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Objective To evaluate the efficacy and safety of intra?articular injections of tranexamic acid (TXA) on perioperative blood loss and transfusion in primary unilateral total knee arthroplasty (TKA). Methods Primary TKA was per?formed on a total of 380 patients (380 knees) affected to various degrees by knee osteoarthritis. All the patients are divided into three groups according to different joint injection for 5 min at the end of surgery in which:120 patients received 1.5 g TXA injec?tion,136 patients received 0.5 g TXA injection, 124 patients no pharmacological intervention (control group). Blood loss, hidden blood loss, blood transfusion, drainage volume and limb circumference change after TKA were assessed. Results All the surger?ies were well performed. No complication including infection, necrosis, and fat liquefaction has been observed. The results indicat?ed no significant difference with pairwise comparisons in intra?operative time, intra?operative blood loss, hospitalization time, anes?thesia, and drainage volume and limb circumference change. The mean postoperative hidden blood loss (1.5 g TXA group 693.29± 377.91 ml, 0.5 g TXA group 835.41±481.97 ml, the control group 1 032.75±322.19 ml) and transfusion (1.5 g TXA group 7.5%, 0.5 g TXA group 13.2%, the control group 20.2%) requests were significantly different with pairwise comparisons among the three groups. Compared with the control group, both 1.5 g TXA group and 0.5 g TXA group showed better effects (P<0.05). Compared with the 0.5 g TXA group, 1.5 g TXA group showed better effects (P<0.05). Conclusion It can be concluded that intra?articular injection of TXA in patients undergoing unilateral TKA could significantly reduce postoperative hidden blood loss and blood trans?fusion, and did not increase the risk of phlebothrombosis. This efficacy demonstrated a concentration dependent effect. Compared with 0.5 g TXA, 1.5 g TXA performed a better efficacy.
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Objective To investigate the effect of thrombelastography ( TEG ) monitoring on anticoagulation therapy in deep vein thrombosis ( DVT ) in the perioperative period of arthroplasty replacement through dynamic detecting of TEG.Methods 60 patients under went total knee arthroplasty ( TKA) were selected as the patient group from 2011 to 2013, Including 22 men and, 38 women, aging from 50 to 74 years old.These patients were divided into low molecular weight heparin ( LMWH ) group and rivaroxaban group according to random number table.Each group had 30 cases.Patients in both were all given routine dose anticoagulant drugs to prevent DVT.Other treatment were the same as conventional therapy for both group patients.Meannhile, 42 health examination participants were selected as the control group, 24 men and 18 women, aging from 45 to 75 years old.The parameters of TEG were measured by TEG@5000 thromboelastograph hemostasis system ( American Haemoscope Corporation).DVT was diagnosed by LOGIQ 7 color Doppler ultrasonic diagnostic apparatus of American GE Corporation. Data were analyzed by SPSS17.0.The predictive value of TEG on DVT was evaluated by receiver operating characteristic cure (ROC),sensitivity,specificity,positive predictive value (PPV) and negative predictive value (NPV). Results Abnormal detection rates of Angle,MA,CI in rivaroxaban group(36.7%,46.7%,36.7%) were higher than LMWH group ( 10.0%, 20.0%, 13.3%) , and the differences between both groups all had statistical significance between both group(χ2 =5.963,P=0.015;χ2 =4.800,P=0.028;χ2 =4.356,P=0.037).CI , MA and Angle had better clinical diagnostic value on DVT.Their sensitivity was 75.0%, 75.0% and 62.5%, specificity respectively was 80.8%, 76.9%and 78.8%respectively.MA=68.35 mm could be the best clinical diagnosis of critical point on DVT at anticoagulation treatment endpoint.Conclusion TEG can monitor coagulation state of TKA patients, TEG′R can evaluate the safety and effectiveness of anticoagulation therapy on DVT.(Chin J Lab Med, 2015, 38:333-336)
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Objective To investigate the predictive value and clinical significance of dynamic monitoring of thromboelas?tography (TEG) and D?dimer on anticoagulation therapy concurrenting DVT in the perioperative period of arthroplasty replace?ment. Methods All of 60 patients of total knee arthroplasty (TKA) were selected as patient group from 2011 to 2013. They were divided into low molecular weight heparin (LMWH) group and rivaroxaban group according to random number table. LM?WH group was given LMWH (xi fu quan) 4250 IUAXa 12 h after knee replacement, im, qd for 7 days, then rivaroxaban 10 mg, qd for 7 days. Rivaroxaban group was given rivaroxaban 10 mg 6 h after knee replacement, qd for 14 days. Meanwhile, 42 health examination participants were selected as control group. The parameters of TEG were detected by TEG 5000 thrombo?elastograph hemostasis system (American Haemoscope Corporation). Results D?dimer levels of postoperative before anticoagu?lation therapy were highest and there was statistical difference, while other parameters had no statistical difference. Intra?group comparison:the levels of R, K, Alpha, CI of TEG and D?D in LMWH group and the levels of Alpha, MA, CI of TEG and D?D in ri?varoxaban group had statistical difference, while other parameters' levels showed no statistical difference. At anticoagulation treat?ment endpoint, DVT occurred in 8 cases with an incidence of 13.3%(8/60). 7 cases were intramuscular vein thrombosis, and 1 case was popliteal vein thrombosis. The levels of Alpha, MA, CI of TEG and D?D in DVT group were higher than no DVT group, and there was statistical difference. TEG's CI, MA, Alpha and D?dimer had better clinical diagnostic value on DVT, whose area un?der receiver operating characteristic cure (ROC) respectively was 0.746, 0.733, 0.707 and 0.644, with sensitivity of 75%, 75%, 62.5%and 62.5%, specificity of 80.8%, 76.9%, 78.8%and 71.1%, positive predictive value of 37.5%, 33.3%, 31.3%and 25.0%, and negative predictive value of 95.4%, 95.2%, 93.2%and 93.1%. MA=68.35 mm was the best clinical diagnosis of critical point on DVT at anticoagulation treatment endpoint. Conclusion CI, MA, Alpha of TEG are better than D?dimer in predicting the inci?dence of DVT in the perioperative period of orthopaedics major operation. If these indexes are detected, the diagnosis value ’s ac?curacy of DVT will be improved.
