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BACKGROUND: Hip and knee arthroplasty has been widely carried out in various levels of hospitals. The amount of hip and knee joint surgery has increased year by year. The surgical methods and techniques have reached a difficult time. Promoting the clinical pathway is an effective method to improve the treatment effect. OBJECTIVE: To systemically evaluate the difference between the clinical pathways and conventional pathways in total hip arthroplasty and total knee arthroplasty. METHODS: Clinical trials about the comparison of conventional and clinical pathways in total hip arthroplasty and total knee arthroplasty were searched in MEDLINE, Cochrane Library, EMbase, and CNKI. Study selection, data collection and evaluation of methodological quality were undertaken by two reviewers independently. The Cochrane Collaboration’s RevMan 5.0 was used for data analyses. RESULTS AND CONCLUSION: (1) Totally 17 clinical trials meeting research design criteria were included in this analysis, including 13 semi-randomized controlled trials and 4 randomized controlled trials. (2) The incidence of complications in the traditional method group was higher than that in the clinical pathway group [OR=0.63, 95%C/(0.53, 0.74), P < 0.000 01]. (3) Pain visual analogue scale score [MD=1.49, 95%C/(0.69, 2.85), P=0.001], postoperative Harris hip score [MD=19.31, 95%C/(-13.98, -4.92), P< 0.000 1], and 5-year prosthesis survival rate [OR=0.59, 95% Cl (0.36, 0.98), P=0.04] were better in the clinical pathway group than in the traditional method group. (4) There was no significant difference in postoperative mean deviation of mechanical axes of lower limbs after total knee arthroplasty in both groups [MD-0.0Q, 95%C/(-0.14, 0.14), P=0.99]. (5) Results showed that compared with traditional technique, hip and knee arthroplasty patients who entered the clinical pathway had better clinical efficacy, fewer complications and better joint function after operation.
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BACKGROUND: The concept of the lateral wall as a hot area has emerged in recent years, and has great guiding significance for the treatment of intertrochanteric fractures. OBJECTIVE: To review the definition, scope, thickness of the lateral wall and its important role in the surgical treatment of intertrochanteric fractures. METHODS: The authors searched Wanfang, CNKI, PubMed, and Web of Science. The search terms were “intertrochanteric fracture, lateral wall, fracture fixation” in Chinese and English. The retrieved documents were sorted, analyzed and summarized. RESULTS AND CONCLUSION: (1) The definition, scope, thickness and measurement method of the lateral wall and its clinical significance were sorted out. (2) Classification criteria based on lateral intertrochanteric fractures of the femur were summarized. (3) In terms of treatment, four kinds of treatment methods: Extramedullary fixation, intramedullary fixation, artificial joint replacement and other treatment methods were listed. Causes and treatment of fracture of lateral wall during and after operation were analyzed. (4) The results showed that the integrity of the lateral wall directly affected the stability of the internal fixation, even the success of the internal fixation. The complete lateral wall can prevent the distal femur from moving inward and the head pin from withdrawing, and prevent the coxa varus deformity. Clinicians should make use of detailed imaging examination, analyze fracture types, comprehensively consider various factors, and select appropriate repair methods.
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Objective: To observe the clinical effects of the combination of auxiliary exercise instrument and systematic activity for preventing the formation of postoperative deep venous thrombosis (DVT) of artificial joint replacement. Methods: 217 patients who once underwent replacements of hip joint and knee joint were randomly divided into 3 groups as random method. The patients of A group (72 cases) received auxiliary exercise instrument, and those of B group (73 cases) received systematic activity, and those of C group(72 cases) received combinative treatment of auxiliary exercise instrument and systematic activity. And all of these patients received corresponding nursing scheme to prevent postoperative DVT of artificial joint replacement, respectively. And the symptoms of them at pre-operation and 12d of post-operation were observed, respectively, and the changes of plasma D- dimer(D-D), prothrombin time activity percentage (PTA), fibrinogen (FB), activated partial thromboplastin time (APTT), prothrombin time (PT) and international normalized ratio (INR) also were detected and compared. Results: At the postoperative 1st d, 3th d, 7th d, 12th d, the limb diameter above ankle at 5 cm of patients of C group was significantly less than that of other two group (F=4.066, F=4.256, F=3.452, F=4.678, P<0.05), respectively. However the differences of limb diameter above patella at 10cm of patients among three groups were no significant. And surface temperature above ankle at 5 cm of the C group at 1st d, 3th d, 7th d and 12d were significantly lower than those of other two groups (F=4.659, F=4.325, F=3.196, F=4.754, P<0.05), respectively. And the numbers of gastrocnemius Neuhof symptom and gastrocnemius Homans symptom of C group were significantly lower than that of other two groups (x2=13.317, x2=8.517, P<0.05), respectively. At the 7th d, the plasma D-D of C group was significantly lower than other two groups (F=5.063, P<0.05), while the differences of other plasma indicators among the three groups were no significant. Conclusions: Auxiliary exercise instrument combined with systematic activity has better therapeutic effect for preventing postoperative DVT of artificial joint replacement and it is worthy to be popularized in clinical practice.
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Patients with hip osteoarthritis or other hip joint diseases suffer from pain, limited joint function and psychological disorder, which are responsible for difficulties in sexual life. Total hip arthroplasty can effectively relieve the pain of hip joint and improve the range of joint motion, thus improving the frequency and performance of sexual life of patients. Good quality of sexual life is related to the postoperative satisfaction of patients. However, patients can hardly get the correct guidance on this. After total hip arthroplasty, male patients are earlier to recover sexual life than female patients. The time of the most patients to recover sexual life is 1-3 months after surgery, and the safe position of sexual life is stand position. Sugerons should make positive and correct guidance for patients and their sexual partners about safe resumption of sexual life after total hip arthroplasty.
