Blood-conserving and therapeutic efficacy of intravenous tranexamic acid at different time points after primary total knee arthroplasty with tourniquet application: a randomised controlled trial.

BACKGROUND: The use of a tourniquet in combination with tranexamic acid (TXA) not only ensures clear vision, reduces intraoperative blood loss and shortens operative time but also improves cement-bone inter-digitation in total knee arthroplasty (TKA). However, there is no proof whether the blood flow blocking effect of tourniquet affects the antifibrinolytic effect of TXA, and the optimal timing of TXA administration is still unclear. Therefore, this study aims to investigate the effect of the first dose of TXA administered intravenously before tourniquet compression and release in TKA on perioperative blood loss and therapeutic efficacy in patients. METHODS: In this double-blind trial, 90 patients undergoing primary TKA were randomised into 2 groups: Group A, patients received intravenous TXA 10 min before tourniquet compression (20 mg/kg) and 3, 6 and 24 h later (10 mg/kg), and Group B, patients were treated the same as those in Group A but received intravenous TXA before tourniquet release. The primary outcomes were changes in blood loss, haemoglobin and haematocrit. Secondary outcomes included operation and tourniquet times, blood transfusion rate, subcutaneous petechiae and circumferential changes in the operated limb, visual analogue scale (VAS) score, hospital for special surgery (HSS) score, length of stay (LOS) postoperatively, complications and patient satisfaction. RESULTS: No statistically significant difference was found between the 2 groups with regard to age, sex, weight, body mass index (BMI), Kellgren-Lawrence class, preoperative blood volume, preoperative laboratory values, operation and tourniquet times, transfusion rate, knee circumference, preoperative HSS, or VAS score (P:n.s.). There was no significant difference in intraoperative blood loss (IBL) (52.7 ml vs. 63.4 ml, P = 0.07), hidden blood loss (HBL) (91.4 ml vs. 119.9, P = 0.4) or total blood loss (TBL) (144.1 ml vs. 183.3 ml, P = 0.72) between Groups A and B. Haemoglobin, haematocrit and red blood cell count (RBC) dropped to a low point on postoperative day 3 and then rebounded, returning to normal levels on day 21, and the trend of change between the 2 groups was not statistically significant (P:n.s.). There was no significant difference in subcutaneous ecchymosis incidence, knee swelling rate, HSS score, VAS score, LOS postoperatively, complication rate or patient satisfaction (P:n.s.). CONCLUSION: TXA was administered intravenously prior to tourniquet compression could effectively reduce blood loss in patients who had undergone total knee arthroplasty. However, there was no significant difference in knee swelling rate, subcutaneous bruising and petechiae incidence, knee function, complication rate or satisfaction between patients who TXA was given intravenously before tourniquet compression and release in primary TKA.

Application of 3D-printed prosthesis in revision surgery with large inflammatory pseudotumour and extensive bone defect: A case report.

BACKGROUND: Hip revision surgery is the final treatment option for the failure of artificial hip joints, but it is more difficult than the initial operation. For patients with hip joint loosening around the prosthesis combined with large inflammatory pseudotumours and large segment bone defects, hip revision is even more difficult, and clinical reports are rare. CASE SUMMARY: Male, 59 years old. The patient underwent left hip replacement 35 years ago and was now admitted to hospital due to massive masses in the left thigh, shortening of the left lower extremity, and pain and lameness of the left hip joint. X-ray, computed tomography and magnetic resonance imaging revealed prosthesis loosening, left acetabular bone defect (Parprosky IIIB type), and a bone defect of the left proximal femur (Parprosky IIIA type). Inflammatory pseudotumours were seen in the left hip and left thigh. Hip revision surgery was performed using a 3D-printed custom acetabular prosthesis was used for hip revision surgery, which was produced by Arcam Electron Beam Melting system with Electron Beam Melting technology. The operation was successful, and the patient was followed up regularly after the operation. The custom-made acetabular prosthesis was well matched, the inflammatory pseudotumour was completely removed, the postoperative hip prosthesis was stable, and the old greater trochanter fracture was well reduced and fixed. The patient was partially weight-bearing with crutches 3 mo after the operation and walked with full weight-bearing after 6 mo. The hip prosthesis was stable, and there was no recurrence of inflammatory pseudotumours at the last follow-up. The Visual Analogue Scale was 3, and the Harris hip score was 90. CONCLUSION: The use of 3D-printed personalized custom prostheses for complex hip revision surgery has satisfactory surgical results and has great clinical application value.

Electromyographic Biofeedback for Stress Urinary Incontinence or Pelvic Floor Dysfunction in Women: A Systematic Review and Meta-Analysis.

