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Objective:To evaluate the risk factors related to the mid-term outcomes of hip preserving surgery for early stages osteonecrosis of the femoral head (ONFH) basing on China-Japan Friendship Hospital (CJFH) classification system.Methods:From June 2012 to September 2016, there were consecutive 325 patients (432 hips) were enrolled and divided into different preserving surgery groups, namely core decompression (CD) group 141 hips and "lightbulb" operation (LB) group 291 hips, respectively. Harris hip score (HHS) was used to evaluate the clinical outcomes. The progression of ONFH was observed by radiography. Clinical failure was defined as worsen of HHS and/or radiographic evaluation. Clinical endpoint events were marked as significant hip pain (HHS<70), and/or collapse of the femoral head requiring further interventions. Potential risk factors, including sex, age, etiology, the duration from symptom onset to treatment, preoperative CJFH type, ARCO stage and HHS, were analyzed using univariate risk analysis and Cox regression multivariate risk model.Results:The rate of hip failure was 47.5% (67/141) in CD group, including type C+M 13.0% (3/23), L1 38.1% (24/63), L2 82.4% (14/17) and L3 68.4% (26/38), respectively. There was significant difference in age (χ 2=3.887, P=0.049), type of CJFH (χ 2=40.943, P=0.000) in CD group. The Cox regression analysis revealed that age≥40 ( HR=2.325, 95% CI 1.398, 3.866, P=0.000), pre-HHS 70-80 ( HR=2.163, 95% CI 1.140, 4.105, P=0.018) and <70 ( HR=2.597, 95% CI 1.173, 5.749, P=0.019), type L2 ( HR=35.052, 95% CI 7.721, 159.133, P=0.000) and L3 ( HR=13.242, 95% CI 3.104, 56.491, P=0.000) were associated with failure of core decompression. The rate of hip failure was 36.4%(106/291) in LB group, including type C+M 33.3% (1/3), L1 31.3% (41/131), L2 84.6% (22/26) and L3 32.1% (42/131), respectively. There were significant differences in age (χ 2=8.437, P=0.004), pre-HHS (χ 2=19.737, P=0.000) and type of CJFH (χ 2=29.265, P=0.000) in LB group. The Cox regression analysis showed that poor pre-HHS ( HR=5.102, 95% CI 2.339, 11.129, P=0.000), type L2 ( HR=32.761, 95% CI 6.165, 43.507, P=0.000) were associated with failure of "lightbulb" preserving surgery. Conclusion:The results of hip preserving surgery for ONFH are associated with age, preoperative HHS and CJFH typing. The prognosis depends on the severity of symptoms, the residual of weight-bearing joint surface and lateral pillar of the femoral head.
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Osteonecrosis of femoral head (ONFH) has a series of pathological changes and clinical manifestations, including damaged or interrupted blood supply of the femoral head and death of bone marrow and osteocytes. Although subsequent repairing was observed in ONFH, it leads to structural changes or even collapses ultimately. The classification system established by the Association Research Circulation Osseous (ARCO) has been widely used in guiding treatment, estimating prognosis, and evaluating efficacy. In November 2019, 2019 revised version was published on the Journal of Arthroplasty that defined staging system for ONFH developed by an expert group led by Kyung-Hoi Koo, a Korean scholar. It has a great change of ACRO staging system since 1994. The revised ARCO staging system has four-stage system. The features of revised ARCO staging system includes the following items, abolition of stage 0, defining stage I and II as pre-collapse lesions, subgrouping stage III as early and late stage, X-ray evidence of osteoarthritis with accompanying joint space narrowing, acetabular changes and joint destruction classified as stage IV. The revised ARCO staging system simplifies the complexity of the system, but not handles the complexity. Further verification of efficacy and significance of the revised staging system are still required in term of guiding treatment and estimating prognosis.
