Analgesic effect of cocktail therapy combined with femoral nerve block on total knee arthroplasty / 中国组织工程研究

BACKGROUND: Total knee arthroplasty is an important measure to save the function of knee joint, but the postoperative pain caused great pain to patients. On the background of multimodal analgesia, cocktail therapy and femoral nerve block are widely used in clinic, and the analgesic effect is exact; however, the analgesic effect and safety of the two methods used together are unknown, so more clinical evidence is needed. OBJECTIVE: To study the effect and safety of analgesic and functional recovery of cocktail therapy combined with femoral nerve block after total knee arthroplasty. METHODS: Totally 100 patients undergoing primary unilateral total knee arthroplasty were enrolled. One hundred patients were randomly divided into two groups (n=50 per group) according to the table of random numbers. Group A was given cocktail therapy combined with femoral nerve block; group B received the injection of same volume of normal saline surrounding the knee joint combined with femoral nerve block. The postoperative resting-state visual analogue scale score, knee joint range of motion, global pain scale, and incidences of adverse reactions were compared between groups. The time and frequency of analgesic drugs were recorded. RESULTS AND CONCLUSION: (1) The postoperative visual analogue scale score at rest in the group A was significantly lower than that in the group B at 24, 36 and 48 hours postoperatively (P < 0.05). The scores at 12 and 72 hours did not differ significantly between groups (P < 0.05). (2) The knee joint range of motion on postoperative 1 and 3 days in the group A was significantly higher than that in the group B (P < 0.05), and no significant difference was detected at 14 days, 1 and 3 months postoperatively (P < 0.05). (3) At 3 months after operation, there was no significant difference in the Global Pain Scale between the two groups (P < 0.05). (4) There was no significant difference in incidences of adverse reactions and additional analgesics between the two groups (P < 0.05). (5) In summary, cocktail therapy combined with femoral nerve block can relieve the early resting pain after total knee arthroplasty, and improve the activity of knee joint in the early stage, which is safe and effective.

Herbert screw internal fixation for treating adult osteochondritis dissecans of the knees / 中国组织工程研究

BACKGROUND: Osteochondritis dissecans of the knee in adults may lead to local instability of articular cartilage and subchondral bone. If it is not treated in time, it will have a secondary impact on articular cartilage, and the probability of osteoarthritis of knee joint is significantly increased. At present, there is no clear treatment plan. OBJECTIVE: To investigate the clinical effect of knee arthroscopy combined with Herbert bidirectional compression screw internal fixation for osteochondritis dissecans of the knee. METHODS: Adult patients who met the diagnostic criteria of osteochondritis dissecans of the knee from June 2014 to September 2018 were retrospectively analyzed, and those with other knee joint diseases were excluded. There were 43 patients treated, including 25 males and 18 females. All patients were treated with knee arthroscopy combined with Herbert two-way compression screw internal fixation. All patients were adults, aged 18-53 years, with an average age of (29.00±4.62) years. All patients had unilateral knee joint disease, including 19 cases of the left limb and 24 cases of the right limb. Before treatment and at final follow-up, knee motion range was compared. Visual analogue scale score was used to evaluate knee pain. Knee Lysholm score was used to evaluate knee function. RESULTS AND CONCLUSION: (1) Of the 43 patients, 35 completed the follow-up time of more than 1 year, and the follow-up time was 12-20 months, with an average of (14.0±2.5) months. None of the patients had related complications. (2) Knee joint pain and function improved significantly in all patients after surgery. The mean knee motion range before operation was (109.57±12.45)°, and (126.39±13.73)° at the final follow-up (t=-56.72, P <0.001). Visual analogue scale score was (5.53±1.47) before surgery and (0.79±1.35) (t=-137.51, P < 0.001) after surgery. Mean Lysholm score was (58.27±10.51) before surgery, and (89.36±5.43) postoperatively (t=-163.65, P < 0.001). (3) Knee arthroscopy combined with Herbert’s two-way compression screw internal fixation for adult osteochondritis dissecans of knee has reliable fixation and small surgical trauma, which can significantly improve knee function, and the clinical effect is satisfactory.