Electromyographic biofeedback (EMG-BF) can be regarded as an adjuvant to pelvic floor muscle (PFM) training (PFMT) for the management of stress urinary incontinence (SUI). This meta-analysis aimed to compare the efficacy of PFMT with and without EMG-BF on the cure and improvement rate, PFM strength, urinary incontinence score, and quality of sexual life for the treatment of SUI or pelvic floor dysfunction (PFD). PubMed, EMBASE, the Cochrane Library, Web of Science, Wanfang, and CNKI were systematically searched for studies published up to January 2021. The outcomes were the cure and improvement rate, symptom-related score, pelvic floor muscle strength change, and sexual life quality. Twenty-one studies (comprising 1967 patients with EMG-BF + PFMT and 1898 with PFMT) were included. Compared with PFMT, EMG-BF + PFMT had benefits regarding the cure and improvement rate in SUI (OR 4.82, 95% CI 2.21-10.51, P < 0.001; I2 = 85.3%, Pheterogeneity < 0.001) and in PFD (OR 2.81, 95% CI 2.04-3.86, P < 0.001; I2 = 13.1%, Pheterogeneity = 0.331), and in quality of life using the I-QOL tool (SMD 1.47, 95% CI 0.69-2.26, P < 0.001; I2 = 90.1%, Pheterogeneity < 0.001), quality of sexual life using the FSFI tool (SMD 2.86, 95% CI 0.47-5.25, P = 0.019; I2 = 98.7%, Pheterogeneity < 0.001), urinary incontinence using the ICI-Q-SF tool (SMD - 0.62, 95% CI - 1.16, - 0.08, P = 0.024), PFM strength (SMD 1.72, 95% CI 1.08-2.35, P < 0.001; I2 = 91.4%, Pheterogeneity < 0.001), and urodynamics using Qmax (SMD 0.84, 95% CI 0.57-1.10, P < 0.001; I2 = 0%, Pheterogeneity = 0.420) and MUCP (SMD 1.54, 95% CI 0.66-2.43, P = 0.001; I2 = 81.8%, Pheterogeneity = 0.019). There was limited evidence of publication bias. PFMT combined with EMG-BF achieves better outcomes than PFMT alone in SUI or PFD management.

Traumatic Obturator Dislocation of the Hip Joint Associated with Greater Trochanter Fracture: A Case Report.

BACKGROUND: Traumatic obturator dislocation of the hip joint associated with greater trochanter fracture is a rare injury. We used the lateral approach through the rectus abdominis to remove the femoral head dislocated into the obturator, and the posterolateral approach was used for reduction and internal fixation of the femoral greater trochanteric fracture and total hip replacement (THR). Good follow-up results were achieved. To the best of our knowledge, this is the first report on this particular type of injury and on this approach to treating this type of injury. CASE REPORT: The patient was hospitalized due to a traffic accident that resulted in the patient experiencing swelling and deformity accompanied by limited mobility of the left hip and left knee. X-ray examination and CT confirmed that the patient suffered from left hip obturator dislocation, greater trochanter fracture, pelvic fracture (Tile B), left acetabular fracture, right open tibiofibular comminuted fracture (Gustilo III), and posterior urethral injury. The femoral head was removed from the pelvic cavity through a pararectus approach under general anesthesia. A posterolateral approach was used for open reduction, and cable internal fixation for the left intertrochanteric fracture and uncemented THR were performed. RESULTS: The ability to work was restored 6 months after the operation. The Harris hip score, reflecting joint function, was 86 points after 2 years of follow-up observation. CONCLUSION: A lateral approach of rectus abdominis to remove the dislocated femoral head in the pelvis from the obturator should be selected, along with the posterolateral approach for reduction and internal fixation of the intertrochanteric fracture and THR. This case also provides a new reference for the treatment of this type of hip fracture dislocation.

[Comparison of proximal femoral nail antirotation and reconstruction nail for ipsilateral fractures of hip and femoral shaft].

OBJECTIVE: To compare the effectiveness of proximal femoral nail antirotation (PFNA) and reconstruction nail with minimally invasive technique for ipsilateral femoral shaft and extracapsular hip fractures in young and middle-aged patients. METHODS: Sixty-nine young and middle-aged patients with ipsilateral femoral shaft and extracapsular hip fractures were treated between January 2000 and August 2010, and their data were analyzed retrospectively. Of them, fractures were fixed by reconstruction nail in 44 cases (reconstruction nail group) and by PFNA in 25 cases (PFNA group). There was no significant difference in gender, age, weight, injury cause, fracture type, or disease duration between 2 groups (P > 0.05). The operation time, blood loss, fracture healing time, complications, and functional outcomes were compared between 2 groups to evaluate the effectiveness. RESULTS: The operation time and blood loss in the PFNA group were significantly less than those in the reconstruction nail group (P < 0.05). The follow-up time was 12-38 months (mean, 20 months ) in the PFNA group and was 12-48 months (mean, 22 months) in the reconstruction nail group. No complication occurred as follows in 2 groups: wound infection, deep venous thrombosis, pulmonary embolism, breakage of the implants, avascular necrosis of the femoral head, or serious rotation and shortening deformity of lower limbs. In the PFNA group and the reconstruction nail group, 1 patient underwent technical difficulty in nail implant and 7 patients underwent technical difficulty in proximal locking screw, respectively; 3 patients and 6 patients had intra-operative iatrogenic fracture of femoral shaft, respectively; and delayed union of femoral shaft was observed in 1 patient and 2 patients, respectively. The complication rate was 20% (5/25) in the PFNA group and 34% (15/44) in the reconstruction nail group, showing no significant difference (chi2 = 1.538, P = 0.215). No significant difference was found in fracture healing time between 2 groups (P > 0.05). At last follow-up, there was no significant difference in Harris hip score and Evanich knee score between 2 groups (P > 0.05). CONCLUSION: PFNA or reconstruction nail with minimally invasive technique is a good method to treat ipsilateral femoral shaft and extracapsular hip fractures, but the PFNA is superior to the reconstruction nail because of simple operation.

