Clinical application of LARS artificial ligament in anterior cruciate ligament reconstruction: an update / 中华创伤杂志

The anterior cruciate ligament (ACL) is one of the most crucial components to maintain knee joint stability and also the most vulnerable structure during knee-related sports activities. ACL injuries often cause knee instability, difficulty in returning to sports, and secondary degenerative knee disease. Although using autograft to reconstruct the ACL is currently a popular choice in clinical settings, it has drawbacks such as limited autograft source, donor site morbidity and delayed return to sports. Ligament advanced reinforcement system (LARS) artificial ligament possesses unique advantages such as wide availability, no donor-site morbidity, and early recovery, avoiding the problems associated with autograft reconstruction of ACL, and it has drawn increasing attention in recent years. In this paper, the authors reviewed the characteristics of LARS artificial ligament and its application in ACL reconstruction, so as to provide reference for clinical treatment of ACL injuries.

Research progress of knee meniscal repair techniques / 中国修复重建外科杂志

OBJECTIVE@#To review the research progress of meniscus repair in recent years, in order to provide help for the clinical decision-making of meniscus injury treatment.@*METHODS@#The domestic and foreign literature related to meniscal repair in recent years was extensively reviewed to summarize the reasons for the prevalence of meniscal repair, surgical indications, various repair methods and long-term effectiveness, the need to deal with mechanical structural abnormalities, biological enhancement repair technology, rehabilitation treatment, and so on.@*RESULTS@#In order to delay the occurrence of osteoarthritis, the best treatment of meniscus has undergone an important change from partial meniscectomy to meniscal repair, and the indications for meniscal repair have been expanding. The mid- and long-term effectiveness of different meniscal repair methods are ideal. During meniscus repair, the abnormality of lower limb force line and meniscus protrusion should be corrected at the same time. There are controversies about the biological enhancement technology to promote meniscus healing and rehabilitation programs, which need further study.@*CONCLUSION@#Meniscal repair can restore the normal mechanical conduction of lower limbs and reduce the incidence of traumatic osteoarthritis, but the poor blood supply and healing ability of meniscal tissue bring difficulties to meniscal repair. Further development of new biological enhanced repair technology and individualized rehabilitation program and verification of its effectiveness will be an important research direction.

All-inside versus full-tibial tunnel techniques of anterior cruciate ligament reconstruction: a systematic review and meta-analysis / 中华骨科杂志

Objective:To compare the clinical efficacy of arthroscopic all-inside technique versus full-tibial tunnel technique for anterior cruciate ligament (ACL) reconstruction.Methods:Literature on all-inside versus full-tibial tunnel for ACL reconstruction was retrieved from databases including China National Knowledge Infrastructure (CNKI), Wanfang Data, Full-text Database of Chinese Medical Journals, PubMed, Web of Science, and Cochrane Library from their establishment to February 2023. Meta-analysis was performed on the included studies. Random effects model was used if heterogeneity was large, while fixed effects model was used if heterogeneity was small.Results:A total of 13 studies with 511 cases in the all-inside group and 465 cases in the full-tibial tunnel group were included in the meta-analysis, with a mean follow-up of 6-25.8 months. Meta-analysis showed that the graft diameter [ MD=0.42, 95% CI (0.11, 0.73), P=0.007] and International Knee Documentation Committee (IKDC) subjective score [ MD=1.11, 95% CI (0.36, 1.86), P=0.004] of the all-inside group was larger than full-tibial tunnel group, and the tibial tunnel widening of the all-inside group was less than full-tibial tunnel group [ MD=-1.70, 95% CI (-2.38, -1.01), P<0.001]. There were no significant differences in IKDC objective score [ OR=1.09, 95% CI (0.67, 1.78), P=0.730], Lysholm score [ MD=0.99, 95% CI (-0.08, 2.05), P=0.070], Tegner activity score [ MD=-0.01, 95% CI (-0.48, 0.45), P=0.950], bilateral knee anterior laxity difference [ MD=0.32, 95% CI (-0.22, 0.86), P=0.250], negative rate of pivot shift test [ OR=0.80, 95% CI (0.33, 1.91), P=0.610], graft re-rupture rate [ OR=0.76, 95% CI (0.34, 1.74), P=0.524] and return to sport rate [ OR=1.56, 95% CI (0.85, 2.86), P=0.150]. Conclusion:All-inside ACL reconstruction provides satisfactory efficacy. Compared with full-tibial tunnel technique, it has the advantages of larger graft diameter and less tibial tunnel widening, with no difference in joint function within 2 years postoperatively.

