Effect of posture on total hip arthroplasty through direct anterior approach / 中国骨伤

OBJECTIVE@#To investigate the effect of different postures on direct anterior approach(DAA) total hip arthroplasty.@*METHODS@#Total of 94 patients who underwent DAA total hip arthroplasty from July 2016 to June 2020 were retrospectively analyzed. They were divided into two groups according to different positions during the operation, including 45 cases in lateral position and 49 cases in supine position (with the aid of stent). The general data such as gender, affected limb, body mass index(BMI), incision length, operation time, intraoperative bleeding volume, drainage volume 24 hours after operation, hemoglobin difference before and after operation, first landing time after operation, postoperative hospitalization time, postoperative complications, visual analogue scale(VAS) at 1 day, 1, 2 weeks, 1, 3 and 6 months after operation, Harris score at 1, 2 weeks, 1, 3 and 6 months after operation were observed and compared between the two groups.@*RESULTS@#Patients in both groups were followed up for 6 to 12 months with an average of (8.31±2.22) months. There was no significant difference between two groups in gender, affected limb, age, height, weight, body mass index(BMI), preoperative VAS score and preoperative Harris score(P>0.05). The incision length, operation time, intraoperative bleeding volume, 24-hour drainage volume, hemoglobin difference before and after operation, first time to the ground and postoperative hospitalization time of patients in supine position (assisted by stent) group were all better than those in lateral position group(P<0.05);There was no significant difference in the number of blood transfusions during and after operation(P=0.550). There was no significant difference in anteversion angle and abduction angle in the supine position(with the aid of stent) group during and after operation (P=0.825, P=0.066);There was significant difference in anteversion angle and abduction angle in the lateral position group during and after operation(P<0.05). VAS of patients in supine position (assisted by stent) group were lower than those in lateral position group at 1 day, 1, 2 weeks and 1 month after operation(P<0.05), and there was no statistical difference between two groups at 3 and 6 months after operation(P>0.05). Harris scores of patients in supine position(assisted by stent) group were higher than those in lateral position group at 1 week, 1 month and 3 months after operation(P<0.05), and there was no significant difference between two groups at 6 months after operation(P>0.05).@*CONCLUSION@#Compared with the lateral position, the supine position DAA total hip arthroplasty has the advantages of small incision, short operation time, less bleeding, early landing time, short hospitalization time, and small intraoperative acetabular cup position judgment error. It has the advantage of fast postoperative recovery, but the recovery of hip joint function is the same after 6 months.

Efficacy and safety of tranexamic acid in total hip arthroplasty via direct anterior approach / 中国骨伤

OBJECTIVE@#To evaluate the efficacy and safety of local application of tranexamic acid (TXA) in reducing perioperative blood loss in total hip arthroplasty via direct anterior approach (DAA).@*METHODS@#From July 2013 to September 2018, 46 patients with avascular necrosis of the femoral head were divided into tranexamic acid group (@*RESULTS@#The incision healed well and no obvious complications occurred in the two groups. All patients were followed up for 12 to 59 months(averaged 31.11 months). No hip pain was found in the follow-up patients. Hip joint function was improved effectively and no prosthesis loosening occurred. The total perioperative blood loss in tranexamic acid group and normal saline group was(740.09±77.14) ml and (1 069.07±113.53) ml respectively, 24 hours after operation, the drainage volume was (87.61±9.28) ml, (233.83±25.62) ml, the hidden blood loss was (409.65±38.01) ml and (588.33±57.16) ml. the difference of hemoglobin before and after operation was (24.78±2.19) g / L and (33.57±2.95) g / L, the difference was statistically significant (@*CONCLUSION@#local application of tranexamic acid in total hip arthroplasty through direct anterior approach can safely and effectively reduce perioperative blood loss, and does not increase the risk of thrombosis, and does not affect the normal recovery of joint function.

