Coronal curvature of tibial leads to malalignment of tibial prosthesis after total knee arthroplasty / 中国骨伤

OBJECTIVE@#To investigate the effect of tibial coronal curvature on the alignment of tibial prosthesis in patients undergoing total knee arthroplasty (TKA).@*METHODS@#From July 2019 to April 2021, 100 patients with knee osteoarthritis were treated with total knee arthroplasty. Before operation, the full-length films of lower limbs were taken and the tibial bowing angle(TBA) was measured. TBA more than 2° was tibial bending, which was divided into tibial bending group and non bending group. There were 40 cases in tibial bending group, 9 males and 31 females, aged 56 to 84 years old with an average of (69.22±7.10) years. There were 60 cases in the non bending group, 19 males and 41 females, aged from 51 to 87 years old with an average of (70.80±7.21) years. The preoperative tibial length (TL) and medial proximal tibial angle (MPTA) were measured and compared between the two groups. The full-length X-rays of the lower limbs were taken again 3 days to 1 week after operation. The medial angle of the tibial component coronal aligement angle (TCCA) and the outilier rate of force line of the tibial prosthesis were measured and compared between the two groups. Pearson method was used to analyze the correlation between TCCA and age, TCCA and height, TCCA and weight, TCCA and BMI, TCCA and TBA, TCCA and TL, TCCA and MPTA; Spearman method was used to analyze the correlation between TCCA and gender, TCCA and Kellgren-Lawrence(K-L) grade.@*RESULTS@#All 100 patients successfully completed the operation and obtained satisfactory full-length X-rays in standing position. There was no significant difference in TL, MPTA and TCCA between bending group and non bending group(P>0.05). The outilier rate of force line in tibial bending group was 22.5%, and that in non bending group was 6.67%, the difference was statistically significant(P<0.05). The correlation study found that TCCA was strongly correlated with TBA(r=-0.702, P<0.01), weakly correlated with MPTA(r=0.311, P<0.01), and had no correlation with other parameters(P>0.05).@*CONCLUSION@#In patients with knee osteoarthritis undergoing total knee arthroplasty, tibial bending will lead to poor force line of tibial prosthesis. During operation, attention should be paid to osteotomy of proximal tibial vertical tibial mechanical axis and correct installation of prosthesis to avoid poor alignment of prosthesis.

Analysis of influence of sarcopenia on early postoperative function of femoral neck fracture by hip arthroplasty / 中国骨伤

<p><b>OBJECTIVE</b>To determine the association of sarcopenia with short-term postoperative function after hip replacement for femoral neck fractures.</p><p><b>METHODS</b>A prospective study of 181 consecutive patients with femoral neck fractures who underwent hip replacement from May 2014 to January 2017 were performed, including 58 males and 123 females aging from 53 to 92 years old. The general conditions were collected before surgery, skeletal muscle index(ASMI), handgrip strength were measured. Clinical outcomes were followed up including postoperative complications, time of on-site, Harris score (postoperative 2 weeks, 3, 6 months), hospitalization costs, and hospital stay. According to handgrip strength and ASMI, the patients were divided into the sarcopina group and the non-sarcopina group; according to the Harris score at the 6-month follow-up, the patients were divided into good prognosis group and poor prognosis group. Univariate analysis and binary logistic regression analysis were used to investigate whether sarcopenia was a risk factor for poor postoperative hip joint surgery.</p><p><b>RESULTS</b>All patients were followed up at 2 weeks, 3 and 6 months, postoperative early complication included wound infection in 16 cases, thrombus of lower extremity veins in 14 cases, no dislocation, prosthetic loosening and prosthesis related infections occurred. Sarcopenia was present in 82 of 181 patients(45%), Compared with non-sarcopenic patients, sarcopenic patients had a higher risk of postoperative complications, longer postoperative hospital stay, more hospital costs and lower harris scores. In Binary logistic analysis revealed that sarcopenia(=0.08), hemiarthroplasty(<0.001), diabetes(=0.016) and infection(=0.018) were important predictors of unsatisfactory postoperative function.</p><p><b>CONCLUSIONS</b>Sarcopenia is an important predictor of poor postoperative prognosis in patients with femoral neck fractures after hip replacement. The treatment for sarcopenia maybe an important way to protect patients with femoral neck fractures from poor prognosis after hip replacement.</p>

Analysis on related risk factors of hip fracture patient with sarcopenia / 中国骨伤

<p><b>OBJECTIVE</b>To explore occurrence and risk factors of sarcopenia in patients with hip facture.</p><p><b>METHODS</b>From May 2013 to January 2017, 187 patients with hip fractures were collected, including 99 males and 88 females aged from 50 to 95 years old with an average age of (77.40±10.58) years old. General conditions, appendicular skeletal muscle index (ASMI), total fat mass, bone mineral content (BMC), body mass index (BMI), grip strength, preoperative blood vitamin D (VITD), albumin, American Society of Anesthesiologists(ASA) classification and new mobility scores(NMS) were observed and analyzed. According to grip strength and ASMI, patients were divided into sarcopina group and non-sarcopina group, univariate and multivariate statistical methods were used to analyzed.</p><p><b>RESULTS</b>Ninty-nine patients(52.9%) were diagnosed as sarcopenia. Compared with non-sarcopenia group, occurrence of sarcopenia was associated with advanced age, high ASA, low total fat mass, low bone mineral content, low BMI, low albumin, and low NMS. Subsequent binary logistic regression analysis showed that advanced age (OR=1.804, =0.048), high ASA score (OR=3.052, =0.001), low fat content (OR=0.843, =0.006), low bone mineral salt(OR=0.203, =0.026) were risk factors of hip fracture patient with sarcopenia.</p><p><b>CONCLUSIONS</b>Old age, high ASA score, low fat content, low bone mineral content may be related risk factors for sarcopenia in hip fracture patients.</p>

Otimization of auxiliary lines for proximal femoral intramedullary nail in the treatment of simple femoral intertrochanteric fractures / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the clinical outcomes of C-arm X-ray fluoroscopy before incision to make assistant lines and insert the guide wire of PFNA and PFNA blade.</p><p><b>METHODS</b>From January 1st 2012 to January 1st 2015, 132 intertrochanteric fracture patients of type 31A1 and 31A2 according to AO-classification, were retrospectively analyzed. Among them, 62 patients(14 males and 48 females) aged from 52 to 95 years with a mean age of(69.58±8.55) years in traditional group were operated by traditional procedure, while 70 patients in the skin marking group included 15 males and 55 females aged from 61 to 88 years with a mean age of(71.94±7.64) years, on the basis of the traditional operation method, the assistant line of the body surface and the C-arm X-ray was increased, and the guide pin positioning of the proximal femoral nail and the spiral blade was guided by the auxiliary line in the operation. Operative time, frequency of C-arm fluoroscopy, Harris hip score of the third months after surgery and the complications in both groups were queried for statistical analysis.</p><p><b>RESULTS</b>In addition to skin making group 1 patients had superficial wound infection complications, all patients were stage I wound healing. All patients were followed up for 3 to 18 months with an average of (6.81±3.07) months. The operative time was significantly reduced in skin marking group (56.16±6.36) minutes compared to traditional group (59.06±9.19) minutes (>=0.035). And the frequency of C-arm fluoroscopy of skin marking group was(25.89±5.81) times which was also significantly reduced compared to traditional group(31.32±9.81) times (<0.001). There was no statistical difference in Harris hip score at 3 months after operation and the complication rate between the two groups(>0.05).</p><p><b>CONCLUSIONS</b>In this study, a simple and easy method of assistant line marking can shorten the operation time and reduce the number of times of operation.</p>