Methods of reducing the "killer turn" effect in the posterior cruciate ligament reconstruction / 中华骨科杂志

The reconstruction of the posterior cruciate ligament (PCL) through the tibial tunnel is the most commonly used reconstruction technique after ligament injury.However, when the graft passes through the tibial tunnel back to the medial condyle of the femur, a sharp angle is formed at the proximal end of the tibia, called the "killer turn". The existence of the "killer turn" can lead to graft wear and expansion of adjacent tibial tunnel after PCL reconstruction, affecting the stability of the posterior knee joint after operation and even leading to the failure of operation. There are several techniques, such as modifified tibial tunnel technique which the proximal exit of tibial tunnel is located in the inferior and lateral aspect of the PCL tibial anatomic insertion site, increasing the angle between the tibial tunnel and the tibial plateau, creating a tibial tunnel from the anterior lateral side of the tibia, remnant preserving as soft tissue cushion, and inlay and onlay techniques for reconstructing PCL without using tibial tunnel reconstruction, can reduce the "killer turn" effect. The above 6 techniques, theoretically, can effectively reduce or eliminate the "killer turn" effect and improve the posterior stability of the knee joint after PCL reconstruction, so as to improve the clinical efficacy of PCL reconstruction. But, the number of cases using these techniques is relatively small, and their effectiveness, reliability, and advantages and disadvantages for patients still need more clinical practice to further explore and verify.

Causes analysis and coping strategies of posterior laxity after posterior cruciate ligament reconstruction / 中华骨科杂志

It is difficult to maintain the initial posterior stability of the knee after posterior cruciate ligament reconstruction. Residual posterior knee laxity after operation is a problem of PCL reconstruction. It not only results in abnormal kinematics of the knee, but also leads to secondary meniscus injury and cartilage degeneration of the affected knee, and eventually leads to knee osteoarthritis, which may especially happen with persistent and severe posterior laxity. The main reasons of residual posterior knee laxity after PCL reconstruction are: improper treatment of the posterolateral corner injury, poor positioning of the femoral tunnel, small tibial slope, and unreasonable postoperative rehabilitation. There are some concepts and technologies, such as using artificial ligaments, tibial tunnel fixation with suspensory device or suspensory device combined with interference screws, enlargement of graft diameter, all-inside reconstruction combined suture augmentation, slow and gradual postoperative rehabilitation, which can eliminate or reduce the postoperative residual laxity, in order to improve clinical outcomes after PCL reconstruction. For the patients with flat tibial slopes, double-bundle PCL reconstruction and concurrent slope-increasing tibial osteotomy is suggested. It can reduce the risk of posterior laxity and improve the stability of the knee after operation.

All-inside anterior cruciate ligament reconstruction: a review of development, evolution and clinical significance / 中华骨科杂志

Rupture of anterior cruciate ligament (ACL) is one of the most common sports injuries of the knee, which may cause limitation of motor function and degeneration of the knee, seriously affecting patients' living quality. Currently, arthroscopic ACL reconstruction (ACLR) has been identified as the gold standard for ACL rupture. In an effort to further increase surgical accuracy and decrease surgical trauma so as to promotes quick recovery, all-inside ACLR has gained increasing attention in recent years. All-inside ACLR is as effective as traditional reconstruction, but it has benefits such as the preservation of tendons, preservation of bone mass, reduction of postoperative pain, prevention of synovial fluid leakage, expansion of the tendon-bone healing area, avoidance of complications related to extrusion screws, and suitability for children and adolescents. However, applying of numerous novel techniques for all-inside ACLR increases the learning curve, operating time, and cost. Besides, improper bone tunnel fabrication and graft fixation may lead to the widening of the bone tunnel, affecting the surgical effect. Therefore, in order to provide a theoretical foundation for further promoting the clinical application of this technique, this article reviews the development, evolution, and clinical outcomes of this technique as well as its advantages and disadvantages.

Advances in anterolateral ligament reconstruction: clinical practice and controversy / 中华骨科杂志

