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BACKGROUND: The effectiveness of femoral nerve block in perioperative analgesia for total knee arthroplasty has been widely recognized, but the need for combined sciatic nerve block remains controversial.OBJECTIVE: To investigate the analgesic effect and rehabilitation training of femoral and sciatic nerve block in the perioperative period of total knee arthroplasty. METHODS: 150 patients undergoing total knee arthroplasty were randomly divided into three groups: general anesthesia, femoral nerve block and femoral and sciatic nerve block groups. The visual analogue scale scores at rest and in activity, range of motion of the knee, postoperative hospitalization time, adverse effects and the Hospital for Special Surgery scores were recorded and compared among groups.RESULTS AND CONCLUSION: (1) The order of visual analogue scale scores at rest and in activity at each time point postoperatively was as follows: general anesthesia group > femoral nerve block group > femoral and sciatic nerve block group (P 0.05). (5) These results indicate that the femoral and sciatic nerve block has better postoperative analgesia effect compared with general anesthesia and femoral nerve block under multimodal analgesia in total knee arthroplasty, which is favorable for early rehabilitative training.
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BACKGROUND:Periarticular multimodal drug cocktail injection for pain management after total knee arthroplasty (TKA) has been reported,but there are few studies concerning its effect on the range of motion and volume of drainage postoperative,and difference to nerve block.OBJECTIVE:To compare the analgesic effect of periarticular multimodal drug injection and nerve block in TKA.METHODS:Fifty-eight patients undergoing primary unilateral TKA in the First Affiliated Hospital of Anhui Medical University from 1 June 2016 to 31 October 2016 were randomly assigned to experimental and control groups (n=29 per group),followed by received a periarticular intraoperative injection of a 100 mL mixture containing ropivacaine,epinephrine,morphine,and normal saline,and preoperative combined femoral and sciatic nerve block,respectively.Subsequently,the Visual Analogue Scale scores,and range of motion,volume of drainage,hospitalization time,number of the patients given remedial analgesia and complications were compared between two groups.RESULTS AND CONCLUSION:(1) The Visual Analogue Scale scores at rest in the experimental group were significantly lower than those in the control group at 3 days after surgery (P ＜ 0.05).(2) The Visual Analogue Scale scores on movement in the experimental group were significantly lower than those in the control group at 1,2 and 3 days after surgery (P ＜ 0.05).(3) There were no significant differences in the range of motion,volume of drainage,hospitalization time and number of the patients give remedial analgesia between two groups postoperatively (P ＞ 0.05).(4) None appeared with obvious nausea,vomiting and other complications in the two groups.(5) These results indicate that the analgesic effect of periarticular multimodal drug injection is superior to nerve block,and the former is easy to operate,economical and practical.
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BACKGROUND:Patients with knee arthroplasty mostly had bilateral lesions. It is stil controversial to perform simultaneous bilateral surgery or unilateral arthroplasty. The focus of controversy is that bilateral arthroplasty of the same period can get a real upgrade of the repair effect if it does not increase the risk of surgery. There have always existed controversies. OBJECTIVE:To comparatively analyze simultaneous bilateral and unilateral arthroplasty from aspects of safety, economy and effects. METHODS:118 patients suffering from severe bilateral knee osteoarthritis and treated by total knee arthroplasty in the First Affiliated Hospital of Anhui Medical University from April 2011 to April 2014 were divided into simultaneous bilateral arthroplasty group (n=47) and unilateral arthroplasty group (n=71). Variables reflecting safety, economy and effects were set up and data were colected and analyzed. RESULTS AND CONCLUSION: There was no evident difference in safety between simultaneous bilateral arthroplasty and unilateral arthroplasty groups (P > 0.05). In economy and effect, simultaneous bilateral arthroplasty group was significantly better than unilateral arthroplasty group (P < 0.05). These results suggest that with the same surgical management level, if the patient could resist, simultaneous bilateral surgery should be more welcomed, while performing simultaneous bilateral surgery in patients with preoperative cardiovascular diseases should be decided carefuly. Patients with diabetes melitus preoperatively should be guarded against postoperative infection.
