Effects of intraarticular tranexamic acid injection combined with 3-hour drainage tube occlusion postoperatively on blood loss in unicompartmental knee arthroplasty / 中国组织工程研究

BACKGROUND:Unicompartmental knee arthroplasty has become mainstream operation for treatment of unicompartmental osteoarthritis of the knee, but unicompartmental knee arthroplastystil has some problems, such as excessive bleeding-induced postoperative blood transfusion, increased blood transfusion rate, hospitalization expense and complication of blood transfusion. As tranexamic acid for total knee arthroplasty has achieved good effects. It is significant to investigate whether local application of tranexamic acid can effectively reduce blood loss in unicompartmental arthroplasty. OBJECTIVE:To investigate the efficacy and safety of the intra-articular tranexamic acid injection in treating perioperative blood loss in patients undergoing unicompartmental knee arthroplasty. METHODS:122 patients with knee osteoarthritis undergoing unicompartmental knee arthroplastyinthe Department of Orthopedics, the Second Affiliated Hospital ofDalian Medical University from January 2014 to August 2015wereenroled in this study. Al patients were randomly divided into two groups. Patients in the tranexamic acid group were injected with 10 mL of tranexamic acid (containing 1000 mg) + 10 mL of sodium chloride injection in the articular cavity before loosening the tourniquet. Patients in the control group received 20 mL of sodium chloride injection in the articular cavity. In both groups, the drainage tube was clipped for 3 hours after injection.At 48 hours after replacement, the drainage tube was puled out. We compared and analyzed hemoglobin levels and hematocrit at 2 days and 1 month postoperatively, total blood loss and drainage volume at 2 days postoperatively, the number of patients receiving blood transfusion, Hospital for Special Surgery scores of knee function at 1 week and 1 month postoperatively, and thrombosis at 1 week postoperatively, and evaluated effects of tranexamic acid on blood loss after unicompartmental knee arthroplasty. RESULTS AND CONCLUSION:(1) Hemoglobin levels and hematocrit were significantly higher in the tranexamic acid group than in the control group at 2 days postoperatively (P 0.05). (2) Drainage volume and total blood loss were significantly less in the tranexamic acid group than in the control group at 2 days postoperatively (P< 0.05). (3) The number of patients receiving blood transfusion was significantly less in the tranexamic acid group (0 case) than in the control group (6 cases) (P< 0.05). (4) Scores of Hospital for Special Surgery were significantly higher in the tranexamic acid group than in the control group at 1 week postoperatively (P< 0.05). No significant difference in above socres was identified between the two groups at 1 month postoperatively. (5) No venous thrombosis was found at 1 week postoperatively in both groups. (6) These results confirm that during knee medial unicompartmental arthroplasty, intra-articular injection of tranexamic acid combined with 3 hours of blood occlusion can effectively reduce drainage volume, perioperative blood loss, blood transfusion, is beneficial to the early recovery of knee jointfunction after replacement, and does not increase the risk of lower extremity deep venous thrombosis.

Application of cemented and cementless femoral prosthesis in hemiarthroplasty for patients with osteoporosis / 中国组织工程研究

BACKGROUND:Hemiarthroplasty is a proven method for reconstruction of the hip joint function, especialy for the elderly patients who cannot tolerate the total hip arthroplasty. However, for the patients with osteoporosis, there are stil more controversial in clinical practice about using cemented or cementless femoral prosthesis for hemiarthroplasty. OBJECTIVE: To observe the repair effect of cemented or cementless femoral prosthesis when were used for hemiarthroplasty in patients with osteoporosis. METHODS:The clinical data from 105 patients treated with hemiarthroplasty were retrospectively analyzed. Osteoporosis was diagnosed in these patients using the dual energy X-ray absorptiometry before surgery.Patients were divided into bone cement group (n=56) and cementless group (n=49) depending on different types of femoral stem prosthesis. The difference of efficacy between cemented or cementless femoral prosthesis when were used for hemiarthroplasty in patients with osteoporosis was analyzed by comparing the operative time, volume of drainage, post-operative Harris scores of hip joint function and radiographic assessment (prosthesis subsidence, osteolysis, severe stress shielding, heterotopic ossification) during the folow-up after the replacement. RESULTS AND CONCLUSION:In the process of hemiarthroplasty in patients with osteoporosis, the operative time in the cement group was significantly longer than that in the cementless group (P 0.05). At the 1, 3, 6 and 12 of folow-up after replacement, there were no significant differences in the Harris score of hip joint function, total effective rate and radiographic assessment between these two groups (P> 0.05). These results suggest that in the process of hemiarthroplasty in patients with osteoporosis, the clinical efficacy of cementless femoral prosthesis is similar to the cement femoral prosthesis, therefore two prostheses can al be selected; however, the operative time of the cement femoral prosthesis is longer than the cementless femoral prosthesis, so we can give priority to the cementless femoral prosthesis for patients with osteoporosis who can’t tolerate a long operative time because of the poor basic condition.