[Repair of soft tissue defect in extremities with anterolateral thigh perforator flap].

OBJECTIVE: To summarize the clinical effect of anterolateral thigh pedicle or free perforator flap in repairing soft tissue defect in the extremities. METHODS: From March 2000 to January 2009, 32 cases of soft tissue defect were treated with pedicle or free anterolateral thigh perforator flap. There were 30 males and 2 females with an median age of 28 years (4-53 years). Soft tissue defects included left radial side in 3 cases, the left lateral elbow in 1 case, knee in 5 cases, calf in 14 cases, dorsalis pedis in 5 cases, and plantae pedis in 4 cases. The defect area ranged from 9 cm x 6 cm to 15 cm x 13 cm. Nine cases complicated by bone defect and 1 case by radial nerve defect. The time from injury to hospitalization was 1 hour to 4 months (mean 5 days). Defects in 27 cases were repaired by anterolateral thigh perforator flap, simultaneously combined with transplantation with the second toe in 1 case, with sural nerve using arterialized small saphenous vein in 1 case, and with fibular or ilium in 4 cases. Defects in other 5 cases were repaired with flaps pedicled with superior lateral genicular artery. Neuroanastomosis was performed in 14 cases of the flaps. The size of the flaps ranged from 10 cm x 8 cm to 16 cm x 15 cm. Skin defects at donor site were repaired with split thickness skin graft or sutured directly. RESULTS: All patients were followed up from 8 months to 9 years with an average of 18 months. The flaps survived well and the wounds healed by first intention in 29 cases, 3 flaps necrosed and cured after symptomatic management. Skin graft at donor site survived completely in 9 cases. The color and texture and thickness of the flaps were similar to those of recipient site. After 6 months, the sensation of the flaps recovered to grade S3-4 in 14 patients whose cutaneous nerve were anastomosed, partial recovery was observed in other patients. In 4 patients receiving transplantation of fibular or ilium, the bony healing was achieved within 4 to 6 months. No obvious dysfunction was found at the donor site. CONCLUSION: The pedicle anterolateral thigh perforator flap is long and thick with constant location. Anastomosis or transferring is easy to perform. It can provide big area and feeling recovery by nerve anastomosis. It is an effective method to repair soft tissue defect of the extremities.

Intracavity measurement of liquid crystal layer thickness by wavelength tuning of an external cavity laser diode.

The gap of a planar-aligned liquid crystal (LC) cell is measured by a novel method: Monitoring the change in output wavelength of an external-cavity diode laser by varying the voltage driving the LC cell placed in the laser cavity. This method is particularly suitable for measurement of LC cells of small phase retardation. Measurement errors of +/-0.5 % and +/-0.6 % for 9.6-microm and 4.25-microm cells with phase retardations of 1.63 microm and 0.20 microm respectively are demonstrated.

Mode-hop-free fine tuning of an external-cavity diode laser with an intracavity liquid crystal cell.

A planar nematic liquid crystal (NLC) cell is incorporated into a Littman-type external cavity as the wavelength-tuning device for a semiconductor laser diode. By varying the driving voltage of the NLC cell and laser diode bias current simultaneously, we demonstrate single-mode oscillation and mode-hop-free tuning over 19.2 GHz at 775 nm. The result is in good agreement with the theoretical predictions.

Single-longitudinal-mode semiconductor laser with digital and mode-hop-free fine-tuning mechanisms.

We report a novel external cavity laser diode (lambda= 1.5 mum). An intra-cavity liquid crystal pixel mirror allows digitally tuning of the laser wavelength to more than 40 wavelength channels of 100 GHz spacing according to the International Telecommunication Union (ITU) grid. Laser wavelength can further be fine-tuned by varying the driving voltages applied to an intra-cavity planar nematic liquid crystal phase plate. With a cell 52.3 mum in thickness, the output frequency can be continuously tuned over 1.89 GHz. The root-mean-square voltage required for driving the phase plate was from 1.00 to 4.56 volts.