Wrist arthroscopy-assisted titanium internal Fixator for the treatment of complex distal radius fractures / 中国组织工程研究

BACKGROUND: Traditional complex of diagnosis and treatment of distal radius fractures, did not get the repair in time and clinical misdiagnosis is not uncommon, become an important reason for the wrist joint pain and dysfunction. Wrist joint complexity assisted treatment of distal radius fractures can more accurately judge complexity of the distal radius fracture damage. The microscopic surgery can protect the blood supply, can also repair intra-articular ligament, cartilage injury, and along with all the dislocation, fracture of carpal bone fixed effectively. OBJECTIVE: To retrospectively analyze clinical effects of distal radial anatomical locking plate for complex distal radius fractures by joint arthroscopy. METHODS: Totally 19 patients with complex distal radius fractures, who were treated in the Department of Trauma and Hand Surgery, Sichuan Provincial Orthopedic Hospital from September 2016 to May 2018, were included in this study. According to AO classification, there were B2 type in 1 patient, B3 type in 2 patients, C1 type in 5 patients, C2 type in 7 patients and C3 type in 4 patients. All patients signed the informed consent. This study was approved by the Hospital Ethics Committee. Open reduction and internal fixation with anatomical locking plate of distal radius assisted by wrist arthroscopy were used to repair the intercarpal interosseous ligaments and triangular fibrocartilage complex, and to fix the wrist fracture. At 1 year after treatment, the range of wrist motion, grip strength, radial height, palm inclination angle and ulnar angle were compared with the healthy side, and the functional evaluation was conducted with Mayo wrist score. RESULTS AND CONCLUSION: (1) Nineteen patients received postoperative follow-up. The healing time of distal radius was 5-12 months, with an average of 7 months. (2) At 1 year after surgery, no significant difference was detected in the range of wrist motion, grip strength, radial height, palm inclination angle and ulnar angle (P > 0.05). (3) The Mayo wrist score was excellent in 9 cases, good in 8 cases, and average in 2 cases, with the excellent and good rate of 90%. (4) Treatment of complex distal radius fractures with distal radial anatomical locking plate by wrist arthroscopy can accurately restore the stability of the joint, and simultaneously repair the fracture with cartilage damage and intra-articular ligament, which is conducive to early functional exercise and has a satisfactory effect.

Comparison of cervical motion range and curvature after C3 laminectomy and mini-titanium plate fixation after single-door vertebroplasty / 中国组织工程研究

BACKGROUND: Axial symptoms often occur in patients after posterior cervical single-door vertebroplasty. Some studies have proposed a modified surgical method to remove C3 lamina and retain cervical semisacinous muscle on C2 spinous to reduce the occurrence of axial symptoms after surgery. OBJECTIVE: To compare the clinical effects, cervical motion range and curvature of C3 laminectomy and mini-titanium plate fixation after single-door vertebroplasty. METHODS: Totally 43 patients with cervical spondylosis were selected from the General Hospital of Southern Theater Command of PLA from June 2012 to June 2017, including 25 males and 18 females. Among them, 27 patients underwent C3-6 or C3-7 single-door mini-titanium fixation vertebroplasty as fixation group and 16 patients underwent C4-6 or C4-7 single-door mini-titanium fixation vertebroplasty through posterior approach after C3 laminectomy as resection group. Preoperatively, 6 months postoperatively and at final follow-up, JOA score, cervical motion range, and C2-7 Cobb angle were compared between the two groups. This study was approved by the Ethics Committee of General Hospital of Southern Theater Command of PLA. RESULTS AND CONCLUSION: (1) All 43 patients successfully underwent the operation without vascular or spinal cord injury. (2) JOA score was higher in the two groups at postoperative 6 months and final follow-up than that preoperatively (P 0.05). (3) Motion range in the two groups was smaller at postoperative 6 months and final follow-up than that preoperatively (P < 0.05). Motion range was smaller in the fixation group than in the resection group at postoperative 6 months and final follow-up (P < 0.05). (4) C2-1 Cobb angle in the two groups was smaller at postoperative 6 months and final follow-up than that preoperatively (P < 0.05). C2-7 Cobb angle was smaller in the fixation group than in the resection group at postoperative 6 months and final follow-up (P < 0.05). (5) There was no hypersensitivity, rejection or immune response in the two groups. (6) Results indicate that C3 laminectomy and mini-titanium plate fixation have the same effect on improving neurological function, but the removal of C3 lamina can more effectively prevent the reduction of postoperative cervical motion range and curvature.

