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Objective:To analyze the factors affecting the relative height change of the patella after primary robotic-assisted total knee arthroplasty (R-TKA).Methods:The data of 97 patients with osteoarthritis of the knee treated with R-TKA admitted from June 2021 to March 2022 were retrospectively analyzed, including 15 males and 82 females, aged 70.0±5.4 years (range, 58-80 years). The bone resection parameters of the robotic system were recorded intraoperatively, including the bone resection amount of the medial and lateral distal femur, medial and lateral posterior femoral condyle and medial and lateral tibial plateau. The Blackburne-Peel index (BPI) and Caton-Deschamps index (CDI) were used to measure the preoperative and postoperative relative patellar height on lateral radiographs, as well as the posterior tibial slope (PTS) and the change in patellar ligament length before and after surgery. The relationship between the change in relative patellar height and the variables of interest was analyzed using partial correlation and multiple linear regression.Results:The mean postoperative CDI was lower than preoperatively (0.79±0.15 vs. 0.91±0.13, t=9.69, P<0.001), and the percentage of patients with postoperative CDI<0.6 was higher than preoperatively (9.3% vs. 0; χ 2=12.92, P<0.001); the differences in mean postoperative BPI and percentage of patients with postoperative BPI<0.45 were not statistically significant compared to preoperatively (0.69±0.13 vs. 0.71±0.17, t=1.35, P=0.182; 11.3% vs. 17.5%, χ 2=1.50, P=0.220). The mean patellar ligament length on the first postoperative day was 2.29 mm shorter than preoperatively, there was a statistically significant difference ( t=5.90, P<0.001). Partial correlation analysis showed that the amount of patellar ligament length change was positively correlated with the amount of BPI and CDI change ( r=0.84, P<0.001; r=0.70, P<0.001), and the amount of PTS change and the mean distal femoral bone resection were negatively correlated with the amount of BPI ( r= -0.41, P<0.001; r=-0.32, P=0.002) and CDI ( r=-0.23, P=0.029; r=-0.25, P=0.017) change. In contrast, the amount of posterior femoral condyle bone resection and tibial plateau bone resection did not correlate with the change of BPI and CDI. Multiple linear regression analysis showed that the amount of patellar ligament length change, PTS change and the distal femoral bone resection were factors influencing the change of BPI ( β=0.03, P<0.001; β=-0.01, P<0.001; β=-0.02, P=0.021) and CDI ( β=0.02, P<0.001; β=-0.01, P=0.001; β=-0.02, P=0.008). Conclusion:Amount of patellar ligament length change, PTS change and the distal femoral bone resection are factors affecting the BPI. In order to obtain a better relative patellar height in the primary R-TKA, attention should be paid to the adjustment of the distal femoral bone resection and PTS, while taking the necessary measures to reduce the postoperative patellar ligament length changes.
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To investigate the effect of captopril on the dentin bonding durability of self-etch adhesive. Different concentrations of captopril ethanol solutions or captopril ethanol/water solutions were prepared to pretreat dentin as primer for the self-etch adhesives. The surface morphology of the dentin was observed with scanning electron microscopy (SEM). Based on the morphology analysis, the pretreatment condition was selected and two self-etch adhesives were employed to evaluate the improvement effect of the captopril pretreatment on the dentin bonding durability. : SEM showed that the pretreatment of captopril ethanol solutions and captopril ethanol/water solutions were able to remove the smear lay and partially expose collagen matrix. According to the SEM results, the pretreating condition of captopril ethanol/water solution with the pretreating time of was selected for further dentin bonding study. For Clearfil SEBOND system, the immediate bonding strength increased from to (0.05]. For Clearfil S BOND system, there was no significant difference in the immediate bonding strength between the experimental group [(4.07) MPa] and the control group[(4.11) MPa]. But after one-year aging, the bonding strength of the experimental group was higher than that of the control group <0.05]. : The pretreatment with captopril ethanol/water solution increases the dentin bonding strength of the self-etch adhesive systems and also improves the bonding durability.