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Objective@#To compare the efficacy of core decompression with autologous bone marrow mononuclear cell grafting with impacted bone grafting in treating bilateral femoral head necrosis.@*Methods@#From January 2011 to January 2017, a total of 44 patients with bilateral femoral head necrosis (88 hips) were admitted to the Department of Orthopaedics, China-Japan Friendship Hospital, including 35 males and 9 females with aged 34.9±7.2 years old (ranged from 22-48 years). Core decompression with autologous bone marrow mononuclear cell and impacted bone grafting were conducted to each hip joint for every patient. All patients were followed up for every 3 months at the first year postoperatively and for every 6 months thereafter. The following clinical measurement were recorded, Harris hip score (HHS), visual analogue score (VAS), the anterior-posterior and frog lateral radiographs, and CT. The 5-year survival rate of the hip was calculated with the endpoint event being defined as a need for total hip arthroplasty or other surgical intervention, or a HHS less than 70.@*Results@#The postoperative follow-up duration was 50.5±34.2 months in the impacted bone grafting group and 54.0±33.1 months in the core decompression with autologous bone marrow mononuclear cells group. Fifteen hips in the impacted bone grafting group and 13 hips in the core decompression with autologous bone marrow mononuclear cell group failed during the follow-up. The 5-year cumulative survival rates of the hips in two groups were 64.7% and 72.1%, respectively [HR=1.178, 95%CI(0.561, 2.477)]. In the impacted bone grafting group, the 5-year survival rates of the hip joints at the ARCO IIIB+IIIC and IIIA stages were 42.9% and 74.2%, respectively [HR=3.258, 95%CI(1.172, 9.059)]. In the core decompression with autologous bone marrow mononuclear cell group, the 5-year survival rates of hips at the ARCO stage I, II and IIIA stages were 50.0%, 75.3%, and 71.4%, respectively (χ2=0.757, P=0.685). Age, gender, BMI, preoperative HHS and etiology did not affect the effects of core decompression with autologous bone marrow mononuclear cell grafting or impacted bone grafting (P>0.05). The preoperative VAS of the impacted bone grafting group and the core decompression with autologous bone marrow mononuclear cell grafting group were 4.80±0.62 and 3.27±1.17, respectively (t=8.625, P<0.001). At the last follow-up, the VAS was reduced to 2.84±1.95 and 2.25±2.08, respectively (t=2.712, P=0.01; t=7.087, P<0.001) with significant difference in postoperative VAS between the two groups (t=2.489, P=0.017). The preoperative HHS of the impacted bone grafting group and the core decompression with autologous bone marrow mononuclear cell grafting group were 77.02±5.03 and 82.57±5.71, respectively (t=7.822, P<0.001). At the last follow-up, the HHS increased to 81.57±12.81 and 83.55±12.87, respectively. The difference between the preoperative and postoperative HHS was statistically significant in the impacted bone grafting group (t=2.389, P=0.021) but not in the core decompression with autologous bone marrow mononuclear cell grafting group (t=0.451, P=0.654). There was no significant difference in postoperative HHS between the two groups (t=1.353, P=0.183).@*Conclusion@#Both impacted bone grafting and core decompression with autologous bone marrow mononuclear cell grafting are safe and effective methods in treating femoral head necrosis. The ARCO stage is a risk factor affecting the prognosis of hips after impacted bone grafting, which has no effect on the mid-term survival of hips after core decompression with autologous bone marrow mononuclear cell grafting.
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Objective@#This research studied the clinical manifestation, classification and countermeasure of nipple ischemia after the corrective surgery of congenitally inverted nipples using a tractor.@*Methods@#From October 2014 to October 2016, the symptoms, treatments and outcomes of postsurgical nipple ischemia (n=81) of 43 patients were collected and analyzed to propose a clinical classification theory.@*Results@#This theory divided nipple ischemia into 3 categories of incidence: Grade Ⅰ at 13.58% (11/81), Grade Ⅱ at 11.11% (9/81), and Grade Ⅲ at 2.47% (2/81). After changing dressing for 7-34 days (the average of 15 days), all GradeⅡand Ⅲ wounds healed eventually.@*Conclusions@#The clinical classification theory of nipple ischemia can provide significant guidance for clinical observations, treatments and prognosis.
