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BACKGROUND: Although mechanical alignment technique ensures the long-term survival rate of knee arthrosis, some patients are still not satisfied with the effect of total knee arthroplasty and the function of knee joint after operation. OBJECTIVE: Meta-analysis was used to evaluate the effect of kinematic alignment technique and mechanical alignment technique in the guidance of total knee arthroplasty. METHODS: The literature of clinical controlled study of kinematic alignment and mechanical alignment in the guidance of total knee arthroplasty published from the date of establishment to July 2019 was searched in Chinese Biomedical Literature Database, Wanfang data, CNKI, VIP data, PubMed, Cochrane Library, and Embase. The literature was screened, and evaluated; data were extracted. Review Manager 5.3 software was used for statistical analysis. RESULTS AND CONCLUSION: (1) A total of 945 cases were included in 12 articles, including 470 cases in kinematic alignment group and 475 cases in mechanical alignment group. (2) The results of meta-analysis showed that the operation time was shorter in the kinematic alignment group than in the mechanical alignment group [MD=-15.44, 95%C/(-27.16, -3.71)]. Western Ontario and McMaster University Osteoarthritis Index was better in the kinematic alignment group than in the mechanical alignment group [MD=-8.40, 95%C/(-15.39, -1.40)]. Oxford knee score was better in the kinematic alignment group than in the mechanical alignment group [M7=4.72, 95%C/(0.24, 9.21)]. Distal angle of mechanical lateral femur and proximal angle of mechanical medial tibia were significantly larger in the mechanical alignment group than in the kinematic alignment group (all P 0.05). (4) The function of knee joint after kinematic alignment for guiding total knee arthroplasty was better than that in mechanical alignment group. However, the imaging and perioperative results were similar, and the incidence of complications was not increased after operation. It is suggested that kinematic alignment may be a lower extremity force alignment method to guide total knee arthroplasty.
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Objective To systematically evaluate the postoperative complications following open reduction and internal fixation combined with vascularized bone flap graft versus only reduction and internal fixation for femoral neck fractures.Methods CNKI,Wan Fang Chinese database,Pubmed,EMBASE and Google Scholar English database were searched for the randomized controlled trials from January 1,2000 through October 31,2017 which compared open reduction and internal fixation combined with vascularized bone flap graft (combined surgery group) with only reduction and internal fixation (simple surgery group) for femoral neck fractures.The data concerning postoperative nonunion and avascular necrosis of the femoral head were extracted.The 2 surgical treatments of the patients with femoral neck fracture were compared in terms of the 2 complications.Statistical analyses were conducted using software Stata 12 by relative risk (RR) and corresponding 95％ confidence intervals (95％ CI).Results According to our inclusion and exclusion criteria,a total of 23 studies were included,involving 2,162 cases (1,048 cases receiving combined surgery and 1,114 cases simple surgery).The Meta analyses showed that the fracture nonunion rate for the combined surgery group was significantly lower than that for the simple surgery group [RR =0.27,95％ CI(0.19,0.38),P ＜ 0.001] and the rate of avascular necrosis was also significantly lower for the former than for the latter [RR =0.31,95 ％ CI(0.24,0.42),P ＜ 0.001].Conclusion In the treatment of femoral neck fractures,open reduction and internal fixation combined with vascularied bone graft may lead to lower rates of nonunion and avascular necrosis of the femoral head than simple open reduction and internal fixation.
