The influence of direct anterior approach and postero-lateral approach on wound complications after total hip arthroplasty: A meta-analysis.

To date, we have reviewed the synthesis literature critically through four databases: PubMed, Embase, Cochrane Library and Web of Science. Eight relevant studies were examined after compliance with the criteria for inclusion and exclusion, as well as documentation quality evaluation. This report covered all randomised, controlled studies of total hip arthroplasty (THA) comparing the direct anterior approach (DAA) with the postero-lateral approach (PLA). The main result was surgical site infection rate. The secondary results were duration of the operation, length of the incision and VAS score after surgery. The results of the meta-analyses of wound infections in the present trial did not show any statistically significant difference in DAA versus PLA (between DAA and PLA) (OR = 1.42, 95%CI: 0.5 to 4.04, p = 0.51). Compared with PLA, DAA had shorter surgical incision (WMD = -3.2, 95%CI: -4.00 to -2.41; p < 0.001) and longer operative times(WMD = 14. 67, 95%CI: 9.24 to 20.09; p < 0.001). Postoperative VAS scores were markedly lower in DAA compared with PLA within 6 weeks of surgery (p < 0.05), with low heterogeneities(I2 = 0). We found that DAA did not differ significantly from PLA in terms of the risk of wound infection for THA and that the surgical incisions was shorter and less postoperative pain after surgery, even though DAA surgery takes longer.

Effectiveness of optimised care chain for hip fractures in elderly Chinese.

BACKGROUND: Studies have found that optimised care chain (OCC) can promote the recovery of hip fracture patients. Fast track (FT) has been widely proven to play a good role, but there is no systematic review report. METHODS: We conducted a comprehensive search and obtained search data as of April 2020. These included randomised controlled trials (RCTs) and cohort trials (CTs). We applied the research input Review Manager 5.3 for data synthesis, and used Stata 12.0 for meta- regression analysis. RESULTS: This review reported 2200 hip fractures. Our analysis showed that OCC can reduce complications and 1-year mortality, and shorten the length of stay (LOS). After dividing the complications into bed-related complications and other complications, OCC has advantages in reducing bed-related complications, but has no significant effect on other complications. For the conventional care group, the secondary outcome of the OCC group showed there was no significant difference in duration of surgery, and the rest were significantly improved. Subgroup analysis between green channel (GC) and FT showed a shorter LOS for GC. CONCLUSIONS: This meta-analysis suggests that the use of OCC in China promotes rehabilitation in elderly patients with hip fractures, that FT and GC are similar in effect in China, and that GC shows a greater advantage in reducing LOS.

The effect of the α7nAChR agonist on Wnt/ß-catenin signaling in osteoporosis.

The cholinergic pathway neurotransmitter acetylcholine (ACh) regulates the inflammatory cascade through a specific α7 nicotinic acetylcholine receptor (α7nAChR). However, the role and related mechanisms of α7nAChR in osteoporosis (OP) remain unclear. Therefore, this study aims to analyze the effects of α7nAChR on osteoblasts and related mechanisms. Mouse osteoblast MC3T3-E1 was cultured in vitro and divided into a control group and an α7nAChR agonist group (2.4 and 4.8 mg/kg.d). An MTT assay was used to detect the osteoblast activity, an ARS staining assay was used to analyze the formation of calcified nodules of osteoblasts, and an alkaline phosphatase (ALP) activity colorimetric assay was used to determine the ALP activity. Real-time PCR was performed to analyze the expression of RUNX2 and OPN mRNA. The inflammatory factor tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) secretions were analyzed by ELISA. The α7nAChR agonists dose-dependently promoted osteoblast proliferation, increased calcified nodules, ALP activity, RUNX2 and OPN mRNA expression, decreased inflammatory factors TNF-α and IL-6 secretion, and increased Wnt1, ß-catenin mRNA and protein expression. Compared with the control group, the differences were statistically significant (P<0.05). α7nAChR agonists can inhibit the proliferation and differentiation of osteoblasts by regulating the Wnt/ß-catenin signaling pathway, and then participate in the regulation of osteoporosis.