Application of computer navigation in total knee Arthroplasty / 中国组织工程研究

BACKGROUND: With the development of precision medicine, knee replacement under navigation has been paid more and more attention. Precision medicine allows for more accurate implant placement and better limb alignment. However, precision medicine can also make surgery much longer. OBJECTIVE: To evaluate the application of Aesculap Ortho-Pilot non-image-dependent wireless navigation in total knee arthroplasty. METHODS: Data of 42 patients with unilateral knee osteoarthritis admitted to the First Affiliated Hospital of Anhui Medical University from April to November 2017 were retrospectively collected. First total knee arthroplasty was conducted by the same surgeon. According to surgical methods, the patients were divided into two groups: The navigation group (n=21) received a total knee arthroplasty under the assistance of Ortho-Pilot non-image-dependent wireless navigation, and the non-navigation group (n=21) received a regular total knee arthroplasty. Operation time and drainage volume were recorded in both groups. X-ray film of weight bearing was taken 12 months after operation. Mechanical axis of the lower extremity, the mechanical proximal medial proximal angle of the mechanical shaft of the tibia, the distal lateral angle of the femoral mechanical axis, sagittal tibial component angle and the number of alignment deviation of the lower extremity (>3°) were compared between the two groups. Knee range of motion and Hospital for Special Surgery knee score were evaluated. This study was approved by the Ethics Committee of First Affiliated Hospital of Anhui Medical University. RESULTS AND CONCLUSION: (1) Operation time was longer in the navigation group than in the non-navigation group (P 3° and the variables of medial angular separation of proximal end of the mechanical axis of the tibia between the two groups (P > 0.05). (3) At postoperative 12 months, the range of motion was larger in the navigation group than in the non-navigation group (P 0.05). (4) Results suggested that total knee arthroplasty assisted by computer navigation can improve the accuracy of lower limb alignment, accuracy of prosthesis placement and knee range of motion. However, the operation time was improved, so the advantages and disadvantages should be considered comprehensively.

Finite element analysis of cervical spine (C2-c7) with degenerated disc under normal loading and massage / 中国组织工程研究

BACKGROUND: Massage is a cost-effective treatment for cervical spondylosis. When the cervical vertebrae with different degenerative degree of intervertebral disc are massaged, the massage strength will have different effects because of the different degenerative degree, and improper manipulation of massage may also cause damage to the degenerative cervical vertebrae. At present, the related research is still lacking. OBJECTIVE: To investigate the mechanism of mechanical changes of cervical vertebrae with different degrees of disc degeneration under normal load and massage, and to explore the influence of massage rotation angle on different degrees of disc degeneration, so as to provide operational guidance for cervical vertebrae with different degrees of disc degeneration. METHODS: The finite element model of three-dimensional human cervical vertebrae (C2-C7) with high geometric similarity and accuracy and 2 million grids was established. The model with different degrees of cervical vertebrae degradation was obtained by changing the parameters of intervertebral disc. The finite element method was used to explore the mechanical mechanism of different degenerative degrees of intervertebral disc under the action of massage. RESULTS AND CONCLUSION: (1) After degeneration, the stress of intervertebral disc was redistributed; the bearing capacity of nucleus pulposus decreased; the bearing capacity of annulus fibrosus increased significantly; and the joint stress also increased. (2) Under normal load condition, the stress concentration area of the fiber ring was mainly located at the posterior side of the cervical spine. With the increase of degradation degree, the stress concentration region extended inward from the edge and the area increased. (3) The stress concentration area of fiber ring was mainly at the back and left and right sides with massage angle. The higher the degree of degradation, the greater the stress concentration area and the greater the stress value was. (4) When the massage was in rotation phase, the higher the degree of degeneration, the smaller the axial displacement and the smaller the deformation ability of the disc was. (5) C4-5 intervertebral disc degeneration will affect the maximum stress and joint contact force of the vertebral body (C4, C5) of the segment, and the stress value increases with the degree of degradation, but the degradation has no obvious effect on other segments. (6) Combined with the stress safety and deformation ability, the rotation angle should be reduced according to the degree of degradation.