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Objective To investigate the efficacy of calf self weight traction reduction combined with locking plate fixation for the treatment of intertrochanteric fractures in the elderly.Methods A retrospective case series study was conducted on the clinical records of 174 elderly patients with the modified Evans Ⅰ-Ⅲ types of fresh intertrochanteric fractures treated with locking plate from January 2012 to December 2015.According to treatment method,the patients were assigned to traction bed reduction with locking plate fixation (Group A,62 patients) and calf self weight traction reduction with locking plate fixation (Group B,112 patients).Group A comprised 32 males and 30 females,with age range of 65-91 years [(72.47 ± 6.35) years].Group B comprised 68 males and 44 females,with age range of 65-95 years [(73.23 ± 6.05) years].The time of reduction,operation time,incision length,intraoperative blood loss,frequency of fluoroscopy,postoperative drainage volume,hospital stay,postoperative weightbearing standing time or walking time (ambulation time),surgical complications,and fracture healing were recorded.Harris and modified Barthel index score in Chinese (MBI-C) were used to evaluate the functional recovery of hip joint.Results All patients were followed up for 5-61 months (mean,15 months),and noted with fracture healing.The time of reduction in Group A was (13.27 ± 3.03) minutes,longer than that in Group B (0 minute) (P ＜0.05).The operation time in Group A was (63.63 ± 13.90)minutes,longer than that in Group B [(59.62 ± 8.38) minutes] (P ＜ 0.05).Fluoroscopy in Group A was (5.35 ± 2.36) times,more than (4.28 ± 3.11) times in Group B (P ＜ 0.05).There were no significant differences in the incision length,intraoperative blood loss,postoperative drainage volume,ambulation time,fracture healing time,Harris score,and MBI-C index between the two groups (P ＞0.05).There were no significant differences in the postoperative complications such as deep venous thrombosis,pulmonary infection,incisional infection,urinary tract infection,delirium,bed sores,cardiac insufficiency,electrolyte disturbance,and postoperative plate rupture between the two groups (P＞0.05).The incidence of deep vein thrombosis was 9.7％ (6/62) in Group A,and 4.5％ (5/112) in Group B (P ＞0.05).No screw fracture,nail and plate combination failure,bone nonunion,or screw cut out of the femoral head were observed in both groups.Conclusions For the modified Evans Ⅰ-Ⅲ types of intertrochanteric fractures,both traction bed reduction and calf weight reduction with locking plate have equivalent efficacy.However,the latter method has advantages of shorter reduction and operation time and less intraoperative X-ray exposure,and hence is worthy of clinical application.
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Objective To understand the epidemic situation of hydatid disease in Gansu Tibetan Autonomous Prefecture(Gannan state) Gannan Province,and prevalence of the disease in population,livestock and final host dogs,and to evaluate the effectiveness of prevention and control measures.Methods In 2012:①An investigation was carried out according to the requirements of Technical Solutions of Hydatid Disease Prevalence,Gansu Province; in every county(city) of Gannan Prefecture,administrative villages were selected as survey units,by stratified cluster sampling based on the semi agricultural semi pastoral areas,pastoral areas,agricultural areas and towns.According to the proportion of the population of each layer to the population of each county,the number of people and the number of villages to be surveyed were determined.Sixteen villages were selected,and 200 people were selected in each village(from a neighboring village to make up the insufficient number in case of need),and B ultrasound method was used to carry out the census.②Children serum survey:stratification was done according to pastoral areas,semi agricultural semi pastoral areas,agricultural areas and towns population in each county(city),1 primary school was selected,children less than 12 years old were examined by B Ultrasound,and serum antibodies of Echinococcus granulosus were tested by enzyme-linked immunosorbent assay(ELISA).③ Surveillance of source of infection:in the selected villages,20 kennel households were selected in each village,dog feces was collected,and canine Echinococcus antigen was detected by double antibody sandwich ELISA method.④)Monitoring of intermediate host:1 000 sheep (or 500 cattle) were selected in each county(city),and hydatid disease was examined by anatomical method.⑤Investigation of health education was done in the form of a questionnaire survey of hydatid disease prevention knowledge and behavior survey on the awareness rate.Results The prevalence rate of population was 0.10％ (29/28 960); prevalence rate of herdsmen was 0.13％ (17/13 015); farmers prevalence rate was 0.06％(8/12 780); in children under 12 years of age,the infection rate was 2.64％ (336/12 728) ; dog infection rate were 3.90％ (117/3 001) ; livestock infection rate was 1.72％ (121/7 027); and the infection rates of cattle and sheep were 2.41％(38/1 574) and 1.52％(83/5 453),respectively.The rate increased from 40％(720/1 800) to 70％(1 260/1 800) of hydatid disease prevention knowledge awareness in farmers and herdsmen after health education.Conclusions The scope of hydatid disease in Gannan Prefecture is broad; the patient population mainly is herdsmen,and farmer is second.Epidemic factors include contact canine and vices; the farmers and herdsmen have low awareness of hydatid disease prevention knowledge.Poor production and lifestyle are difficult to change in the short term,we need to further strengthen the prevention measures.