Hemostatic efficacy of tranexamic acid and ε-aminocaproic acid in hip and knee arthroplasty:a Meta-analysis / 中国骨伤

OBJECTIVE@#To systematically evaluate the hemostatic efficacy of tranexamic acid and ε-aminocaproic acid in total hip arthroplasty (THA) and total knee arthroplasty (TKA).@*METHODS@#Randomized controlled trials (RCT) and retrospective case-control studies about tranexamic acid and ε-aminocaproic acid for the comparison of THA or TKA were searched electronically in PubMed, EMbase, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang, VIP from the time of building databases to July 2020. Two investigators carried out literature screening and data extraction according to the inclusion and exclusion criteria respectively. The methodological quality of the included randomized controlled studies was evaluated through the Cochrane Handbook, and the methodological quality of the included retrospective case-control studies was evaluated through the NOS scale. Blood loss, the incidence of thrombosis complications, per capita input of hemoglobin were Meta-analyzed by Review Manager 5.3 software.@*RESULTS@#A total of 6 articles were included, including 4 RCTs and 2 retrospective case-control studies. A total of 3 174 patients, including 1 353 in the tranexamic acid group and 1 821 in the ε-aminocaproic acid group. Meta-analysis results showed that there were no difference statistical significance in blood loss [MD=-88.60, 95%CI(-260.30, 83.10), P=0.31], blood transfusion rate [OR=1.48, 95%CI(0.96, 2.27), P=0.08], thrombotic complications [OR=0.80, 95%CI(0.07, 8.83), P=0.85], per capita hemoglobin input [MD=0.04, 95%CI(-0.02, 0.10), P=0.18] between tranexamic acid group and ε-aminocaproic acid group during THA. While in TKA, the blood loss of the tranexamic acid group was less than that of the ε-aminocaproic acid group [MD=-147.13, 95%CI(-216.52, -77.74), P<0.0001], the difference was statistically significant. The blood transfusion rate [OR=1.30, 95%CI(0.74, 2.28), P=0.37], thrombotic complications [OR=0.95, 95%CI(0.38, 2.36), P=0.92], per capita hemoglobin input [MD=-0.00, 95%CI(-0.05, 0.06), P=0.48], tourniquet time [MD=1.54, 95%CI(-2.07, 5.14), P=0.40] were similar between two groups, the difference was not statistically significant.@*CONCLUSION@#In THA, tranexamic acid and ε-aminocaproic acid have similar hemostatic effects, while in TKA, tranexamic acid can effectively reduce the patient's blood loss and has a better hemostatic effect. Tranexamic acid is recommended as one of the first choice hemostatic drugs for TKA.

Comparison of femoral tunnel and early curative effect analysis between arthroscopic three approach and traditional anteromedial portal for reconstruction of anterior cruciate ligament / 中国骨伤

