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Objective:To investigate the clinical efficacy of ultrasound-guided closed reduction and percutaneous Kirschner wire fixation in the treatment of supracondylar fractures of the humerus in children.Methods:The clinical data of 78 children with Gartland type II and type III straight-type supracondylar fractures of the humerus who received treatment in The First Affiliated Hospital of Anhui Medical University from October 2019 to October 2022 were retrospectively analyzed. These children were divided into an observation group ( n = 38) and a control group ( n = 40) according to different treatment methods. The observation group was subjected to ultrasound-guided closed reduction and percutaneous Kirschner wire fixation. The control group was given C-arm fluoroscopy-guided closed reduction and percutaneous Kirschner wire fixation. Mayo elbow performance score (MEPS), clinical healing time, operative time, and the incidence of intraoperative complications such as vascular and nerve injury were compared between the two groups. Results:Both groups of children achieved closed reduction without open reduction. The operative time in the observation group was (30.68 ± 5.45) minutes, which was significantly shorter than (40.54 ± 5.78) minutes in the control group ( t = 2.30, P < 0.05). The healing time of the fracture in the observation and control groups was (32.73 ± 4.56) days and (36.47 ± 6.24) days, respectively, and there was no significant difference between the two groups ( P > 0.05). The range of joint motion and elbow hyperextension angle range in the observation group were (148.78 ± 3.81)° and (8.72 ± 8.92)°, respectively, and they were (147.24 ± 4.36)° and (7.98 ± 8.86)°, respectively in the control group. There were no significant differences in the range of joint motion and elbow hyperextension angle range between the two groups (both P > 0.05). The excellent and good rate of joint function in the control and observation groups was 92.5% (37/40) and 92.1% (35/38), respectively. There was no significant difference in excellent and good rate of joint function between the two groups ( P > 0.05). There were three cases of postoperative nerve damage in the control group and no vascular or nerve damage was observed in the observation group. There were significant differences in the number of cases of vascular or nerve injury between the two groups ( χ2 = 3.97, both P < 0.05). Conclusion:Ultrasound-guided closed reduction and percutaneous Kirschner wire fixation for the treatment of supracondylar fractures of the humerus can shorten the operative time, decrease the incidence of intraoperative nerve injury, and reduce the X-ray exposure time of doctors and patients.
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Objective:To investigate the clinical value of the modified lateral approach to the shoulder for the treatment of proximal humeral fractures.Methods:A total of 64 patients with proximal humeral fractures who received treatment in Zhoushan Branch, Ruijin Hospital, Shanghai Jiaotong University School of Medicine from May 2018 to May 2022 were included in this study. They were randomly divided into observation and control groups ( n = 32/group). The observation group was treated using a modified lateral approach to the shoulder. The control group was treated using the anteromedial approach to the shoulder. Perioperative indexes (operation time, intraoperative blood loss, postoperative drainage volume, hospital stay, and incision length) were compared between the two groups. Before surgery, 1 week and 3 months after surgery, the visual analogue scale score and the Constant-Murley shoulder assessment score were compared between the two groups. Before surgery and 3 months after surgery, the shoulder range of motion was compared between the two groups. The incidence of complications was also compared between the two groups. Results:The operation time, intraoperative blood loss, postoperative drainage volume, hospital stay, and incision length in the observation group were shorter or lower than those in the control group ( t = 7.42, 26.85, 10.90, 2.73, 10.59, all P < 0.05). At 1 week and 3 months after surgery, the visual analogue scale score in the observation group was significantly lower than that in the control group ( t = 5.80, 6.06, both P < 0.001). At 1 week and 3 months after surgery, the Constant-Murley shoulder assessment score in the observation group was (62.96 ± 12.05) points and (74.96 ± 14.52) points, respectively, which were significantly higher than (56.74 ± 9.62) points and (67.88 ± 12.25) points in the control group ( t = 2.28, 2.10, both P < 0.05). After surgery, the range of motion of the shoulder joint in the observation group was greater than that in the control group, including forward flexion, backward extension, external rotation, and internal rotation ( t = 2.54, 3.19, 2.40, 4.00, all P < 0.05). The incidence of complications in the observation group was 6.25% (2/32), which was significantly lower than 28.13% (9/32) in the control group ( χ2 = 5.39, P < 0.05). Conclusion:The modified lateral approach to the shoulder has a marked effect on proximal humeral fractures. The approach can improve shoulder function, shorten operation time, and decrease the incidence of complications.