Comparisonof early joint amnesia degree after posterior cruciate-retaining and posterior stabilized total knee arthroplasty / 中国组织工程研究

BACKGROUND: Clinical long-term follow-up showed that there is no obvious difference in knee range of motion, 10-15 year prosthesis survival rate, and main clinical manifestations after replacement of posterior cruciate-retaining and posterior stabilized prostheses. However, the debate over the superiority and inferiority of the two knee prostheses remains. OBJECTIVE: To compare the differences of early functional recovery of patients with unilateral knee osteoarthritis after posterior cruciate-retaining and posterior stabilized prosthesis replacement. METHODS: A total of 60 patients with knee osteoarthritis admitted to the First Affiliated Hospital of Anhui Medical University from July 2018 to September 2019 were selected, including 13 males and 47 females, aged 46-83 years old. Of them, 30 patients received posterior cruciate-retaining prosthesis replacement, and 30 patients received posterior stabilized prosthesis replacement. At 3 months after operation and at the last follow-up, joint amnesia score, knee function HSS score, visual analogue scale score, and knee motion range were assessed. The study was approved by the Ethics Committee of the First Affiliated Hospital of Anhui Medical University. RESULTS AND CONCLUSION: (1) Sixty patients were followed up for 5-16 months, and no complications such as periprosthetic infection, loosening, dislocation, or stiffness occurred during the follow-up. (2) At 3 months after surgery and at the last follow-up, joint amnesia score, HSS scores, visual analogue scores, and knee motion range were not significantly different between the two groups (P > 0.05). (3) The results showed that joint amnesia score was not significantly different in early stage after the posterior cruciate-retaining and posterior stabilized prosthesis replacement for unilateral knee osthoarthritis.

Functional outcome after arthroscopic repair of triple shoulder instability / Resultado funcional após reparo artroscópico da tríplice instabilidade do ombro

ABSTRACT OBJECTIVE: To evaluate the functional outcomes of patients submitted to arthroscopic repair of triple labral lesion. METHODS: This was an analytical retrospective study of patients who underwent arthroscopic treatment of triple labral lesion from March 2005 to December 2014. Patients with at least one year of postoperative follow-up were included. A total of nine patients were evaluated. The mean age was 32.3 years and the dominant side was affected in five patients. Patients were functionally assessed regarding the range of motion (ROM) in elevation, external rotation with the arm close to the body the arm in abduction of 90°, and internal rotation, and by the Carter-Rowe score. The degree of satisfaction was assessed at the end of the follow-up period. RESULTS: Three patients had less than five episodes of instability, four patients had between five and ten episodes, and two patients had more than ten episodes. Seven patients had positive O'Brien test for SLAP lesions and positive apprehension test in abduction and external rotation, and only one patient had apprehension in adduction and internal rotation. Three patients persisted with positive O'Brien test and one with apprehension in abduction and external rotation at the end of follow-up. The range of motion was complete in all cases. The median Carter-Rowe score increased from 40 preoperatively to 90 (p = 0.008). CONCLUSION: The arthroscopic repair of triple labral lesions allows for the restoration of the stability of the glenohumeral joint, achieving excellent functional results.

RESUMO OBJETIVO: Avaliar os resultados funcionais dos pacientes submetidos a reparo artroscópico da tríplice lesão labral do ombro. MÉTODOS: Estudo analítico retrospectivo de pacientes com tríplice lesão labral do ombro, submetidos a tratamento artroscópico de março de 2005 a dezembro de 2014. Foram incluídos pacientes com pelo menos um ano de seguimento pós-operatório. Nove pacientes foram avaliados. A média foi de 32,3 anos e o lado dominante foi afetado em cinco pacientes. Os pacientes foram avaliados funcionalmente por meio da amplitude de movimento em elevação, rotação externa com o braço junto ao corpo e com o braço em abdução de 90°, rotação interna e por meio do escore de Carter-Rowe. O grau de satisfação foi avaliado no fim do seguimento. RESULTADOS: Três pacientes tiveram menos de cinco episódios de instabilidade, quatro entre cinco e dez e dois mais de dez. Sete pacientes tiveram teste de O'Brien positivo para lesão do lábio superior de anterior para posterior (Slap, do inglês superior labrum anterior to posterior lesion) e apreensão em abdução e rotação externa positiva; apenas um apresentou apreensão em adução e rotação interna. Três pacientes persistiram com teste de O'Brien positivo e um com apreensão em abdução e rotação externa no fim do seguimento. A amplitude de movimento esteve completa em todos os casos na última avaliação. A média do escore de Carter-Rowe aumentou de 40 no pré-operatório para 90 (p = 0,008) . CONCLUSÃO: O reparo artroscópico da tríplice lesão labral permite restaurar a estabilidade da articulação glenoumeral e alcança excelentes resultados funcionais.