Surgical Treatment of Prolapse of Lumbar Intervertebral Disc and Segmental Instability / 中国康复理论与实践

@#Objective To evaluate the operative results of the prolapse of lumbar intervertebral disc and segmental instability.Methods37 patients with prolapse of lumbar intervertebral disc and segmental instability were treated surgically, including nucleus gelatinosus extirpation,!lumbar fusion and transpedicular screw fixation with an average 9-month follow-up after the operation.ResultsAfter the treatment, the completely spine arthrodesis was obtained in all cases. Of 37 cases, 28 cases showed excellent clinical results, 7 cases were good, 2 cases improved, and the total fineness rate was 95.6%.ConclusionIt is an effective therapy for patients with prolapse of lumbar intervertebral disc and segmental instability that fusing and fixing the lumbar with transpedicular screw after nucleus gelatinosus extirpation.

Experimental study of the compositive applying of nourishing Piyin Remedy and bovine brain extract on spinal cord injury of rats / 中国康复理论与实践

@# ObjectiveTo study the effect and mechanisms of nourishing Piyin Remedy (nPR) and bovine brain extract (bBE) on experimental spinal cord injury (SCI) of rat.Methods80 healthy SD rats were divided into 5 equal groups randomly: bBE group supplied through subarachnoid cavity, normal saline (NS) group supplied through subarachnoid cavity, nPR group, NS orally taken group, combined group. Animal models were made by Allen's equipment on T8～T9 segment. The spinal nerve function, somatosensory evoked potentials (SEP), retrograde and label technique of horseradish peroxidase, gross observation, histological and morphometric analysis were taken as the observed indices.ResultsThe values of observed indices of bBE group and nPR group improved evidently compared with their own control groups; that of combined group was prior to sole administration.ConclusionnPR can hold back the secondary SCI and accelerate the recovery of spinal nerve function; bBE can stimulate the improvement of injuried nerve fibers; the joint of nPR and bBE can make a synergic effect.

Preventing dura mater adhesion by continuous irrigation after laminectomy / 中国康复理论与实践

@#ObjectiveTo observe the effect of continuous irrigation on preventing dura mater adhesion after laminectomy.Methods30 New Zealand rabbits were used as the animal model. Laminectomy was performed in L 2 and L 6 segments of every rabbit respectively through two incisions. One incision was sutured directly, and as the control group. Irrigative pipe was put into the other incision as the irrigation group and continuously irrigating for 72 h. The animals were sacrificed at 4, 8 and 12 weeks postoperatively. The specimens were prepared for macroscopy, light microscopy, electron microscopy and computer image analysis.ResultsAt 12th week, macroscopy and light microscopy showed that in the control group epidural scar was dense and widespread, and adherent to dura tightly, but in irrigation group epidural scar was loose and limited, and adherent to dura scarcely. There was a significant difference between two groups (P<0.05). Electron microscopy showed that in control group the epidural tissue was mainly dense scar, and in irrigation group it was mainly fat tissue which mixed with a few of collagen fibers.ConclusionThe continuous irrigation has a preventive effect on adhesion of dura mater after laminectomy in rabbit.

Treatment of postoperative infection of lower extremity fracture with external fixation device combined with closed irrigation / 中国康复理论与实践

@#ObjectiveTo observe the clinical therapeutic effect of postoperative infection of fracture bone of lower extremity treated with external fixation device combined with closed irrigation.Methods32 patients of long bones fracture of lower extremities with postoperative infections were treated with composite external fixation device combined with focus clearance and continuing closed irrigation.ResultsThrough 1.5～3 years follow-up, there was no infection relapse in 31 extremities, 26 bones' fractures healed in half a year, there was no malunion such as crispation or angulation and there was no complication of serious anchylosis.ConclusionIt is an efficient way to treat postoperative infection of fracture bone of lower extremity with external fixation device combined with closed irrigation.

Experimental study of nourishing Piyin Remedy on rat with spinal cord injury / 中国康复理论与实践

@#ObjectiveTo study the therapeutic effect and mechanisms of nourishing Piyin Remedy (nPR) on experimental rat spinal cord injury.MethodsThirty-two healthy SD rats were divided into 2 equal groups randomly: nPR group and injured group. Animal model of incomplete injury of spinal cord was made by Allen's equipment on rat's T8—T9 segment. The spinal nerve function,SEP,retrograde and label technique of horse radish peroxidase,gross observation,histological and morphometric analysis were taken as the observed indices.ResultsThe value of observed indices of nPR group were improved evidently compared with injured group.ConclusionNourishing Piyin Remede can hold back the secondary spinal cord injury and accelerate the recovery of spinal nerve function.