Multidisciplinary team for treatment of hip fracture in the elderly / 中华创伤骨科杂志

Objective:To explore multidisciplinary team (MDT) for the treatment of hip fracture in the elderly.Methods:A retrospective analysis was done of the 196 elderly patients who had been admitted to Department of Joint Surgery, Beijing Shijitan Hospital from September 2017 to December 2018 for hip fractures. They were divided into 2 groups depending on whether MDT had been applied or not. In the MDT group of 102 patients, there were 43 males and 59 females with an age of 81.9±8.4 years, and 63 femoral neck fractures and 39 intertrochanteric fractures. In the traditional treatment group of 94 patients, there were 37 males and 57 females with an age of 81.3±8.6 years, and 55 femoral neck fractures and 39 intertrochanteric fractures. The 2 groups were compared in terms of complications and mortality during hospitalization, interval from admission to surgery, total hospital stay, and Harris hip scores at 6 months after surgery.Results:There were no statistically significant differences in general data before surgery between the 2 groups, indicating comparability ( P>0.05). Eighty-four patients (89.4%) in the traditional treatment group and 98 patients (96.1%) in the MDT group underwent surgery, showing no significant difference between the groups ( χ2=3.327, P=0.068). In the patients undergoing surgery in the MDT group, the incidences of postoperative delirium [12.2% (12/98)], pulmonary infection [11.2% (11/98)], cardiogenic disease [13.3%(13/98)], electrolyte disturbance[12.2%(12/98)] and deep venous thrombosis of lower extremity [6.1% (6/98)] were significantly lower, the interval from admission to surgery (1.9 d±0.9 d) and total hospital stay (10.2 d±0.9 d) significantly shorter, and Harris hip scores (81.3±6.2) at 6 months after surgery significantly higher than those in the patients undergoing surgery in the traditional treatment group [31.0%(26/84), 22.6% (19/84), 25.0% (21/84), 28.6% (24/84), 16.7%(14/84); 3.1 d±1.6 d and 14.1 d±6.2 d; 75.4±7.8; respectively] (all P<0.05). Conclusion:In the treatment of hip fracture in the elderly, multidisciplinary team is effective in reducing complications during hospitalization, shortening the interval from admission to surgery and total hospital stay, and promoting functional recovery of the hip.

Effect of tranexamic acid on perioperative blood loss, D-Dimer and fibrinogen in total knee arthroplasty / 中国医师杂志

Objective To investigate the effects of tranexamic acid (TXA) on perioperative blood loss,D-Dimer and fibrinogen (FIB) in total knee arthroplasty (TKA).Methods A prospective study,from December 2016 to November 2017 patients with end-stage knee osteoarthritis underwent unilateral TKA were randomly divided into two groups.Patients in treatment group received two doses of 15 mg/kg TXA by intravenous inffusion 1 hour pre-operation and before the release of tourniquet;the control group was replaced with the same amount of saline.The preoperative and 3 days post-operation hemoglobin,hematocrit value,drainage,blood transfusion were recorded.The D-Dimer and FIB were dynamically monitored before operation and 1,3,7,14 d after the operation.And there were also observations for whether they had deep vein thrombosis and both lower limbs of all patients were examined by the color Doppler ultrasonography 14 days after operation.Results The drainage and the total blood loss in treatment group was significantly less than in control group (P ＜ 0.01,P ＜ 0.05).The volume of both allogeneic and autologous blood transfusion in treatment group were significantly less than those in the control group (P ＜0.01).The ratio of allogenic blood transfusion was 14.6％ (6/41) in treatment group,38.1％ (16/42) in control group (P ＜ 0.01).D-dimer at 1,3d post-operation in treatment group was significantly lower than that in the control group (P ＜0.05),but the difference was getting smaller at 7,14d post-operation (P ＞0.05).FIB at any time point between the two groups was no significant difference (P ＞ 0.05).There was no symptomatic deep venous thrombosis (DVT) in all of the three groups within 14 days.Conclusions The TXA infused intravenous can significantly decrease drainage,the total blood loss and blood transfusion without increasing risk for DVT in TKA.but early post-operation TXA could affect the level of D-dimer,thus affecting the value of early warning of DVT.

Arthroscopy-assisted percutaneous cannulated screw fixation for Ideberg Ⅲ glenoid fractures / 中华创伤杂志

Objective To investigate the clinical effect of arthroscopy-assisted percutaneous cannulated screw fixation for Ideberg Ⅲ glenoid fractures.Methods A retrospective case series study was conducted to analyze the clinical data of 28 patients with Ideberg Ⅲ glenoid fracture admitted to the Honghui Hospital Mfiliated to Medical College of Xi'an Jiaotong University from January 2014 to January 2017.There were 19 males and nine females,aged 20-49 years [(32.5 ± 3.5)years].All patients were classified as Ideberg Ⅲ glenoid fractures.All patients were treated with arthroscopy-assisted percutaneous cannulated screw fixation.The length of incision,complications and range of motion of shoulder joint were recorded.The shoulder function was evaluated by University of California at Los Angeles (UCLA) score and visual analogue score (VAS) before and after operation.Results All patients were followed up for 24-36 months [(25.6-± 4.5) months].The incision ranged from 2.0 cm to 3.7 cm [(2.3 ± 0.8) cm].No infection,re-displacement or nonunion occurred.One year after operation,the results of range of motion were as follows:anterior flexion (160.7 ± 5.5)°,abduction (150.8 ± 6.8)°,and external rotation (38.4 ± 7.5) °.The mean UCLA score was increased from preoperative (7.2 ± 1.2) points to (33.5 ± 3.2) points (P ＜ 0.05),and the mean VAS score was decreased from preoperative (7.8 ± 3.2) points to (1.3 ± 0.5) points (P ＜ 0.05).Conclusion For Ideberg Ⅲ glenoid fractures arthroscopyassisted percutaneous cannulated screw fixation can relieve the pain and reduce complications,which is beneficial to the recovery of shoulder function.