Stationary cycle training for improving lower limb muscle tension and motor function in children with spastic cerebral palsy / 中华物理医学与康复杂志

Objective To observe the effects of stationary cycle training on lower limb muscle tension and motor function in children with spastic cerebral palsy.Methods Sixty-seven children with spastic cerebral palsy were divided into a treatment group (n =34) and a control group (n =33).Both were treated with routine rehabilitation therapy,including neurodevelopment treatment,massage and physical agent therapy.The treatment group additionally cycled on a stationary bicycle for 20 min a day,five days a week for 3 months.Muscle tension in the children's adductor,hamstring and gastrocnemius muscles was evaluated using the modified Ashworth scale (MAS),while the adductor angle,popliteal fossa angle and foot dorsiflexion angle were measured using a joint protractor.Moreover,the 88-item version of the Gross Motor Function Measure (GMFM-88) was used to evaluate gross motor function.Results After treatment the average muscle tension of both groups was significantly lower than before treatment.The average muscle tension scores of the adductors,hamstrings and calf muscles of the treatment group [(1.79±0.54),(1.00±0.60),(2.29 ±1.77)] were significantly lower than those of the controls [(1.82 ± 0.53),(1.15 ± 0.44),(2.52 ± 1.89)].The adductor angles,popliteal fossa angles and foot dorsiflexion angles of both groups were significantly larger than before treatment,and the angles in the treatment group [(97.06 ± 19.03) °,(53.38 ± 12.54) ° and (8.38 ± 9.11) ° respectively] were significantly larger on average than those in the control [(98.94 ± 21.42) °,(56.52 ± 12.90) ° and (5.30 ± 14.30) ° respectively].After treatment the total GMFM scores of both groups were better than before treatment,but the treatment group's average score(138.18 ± 54.86) was significantly better than that of the control group(112.21 ± 62.44).Conclusion Three months of stationary cycle training can effectively reduce the muscle tension of children with spastic cerebral palsy and improve their motor function.

Biomechanical Effects of Facet Capsule Injuries in Posterior Lumbar Fusion Operations

OBJECTIVES: Although posterior lumbar fusion operations had been reported to accelerate spinal degeneration, there have been only a few studies for their biomechanical effects. We have studied the change of motion range at the vertebral joint one level above the fusion(UVJ) in pedicle screw fixation group(PSF)(n=13) where facet capsule was destroyed and in posterior lumbar interbody fusion group(PLIF)(n=8) where it was spared. PATIENTS AND METHODS:The patients were divided into early(3 to 6 months) and late(over 12 months) according to postoperative follow-up period. The flexion, extension and flexion-extension angles(FA, EA, FEA) were measured at the UVJ with pre-operative, early and late post-operative films. RESULTS: Mean age and male to female ratio were 52.7+/-9.3 and 1:3.2. Mean follow-up periods were 144.1+/-30.0 and 528.8+/-160.3 days in early and late groups, respectively. The FEA and FA in the late PSF(11.8+/-3.1, 8.5+/-2.9) were significantly greater than pre-operative angles(7.8+/-3.9, 5.1+/-3.7)(p<0.01, p<0.05). All angles in the PLIF showed no significant changes with time. The FEA and FA in the late PSF(11.8+/-3.1, 8.5+/-2.9) were significantly greater than those of the late PLIF(7.6+/-2.3, 3.4+/-2.0)(p<0.01, p<0.001). All angles at early follow-up period were similar between PSF and PLIF. The EA showed no significant change in relation with follow-up period or fusion method. CONCLUSION: As a result, the facet capsule injury in pedicle screw fixation seems to be related with increased flexion angle or degeneration of the adjacent joint above the fused vertebra in the late phase.