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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 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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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
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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Objective To investigate the recovery of knee joint function in patients with recurrent patellar dislocation treated by reconstruction of medial patellofemoral ligament with EndoButton double bundles.Methods A retrospective analysis was performed for 26 patients with recurrent patellar islocation who were treated in The Second Hospital of Tangshan from February 2014 to July 2016,with a total of 26 knees,aged 14-29 years.All patients underwent medial patellofemoral ligament reconstruction with autologous semitendinosus muscle.Double tunnel technique was used in medial patella and single tunnel technique was used in femoral side.Twenty-four patients were followed up for 12 to 24 months.The recovery of knee joint function was evaluated by Kujala score,Lysholm score,patellar fitness angle and patellar tilt angle before and after treatment.Results None of the follow-up patients had dislocation again,and the fear test was negative.The preoperative Kujala score and Lysholm score were (59.67 ± 5.28) and (61.75 ± 5.45) respectively.The corresponding scores at the last follow-up were (87.21±4.21) and (90.13±2.47).There were significant differences between the two scores (t =-19.98,-23.24,all P ＜0.01).The patellar fit angle changed from (23.17±3.63)degrees before operation to (14.17±2.01)degrees after operation.There was significant difference between the two scores.(t =10.62,P＜ 0.01);Patellar tilt angle changed from preoperative (18.33±3.92)degree to postoperative (2.45± 1.10)degree,the difference was significant (t =19.10,＜0.01).Conclusion EndoButton double-bundle reconstruction of medial patellofemoral ligament is effective in the treatment of patellar dislocation with satisfactory recovery of knee joint function.
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Objective To explore the clinical effect of proprioceptive training on knee joint function rehabilitation after minimally invasive surgery for patellar fracture.Methods Fifty-eight patients with minimally invasive Kirschner wire tension band internal fixation under arthroscopy in department of orthopedics,Peking Union Medical College Hospital of Chinese Academy of Medical Sciences from March 2016 to April 2018 were selected as research objects,and were divided into experimental group and conventional group according to digital lottery,Twenty-nine cases in each group.The conventional group received conventional rehabilitation therapy such as joint range of motion (ROM) training,joint mobilization technique,muscle strength training,weight-bearing standing and ambulation training,The experimental group added proprioception training on the basis of the conventional group.The affected knee active range of motion (AROM),Lysholm knee scoring scale (LKSS),Berg balance scale (BBS) score and modified Barthel index (MBI) score before treatment and after 2 months of treatment between the two groups were observed and compared.According to the LKSS scoring system,the effect of knee function rehabilitation was evaluated.Results After 2 months of treatment,the active range of motion of the knee joint in the experimental group ((120.3± 17.1) °) was better than that in the conventional group ((100.4± 17.5) °),with significant difference (t =4.380,P =0.000);the LYSHOLM knee joint function score in the experimental group ((93.2 ± 5.3) points) was higher than that in the conventional group ((80.6 ± 7.7) points),with significant difference (t=7.259,P=0.000);the score of BERG balance scale ((52.4±1.6) points vs.(43.7±2.8)points),the difference was significant (t =14.528,P =0.000);the score of improved BARTHEL index ((92.5± 3.1) points vs.(85.6± 2.2) points),the difference was significant (t =9.775,P=0.000).The excellent and good rate of knee joint function in the experimental group was 93.10％ (27/29),which was significantly higher than 72.41％ (21/29) in the conventional group.There was significant difference between the two groups (Z =-2.390,P =0.017).Conclusion The proprioceptive training has a remarkable effect on knee joint function rehabilitation after minimally invasive surgery for patellar fracture.It can significantly improve the range of motion,joint stability and motion control ability of the affected knee,and improve the daily living ability of the patients.