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Objective:To investigate the effects of types of ulnar styloid process fracture on the treatment of distal radius fracture.Methods:The 80 patients were analyzed retrospectively who had been treated at The First Department of Hand Surgery, Honghui Hospital from January 2019 to January 2020 for fracture of distal radius complicated with fracture of ulnar styloid process. They were 25 males and 55 females, aged from 30 to 85 years (average, 58.6 years). According to the types of ulnar styloid process fracture, 40 patients were assigned into a Hauck type Ⅰ group and the other 40 into a Hauck type Ⅱ group. The 2 groups were compared in terms of operation, postoperative complications, hospital stay, bone union, visual analogue scale (VAS) on postoperative 1 to 3 days, and modified Mayo wrist function score, wrist range of motion and quality of life by WHOQOL-BREF at the last follow-up.Results:The 2 groups were comparable because there was no significant difference in age, gender, American Society of Anesthesiologists (ASA) rating, or time from injury to operation between them ( P>0.05). All the patients were followed up for 12 to 24 months (average, 17 months). There was no significant difference between Hauck type Ⅰ group and Hauck type Ⅱ group in operation time, intraoperative blood loss, hospital stay, rate of postoperative complications, fracture union, modified Mayo wrist function score or VAS on postoperative 1 to 3 days ( P>0.05). At the last follow-up, the palm tilt and ulnar inclination angles were 13.8°±1.9° and 21.6°±2.8° in Hauck type Ⅰ group, significantly larger than those in Hauck type Ⅱ group (11.9°±1.6° and 18.8°±2.3°) ( P<0.05). At the last follow-up, Hauck Ⅰ group scored 85.3±6.4,85.6±6.5, 84.7±6.3 and 85.0±6.7 respectively in the domains of physical health, psychology, environment and social relationships, significantly higher than those Hauck type Ⅱ group did (78.5±6.5, 78.9±6.5, 77.8±6.1 and 77.9±6.3) ( P<0.05). Conclusions:In open reduction and internal fixation for distal radius fracture, Hauck Type Ⅰ fracture of ulnar styloid process has no significant effect on the functional recovery of the wrist but Hauck Type Ⅱ fracture of ulnar styloid process may. Therefore, surgical fixation needs to be strengthened if Hauck Type Ⅱ fracture of ulnar styloid process is complicated.
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Objective:To explore the effect of postoperative intravenous drip of tranexamic acid on perioperative blood loss, coagulation function and knee joint function in patients undergoing total knee arthroplasty.Methods:A total of 100 patients who underwent unilateral total knee arthroplasty for the first time from August 2018 to August 2020 in Dingzhou People′s Hospital were selected and divided into the tranexamic acid group and the control group according to registration order, with 50 cases in each group. The tranexamic acid group was given intravenous infusion of tranexamic acid immediately after the operation, and the control group was given intravenous infusion with the same dose of normal saline after the operation. The postoperative drainage volume was evaluated at 12 h after the treatment, and the total blood loss and occult blood loss were calculated. The change value of hemoglobin, related indexes of the coagulation function at 24 h after the operation, the knee joint range of motion before and after the operation, and Hospital for Special Surgery knee score (HSS score) were recorded. The proportion of blood transfusion, the rate of deep vein thrombosis and the incidence of pulmonary embolism were compared.Results:The postoperative drainage, total blood loss and occult blood loss in the tranexamic acid group were significantly lower than those in the control group ( P<0.05). The change value of hemoglobin in the tranexamic acid group was significantly lower than that in the control group: (33.32 ± 8.87) g/L vs. (47.37 ± 9.26) g/L, t = 7.75, P<0.05. There was no statistically significant difference in related indexes of coagulation function in the two group at 24 h after the operation ( P>0.05). The range of motion of the knee joint and the HSS scores in the tranexamic acid group were significantly greater than those in the control group: (98.57 ± 7.28)° vs. (87.20 ± 8.05)°, (87.25 ± 8.30) points vs. (78.37 ± 10.20) points, t =7.41, 4.78, P<0.05. The proportion of postoperative blood transfusion, the rate of deep vein thrombosis and the incidence of pulmonary embolism in the tranexamic acid group were significantly lower than those in the control group: 14.0%(7/50) vs. 32.0%(16/50), 6.0%(3/50) vs. 20.0%(10/50), 4.0%(2/50) vs. 16.0%(8/50), χ2 = 4.57, 4.33, 4.00, P<0.05. Conclusions:Tranexamic acid can reduce perioperative bleeding in patients undergoing total knee arthroplasty, reduce the proportion of patients undergoing blood transfusion, without increasing the risk of thrombosis and pulmonary embolism complications. Besides, it doesnot affect the coagulation function, and can accelerate the recovery of knee joint function.
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Objective:To investigate the effects of Manchester Pain Management Model (MPMM) on postoperative pain and joint function for patients undergoing rotator cuff repair surgery.Methods:A total of 66 patients undergoing rotator cuff repair surgery from February 2017 to October 2020 in the First People′s Hospital of Hefei were divided into experimental group and control group by random digits table method, with 33 cases in each group. The control group received routine nursing; based on the routine care, the experimental group implemented MPMM-based intervention. The degree of pain and shoulder function of the two groups were assessed by Visual Analogue Scale (VAS) and Constant-Murley Scale (CMS).Results:During the study period, 1 case in the experimental group was lost, 32 cases in the final experimental group and 33 cases in the control group. There was no significant difference in the score of VAS and CMS before surgery between the two groups ( P>0.05). At 1 day, 3 days, 3 weeks and 6 weeks after surgery, VAS scores in the experimental group were 5.47 ± 1.72, 4.63 ± 1.16, 3.25 ± 0.78, 1.81 ± 0.52, lower than those scores in the control group 6.42 ± 1.03, 5.45 ± 1.54, 4.30 ± 0.64, 2.39 ± 0.47, the differences were statistically significant ( t values were 2.36-3.11, all P<0.05). At 3, 6, 12 weeks after surgery, CMS scores in the experimental group were 57.09 ± 4.32, 67.75 ± 4.60, 81.94 ± 4.18, higher than those scores in the control group 52.27 ± 5.39, 64.24 ± 3.76, 78.91 ± 4.36, the differences were statistically significant ( t=3.97, 3.37, 2.89, all P<0.01). Conclusions:MPMM can effectively alleviate the postoperative pain and promote the recovery of joint function in patients undergoing rotator cuff repair surgery.