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Objective To evaluate the efficacy of locking compression plate (LCP) and retrograde intramedullary nail (RIMN) in the treatment of periprosthetic fractures after total knee arthroplasty (TKA),providing reference for surgeons to select the fixation approach.Methods Cochrane Library,PubMed,Embase,Medline,Wanfang database,VIP Database for Chinese Technical Periodicals,and China National Knowledge Infrastructure (CNKI) were searched to identify the retrospective comparison studies (RCS) which compared the clinical outcomes of LCP and RIMN for patients with periprosthetic supracondylar fractures of the distal femur after TKA.The quality of included literatures was evaluated by Newcastle-Ottawa scale(NOS).Meta-analysis was performed using Revman 5.3 software to compare the operation time,Knee society score (KSS),fracture healing time,nonunion rate,reoperation rate,and incidence of complications between the two groups.Results Ten retrospective comparison studies involving 487 patients were identified including LCP group (296 cases) and RIMN group (191 cases).The meta analysis results showed that no significant differences were found in the operation time (MD =10.89,95％ CI-9.56-31.33,P ＞ 0.05),KSS (MD =1.11,95％ CI-8.88-11.10,P =0.83),fracture healing time (MD =0.00,95％ CI-1.51-1.51,P ＞0.05),nonunion rate (OR =0.71,95％ CI 0.38-1.31,P ＞ 0.05),reoperation rate (OR =0.65,95％ CI 0.22-1.91,P ＞ 0.05),and complication incidence rate (0R=0.69,95％CI0.38-1.26,P＞0.05) between these two groups.Conclusions There are no significant differences in the operation time,KSS,fracture healing time,nonunion rate,reoperation rate,and complications between LCP and RIMN groups.LCP and RIMN have similar clinical outcomes in treating periprosthetic supracondylar femoral fracture following TKA.
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BACKGROUND:Extracorporeal shock wave has been shown to influence the physiological function of endothelial cel s via the activation of mechanoreceptors and specific signal transduction system, and gene expression regulation. OBJECTIVE:To explore the impact of different energy flow densities and numbers of shots of extracorporeal shock waves on the new vessel formation ability, migration capability and apoptosis of bone microvascular endothelial cel s. METHODS:Bone microvascular endothelial cel s isolated from the femoral head of patients undergoing arthroplasty were subcultured in vitro, and then were immunofluorescently evaluated with endothelial cel marker antibodies to CD31 and von Wil ebrand factor (vWF), and grouped according to different energy flow densities (low, 0.03 mJ/mm2;high, 0.11 mJ/mm2) and numbers of shots (400 and 800). Capil ary-like tube formation, migration capability and apoptosis of bone microvascular endothelial cel s were determined by 3-D culture in vitro, scratch test, and flow cytometry, respectively. RESULTS AND CONCLUSION:vWF and CD31 were positively expressed in approximately 100%of bone microvascular endothelial cel s, which indicates the cultured cel s had characterization of microvascular endothelial cel s. Extracorporeal shock wave enhanced angiogenesis and migration capability of bone microvascular endothelial cel s derived from the femoral head, and especial y low-energy flow density of extracorporeal shock wave exerted more superior effects. Angiogenesis of bone microvascular endothelial cel s was decreased with the increased shot number in the low-energy flow density group. In addition, extracorporeal shock wave inhibited bone microvascular endothelial cel apoptosis induced by steroids. Our results suggest that energy flow density and number of shots of extracorporeal shock waves impact the physiological function of bone microvascular endothelial cel s derived from the femoral head.
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BACKGROUND:Decel ularized scaffolds are special for retaining the tubular structure used for nutrition transport, and providing a similar inner environment for cel growth. OBJECTIVE:To study the preparation of the decel ularized whole liver bioscaffold and to explore its repair outcomes for liver injury. METHODS:Livers from 12 Sprague-Dawley rats were used for preparing the decel ularized whole liver bioscaffold by chemical detergent-enzymes decel ularized technology. Models of liver injury were established in another 24 Sprague-Dawley rats and randomized into two groups:the decel ularized whole liver bioscaffold was implanted into the rat liver lesions in experimental group, and controls were given the injection of normal saline. Thirty days later, the serum levels of alanine aminotransferase and glutamic-oxaloacetic transaminase were detected, and liver tissues were removed for hematoxylin-eosin staining. RESULTS AND CONCLUSION:Hematoxylin-eosin staining showed that extracel ular matrix-like structures existed in the decel ularized bioscaffold;cel components were completely removed from the liver, the col agen fibers in the scaffold arranged regularly and were not dissolved under electron microscope. The serum levels of alanine aminotransferase and glutamic-oxaloacetic transaminase in the experimental group were significantly lower than those in the control group (P<0.05). Hematoxylin-eosin staining showed a large number of blue-stained and dense distributed nuclei, and pink distribution of col agen fibers that had no overt breakages in the control group, while pink and dense structures in the experimental group. These results suggest that the decel ularized whole liver bioscaffold is easy to obtain, and can promote the injured liver repair.