OBJECTIVE@#To study the three-approach and traditional anterior medial technique to establish the femoral tunnel of position, length, and coronal angle and the early efficacy of anterior cruciate ligament reconstruction.@*METHODS@#Through retrospective research, from December 2018 to June 2019, a total of 36 patients diagnosed with simple anterior cruciate ligament tear and undergoing surgery were collected. All patients had a clear history of knee sprains and were divided into two groups. A group of 16 patients, including 11 males and 5 females, with an average age of (30.13±6.54) years and an injury time of 7 to 60 (30.19±15.78) days, three-approach technique was used to drill the femoral tunnel to reconstruct the anterior cruciate ligament. Another group of 20patients, including 15 males and 5 females, with an average age of (30.80±8.60) years, and an injury time of 7 to 60 (27.35±15.50) days, the traditional anterior medial approach was used to drill the femoral tunnel to reconstruct anterior cruciate ligament. CT 3D reconstruction technique was used to evaluate the femoral tunnel and the knee joint function was evaluated by Lysholm score of the knee joint.@*RESULTS@#All patients achieved primary healing after the surgical incision. No femoral tunnel fracture, vascular and nerve damage, difficulty in graft passage during the operation, and venous thrombosis occurred. All 36 patients were followed up on an outpatient basis, with a follow up period of 9 to 15 (12.00±2.83) months. Three-dimensional CT reconstruction was used to evaluate the femoral tunnel of the patients. The position of the femoral tunnel was described using the quartile method as the three-approach group:the lower (27.83±1.97) % of the femoral condyle and the posterior (25.57±3.20) %;the traditional approach group:the lower (28.38±3.21) % of the femoral condyle and the posterior (26.23±3.20) %. Bone tunnel length, three-approach group:(35.20±5.52) mm in total length, (23.20±2.07) mm in thick bone tunnel;traditional approach group:(34.60±4.26) mm in total length, (22.56±2.50) mm in thick bone tunnel. Coronal plane angle, three-approach group:(47.93±5.98) °;traditional approach group:(41.78±6.62) °. Knee joint Lysholm score, three-approach group:48.67±4.18 before surgery;97.00±2.48 at last follow up;traditional approach group:49.75±5.33 before surgery, 97.30±2.68 at last follow up, there were significant differences before and after surgery, no significant statistical difference between two groups.@*CONCLUSION@#The positions of the femoral tunnel drilled by the two methods were within the range of the anatomic stop of the anterior cruciate ligament, and there was no statistical difference. Compared with the traditional anterior medial approach, the coronal plane angle of the femoral tunnel drilled by the three-approach approach is relatively large, and there were no statistical differences in the length of the tunnel, the early postoperative effect of the two surgical methods, and the operation time. But the three approach has a wider and clearer vision. In addition, the knee flexion angle required for drilling the femoral tunnel during surgery is significantly smaller than that of traditional approach technology, which reduces the difficulty of surgery.

Research progress on the application of lower limb alignment in discoid meniscus injury / 中国骨伤

Discoid meniscus injury is a kind of common sports injury. Its treatment methods include arthroscopic discoid meniscus plasty, discoid meniscus subtotal resection, discoid meniscus total resection and so on. Although the short-term clinical effect is good, the long-term clinical effect is not ideal. At present, different scholars have different views on the choice of surgical methods for discoid meniscus injury. In recent years, many scholars have shown that the choice of operation and the change of lower limb force line are related to the therapeutic effect of discoid meniscus injury. This paper mainly summarizes the current situation of the treatment of discoid meniscus injury and the changes of the force line of the lower limbs after operation, and expounds therole of the evaluation of the force line of the lower limbs in the treatment of discoid meniscus, so as to provide the basis for the clinical individualized treatment of discoid meniscus injury.

The risk factors of periprosthetic fracture after hip arthroplasty:a meta-analysis / 中国骨伤

OBJECTIVE@#To explore risk factors of the periprosthetic fracture after hip arthroplasty.@*METHODS@#Potential studies were searched in databases including Pubmed, Embase, Cochrane Library, CNKI as well as Wanfang Database up to November 2018 and references in related literatures. The methodological quality of literature was estimated by Newcastle-Ottawa Scale. Raw data were merged and tested mainly by Revmain 5.3.@*RESULTS@#Seventeen studies in total were appropriate with 90 632 patients. The results revealed that it increased the risk of periprosthetic fracture after hip arthroplasty, including female (=1.62, 95%CI:1.44 to 1.82, =3.@*CONCLUSIONS@#Orthopedics doctors should constantly be cantious about the risk factors including female, revision and diagnosis of rheumatoid arthritis. They are supposed to prevent the periprosthetic fracture by gentle operation during hip arthroplasty and monitoring the functional exercise after operations when the above risk factors occur.

