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【Objective】 To explore the effects of platelet-rich plasma (PRP) injection combined with pregabalin on pain and knee function in knee osteoarthritis (KOA). 【Methods】 A total of 220 patients with KOA in our hospital, between June 2020 and April 2022, were enrolled and randomly divided into observation group (n=110) and the control (n=110). The observation group was given PRP injection combined with pregabalin, while control group was given sodium hyaluronate combined with pregabalin. The clinical curative effect, osteoarthritis index (WOMAC), pain level (VAS), knee function [Lysholm-Ⅱ scale, Rasmussen scale], levels of repair-promoting factors [transforming growth factor-β1 (TGF-β1), bone morphogenetic protein 4 (BMP4), insulin growth factor 1 (IGF-1)], inflammatory factors [interleukin-6 (IL-6), tumor necrosis factor α (TNF-α)], oxidative stress indexes [superoxide dismutase (SOD), nitric oxide (NO)] and blood routine [white blood cell count (WBC), platelet count (Plt)], and the occurrence of adverse reactions in the two groups were compared. 【Results】 The response rate of treatment was higher in observation group than control group [94.55% (104/110) vs 83.64% (92/110), P0.05). There was no significant difference in incidence of adverse reactions between the two groups (P>0.05). 【Conclusion】 PRP injection combined with pregabalin can effectively improve knee function, relieve pain, reduce levels of inflammatory factors and oxidative stress injury, and promote the expressions of repair-promoting factors in KOA patients.
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OBJECTIVE@#To evaluate the effects of two different femoral cortical suspension devices (fixation loop and adjustable loop) on tunnel widening and knee function in patients following anterior cruciate ligament reconstruction for 12 months.@*METHODS@#A total of 60 patients who had undergone anterior cruciate ligament reconstruction were included in this study. According to the length of the loop(n)[n= total length of loop-(total length of femoral tunnel-total length of coarse tunnel)] in the rough bone tunnel, the patients were divided into A (adjustable loop was 0 mm in the coarse bone tunnel), B (fixation loop was greater than 0 mm and less than or equal to 10 mm in the coarse bone tunnel) and C (fixation loop was greater than 10 mm in the coarse bone tunnel) groups, of which 11 cases were in group A, 27 cases in group B and 22 cases in group C. In the three-dimensional reconstruction of the knee joint with multi-slice spiral CT, the widening of the bone tunnel in the three groups was compared. At the same time, IKDC, Lysholm and Tegner scores of the patients in the three groups were compared.@*RESULTS@#There were differences in the widening degree of the femoral canal among groups A, B and C, and the median difference of the widening degree of the femoral tunnel 12 months and immediately after the surgery was A < B < C. The difference of femoral canal widening in group A was significantly different from that in groups B and C (P < 0.05).According to the linear regression the relationship between the difference of the width of the femoral canal and the change of the length (n) of the loop in the coarse canal, it was found that there was a linear relationship between the value of n and the difference of the width of the bone canal. With the increase of the value of n, the difference of the width of the bone canal gradually became larger. The median difference of the width of the middle and superior tunnel was negative, while the median difference of the width of the middle and inferior tunnel was positive. During the follow-up, we found that there were no statistical differences in IKDC, Lysholm and Tegner scores among the three groups one year after surgery (P > 0.05).@*CONCLUSION@#Twelve months after surgery, compared with group B (fixed loop group) and group C (fixed loop group), group A (adjustable loop group) had less bone tunnel widening.In groups A, B and C, as the length of the loop in coarse bone tunnel gradually increased, the width of bone tunnel became more significant. At the end of 12 months follow-up after anterior cruciate ligament reconstruction, the medial and inferior femoral tunnel was significantly wider than immediately after surgery, and the medial and superior femoral tunnel had gradually begun to undergo tendon-bone healing. There was no significant difference in knee function scores among groups A, B, and C in the follow-up 12 months after surgery.
