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Objective To compare and analyze the lower limb muscle activity and knee joint force during the stance periods of gait cycle in patients with osteoarthritis before and after total knee arthroplasty (TKA). Methods Based on the OpenSim platform, lower extremity musculoskeletal models of one healthy subject and three patients with osteoarthritis before and after TKA were established. A three-dimensional （3D） motion capture system and a force platform were used to collect the lower limb kinematic data and the ground reaction force during walking, which were used as input parameters to simulate the lower limb muscle activation and knee joint forces. Results The results from the musculoskeletal model were consistent with the results by inverse dynamics based on the 3D motion capture system. The patient's rectus femoris was activated in the loading response and mid stance phases, which was different from that of healthy subject. The activation timing and amplitude of the quadriceps muscle in 3 patients were significantly different before and after TKA. The peak joint forces of 3 patients before TKA were 2.95, 3.15 and 3.43 times of body weight (BW) with the constant load of more than 2 times of BW during stand phase. The peak joint force after TKA were 2.09, 2.48 and 3.96 times of BW respectively. The joint force was not improved and the knee function did not reach the normal level six months after TKA. Conclusions The results of the established musculoskeletal model have certain reliability, and this model can provide a biomechanical auxiliary method for TKA surgery in the future.
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Objective To investigate the effect of preoperative nursing intervention in the prevention of postoperative retention of urine of patients after total knee arthroplasty. Methods 128patients underwent total knee arthroplasty were divided into the intervention group and the control group (64 cases in each group) by random number table.The patients in the control group received routine nursing care and the patients in the intervention group accepted preoperative nursing intervention 3 to 5 days before surgery. The incidence of post-operation urinary retention, catheterization, satisfaction degree and compliance of the patients were compared between the two groups. Results The incidence rate of post-operation urinary retention and catheterization of the patients was respectively 15.6%(10/64) and 7.8%(5/64) in the intervention group,lower than 34.4%(22/64) and 23.4%(15/64) in the control group. The difference was statistically significant (χ2=6.00, 5.93, respectively, P<0.05). The satisfaction degree and compliance of patients were respectively 95.3%(61/64) and 75.0%(48/64) in the intervention group, higher than 85.2%(52/64) and 31.3%(20/64) in the control group,the difference was statistically significant (χ2=6.12, 24.60,respectively, P < 0.05). Conclusions Preoperative nursing intervention have good effect in the prevention of postoperative retention of urine and improving satisfaction degree of patients underwent total knee arthroplasty.
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Objective To compare the short-term effects of myocapsular flap repair through minimal posterior approach in Hip arthroplasty with traditional posterior approach in hip arthroplasty in elderly femoral neck fractures. Methods From August 2007 to may 2009, a total of 126 femoral neck fracture patients were randomly divided into two groups, with 63 patients treated with myocapsular flap repair through minimal posterior approach (the modified group), and 63 patients treated with traditional posterior approach (the traditional group). Fifty-eight patients underwent the first-ever total hip replacement and 68 patients underwent artificial double-acting femoral head replacement. Eighty-four cases were inserted with cemented implants and 42 cases with uncemented. Data of incision length, operation time, blood loss volume, drainage amount, blood transfusion volumes were recorded separately. Postoperative complications related to the surgery and hip joint function were also documented. Function of hip joint was scored with Harris scale. All data were statistically analyzed. Results Five patients died within 1 year of surgery, and 4 patients dropped out. All the remained 117 patients were followed up for 12 - 24 months. There were no significant difference in age, type of fracture and artificial the incision length in the modified group was significantly shorter than that in the traditional group([ 10. 5 ± 2. 4 ]cm vs [ 17. 2 ± 3.6 ] cm, t = 3. 012, P = 0. 004). The average operating time was significantly shorter in the modified group compared to the traditional group (t = 2. 455, P = 0. 038). Blood loss, drainage amount, blood transfusion volumes in the modified group were less than those in the traditional group( t = 3.211,2. 986 and 3. 352 ,Ps ＜ 0. 01, respectively). Conclusion Myocapsular flap repair through minimal posterior approach in Hip arthroplasty is a reasonable, mini invasive technique for hip replacement in older with a less blood loss and shorter operating time.fractures
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[Objective]To measure the posterior sloope angle of proximal tibial medial meniscus(PSAPTMM) in Chinese adult,provide parameters for improving the design of knee prosthesis more suitable for Chinese and for resecting tibial plateau in total knee arthroplasty.[Method]Sixty-three male knees and 52 female knees of Chinese,without tibial deformity,genu varum and valgum,abnormal change of articular surface,and tibial trauma,with average age of 45.6 years(ranged,20~74 years,were divided into 3 groups according to persons age: group A,18~39 years;group B,40~50 years;group C,more than 60 years.The sagital tomography of medial meniscus of MRI were taken,stored,and measured using JENNY way.The data were analyzed statistically.[Result]By two factors analysis,the sex and age had no significant influence on PSAPTMM,and the angle was not different between the left and right knee.In male adult,the average degree of left PSAPTMM was(2.7?1.8,of the right(2.9?1.7)? with an average degree of both sides of(2.9?1.8.In female adult,the average degree of left PSAPTMM was(3.5?1.7,of the right(2.8?1.6,with the average degree of both sides(3.2?1.7.The average degree of group A were(3.6?1.6,group B(2.7?1.8,group C(2.8?1.7.There showed no significant difference of PSAPTMM between sex,side,and age.[Conclusion]The average degree of PSAPTMM in northern Chinese adult is(3.0?1.7,ranges from(0~6.2,and is larger than that of the westerns.
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Objective The measurement of normal tibia was aimed to obtain the value of the posterior slope angle of the medial tibial plateau in Chinese adult and its related parameters in order to improve the design of knee prosthesis more suitable for Chinese people, and also provide an essential features of tibia for resecting tibial plateau in total knee arthroplasty. Methods 450 knees of 428 persons which were healthy Chinese adult long living in North China, were 252 male knees and 198 female knees with an average age of 43.9 years ranging from 18 to 79 years. The criteria of the subjects were no tibial deformity, no genu varum and valgum, abnormal changes of articular surface, and had sustained ever any tibial trauma. Depending on the age of subjects, they were divided into three groups, group A was between 18 and 39 years, group B between 40 to 59 years, and group C more than 60 years. Moreover, 6 tibias harvested from healthy Chinese corpses were measured as well. Computer radiography was used to take standard lateral aspect of X-ray film. The imagines were stored into computer by scanning the films, and so the measurement was taken in computer using Danzig method. The data were analyzed statistically. Results By two factors analysis, the sex and age had no significant influence of the posterior slope angle of the tibia; furthermore, the angle was not different between the left and right tibia. In male adult, the average degrees of left posterior slope angle of the medial tibial plateau were 13.2??4.4?, the right 10.5??5.1?, and the average degrees of posterior slope angle of both sides were 11.7??4.9?. In female adult, the average degrees of left posterior slope angle of the medial tibial plateau were 11.2??3.5?, the right 10.6??4.4?, and the average degrees of posterior slope angle of both sides were 10.8??4.0?. The average degree of group A were 11.7??4.4?, group B 10.4??4.7?, group C 12.3??4.4?. In summary, there was no significant difference of posterior slope angle of the medial tibial plateau between sex, side and age. Conclusion The average degrees of posterior slope angle of the medial tibial plateau in North China adult were 11.3??4.5? ranging from 0??21? to 9?-13?, and were larger than that of the Westerns.