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Objective:To compare the location and efficacy of femoral tunnel near-isometric reconstruction of anterior cruciate ligament (ACL) between the transtibial and assisted medial approaches.Methods:The clinical data of 47 patients were retrospectively analyzed who had been admitted by Department of Orthopaedics, The 904 Hospital of PLA for ACL rupture from January 2018 to December 2019. They were divided into 2 groups according to different surgical approaches. In groups A of 21 cases, there were 15 males and 6 females with an age of (29.5 ± 4.8) years and their ACL was reconstructed through the transtibial approach with adjustable Endobutton plate; in group B of 26 cases, there were 18 males and 8 females with an age of (31.2 ± 9.6) years and their ACL was reconstructed through the assisted medial approach with adjustable Endobutton plate. The 2 groups were compared in terms of location of femoral tunnel, Lysholm score and International Knee Documentation Committee (IKDC) score at the last follow-up, and anterior-posterior and rotational stability of the knee joint.Results:There was no significant difference in the preoperative general data between the 2 groups, showing comparability ( P>0.05). The 47 patients were followed up for 18 to 27 months (average, 22.3 months). As for the center of the inner opening of the femoral tunnel located by the four grid table method, the X-axis loci was 25.6% ± 2.5% and 26.7% ± 1.8% respectively in groups A and B, showing no statistically significant difference ( P>0.05) while the Y-axis loci 19.8% ± 2.0% and 30.6% ± 1.5% respectively in groups A and B, showing a statistically significant difference ( P<0.05). At the last follow-up, the lyholm scores were 90.9 ± 3.4 and 92.4 ± 3.9 and the IKDC scores 89.9 ± 3.5 and 90.2 ± 3.8 respectively in groups A and B, showing no significant difference between the 2 groups ( P>0.05). There was no significant difference either in the results of front drawer test, Lachman test or axial displacement test between the 2 groups ( P>0.05). Conclusion:In femoral tunnel near-isometric reconstruction of ACL, the transtibial approach can result in a tunnel location which is closer to the top of the condyle than the assisted medial approach, but both approaches can lead to satisfactory curative efficacy in the short postoperative period.
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Objective To investigate the effect and safety of topical tranexamic acid (TXA) plus cocktail analgesic for reducing blood loss during total knee arthroplasty (TKA).Methods A prospective case control study was made on 60 patients scheduled to undergo TKA because of knee injuries between August 2015 to June 2016.There were 13 males and 47 females,with the mean age of 65.5 years (range,51-80 years).Traumatic arthritis occurred in 44 patients and degenerative arthritis in 16 patients.The patients were assigned to separate cocktail analgesic group (Group A,n =30) and topical TXA plus cocktail analgesic group(Group B,n =30),according to the random number table.Patients in Group A received multiple-point intra-articular cocktail analgesic injection before implantation of the prosthesis in TKA.While patients in Group B received multiple-point intra-articular TXA plus cocktail analgesic injection before implantation of the prosthesis.Between-group differences were compared with respect to intraoperative blood loss,hemoglobin change (Hb),haematocrit (Hct),postoperative drainage,total blood loss,hidden blood loss,blood transfusion rate,Hospital for Special Surgery (HSS) score,incidence of deep venous thrombosis (DVT) and other complications.Results All patients were followed up for 3 months.Perioperative Hb reduction in Group B was 18.5 (13.0,26.0) g/L,less than 23.0 (21.0,35.5) g/L in Group A (P ＜ 0.05).Hct was reduced by 5.6 (4.1,7.8) ％ in Group B,while 7.2 (6.1,10.7) ％ in Group A (P ＜ 0.05).Postoperative drainage volume,total blood loss and occult blood loss in Group B were 105.0(60.0,223.8) ml,596.0(426.1,795.3) ml,422.3 (228.9,624.0) ml respectively,decreased compared to Group A [162.5 (118.8,245.0) ml,788.3 (583.0,1 082.4) ml,603.2 (435.2,884.7)ml respectively] (P ＜0.05).There were no significant differences in intraoperative blood loss,blood transfusion rate,HSS score and DVT incidence between the two groups (P ＞0.05).Conclusion Topical TXA plus cocktail analgesic can reduce blood loss during perioperative period in TKA,without increasing the risk of DVT.
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Objective To study the influencing factors of postoperative cognitive dysfunction ( POCD) in elderly patients after knee joint replacement. Methods 165 cases of elderly patients undergo-ing knee replacement surgery were recruited in the study. According to whether there was POCD,the patients were divided into POCD group (35 cases) and non POCD group (130 cases).The gender,age,educational level,medical history,physical exercise,operation mode( cruciate-retaining total knee arthroplasty and poste-rior stabilized total knee arthroplasty) ,operation time,blood loss,preoperative depression score and postoper-ative pain score were recorded and compared.The logistic multiveariate regression analysis was conducted to analyze the risk factors of POCD in elderly patients with knee replacement. Results (1)There were statis-tically significant differences in the total score of MoCA, visual space and executive function,naming and de-laying recall between non-POCD group and POCD group after the operation ( Z=-5. 327, P=0. 000;Z=-3.140, P=0.002;Z=-2.910, P=0.004;Z=-3.333, P=0.001). (2)The results of logistic multiveariate regression analysis showed the age>70 years old ( OR=3.708,95%CI =1.037-13.261, P4 ( OR=3.149,95%CI=1.072~9.251, P<0.05) were risk factors of POCD,and physical exercise ( OR=4.330,95%CI =1.294-14.488, P<0.05) and CR-TKA( OR=0.187,95%CI =0.045-0.781, P<0.05) were the protective factors of POCD. Conclusion The overall level of cognitive function in elderly patients after knee replacement surgery is low. The advanced age,hypertension,diabetes,lack of physical exercise,choice of operation method,postoperative pain and preoperative depression are important influence factors of POCD.
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OBJECTIVE:To explore the risk factors of adverse reaction of cefazolin drugs by Logistic model. METHODS:Re-lated information was collected from the information system of our hospital,and SPSS 19.0 software was conducted for statistical analysis. RESULTS:Totally 855 patients were enrolled,30 of which had adverse reactions(3.51%). According to the results of Logistic analysis,intravenous administration with the concentration of ≥20 mg/ml (OR=7.857,95% CI:1.566-39.431,P=0.003) was the risk factor of adverse reaction of cefazolin drugs when single dose was above 2 g (OR=13.75,95% CI:2.423-78.028,P1.75 g with ad-ministration time of 0:00-9:05 and concentration of above 7 mg/ml. According to the predictive thresholds,the risk of patients with adverse reaction can be predicted to promote safe and effective use of cefazolin.