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Humans , Anterior Cruciate Ligament Injuries/surgery , Anterior Cruciate Ligament Reconstruction , Femur/surgery , Knee Joint/surgery , Tendons , Treatment OutcomeABSTRACT
BACKGROUND: It is still lack of sufficient clinical evidence whether the patients can benefit from the routine use of elastic bandages after total knee arthroplasty. OBJECTIVE: To explore whether the use of elastic compression bandage after first total knee arthroplasty is beneficial to the prognosis of patients. METHODS: Totally 60 knee osteoarthritis patients who received bilateral knee arthroplasty in the Department of Joint Surgery, West Coast Hospital Branch of Affiliated Hospital of Qingdao University were selected from September 2017 to September 2018. One limb of the patient was covered with a general surgical dressing, while an elastic bandage was applied from the instep to the middle of the thigh (elastic compression bandage group). One limb was covered only with a general surgical dressing (control group). All patients signed the informed consent. The study was approved by the Hospital Ethics Committee. Circumference (thigh, knee and calf), flexural activity (range of motion) and visual analogue scale of the lower extremities were measured at 1, 2, 3 and 7 days after the operation by professionals who were not involved in patient management. Drainage volume 24 hours after operation and the occurrence of complications within 30 days after operation were recorded. RESULTS AND CONCLUSION: (1) At 1, 2, 3, and 7 days after surgery, circumference of thigh, knee and calf was smaller in the elastic compression bandage group than in the control group. Range of motion of the knee was better in the elastic compression bandage group than in the control group (P < 0.001). (2) At 1 and 2 days after surgery, resting visual analogue scale scores were higher in the elastic compression bandage group than in the control group (P < 0.001). At 7 days, resting visual analogue scale scores were lower in the elastic compression bandage group than in the control group (P < 0.001). No significant difference in visual analogue scale scores was found between the two groups at 3 days. Sports visual analogue scale scores in the elastic compression bandage group were higher than in the control group at 1 and 2 days (P < 0.001). However, no significant difference in sports visual analogue scale scores was detected between the two groups at 3 and 7 days. (3) There was no difference in wound-healing complications between the two groups, but the sample size was too small for meaningful statistical analysis. (4) There was a statistically significant difference in drainage volume between the two groups at 24 hours after surgery. (5) No deep infection, venous thrombosis or reoperation occurred within 30 days. (6) It is concluded that the application of elastic compression bandage from the instep to the middle of the thigh after the first total knee arthroplasty can effectively reduce the swelling of the operative limb and postoperative blood loss, increase the flexion and extension of the operative limb, which is conducive to the rapid recovery after the operation. It is worth popularizing and applying.
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BACKGROUND: Studies have shown that the adjuvant use of long bone distraction device for unstable tibial plateau fractures achieved satisfactory results, but the safety of its use of long bone distraction device is not high, and the device could easily lead to soft tissue damage. OBJECTIVE: To compare the clinical efficacy of modified knee joint spreader combined with minimally invasive percutaneous plate internal fixation and traditional incision reduction plate internal fixation for the treatment of complex tibial plateau fractures. METHODS: A total of 71 patients with complicated tibial plateau fractures admitted to Xiangdong Hospital Affiliated to Hunan Normal University from January 2016 to January 2018 were included, including 48 males and 23 females. The 34 patients in the experimental group received modified knee spreaders combined with minimally invasive percutaneous plate internal fixation treatment. The 37 patients in the control group received traditional open reduction and plate internal fixation. The incision length, operation time, intraoperative blood loss, hospital stay, the time of fracture healing and the incidence of postoperative complications were compared between the two groups. Knee HSS scores were assessed at 1 month and at the last follow-up. The trial was approved by the Ethics Committee of Xiangdong Hospital Affiliated to Hunan Normal University. RESULTS AND CONCLUSION: (1) The operation time, intraoperative blood loss, incision length, and hospital stay were shorter in the experimental group than in the control group (P 0.05). (2) One case of joint stiffness and one case of traumatic arthritis were found in the experimental group. One case of postoperative infection, five cases of joint stiffness, one case of traumatic arthritis and one case of loosening of the internal fixation were found in the control group. The incidence of complications in the experimental group was less than that in the control group (P 0.05). (4) The results showed that compared with the traditional open reduction and internal fixation, the modified knee spreader combined with minimally invasive percutaneous plate internal fixation for complex tibial plateau fractures can improve the operation efficiency, reduce surgical trauma, reduce the incidence of postoperative complications, and shorten hospital stay for patients.