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Adhesivos , Captopril , Recubrimiento Dental Adhesivo , Dentina , Recubrimientos Dentinarios , Ensayo de Materiales , Microscopía Electrónica de Rastreo , Cementos de ResinaRESUMEN
Objective To study the effect of high-dose methylprednisolone intravenous pulse therapy on immunoglobulins and CD series in patients with active moderate-to-severe Graves' orbitopathy. Methods Twenty-seven patients with active moderate-to-severe Graves' orbitopathy were enrolled in this study. All the patients received iv methylprednisolone pulse therapy for 12 weeks according to the 2016 European Thyroid Association/European Group on Graves'Orbitopathy(EUGOGO) Guidelines. Serum thyroidal autoantibodies, such as thyroid-stimulating hormone receptor antibody ( TRAb) , anti-thyroperoxidase antibody ( TPOAb) , and serum immunoglobulins, such as IgG, IgE, IgA, IgM were evaluated at the baseline, at the end of 4th and 12th week. Percentages of CD3+ T cells, CD4+ T cells, CD8+T cells and CD19+ B cells, CD16+ or CD56+ NK cells were also evaluated at each time point. Results TRAb, TPOA and IgE, IgG, IgA were significantly decreased both after 4th week and after 12th week (all P<0.05). Percentages of CD3+ T cells, CD4+ T cells and CD4+/CD8+ ratio were gradually decreased after treatment. However, change of CD8+T cells was not significant (P>0.05). Conclusion High-dose methylprednisolone may exert an immunosuppressive effect not only by modifying humoral and cellular immune functions, but also by decreasing serum immunoglobulins.
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As one of the major causes of disability in the elderly population,knee osteoarthritis is a common degenerative joint disease.The general treatment approaches for knee osteoarthritis include physical therapy,nonsteroidal anti-inflammatory drugs (NSAIDs),intra-articular injection of steroid hormones,viscosupplementation and surgery,etc.Hyaluronic acid (HA) is a kind of macromolecule which plays pivotal roles in the articular physiology as a key component of synovial fluid and cartilage.Intra -articular injection of hyaluronic acid (IA-HA) is established as a local therapy to restore the viscoelasticity of synovial fluid and achieve physiological stability.Numerous clinical trials have demonstrated that IA-HA is effective in relieving pain and reducing structural damage in patients with knee osteoarthritis.Generally,the pain-relieving activity of IA-HA is comparable to or higher than that of NSAIDs,intra-articular corticosteroids,and physical therapy.In addition,IA-HA treatment is tolerated and is associated with less adverse events in comparison with NSAIDs,which elicits gastrointestinal bleedings and is associated with increased mortality.Studies in the mechanisms of action also revealed that HA could specifically bind to the membrane receptor (such as CD44) and adhesion molecules (ICAM-1) in cells.The connection may stimulate functional activities,including cell migration and proliferation.However,debates on whether hyaluronic acid produces significant clinical benefits still exist in the literature and different clinical practice guidelines.The variability in pharmaceutical property of different HA products,the severity of knee osteoarthritis,treatment protocol and injection technique can potentially have impacts on the outcomes of treatment of knee osteoarthritis with IA-HA.
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Objective To explore the clinical effects of optimized articulating medullary-sparing spacer in the treatment of infectious hip arthritis.Methods From June 2010 to June 2016,the clinical data of 15 patients with infectious hip arthritis who were treated by modified articulating medullary-sparing spacer were analyzed retrospectively.There were 6 males and 9 females with the average age of 49.6±9.6 years old (range,32-61 years).8 cases were primary hip infections and 7 cases were secondary hip joint infections.After complete debridement in the first phase of surgery,the modified articulating medullary-sparing spacers were fabricated and installed using the larger diameter and angled Steinmann pins as the endoskeleton and the femoral head spacers made by hubbing.Two-stage THA revision for each patient was conducted after infection controlled.To evaluate the clinical results,the infection and treatment condition of every patient were collected at preoperative,interim period and latest fellow-up.The spacer status in interim period and prosthesis status after two-stage THA revision were observed.And Harris hip score system was used to evaluate the hip joint function in different stages.Results All patients were cured with mean follow-up time of 40.9± 10.8 months (range,28-62 months).During the interim period,spacer dislocation was observed in a case,which was successfully treated by manual reduction under general anesthesia.In other cases,the affected limbs maintained good function and partial weight bearing.After the second-stage THA,no prosthesis loose,dislocation,fracture,deep vein thrombosis and injury of major vessels or nerves were observed.The clinical symptoms and hip joint function of all cases were significantly improved.The Harris hip score was improved from 33.7±6.9 preoperatively to 59.5±8.5 in interim period and 90.8±4.4 at the latest fellow-up,and the difference was statistically significant among three stages.Conclusion The larger diameter and angled Steinmann pins as the endoskeleton,combined with the femoral head spacers made by hubbing,effectively enhanced the mechanical strength of the articulating medullary-sparing spacers.The optimized spacers provided effective treatment of infectious hip arthritis,while allowing good function and partial weight-bearing during the interim period.
