ABSTRACT
To evaluate the efficacy and safety of Chinese patent medicine in the treatment of knee osteoarthritis(KOA) with network Meta-analysis, and provide evidence-based medicine evidences for clinical practice. PubMed, Cochrane Library, EMbase, CNKI, Wanfang, VIP and CBM were used to search for clinical randomized controlled trials(RCTs) on Chinese patent medicines for treatment of knee osteoarthritis, with a time limit from the establishment of each database to March 2020. The bias risk assessment tool recommended by Cochrane was used to evaluate the quality of the included RCTs. The network Meta-analysis was performed by Stata 14.0 software. A total of 5 788 patients in 58 RCTs were included, involving 9 kinds of Chinese patent medicines. The results of the network Meta-analysis indicated that in terms of total effective rate, the top three optimal medication regimens were Jinwu Gutong Capsules + Amino Acid Glucose(AAG), Xianling Gubao + AAG and Biqi Capsules; the top three interventions to reduce the VAS score were Panlongqi Tablets > Xianling Gubao + AAG > Xianling Gubao + non steroidal anti-inflammatory drugs(NSAIDs); the top three interventions to reduce the total score of WOMAC were Jintiange Capsules+NSAIDs> Jinwu Gutong Capsules + AAG > Biqi Capsules + NSAIDs; the top three medication schemes with better curative effect to reduce Lequesnse index were Xianling Gubao + NSAIDs > Biqi Capsules + NSAIDs > Jintiange Capsules + NSAIDs; the top three interventions to reduce TNF-α level Xianling Gubao + AAG > Jintiange Capsules > Jintiange Capsules + AAG=Jinwu Gutong Capsules + AAG. In terms of safety, the top five interventions with the least adverse reactions were Biqi Capsules > Jinwu Gutong Capsules > Biqi Capsules + NSAIDs > Xianling Gubao + NSAIDs > Jintiange Capsules. The combined application of Chinese patent medicine and NSADIs or AAG can improve the clinical treatment effect and reduce adverse reactions in KOA patients.
Subject(s)
Humans , Biological Products , China , Drugs, Chinese Herbal , Network Meta-Analysis , Nonprescription Drugs , Osteoarthritis, Knee/drug therapyABSTRACT
BACKGROUND: At present, there is no consensus on the risk factors for delirium after hip fracture in the elderly, and there is no risk prediction system that can effectively assess the risk of delirium after hip fracture in the elderly. OBJECTIVE: To identify the risk factors of postoperative delirium of elderly hip fracture. METHODS: Studies about delirium of elderly hip fracture patients were retrieved by computer. Quality of the studies was assessed. Analysis of sensitivity and heterogeneity was performed by RevMan 5.3 software and cumulative effects were calculated by either fixed or random effects models. RESULTS AND CONCLOUSION: (1) Totally 15 studies included 872 cases of delirium and 3 221 cases of non-delirium. (2) The results of meta-analysis showed that:univariate analysis indicated that preoperative cognitive dysfunction[pooled OR=4.99,95%CI(2.66,9.37),P=0.000],age[pooled MD=3.60,95%CI(2.21, 5.00),P=0.000],preoperative complications ≥ 3[pooled OR=2.83,95%CI(2.12,3.79),P=0.000],preoperative hemoglobin<100 mg/L[pooled OR=2.09, 95%CI(1.17,3.76),P=0.01],preoperative albumin<35 g/L[pooled OR=2.29,95%CI(1.77,2.97),P=0.01],general anesthesia[pooled OR=2.17,95%CI(1.41, 3.34),P=0.000 4],the type or treatment of hip fracture[pooled OR=1.36,95%CI(1.04,1.78),P=0.02],operation time[pooled OR=2.88,95%CI(1.42,5.82), P=0.003],and intraoperative blood loss[pooled MD=36.97,95%CI(25.74,48.19),P=0.000]were the risk factors of postoperative delirium of elderly hip fracture patients.(3)Multivariate analysis showed that preoperative cognitive dysfunction[pooled=4.94,95%CI(2.23,10.95),P=0.000],age[pooled MD=2.84,95% CI(1.89, 3.78),P=0.000],preoperative complications ≥ 3[pooled OR=3.05,95%CI(2.11,4.41),P=0.000],general anesthesia[pooled OR=4.29,95%CI(1.40,13.14), P=0.01],and operation time ≥ 2.5 hours[pooled OR=2.62,95%CI(1.68,4.08),P=0.000]were independent risk factors for postoperative delirium of elderly hip fracture patients. (4) In conclusion, the independent risk factors of postoperative delirium of elderly hip fracture patients are preoperative cognitive dysfunction, age, preoperative complications ≥ 3, general anesthesia and operation time ≥ 2.5 hours. The type of fracture, preoperative waiting time, and type of operation are not related to postoperative delirium. However, due to the low quantity and quality of the included literature, the conclusion needs the support from many high-quality studies.