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BACKGROUND: The traditional surgical treatment of proximal tibial fractures has extensive dissection of the fracture site, and affects local blood circulation, increases the incidence of delayed union and nonunion. In recent years, the rising minimally invasive internal fixation system can protect the local soft tissue and blood circulation to the maximum extent, and provide better conditions for fracture healing. The application of new spreader also solves the problems of stability and durability of traditional manual traction reduction, and the combination of the two is gradually concerned. OBJECTIVE: To explore the effect of a new minimally invasive spreader assisted reduction and less invasive stabilization system for the treatment of proximal tibial fractures. METHODS: Twenty-two patients with proximal tibial fractures treated from May 2016 to October 2019 were studied and randomly assigned to control group and observation group (n=11 per group). Patients in the control group were treated with conventional manipulative reduction and conventional incision plate internal fixation. Patients in the observation group were treated with a new minimally invasive spreader assisted reduction and less invasive stabilization system. This study was approved by the Ethics Committee of Fifth Hospital, Guangzhou Medical University. RESULTS AND CONCLUSION: Compared with the control group, Rasmussen knee function score was better in the observation group at the last follow-up. Intraoperative blood loss, operation time, length of hospital stay, and weight-bearing time in the observation group were better than those in the control group. Postoperative complications such as joint limitation and delayed fracture healing were less in the observation group than in the control group. However, the healing time was not statistically significant between the two groups. Moreover, infection of the incision and loosening and fracture of the internal fixator were not statistically significant between the two groups. These indicated that the application of a new minimally invasive spreader combined with less invasive stabilization system for proximal tibial fractures can reduce surgical reduction time and local soft tissue damage, which is beneficial to early functional exercise and can reduce postoperative complications.
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Objective:To investigate the clinical efficacy of Simiaosan combined with arthroscopic radiofrequency ablation in the treatment of acute traumatic knee synovitis and its effects on inflammatory markers and knee joint function. Method:A total of 92 patients with acute traumatic knee synovitis who were treated in our hospital from February 2017 to November 2018 were randomly divided into observation group and control group, with 46 cases in each group. The patients in observation group were treated with Simiaosan combined with arthroscopic radiofrequency ablation, while the patients in control group were treated radiofrequency ablation combined with Gubi tablet, synovitis granule and imrecoxib tablets. The efficacy in the two groups was observed one month after operation. The degree of pain and the swelling of knee joint were evaluated before and one month after operation, and the function of knee joint was evaluated by lysholm knee score system (LKSS) before and one month after operation. And at the same time, the knee joint activity was measured, erythrocyte sedimentation rate (ESR) was analyzed by Wechsler's method, and hypersensitivity C-reactive protein (hs-CRP) was detected by immunoturbidimetry. The adverse reactions and complications of the two groups were observed. Result:Compared with control group after treatment, the total effective rate in observation group was significantly higher than that in control group, with statistically significant differences (P<0.05). The visual analogue scale (VAS) scores of knee pain in both groups after treatment were significantly lower than those before treatment (P<0.05), while the joint swelling scores were significantly higher (P<0.05). After treatment, the VAS score of knee pain in observation group was significantly lower than that of control group at the same time (P<0.05), while the joint swelling score was significantly higher (P<0.05). After treatment, the LKSS score and the range of motion of the affected knee joints in both groups were significantly increased compared with those before treatment (P<0.05), but with more significant improvement in observation group (P<0.05). The levels of ESR in peripheral blood and hs-CRP in serum of the two groups were significantly lower than those before treatment (P<0.05), especially in observation group (P<0.05). No obvious side effects were observed in observation group during the treatment with Simiaosan. There was no significant difference in the incidence of complications between the two groups. Conclusion:The treatment of Simiaosan combined with radiofrequency ablation under arthroscope has a significant efficacy in the treatment of acute traumatic gonarthromeningitis. The knee joint function of the patients was significantly improved, and the mechanism may be related to the inhibition of inflammatory reaction in vivo.