Percutaneous kyphoplasty for the treatment of osteoporotic vertebral compression fracture with degenerative scoliosis / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the therapeutic effects of percutaneous kyphoplasty (PKP) for the treatment of osteoporotic vertebral compression fracture (OVCF) with degenerative scoliosis.</p><p><b>METHODS</b>From March 2009 to March 2014,121 patients undergoing PKP for the treatment of osteoporotic vertebral compression fracture (OVCF) with degenerative scoliosis were retrospective analyzed. There were 41 males and 80 females,ranging in age from 56 to 92 years with an average of 73.2 years. Preoperative and postoperative 3 d respectively pain visual analogue scale (visual analogue score, VAS) and Oswestry Disability Index assessed pain and functional recovery of patients and preoperative and postoperative 3 d lumbar lordosis, scoliosis Cobb angle were analyzed.</p><p><b>RESULTS</b>All the patients were followed up, and the duration ranged from 6 to 24 months, with a mean time of 11 months. All the patients achieved success in operation without serious complications. The operation time ranged from 30 to 65 min with an average of 42.2 min. Local leakage of bone cement was not found in canal. The VAS and Oswestry Disability Index at the 3rd day after operation decreased significantly compared with those of the preoperative (P < 0.05), and the lumbar lordosis and scoliosis Cobb angle also improved significantly compared with those of the preoperative (P < 0.05).</p><p><b>CONCLUSION</b>Percutaneous kyphoplasty (PKP) for the treatment of thoracolumbar scoliosis osteoporotic fracture can significantly improve patients spinal deformity, pain relief, which is worth of recommending.</p>

Observation of clinical effects of surgery for trailing edge fracture of tibial plateau medial condyle and posterior cruciate ligament avulsion fracture / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the clinical effects of enblock distal radius T-plate fixation in treating trailing edge fracture of tibial plateau medial condyle and posterior cruciate ligament (PCL) avulsion fracture.</p><p><b>METHODS</b>From September 2008 to November 2011, 5 patients with trailing edge fracture of tibial plateau medial condyle and PCL avulsion fracture caused by knee joint hyperextension,were treated with surgery. There were 3 males and 2 females with an average age of 35 years old (25 to 42). Left knee injury was in 3 cases and right knee had in 2 cases; 2 cases caused by sports injury and 3 cases caused by road accident. All patients were undergone emergency treatment. Fractures were anatomically reduced and fixed with T-plate through poples approach. Complications were observed after operation. Bone healing and clinical effects were respectively evaluated by X-rays and HSS system.</p><p><b>RESULTS</b>Five patients were followed up for 1 to 4 years with a mean of 2 years. All incisions obtained healing of I stage. All knee joints recovered well and were stable with inflexion more than 120 degrees, no complications such as knee joint pain, injuries of nerve and blood vessel, infection, internal fixation failure were found. The mean score of HSS system was 94.40 +/- 6.09 and all patients got excellent result.</p><p><b>CONCLUSION</b>For the treatment of trailing edge fracture of tibial plateau medial condyle and PCL avulsion fracture caused by knee joint hyperextension, enblock distal radius T-plate fixation had advantages of good stability,higher success rate, and knee joint function can recover well.</p>

Clinical effects of steel plate fixation for the failure of arthrodesis of ankle by screw fixation / 中国骨伤