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Objective:To explore the effects of modified Duhuo Jisheng Decoction combined with Traditional Chinese Medicine (TCM) fumigation on joint function and inflammatory mediators in synovial fluid of patients with knee osteoarthritis.Methods:A total of 203 patients with knee osteoarthritis who met the inclusion criteria between March 2020 and March 2021 in the hospital were divided into observation group (102 cases) and control group (101 cases) according to the random number table method. The control group was given oral administration of celecoxib capsules + TCM fumigation, and the observation group was given modified Duhuo Jisheng Decoction on the basis of the control group. Both groups were treated for 3 months. TCM symptoms were scored before and after treatment, and Japanese Orthopaedic Association scores (JOA) was used to evaluate the knee function. Immunoturbidimetry was adopted to detect serum high-sensitivity C-reactive protein (hs-CRP), and ELISA was used for the detection of levels of TNF-α and IL-6 in synovial fluid, and the clinical efficacy was evaluated.Results:The total effective rate was 90.2% (92/102) in observation group and was 79.2% (80/101) in control group ( χ2=4.74, P=0.030). The JOA scores at 1 month and 3 months after treatment in observation group were significantly higher than those in the control group ( t=3.17, 7.74, all Ps<0.01). The scores of cold and painful knee joint, soreness and weakness of waist and knees, joint swelling and inhibited bending and stretching were significantly in the observation group after treatment lower than those in the control group ( t=7.61, 10.81, 6.62, 8.77, all Ps<0.001). The levels of TNF-α and IL-6 in synovial fluid and level of serum hs-CRP were significantly in the observation group after treatment lower than those in the control group ( t=7.97, 9.52, 9.56, all Ps<0.001). During treatment, the incidence rate of adverse reactions was 32.7% (33/101) in control group and that of observation group was 19.6% (20/102) ( χ2=4.49, P=0.034). Conclusion:Modified Duhuo Jisheng Decoction combined with TCM fumigation can improve the clinical symptoms and knee function, relieve the inflammatory response and enhance the clinical efficacy of patients with knee osteoarthritis.
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OBJECTIVE@#To evaluate the relationship between postoperative knee function and the sagittal position of tibial component in unicompartmental knee arthroplasty (UKA).@*METHODS@#We retrospectively enrolled the patients who underwent UKA from January 2016 to May 2020. They were assigned into 2 groups according to postoperative posterior tibial slope (PTS): the normal PTS group (PTS≥3° and PTS < 8°) and the abnormal PTS group (PTS < 3° or ≥8°). The patients were followed up for at least 12 months. The postoperative Knee Society Clinical Score (KSS-C), Knee Society Functional Score (KSS-F) and knee range of motion (ROM) were compared between the two groups.@*RESULTS@#A total of 72 patients (82 knees) were included with 51 patients (58 knees) in PTS normal group and 21 patients (24 knees) in PTS abnormal group. All the patients were followed up with median of 23.6 months. There was no significant difference in the general data [gender, age, body mass index (BMI)], pre-operative knee range of motion, preoperative KSS-C score and KSS-F score (P > 0.01). The KSS-C score, KSS-F score, and knee range of motion significantly improved after surgery (P < 0.01) for all the patients. The postoperative KSS-C score in normal PTS group (88.76±2.79) was significantly higher than the KSS-C score in abnormal PTS group (84.42±3.35, P < 0.01), but no significant difference between the 2 groups was observed in postoperative KSS-F score and knee range of motion (P > 0.01). In addition, there was no correlation between the change of PTS and postoperative KSS-C score (r=-0.034, 95%CI: -0.247 to 0.186, P = 0.759), KSS-F score (r = -0.014, 95%CI: -0.238 to 0.198, P = 0.901) and knee range of motion (r= 0.045, 95%CI: -0.214 to 0.302, P = 0.686).@*CONCLUSION@#The posterior tibial slope between 3° and < 8° can be recommended to improve knee joint function in mobile UKA, and excessive or insufficient PTS should be avoided.