Effect of equiaxial tensile strain in early differentiation of mesenchymal stem cells into cartilage cells / 中国骨伤

<p><b>OBJECTIVE</b>To observe the effect of cyclic equiaxial tensile strain in the early differentiation of bone marrow mesenchymal stem cells(BMSCs) into cartilage in mouse under conditions of two-dimensional culture, and to investigate the mechanism of cyclic equiaxial tensile strain in early chondrogenic differentiation.</p><p><b>METHODS</b>Sixteen KM mouse aged 4 weeks were selected, male and female unlimited, with an average weight of 19.5 g (17 to 21 g). After extracting and isolating the BMSCs from KM mouse, then subculture the BMSCs to the 3rd generation. Seed the cells in the biological plate(BioFlex). According to experimental design, the cells were divided into 6 groups, blank group: ordinary culture medium was cultured for 8 days without isometric cyclic tensile strain stimulation. Control group: chondrogenic differentiation medium was used to culture for 8 days without isometric cyclic tensile strain stimulation. Experimental group: the experimental group was divided into 4 groups, all of which were cultured with chondrogenic differentiation medium for 8 days. During which isometric cyclic tensile strain stimulation was given for 1, 3, 5 and 7 days respectively. At the 8th day, all the cells were collected, the expression of the Sox9, Col-II and ROCK 1 signaling pathway-related molecules was analyzed by RT-PCR. Cells in each group were extracted, and the efficiency of cell proliferation in each group was detected by CCK-8. Glycosaminoglycan content in medium changed last was detected using ELISA. Pericellular matrix was observed by Safranin O staining and Alcian Blue staining. Normal measurement data using mean±standard deviation compared between the blank group and control group using paired t-test, compared between the experimental group and relative group using single factor analysis of variance.</p><p><b>RESULTS</b>(1)After 8 days of culture, compared with the control group, the relative expression of Sox 9 and Col-II mRNA in the experimental group increased gradually with the increase of loading time(<0.05), while the relative expression of ROCK1 mRNA decreased(<0.05). Compared with the blank group, the relative expression of ROCK1 mRNA in experimental group and control group increased (<0.05). (2)With the increase of loading time, the experimental group showed a trend of decreasing at first and then increasing, but compared with the blank group and the control group, the control group decreased significantly. (3)Glycosaminoglycan content in the medium changed last was detected by ELISA. The glycosaminoglycans in the experimental group increased gradually, and the content changes on 7 days loading group were statistically significant compared with other groups(<0.05). (4)Safranin O and Alcilan staining showed that there was a tendency of cartilage differentiation in the experimental group, and the shape gradually increased with time, which was more obvious than that in the control group; The PCM, Col-II and GAG in the experimental group increased gradually with the increase of mechanical stimulation days, which were more obvious than those in the control group.</p><p><b>CONCLUSIONS</b>Under conditions of two-dimensional culture, in the early differentiation of mesenchymal stem cells into cartilage, cyclic equiaxial tensile strain can promote the proliferation of BMSCs and the differentiation into chondrocytes. Moreover, cyclic equiaxial tensile strain may promote chondrogenic differentiation through inhibiting the Rho/ROCK 1 signaling pathway.</p>

Classification and reconstruction of acetabular defects in revision total hip arthroplasty / 中国骨伤

As a mature technology gradually, the total hip arthroplasty has been known and conducted by more and more orthopedic surgeons. However, it also increased the number of hip revisions. The reasons for revision of hip mainly include: unstable, infection, aseptic loosening prosthesis, prosthesis peripheral fracture, liner wear and so on, and the acetabulum bone defect and the choice of acetabular prosthesis have been perplexing surgeons. In this paper, we summarise classification and reconstruction of acetabulum bone defect in hip revision oprations, compare the advantages and disadvantages of all kinds of classification, on this basis can have more than one bone grafting mode and the choice of the acetabulum prosthesis for reconstruction of acetabulum, then expound the ways of material sources, bone grafting modes and complex acetabulum bone defect reconstruction as well as the choice of the ways of fixed prosthesis, providing the basis for clinical doctors to deal with all kinds of acetabulum bone defect and the choice of the acetabulum prosthesis, guiding patient specific therapy more precisely.