<p><b>OBJECTIVE</b>To observe the therapeutic effects of steel plate fixation after the failure of arthrodesis of ankle by screw fixation.</p><p><b>METHODS</b>From August 2001 to October 2011, 15 patients were with steel plate fixation after failure of arthrodesis of ankle by screw fixation. Among patients, 9 cases were males and 6 cases were females,ranging age from 40 to 65 years old with the average of 56 years old. Ten cases were in left and 5 cases were in right. Screws were removed and steel plate was fixed intraoperatively, and plaster external fixation for postoperation. Clincal effect were evaluated according to AOFAS scoring system from pain, waliking ability and aligment before and after operation, and X-ray was used to evaluate joint fusion after operation.</p><p><b>RESULTS</b>All patients were followed up, and the duration ranged from 4 months to 4 years with an average of 2 years. The incison were healed in stage I. No ankle pain,injury of blood vessel and nerve,infection and farilure of internal fixation occuerred. The AOFAS score increased from 36.86 +/- 8.32 preoperatively to 85.09 +/- 4.65 (t = -26.366, P = 0.000).</p><p><b>CONCLUSION</b>Steel plate fixation after the failure of ankle arthrodesis of screw fixation has the advantages of rigid stability, simple manipulation and high success rate, less pain, perfect recovery.</p>

Case-control study on ultra-early application with intermittent pneumatic compression to prevent postoperative deep venous thrombosis of intertrochanteric femoral fracture in elderly patients / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the clinical effects of ultra-early application with intermittent pneumatic compression (IPC) in preventing postoperative lower limbs deep venous thrombosis (DVT) of intertrochanteric fractures in elder patients.</p><p><b>METHODS</b>From May 2008 to May 2010, 80 patients with intertrochanteric fractures were randomly divided into ultra-early group and postoperative group. In ultra-early group, there were 21 males and 19 females, ranging in age from 67 to 86 years with an average of (76.4 +/- 13.27) years; in postoperative group, there were 26 males and 14 females, ranging in age from 68 to 89 years with an average age (75.8 +/- 12.71) years. IPC was respectively used at the 3rd day before operation (ultra-early group) and postoperative that day (postoperative group). Serum D-dimer of all the patients were measured at the 3rd day before operation and at the 3rd, 7th,14th days after operation. Lower limbs DVT were observed by ultrasound at the 3rd, 14th days postoperatively. Perioperative bleeding volume of patients were compared between two groups.</p><p><b>RESULTS</b>There was no statistical difference in the serum D-dimer concentration and lower limbs DVT between two groups at the 3rd day before operation (P > 0.05). There was no statistical difference in perioperative bleeding volume between two groups (P > 0.05). In ultra-early group, Serum D-dimer concentration at the 3rd, 7th days after operation was respectively (351.00 +/- 104.34), (412.31 +/- 106.95) microg/ml; and in postoperative group, the item was respective (419.34 +/- 145.38), (509.16 +/- 146.05) microg/ml; serum D-dimer concentration in ultra-early group was lower than postoperative group (P < 0.05). There was no significant differences in serum D-dimer concentration at the 14th day after operation between two groups (P > 0.05). Incidence of DVT in postoperative group was 22.5%, which was higher than that of ultra-early group at the 14th day after operation (P < 0.05). There was no significant differences at the 3rd day after operation between two groups (P > 0.05).</p><p><b>CONCLUSION</b>Compared with postoperative application with IPC, ultra-early application with IPC could reduce the level of serum-dimer and the incidence of DVT without increase perioperative blood of intertrochanteric fracture in elder patients.</p>

Experimental study on invigorating kidney and activating blood on preventing and curing SD rats with knee osteoarthritis / 中国骨伤