Rupture of the anterior cruciate ligament (ACL) is one of the most frequent forms of knee sports injuries. Nowadays, ACL reconstruction is commonly performed to help patients restore their rotational stability. However, in patients with high risk factors, the risk of ACL reconstruction failure remains high, primarily because of continuous postoperative anterolateral rotational instability. This rotational instability after ACL reconstruction has prompted researchers to focus on the anterolateral complex of the knee, such as iliotibial tract and anterolateral ligament (ALL). Among them, ALL has remained largely unappreciated for more than a century since its discovery in 1879. Even though it is still controversial, most studies in recent years have supported the anterolateral ligament as an independent ligament and a crucial anatomical component for preserving the rotational stability of the knee joint. Although augmentation of the anterolateral complex has experienced twists and turns, the anatomic ALL reconstruction, which can be performed minimally invasively and has a low risk of complications and minimal injury, is reappearing as a key strategy to address this problem. Currently, the majority of scholars believe that the need for combined ALL reconstruction during ACL reconstruction should be taken into account when there is severe rotational instability present, such as high-grade pivot shift test preoperatively, ACL revision surgery, and high requirements for rotational stability, such as age less than 25 years and the need to participate in pivoting sports. The corresponding suggested criteria are also put forth in the authoritative consensus of both domestic and foreign sources. However, the surgical indications chosen by different experts based on their individual experiences are not all consistent. Due to conflicting reports on the actual impact of ALL reconstruction on improving rotational stability and whether it will excessively restrict knee's internal rotation function, there is still much debate among researchers regarding whether ALL reconstruction and ACL reconstruction should be combined. Currently, there are two main reconstruction techniques: ALL single bundle reconstruction and Y-construct ALL double bundle reconstruction. Y-construct ALL double bundle reconstruction has a better ability to restore the original anatomy and is recommended in the consensus, but there is still a lack of randomized controlled trials between the two techniques. Therefore, the combination of ALL reconstruction at the time of ACL reconstruction has been clinically started in recent years for patients who are susceptible to failure after ACL reconstruction, which also raises many controversies.

Navigation-assisted valgus stress method can avoid over correction of high tibial osteotomy / 中华骨科杂志

Objective:To explore the role of navigation-assisted valgus stress method in avoiding excessive correction of lower limb mechanical axis after high tibial osteotomy (HTO).Methods:A retrospective study was carried out on osteoarthritis (OA) patients who were treated with HTO for medial compartment pain of knee from January 2020 to March 2022 in the Department of Joint Surgery, Shanghai Changhai Hospital, the First Affiliated Hospital of Naval Medical University. According to the different ways of confirming alignment during operation, they were divided into computer navigation assisted valgus stress HTO group (referred to as navigation group) and traditional rod fluoroscopy HTO group (referred to as traditional group). There were 28 patients in the navigation group, 10 males and 18 females, with age of 54.4±9.1 years (range, 41-73 years) and body mass index of 26.1±3.3 kg/m 2 (range, 19.8-35.2 kg/m 2); There were 30 patients in the traditional group, 13 males and 17 females, aged 56.9±8.5 years (range, 40-70 years), with a body mass index of 25.7±4.0 kg/m 2 (range, 19.2-32.9 kg/m 2). Measuring the mechanical femoral tibial angle (mFTA), joint line convergence angle (JLCA), medial proximal tibial angle (MPTA), Lysholm score and Hospital for Special Surgery (HSS) score before operation and at the last follow-up of the two groups, and conduct statistical analysis. Results:Both groups were followed up. The follow-up time of navigation group and traditional group was 21.3±8.7 months and 22.5±7.6 months, respectively, with no significant difference ( t=0.53, P=0.596). There were significant differences between the two groups in the amount of mechanical axis correction (ΔmFTA) and the amount of bone correction (ΔMPTA) ( t=2.09, P=0.041; t=2.58, P=0.012), while there was no significant difference in ΔJLCA ( t=0.32, P=0.753). In the navigation group, there were 9 cases (32%) of undercorrection, 17 cases (61%) with acceptable alignment, and 2 cases (7%) with over correction, while in the traditional group, there were 5 cases (17%) with under correction, 13 cases (43%) with acceptable alignment, and 12 cases (40%) with over correction. There was significant difference in the distribution rate of alignment between the two groups ( P=0.012), and the rate of overcorrection in the navigation group was significantly lower than that in the control group (7% vs. 40%, P=0.005). The intra group correlation coefficient between the navigation correction mechanical axis and ΔmFTA was 0.787. There was no significant difference in Lysholm score and HSS score between the two groups before and after surgery (all P>0.05), and they were significantly improved after operation (all P<0.05). Conclusion:Navigation-assisted valgus stress method HTO is reliable, which can accurately achieve the target alignment, reduce the incidence of over correction, and obtain good clinical results.