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Objective To evaluate the treatment of radial head fracture of different type. Methods The clinical data of 80 radial head fracture cases from November, 1999 to December,2009 were collected and analyzed retrospectively. Among the 80 cases,12 cases received conservative treatment( all type Mason Ⅰ ) ;48 cases received open reduction internal fixation (ORIF) (4 case type Mason Ⅰ ,15 cases type Mason Ⅱ ,24 cases type Mason Ⅲ,5 cases type Mason Ⅳ ); 12 cases received removing radial head ( 4 cases type Mason Ⅲ and 8 cases type Ⅳ ).8 cases received artificial joint replacement ( 8 cases type Mason Ⅳ ). Results All cases were followed up for 1.0 -4. 1 years. According to the Mayo Elbow Performance Index, the excellent and good rate of treatment in nonoperative,ORIF,excision of the radial head as well as artificial joint replacement was 83.3 % (10/12) ,87.5 %(42/48) ,75.0% (9/12) and 100. 0% (8/8) ,respectively. Conclusions Conservative treatment can be selected for type Mason Ⅰ ;Open reduction and internal fixation can be selected for type Mason Ⅱ , type Mason Ⅲ and part of type Mason Ⅳ. The excision of radial head or mental prosthesis replacement is alternative for type Mason Ⅳ for those can not be treated with open reduction and internal fixation.
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Objective To discuss the subcutaneous hematoma of the chest wall after artificial femoral head replacement in order to improve the prognosis of patients. Methods One patient complicated with subcutaneous hematoma of the chest wall after artificial femoral head replacement on October,2009.Aborative treatment and nursing was given and the treatment effect was observed. Results The hematoma and congestion were all absorbed after two weeks of treatment and nursing. Conclusions The nursing point of subcutaneous hematoma of the chest wall after artificial femoral head replacement includes monitoring of vital signs, drainage volume, identification of anemia feature, scrupulosly systemic observation and nursing of hematoma.
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Objective To explore the reconstructive methods of benign bone tumor defects in proximal joint. Methods Operative treatment was performed in 11 cases with benign bone tumor defects in proximal joint, a-mong whom 4 cases were treated by curettage,cauterization of wall and bone grafting,3 cases were treated by filling branch through segment fibula transplantation with vascular,2 cases were treated by fibula head transplantation with vascular to reconstruct the glenohumeral joint and rediocarpal joint, and 2 cases were treated by artificial joint re-placement. Results The follow-up ranged from 1.5 to 6 years. All of cases got excellent bone unioned without re-lapse and 2 cases of them developed with little limitation in joint function. Conclusion The importance and recon-structive achievement of fibula transplantation in treating the benign bone tumor defects in proximal joint should be thought fully. The indication of artificial tumor prosthesis replacement should be strictly mastered.
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@#ObjectiveTo evaluate the feasibility of artificial joint replacement in patients complicated with type 2 diabetes mellitus(DM).Methods18 patients with DM accepted the artificial joint replacement after fracture at the femoral neck.They were followed-up with the Harris hip score and radiographs for average 45.5 months(range 23～86 months).The fasting blood glucose(FBG) levels and other associated indexes were monitored during the periods after operation.ResultsAll the patients can walk freely except 3 elder patients that walk with the help of crutch.Radiographic studies showed that 13 cases were excellent,osteophytes appeared around acetabulum in 4 cases,among which 2 cases had the decrease in the hip joint space,and the subsidence appeared in other 2 cases but it was less than 2 mm.The mean of Harris hip score was(81.9±14.8).The body weight index and the level of PBG were negatively correlated with the outcomes of Harris hip score.ConclusionPatients with type 2 diabetes mellitus may accept artificial joint replacement well.It is very important to maintain the body weight and the level of PRG in a normal range after operation.
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Objective To study the relationship between intraoperative findings during knee joint replacement and clinical manifestations in elderly patients with knee osteoarthritis.Methods A total of 150 cases of senile knee osteoarthritis(182 knee joints) was selected for total knee replacement.Their X-ray examination results were gathered for recording the impairment of the articular surface,the joint space narrowing,and the location and amount of osteophytes.An MRI examination was performed in some of the cases for recording changes of fibrocartilage and locations of meniscus.Results Out of the 150 cases,there were 108 cases of genu varum(mean inversion angle,12.5?;range,0?~25?),21 cases of genu valgum(mean eversion angle,18.3?;range,15?~25?),and 21 cases of flexion contracture (mean angle,15.3?;range,0?~40?).The X-ray findings showed varying degrees of joint space narrowing in all the 150 cases,and osteophytes on the posterior border or at lateral part of the knee joint in 131 cases(152 joints).MRI examinations were performed in 11 cases(15 joints),in which discontinuous,cystoid,and worn-out fibrocartilages were seen.Radial displacement of the meniscus was found.Intraoperative findings proved that the fibrocartilage on the articular surface on the side with joint space narrowing was severely worn away,the collateral ligaments were contracted,the osteophytes were seen at the posterior part of the tibia and the femur,and abrasion or radial displacement of the meniscus on the side with joint space narrowing.Conclusions Joint space narrowing,varus or valgus deformity,osteophytes,and radial displacement of the meniscus are usually found in aged patients with knee osteoarthritis.