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OBJECTIVE： To observe the efficacy and safety of fluorouracil combined with paracetamol in the treatment of knee osteoarthritis and its effects on related indexes. METHODS： Totally 115 patients with knee osteoarthritis admitted to our hospital from March 2015 to March 2018 were divided into control group （57 cases） and observation group （58 cases） according to medication plan. Control group was given Paracetamol tablets 0.3 g orally， 3 times a day， for consecutive 8 weeks. Observation group was additionally given intra-articular injection of Fluorouracil injection 0.075 g on the basis of control group， once a week， 4 times as a treatment course， for 2 courses in total. Clinical efficacies， VAS scores， Lysholm knee scores， Fugl-Meyer Assessment （FMA） scores， Barthel indexes， WHO QOL-BREF scores before and after treatment and the occurrence of ADR of 2 groups were observed. RESULTS： The total response rate of observation group was 94.83％， which was significantly higher than 78.95％ of control group （P＜0.05）. Before treatment， there was no statistical significance in VAS score， Lysholm knee scores， FMA scores， Barthel index or QOL-BREF scores between 2 groups （P＞0.05）. After treatment， VAS scores of 2 groups were significantly lower than before treatment， and the observation group was lower than the control group； Lysholm knee scores， FMA scores， Barthel indexes and QOL-BREF scores were significantly higher than the same group before treatment， and observation group was significantly higher than control group （P＜0.05）. There was no statistical significance in the incidence of ADR between 2 groups （P＞0.05）. No severe ADR was found in 2 groups during treatment. CONCLUSIONS： Fluorouracil combined with paracetamol can significantly improve therapeutic efficacy of patients with knee osteoarthritis， and can significantly improve knee function， motor function， self-care ability and quality of life without increasing the occurrence of ADR.
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Objective To explore the correlation between gait parameters at 14 days and knee function and quality of life at 3 months after total knee arthroplasty (TKA). Methods Eighteen patients who underwent TKA were analyzed by using three-dimensional gait analysis system to observe their gait parameters. Knee joint function and life quality of the patients at 3 months after TKA were evaluated with WOMAC (Western Ontario and McMaster Universities Arthritis Index) and SF-36 (short form 36-item health survey scores) assessment scale and their correlations were analyzed simultaneously. Results At 14 days after TKA, single support time (SST) and peak knee flexion at swing (PKF) of the operated side of the leg were significantly smaller than those of the healthy side of the leg. The knee flexion angle at mid-stance (MKF) and knee valgus angle at mid-stance (MKV) of the operated side of the leg were significantly larger than those of the healthy side of the leg. There was a moderate negative correlation between the spatiotemporal parameters of the operated side of the leg and the WOMAC score during gait, while a high correlation between the WOMAC score and peak knee flexion at swing (PKF), MKF and MKV. Except for the step length and forward velocity, the other gait parameters were significantly correlated with SF-36 life quality score. The single support time (SST) and PKF had a highly positive correlation, while the MKF and MKV had a moderate negative correlation with SF-36 life quality score. Conclusions The SST, MKF, MKV and PKF in postoperative early gait analysis (14 days) results can be used as the effective indicators to judge postoperative knee function and rehabilitation efficacy of life quality after TKA surgery.
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Objective?To explore the effect of meniscus partial excision under arthroscopy for meniscus injury of knee joint, and compare it with meniscus plasty and conservative treatment.?Methods?The clinical data of 95 patients with meniscus injury of knee joint from September 2012 to September 2015 were analyzed retrospectively. According to the treatment plan, the patients were divided into partial meniscectomy group (37 cases), meniscus angioplasty group (30 cases) and conservative treatment group (28 cases). After 6 months of treatment, the clinical curative effect was evaluated. After 6 months and 2 years of treatment, L-ROM was used to measure the range of motion, and the visual analogue scale (VAS) was used to evaluate the pain degree. The knee function score (Lysholm) was issued to evaluate knee function. The incidence rates of long-term complications in the three groups were recorded.?Results?The total response rate in partial meniscectomy group (97.30%) and meniscus angioplasty group (86.68%) were higher than conservative treatment group (53.57%) (P < 0.05). There was no significant difference between partial meniscectomy group and meniscus angioplasty group (P > 0.05);After 6 months and 2 years of treatment, the knee range of motion and Lysholm scores of the three groups were significantly higher than those before treatment while VAS scores were significantly lower (P < 0.05). However, there were no significant differences between partial meniscectomy group and meniscus angioplasty group (P > 0.05) but there was significant difference, compared with conservative treatment group (P < 0.05). Lysholm scores of partial meniscectomy group were significantly higher than meniscus angioplasty group and conservative treatment group (P < 0.05), and there was significant difference between meniscus angioplasty group and conservative treatment group (P < 0.05).?Conclusion?The effect of arthroscopic surgery in the treatment of meniscus injury of knee joint is accurate. Arthroscopic partial meniscectomy has more advantages in improving the knee function.
