ABSTRACT
BACKGROUND: Heterotopic ossification (HO) is common following primary total hip arthroplasty (THA) in patients with ankylosing spondylitis (AS), which may cause certain influence on functional recovery.OBJECTIVE: To explore the risk factors for HO after primary THA in AS patients.METHODS: The clinical and radiological data from 87 patients (132 hips) with AS undergoing primary THA between June 2011 and December 2015 were retrospectively analyzed, and followed up for more than 6 months. The radiological information included preoperative and postoperative hip anteroposterior and lateral radiographs. The presence of HO surrounding the prosthesis was evaluated on the radiographs at the last follow-up and graded according to the Brooker classification. Risk factors for HO were divided into invariable factors (age, sex, course and with or without ankylosed hip) and variable factors (preoperative C-reactive protein level, preoperative erythrocyte sedimentation rate, intraoperative blood loss, operation time, prosthesis types and anesthesia methods) to determine the pertinent risk factors.RESULTS AND CONCLUSION: (1) Totally 43 hips (32.6%) were found to have developed into HO. (2) Invariable risk factors including male (P=0.029), preoperative ankylosed hip (P < 0.001), and course (P=0.029) increased the prevalence of HO. Among the variable risk factors, prolonged operation time (P=0.031) and general anesthesia (P=0.003)were associated with the increased occurrence of HO. Age, preoperative C-reactive protein level and erythrocyte sedimentation rate, intraoperative blood loss, and prosthesis types had no obvious correlation with HO. (3) These results suggest that to prevent the formation of HO following THA in AS, efforts to reduce the operation time and avoid general anesthesia should be considered.
ABSTRACT
BACKGROUND: Total hip arthroplasty is an effective measure to treat hip involvement in ankylosing spondylitis.Ankylosing spondylitis patients have different degrees of anemia after total hip arthroplasty. The hidden blood loss accounts for a large proportion of perioperative blood loss in total hip arthroplasty, and can affect the recovery of joint function.OBJECTIVE: To investigate risk factors of hidden blood loss after total hip arthroplasty in patients with hip involvement in ankylosing spondylitis.METHODS: We studied a consecutive series of 70 hips in 60 patients with ankylosing spondylitis hip involvement who were converted to cementless total hip arthroplasty. The average age of surgery was 35.12 years. The hidden blood loss was calculated according to Cross formula linear equation. The effects of operation time, erythrocyte sedimentation rate,C-reactive protein, body mass index, Bath ankylosing spondylitis radiology index, allogenic blood transfusion, and osteoporosis on hidden blood loss after total hip arthroplasty in patients with ankylosing spondylitis were analyzed. The patients were divided into the high blood loss group (≥ 480 mL) and the low blood loss group (< 480 mL) according to the high blood loss. Risk factors of high hidden blood loss after total hip arthroplasty in patients with ankylosing spondylitis were analyzed by single factor analysis and multivariate Logistic regression analysis (SPSS 17.0).RESULTS AND CONCLUSION: (1) The hidden blood loss after primary total hip arthroplasty in patients with ankylosing spondylitis was (737.76±419.18) mL, and the total blood loss was (1312.83±487.41) mL, and the percentage of hidden blood loss was 51.48%. The high blood loss group included 41 hips, and the low blood loss group included 29 hips; and the ratio was 41:29. (2) Single factor analysis showed that the operation time, Bath ankylosing spondylitis radiology index and osteoporosis, allogenic blood transfusion, decrease of hemoglobin were significantly associated with high hidden blood loss. (3) Multivariate Logistic regression analysis showed that Bath ankylosing spondylitis radiology index,allogeneic blood transfusion, and decrease of hemoglobin were significantly associated with high hidden blood loss. (4)Hidden blood loss is an important portion of total blood loss after primary total hip arthroplasty in patients with ankylosing spondylitis. Bath ankylosing spondylitis radiology index, allogeneic blood transfusion and decrease of hemoglobin are risk factors for high hidden blood loss.
ABSTRACT
Objective To study correlation between biochemical markers of bone metabolism and postmenopausal osteoporot-ic vertebral fractures.Methods The clinical data of 100 cases with postmenopausal osteoporotic were study retrospectively.Fifty patients were postmenopausal osteoporotic,the rests were postmenopausal osteoporotic vertebral fractures.Lumbar spine,hip BMD,serum P1NP,β-CTX,N-MID,25-(OH)VitD and Ca2 + were recorded.Results There was a significant difference among ser-um P1NP,β-CTX and 25-(OH)VitD(P 0.05).Conclusion Serum P1NP and 25-(OH)VitD could predict risk of postmenopausal osteoporotic vertebral fractures.Biochemical markers of bone metabolism combined with BMD could reduce postmenopausal osteoporosis fractures.