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Humans , Arthroplasty, Replacement, Knee , Knee Joint/surgery , Knee Prosthesis , Osteoarthritis, Knee/surgery , Range of Motion, Articular , Retrospective Studies , Treatment OutcomeABSTRACT
Objective:To analyze the effect of systematic exercise with a self-designed foot-ankle exerciser on postoperative ankle function in patients with tibial pilon fracture.Methods:A retrospective study was conducted of the 84 patients with tibial pilon fracture who had been treated by open reduction and internal fixation at Nanhua Hospital Affiliated to Nanhua University from May 2018 to January 2020. According to the difference in rehabilitation, they were divided into a control group ( n=42) which were subjected to staged functional rehabilitation after operation and an observation group ( n=42) which was subjected to systematic exercise with a self-designed foot-ankle exerciser. In the control group there was 26 males and 16 females with an age of (36.6±4.8) years (from 20 to 55 years); in the observational group there were 27 males and 15 females with an age of (36.4±4.5) years (from 21 to 57 years). The 2 groups were compared in terms of postoperative recovery, ankle functional recovery, postoperative quality of life, and rate of complications. Results:The 2 groups were comparable due to the insignificant differences in their preoperative general data ( P>0.05). The time for first ambulation [(3.7±0.3) weeks], time for fracture union [(9.1±0.8) weeks], and time for full-weight bearing [(6.5±0.9) weeks] in the observational group were all significantly shorter than those in the control group [(4.1±0.5) weeks, (10.9±1.2) weeks and (7.2±1.1) weeks] ( P<0.05). The good to excellent rate of ankle functional recovery was 92.9% (39/42) for the observational group, significantly higher than that for the control group (73.8%, 31/42) ( P<0.05). The scores for postoperative quality of life in the observational group were significantly higher than those in the control group in dimensions of material, psychology, society and body ( P<0.05). The rate of total postoperative complications in the observational group was 2.4% (1/42), significantly lower than that in the control group (10.9%, 8/42) ( P<0.05). Conclusions:For patients with tibial pilon fracture undergoing the same surgical procedures, systematic exercise with our self-designed foot-ankle exerciser can promote functional recovery of the ankle joint, improve postoperative quality of life, and reduce incidence of postoperative complications.
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Objective:To study the clinical effect of thin replantation combined with vacuum assisted closure (VAC) in the treatment of large area retrograde skin avulsion injury.Methods:A total of 42 patients with large scale retrograde skin avulsion injury admitted to the trauma center of Zhuzhou Central Hospital from April 2017 to April 2019 were enrolled in this study, and were treated with VAC continuous negative pressure drainage after operation. The wound survival rate, wound survival area, wound infection, replantation skin performance and joint mobility were observed.Results:All of the 42 patients were followed up for 8-50(23.56±3.56)months. 35 patients survived the stage 1 skin grafting, the skin flap survived, and the wound had no obvious skin defect. After active dressing change, the wound healed well, and no second operation was needed. Small area necrosis occurred in the first stage wound of 7 patients due to large skin defect, and the wound healed well after the second stage surgical transplantation and enhanced dressing change. The Hospital for Special Surgery (HSS) score of 26 patients was 80-95(87.96±3.21), and the American Orthopaedic Foot and Ankle Society (AOFAS) score of 22 patients was 80-96(88.79±3.41). All patients had good skin sensation, elasticity, pressure resistance, wear resistance and color, and joint mobility was good without obvious limitation of movement.Conclusions:Thinning replantation combined with VAC negative pressure drainage in the treatment of large area retrograde skin avulsion injury can significantly promote the application of wound surface and skin graft, which is conducive to drain the drainage fluid out of the body, reduce the wound infection rate, improve the survival rate of skin grafting and improve joint function.
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Objective:To investigate the effect of biological long stem hemiarthroplasty on postoperative hip joint function, serum bone markers, angiotensin Ⅱ (Ang Ⅱ) and cortisol (Cor) levels in elderly patients with intertrochanteric fractures.Methods:A total of 120 elderly patients with intertrochanteric fractures in General Hospital of Northern Anhui Coal and Power Group from June 2017 to June 2019 were selected. According to the principle of non-randomized clinical concurrent controlled study and patient′s voluntariness, they were divided into arthroplasty group and internal fixation group, with 60 cases in each group. Proximal femoral nail antirotation (PFNA) was used in the internal fixation group, and the biological long stem hemiarthroplasty was performed in the arthroplasty group. The related indexes of perioperative operation and complications, the levels of serum AngⅡ and Cor before and after operation, the levels of serum bone markers osteocalcin (OC), calcitonin (CT), alkaline phosphatase (ALP) before and after operation were compared between the two groups. After followed up for 6 months after the operation, Harris hip function score and Barthel index (BI) score, quality of life score (GQOL-74) before and after operation, and the excellent and good rate of hip joint function at 6 months after operation were compared between the two groups.Results:The time of getting out of bed in the arthroplasty group was shorter than that in the internal fixation group, the operation time was longer than that in the internal fixation group, and the amount of blood loss and postoperative drainage were higher than those in the internal fixation group, and the differences were statistically significant ( P<0.05). The postoperative complication rate in the arthroplasty group was lower than that in the internal fixation group: 8.33%(5/60) vs. 25.00%(15/60), and the difference was statistically significant ( χ2 = 6.000, P<0.05). The levels of serum AngⅡ and Cor in the two groups were higher than those before the operation at the 1st and 3rd day after the operation, but the levels of serum AngⅡ and Cor in the arthroplasty group were also higher than those in the internal fixation group: at the 1st day after the operation: (218.68 ± 