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Objective To discuss the efficacy of Lamiophlomisrotata Dripping Pill combined with intra-articular injection of medical ozone in the treatment of knee osteoarthritis.Methods Eighty patients with knee osteoarthritis were selected,the control group (39 cases) were administered Lamiophlomisrotata Dripping Pill,the observation group (41 cases) were administered Lamiophlomisrotata Dripping Pill combined with intra-articular injection of medical ozone.The efficacy of Lamiophlomisrotata Dripping Pill combined with intra-articular injection of medical ozone in the treatment of knee osteoarthritis were evaluated by efficacy,knee function,and inflammatory factor.Results After treatment,the effective rate of the observation group was higher than that of the control group (P ＜ 0.05).In the observation group,there were 38 cases of patients who felt pain,tenderness,and swelling symptom relief.There were 28 cases in the control group.After treatment,the scores of pain,activity,walking ability,and KSS in the observation group were higher than that of the control group (P ＜ 0.05).There was no statistical significance on the stability between two groups.Before treatment,there were no statistical significance on the IL-6,IL-8,and TNF-α.After treatment,the IL-6,IL-8,and TNF-αt were increased in two groups (P ＜ 0.05).And these indexes in the observation group were higher than that of the control group (P ＜ 0.05).Conclusion In summary,Lamiophlomisrotata Dripping Pill combined with medical ozone had good effect on the knee osteoarthritis.It could release the pain,improve knee function and anti-inflammatory.It was worthy of clinical use.
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Objective To study the effects of different ranges of isokinetic quadriceps training for improving the func-tion of knee joint after total knee arthroplasty (TKA),and provide the theoretical and clinical experiences for the early reha-bilitation of TKA.Methods A total of 73 TKA cases were randomly allocated into 3 groups for isokinetic quadriceps train-ing with ranges of 0°-30° (n=25), 31°-60° (n=24) and 61°-90° (n=24). The isokinetic quadriceps training was for two months. The isokinetic muscle strength and the IKS scores were recorded before and after the training in three groups. Re-sults After training, the isokinetic muscle strength increased significantly in three groups (P<0.05). The IKS scores in-creased significantly only in 0°-30° training group after training (P<0.05). There was no significant difference in IKS score before and after training in 31°-60° group and 61°-90°group. The IKS score after training was positively correlated with the isokinetic muscle strength only in 0°-30° group (P<0.05). Conclusion After TKA, isokinetic quadriceps training with a 0°-30° range of motion can improve the strength of quadriceps and the knee function.
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Objective To observe the clinical effects of double support plate via posteromedial approach in the treat?ment of tibial plateau fracture of posterior column. Methods A total of 21 cases of tibial plateau fracture in closed posterior column with an average age of 34.6 (range, 21 to 56) years old were treated using double support plate through posteromedial approach from January in 2010 to January in 2013(16 males and 5 females). Among all, 4 cases were combined with lateral column fracture and 17 cases were three column fracture. Wound healings were observed after operation. X-ray examina?tions were performed at 2 weeks, 3 months, 4 months, 6 months and 12 months after operation as well as at last follow up. The averaged healing time was calculated. Changes of tibial plateau angle and posterior slope angle were compared between time points at 2 weeks after operation and at last follow up. Rasmussen knee score criteria was employed to assess knee joint recovery. Results The mean follow-up was (18.2 ± 1.8) months. No infection was reported. The average fracture healing time was 3.8(3.8±0.6)months. There was no significant difference between tibia plateau angle and posterior slope angle be?tween time points at 2 weeks after operation and at last follow-up (P<0.05). According to Rasmussen knee score criteria at last follow-up, 13 cases were graded as excellent, 6 cases as good, and 2 case as fair, with an excellent and good rate of 90.5%. Conclusion With posteromedial approach, the fractures of medial column, posteromedial and posterolateral of pos?terial column can be exposed well. Using double support plates to fix posteromedial and posterolateral of posterior column fracture can effectively prevent loss of reduction and the function of knee recovered well postoperatively.
