and its involvement extent after rotator cuff tear.</p><p><b>METHODS</b>In the experimental group, the roof of SAB was obtained from 30 cases of rotator cuff tear both at the tear site and a site 2.5-3.0 cm distal to the tear site during rotator cuff repair. In the control group, the roof of SAB was obtained from the exposed site of recurrently dislocated shoulder or fractured humeral shaft of 8 cases. The specimens were stained with hematoxylin and eosin and observed under a transmission electron microscope. The cell number was quantitated through counting the blue-stained nucleus in SAB with a computer image analysis system.</p><p><b>RESULTS</b>The number of cells increased significantly in the roof of SAB in the experimental group compared with that of the control group. However, no difference of the bursal reaction was found among the type of rotator cuff tear, the bursa thickness and the presence of fluid in the bursa. The great majority of cells were type B cells observed under the transmission electron microscope.</p><p><b>CONCLUSIONS</b>The increase in cell number in the roof of SAB in the experimental group is a reactive increase rather than an inflammatory process and the involvement of SAB is not limited in extent. The change of the roof of SAB is a secondary reaction to the rotator cuff tear.</p>

Neutron source design for boron neutron capture synovectomy

Se diseñó una fuente de neutrones para la Sinovectomía por Captura de Neutrones en Boro. La fuente utiliza una fuente isotópica de 239PuBe que se inserta en el centro de contenedor cilindrico con un arreglo heterogéneo de dos moderadores. Los moderadores estudiados son agua ligera/agua pesada, grafito/agua pesada, lucita/agua pesada y polietileno/agua pesada. La fluencia total y la de los neutrones térmicos producidas se emplearon para seleccionar el mejor embalaje. Así, el espectro que produce una fuente de 239PuBe dentro del moderador con polietileno/agua pesada se utilizó como término fuente para calcular los espectros de neutrones dentro de un modelo de rodilla. La composición elemental utilizada para modelar el saco y el líquido sinovial fue la del agua, la del tejido sanguíneo y la de este último con dos concentraciones de boro. Encontramos que cuando la composición elemental del saco sinovial se asume igual a la del tejido sanguíneo con 0.278 por ciento en peso de boro el kerma debido a los neutrones es 7351 veces mayor al que se obtiene cuando la composición del saco sinovial es la del agua.

Plica sinovial de joelho em cadáveres de recém-nascidos: comparação entre Anatomio e Artro-TC / Synovial knee plica in newborn cadaver knee: a comparasion between Anatomy and Arthro-TC

Fifty-two newborn knees were used to verify the validity of the arthro-TC of double contrast for the diagnosis of normal synovial plicas, aiming at classifying and verifying their quantitative incidence and ethnic distribution. The plica synovialis mediopatellaris was identified in brown (60 percent), white (40 percent) and black races (9 percent) in this study. The incidence in black people was quite low as compared to white and brown people. The most commonly found folds were the plica synovialis infrapatellaris (69 percent) followed by the plica synovialis suprapatellaris (44 percent) and plica synovialis mediopatellaris (31 percent). Plicas were not found in 6 percent of the knees. The communication of bursa patellares with the articulation of the knee is present at birth in 85 percent of newborns. Identification of plica synovialis infrapatellaris was difficult because it is covered by abundant fat tissue. Arthro-TC was studied and analyzed by six observers, three radiologists and three orthopedic surgeons. The results showed a medium sensibility of 72 percent and a medium specificity of 60 percent for radiologist versus 89 percent and 61 percent for orthopedist surgeons, respectively.

Interspinous bursa and spinal instability.

STUDY DESIGN: This is a prospective study. Interspinous tissue was taken intraoperatively for pathological examination for the presence of bursa. The pathologist was unaware of the X-ray findings in each specimen. The presence of bursa was then correlated with X-ray evidence of hypermobility in each segment. OBJECTIVE: To verify the pathogenesis of interspinous bursal formation. SUMMARY OF BACKGROUND DATA: Interspinous bursa is common in the older population. It has been associated with degenerative lumbar diseases, aging and anatomical distance between the spinous process. However, no detailed exploration of the segmental instability as a cause of bursal formation has been done. METHOD: The insterspinous tissue was taken intraoperatively from patients diagnosed as multilevelled spinal stenosis who underwent extensive decompression, fusion and instrumentation. The specimens were examined by the same pathologist for the existence of bursa. The presence of bursa was correlated with X-ray motion study of each spinal segment by student t-test. RESULTS: The existence of bursal was significantly correlated with angular mobility of more than 10 degrees. CONCLUSION: Angular mobility is a possible cause of interspinous bursa. On the contrary, the presence of insterspinous bursa may be evidence of segmental hypermobility.