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BACKGROUND:Knee-parameter measurements play an important role in the designing of the knee prosthesis. Currently, we have more and more research of the total knee replacement, while uni-condylar knee replacement study is few. OBJECTIVE: To obtain the parameters of the normal femoral condyles and explore its correlation with osteotomy and prosthesis design of the knee joint during uni-condylar knee replacement. METHODS: Normal knee joints of 60 cases (60 knees) were selected. We measured the parameters by using thin-section CT scan and post-processing techniques, including arc diameter of the lowest point of the femoral condyle on the coronal plane, arc diameter of the distal point of the posterior condyle of the femur on the transverse plane, arc diameter of the distal point of the posterior condyle of the femur on the sagittal plane, and arc diameter of the lowest point of the femoral condyle on the sagittal plane, and analyzed the correlation with sex and height. RESULTS AND CONCLUSION:The diameter of the arc that passes through the lowest point of femoral medial condyle in the coronal plane was (42.685±1.389) mm. The diameter of the arc that passes through the farthest point of posterior of femoral medial condyle in the cross-section was (42.732±1.440) mm. The diameter of the arc that passes through the lowest point of femoral medial condyle on the sagittal plane was (45.473±1.332) mm. The diameter of the arc that passes through the farthest point of posterior of femoral medial condyle on the sagittal plane was (42.587±1.446) mm. The results illustrate that knee condyle related parameters were positively correlated with height. Parameters in males were significantly greater than in females. The diameter of the arc that passes through the lowest point of femoral medial condyle on the sagittal plane was significantly larger than that of the farthest point of femoral posterior medial condyle on the sagittal plane (P < 0.001). There was no significant difference among the diameter of the arc that passes through the lowest point of femoral medial condyle on the coronal plane, the diameter of the arc that passes through the farthest point of posterior of femoral medial condyle on the cross-section and that of the farthest point of femoral posterior medial condyle on the sagittal plane.
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BACKGROUND:The relationship between the occurrence time and clinical symptoms of bone marrow edema in nontraumatic femoral head necrosis is stil controversial. OBJECTIVE:To evaluate the relationship of bone marrow edema in nontraumatic femoral head necrosis with Association Research Circulation Osseous (ARCO) staging and pain grading. METHODS: Forty-eight patients with nontraumatic femoral head necrosis (58 hips) were confirmed to have bone marrow edema on MRI T1 weighted images and T2 fat suppression images. Then, the patients were graded according to the MRI Classification Method reported by Zhao Pei-rong, the ARCO Staging System and Harris hip score for pain grading. We analyzed the correlation of bone marrow edema with ARCO staging and pain grading. RESULTS AND CONCLUSION:The incidence rate of bone marrow edema in ARCO I-III was increased in sequence, and the difference was statisticaly significant (χ2=27.69,P=0.001); the average rank of bone marrow edema in ARCO I-III was increased significantly (χ2=19.947,P=0.000). The incidence rate of bone marrow edema also increased among different pain grading, and the difference was statisticaly significant (χ2=57.0, P=0.000); the average rank of bone marrow edema among different pain grading was increased significantly (χ2=174.0,P=0.000). The presence and aggravation of bone marrow edema indicate the enlargement of necrosis area and the aggravation of symptoms in patients with nontraumatic femoral head necrosis, which can be used as an auxiliary index for the appraisal of disease progression.