Application of cold chain positioning system in transport of neonatal inherited metabolic disease screening samples / 预防医学

Abstract@#Transport of filter paper-dried blood spot samples is a critical procedure during the screening of neonatal inherited metabolic diseases, which is of great significance for the screening accuracy. In order to ensure the timing and safety of sample transport, the cold chain positioning system was initiated by Zhejiang Provincial Center for Quality Control of Neonatal Disease Screening since March 2015. Based on the framework of neonatal disease screening information management system, the function of the logistics transport management system was included in this positioning system, with aims to achieve the monitoring and tracking of sample transport processes through real-time positioning of the sample transport box via China Unicom 4G logistics card and global positioning system/BeiDou Navigation Satellite System. The samples are maintained in a transport environment at 2 to 8 °C via the temperature-controlled box made of 5 °C phase-changed cold-stored materials and general packet radio service (GPRS) temperature recorders. The mean pretest turnover duration reduced from 8.44 days to 5.03 days following introduction of the cold chain positioning system, and the percentage of timely sample delivery increased from 31.69% to 77.90%, while the withdrawal rate of unqualified samples reduced from 0.12% to 0.08%. The cold chain positioning system meets the requirements of transport of filter paper-dried blood spot samples, which has a high potential in screening of neonatal inherited metabolic diseases.

Quality monitoring and evaluation of neonatal diseasescreening in Zhejiang Province / 预防医学

Abstract@#Neonatal disease screening is a major tool for prevention of birth defects, and monitoring and evaluation of neonatal disease screening facilitates the improvements in screening quality and efficiency. A strict quality control of screening, diagnosis, treatment and follow-up of neonatal diseases is performed in Zhejiang Provincial Center for Quality Control of Neonatal Disease Screening. In this study, the data pertaining to screening of neonatal inherited metabolic diseases, hearing loss and congenital heart diseases were collected in Zhejiang Province from 2018 to 2020, and the screening rate, recall rate of suspected screening-positive neonates, and detection rate of diseases were calculated to assess the quality of neonatal disease screening. The screening rate and recall rate of neonatal inherited metabolic diseases, hearing loss and congenital heart diseases were high in Zhejiang Province, and the detection of screened diseases was stable, indicating a high overall quality of neonatal disease screening. Increasing the impact of neonatal disease screening and consolidating the screening achievements should be given a high priority during the future quality control of neonatal disease screening in Zhejiang Province.

Quality evaluation of tandem mass spectrometry screening for neonatalinherited metabolic diseases in Zhejiang Province from 2009 to 2021 / 预防医学

Objective@#To evaluate the quality of tandem mass spectrometry (MSMS) screening for neonatal inherited metabolic diseases in Zhejiang Province from 2009 to 2021.@*Methods@#The data pertaining to MSMS screening for neonatal inherited metabolic diseases in Zhejiang Province from 2009 to 2021 were collected from the database created by Zhejiang Provincial Center for Neonatal Disease Screening. The percentage of MSMS screening, percentage of recall of suspected screening-positive infants and incidence of neonatal inherited metabolic diseases were analyzed retrospectively to evaluate the quality of MSMS screening for inherited metabolic diseases.@*Results@#A total of 4 706 916 newborns were screened among 8 297 039 live births by MSMS in Zhejiang Province from 2009 to 2021, and the percentage of MSMS screening increased from 5.48% to 97.54%, with a mean percentage of 56.73%. Of 46 838 suspected screening-positive infants, 45 527 infants were recalled, and the percentage of recall increased from 94.57% to 98.62%, with a mean percentage of 97.20%. A total of 1 038 infants were definitively diagnosed with inherited metabolic diseases in Zhejiang Province from 2009 to 2021, with an overall incidence rate of 1/4 535, and the incidence rates of amino acid metabolic disorder, fatty acid oxidation metabolic disorder and organic acid metabolic disorder were 1/11 767, 1/13 763 and 1\15 902, respectively. Of the 11 cities in Zhejiang Province, the highest percentage of tandem mass spectrometry screening for inherited metabolic diseases was found in Hangzhou City (83.01%), and the highest percentage of recall of suspected screening-positive infants was se en in Zhoushan City (99.08%). @*Conclusions@#A high percentage of MSMS screening for neonatal inherited metabolic diseases was observed in Zhejiang Province from 2009 to 2021; however, there was a region-specific percentage of screening, and the recall of suspected screening-positive infants remains to be improved.

