2024年 · 第104卷第41期

The patient, a 43-year-old female, went to the Department of Neurology, the Third Hospital of Hebei Medical University for "weakness of right lower limb accompanied by walking and stepping on cotton for one and a half years". One and a half years ago, the patient developed weakness of the right lower limb accompanied by the feeling of stepping on cotton while walking, and the local flaky numbness area of the right hypochondrion gradually expanded to the anterior side of the right lower limb, and the above symptoms gradually worsened. Previous diagnosis of lumbar disc herniation due to intermittent low back pain with radiating pain in the left lower limb for 6 years. Physical examination: clear, no obvious abnormalities in cranial nerves, right lower limb muscle strength grade III, remaining limb body muscle strength grade V, limb muscle tone acceptable, right lower limb knee tendon reflex active, both upper limbs and left lower limb knee tendon reflex normal, bilateral ankle reflex disappeared, right T₈~ L₃Horizontal hypoalgesia, weakened vibration sensation of tuning forks in both lower limbs, positive bilateral Pap sign, low skin temperature with mild cyanosis in the left lower limb, and normal urine and stool. The patient's thoracic spine MRI plain scan showed T_3~4The subarachnoid space at the anterior edge of the horizontal spinal cord disappeared, the spinal cord moved forward, the spinal cord in the diseased segment became thin, flattened, curved at an angle, and the subarachnoid space behind the corresponding horizontal spinal cord widened (Figures 1~3, shown by arrows). This patient mainly presented with atypical spinal cord hemisection injury. In addition, there were bilateral pyramidal tract damage, hypothermia of contralateral limbs, cyanotic skin color and other signs of autonomic nerve damage. Combined with MRI sagittal position showing T₃The horizontal spinal cord is advanced, thinned, with a "C" shape change, and the dorsal subarachnoid space is enlarged without tumor formation. It is also different from the characteristics of "knife incision sign" caused by arachnoid mesh band, so it is considered as spinal hernia. Spinal hernia is a clinical manifestation of a series of spinal cord compression caused by anterior or anterior lateral herniation of the spinal cord through the defective dura mater. The disease mostly starts slowly, and the most common sign is Brown-Sequard syndrome, which is characterized by pain and temperature disturbance in one limb, weakness in the contralateral limb with impaired proprioception such as vibration and position sensation. The most common sites of spinal cord hernias are located in T_2~10Horizontal, spinal cord MRI sagittal lesion segment spinal cord has a "C" nodular shape, and the dorsal subarachnoid space is enlarged. Typical spinal cord hernia can show spinal cord herniation out of the subdural space in MRI transverse position, showing "double spinal cord sign". The treatment measures of this disease are mainly through surgery to directly suture the hernia mouth, hernia sac enlargement and hernia sac dura repair to improve the symptoms.

A 45-year-old male went to the Second Affiliated Hospital of Xi' an Jiaotong University for "right knee pain for 2 months". The patient experienced right knee joint pain 2 months ago, which was aggravated when moving and relieved when resting. There was no bouncing, no interlocking, no swelling, and no significant relief was seen after oral medication. The physical examination of the knee joint showed no obvious abnormalities in the appearance of both knee joints, no varus deformity, positive tenderness in the medial joint space of the right knee joint, normal joint mobility, negative medial and lateral stress test, negative anterior drawer test, negative posterior drawer test, negative medial grinding test, negative lateral grinding test, negative Lachman test, and negative axial shift test. X-ray examination of the right knee showed calcification of the soft tissue in the medial condyle of the right medial femur (Figure 1, indicated by arrows). MRI of the right knee showed abnormal signals in the out-of-shape area of the medial collateral ligament (MCL) of the right knee, considering the possibility of injury; Bone marrow edema of the right medial femoral condyle; Subcutaneous soft tissue edema of the right knee (Figure 2, shown by arrows). Considering the possibility of diagnosis of knee MCL calcification (Pellegrini-Stieda syndrome), the preoperative routine laboratory tests were improved, and no obvious surgical contraindications were found. Arthroscopic microfracture of medial femur of right knee + resection and reconstruction of MCL lesions were performed under subarachnoid block anesthesia. Intraoperative pathological diagnosis: "right MCL" calcified nodule. After operation, the patient was given treatment such as analgesia, swelling reduction, acid suppression and infection prevention. He wore braces and actively performed functional exercises. At the re-examination 3 months later, the patient claimed that he had recovered well, and no obvious positive signs were found on physical examination. MRI of right knee joint showed that MCL signal was slightly increased; A small amount of fluid accumulation in the joint cavity of the right knee. The knee MCL calcification sign is defined as a combination of imaging manifestations of MCL at or near the proximal insertion of the medial femoral condyle and concomitant medial knee pain or limited range of motion. In this case, the patient had pain in the right knee joint, and the X-ray film showed calcification of the medial soft tissue of the medial femoral condyle. Combined with the intraoperative pathological diagnosis of "right MCL" calcified nodule, the sign of MCL calcification in the knee joint was confirmed.