<p><b>OBJECTIVE</b>To explore the effects and mechanism of invigorating kidney and activating blood, invigorating kidney and expelling wind on hemorheology, IL-1β and TNF-α of SD rats with knee osteoarthritis, then definite the evolution of muscle certified turning into heumatism and compare the effect of Chinese herbal.</p><p><b>METHODS</b>One hundred and eighty SD rats with 3-month-old (each weight was 185 to 215 g) received intra-articular injection of papain solution for establishing knee OA models. All rats were randomly divided into activating blood group, preventing group, expelling wind group, invigorating kidney group, invigorating kidney and activating blood group and model group. Laboratory indexes were obtained at the 30th, 60th, 90th days after gastric perfusion, which including state of mind, activity, fur, weight, joint swelling, largely image, hemorheology, inflammation and HE pathological appearance.</p><p><b>RESULTS</b>After operation, rats appeared blood stasis and swelling and difficulty crawling. There was significant difference of hemorheology in invigorating kidney and activating blood group the content of IL-1β and TNF-α was obviously lower than model group (P < 0.05 ). While the content of IL-1β and TNF-α on the early stage was obviously higher than late stage (P < 0.05).</p><p><b>CONCLUSION</b>Knee osteoarthritis mainly show synovial inflammation at the early stage, inflammation at early stage is more severe than late; invigorating kidney and activating blood decoction can inhibit the knee cartilage injury, improve blood circulation and prevent local inflammatory reaction. Activating blood decoction and invigorating kidney and activating blood Decoction have certain curative effect in early time, but the effects of invigorating kidney and activating blood Decoction is more effective than other on the late stage.</p>

Research on the role of metabolism of fatty substance and osteoclast activity during the development of steroid-induced necrosis of femoral head / 中国骨伤

<p><b>OBJECTIVE</b>To explore the role of metabolism of fatty substance and osteoclast activity during the process of steroid-induced necrosis of femoral head through mice model inducing and model index measurement.</p><p><b>METHODS</b>Forty SD male mice were divided into 2 groups randomly, the control group and the experiment group. After the gluteal injection of colibacillus endotoxin,the experiment group was given gluteal injection of prednisolone acetate 35.5 mg/kg per week, and 2 ml of normal saline to the control group. The mice were killed 12 weeks later and tested the content of Trap-5b, TC and TG of the blood serum. Vitodynamics, bone density were measured and sections of HE staining, Ca2+ and TRACP staining was made then statistic analysis was performanced.</p><p><b>RESULTS</b>The content of TC, TG and Trap-5b increased apparently (P < 0.01). Large amount of osteoclasts were found in local medullary cavity. There was severe bone loss and decrease of vitodynamics in subchondral bone (P < 0.01) in experiment group.</p><p><b>CONCLUSION</b>Metabolic disorder of fatty substance is the key pathogenesis of steroid-induced avascular necrosis of femoral head. Decrease of vitodynamics in subchondral bone due to hyperactivity and increase of osteoclast lead to collapse of femoral head directly.</p>

The selection of responsible veterbal body in PKP (percutaneous kyphosis plasty) for aged osteoporotic spinal multiple fracture / 中国骨伤

<p><b>OBJECTIVE</b>Through an analysis of the effect of PKP (percutaneous kyphosis plasty) for aged osteoporotic spinal multiple fracture to demonstrate the importance of the selection of responsible veterbal body.</p><p><b>METHODS</b>Twenty-four consecutive procedures were performed in 19 aged patients with osteoporotic spinal compression fractures from May 2004 to October 2007. The 24 responsible veterbal bodies were confirmed by the manifestations of MRI, X-ray, physical examination before the procedures. Established work path through hibateral vertebral arch, put into saccule, poured in bone cement under X-ray perspective. To observe the condition about symptom improving, fractured reduction and complications after operation.</p><p><b>RESULTS</b>The operations were successfully completed and the pain released obviously at 2 days after operation. The patients can walk next day after operation and no complication found. The mean loss percent of the anterior and middle vertebal heights were respectively (34.22 +/- 11.51)% and (26.53 +/- 11.61)% before operation,postoperative were respectively (13.21 +/- 11.43)% and (15.10 +/- 6.50)%. The mean kyphosis corrected from (24.50 +/- 3.10) degrees to (8.70 +/- 4.30) degrees; the VAS scores decreased from 83.00 +/- 6.00 to 27.00 +/- 5.00. There was significant difference between before and after operation (P < 0.01).</p><p><b>CONCLUSIONS</b>PKP for aged osteoporotic spinal multiple fractures by selecting true veterbal body has satisfactory clinical efficacy. We should emphasize the importance of the selectivity of responsible veterbal body in the procedures. It needs three essential elements: (1) Obviously spinous process tenderness and rap pain. (2) X-rays showed veterbal body compression fracture; MR showed low signal in veterbal body by T1WI, and high signal by T2WI, STIR. (3) The manifestation of radiology can be explained clearly by clinical symptomes arid signs.</p>

