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Objective To evaluate the clinical effect of electromagnetic navigation system to locate the distal locking screw of tibia intramedullary nail. Methods From February 2010 to December 2016, 79 cases of tibia shaft fractures requiring treatment with intramedullary nailing were selected and divided into the navigation group and free hand locking group according to intramedullary nail locking methods. Forty-four cases in navigation group used an electromagnetic navigation system to lock the distal end of the intramedullary nail,while 35 cases in free hand locking group used a free-hand technique. The intraoperative X-ray exposure time,distal locking time,healing time, and the success rate of one-time distal locking were recorded compared between two groups. Results The average time of diatal locking using electromagnetic navigation technology was less than that of the free hand locking group,and the exposure time of fluoroscopy was also reduced, the differences were significant(P ＜ 0. 05). There was no difference in fracture healing time between the two groups(P ＞ 0. 05), one-time success rate of navigation group was 100％,which was higher than 37. 34％ of the free hand locking group, the difference was significant(P ＜ 0. 05). Conclusion Compared with free hand technology, the advantage of using electromagnetic navigation system to lock the distal nail of tibia intramedullary nail is high efficiency, short locking time and no radiation.
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Objective To evaluate the feasibility of making the osteoarthritis (OA) model in the medial collateral ligament and the medial meniscus excision in rats,and to explore the mechanism of MMP-13 and ADAMTS-5 protein in the cartilage of rat osteoarthritis models.Methods Forty SD rats were randomly divided into model group(n =30) and sham operation group(n =10).The knee joint OA model was made from the medial collateral ligament of the knee and the medial meniscus,and the sham operation group was sutured after opening the capsule of the knee joint.Rats in the model group were killed at 4,6,and 8 weeks after the operation,and the sham operation group died of the rats at 8 weeks after the operation.The articular cartilage tissue of rats was taken.The expression level of MMP-13 and ADAMTS-5 protein in cartilage tissue was detected by Western blot and immunohistochemistry.Results Cartilage degeneration was observed in the model group 4 weeks after operation,and degeneration was further aggravated at 6 and 8 weeks.There was no significant degeneration in the sham operation group.There was a significant difference in the articular cartilage score between the two groups (P ＜ 0.05).The results of Western blot detection showed that the protein expression of MMP-13 and ADAMTS-5 was low in the sham operation group.The MMP-13 model began to rise for 4 weeks,and continued to rise in the 6th week,and the 8th week was lower than that of the previous one.The protein expression had significant difference in all groups at 4 weeks,6 weeks and 8 weeks (P ＜ 0.05).The ADAMTS-5 model began to rise for 6 weeks,and the expression level was maintained before the model was maintained for 8 weeks.The protein expression at 4 weeks compared to that at 6 weeks and 8 weeks had significant difference(P ＜0.05).The protein expression in rat articular cartilage tissue at 6 weeks and 8 weeks had no significant difference (P ＞ 0.05).The expression trend of immunohistochemical detection protein was consistent with that of Western blot.Conclusion The animal model of OA can be established by using the method of medial collateral ligament dissection and medial meniscectomy.The expression level of MMP-13 and ADAMTS-5 in different stages of OA has changed significantly.Further research is needed to explore its related signaling pathways.
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BACKGROUND: Total knee arthroplasty is usually administered by intravenous and topical ways. The two ways have been the focus of research in reducing perioperative blood loss and blood transfusion rate. OBJECTIVE:To evaluate the effects of topical tranexamic acid versus intravenous tranexamic acid on blood loss and blood transfusion rate after total knee arthroplasty and analyze whether they increased the occurrence of postoperative thromboembolic events. METHODS: Electronic databases: PubMed, Embase, Cochrane library, Wanfang and CNKI from inception to 1 August 2016 were searched for studies on the use of tranexamic acid after total knee arthroplasty. The studies meeting the criteria were included. The quality of the included studies was evaluated. Extracted data were analyzed using Revman 5.3 software for meta-analysis. RESULTS AND CONCLUSION: (1) Twelve randomized controlled trials involving 1 159 patients (548 cases of topical application; 611 cases of intravenous injection)were included.(2)There were no significant differences in perioperative total blood loss(WMD=-4.22,95%CI:-10.87–2.43,P>0.05),postoperative drainage(MD=25.03,95% CI:-30.58-80.63,P>0.05),postoperative hemoglobin decline(MD=0.54,95%CI:0.11–0.98,P>0.05),blood transfusion rate(RR=1.15,95CI:0.82-1.61,P>0.05)and incidence of deep venous thrombosis(RR=1.22,95% CI:0.512.89,P>0.05).(3)The best timing for intravenous injection and optimal dose for topical application remain to be further verified.