42.04) mmol/L vs. (158.19 ± 34.36) mmol/L, (327.15 ± 39.08) μg/L vs. (285.42 ± 34.06) μg/L; at the 3rd day after the operation: (169.46 ± 32.73) mmol/L vs. (138.02 ± 25.97) mmol/L, (294.83 ± 33.95) μg/L vs. (262.64 ± 30.57) μg/L, and the differences were statistically significant ( P<0.05). The levels of serum OC, CT, and ALP in the two groups at 1 month and 3 months after operation were higher than those before the operation, the levels of serum OC, CT, and ALP in the arthroplasty group were higher than those in the internal fixation group: at 1 month after operation: (17.40 ± 4.25) μg/L vs. (14.96 ± 3.79) μg/L, (1.34 ± 0.49) ng/L vs. (1.15 ± 0.43) ng/L, (159.49 ± 19.75) U/L vs. (137.24 ± 17.28) U/L; at 3 months after operation: (19.18 ± 5.79) μg/L vs. (16.24 ± 4.36) μg/L, (1.46 ± 0.57) ng/L vs. (1.24 ± 0.50) ng/L, (180.94 ± 22.42) U/L vs. (163.72 ± 19.36) U/L, and the differences were statistically significant ( P<0.05). TheHarris hip function scores at 1, 3 and 6 months after the operation in the two groups were higher than those before the operation, the Harris hip function scoresin the arthroplasty group were higher than those in the internal fixation group, and the differences were statistically significant ( P<0.05). The excellent and good rate of hip joint function at 6 months after operation in the arthroplasty group was higher than that in the internal fixation group: 90.00%(54/60) vs. 75.00%(45/60), and the difference was statistically significant ( χ2 = 4.675, P<0.05). The scores of BI, GQOL-74 at 1, 3, 6 months after operation in the two groups were higher than those before operation, the scores of BI, GQOL-74 at 1, 3, 6 months after operation in the arthroplasty group were higher than those in the internal fixation group, the differences were statistically significant ( P<0.05). Conclusions:Compared with PFNA internal fixation, the treatment of elderly patients with femoral intertrochanteric fracture with biological long stem hemiarthroplasty can promote the recovery of patients, reduce complications, reduce the impact on bone markers, and more effectively improve the patient′s hip joint function, ability of daily living and quality of life, but it is more traumatic to the body and has a strong stress response.
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Objective To evaluate the application value of tranexamic acid in total knee arthroplasty. Methods 120 elderly patients with knee osteoarthritis admitted to Department of Joint Surgery in our hospital from December 2018 to March 2020 were selected as study subjects. They were divided into the control group and the observation group by random number table method, with 60 patients in each group. The control group was treated with total knee arthroplasty. The observation group received one tranexamic acid injection during and after total knee arthroplasty. Both groups were followed up for 6 months after the operation. The operation-related indexes in two groups, preoperative and postoperative coagulation function 48 h after operation, preoperative and postoperative knee joint function 6 months after operation were compared. The incidence of complications during hospitalization in the two groups was counted. Results The intraoperative blood loss, hidden blood loss and postoperative drainage volume of the observation group were lower than those in the control group (P<0.05). The postoperative drainage time, drying time and wound healing time in the observation group were all shorter than those in the control group (P<0.05). There was no significant difference in prothrombin time (PT), partial thromboplastin time (APTT) and whole blood fibrinogen (FIB) between two groups before the surgery and 48 h after operation (P>0.05). No statistically significant difference was observed between the two groups (P>0.05). Compared with those before operation, the pain, walking stability, walking distance, walking assistance, flexor extension and muscle strength scores of the subjects in the two groups increased 6 months after the operation. The index scores in the observation group were higher than those in the control group (P<0.05). During the treatment, the total complication rate was 8.33% in the observation group and 13.33% in the control group, with no statistically significant difference between the two groups (P>0.05). Conclusion Tranexamic acid can effectively reduce blood loss, postoperative drainage volume, and postoperative drainage time in total knee arthroplasty for elderly patients with knee osteoarthritis. It promotes wound healing, improves knee joint function, and has little effect on coagulation function and less postoperative complications.
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BACKGROUND: The most common surgical procedure for the treatment of distal humeral fracture in the elderly is open reduction and internal fixation and total elbow arthroplasty. There is still a lack of systematic evaluation of the efficacy between the two methods, and further research is needed to better guide clinical work. OBJECTIVE: To compare the clinical efficacy of open reduction and internal fixation combined with total elbow arthroplasty in the treatment of elderly patients with distal humeral fractures. METHODS: The computer was used to retrieve information in databases such as PubMed, The Cochrane Library, EMBASE, Science Direct, CNKI, Wanfang, and VIP. An observational cohort study or randomized controlled trial was performed in the study of open reduction and internal fixation/total elbow arthroplasty for the treatment of elderly patients with distal humeral fractures. The search period was 1998-2018. Studies were read and screened; data were extracted and the quality of the study was assessed by two persons independently. Data analysis was performed using RevMan 5.3. RESULTS AND CONCLUSION: (1) A total of 10 studies were included in 1 069 patients. (2) Meta-analysis results showed that total elbow arthroplasty group was superior to the open reduction and internal fixation group in the incidence of total complications (OR=1.67, 95%C/: 1.19-2.35, P=0.003), Mayo elbow performance score at the last follow-up (MD=-12.68, 95%C/: -16.60 to -8.77, P 0.05). (4) These results confirmed that the total complication rate of the total elbow arthroplasty group was lower than that of the open reduction and internal fixation group, and the elbow joint function was better than that of the open reduction and internal fixation group. For elderly patients with distal humeral fracture, the degree of osteoporosis is different, and the articular surface is difficult to be effectively reset. The treatment of total elbow arthroplasty should be considered.