ABSTRACT
BACKGROUND: Bone defects are one of the most important challenges that surgeons have to manage in total knee arthroplasty. The reasonable treatment method can guarantee the effect of the repair operation. OBJECTIVE: To review the relevant literatures concerning bone defects treated by primary total knee arthroplasty and revision total knee arthroplasty, and to analyze the optimal managements for different types of bone defects. METHODS: Relevant literatures were identified in China National Knowledge Infrastructure, Wanfang data, Vip, PubMed, Medline, and Web of Science. The key words were "total knee arthroplasty, total knee replacement, revision total knee arthroplasty, bone loss, bone defect, bone deficiency, management". The included studies were analyzed and summarized. RESULTS AND CONCLUSION: (1) Sixty-two studies regarding total knee arthroplasty for bone defects were included, without recognized standards on the type of bone defects. AORI is the most widely used classification for bone defects. (2) Pre-operated detailed evaluation including laboratory and radiographic examination, and accurate diagnosis are the key to success. (3) Management of bone defect was similar in tibia and femur, but there is still no standard classification and management of patellar bone defect. (4) Using stem fixation whenever a femoral or tibial component is revised can improve clinical outcome. (5) Through detailed evaluation, accurate diagnose and appropriate classification of bone defect, selection, according to the characteristics of different strategies, the age of the patient and the needs of life, can get a good clinical result.
ABSTRACT
BACKGROUND: Proximal femoral nail antirotation (PFNA) is the most commonly used internal fixation for femoral intertrochanteric fracture. However, a large amount of hidden blood loss makes negative effect on the functional recovery postoperatively. OBJECTIVE: To compare the clinical efficacy of the modified incision and standard incision in PFNA for femoral intertrochanteric fracture. METHODS: Sixty-nine patients with femoral intertrochanteric fractures were analyzed retrospectively, and were then divided into two groups, followed by treated with modified incision of PFNA (group A) or standard incision of PFNA (group B). The postoperative biomechanical stability, fracture healing time, complications, Harris scores at the last follow-up, proximal incision length, operation time, and blood loss were compared between two groups. RESULTS AND CONCLUSION: (1) All the patients were followed up for more than 12 months. The fracture healing time, Harris scores at the last follow-up and incidence of postoperative complications did not differ significantly between two groups. (2) The intraoperative blood loss, total blood loss and total blood transfusion in the group A were significantly less than those in the group B (P < 0.05). (3) The proximal incision length and operation time in the group A were significantly shorter than those in the group B. (4) These results manifest that in the treatment of femoral intertrochanteric fracture, both methods exhibit good biomechanical properties and stability. Notably, compared with the standard incision method, the modified incision method has less trauma, shorter operation time, less blood loss and blood transfusion.
ABSTRACT
BACKGROUND: Unicompartment knee arthroplasty (UKA) is gradually applied in the treatment of knee osteoarthritis, and the management of perioperative blood loss is a hot spot in clinical research. It is very important to control perioperative blood loss and changes in hemoglobin level for postoperative rapid recovery. OBJECTIVE: To investigate the changes in the blood-related indexes during the management of perioperative blood loss in UKA, so as to provide technical reference and data reference for clinical application. METHODS: Clinical data 70 patients undergoing UKA at the Department of Bone and Joint of Guangdong Provincial Hospital of Chinese Medicine from January to December 2015 were analyzed retrospectively, and received the management of perioperative blood loss. The operation time, intraoperative blood loss, postoperative drainage volume, total blood loss and rate of blood transfusion were recorded; the preoperative hemoglobin, albumin, coagulation indexes, D-dimer, erythrocyte sedimentation rate and C-reactive protein were investigated. The effect of operation on the postoperative blood loss and drainage volume was analyzed. RESULTS AND CONCLUSION: (1) The operation time was (89.36±19.89) minutes, intraoperative blood loss was (39.71±23.64) mL, postoperative drainage volume was (56.21±34.21) mL, and rate of autologous blood transfusion was 0. (2) The operation time exerted no effect on the intraoperative blood loss (P=0.685 7), but affected on the postoperative drainage volume (P=0.021 6). (3) The total postoperative blood loss was little, and the blood loss did not differ significantly at 3 hours, 1, 3 and 7 days postoperatively (P > 0.05). (4) There was a slight decline in hemoglobin on days 1-3 after surgery, and then returned slowly; the erythrocyte sedimentation rate and C-reactive protein increased rapidly within 1 day after surgery and declined within 1-3 days; the D-dimer rapidly increased on day 1 after surgery, then rapidly decreased on days 1-3, and then slowly increased on days 3-7; the plasma total protein and albumin were stable and fluctuated in the normal range within 1-3 days. (5) These results suggest that the UKA had short operation time, few total blood loss and slight fluctuation, and the blood-related indexes exhibit different fluctuations. Moreover, the preoperative management of blood loss can reduce the total blood loss and rate of blood transfusion..