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<p><b>OBJECTIVE</b>To perform a meta-analysis on clinical outcomes of minimally invasive percutaneous plate osteosynthesis (MIPPO) or open reduction and internal fixation (ORIF) for distal tibial fractures in adults.</p><p><b>METHODS</b>Pubmed database (from 1968 to March 2014), Cochrane library and CNKI database (from 1998 to March 2014) were searched. Case-control study on minimally invasive percutaneous plate osteosynthesis (MIPPO) or open reduction and internal fixation (ORIF) for distal tibial fractures in adults were chosen,and postoperative infection, operative time, blood loss, fracture nonunion rate, delayed union,fracture malunion rate were seen as evaluation index for meta analysis. The system review was performed using the method recommended by the Cochrane Collaboration.</p><p><b>RESULTS</b>Totally 5 studies (366 patients) were enrolled. Meta-analysis showed that there were significant meaning in postoperative infection between MIPPO and ORIF [OR = 0.23,95% CI (0.06,0.92), P = 0.04]; fracture nonunion rate in MIPPO was lower than in ORIF group [OR = 0.16, 95% CI (0.03,0.76), P = 0.02]; operative time in MIPPO was shorter than in ORIF group, and had significant difference [MD = -14.42, 95% CI (-27.79, -1.05), P < 0.05]; blood loss in MIPPO was less than in ORIF group [MD= -87.17,95%CI (-99.20, -75.15), P < 0.05]; there was no obviously meaning in delayed union between two groups.</p><p><b>CONCLUSION</b>For distal tibial fractures in adults, MIPPO has, advantages of short operative time, less blood loss, lower incidence of infection and fracture non-uniom, but with high fracture malunion rate. MIPPO for distal tibial fractures in adults is better than ORIF, and the best treatment should choose according to patient's condition.</p>
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Humans , Bone Plates , Fracture Fixation, Internal , Methods , Fracture Healing , Minimally Invasive Surgical Procedures , Methods , Operative Time , Tibial Fractures , General SurgeryABSTRACT
<p><b>BACKGROUND</b>Several studies, including those done in China, report that paravertebral vascular injury during posterior spinal surgery can greatly harm patients, though it is a relatively rare complication. However, few studies have examined their course and anatomic relationship to the spine. The aim of this study was to measure the course of the major paravertebral vessels and their positional relationships to the vertebral bodies in Chinese subjects using computed tomography.</p><p><b>METHODS</b>We studied a total of fifty subjects who underwent thoracolumbar computed tomography from T1-S1 at our institution. We measured the theoretical distance, actual distance, theoretical angle, and actual angle of the paravertebral vessels at each thoracolumbar intervertebral disc.</p><p><b>RESULTS</b>The paravertebral artery actual angle at T4-L4 ranged from -11.41 to 79.75° and the actual distance from 16.98 to 52.53 mm. The actual angle of the inferior vena cava at L1-L5 intervertebral disc ranged from -40.75 to 34.50° and the actual distance from -36.63 to 61.69 mm. There was no significant difference in the actual angle of the paravertebral vein or in the actual distance in the thoracic segments according to gender (P > 0.05). However, the actual distance in the lumbar segments were significantly different according to gender (P < 0.05).</p><p><b>CONCLUSIONS</b>The major paravertebral vessels' course is closer to the mid-sagittal plane as they move posterior along the vertebrae, and the actual distance of the paravertebral artery and azygos vein increase, while the actual distance of the inferior vena cava decreases. The course of the lumbar paravertebral vessels varies, especially at L4/L5, and may be more prone to intraoperative injury in female subjects.</p>
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Adolescent , Adult , Female , Humans , Male , Middle Aged , Young Adult , Arteries , Wounds and Injuries , Azygos Vein , Diagnostic Imaging , Wounds and Injuries , Iliac Vein , Diagnostic Imaging , Wounds and Injuries , Lumbar Vertebrae , General Surgery , Tomography, X-Ray ComputedABSTRACT