Research progress on the effects of the tensile strain stimulation on proliferation differention and pericellular matrix of cartilage / 中国骨伤

Mechanical stimulation widely exists in the body and participates in adjusting biological behavior of many kinds of cells. As a common stress pattern in the body, the tensile strain widely exists in many organs, such as bone and cartilage, muscle tendon, cardiac and pulmonary vessels, and so on. In recent years, with the development of the researches of biomechanics, a variety of mechanical loading devices, which are used to simulate the complex mechanical stimulation in the body to provide the tensile strain including the isometric, uniaxial and various types of mechanical waveform, came into being. This is a huge boost to biomechanical research. Many researchers have found that the tensile strain stimulation can lead to the transformation of proliferation, differentiation and apoptosis of cells and change of cell matrix. However, for the same kind of cells, different kinds of tensile strain stimulation can lead to different and even the contrary results. In this paper, the effects of the tensile strain on the proliferation, differentiation and matrix of cartilage were reviewed. Understanding these characteristics will have important implications for the mechanism of cell proliferation and differentiation under the biomechanic stimulation and the prevention and treatment of diseases.

Diagnostic value of Blumensaat angle for anterior cruciate ligament injury / 中国骨伤

<p><b>OBJECTIVE</b>The receiver operator characteristic(ROC) curve was used to determine the best Blumensaat angle for the diagnosis of anterior cruciate ligament injury, so as to objectively evaluate the diagnostic value of Blumensaat angle for anterior cruciate ligament injury.</p><p><b>METHODS</b>Total 167 patients who had knee arthroscopic treatment in a hospital from January 2015 to January 2016 were retrospectively studied, and the patients' age, gender, left and right limb condition were recorded. The patients were divided into two groups according to Blumensaat angle measured on the MRI: group A(Blumensaat angle<=0°), and group B(Blumensaat angle >0°). The ROC curve was drawn from the statistical data of the group B to get the best critical value of the anterior cruciate ligament injury when the Blumensaat angle was more than 0°. According to the best critical value obtained by ROC curve, the coincidence rate of the total sample was obtained.</p><p><b>RESULTS</b>There were no significant differences in patients' age, gender, and affected limbs. There were 51 patients in group A, in which 49 patients were diagnosed as anterior cruciate injury under arthroscopy(gold standard for diagnosis of anterior cruciate ligament injury), and 2 patients were diagnosed as no anterior cruciate injury under arthroscopy. When the Blumensaat angle was<0°, the coincidence rate was 96.07%. In group B(116 cases), the area under the ROC curve was 0.910, the best cutoff corresponds to 15°; the sensitivity was 70.0%, and the specificity was 95.8%. When the Blumensaat angle was >=15°, the probability of anterior cruciate ligament injury was greater. When the Blumensaat angle was 0° to 15°, the anterior cruciate ligament was more likely to be not injured. The Blumensaat angle<=0°or>=15° were used to diagnose the injury of anterior cruciate ligament. Compared with the results of arthroscopy, the coincidence rate of the total sample was 92.8%.</p><p><b>CONCLUSIONS</b>Blumensaat angle is helpful to diagnose the ACL injuries. When the Blumensaat angle was <=0° or >=15°, the probability of ACL injury is greater.</p>

Current therapy progress on the recurrent patellar dislocation / 中国骨伤

Patients who suffer from the recurrent patellar dislocation mainly show the recurrent dislocation of patellar, giving way, most patients have the history of trauma or dysplasia of keen joint. Traditional therapies of recurrent patellar dislocation include medical retinaculum placation, lateral retinaculum release, tibial tubercle osteotomy, femoral trochleoplasty etc. In recent years, with the development of anatomical and biomechanical researches on medial patellofemoral ligament(MPFL), more and more experts focus on the role of MPFL played in preventing the patellar dislocation. The treatment of recovering and correcting patellar tracking through MPFL reconstruction has been increasing gradually. However, till now, there was no therapy which could heal the recurrent patellar dislocation completely. The specific therapies of recurrent patellar dislocation are combination therapies, decided according to the anatomical and biomechanical conditions of patients, for recovering the stability of patients' patellar, the lower limb alignment and the function of keen-joint.