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Objective To analyze the evolution of acetabular morphology changes of different Crowe types among adults with developmental dysplasia of the hip through standard hip 3D CT reconstruction.Methods From June 2010 to January 2013,there were 62 patients with 68 hips (8 hips of 6 male cases,56 female cases of 60 hips) diagnosed as acetabular dysplasia in our hospital,with an average age of 53.7±5.8 years old (range,47-59 years).According to Crowe classification,there were 14 cases (17 hips) of Crowe type Ⅰ,17 cases (17 hips) of Crowe type Ⅱ,15 cases (17 hips) of Crowe type Ⅲ,and 16 cases (17 hips) of Crowe type Ⅳ.Through standard hip 3D CT reconstruction,Harris nest in the pelvic side 3D image was marked,and the coronal and horizontal position of acetabular rotation center was determined by using the cross axis; secondly,in the anteroposterior 3D image (by gray level adjustment to the shape of X ray perspective effect) through Ranwant triangulation,sagittal position of the center of rotation of the hip joint was determined; finally,the acetabular rotation center in the acetabular horizontal reconstruction plane.The bone stock of anterior and posterior columns of acetabular was observed and acetabular anteversion,front cover angle,rear cover angle and medial wall thickness were measured.Results 1) With Crowe type increased,acetabular anteversion angle gradually increased as well,and there was a positive correlation between them with statistically significant (P＜0.05) except in Crowe Ⅰ and Ⅱ group.2) With Crowe type increased,anterior acetabular coverage angle was significantly decreased; the mean anterior acetabular coverage angle of Crowe Ⅲ and Ⅳ groups was less than 50°.3) With Crowe type increased,posterior acetabular coverage angle was decreased significantly as well the mean posterior acetabular coverage angle of Crowe Ⅲ and Ⅳ groups was less than 90°.4) With Crowe type increased,acetabular medial wall thickness was increased significantly.Conclusion Adult acetabular morphology changes between different Crowe types in patients with developmental dysplasia of the hip.For acetabular reconstruction of Crowe Ⅰ and Ⅱ,we could make full use of the acetabular bone stock of anterior and posterior column; for acetabular reconstruction of Crowe Ⅲ and Ⅳ,we could moderately shift the acetabular center superiorly and (or) medially.
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Objective To investigate relationship between polyethylene wear and decrease of femoral offset after total hip arthroplasty (THA).Methods Ninety patients who had undergone unilateral THA were recruited in this study.Coreldraw 12.0 software was used to measure change of femoral offset on the basis of immediate anteroposterior radiographies of bilateral hip after THA.In the light of the decreasing value of femoral offset (F),all patients were equally into 5 groups:F＜2 mm,2≤F≤4 mm,4＜F≤6 mm,6＜F≤8 mm and 8＜F≤ 10 mm.At final follow up,some parameters about polyethylene wear were measured by using Coreldraw 12.0 software on the basis of anteroposterior radiographies of bilateral hip.Results The linear wear volume was 0.72±0.13 mm in group F＜2 mm,0.78±0.11 mm in group 2≤F≤4 mm,0.87±0.09mm in group 4＜F≤6 mm,0.99±0.09 mm in group 6＜F≤8 mm,and 1.17±0.15 mm in group 8＜F≤10 mm.The linear wear rate was 0.132±0.025 mm/yr in group F＜2 mm,0.139±0.019 mm/yr in group 2≤F≤4 mm,0.159±0.029 mm/yr in group 4＜F≤6 mm,0.183±0.032 mm/yr in group 6＜F≤8 mm,and 0.213±0.023 mm/yrin group 8＜F≤ 10 mm.The linear wear angle was 5.0°±3.5° in group F＜2 mm,3.2°±3.8. in group 2≤F≤4mm,-4.3°±4.9° in group 4＜F≤6 mm,-8.7°±4.1° in group 6＜F≤8 mm,and -13.0°±4.7° in group 8＜F≤ 10mm.For three parameters above,there were significant differences between groups,except between group F＜2 mm and group 2≤F≤4 mm.Conclusion The femoral offset should be restored to its anatomic status in THA to avoide superior lateral displacement of center of the femoral head,which could result in uneven stress distribution and increase polyethylene wear.