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<p><b>BACKGROUND</b>This study aimed to evaluate the effects of standard rescue procedure (SRP) in improving severe trauma treatments in China.</p><p><b>METHODS</b>This study was conducted in 12 hospitals located in geographically and industrially different cities in China. A standard procedure on severe trauma rescue was established as a general rule for staff training and patient treatment. A regional network (system) efficiently integrating prehospital rescue, emergency room treatments, and hospital specialist treatments was built under the rule for information sharing and improving severe trauma treatments. Treatment outcomes were compared between before and 1 year after the implementation of the SRP.</p><p><b>RESULTS</b>The outcomes of a total of 74,615 and 12,051 trauma cases were collected from 12 hospitals before and after the implementation of the SRP. Implementation of the SRP led to efficient cooperation and information sharing of different treatment services. The emergency response time, prehospital transit time, emergency rescue time, consultation call time, and mortality rate of patients were 24.24 ± 4.32 min, 45.69 ± 3.89 min, 6.38 ± 1.05 min, 17.53 ± 0.72 min, and 33.82% ± 3.87% (n = 441), respectively, before the implementation of the standardization and significantly reduced to 10.11 ± 3.21 min, 22.39 ± 4.32 min, 3.26 ± 0.89 min, 3.45 ± 0.45 min, and 20.49% ± 3.11%, separately (n = 495, P < 0.05) after that.</p><p><b>CONCLUSIONS</b>Staff training and SRP can significantly improve the efficiency of severe trauma treatments in China.</p>
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Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Adulto Jovem , China , Serviços Médicos de Emergência , Padrões de Referência , Ferimentos e LesõesRESUMO
To report early efficacy and safety of the proximal femoral nail antirotation-Asia for intertrochanteric fractures in elderly Chinese patients. This retrospective study was carried out in the Second Hospital of Anhui Medical University, Anhui, China between June 2009 and December 2012. A total of 108 patients with intertrochanteric fractures were available for the outcome analysis in the study. There were 62 female and 46 male patients with a mean age of 75 +/- 10 years. The stable group included 18 cases of 31 A1 fractures, the unstable group included 68 cases of 31 A2 fractures, and 22 cases of 31 A3 fractures. Follow-up evaluations were performed at 1, 3, 6, 9, and 12 months, and every year thereafter. During the average 29 +/- 9 months early follow-up period, 4 patients [4%] were lost, and 6 patients [6%] died within 6 months due to causes unrelated to the fracture. Fracture union occurred in all patients, 83 patients [85%] showed an excellent, or good outcome. The mean Harris Hip Score was 85.2 +/- 7.5 points. Mechanical failures, such as bending, or breaking of the implant were not seen, and cut-outs were not observed. The results suggest that proximal femoral nail antirotation-Asia is effective and safe in the treatment of inter-trochanteric fractures in elderly Chinese patients
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<p><b>OBJECTIVE</b>To investigate the risk of hidden blood loss about applying rivaroxaban after total hip arthroplasty.</p><p><b>METHODS</b>From October 2009 to May 2012,88 patients with femoral head necrosis were treated with primary total hip arthroplasty. All the patients were divided into Rivaroxaban group(44 cases)and control group(44 cases). There were 25 males and 19 females in the Rivaroxaban group, with an average age of (58.48 +/- 15.19) years old; in the control group,24 patients were male and 20 patients were female, with an average age of (61.11 +/- 13.54) years old. The patients in the Rivaroxaban group took Rivaroxaban orally from the first day after operation with a dose of 10 mg each day, and treatment course was 14 days. The patients in the control group took placebo orally at the same time. Dominant blood loss and transfusion were recorded, blood routine examinations were taken before operation and at 3 days after operation. The total blood loss and hidden blood loss were calculated according to the formula.</p><p><b>RESULTS</b>The mean total blood loss was (1509.56 +/- 325.23) ml and the hidden blood loss was(581.47 +/- 215.01) ml, accounting for (37.88 +/- 10.42)% in the Rivaroxaban group. The mean total blood loss was (1262.30 +/- 397.95) ml and the hidden blood loss was (395.59 +/- 97.33) ml, accounting for (30.62 +/- 0.20)% in the control group. The total blood loss, hidden blood loss and transfusion in the Rivaroxaban group was significantly more than those in control group,b ut there was no significant difference on dominant blood loss between two groups.</p><p><b>CONCLUSION</b>Rivaroxaban increased the overall bleeding risk of total hip arthroplasty, especially hidden bleeding risk, which should be careful used.</p>