Study on effect of different extraction methods on anti-inflammatory and analgesic activity of Anemone hupehensis / 重庆医学

Objective To investigate the effect of different extraction methods on anti-inflammatory and analgesic activity of Anemone hupehensis.Methods The different abstracts were prepared from the whole herb of Anemone hupehensis.The analgesic effect was observed by adopting the mouse torsion and electric heating plate method,and the anti-inflammatory activity was comprehensively evaluated by using the mouse ear tumefaction,toe tumefaction and tampon granulation tumefaction exprements.Results Compared with the blank model group,the anti-inflammatory action difference of low dose in the water layer parts of mouse ear tumefaction,toe tumefaction and tampon granulation tumefaction had no statistical significance(P＞0.05),and the extracting parts of rest doses all had significant anti-inflammatory and analgesic effect (P＜0.05).Ethyl acetate part had strongest activity in the electric heating plate experiment.N-butanol part had strongest activity in the ear tumefaction,toe tumefaction,tampon granulation tumefaction experiments and torsion method.Conclusion The whole herb of Anemone hupehensis has prominent anti-inflammatory and analgesic effect,and the ethyl acetate part E and N-butanol part are main effective parts.

Investigation on parent's and preschool children's dental health behavior in pudong new area of shanghai / 中国实用护理杂志

Objective To get informed of the parents' oral health behaviors,children's oral hygiene habits and the correlation between the two,to lay the foundation of building up joint educational pattern of the oral health between pre-school children and their parents.Methods The questionnaire between preschool children and their parents was applied.By cluster sampling,124 pre-school children from 5 kindergartens in the local community were selected to participate the survey.The oral health behaviors of parents and their kids were investigated and the results underwent analysis.Results Parents’ oral health behaviors were closely related to children's,which was embodied by three parts,such as the starting age of brushing teeth,the duration of brushing and the habits of gargling after meals.As to parents,the knowledge sources of oral health mainly came from TV and broadcast programs (82.3％),newspapers and periodicals,magazines and popular science readings (51.6％),relatives and friends (27.4％),but the anticipated knowledge sources were from medical personnel (90.3％),TV and broadcast programs (53.2％),community activities on health education (51.6％).Conclusions Pre-school children's oral health behaviors are currently good; more emphasis should be laid on the effect of parents' behaviors to their children's oral health; it's necessary to hold more community activities on health education.

Study of analgesia and anti-inflammatory effect of Shui ethnic medicine Maguangwa* / 重庆医学

Objective To investigate the analgesic and anti-inflammatory effects of Shui ethnic medicine Maguangwa .Methods Acetic acid-provoked writhing and hot plate provocation of pain were adopted to observe the analgesic effect of Shui ethnic medicine Maguangwa ,and xylene-induced ear swelling was used to observe the anti-inflammatory effect of Shui ethnic medicine Maguangwa There were five experimental groups ,i .e .,the blank control group ,the aspirin group(positive control) ,the 0 .84 g/kg Shui ethnic medicine Maguangwa group(group Ⅰ) ,the 0 .42 g/kg Shui ethnic medicine Maguangwa group(group Ⅱ ) ,and the 0 .21 g/kg Shui ethnic medicine Maguangwa group(group Ⅲ) .Results The writhing latency increased significantly and the writhing frequency de-creased significantly in the positive control group ,group Ⅰ and group Ⅱ ,when compared with the blank control group(P0 .05) .Before medica-tion the pain threshold of mice in each group differed insignificantly (P>0 .05) .At 30 min ,60 min ,90 min and 120 min after medi-cation ,the pain threshold increased significantly in the positive control group ,group Ⅰ ,and group Ⅱ ,when compared to the blank control group(P0 .05) ,or between group Ⅲ and the blank control group(P>0 .05) .When compared with the blank control group ,the right ear mass and degree of swelling decreased significantly in the positive control group ,group I and group Ⅱ (P0 .05) ,or between group Ⅲ and the blank control group(P>0 .05) .Conclusion Shui ethnic medicine Maguangwa exhibits potent analgesic and anti-inflammatory effects in a dose-dependent manner .

Synergistic Action of Zicao Tianhuafen Decoction and Mifepristone on Abortion / 广州中医药大学学报

[Objective] To observe the effect of Zicao Tianhuafen Decoction (ZTD), mainly composed of Radix Arnebiae seu Lithospermi, Radix Trichosanthis, Rhizoma Bletillae, Radix Notoginseng and Radix Codonopsis Pilosulae, on abortion induced by mifepristone. [Methods] One hundred and sixty cases were randomly allocated to two groups. After administration of mifepristone in the two groups, Group A was given ZTD while Group B was not. Complete abortion rate, incomplete abortion rate, ineffective rate, vaginal bleeding volume and bleeding time were observed after treatment. [Results] The complete abortion rate was 96.25% in Group A and 86.25% in Group B (P = 0.058). Vaginal bleeding volume was less and bleeding time shorter in Group A than those in Group B(P = 0.001). [Conclusion] ZTD can decrease the vaginal bleeding volume and shorten the bleeding time and tends to increase the complete abortion rate.