Research advances on anterior shoulder instability associated with glenoid bone defect / 中华骨科杂志

Anterior shoulder instability is a very difficult issue to treat,especially with glenoid bone defect.When the defect is small,there is little influence on shoulder instability.The larger the defect is,the more influence there will be.Most authors agree that glenoid bone reconstruction should be considered when glenoid bone defect is more than 20％-25％.In this condition soft tissue procedures alone are not enough to provide stability to the shoulder.To date,there is still not an ideal typing of glenoid bone defect.There are many methods of assessing the size of bone defect.Pico system is one of the most common methods,as it is easier and more precise.Numerous surgical procedures have been described to address the bone defect.The Bristow procedure,the Latarjet procedure and the Eden-hybinette procedure are effective and most popular around the world.The Latarjet procedure can provide more bone blocking than the Bristow procedure,and is more popular.The Eden-hybinette procedure dose not need coracoid transfer and then has no damage of normal anatomical structure.But it also lack the hanging effect of the conjoint tendon.After all,each procedure has its advantage and disadvantage in treating anterior shoulder instability associated with glenoid bone defect and should be chosen depending on the characteristics of each patient and the preference of each surgeon.Furthermore,more new and effective treatments are still needed.

Comparative study of high frequency ultrasound and MRI in the diagnosis of rotator cuff tears / 实用放射学杂志

Objective To comparative evaluation the application value of high frequency ultrasound (HFU)and magnetic reso-nance imaging (MRI)in the diagnosis of rotator cuff tears(RCT).Methods 86 patients of unilateral RCT confirmed by shoulder ar-throscopy were chosen.The detection rate by HFU and MRI before the surgery was compared.Shoulder arthroscopic finding was as the evaluation standard,the accuracy of HFU and MRI in the diagnosis of RCT was calculated which included:total (full and partial) RCT,full RCT,partial RCT.Chi-square test was used to compare the accuracy rate.Results Among 86 patients,30 patients with full RCT and 56 patients with partial RCT were detected by shoulder arthroscopy,in which 28 patients with full RCT and 43 patients with partial RCT were found by HFU,and 28 patients with full RCT and 5 1 patients with partial RCT were found by MRI respec-tively.The accuracy of HFU and MRI in the diagnosis of total,full,partial tear RCT were 82.6%,93.3%,76.8% and 91.9%,93.3%, 91.6% respectively.There was no significant difference between HFU and MRI in diagnosing total and full RCT(P >0.05),the ac-curacy on HFU in diagnosing partial RCT was slightly lower than that on MRI (P <0.05).Conclusion Both HFU and MRI have relatively high accuracy in diagnosing full RCT,HFU is slightly lower than MRI in diagnosing partial RCT.

Cannulated screws internal fixation plus three-column reconstruction for treatment of Lisfranc' s joint injuries / 中华创伤杂志

Objective To evaluate the preliminary outcome of cannulated screw internal fixation in treatment of the tarsometatarsal joint injuries.Methods From January 2005 to October 2010,21 patients(14 males and 7 females)with the tarsometatarsal joint injuries were treated.Their age ranged from 21 to 62 years(average 38.2 years).According to anatomical three-column classification,there were four patients with single medial column injury,four with medial and middle column injuries,three with middle and lateral column injuries,two with single lateral column injury and eight with three column injuries.The injury causes included traffic injury in nine patients,machine injury in eight and fall from height injury in four.The period from injury to admission was 2-15 hours(mean 5 hours).During operation,open reduction was performed,followed by internal fixation with the cannulated screw.X-ray examination was done in the regular follow-up and function was evaluated by using Maryland scoring system.Results Of all,19 patients were followed up for 4-47 months(mean 20 months),which showed no infection,loosing or breakage of the internal fixation.According to the Maryland scoring system,the clinical outcome was rated as excellent in eight patients,good in seven,fair in two and poor in two,with excellence rate of 79％.Conclusions The three-column theory plays an important role in clinical diagnosis and therapy of the tarsometatarsal joint injuries.Open reduction and cannulated screw internal fixation may attain satisfactory clinical results in treatment of the tarsometatarsal joint injuries.

Percutaneous vertebroplasty in the treatment of osteoporotic thoracolumbar vertebral compression fractures / 中国矫形外科杂志

[Objective]To observe the clinical results of percutaneous vertebroplasty in the treatment of painful osteoporotic thoracolumbar vertebral body compression fractures in old people.[Method]Six cases of PVP and 2 cases of kyphoplasty were performed with polymethylmethacrylate(PMMA) through unipedicular or bipedicular under C-arm fluoroscopy.[Result]No leakage of PMMA was found in the operation,the pain was clearly relieved or disappeared postoperatively,no severe complication occurred.[Conclusion]PVP is safe,effective and enconomical in the treatment of painful osteoporotic thoracolumbar vertebral body compression fracture.