<p><b>BACKGROUND</b>The aim of this study was to determine the relationship between prosthesis coverage and postoperative hidden blood loss (HBL) in primary total knee arthroplasty (TKA).</p><p><b>METHODS</b>A total of 120 patients who had undergone unilateral TKA from August 2012 to May 2013 were retrospectively studied. The Gross formula was used to calculate the amount of HBL. Routine standard anteroposterior (AP) and lateral X-ray films of the knee joint were taken postoperatively and used to measure the percentages of coronal femoral and of coronal and sagittal tibial prosthetic coverage. Then Pearson's correlation analysis was performed to assess the correlations between the percentages of prosthetic coverage for each AP and lateral position and HBL on the first and third postoperative days.</p><p><b>RESULTS</b>The volumes of HBL on the first and third postoperative days after TKA were (786.5 ± 191.6) ml and (1 256.6 ± 205.1) ml, respectively, and lateral X-ray film measurements of percentages of coronal femoral, tibial coronal, and sagittal prosthetic coverage were (87.9 ± 2.5)%, (88.5 ± 2.2)%, and (89.1 ± 2.3)%, respectively. Pearson's correlation analysis showed statistically significant correlations between percentages of total knee prosthetic coverage for each AP and lateral position and volumes of HBL on the first and third postoperative days (P < 0.05).</p><p><b>CONCLUSIONS</b>HBL after TKA correlates with degree of prosthetic coverage. To some extent, the size of the surfaces exposed by osteotomy determines the amount of HBL. Choice of the appropriate prosthesis can significantly reduce postoperative HBL. Designing individualized prostheses would be a worthwhile development in joint replacement surgery.</p>
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Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Arthroplasty, Replacement, Knee , Knee Joint , General Surgery , Postoperative Hemorrhage , Retrospective StudiesABSTRACT
<p><b>BACKGROUND</b>The incidence of total hip replacement in the younger and more active patients is ever increasing. The ceramic-on-ceramic (COC) bearing was developed to reduce wear debris-induced osteolysis and loosening and to improve the longevity of hip arthroplasties. Few studies have reported the clinical results and complications of the new zirconia-toughened ceramic total hip arthroplasty (THA).</p><p><b>METHODS</b>A consecutive series of 132 young patients (177 hips) that underwent primary cementless THAs between January 2010 and December 2012 were included in this study. These arthroplasties all had fourth-generation COC bearings performed through a posterolateral approach. The average age was (41.8 ± 8.3) years (ranging from 22 to 55 years), and the mean follow-up period was (24.5 ± 9.4) months (ranging from 12 to 47 months). The results were evaluated both clinically and radiographically. Harris hip score (HHS) was determined before surgery and at the time of each follow-up. Presence of postoperative groin or thigh pain and squeaking were recorded. Other complications such as dislocations, periprosthetic fractures, and ceramic components fractures were diagnosed and treated in emergency.</p><p><b>RESULTS</b>The average HHSs improved from preoperative 60.3 ± 10.7 (ranging from 29 to 76) to 91.0 ± 5.1 (ranging from 74 to 100) at the final follow-up (t = 45.064, P < 0.05), and 97.7% of cases were scored as excellent and good results. At the last follow-up, incidental inguinal pain was found in three hips (1.7%) and thigh pain in 11 hips (6.2%). Radiographs showed a high rate of new bone formation around the acetabular and stem components. No obvious osteolysis or prosthesis loosening was detected. Complications occurred in six hips (3.4%): posterior dislocation in two hips (1.1%), periprosthetic femoral fracture in one hip (0.6%), asymptomatic squeaking in two hips (1.1%), and ceramic liner fracture in one hip (0.6%).</p><p><b>CONCLUSIONS</b>The fourth-generation COC THA showed excellent clinical results in younger active patients with no osteolysis-related prosthesis failure at a short-term follow-up study. Surgeons should still be aware of the potential risks of complications such as dislocation, periprosthetic fracture, squeaking, and ceramic components fracture.</p>
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Adult , Female , Humans , Male , Middle Aged , Young Adult , Arthroplasty, Replacement, Hip , Methods , CeramicsABSTRACT