Three-tunnels core decompression with implantation of bone marrow stromal cells (bMSCs) and decalcified bone matrix (DBM) for the treatment of early femoral head necrosis / 中国骨伤

<p><b>OBJECTIVE</b>To analyse retrospectively 3-tunnels core decompression with implantation of bone marrow stromal cells(bMSCs) and decalcified bone matrix (DBM) for treatment of femoral head necrosis in early stages, and to study its therapeutic results and indications.</p><p><b>METHODS</b>According to the University of Pennsyvania system of classification and staging,to treat the patients with 3-tunnels core decompression with implantation of bone marrow stromal cells (bMSCs) and decalcified bone matrix (DBM) for treatment of early femoral head necrosis. Among the total 87 patients (103 hips), the male was 71 (86 hips) and the female 16 (17 hips) with the average age of 47 years old. The average course of disease was 1.3 year. The effect was evaluated by the clinical symptoms, the Harris' scores and the manifestations of radiology before and after operation.</p><p><b>RESULTS</b>All the patients were followed up more than 2 years (average 26 months). The average Harris' scores increased from preoperation 47.3 to postoperation 74.0. The average rate of excellent and good results was 75.7%. The rate of excellent and good was 88% (22/25) in type I, 78.7% (37/47) in type II and 61.3% (19/31) in type III. No severe complications were observed.</p><p><b>CONCLUSION</b>Three-tunnels core decompression with implantation of bMSCs and DBM not only removal the focus of disease, but also use DBM the induction of bone and autologous hone marrow stem cells to differentiate the functions of the femoral head can be resumed loading structure, eliminate pain,improve joint function. It is an effective method for early femoral head necrosis.</p>

Experimental study on treatment of femoral head necrosis with arterial perfusion of marrow stem cells / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To explore the effect of arterial perfusion of marrow multifunctional stem cells (MFSC) in treating femoral head necrosis and its mechanism.</p><p><b>METHODS</b>The rabbit model of femoral head necrosis was established by large dose of methyl-prednisone through Shwartzman response. Bone marrow was extracted from femoral bone of model rabbit and isolated in vitro for culturing and proliferating MFSC. The experimental rabbits were randomly divided into 4 groups, treated with normal saline (A), Salvia + urokinase (B), MFSC (C) and MFSC + Salvia + urokinase (D), respectively, they were sacrificed in batches at 2 and 4 weeks after treatment, and changes in various parameters, including molybdenum target roentgenogram, routine pathology with HE staining, tetracycline labeled fluorescent microscopy and ultrastructure alteration by scanning electron microscope (SEM), were observed.</p><p><b>RESULTS</b>Typical appearance of femoral head necrosis was shown in the successfully modeled rabbits. Two and 4 weeks after treatment by high selective drug via medial and lateral femoral circumflex arterial perfusion, the X-ray examination showed significant improvement of bone density; pathohistologic manifestation showed decrease of empty bone lacuna, increase of osteoblast and new bone formation; tetracycline fluorescent labeled microscopic picture showed bright fluorescent band of increased osteoblasts in necrosis repairing region with widened border; SEM displayed irregularly arranged fibrosis in necrosis region, abundant organelles in osteoblasts with few empty bone lacuna. The above-mentioned improvement was more significant in rabbits treated by MFSC.</p><p><b>CONCLUSION</b>High selective femoral drug arterial perfusion in treating femoral head necrosis could accelerate the process of revascularization and re-ossification in rabbits. As compared with Salvia, MFSC showed quicker and more potent effect.</p>