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OBJECTIVE@#To study and compare the effect of indwelling drainage tube and extubation time on occult hemorrhage and functional recovery after total hip arthroplasty(THA).@*METHODS@#From July 2017 to June 2018, 123 patients who underwent THA in our hospital for the first time were selected as the subjects of study. According to whether the drainage tube was retained or not and the time of extubation, they were divided into three groups:in group A, 41 patients (24 males, 17 females, age 53 to 77 years) did not put drainage tube after THA;in group B, 41 patients were removed 24 hours after THA, 26 males and 15 females, aged 55 to 74 years;in group C, 41 patients were removed 48 hours after THA, 25 males and 16 females, aged 52 to 75 years. The VAS score of pain 72 hours after THA, the total and recessive blood loss, the time of starting functional exercise, and the incidence of postoperative limb swelling were recorded. All the patients were followed up for one year after discharge. Harris hip score was used to evaluate the degree of hip function recovery one year after operation.@*RESULTS@#The occult blood loss of group A, B and C were(513.6±25.3), (521.7±33.4), (519.3±29.8) ml, respectively, with no significant difference(>0.05). There was no significant difference in blood loss in operation among the three groups(>0.05). In group B and C, the postoperative apparent blood loss was more than that in group A (0.05). The time of getting out of bed in group A was shorter than that in group B and C (0.05). There was no significant difference in the incidence of complications among three groups (>0.05).@*CONCLUSION@#Whether the drainage tube is left or not and the time of extubation have no significant effect on the latent blood loss and functional recovery after THA, but without drainage tube after THA can reduce the apparent blood loss, patients can get out of bed at 6 hours after THA, which is more conducive to the recovery and nursing of patients.
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Aged , Female , Humans , Male , Middle Aged , Airway Extubation , Arthroplasty, Replacement, Hip , Drainage , Recovery of Function , Treatment OutcomeABSTRACT
Objective To evaluate the treatment of lateral tibial plateau fractures involving the posterolateral condyle with double plate fixation via the combined anterolateral and posterolateral approaches.Methods From January 2013 to August 2015,12 patients with lateral tibial plateau fracture involving the posterolateral condyle were treated by double plate fixation via the combined anterolateral and posterolateral approaches.They were 8 males and 4 females,with an average age of 36.9 years (range,from 23 to 58 years).According to the Schatzker classification,we had 8 ones of type Ⅱ,3 ones of type Ⅴ and one of type Ⅵ.Firstly,the posterolateral condylar fractures were stabilized temporarily by the Kirschner wire after reduction through the posterolateral approach.Secondly,the lateral tibial plateau fractures were dealt with via the anterolateral approach,and fixated with a proximal tibial locking plate.Finally,a T-shaped plate for the distal radius was used to support the posterolateral condyle.The clinical and radiographic results were evaluated using the Hospital for Special Surgery (HSS) knee score and the Rasmussen Score,respectively.Results The average operative time was 143.3 min (range,from 110 to 210 min);the average intraoperative blood loss was 190.0 mL (range,from 100 to 300 mL).The follow-ups for the 12 cases ranged from 12 to 24 months (average,16.6 months).All the cases obtained clinical healing after 12 to 24 weeks (average,16 weeks).At the last follow-up,the HSS knee-scores ranged from 65 to 98 points (average,84.6 points),giving 7 excellent cases,3 good ones and 2 fair ones.The Rasmussen radiological scores ranged from 13 to 18 points (average,17.1 points),giving 8 excellent and 4 good cases.Conclusions The combined anterolateral and posterolateral approaches can offer excellent exposure for articular reduction and fixation with double plates,achieving satisfactory radiological and functional results in lateral tibial plateau fractures involving the posterolateral condyle.First reduction of the posterior lateral condylar fractures,followed by reduction and fixation of the anterolateral plateau fractures and finally fixation of the lateral condylar fractures,can lead to effectively improved knee function for the patients.