Research progress on tranexamic acid application strategy in total knee arthroplasty / 中国骨伤

Tranexamic acid(TXA) as an antifibrinolytic drugs used to reduce the total knee arthroplasty(TKA) postoperative blood loss is a hot issue in recent years. Such as blood loss, hemoglobin, transfusion rate and other relevant indexs effected by the impact of total knee replacement have been studied and investigated by many scholars. There is no a gold standard about how to safely and effectively apply the TXA. Depending on the dose, TXA may be used by body weight or using 1.5 g or 3.0 g directly. Depending on the different route of administration, TXA may be intravenous infusion, topical application and oral medication. Depending on the using opportunity, TXA can be used preoperative, intraoperative, postoperative or combined application with different times. Without any increase in the chances of thrombosis after TKA, choosing the more scientific instructions to play the greatest utility TXA is a hot issue recently.

Overexpression of Sox9 gene by the lentiviral vector in rabbit bone marrow mesenchymal stem cells for promoting the repair of cartilage defect / 中国骨伤

<p><b>OBJECTIVE</b>To study the overexpression of Sox9 gene on rabbit bone marrow mesenchymal stem cells for repairing articular cartilage injury in vivo.</p><p><b>METHODS</b>Rabbit bone marrow mesenchymal stem cells (BMSCs) were transduced with lentivirus vector containing Sox9 gene and then cartilage specific molecule was detected by RT-PCR in vitro. Total 48 knee joints of 24 mature New Zealand white rabbits were randomly divided into 3 groups according to different defect treatment. After animals anesthesia,a full-thickness cylindrical cartilage defect of 4 mm diameter and 3 mm deep was created in the patellar groove using a stainlesssteel punch. Meanwhile, the transfected cells were implanted to repair the rabbit model with full-thickness cartilage defects. Cartilage defects tissue was observed with light microscope, electron microscope, HE and immunohistochemistry staining to assess the repair of defects by the complex at 6 weeks or 12 weeks after the implantation.</p><p><b>RESULTS</b>At 3 days after the transfection, Sox9 gene expression was highest and Sox9 gene expression decreased with the increase of time. At 3 days after the transfection, the expression of collagen type II began and reached the peak at 14 days. It showed that the bone marrow mesenchymal stem cells went into chondrogenic differentiation after transfected by Sox9 gene. Histological observation showed that at 6 weeks after the operation, the defects in the experimental group was filled with hyaline like cartilage tissue, 12 weeks after operation,the defects of cartilage and subchondral bone had satisfactory healing. Both at 6 and 12 weeks postoperatively, the defects were filled with fibrous tissues in control groups. Meanwhile, immunohistochemical staining of sections with type II collagen antibodies showed the proteins in the regenerated tissue stained positive for type II collagen and stronger than the control groups. The histological scoring system indicated that the cartilage repair of experiment groups were better than the two control groups with statistical significances.</p><p><b>CONCLUSION</b>Overexpression of Sox9 gene on rabbit bone marrow mesenchymal stem cells (BMSCs) promote the repair of cartilage defect.</p>

Gene expression of bone mesenchymal stem cells transduced by the lentiviral vector of SOX9 gene / 中国骨伤