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Objective To investigate the application of 16-slice spiral computed tomography (CT) three-dimensional reconstruction in the diagnosis and treatment of tibial plateau fractures.Methods A retrospective analysis was performed on the clinical data of 58 patients with tibial plateau fractures from January 2014 to October 2016 in Ningbo Yinzhou People's Hospital.All patients underwent locking plate internal fixation.All patients underwent radiographs of the tibial plateau before and after surgery with 16-slice spiral CT three-dimensional reconstruction,multiplanar reconstruction technology inspection.The detection rates of tibial plateau fractures and the 7-day fracture collapse surface between the two examination methods were compared,and the knee joint function before and after surgery was evaluated.Results The detection rate of tibial plateau fractures by CT three-dimensional reconstruction examination was 100.0％,which was higher than that by the X-ray examination (89.7％),the difference was statistically significant(x2 =4.39,P ＜ 0.05).The fracture collapse value of CT three-dimensional reconstruction examination after 7 days of operation was (3.42 ± 0.86),which was significantly higher than that of X-ray examination (1.27 ± 0.53) (t =16.21,P ＜ 0.05).The postoperative knee function score after surgery [(56.4 ±4.8) points] was significantly higher than that before surgery[(83.1 ± 7.5) points] (t =22.84,P ＜0.05).Conclusion The detection rate of 16-slice spiral CT three-dimensional reconstruction and multi-planar reconstruction is higher than X-ray film in tibial plateau fractures,especially for invisible fractures of the tibial plateau.It is more comprehensive and intuitive,multi-faceted display of fracture types and local structural relationships,which is worthy of clinical application.
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Objective@#To explore the relationship between the expression of inflammatory factors and the degree of pain in patients with Kashin-Beck disease after total knee arthroplasty.@*Methods@#Forty-nine patients with Kashin-Beck disease and 55 patients with knee osteoarthritis who underwent total knee arthroplasty in the Department of Orthopaedics, Gansu Provincial People's Hospital from January 2016 to December 2018, were selected, as the Kashin-Beck disease group and osteoarthritis group, respectively, and 50 healthy subjects who underwent healthy physical examination at the same time were selected as the control group. At the 7th day after operation, 3 ml of fasting venous blood was collected from all subjects. The expression levels of interleukin (IL)-6, tumor necrosis factor (TNF)-α, and C-reactive protein (CRP) were measured by enzyme-linked immunosorbent assay (ELISA); the visual analogue score (VAS) and knee society score (KSS) were used to compare the pain degree and knee function of each group; correlation analysis between postoperative inflammatory factor levels and VAS, KSS scores in patients with Kashin-Beck disease were studied.@*Results@#The expressions of IL-6 [(78.17 ± 13.28), (60.28 ± 9.92), (9.65 ± 3.12) ng/L], TNF-α [(126.67 ± 15.83), (105.29 ± 12.76), (21.09 ± 5.82) ng/L] and CRP [(11.23 ± 3.41), (8.31 ± 2.54), (2.14 ± 1.01) mg/L] in Kashin-Beck disease group, osteoarthritis group and control group were significantly different (F=12.397, 19.982, 9.167, P < 0.05); and the VAS scores [(5.21 ± 1.44), (2.98 ± 1.03), (0.61 ± 0.22) points], and KSS scores [(60.15 ± 8.91), (72.91 ± 9.19), (93.92 ± 5.73) points] between the three groups were statistically different (F=21.092, 16.743, P < 0.05). The correlation analysis showed that IL-6, TNF-α, and CRP levels were positively correlated with VAS scores in patients with Kashin-Beck disease (r=0.517, 0.498, 0.522, P < 0.05), and negatively correlated with KSS scores (r=-0.509,-0.514, -0.487, P < 0.05).@*Conclusion@#After total knee arthroplasty for patients with Kashin-Beck disease, the expression levels of inflammatory factors IL-6, TNF-α and CRP are higher, and they are associated with postoperative pain and knee function recovery.