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ObjectiveTo observe andanalyze the clinical efficacy of needle knife treatment for knee meniscus injury from improving knee biomechanical balance and to provide a therapeutic basis and method for clinical practice.MethodOne hundred patients (112 knees) with knee meniscus injury meeting the inclusion criteria were allocated, in order of visits, to observation and control groups, 50 cases each. They were treated with a needle knife and an injection of sodium hyaluronate injectio into knee joint cavity, respectively. Changes in the indices were observed and assessed in the two groups by recording the plantar pressure analysis score and the knee function score before and after treatment and at follow-up. The clinical therapeutic effects were evaluated in the two groups.ResultThemaximum load, time integral difference value and load ratio around the knee joint decreased significantly in both observation and control groups after treatment and at follow-up (P<0.05). The regulating effect on knee joint force balance was better in theneedle knife group than in the control group (P<0.05). The improving effect on knee joint function was significantly better in the observation group than in the control group (P<0.01). The excellence rate was significantly higher in the observation groupthan in the control group after treatment and at follow-up (P<0.05).ConclusionNeedle knife treatment restores the function of the knee joint by loosing focal soft tissues around the knee joint, improving knee joint load imbalance and correcting the mechanical equilibrium around the knee joint in patient with knee meniscus injury. It has a definite curative effect on the disease.
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ObjectiveTo explore the effect of Chinese Daoyingong method on knee osteoarthritis.Methods Eighty patients with knee osteoarthritis were randomly divided into the experiment group and control group in equal number.The control group was given the routine medicine combined with Chinese fumigation and the experiment group was treated with Chinese Daoyin method beside the treatment in the control group.The two groups were compared in terms of the score on visual analog scale of pain and the score on knee function before and after treatment.Results The visual analog scale of pain in the experiment group was significantly lower than that in the control group after intervention and the score on knee function was significantly higher than that of control group (P<0.001). Conclusion The intervention with Chinese Daoyingong method plus routine medication and Chinese herbal fumigation is effective in the treatment of knee osteoarthritis.
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Objective To investigate the effect of early rehabilitation treatment on functional improvement after total knee arthroplasty. Methods 48 patients (53knees) of rehabilitation in our hospital from 2010 to 2013 were divided into 2 groups, 22 patients (25knees) in control group were given common rehabilitation training, 26 patients (28 knees) in observation group were given early rehabilitation treatment. Results All the ROM, knee score and function score of 2 groups were improved, and observation group were better than that of control group (P<0.05),at the last follow-up, the PF, BP and VT of observation group were better than control group (P<0.05) . Conclusion Early rehabilitation treatment can significantly promote the knee function recovery after surgery and improve the life quality of patients, so it deserves to be generalized.
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BACKGROUND:Knee society score of Peking Union Medical Col ege has been promoted and used in the 306th Hospital of PLA for 2 years and we have accumulated some clinical data. OBJECTIVE:To analyze the stability and feasibility for suitable clinical medical practice of knee society score of Peking Union Medical Col ege. METHODS:Fifty-five patients with osteoarthritis of the knee were included, and the patients were divided into three groups:the preoperative group;3 months postoperative fol ow-up group;6 months postoperative fol ow-up group. The measurement results obtained by the application of the scale were compared to those of the Western Ontario and McMaster Universityies Ostroarthritis Index, visual analog scale, and hospital for special surgery score, and then knee society score goodness-of-fit analysis was performed based on the structural equation model. RESULTS AND CONCLUSION:Knee society score performance assessment of the signs and symptoms of osteoarthritis of the knee patients was positively correlated with the pain severity of visual analog scale score;the overal knee society score of the patients after 6-month fol ow-up was significantly improved compared with that before treatment. The knee society score after 3-and 6-month fol ow-up was significantly higher than that before treatment, and the score was quite with the hospital for special surgery score. The overal assessment of the knee society score after treated for 3 and 6 months was improved for more than grade Ⅰ, the visual analog scale score was decreased for more than 30%. The pain assessment items and physiological functional assessment items of Western Ontario and McMaster Universityies Ostroarthritis Index after 6-month fol ow-up were significantly better than those before treatment (Pgoodness-of-fit analysis showed that the scale had good goodness which had scientific nature and application value.