ABSTRACT
BACKGROUND:Jumonji domain-containing histone demethylase (JMJD) can promote osteoblast differentiation, and estrogen-related receptor alpha (ERRα) can promote osteoblast differentiation and increase bone formation. However, little is reported on the association between postmenopausal osteoporosis andJMJD and ERRα. OBJECTIVE: To study the changes in the JMJD2 family expression in patients with postmenopausal osteoporosis. METHODS: Postmenopausal patients with osteoarthritis of the hip scheduled for total hip arthroplasty, aged 50-70 years, were enroled, including 10 postmenopausal osteoporosis patients (experimental group) and 10 patients with no postmenopausal osteoporosis (control group). During the arthroplasty, the cancelous bone specimens from the femoral head were colected. Then, immunohistochemistry and western blot assay were used to detect expression of histone demethylase (JMJD2A, JMJD2B), histone methylation (H3K9me3, H3K36me3) and ERRα. RESULTS AND CONCLUSION:In the experimental group, the expressions of JMJD2A, JMJD2B and ERRαwere from weakly positive to positive; these expressions were significantly lower in the experimental group than the control group (P < 0.05). The expressions of H3K9me3 and H3K36me3 were significantly higher in the experimental group than the control group (P < 0.05). These findings indicate that the expression of JMJD2A and JMJD2B is consistent with the expression of ERRα in the patients with postmenopausal osteoporosis, and JMJD is likely to serve as an antagonistic enzyme of osteoporosis.
ABSTRACT
BACKGROUND:Tranexamic acid is extensively used in the primary total knee replacement, but there are many different methods. OBJECTIVE:To explore the efficacy and safety of the intra-articular injection of tranexamic acid with pressurization in reducing the blood loss of primary total knee replacement. METHODS:Total y 56 patients undergoing unilateral total knee arthroplasty were enrol ed and randomly divided into two groups. Patients were given the intra-articular injection of 100 mL of saline solution dissolving 2.0 g of tranexamic acid with large pad pressure bandaging the knee, and 4-hour drainage tube close, and then underwent negative pressure suction (experimental group);differently, the controls were given the normal pad bandage group. The drainage tube was removed within 48 hours after replacement. The patient blood routine examination was performed at the 3rd day, and at the same time, the volume of drainage was recorded;and the color Doppler ultrasound in ipsilateral lower extremity veins was conducted to observe the incidence of thrombosis at 4-5 days. RESULTS AND CONCLUSION:(1) The total blood loss, postoperative dominant blood loss, and hidden blood loss in the experimental group were significantly less than those in the control group (P0.05). (3) These results indicate that the intra-articular injection of tranexamic acid with pressurization can significantly reduce the postoperative blood loss in the primary total knee arthroplasty, without increasing the risk of deep vein thrombosis.
ABSTRACT
Objective To compare the effectiveness of anterior cruciate ligament (ACL) reconstruction using Rigid-Fix for autogenous tendons fixation between by Ethibond excel polyester sutures combined with high-strength sutures and by Ethibond excel polyester sutures. Methods From October 2011 to August 2013, 48 cases of ACL rupture underwent ACL reconstruction using RigidFix for autogenous tendons fixation. Ethibond excel polyester sutures combined with high-strength sutures were used in 25 cases (observation group) and Ethibond excel polyester sutures were used in 23 cases (control group). There was no significant difference in gender, age, side, disease duration, and preoperative Lachman test, Lysholm score, and the International Knee Documentation Committee (IKDC) score be-tween the two groups ( >0.05). While the treatment and rehabilitation measures were identical. Result The opera-tion performed smoothly. Vessel, nerve and meniscus were not injured. No complication of donor site pain and myas-thenia of affected knee after operation. At 6 months and 2 years after operation, the Lachman test, the Lysholm score and the IKDC score were superior significantly to those before operation in both groups ( 0.05). Conclusion Anterior cruciate ligament reconstruction by Ethibond excel polyester su-tures combined with high-strength sutures using RigidFix for autogenous tendons fixation presented satisfactory clinical results, whether using high-strength sutures during operation needs to be further study.