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BACKGROUND: Unicompartmental knee osteoarthritis can be treated clinically with either total or partial knee arthroplasty. In the choice of treatment methods, a variety of factors lead to significant differences. There is little reliable evidence to guide the clinical surgical options. OBJECTIVE: To compare the short-term curative effect of unicompartmental and total knee arthroplasties in the treatment of unicompartmental osteoarthritis and to explore the effects of two treatment methods on the balance function of patients. METHODS: This was a perspective trial. The patients with unicompartmental knee osteoarthritis were divided into unicompartmental knee arthroplasty group (22 cases, 23 knees) and total knee arthroplasty group (30 cases, 30 knees) based on surgical method. All patients signed the informed consents and the study was approved by the hospital ethical committee. The operation time, hospitalization time, Hospital for Special Surgery score, and the range of motion of the knee joint were compared between two groups to evaluate the early efficacy. The patients’ balance function was evaluated using the Tecnobody Proprioception Test System, Timed Up and Go test, and Berg Balance Scale before and 3 months after surgery. RESULTS AND CONCLUSION: (1) Compared with the total knee arthroplasty group, the unicompartmental knee arthroplasty group had shorter operation time and hospitalization time (P 0.05). The Tecnobody Proprioception Test System scores at 3 months after surgery in the unicompartmental knee arthroplasty group were significantly higher than those in the total knee arthroplasty group (P < 0.001). (3) These results indicate that both unicompartmental and total knee arthroplasties have satisfactory short-term results in the treatment of unicompartmental knee osteoarthritis. Unicompartmental knee arthroplasty is superior to total knee arthroplasty in terms of operation time, hospitalization time, and balance function recovery.
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BACKGROUND: The impact of obesity on total hip arthroplasty has been discussed. However, there is a lack of follow-up study on the patients with different body mass indexes using three-dimensional gait analysis. OBJECTIVE: To investigate the effect of body mass index on the early-term functional recovery after total hip arthroplasty by three-dimensional gait analysis. METHODS: Sixty patients who underwent total hip arthroplasty at Department of Joint Surgery of Affiliated Zhongshan Hospital of Dalian University from January 2017 to June 2018 were enrolled. According to the body mass index at admission, they were divided into overweight group (body mass index ≥ 25 kg/m2) and normal group (body mass index 0.05). The operation time in the overweight group was significantly longer than that in the normal group (P=0.000). (2) In terms of time-distance parameters, there was no significant difference in the stride length, stride frequency and mean velocity between two groups. The stride length in the overweight group was smaller than that in the normal group (1.08±0.18 vs. 1.35±1.45 m). (3) The range of motion of each planes of hip joint in the overweight group was significantly less than that in the normal group (P < 0.05). (4) In terms of kinetic parameters, the peak torque of hip flexion in the overweight group was significantly less than in the normal group (P=0.011). There was no significant difference in the peak torque of hip extension between two groups (P=1.000). (5) To conclude, obesity has certain effect on the early functional recovery after total hip arthroplasty.
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BACKGROUND: Numerous clinical data have shown that electro-acupuncture in the treatment of knee osteoarthritis has the advantages of fast onset, good therapeutic effect and less side effects, but there is a lack of multicenter large-sample clinical research regarding the treatment of knee osteoarthritis. OBJECTIVE: To systematically evaluate the effect of electro-acupuncture on pain relief and joint function in patients with knee osteoarthritis by meta-analysis. METHODS: The literatures related to clinical randomized controlled trials of electro-acupuncture treatment of knee osteoarthritis were retrieved in CNKI, Wanfang, VIP, PubMed, Embase and Cochrance Library database from the inception to June 2019. After literature screening, a meta-analysis of included studies was carried out using Review Manager 5.3. RESULTS AND CONCLUSION: Finally, 11 articles were included in the study, with 721 cases of knee osteoarthritis. There were 366 cases in the electro-acupuncture group and 361 in the control group with routine acupuncture or drug treatment. Compared with the control group, the total effective rate, cure rate, visual analogue scale score, WOMAC score and ISOA score in the electro-acupuncture group were significantly higher than those in the control group [odds ratio (OR)=3.22, 95% confidence interval (CI)(2.13, 4.87), Z=5.53, P < 0.000 01; OR=2.73, 95%CI(1.80, 4.15), Z=4.72, P < 0.000 01; mean difference (MD)=-1.00, 95%CI(-1.71, -0.30), Z=2.80, P=0.005; MD=-7.69, 95%CI(-10.31, -5.07), Z=5.75, P < 0.000 01; MD=-2.22, 95%CI(-3.74, -0.70), Z=2.86, P=0.004]. Based on the evidence of meta-analysis, the short-term effect of electro-acupuncture on knee osteoarthritis is definite, and electro-acupuncture can play a positive effect on pain symptoms and joint function of knee osteoarthritis patients with few adverse reactions. Considering small sample size, low-quality literatures and possible presence of bias factors, further investigations on more high-quality randomized controlled trials are warranted.
