Rivaroxaban and Low Molecular Weight Heparin Calcium to Prevent Deep Vein Thrombosis after Artificial Joint Replacement / 中国康复理论与实践

@# Objective To observe the effect of the rivaroxaban and low molecular weight heparin calcium to prevent deep vein thrombosis (DVT) after artificial joint replacement. Methods 167 patients included 114 cases for total hip arthroplasty and 53 cases for total knee replacement from Novermber, 2009 to October, 2010 were divided into two groups: observation group (n=84) was treated with rivaroxaban tablets, 6 h after surgery, 10 mg/d, 2 weeks for knee arthroplasty, 5 weeks for total hip arthroplasty; and control group (n=83) was treated with low molecular weight heparin calcium 2500 IU 2 h before and after surgery for 5 d. Ultrasonography was used to detect the deep vein lumen size change and DVT rate of bilateral lower extremities in all patients before and after surgery. Activated partial thromboplastin time (APTT) was tested before surgery, and 2 d, 5 d, 7 d, 14 d, 35 d after surgery. Results ① Incidence of DVT showed that there were 9 cases (10.7%) with DVT in the observation group; there were 15 cases with DVT (18.1%) in the control group. ② Lower limb deep vein lumen size change comparison: there were 23 cases (27.4%) with superficial femoral vein stenosis more than 2 mm in the observation group while 38 cases (45.8%) in the control group, there were 27 cases (32.1%) with popliteal veins stenosis more than 2 mm in the observation group and 47 cases (56.6%) in the control group (P<0.01). ③APTT: APTT prolonged >10 s was 0 in the observation group while 23 cases (27.7%) in the control group (P<0.01). Conclusion Trivaroxaban may prevent DVT after artificial joint replacement and be better than low molecular weight heparins calcium.

Expandable Intramedullary Nail in Unreamed Treatment of 31 Patients with Proximate Tibia Fracture / 中国康复理论与实践

@#Objective To evaluate clinical effect of expandable intramedullary nail in unreamed treatment of tibia fracture.Methods 31 patients with proximate tibia fracture were treated with expandable intramedullary nail and unreamed.Among those patients,4 cases were compound fracture,27 cases were closed fracture;16 cases were AO/ASIF type A,4 cases were type B and 11 cases were type C.The following-up of 9 months to 5 years(average 2 years) performed after operation.Results The fractures of 30 patients healed up and patients' functions recovered.1 case with comminuted and multiple fracture got delayed union.Conclusion Expandable intramedullary nail is an utility and satisfactory method to treat proximate tibia fracture.

Changes of Femoral Head Bone Metabolism Induced by Diabetes Mellitus / 中国康复理论与实践

@#Objective To explore the pathological changes of the femoral head bone metabolism induced by diabetes mellitus.Methods Seventy rabbits were divided into the control group and experiment group randomly. The control group were injected with saline; while the experiment group were injected with Alloxan through ear-edge vein quickly to establish the immediate diabetes mellitus model. The histopathology, ultrastructure, biochemistry, hemorrheology, and platelet function of all animals of two groups were detected in different periods.Results In the experiment group, 2 animals' bone trabecula were found disorder and vacant bone lacuna was 14% in the 4th week; in the 8th week, 3 animals' part bone trabecula were found breakage, defluxion, vacant bone lacuna was 28%; in the 12th week, 5 animals' bone trabecula were found breakage, defluxion obviously, vacant bone lacuna was 56%. Under TEM, there was some lipid droplet in bone cells, bone cellular necrotized at different levels. Myelosis decrease, the number and diameter of adipose cell increased. In the 8th and 12th week, the content of serum calcium decreased and that of serum phosphorus increased in the experiment group compared with the control group ( P<0.05, P<0.0l), and the product of calcium and phosphorus of the experiment group in the 12th week was lower than that of the control group (P<0.05).Conclusion DM can cause osteoporosis. Capillary fracture happens in the arch bridge structure of femoral head under machine press while being pressed. Along with the course of DM process, capillary fracture accumulates, bone under cartilage compress and collapse. It can oppress bone capillary to cause ischemia. All factors result in the basic pathology and the primary pathogenesy of the femoral head.

Bionic bone implantation combined with limited contracted titanium net duct on the repairment of rabbit bone defect / 西安交通大学学报(医学版)

Objective To investigate the effect of MHA-bBMP implantation combined with limited contacted titanium net duct fixation on femoral shaft bone defect in rabbits.Methods A total of 48 rabbits were divided into experimental group(treated with bionic bone MHA-bBMP plus titanium net duct) and control group(treated with iliac autograft plus titanium net duct).The rabbit femoral shaft bone defect model was established by cutting 10mm bone fragment off.After operation,bionic bone MHA-bBMP/iliac autograft was implanted into the bone defect area and fixed with limited contacted titanium net duct.The general condition,serum alkaline phosphates,X-ray,histopathologic and electron microscopic examinations were performed.Results The fixation stability of titanium net duct in the two groups was good.The bone defect in the two groups was repaired.The phosphates,X-ray,histopathologic and electron microscopic examinations in the two groups were not significantly different.Conclusion The limited contacted titanium net duct can provide a reliable fixation effect on the graft and bone defect ends.Induction bone formation activity of MHA-bBMP is comparable to the iliac autograft.