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<p><b>OBJECTIVE</b>To compare clinical results of treatment of Pipkin type I and II femoral head fractures through modified Smith-Peterson(S-P) approach and modified Hardinge approach.</p><p><b>METHODS</b>From July 2005 to July 2014, 42 patients with Pipkin type I and II femoral head fractures were treated with operation. A total of 23 patients in anterior group was treated with modified S-P approach including 17 males and 6 females with an average age of (29.3±9.4) years old, 5 cases of type I by excision of the fragement, 3 cases of type I and 15 cases of type II cases by fixation of the fragement. While a total of 19 patients in the lateral group was treated with modified Hardinge approach including 15 males and 4 females with an average age of (31.4±10.0) years old, 3 cases of type I by excision of the fragement, 4 cases of type I and 12 cases of type II by fixation of the fragement. Operative time, blood loss during operation and fracture healing time were observed and compared. The clinical and radiographic outcomes of the patients were measured using Thompson-Epstein scoring scale. The effect of hip reduction time of less than 6 h, 6 to12 h, and more than 12 h, the effect of surgery time within 24 h and more than 24 h after injury were compared.</p><p><b>RESULTS</b>All patients were followed up from 24 to 60 months with an average of(30.29±6.95) months. The operation time (61.96±12.22) min, blood loss (46.09±18.03) ml, and (74.74±10.06) min, blood loss (72.11±19.88) ml in lateral group in the anterior group were better than those of lateral group(<0.05). In anterior group, fracture healing time was(12.22±1.70) weeks, the results were excellent in 8 cases, good in 10 cases, fair in 4 cases and poor in 1 case, the excellent and good rate was 78.3%, the incidence of avascular necrosis of femoral head was 8.69%(2/23), and the incidence of heterotopic ossification was 13.04%(3/23). While in lateral group, the fracture healing time was(12.42±1.95) weeks, the results were excellent in 6 cases, good in 7 cases, fair in 3 cases and poor in 3 cases, the excellent and good rate was 68.4%, the incidence of avascular necrosis of femoral head was 10.53%(2/19), and the incidence of heterotopic ossification was 5.26%(1/19). There was no significant difference in fracture healing time, postoperative effect and postoperative complications between the anterior group and lateral group(<0.05). The effect of patients with reduction time of hip dislocation less than 12 h was significantly better than that of more than 12 h, there was no significant difference in the effect between reduction time within 6 h and 6 to 12 h. There was no significant difference in the outcome between surgical patients within 24 h and more than 24 h after injury.</p><p><b>CONCLUSIONS</b>Dislocated hip of Pipkin type I and II femoral head fractures should be closed reduction within 6 h. If conditions are limited, the reduction time can be accepted within 12 h. Both of modified S-P approach and modified Hardinge approach are effective in treating Pipkin type I and II femoral head fractures, and can obtain excellent outcomes. Moreover, modified S-P approach has advantage of less trauma, less blood loss, shorter operative time.</p>
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Age-related hearing loss (AHL) is one of the most common sensory disorders among elderly persons. The inwardly rectifying potassium channel 5.1 (Kir5.1) plays a vital role in regulating cochlear K(+) circulation which is necessary for normal hearing. The distribution of Kir5.1 in C57BL/6J mice cochleae, and the relationship between the expression of Kir5.1 and the etiology of AHL were investigated. Forty C57BL/6J mice were randomly divided into four groups at 4, 12, 24 and 52 weeks of age respectively. The location of Kir5.1 was detected by immunofluorescence technique. The mRNA and protein expression of Kir5.1 was evaluated in mice cochleae using real-time polymerase-chain reactions (RT-PCR) and Western blotting respectively. Kir5.1 was detected in the type II and IV fibrocytes of the spiral ligament in the cochlear lateral wall of C57BL/6J mice. The expression levels of Kir5.1 mRNA and protein in the cochleae of aging C57BL/6J mice were down-regulated. It was suggested that the age-related decreased expression of Kir5.1 in the lateral wall of C57BL/6J mice was associated with hearing loss. Our results indicated that Kir5.1 may play an important role in the pathogenesis of AHL.
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Animals , Mice , Aging , Genetics , Metabolism , Cations, Monovalent , Fluorescent Antibody Technique , Gene Expression Regulation , Ion Transport , Mice, Inbred C57BL , Microtomy , Potassium , Metabolism , Potassium Channels, Inwardly Rectifying , Genetics , Metabolism , Presbycusis , Genetics , Metabolism , RNA, Messenger , Genetics , Metabolism , Spiral Ligament of Cochlea , MetabolismABSTRACT
Objective To evaluate the diagnostic value of the early rheumatoid arthritis (RA) classification criteria for early RA and to assess the clinical efficacy of knee arthroscopic synovectomy for RA.Methods A total of 62 patients who had arthritic complaints with disease duration less than one year were treated with knee arthroscopic synovectomy.Patients were diagnosed as RA confirmed by changes of synoviomorphous under arthroscopy,synovial biopsy,immunological biochemical laboratory and MRI,and compared with the preoperative ERA diagnosis.The efficacy was assessed at the third months and more than 12 months after operation,including Health Assessment Questionnaire (HAQ),Lysholm score,laboratory parameters of erythrocyte sedi-mentation rate (ESR) and C-reactive protein (CRP).Results The sensitivity and specificity in the early RA classification criteria for RA diagnosis were 81.58％ and 91.67％.38 patients diagnosed as RA and the remaining 24 patients were significantly improved of HAQ,Lysholm score,ESR,CRP compared with preoperation,showed statistical difference (P ＜ 0.01).There were still statistical differences between the follow-up results of the group of patients with RA in different period after operation (P ＜ 0.01).Conclusion The early RA classification criteria is worthy of clinical application,because it has the advantages of simple,practical,and is beneficial to early diagnosis of RA.The early RA patients should be treated with knee arthroscopic synovectomy as far as possible.It can improve not only the knee function,but also the general symptoms,and it can interrupt the RA pathological process,effective maintain curative effect after operation.