Effectiveness of arthroscopic "hybrid" suture for delaminated rotator cuff tear: A prospective randomized controlled study / 中国修复重建外科杂志

OBJECTIVE@#To investigate the effectiveness of "hybrid" suture with en masse combined with double-layer repair under arthroscopy in repair of delaminated rotator cuff tear by comparison with en masse suture.@*METHODS@#Fifty-six patients with delaminated rotator cuff tears met selection criteria between June 2020 and January 2022 were included in the study. Patients were divided into two groups ( n=28) using a random number method. The patients in trial group underwent arthroscopic "hybrid" suture with the combination en masse and double-layer suture. The patients in control group underwent en masse suture under arthroscopy. There was no significant difference between the two groups ( P>0.05) in terms of gender, age, rotator cuff tear side, tear size, cause of injury, disease duration, and preoperative American Association of Shoulder and Elbow Surgeons (ASES) score, the University of California at Los Angeles (UCLA) shoulder scoring, visual analogue scale (VAS) score, and shoulder range of motion (forward flexion and lateral external rotation). The operation time, the difference of ASES score, UCLA score, VAS score, and shoulder range of motion (forward flexion and lateral external rotation) between pre- and post-operation were recorded and compared between the two groups ( P>0.05). The rotator cuff healing was examined by MRI and evaluated based on the classification criteria of rotator cuff healing proposed by Sugaya et al.@*RESULTS@#Three cases (1 case in the trial group and 2 cases in the control group) were excluded from the study due to loss of follow-up. Twenty-seven cases in the trial group and 26 cases in the control group were included in the final study analysis. All operations of the two groups were completed successfully. There was no significant difference in the operation time between groups ( P>0.05). The follow-up time was 10-12 months (mean, 10.9 months) in the trial group and 10-13 months (mean, 11.4 months) in the control group. All incisions healed by first intention. No surgery-related complications occurred. The UCLA score, ASES score, VAS score, and shoulder range of motion (forward flexion and lateral external rotation) of both groups at 9 months after operation were significantly superior to those before operation ( P<0.05). The difference of UCLA score, ASES score, and VAS score between before and after operation in the trial group were significantly better than those in the control group ( P<0.05). There was no significant differences between the two groups in the difference of shoulder range of motion (forward flexion and lateral lateral rotation) ( P>0.05). At 9 months after operation, according to the classification criteria of rotator cuff healing proposed by Sugaya et al, MRI showed that the rotator cuff healing of the trial group was significantly better than that of the control group ( P<0.05).@*CONCLUSION@#Compared with en masse suture, arthroscopic "hybrid" suture for the repair of delaminated rotator cuff tear has advantages in relieving pain and improving shoulder joint function, and the rotator cuff healing is better.

Clinical features and proportion analysis of adult hip fractures at 11 hospitals in Southwest China from 2010 to 2011 / 中华外科杂志

<p><b>OBJECTIVE</b>To analyze the clinical feature and constituent ratio of adult hip fractures in Southwest China.</p><p><b>METHODS</b>The data of adult inpatients and outpatients with hip fractures treated between January 2010 and December 2011 in 11 hospitals of the Southwest China were collected and analyzed. The data includes gender, age, age distribution and fracture pattern according to AO classification.</p><p><b>RESULTS</b>There were a total of 2,833 adult hip fractures, including 1,340 (47.30%) males and 1,493 (52.70%) females, with a male-to-female incidence ratio of 1: 1.11 and a mean age of (66±18) years. The highest frequency of hip fractures was seen in the 71 to 85 years age group (42.18%, 1,195/2,833). There were 844 fractures (29.79%) in the young and middle-aged group (16-<60 years) and 1 898 fractures (70.21%) in the geriatric group (≥60 years). Men had a higher rate than women (men: 577 fractures, 68.4%) in the young and middle-aged group, while women had a higher rate than men (women: 1,226 fractures, 61.64%) in the geriatric group, with a significant difference in the sex distribution between the two groups (χ2=214.001, P<0.01). The proportion of intertrochanteric fracture (type 31-A), femoral neck (type 31-B) and femoral head fracture (type 31-C) was 46.59%, 49.74% and 3.67% respectively. The highest frequency of the sub-type in each fracture type was type 31-A2, type 31-B2 and type 31-C2.</p><p><b>CONCLUSIONS</b>Women have a higher rate than men in Southwest China. Geriatric patients are more than the young and middle-aged patients. The femoral neck fractures, intertrochanteric fractures and femoral head fractures are in descending orders according to the proportion of the three different hip fractures.</p>

Efficacy and safety of tranexamic acid on blood loss after unilateral total knee arthroplasty / 中国组织工程研究