<p><b>OBJECTIVE</b>To construct one lentiviral vector containing mouse SRY-related high mobility group-box gene 9 (SOX9) and transfect the murine bone mesenchymal stem cells (mBMSCs) in vitro and observe the expression of target gene.</p><p><b>METHODS</b>RNA from the vectors containing mouse SOX9 gene were extracted and SOX9 genes were amplified by reverse transcription-Polymerase Chain Reaction (RT-PCR). The SOX9 genes were connected into lentiviral vectors pGC-FU. Then pGC-FU-SOX9 transduced into 293T cells to produce recombinant lentivirus called as Lenti-SOX9-EGFP. mBMSCs were transfected. The expression of target gene was detected by immunofluorescence, RT-PCR and Western Blot.</p><p><b>RESULTS</b>Lenti-SOX9-EGFP was recombined successfully and transduced efficiently into mBMSCs. The expression of SOX9 gene was confirmed by RT-PCR and Western Blot.</p><p><b>CONCLUSION</b>Lentiviral vector of mouse SOX9 gene can transfect successfully into mBMSCs. Meanwhile, SOX9 gene may be expressed in mBMSCs. This will provide the target cells for the following study about SOX9 gene repairing cartilage injury.</p>

Gene expression of bone mesenehymal stem cells transduced by the lentiviral vector of SOX9 gene knockdown / 中国骨伤

<p><b>OBJECTIVE</b>To construct one lentiviral vector containing mouse SRY-related silencing group--box gene 9 (SOX9) and to transfect murine bone mesenehymal stem cells (mBMSCs) in vitro and observe the expression of target gene.</p><p><b>METHODS</b>RNA inteference target sequence was designed in connectin with mice SOX9 gene sequence. The double strands DNAoligo containing interference sequence were synthesized and cloned into lentivirus vector. The siRNA lentiviral vector with SOX9 gene silencing was constructed and identified, which was transfected into rat bone mesenehymal stem cells. The expression of target gene was detected by immunofluorescence, RT-PCR and Western blot.</p><p><b>RESULTS</b>Lenti-SOX9-siRNA-EGFP was recombined successfully and transduced efficiently into mBMSCs. The expression of SOX9 gene silencing was confirmed by RT-PCR and Western blot.</p><p><b>CONCLUSION</b>Mouse SOX9 gene silencing by RNA interference and Lentiviral vector can transfected successfully into mBMSCs. Meanwhile,SOX9 gene may be silenced in SOX9 transduced mBMSCs. This will provide target cells for the following study about SOX9 gene respairing cartilage injury.</p>

Treatment of lumbar intervertebral disc herniation with coblation combined with ozone nucleus pulposus ablation / 中国骨伤

<p><b>OBJECTIVE</b>To compare the clinical effects between coblation combined with ozone nucleus pulposus ablation and single radiofrequency ablation of nucleus pulposus in treating a simple segment inclusive lumbar intervertebral disc herniation.</p><p><b>METHODS</b>From June 2009 to June 2011,33 patients with lumbar intervertebral disc herniation were treated with coblation combined with ozone nucleus pulposus ablation (group A),including 19 males and 14 females,ranging in age from 20 to 60 years old with an average of (40.4+/-8.8) years old,in the course of disease from 12 to 38 months with an average of (19.9+/-5.8) months;31 patients were treated with single radiofrequency ablation of nucleus pulposus(group B),ineluding 18 males and 13 females,ranging in age from 20 to 60 years old with an average of (39.8+/-7.3) years old,in the course of disease from 12 to 48 months with an average of (19.2+/-8.1) months. Visual analogue score(VAS) and JOA score system was respectively used to evaluate pain and function after operation.</p><p><b>RESULTS</b>All patients were followed up more than 1 year. No injuries of nerve root and cauda equina nerve,infection were found. There was no significant difference in VAS score between two groups at 1 month after operation (P>0.05),but at 12 months after operation,VAS score of group A was better than that of group B (P<0.05). There was no significant difference in JOA score between two groups at 12 months after operation (P>0.05). According to the functional improvement rate to evaluate the clinical effects,in group A,9 cases got excellent results, 21 good,3 fair;and in group B,6 excellent,18 good,7 fair. Clinical effects of group A was better than that of group B (P<0.05).</p><p><b>CONCLUSION</b>Clinical effects of coblation combined with ozone nucleus pulposus ablation is better in treating a simple segment inclusive lumbar intervertebral disc herniation.</p>