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BACKGROUND:Knee osteoarthritis is prevalent among the middle-aged and senior people in Asian countries, however, the epidemiology survey of total knee arthroplasty is rarely reported in China. OBJECTIVE: To retrospectively analyze the data of patients undergoing total knee arthroplasty from 2008 to 2013 in Hefei City, and explore the distribution of age and gender of these patients. METHODS: A retrospective analysis among patients undergoing total knee arthroplasty from January 1st 2008 to December 31st 2013 in Hefei City was performed. Data were extracted from the database of Medical Records Room of Relevant Hospitals in Hefei City, including the patient’s gender, age, disease duration, education level, body mass index and surgical site. In addition, more clinical information in one hospital were selected and analyzed, to compare the difference of clinical features between men and women. RESULTS AND CONCLUSION:From 2008 to 2013, totaly 1 146 patients underwent total knee arthroplasty due to knee osteoarthritis. The rate of total knee arthroplasty increased over the 6 years and was much higher in women than in men. The single-centre registry data revealed that there was no difference in age, disease duration, education level, and body mass index and surgical site between men and women. Our findings indicate that, the rate of total knee arthroplasty is increasing steadily from 2008 to 2013 in Hefei City and is higher in women than in men. Risk factors that account for such disparity in total knee arthroplasty utilization need to be further investigated.
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BACKGROUND:With the development of stem cellresearch and regenerative medicine, a growing number of technique applications of bone marrow mesenchymal stem cells have been used for treatment of femoral head necrosis. Simple grafting and injection of bone marrow mesenchymal stem cells has a poor effect, which is combined with scaffold materials as cells carrier plays a better role. OBJECTIVE:To review the research progress of bone marrow mesenchymal stem cells and carriers in the treatment of femoral head necrosis and to look into the future development prospects. METHODS:A computer-based online search of PubMed (1989/2013) and CNKI (1989/2013) was performed for articles with the key words“osteonecrosis of the femoral head, avascularnecrosis, bone marrow mesenchymal stem cells, carrier or scaffold material”in English and Chinese, respectively. The advantages and limits of various carries and scaffolds were summarized. RESULTS AND CONCLUSION:Ideal carriers can promote and induce ability of bone marrow mesenchymal stem cells to repair the femoral head. There is a variety of existing carriers, including autologous cancellous bone, al ograft bone, natural biological materials, organic materials, bio-ceramic, nano-materials. Since each material has its own advantages and limitations, composite materials have begun to be used in searching for ideal carriers and scaffolds, and there are however stil some issues that remain to be solved, such as lacking of unified standard of production, specification and making process;how to control and prevent the immune response and inflammation after implantation;how to ensure that the degradation rate of scaffold matches the generation rate of bone and cartilage in the femoral head;and how to identify the cytotoxicity, biocompatibility and therapeutic effects after implantation.
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BACKGROUND:Distal femur is a predilection site for primary bone tumors, most of which are treated with salvage treatment. There are many reports on the early-stage, mid-term and prognosis of the distal femur tumor-type artificial knee joint prosthesis, but reports on long-term function and prognosis are less. OBJECTIVE:To study the long-term prognosis and limb function after treatment with rotating-hinge knee prosthesis. METHODS:Thirty-four patients with distal femoral bone tumors admitted to the Department of Orthopedics, the First Affiliated Hospital of Anhui Medical University between January 2000 and June 2008 were retrospectively analyzed, including 19 males and 15 females. Al patients were subjected to rotating hinge knee prosthesis replacement. RESULTS AND CONCLUSION:The mean fol ow-up period was 62.4 months (range 11 to 126 months). At the final of fol ow-up, 23 patients were event-free alive and 11 patients were dead. Seven of 23 survival patients suffered from prosthesis related complications, including four cases of prosthesis revision and three cases of amputation. The event-free survival rate of 23 patients undergoing replacement of domestic tumor prosthesis around the knee was 67.6%in 5 years. The mean functional score of affected limb was 19.30 (7 to 27 points):excellent in 6 cases, good in 16, fine in 5 and poor in 2. The excellent-good rate was 75.9%. The clinical outcomes suggested that the satisfactory limb function and survival rate could be achieved with the application of domestic tumor prosthesis replacement for treatment of malignant bone tumors around the knee.