BACKGROUND:As a more common method in the orthopedic field, the method of intra-articular injection drugs has distinct curative effects, but there are some complications. In a certain extent, this method caters to the psychological fear of surgery, and can serve as a kind of conservative treatment. But some experts believed that because of the limit of sterile conditions, intra-articular injection of drugs wil increase the risk of intra-articular infection and they opposed this method. OBJECTIVE:To review the efficacy and adverse reactions of intra-articular injection drugs in recent years, and explain clinical applications of intra-articular injection drugs in orthopedics. METHODS:A computer-based search was conducted in PubMed and Wanfang database for articles related to the application of intra-articular injection drugs in orthopedics published between January 2007 and December 2013. The English and Chinese key words were“intra-articular, injection, orthopaedics, tranexamic acid, hyaluronic acid, corticosteroid, drugs”. Data were checked in the first trial, old articles and repetitive studies were excluded. The relevant 43 articles accorded with inclusion criteria were reviewed. RESULTS AND CONCLUSION:In orthopedics, the method of intra-articular injection drugs is simple, economic and effective, but at the same time, there are some side effects. Tranexamic acid by intra-articular injection can significantly reduce blood loss after total joint replacement, is safety and economic. Intra-articular injection joint lubricant can reduce internal friction of joints and improve the adhesion of joint cavity, can be used as a good conservative treatment for osteoarthritis. Intra-articular injection hormone drugs can treat inflammatory arthritis, and short-term curative effect is obvious, but due to large long-term side effects, the method is not recommended now. Intra-articular injection of analgesic drugs and other drugs have both advantages complications. The efficacy of intra-articular injection drugs in orthopedics is obvious;meanwhile, this method has some complications. Orthopedic surgeons should select related drugs by indications. We stil need to further make reasonable regimen with intra-articular injection drugs in future large-scale study.
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BACKGROUND:It is a clinical difficult in the treatment of osteonecrosis with joint preservation, and to solve this problem, a variety of bone graft substitutes are at the exploration stage. OBJECTIVE:To evaluate the clinical outcome of lightbulb operation with porous bioceramic β-tricalcium phosphate in a consecutive series of patients with osteonecrosis of the femoral head. METHODS:From January to December 2008, 58 patients (88 hips) who had undergone lightbulb operation with porous bioceramic β-tricalcium phosphate were involved in this study. Al patients were evaluated both clinicaly and radiographicaly at postoperative 3, 6, 12 months and annualy. Functional improvement was assessed with the Harris hip score. RESULTS AND CONCLUSION: Among these patients, 56 patients (85 hips) were folowed up for 2-5 years. According to the ARCO staging system, there were 27 hips of stage II, 40 hips of stage IIIa, 18 hips of IIIb. According to the hospital’s classification, type C was in 4 hips, L1 in 15 hips, L2 in 28 hips, and L3 in 38 hips. According to the Harris hip score system, excelent outcome was in 55 hips, good in 12 hips, fair in 5 hips and poor in 13 hips. Nine of 11 patients who failed to preserve their own joints were subjected to hip replacement. The mean preoperative and postoperative Harris scores were 61.2 and 85.3, respectively, with a mean improvement of 24.1 points (P < 0.001). All hips were radiologically stable, with no progress of osteonecrosis, and bone density in the bone graft area increased obviously. The replacement time of porous bioceramic β-tricalcium phosphate was 1-1.5 years. These findings suggest that the porous bioceramic β-tricalcium phosphate provides an option to treat osteonecrosis of the femoral head with satisfactory clinical outcomes, and profits the repair and reconstruction of femoral head osteonecrosis. When in the lateral column of femoral head, the porous bioceramic β-tricalcium phosphate can play a supporting role in the lateral column of the necrotic area, and further prevent collapse, which is suitable for patients with osteonecrosis of the femoral head, especially for those with joint preservation.