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ObjectiveTo investigate the role of SAA in rheumatoid arthritis(RA) pathogenesis by analyzing the expression of serum amyloid protein A(SAA) in serum,synovial fluid and synovial membrane in patients with RA.MethodsSAA levels in the serum and synovial fluid in each group were detected.Sera SAA was tested by Western blotting,while the expression of SAA in RA and osteoarthritis(OA) synovium was detected by immunohistochemistry.Comparisons between groups were performed by t-tests or KruskaWallis test.ResultsThe serum levels of SAA were significantly higher in RA [(318±132) μg/L] than those in OA [(127±47) μg/L] and healey controls [(127±41) μg/L,P＜0.01].In RA,the SAA levels in the synovial fluid [ (571±473) μg/L ] were significantly higher when compared to those in O A [ (129±33) μg/L](t=2.46,P=0.04).Western blotting results showed that SAA bands were found in the serum samples of each group,and higher expression of SAA were seen in RA.Pathology study had showed that SAA was observed mainly in endothelial cells,synovial fibroblasts,macrophages and perivascular areas in RA synovium.In OA,SAA was observed in perivascular areas and synovial fibroblasts.ConclusionIn RA,SAA levels in both serum and synovial fluid are significantly higher than those in the controls.High expression of SAA in RA synovium can be observed.Our results suggest that SAA may play a role in inflammation reaction and joint destruction of RA.
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Objective To investigate the preliminary clinical outcome following PCL-retaining total knee arthroplasty (TKA) with 0°or 5°posterior tibial slope. Methods From Jan 2008 to Mar 2009, 84 patients (84 knees) with osteoarthritis (OA) underwent primary PCL-retaining TKA operations by the same surgical team. Among them, 27 patients (7 males, 20 females, with the average age of 69.5 years) underwent TKA using a cutting block and intramedullary cutting guide designed to impart a 5° posterior tibial slope (group A); 57 patients (15 males, 42 females, with the average age of 67.4 years) underwent TKA using a cutting block and intramedullary cutting guide designed to impart a 5°posterior tibial slope (group B). The preoperative demographic data and functional data had no statistical differences. The postoperative tibial posterior angle, maximum extension, maximum flexion and Knee Society Score (KSS) were compared between the two groups. Results All patients were followed up 12～24 months with an average of 15.7 months. No paralysis, wound infection, prosthesis dislocation and loosening were found. The postoperative tibial posterior angle was 5.7°±2.1° in group A and 0.9°±0.6°in group B (P＜ 0.05). The postoperative maximum extension was 0.8°±0.3°in group A and 1.2°±0.4°in group B (P ＞0.05). The postoperative maximum flexion was 115.7°±4.8°in group A and 101.1°±5.6°in group B (P＜ 0.05). The postoperative KSS was 87.6±5.9 in group A and 83.3±7.2 in group B (P ＞0.05). Conclusion Increasing tibial posterior slope improved the postoperative maximum flexion, but not the maximum extension and KSS, in PCL-retaining TKA.
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Objective To investigate the biomechanics of the tissue engineered tendons which use the embryonic tendon cells as the seed-cells and the silk as the scaffolds. Methods Two groups were set up with one as the group with tenocytes and the other as the group without tenocytes. Tissue engineered tendons were taken out at 2-week, 4-week, 6-week, 8-week post-operation, with 20 samples per-group each time. The values of biomechanics were measured and analyzed using the software SPSS 13.0. Results The biomechanical properties of the tissue engineered tendons in the group with tenocytes were significantly better than those in the group without tenocytes (P<0.05). In the group with tenocytes, the vitodynamics results got better with the increase of implantation time (P<0.05) except for the results of 8-week post--operation(P>0.05). But in the group without tenocytes, only the results of that from 8-week post-operation were of significant significance (P<0.05). Conclusion The results presented in the current study demonstrated that silk could stick tenocytes well, hold the characteristics of great resistance to draw after adhesion of tenocytes, and formed the tissue engineered tendon gradually in chickens, suggesting its potential application in the treatment of the defect of tendon.
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[Objective]To investigate the possibility of construction of tendon defect with allogeneic embryonic tenocyte combined with silk.[Method]Roman hens were randomly divided into 2 groups: construction with allogeneic tenocyte combined with silk as cell group,construction with silk alone as non-cell group.The pathology,vitodynamics and elongation were compared between 2 groups at 2,4,6,and 8 weeks postoperatively.[Result]Collagen production and vitodynamics in cell group were better than those in non-cell group significantly(P