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Objective To investigate the influence of endothelial progenitor cells on the proliferation and differenti-ation of neural stem cells in vitro under the condition of co-culture. Methods We used the mature methods of iso-lation, culture and identification on cells to get the spinal cord NSCs and peripheral blood EPCs from the SD rats, and then put them together in the Transwell chamber in vitro. Set the untreated NSCs as a control group. On the 4th day, we calculated the number and diameter of neurospheres. After that, removing the insert of transwell with EPCs, and inducing the NSCs to differentiate. On the 7th day, we conducted MAP-2 immunofluorescence staining on the cells of induced-differentiation group with fluorescence microscopy, then observed the expression of the anti-gen and calculated the percentage of the differential neurons in the NSCs. All the data were analyzed using statisti-cal method. Results The average number of neurosphere in co-culture group was 10.3±2.2,it was significantly more than that in the control group, and the diameter was under the same situation,the average diameter was up to (49.0±5.3)μm. The percentage of the cells which differentiated into neurons in the co-culture group was signifi-cantly higher than that in the control group, the percentage was(32.1±1.8)%. Conclusion EPCs promote the proliferation of NSCs and induce the differentiation of NSCs into neurons in vitro.
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20 cases of artificial total hip joint rebuilding were selected, all of which were unilateral total hip joint rebuilding. Harris scores before and after the surgery and hip joint activity evaluation were carried out to the pa-tients. The average follow-up duration was 1 to 2 years. Up to the last follow-up,the activity of hip joint had been obviously improved compared with that before the operation. Through X-ray, the phenomena such as radiolucent zone around the prosthesis,prosthesis shift or osteolysis around the prosthesis haven't been seen. The short-term clinical effect of artificial total hip joint rebuilding was obvious for patients with hailure of first total hip joint re-placement caused by various reasons.
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BACKGROUND: Currently, therapies for spinal cord injury include steroid pulse therapy, surgical decompression and stem cel therapy. A lot of work has been focused on stem cel therapy for spinal cord injury which has become a hot spot. OBJECTIVE: To summarize the research status and progress in induced pluripotent stem cells for treatment of spinal cord injury. METHODS: A computer-based online search of PubMed (1980-01/2011-11) was performed for articles in English using the keywords of “spine injury, induced pluripotent stem cells, IPS”RESULTS AND CONCLUSION: A total of 35 articles were included in result analysis, in which, stem cel therapy for treatment of spinal cord injury is agreed or supported. Induced pluripotent stem cells are isolated directly from the body, which solves ethical and moral issues in the transplantation of stem cells, meanwhile avoids al ograft rejection and also provides a large source of cells. Stem cel therapy for spinal cord injury is widely used in animal experiments but few in clinical application. However, stem cel therapy has a good effect in the animal experiments, and shows a higher safety. The existing problems of induced pluripotent stem cells to treat spinal cord injury mainly include immature differentiating method of induced pluripotent stem cells and more complications. Therefore, induced differentiation and security of induced pluripotent stem cells for treatment of spinal cord injury wil become a research key.
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Objective To investigate surgical techniques for tibial plateau fractures involving the posterior column and the corresponding clinical effect.Methods From March 2009 to January 2012,32 patients with tibial plateau fracture involving the posterior column underwent surgical treatment in our hospital,including 21 males and 11 females,aged from 23 to 60 years (average,40.4 years).There were 30 cases of closed fracture and 2 cases of open fracture.Two patients combined with anterior cruciate ligament avulsion fracture,and 3 patients with posterior cruciate ligament avulsion fracture.Posterolateral and anteromedial approaches were used in 6 patients with posterolateral and medial columns fracture.Posteromedial and anterolateral approaches were used in 7 patients with posteromedial,medial and lateral columns fracture; a small anteromedial incision was added in 2 of them.Posteromedial and anterolateral approaches were used in 11 patients with posteromedial and lateral columns fracture.Posteromedial and posterolateral approaches were used in 2 patients with posteromedial and posterolateral columns fracture,while a single posteromedial approach was used in another patient with same fracture.Posteromedial and anterolateral approaches were used in 3 patients with posteromedial,posterolateral and lateral columns fracture,while posterolateral and anterolateral approaches were used in other 2 patients with same fracture.Results All patients obtained satisfactory exposure and reduction.They were followed up for 5 to 24 months (average,10.7 months).The average bone union time was 15.9 weeks,and the average time from operation to full weight-bearing was 18.1 weeks.The average range of motion of knee was 113.3°.According to HSS (Hospital for Special Surgery) score,the results were excellent in 22 cases,good in 6 cases,fair in 3 cases and bad in 1 case; the total excellent and good rate was 87.5％.Conclusion For tibial plateau fractures involving posterior column,satisfactory reduction and fixation can be obtained via posteromedial and posterolateral approaches which have many advantages such as earlier functional exercise,fewer complications and excellent clinical results.