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BACKGROUND:Tranexamic acid has been more and more used in reducing bleeding after joint replacement, but its usage method and dosage remain controversial, and become a hot focus in recent years. OBJECTIVE:To investigate the efficacy of intra-articular injection of tranexamic acid on postoperative blood loss and limb circumference changes in patients who received unilateral total knee arthroplasty. METHODS:From March to October 2013, clinical data of 90 patients undergoing primary unilateral total knee arthroplasty were randomized to the tranexamic acid group and the control group, including 19 males and 71 females. The 30 patients in the tranexamic acid group received 50 mL of 3%tranexamic acid dilute solution inside knee joint after capsule closure, and 60 patients in the control group received the same volume of physiological saline. No significant difference in age, height, body mass index, anticoagulation, the type of prosthesis, tourniquet time and preoperative diagnosis was detected between the two groups (P>0.05). The amounts of intraoperative and postoperative blood loss and blood transfusion, postoperative drainage volume, the preoperative and postoperative limb circumference 10 cm above the operated knee were recorded. Routine blood test was reviewed after the surgery. RESULTS AND CONCLUSION:There were no significant differences in total blood loss, postoperative drainage volume and limb circumference changes between tranexamic acid and control groups (P>0.05). The amount of postoperative hidden blood loss was significantly less in the tranexamic acid group than in the control group (t=-2.683, P<0.05). These data suggested that the intra-articular injection of tranexamic acid intraoperatively in patients receiving total knee arthroplasty could significantly reduce the amounts of postoperative hidden blood loss, and did not affect the postoperative limb circumference changes.
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Objective To explore the regular progressive pattern of nontraumatic osteonecrosis of the femoral head (ONFH) in order to establish the reliable and convenient new classification of ONFH.Methods The coronal section of the femoral head was divided into three pillars (medial,central and lateral).The mid-coronal section of the femoral head on MRI was selected.The China-Japan Friendship Hospital (CJFH)classification of ONFH was established according to the site of necrotic focus in three pillars.A total of 153hips with ONFH were classified according to CJFH classification and Japanese Investigation Committee (JIC)classification,respectively.The collapse rate was observed and compared between both classifications of ONFH.Results The CJFH classification for ONFH consists of 3 types:type A,the medial pillar was involved; type B,the medial and central pillars were involved; type C,the lateral pillar was involved.According to site of necrosis focus in the lateral pillar,the type C was divided into 3 types:C1,there pillars were involved but there still was some normal tissue in lateral pillar;,C2,partial central pillar and all lateral pillar were involved; C3,the whole femoral head was involved.The natural history of the ONFH showed the collapse rate of type C2 and C3 in CJFH classification (95.3％) was higher than that (72.3％) of type C2 in JIC classification.Conclusion The CJFH classification of ONFH based on three pillars is more sensitive than JIC classification in predicting collapse of the femoral head.Moreover,the CJFH classification is convenient to use.
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Objective To investigate the feasibility and accuracy of volumetric measurement of necrotic lesion using CT and MRI,and to assess the value of necrotic lesion volume in predicting collapse of the femoral head in patients with avascular necrosis of the femoral head(ANFH). Methods Comparison among CT,MRI and gross section was performed in 25 femoral heads of 18 patients who underwent total hip replacement for established ANFH.The volume of necrotic lesion was measured using fluid displacement.CT and MRI data were transferred to a computer to calculate the volume of necrotic lesion using software.One way ANOVA was used to compare the volumes of necrotic lesion measured by CT,MRI and gross section.A total of 62 patients (92 hips) who were diagnosed with ANFH but without collapse by CT were followed up 24 months.Student t-test was used to compare the ratio of the volumes of the necrotic lesion and entire femoral head in the hips with and without collapse and ROC curve analysis was carried out.Results CT and MRI coincided with gross section in the necrotic area,proliferative area and extralesional area.The volumes of the necrotic lesion measured by CT,MRI and gross section were ( 20.5 ± 5.2 ),( 21.4 ± 4.8 ),( 20.9 ± 5.2 ) cm3,respectively.There was no significant difference among the necrotic volumes measured by the three methods(F =0.185,P =0.831 ).In fifty-seven out of 92 hips,collapse of the femoral head occurred during the follow-up.The ratio of the volumes of the necrotic lesion and entire femoral head was higher in hips with collapse than in hips without collapse[ (34.5 ±9.3)％ vs.(23.4 ±8.4)％ ;t =5.749,P=0.000].The area under the ROC curve was 0.808. Conclusions The volume of the necrotic lesion plays an important role in the collapse of femoral head in patients with ANFH.Both CT and MRI can identify the shape and location of the necrotic lesion intuitively and stereospecifically and can determine the volume of the necrotic lesion accurately.