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OBJECTIVE: To observe the difference of therapeutic effect between hysteretic acupuncture and Celecoxib capsules for knee osteoarthritis(KOA), and to investigate their effects on levels of interleukin 6(IL-6) and tumor necrosis factor α(TNF-α) in articular fluid. METHODS: Seventy-two patients with KOA were randomly divided into hysteretic acupuncture and me-dication groups, with 36 cases in each group. The patients of the hysteretic acupuncture group received hysteretic acupuncture stimulation at Dubi (ST35), Neixiyan (EX-LE4), Zusanli (ST36), Yanglingquan (GB34), Yinlingquan (SP9), Xuehai (SP10), Liangqiu (ST34) and Heding (EX-LE2) as the main acupoints for 30 min once daily. The patients of the medication group received oral administration of Celecoxib capsules(200 mg) once daily. Both of the two groups were treated with 14 days as a course of treatment, with a 2-day rest between each course of treatment, and the treatments were conducted for 2 courses. The visual analogue scale(VAS) score of pain, Lequesne index score, IL-6 and TNF-α level in joint fluid and the change of traditional Chinese medicine(TCM) syndrome score were observed before and after treatment. RESULTS: Compared with pre-treatment, the VAS score, Lequesne index score, IL-6 and TNF-α level, and total TCM syndrome score decreased significantly after treatment in both of the two groups (P0.05). No adverse events occurred in both groups during the treatment. CONCLUSION: Hysteretic acupuncture can effectively relieve pain symptoms and improve joint function in KOA patients. Its effect is comparable to that of oral administration of Celecoxib capsules.
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Objective@#To investigate the clinical effect of early holistic treatment in elderly patients with intertrochanteric fracture.@*Methods@#From January 2017 to December 2017, 84 elderly patients with intertrochanteric fracture received by orthopaedics department of Shaoxing Central Hospital were divided into two groups.The observation group (46 patients) received early holistic therapy, and the control group (38 patients) received traditional orthopaedic trauma treatment.Two groups of patients were treated with proximal femoral anti-rotation intramedullary nail fixation, and the therapeutic effect was compared between the two groups.@*Results@#After 12 months of follow-up, the scores of Harris(evaluation standard of total hip joint curative effect) pain, mobility, deformity, function and total scores in the observation group were (39.13±2.66)points, (3.40±0.44)points, (3.30±0.38)points, (37.73±2.44)points, (83.56±2.51)points, respectively, which were higher than those in the control group[(37.05±2.95)points, (3.17±0.59)points, (3.09±0.52)points, (35.67±3.19)points, (78.98 ±3.37)points], there were statistically significant differences between the two groups (pain: t=3.395, P=0.001; activity: t=2.044, P=0.044; deformity: t=2.135, P=0.035; function: t=3.352, P=0.001; total score: t=7.131, P=0.000). After 12 months of follow-up, the excellent and good rate of operation in the observation group was 84.78%, which was higher than 71.05% in the control group, there difference was statistically significant between the two groups (χ2=5.477, P=0.019). The clinical statistics showed that the time from injury to operation, the time of ambulation and hospitalization in the observation group were (2.31±0.53) d, (3.53±0.69)d, (15.86±2.60)d, respectively, which were shorter than those in the control group[(3.45±1.02)d, (5.02±1.13)d, (19.73±3.12)d], the differences were statistically significant between the two groups (the time from injury to operation: t=6.585, P=0.000; the time of ambulation after operation: 7.128, P=0.000; hospitalization time: t=6.202, P=0.000). The incidence of complication was 6.52% in the observation group and 23.68% in the control group, the difference was statistically significant between the two groups (χ2=11.484, P=0.000). There was no death in the observation group at 12 months after operation, and the mortality rate in the control group was 2.63%, the difference was no statistically significant between the two groups (χ2=2.665, P=0.102).@*Conclusion@#The application of early holistic treatment concept in the treatment of elderly patients with intertrochanteric fracture can improve the therapeutic effect and shorten the rehabilitation process of the patients.