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Objective@#To investigate the application of 16-slice spiral computed tomography (CT) three-dimensional reconstruction in the diagnosis and treatment of tibial plateau fractures.@*Methods@#A retrospective analysis was performed on the clinical data of 58 patients with tibial plateau fractures from January 2014 to October 2016 in Ningbo Yinzhou People's Hospital.All patients underwent locking plate internal fixation.All patients underwent radiographs of the tibial plateau before and after surgery with 16-slice spiral CT three-dimensional reconstruction, multiplanar reconstruction technology inspection.The detection rates of tibial plateau fractures and the 7-day fracture collapse surface between the two examination methods were compared, and the knee joint function before and after surgery was evaluated.@*Results@#The detection rate of tibial plateau fractures by CT three-dimensional reconstruction examination was 100.0%, which was higher than that by the X-ray examination (89.7%), the difference was statistically significant(χ2=4.39, P<0.05). The fracture collapse value of CT three-dimensional reconstruction examination after 7 days of operation was (3.42±0.86), which was significantly higher than that of X-ray examination (1.27±0.53)(t=16.21, P<0.05). The postoperative knee function score after surgery [(56.4±4.8)points] was significantly higher than that before surgery[(83.1±7.5)points] (t=22.84, P<0.05).@*Conclusion@#The detection rate of 16-slice spiral CT three-dimensional reconstruction and multi-planar reconstruction is higher than X-ray film in tibial plateau fractures, especially for invisible fractures of the tibial plateau.It is more comprehensive and intuitive, multi-faceted display of fracture types and local structural relationships, which is worthy of clinical application.
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Objective To explore the relationship between the expression of inflammatory factors and the degree of pain in patients with Kashin-Beck disease after total knee arthroplasty. Methods Forty-nine patients with Kashin-Beck disease and 55 patients with knee osteoarthritis who underwent total knee arthroplasty in the Department of Orthopaedics, Gansu Provincial People's Hospital from January 2016 to December 2018, were selected, as the Kashin -Beck disease group and osteoarthritis group, respectively, and 50 healthy subjects who underwent healthy physical examination at the same time were selected as the control group. At the 7th day after operation, 3 ml of fasting venous blood was collected from all subjects. The expression levels of interleukin (IL)-6, tumor necrosis factor (TNF)-α, and C-reactive protein (CRP) were measured by enzyme-linked immunosorbent assay (ELISA); the visual analogue score (VAS) and knee society score (KSS) were used to compare the pain degree and knee function of each group; correlation analysis between postoperative inflammatory factor levels and VAS, KSS scores in patients with Kashin-Beck disease were studied. Results The expressions of IL-6 [(78.17 ± 13.28), (60.28 ± 9.92), (9.65 ± 3.12) ng/L], TNF-α [(126.67 ± 15.83), (105.29 ± 12.76), (21.09 ± 5.82) ng/L] and CRP [(11.23 ± 3.41), (8.31 ± 2.54), (2.14 ± 1.01) mg/L] in Kashin-Beck disease group, osteoarthritis group and control group were significantly different (F =12.397, 19.982, 9.167, P < 0.05); and the VAS scores [(5.21 ± 1.44), (2.98 ± 1.03), (0.61 ± 0.22) points], and KSS scores [(60.15 ± 8.91), (72.91 ± 9.19), (93.92 ± 5.73) points] between the three groups were statistically different (F = 21.092, 16.743, P < 0.05). The correlation analysis showed that IL-6, TNF-α, and CRP levels were positively correlated with VAS scores in patients with Kashin-Beck disease (r = 0.517, 0.498, 0.522, P < 0.05), and negatively correlated with KSS scores (r = - 0.509, - 0.514, - 0.487, P < 0.05). Conclusion After total knee arthroplasty for patients with Kashin-Beck disease, the expression levels of inflammatory factors IL-6, TNF-α and CRP are higher, and they are associated with postoperative pain and knee function recovery.
