Risk factors and preventions of total hip replacement and total knee replacement / 国际外科学杂志

Total joint replacement (e.g.total hip replacement,total knee replacement) is one of the most common and most successful orthopaedic procedures.Infection after total joint arthroplasty is a devastating complication that causes pain and dysfunction,increases the cost.It is important to prevent postoperative infection.There are preoperative,perioperative and postoperative risk factors of total joint replacement,and preventions should base on these risk factors.This article reviews muhiple preoperative,perioperative and postoperative risk factors of postoperative infection and the preventions based on these risk factors.

Diagnostic value of plasma D-dimer and fibrinogen in acute lower extremity deep vein thrombosis after artificial joint replacement / 中华骨科杂志

Objective To evaluate diagnostic value of plasma D-dimer (D-D),fibrinogen (Fg) and Ddimer/fibrinogen (D/F) ratio in acute lower extremity deep vein thrombosis (DVT) after artificial joint replacement.Methods From August 2009 to December 2011,273 patients who had undergone total hip arthroplasty (THA) or total knee arthroplasty (TKA) underwent venography of lower extremity deep vein at 35 days postoperatively.According to results of angiography,all patients were divided into DVT group including 66 patients (15 males and 51 females,median age 66 years) and non-DVT group including 207 patients (70 males and 137 females,median age 63 years).Plasma levels of D-D and Fg were measured by immunoturbidimetry and solidification methods respectively preoperatively and at 3-5 days postoperatively.The differences of plasma levels of D-D and Fg and D/F ratio between the two groups were analyzed with statistical method.Furthermore,diagnostic value of postoperative plasma D-D and D/F ratio in acute DVT was assessed using a receiver operating characteristic (ROC) curve.Results There was no statistical significance in preoperative plasma levels of D-D and Fg,and postoperative plasma levels of Fg between two groups.However,the postoperative plasma levels of D-D and D/F ratio were higher in the DVT group than those in the nonDVT group,and there was significant difference between two groups.In addition,the ROC curve analysis showed that the area under curve of postoperative plasma D-D and D/F ratio was 0.688 and 0.684,respectively,but this difference did not reach statistical significance.Conclusion Plasma Fg may be meaningless for the diagnosis of acute DVT after artificial joint replacement.Although plasma D-D and D/F ratio may be useful for diagnosing acute DVT,the diagnostic accuracy is low.

Extraforaminal lumbar disc herniation: anatomical study and surgical treatment / 中华外科杂志

<p><b>OBJECTIVES</b>To provide the anatomical basis for surgical treatment of extraforaminal lumbar disc herniation (EFLDH) by paraspinous muscle splitting approach and to investigate the effect of its application.</p><p><b>METHODS</b>The relationship among the intertransverse processes, lateral margin of the pars interarticularis, anterior ramus of the lumbar nerve, and anterior ramus of the lumbar artery was studied in 34 cadaveric specimens. From October 1993 to October 1999, eleven cases of extraforaminal lumbar disc herniation were treated by paraspinous muscle splitting approach and retroperitoneal approach.</p><p><b>RESULTS</b>In the extraforaminal region, the anterior ramus of the lumbar artery and venus locate ventrally to the superior half of the intertransverse space, and the anterior ramus of the lumbar artery runs downward behind the nerve. The distance from the lateral margin of the pars interarticularis to the nerve root and the angle between the nerve root and midline sagittal plane were 1.0 - 2.0 cm and 7 degrees - 25 degrees respectively which increased gradually from L(1) to L(5). The period of follow up in 10 of 11 cases was 23 - 98 months. Evaluation according to Low Back Outcome Score showed excellent results in 8 cases, and good in 2.</p><p><b>CONCLUSION</b>Surgical treatment of EFLDH by paraspinous muscle splitting approach is safe, effective and minimal invasive.</p>

The measurement of the posterior condylar angle in distal femur with clinical application in adult / 中华骨科杂志

Objective To investigate the posterior condylar angle(PCA) of distal femur in normal adult, and provide reasonable referenced parameters of the rotational alignment for the total knee arthroplasty in Chinese. Methods This study concluded 118 volunteers(186 knees) in Suwan area (67 males 103 knees, and 51 females 83 knees), whose knees were healthy, without any malformation. The average age was 39.7 years(range, 18-69 years). All subjects were divided into three groups according to the ages: group A, 18-39 years (85 knees); group B, 40-59 years(73 knees); group C, more than 60 years(28 knees). The CT scan was employed to the mechanical axis which was perpendicular to the knee joint in the distal femur. The PCA was measured from the CT film across lateral and medial femoral epicondyle. The factorial design was used to compare the data among three groups. Results First, in the 103 knees of male, 57 in left side and 46 in right side. The PCA were 5.9??1.6? in left side, 5.6??2.6? in right side(mean, 5.8??2.2?). Then in the 83 knees of female, 38 in left side and 45 in right side, the PCA was 5.5??2.5? in left side, 5.2??1.5? in right side(mean, 5.3??1.9?). And the PCA was 5.5??1.9? in group A, 5.7??1.8? in group B, 5.5??2.7? in group C, respectively, and there is no statistical significant difference in either gender or side and age. Conclusion The normal adult PCA of distal femur is 5.6??2.1? in Suwan area, without difference in gender, which is beyond the Westerns obviously. So in the total knee arthroplasty of Chinese, the malalignment will likely occur if the rotational alignment is performed according to Western style, the eversion 3? to the posterior condylar line in distal femur.