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Objective To improve the quality of antibiotics prescriptions in outpatient and emergency departments, to reduce the irrational use of antimicrobial drugs and to improve the quality of pharmacy service through system of rational drug administration.MethodsAnalyzing and evaluating the data of irrational administration of antimicrobial drugs between 2014 and 2015.The data was collected by the system of rational drug administration.ResultsFrom 2014 to 2015, the qualified rate of antibiotics prescriptions increased from 95.40% to 98.71%.Different types of irrational use of antimicrobial agents significantly reduced.ConclusionThe application of system of rational drug administration can improve the qualified rate of antibiotics prescriptions in outpatient and emergency departments and can promote pharmacy service.
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Objective To investigate the effects of Tongfengding capsule combined with diclofenac sodium on blood uric acid level, joint swelling and pain in gout patients. Methods 120 cases of gout patients enrolled in our hospital from January 2014 to June 2016 were selected for the study and divided into the control group and the observation group according to the random number table, with 60 cases in each group. The two groups were given anti-infection, low purine diet and other basic treatment, and both treated with sodium bicarbonate tablets and diclofenac sodium. The observation group was given Tongfengding capsule on this basis and the two groups were treated for four weeks. After treatment, gout related factors erythrocyte sedimentation rate (ESR) was observed in the two groups, and TCM symptoms of redness and swelling, pain scores were evaluated and the onset of gout was observed again at six months after treatment. Results The level of UA (463.47±50.28) CB/(μmol?L) in the control group was significantly higher than that in the control group (434.52±51.63) CB/(μmol?L) (P<0.05). The pain and swelling score of the control group were significantly higher than those in the observation group (P<0.05). The recurrence rate in the observation group (5%) was significantly lower than that in the control group (18.33%) (P<0.05). Conclusion Tongfengding capsule combined with diclofenac sodium can effectively relieve joint swelling, pain symptoms of gout patients and reduce blood uric acid levels with significant clinical efficacy.
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<p><b>BACKGROUND</b>Diversity of orthopedic infections with various local environments affects the pattern and prevalence of pathogens. It is not well-characterized whether different pathogens have different propensity to cause different types of orthopedic infections. We aimed to investigate the frequency of different pathogens derived from orthopedic infections, and determine the relationship between the prevalence of clinical isolates and the type of orthopedic implants, especially focusing on staphylococci.</p><p><b>METHODS</b>From January 2006 to December 2011, orthopedic infections were identified retrospectively from clinical microbiology laboratory and orthopedic medical records. The sources of orthopedic infections were divided into two main groups: those associated with implants and those not associated with implants. Implants-associated infections were further subdivided into five subgroups: arthroplasty, internal fixation, external fixation, internal and external fixation, and others. We analyzed microbiological spectrum in different groups and subgroups. Antibiotic susceptibility of staphylococci was analyzed.</p><p><b>RESULTS</b>Only coagulase-negative staphylococci (CoNS) was significantly more likely to be associated with implants-associated infections (P = 0.029). The overall pathogens prevalence of arthroplasty was significantly different from other subgroups (P < 0.05). 65% isolates from external fixation was Gram-negative bacteria. Some percentage (55%) of S. aureus and (83%) CoNS were resistant to methicillin. No resistance to glycopeptide was seen in all of staphylococci.</p><p><b>CONCLUSIONS</b>Staphylococcus aureus was the most frequent isolates in orthopedic infections but was not associated with the presence or absence of implants. Only CoNS was implants-associated, especially for arthroplasty infection. Cefazolin alone is not enough for orthopedic surgery prophylaxis in settings with a high prevalence of methicillin-resistant staphylococci.</p>
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Humanos , Procedimientos Ortopédicos , Prótesis e Implantes , Microbiología , Estudios Retrospectivos , Staphylococcus aureus , Virulencia , FisiologíaRESUMEN