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Objective To investigate the clinical effect of early holistic treatment in elderly patients with intertrochanteric fracture.Methods From January 2017 to December 2017,84 elderly patients with intertrochanteric fracture received by orthopaedics department of Shaoxing Central Hospital were divided into two groups .The observation group (46 patients) received early holistic therapy ,and the control group (38 patients) received traditional orthopaedic trauma treatment .Two groups of patients were treated with proximal femoral anti -rotation intramedullary nail fixation , and the therapeutic effect was compared between the two groups .Results After12 months of follow -up,the scores of Harris(evaluation standard of total hip joint curative effect ) pain,mobility,deformity,function and total scores in the observation group were (39.13 ±2.66) points,(3.40 ±0.44) points,(3.30 ±0.38) points,(37.73 ± 2.44)points,(83.56 ±2.51) points,respectively,which were higher than those in the control group [(37.05 ± 2.95)points,(3.17 ±0.59)points,(3.09 ±0.52) points,(35.67 ±3.19) points,(78.98 ±3.37) points],there were statistically significant differences between the two groups ( pain:t=3.395,P=0.001;activity:t=2.044,P=0.044;deformity:t=2.135,P=0.035;function:t=3.352,P=0.001;total score:t=7.131,P=0.000).After 12 months of follow-up,the excellent and good rate of operation in the observation group was 84.78％,which was higher than 71.05％in the control group ,there difference was statistically significant between the two groups (χ2 =5.477,P=0.019).The clinical statistics showed that the time from injury to operation ,the time of ambulation and hospitalization in the observation group were (2.31 ±0.53) d,(3.53 ±0.69) d,(15.86 ±2.60) d,respectively, which were shorter than those in the control group [(3.45 ±1.02) d,(5.02 ±1.13) d,(19.73 ±3.12) d],the differences were statistically significant between the two groups (the time from injury to operation:t=6.585,P=0.000;the time of ambulation after operation:7.128,P=0.000;hospitalization time:t =6.202,P=0.000).The incidence of complication was 6.52％in the observation group and 23.68％ in the control group,the difference was statistically significant between the two groups (χ2 =11.484,P=0.000).There was no death in the observation group at 12 months after operation,and the mortality rate in the control group was 2.63％,the difference was no statistically significant between the two groups (χ2 =2.665,P =0.102).Conclusion The application of early holistic treatment concept in the treatment of elderly patients with intertrochanteric fracture can improve the therapeutic effect and shorten the rehabilitation process of the patients .
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Objective@#To observe the effect of home visit on joint function and complications of patients undergoing hip replacement.@*Methods@#Ninety cases of patients with artificial hip replacement who were admitted to our hospital from January to December 2017 were randomly divided into two groups by random Number Table Method.45 patients in the control group were given routine nursing after discharge, and 45 patients in the observation group were treated with home visit nursing. The hip function and living ability of the two groups were evaluated 8, 12, 16 weeks after discharge,and the complication rate was compared.@*Results@#The self-care ability scores of the observation group at 8, 12 and 16 weeks after discharge were 102.23±11.20, 108.36±10.41, 116.25±10.36 higher than those of the control group at 97.86±10.35), 100.21±14.26, 104.23±15.6, with significant differences (t=1.922, 3.097, 4.294, P < 0.05 or 0.01). The Harris scores of the observation group at 8, 12 and 16 weeks after discharge were 82.31±11.27, 87.38±10.05, 95.10±11.23 higher than those of the control group at 78.02±10.23, 83.41±11.74, 89.43±11.62, with significant differences (t=1.891, 1.723, 2.343, P < 0.05). The incidence of complications in the observation group at 16 weeks after discharge was 0 lower than 13.33% (6/45) in the control group (χ2=6.429, P=0.011).@*Conclusions@#Home visit intervention can improve the self-nursing ability of the patients after hip joint operation, promote the recovery of hip function and life ability, and reduce the complications.
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Objective@#To study the effect of postoperative application of tranexamic acid on recovery and prognosis of unilateral total hip arthroplasty.@*Methods@#One hundred and twenty patients who received unilateral total hip arthroplasty in 541st General Hospital of Dongzhen Town from August 2016 to August 2018 were divided into observation group and control group by random number table method, with 60 cases in each group. The control group received intravenous injection of tranexamic acid 10 min before skin incision after anesthesia; on the basis of the control group, the observation group was given tranexamic acid intravenously again 3 h after operation, and the control group was no longer given repeated injection of tranexamic acid. The hemorrhage, hemoglobin (Hb), hematocrit(HCT), hip joint Harris score and complications were compared between the two groups.@*Results@#There was no significant difference in intraoperative blood loss and transfusion between the two groups (P>0.05); the drainage volume, total blood loss, dominant blood loss and recessive blood loss in the observation group were lower than those in the control group [(227.43 ± 20.14) ml vs. (280.91 ± 23.56) ml, (601.01 ± 42.84) ml vs. (667.04 ± 49.21) ml, (281.93 ± 18.50) ml vs. (322.06 ± 21.23) ml, (330.94 ± 21.73) ml vs. (370.03 ± 25.90) ml] (P<0.05). After operation 3 d, the levels of Hb and HCT in observation group were higher than those in control group [(117.07 ± 9.60) g/L vs. (102.19 ± 8.31) g/L, (35.05 ± 2.91)% vs. (32.01 ± 2.77)%] (P<0.05). After operation 2 weeks and 1 month after operation, the hip joint Harris score in observation group was higher than that in control group [(52.03 ± 4.02) scores vs. (48.37 ± 5.05) scores, (67.86 ± 5.29) scores vs. (61.23±5.10) scores] (P<0.05). There was no significant difference in the occurrence of intermuscular venous thrombosis, local hematoma and incision exudation between the two groups(P>0.05).@*Conclusions@#On the basis of preoperative application of tranexamic acid, combined postoperative application of tranexamic acid can significantly reduce the blood loss after unilateral total hip arthroplasty, and help the early recovery of joint function, without increasing complications and with high safety.