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Objective:To investigate the effects of ligamen remnant preservation on knee joint function and proprioception recovery in patients with anterior cruciate ligament (ACL) injuries during ACL reconstruction under arthroscope.Methods:The clinical data of 266 patients with ACL injuries,who were treated in the 174th hospital of PLA from January 2010 to March 2016,were retrospectively analyzed.All the patients underwent ACL reconstruction under arthroscopy,among them,163 patients with remnant preservation were chosen as remnant preservation group;103 patients with completely clearing remnant preservation in the operation,as non remnant preservation group.All the patients were followed up for more than 12 months,and the knee function and proprioception recovery of the two groups were evaluated.Results:There were no significant differences in the knee ipsilateral Lysholm score,international knee documentation committee knee assessment scale (IKDC) score,passive activity detection threshold,passive angle regeneration test results between the two groups before operation,9 and 12 months after operation (P＞0.05).The Lysholm scores and IKDC scores of the two groups at each time point were significantly higher than those before operation,the passive activity detection threshold and passive angle regeneration test results were significantly lower than those before operation (P＜0.05).The Lysholm scores and IKDC scores in the remnant preservation group 3 and 6 months after operation were higher than those in the non remnant preservation group,the passive activity detection threshold and the passive angle regenerated test results were lower than the non remnant preservation group,the difference was statistically significant (P＜0.05).Conclusion:Remnant preservation in the ACL reconstruction under arthroscopy can accelerate the recovery of knee joint function and proprioception,and satisfactory clinical results are achieved,which is worth popularizing.
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@#ObjectiveTo investigate methods of early postoperative rehabilitation and its effects on patients with bicondylar tibial plateau fracture treated by modified dual plating.Methods66 patients with bicondylar tibial plateau fracture from Tianjin Hospital were divided into 2 groups according to the starting time for postoperative rehabilitation: early rehabilitation group (n=30), convalescents rehabilitation group (n=36). The two groups had the same treatment since the fourth week postoperative. Tibial plateau angle (TPA) and posterior slope angle (PA) of tibial plateau were measured to evaluate the stability of proximal tibial and knee alignment. The Hospital for Special Surgery (HSS) score system and knee joint range of motion (ROM) were used as the parameters for knee function.ResultsThe mean value of TPA and PA had no significant changes, compared to the final follow-up and postoperative X-ray films(P>0.05); the differences between the two groups were statistically significant in the mean HSS score and mean value of knee flexion and extention ROM(P<0.01 or 0.05). There was significantly positive correlation between starting time and the total number of treatment was significant(P<0.01), while negative correlation with flexion ROM of knee joint and the HSS score(P<0.01).ConclusionThe correlation between rehabilitation intervention timing and functional recovery for patients with bicondylar tibial plateau fracture treated by modified dual plating is significant, early individual and systematic rehabilitation therapy can effectively improve the prognosis features of patients.
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@# Objective To observe the effect of Chinese medicine Qingre Huoxue Xiaozhong Ⅰ/Ⅱ mixture on the knee joint function disorder after fracture.Methods 143 patients with knee joint function disorder after fracture were randomly divided into the treatment group(n=50),control Ⅰ group(n=48),control Ⅱ group(n=45).The cases of the treatment group were treated with Qingre Huoxue Xiaozhong Ⅰ mixture 150 ml three times per day orally,Qingre Huoxue Xiaozhong Ⅱ mixture exteral washing once every day,and combined with Honghua oil and TDP instrument therapy.The cases of the control Ⅰ group were treated with the prepared medicine Shenjin Dan 6 pieces,three times a day,combined with Honghua oil and TDP instrument therapy.The cases of the control Ⅱ group were treated only with Honghua oil and TDP instrument therapy.15 days were as a treatment course,and performed 1～2 treatment courses.The patients of the three groups also took the vitamins and calcitium simultaneously.The curative effect was evaluated according to the standard of Lysholm Joint Function.Results After treatment,the total excellent rates of the treatment group,control Ⅰ group and control Ⅱ group were 78%,39.58% and 24.44%,respectively,the result of the treatment group was significantly superior to that of the control Ⅰ group and control Ⅱgroup(P<001).The total effective rates of the treatment group,control Ⅰ group and control Ⅱ group were 98%,85.42% and 75.55%,respectively.The effect of the treatment group was also significantly superior that of the control Ⅰ group(P<0.05) and control Ⅱ group( P<0.01).Conclusion The Chinese native medicine Qingre Huoxue Xiaozhong Ⅰ/Ⅱ mixture has an obvious therapeutic effect in the multidisciplinary therapies on the knee joint function disorder after fracture.