<p><b>BACKGROUND</b>This study was designed to analyze three tibial axis reference lines including the anterior tibial cortex (ATC) line, the fibular line (FL), and the anatomical axis of tibia (AAT) line, to determine which line most closely parallels the mechanical axis (MA) of the tibia in the sagittal plane. The clinical relevance of the study is that through finding a reliable landmark on the leg, a surgeon may minimize posterior tibial slope measurement errors thereby and improving the technique for assuring proper alignment of total knee arthroplasty.</p><p><b>METHODS</b>The material for this study included CT scans of the tibia from 85 consecutive patients and 168 knees (78 without osteoarthritis (OA) and 90 knees with OA). Measurements of the angles between the tibial mechanical axis and each of three reference lines in the sagittal plane were carried out using 3D imaging software.</p><p><b>RESULTS</b>Mean angles of 168 knees were as follows: aMT (3.96±0.85)°, aMF (0.70±0.58)°, and aMA (1.40±0.66)°, (aMT: an angle between MA and ATC, aMF: an angle between MA and FL, aMA: an angle between MA and AAT. All abovementioned angles were measured in the sagittal plane of tibia) and the aMF was significantly smaller than the others (P < 0.0001). The mean value of the medial tibial slope angle vs. the MA was (9.19±3.97)°, and this was significantly larger than the mean lateral slope angle of (6.62±4.23)° (P < 0.0001). The difference between aMF without OA and with OA was not statistically significant (P = 0.5015) and the association between the aMT and aMA was strong (r = 0.82, P < 0.01).</p><p><b>CONCLUSIONS</b>FL was more closely parallel to the MA of tibia, and more showed less variation between OA and non- OA controls than ATC and AAT lines. Furthermore, the amount of posterior slope in medial plateau was greater than that in lateral plateau. The findings of this analysis suggest that when using the anterior tibial cortex line as is commonly done with extramedullary tibial resection guides, the tibial resection should be sloped approximately four degrees more posteriorly.</p>
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Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Artroplastia de Reemplazo de Rodilla , Métodos , Imagenología Tridimensional , Métodos , Articulación de la Rodilla , Cirugía General , Osteoartritis de la Rodilla , Cirugía General , Tibia , Cirugía GeneralRESUMEN
<p><b>OBJECTIVE</b>To determine the clinical outcomes of two-staged cementless revision arthroplasty for the treatment of deep periprosthetic infection after total hip arthroplasty.</p><p><b>METHODS</b>Twenty-three patients with deep periprosthetic infection treated with a standard protocol of two-staged cementless revision hip arthroplasty were enrolled in this study. There were 9 male patients and 14 female patients with an average age of 64 years (range, 52-78 years). In all cases, antibiotics-loaded cement spacers were implanted after removal of all the prosthetic components and thorough debridements had been done. All patients had a minimum of 2 weeks of intravenous antibiotics followed by 4 weeks of oral antibiotics after implant removal. After a mean interval of 6.7 months (3-28 months), revision arthroplasties were carried out with cementless femoral components followed by 2 weeks of intravenous antibiotics and 4 weeks of oral antibiotics.</p><p><b>RESULTS</b>The mean follow-up period was (4.3±3.5) years. There were 2 cases of recurrent infections in this study. Intraoperative periprosthetic fractures were observed in 3 patients. One patient had dislocation of the implanted spacer during the interval period and 2 patients had hip dislocation after reimplantation. Mild subsidence of femoral component occurred in 1 patient. There were no cases of loosening of femoral components and cementless acetabular components in patients without infection recurrence. The Harris hip score increased from a preoperative mean of 36±13 to 85±13 at 12 months after reimplantation.</p><p><b>CONCLUSIONS</b>Using cementless prostheses in two-staged revisions of hip periprosthetic infections can provide low rate of infection recurrence and good implant stability, but cautions must be taken when treating patients with infection caused by multidrug-resistant organisms.</p>
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Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Antibacterianos , Artroplastia de Reemplazo de Cadera , Métodos , Estudios de Seguimiento , Prótesis de Cadera , Infecciones Relacionadas con Prótesis , Cirugía General , Estudios RetrospectivosRESUMEN
<p><b>OBJECTIVE</b>To construct a multiple-scale organized implant surface with super-hydrophilicity.</p><p><b>METHODS</b>The SiC paper polished titanium disc was sandblasted and treated with HF/HNO₃ and HCl/H₂SO₄, then acid-etched with H₂SO₄/H₂O₂. The physicochemical properties of the surfaces were characterized by scanning electron microscope, static state contact angle and X-ray diffraction. MC3T3-E1 cells were used to evaluate the effects of the surface on the cell adhesion, proliferation and differentiation.</p><p><b>RESULTS</b>The acid-etching process with a mixture of H₂SO₄/H₂O₂ superimposed the nano-scale structure on the micro-scale texture. The multiple-scale implant surface promoted its hydrophilicity and was more favorable to the responses of osteoprogenitor cells, characterized by increased DNA content, enhanced ALP activity and promoted OC production.</p><p><b>CONCLUSION</b>A multiple-scale implant surface with super-hydrophilicity has been constructed in this study, which facilitates cell proliferation and adhesion.</p>