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One hundred and fifty femoral head necrosis patients with intramedullary decompression received autologous stem cell transplantation. The blood was taken from unilateral or bilateral iliac, in each group the volumes of blood taken were 200, 300 or 400 ml respectively. The number of mononuclear cells was counted before and after centrifugation. The mononuclear cell count in subgroup of 200 ml,300 ml and 400 ml taken from unilateral iliac after centrifugation was (3. 11 ±1. 42) × 1010/L, (2. 62 ±1. 31 ) × 1010/L and(2. 13 ±. 91) × 1010/L. The concentration was significantly lower in subgroup of 400 ml than that of 200 ml (t=5. 118, P<0. 01). The mononuclear cells count in subgroup of 200 ml,300 ml and 400 ml taken from bilateral iliac was(4. 51 ±. 21) × 1010/L, (3. 89 ±. 06) × 1010/L and (2. 98 ±1. 39) × 1010/L, the concentration was significantly lower in subgroup of 400 ml than that of subgroup of 200 ml (t = 6. 446, P < 0. 01). Whether 200 ml or 300 ml or 400 ml blood were taken, the mononuclear cell count in blood taken from bilateral iliac after centrifugation was significantly higher than that from unilateral iliac(t = 3. 119,P < 0. 01; t = 5. 544, P < 0. 01 ;t = 2. 207 ,P < 0. 05). The results indicate that the concentration of isolated bone marrow mononuclear cells is higher from bilateral iliac than unilateral iliac. The concentration of isolated monocytes is reduced gradually with the increased blood volume.
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Objective To explore labeling efficiency and appropriate conditions of Superpara magnetic iron exide nanopaticles (SPIO) nanoparticles for Bone marrow stromal cells(BMSCs). Methods BMSCs were aquired from skeletally mature dogs via iliac crest aspiration and separated by adherent cell cytopheresis.BMSCs were cultured and incubated with SPIO at different concentrations in vitro. The labeling efficiency of BMSCs with different labeling concentrations SPIO nanoparticles as well as detection of characteristics and signal attenuation rules were evaluated by MRI at 1.5T in vitro. Results BMSCs were efficiently labeled by SPIOin vitro and has no alterations to viability and proliferation profiles at this labeling concentration. BMSCs loaded with SPIO can be detected by MRI at certainly cell quantity in vitro(5 × 104). The quantity of SPIO in cells gradually reduced as cell culture time prolonged, with no statistically significant changes in cell death(P＞ 0.05). Conclusion The results demonstrated the potential application of SPIO as a wonderful cell tracer in vitro.
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Objective To investigate the clinical diagnosis and the results of arthroscopic treatment for acetabular labrale tears. Methods From November 2008 to December 2009, 21 patients with unilateral acetabular labrale tears underwent hip arthroscopy were entered in the study, including 9 males and 12 females with an average age of 37.1 years. Physical examination, X-ray examination and magnetic resonance arthrography (MRA) were carried out preoperatively to make the definite diagnosis. Of 21 cases, including labrale debridement in 14 cases, labrale debridement plus femoral osteoplasty in 5 cases and labrale repair plus osteoplasty in 2 cases. Patients were followed-up either by telephone inquiring or out-patient interview.The visual analogue scale (VAS) and Harris hip score were recorded before operation and 6 months after operation respectively. Results All 21 patients showed a positive Fadir impingement sign on the affected hips,meanwhile 15 cases showed a positive Fabir impingement sign, and positive McCarthy test was observed in 9cases. X-ray film showed 11 cases have cam type impingement, among which 6 combined with pincer type impingement. Two cases had acetabulum retroversion alone. On MRA images, signals of contrast agent infiltration in anterior superior quadrant which indicated labrale tear were observed among all cases. All labrale tears were confirmed under arthroscopy. All patients were followed up for average 11.6 months (range, 6-19).The symptoms were obviously released after operation. The VAS decreased from (5.3±1.3) preoperatively to (1.4±-0.9) 6 months postoperatively. The mean Harris hip score improved from (63±9) preoperatively to (84±10) 6 months postoperatively. All the differences had statistical significance. Conclusion Acetabular labrale injury has a close correlation with femoroacetabular impingement. Impingement test and MRA have a high sensitivity and accuracy on clinical diagnosis of labrale tears. Arthroscopic debridement, repair and osteoplasty for labrale tears give a good early outcomes.