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Objective To explore the curative effect of dynamic hip screw(DHS) and proximal femoral nail (PFN)in treatment of intertrochanteric fractures. Methods Dynamic hip screw(DHS) group is A group:30 patients, proximal femoral nail( PFN) group is B group:30 patients. In the respect of the average length of the incision, operation time,blood loss,X-ray exposure times,postoperative drainage volume,blood transfusion volume,antibiotics usage time,hospitalization time,postoperative ambulation time,healing time of fracture,criteria of Harris hip function score after half a year,complication rate,this paper made the comparative analysis of clinical efficacy and statistical analysis between the two groups. Results 60 patients were followed up for 9 months to 4 years, with the average of 2 years and 3 months and no death. The average length of the incision, operation time, blood loss, X-ray exposure times, postoperative drainage volume,blood transfusion volume, DHS group were( 13. 4 ± 1. 9) cm, (92. 8 ± 13. 0) min, (321.0±39.4)ml,(5. 8 ± 1.2)times, (84.1 ± 10. 1)ml, (316.6 ±79. 1 )ml;PFN group were(7.6 ± 1.1 )cm,(59. 0±6. 9)min, (204. 6 ±32. 7) ml, (5.0 ±0.9) times, (53. 9 ± 8. 7) ml, ( 196. 6 ± 18. 2) ml; the differences between two groups were statistically significant ( all P ＜ 0. 05 ) . Hospitalization time, postoperative ambulation time, healing time of fracture,DHS group were(6.2±3.7)d,(17.8±1.8)d,(69. 8 ± 12. 3)d, (13. 0 ± 1. 6) weeks,PFN group were(4.7 ±2. 6)d,( 16.0 ±2. 2)d, (46.9 ±4. 9)d, (11. 3 ±0.7) weeks, the difference was statistically significant (all P＜0. 05). Antibiotic use of time,hip function(Harris score standard)excellent and good rate after half a year, there's no significant difference between the two groups( all P ＞ 0. 05). Complication rate, DHS group:40% ; PFN group: 10%. The difference was statistically significant (P ＜ 0. 05). Conclusion Intertrochanteric fracture fixation PFN group had an advantage of smaller surgical trauma,less bleeding,shorter healing time,more rapid postoperative recovery,lower complication rate and other characteristics comparing with the DHS group. So it was worth being recommended for a wider use.
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of MG-63 cells to cisplatin,and can inhibit the invasion and metastasis of MG-63 cell.
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Objective To establish a experimental method for evaluating nerve regeneration after operation by means of tracing the retrograde axonal plasm flow by 125 I HRP Methods Eighteen SD rats were used The right sciatic nerve of mouse was transected at the site 0 8cm distal to sciatic notch and then anastomosed immediately Four weeks later,500?l of 125 I HRP solution was injected into the right musculi triceps surae The right sciatic nerve segment proximal to the anastomosis site was cut for checking up the intensity of radioactivity in each tissue at 24 hours after injection The fiber number of nerve distal to the site of anastomosis were calculated The relationship between the intensity of radioactivity and the fiber number was analysed Results The relationship between the intensity of radioactivity of sciatic nerve segment proximal to the site of anastomosis and the fiber number of distal sciatic nerve segment was correlation and there was statistic significance. Conclusion The status of nerve regeneration distal to the site of anastomosis can be evaluated by means of intensity of 125 Iodine in the nerve segment proximal to the site of anastomosis