BACKGROUND:Total knee arthroplasty is always associated with peripheral blood loss.Blood transfusion not only involves additional cost and prolongs rehabilitation time,but also carries substantial risk of immunologic reaction and disease transmission.Therefore it is very important to reduce blood loss of total knee arthroplasty.OBJECTIVE:To investigate the efficacy and safety of tranexamic acid on reducing blood loss after total knee arthroplasty.METHODS:We enroled 64 patients with primary osteoarthritis undergoing a unilateral total knee arthroplasty and randomized them into two groups,with 32 patients in each group.Tranexamic acid group: patients received intravenous drop infusion of tranexamic acid dissolved in 250 mL normal saline (10 mg/kg) at 15 minutes before operation; control group: patients just received 250 mL normal saline.Intraoperative blood loss,postoperative blood loss,postoperative hemoglobin levels,amount of blood transfusion,and number of patients requiring blood transfusion were compared.Fibrinogen,prothrombin time and other coagulation indicators were also examined before operation and 3 hours after operation.Deep vein thrombosis in both limbs of al patients was examined bythe color Doppler ultrasonography 30 days after operation.RESULTS AND CONCLUSION:There was no significant difference in intraoperative blood loss between the two groups (P＞0.05).Postoperative volume of blood loss was lower in the tranexamic acid group than in the control group (P＜0.001).The amount of blood transfusion and number of patients requiring blood transfusion were lower in the tranexamic acid group than in the control group (P＜0.001).The postoperative hemoglobin levels were obviously higher in the tranexamic acid group than in the control group (P＜0.001).There was no significant difference in coagulation indicators between two groups at postoperative 3 hours,but D-dimer value in the two groups was significantly higher than that before surgery,and the tranexamic acid group was lower than the control group (P＜0.001).No cases appeared deep vein thrombosis after operation.Experimental findings indicate that,tranexamic acid can effectively reduce postoperative blood loss and blood transfusion,as wel as number of blood transfusions after total knee arthroplasty.And it did not increase the risk of deep vein thrombosis.

Pedicle screw fixation combined with artificial bone graft improves bone formation after thoracolumbar fractures / 中国组织工程研究

BACKGROUND:Simple pedicle screw fixation for thoracolumbar fractures has better outcomes, but there are some deficiencies, such as poor applicability for severe compression or burst fractures, strong vertebral pain, easy to cause vertebral wound denervation and paraspinal muscle injury, and slow recovery. OBJECTIVE:To investigate the clinical effects of pedicle screw fixation combined with artificial bone graft for the treatment of thoracolumbar fractures. METHODS:A total of 126 patients with thoracolumbar vertebral compression fractures, who had undergone pedicle screw fixation without bone graft (control group,n=62) and with bone graft (test group,n=64) were enroled. The fracture healing, anterior vertebral height ratio, sagittal Cobb angle, and loss rate of vertebral height after 6 months were observed by X-ray in the two groups. RESULTS AND CONCLUSION:Al patients were folowed up, and had complete fracture healing after 12-16 months. The anterior vertebral height and Cobb angle were both improved in the two groups at 1 week after operation (P 0.05). New bone formation was observed in the test group at 6 months after operation, and patients were pain-free; but the speed of bone formation was slower in the control group, and patients stil suffered from painful thoracolumbar fractures. There was no difference in the loss of anterior vertebral height and Cobb angle between the two groups (P> 0.05). These findings indicate that pedicle screw fixation combined with artificial bone graft lead to a better recovery in thoracolumbar fractures.

Effects of point contact-dynamic compression plate on cortical bone blood flow in adult goats / 中华创伤杂志

Objective To compare the effects of point contact-dynamic compression plates (PC-DCP) and dynamic compression plates (DCP) on cortical bone blood flow in an intact sheep tibia model. Methods Fifteen mature goats were used in this experiment. After the bilateral tibia of goats were fixed with DCP and PC-DCP respectively, the regional cortical bone blood flow was measured at four time intervals (1 day, 2, 6 and 12 weeks after operation) using radiolabelled microsphere technique. Results After operation, the cortical bone blood flow was acutely decreased at the first day, kept lower than normal level until six weeks and recovered at the 12th week. The blood supply under PC-DCP recovered to normal, even over normal level two weeks after operation and remained at a high level until 12 weeks. Conclusions PC-DCP can markedly protect cortical bone blood flow.

The structure and mechanical properties of the plated bone following point contact-dynamic compression plate and dynamic compression plate fixation / 中华骨科杂志

Objective To compare the effects of point contact-dynamic compression plates (PC-DCP) and dynamic compression plates (DCP) on bone structure and mechanical properties of the plated bone in the intact goat tibia model. Methods Ten matured goats were used. The bilateral intact tibia of goats were fixed with DCP and PC-DCP respectively. The goats were sacrificed at 12 and 24 weeks after operation, and the tibiae were harvested. The structure of bone under plate was studied both by CT scan and histomorphology. The mechanical properties of the plated bone were examined by torsional test. Results At 12 weeks after internal fixation, there was obvious osteoporosis in the cortical bone underneath the plate in the DCP group compared with that of the PC-DCP group. Both of the cortical bone thickness underneath the plate and the torsion strength of the plated tibiae were significantly higher in the PC-DCP group than that in DCP group (P0.05). Conclusion The underlying bone resorption after rigid plate fixation is induced by both the disturbance of the bone blood supply and stress shielding. However, the former is the main cause in the early stage of fixation. PC-DCP is able to prevent bone resorption in the early stage of fixation.