[Comparison of early clinical effects between direct superior approach and posterolateral approach in hemiarthroplasty of femoral neck fracture in the elderly].

OBJECTIVE: To compare and analyze the early clinical effect of direct superior approach(DSA) and posterior lateral approach (PLA) in hemiarthroplasty for elderly patients with femoral neck fracture. METHODS: The clinical data of 72 elderly patients with femoral neck fracture who underwent hemiarthroplasty from January 2020 to December 2021 were retrospectively analyzed. Among them, 36 patients were operated through minimally invasive DSA including 10 males and 26 females with an average age of (82.82±4.05) years old; the other 36 patients underwent traditional PLA including 14 males and 22 females with an average age of (82.79±3.21) years old. The perioperative related indexes and Harris scores during follow-up between two groups were compared. RESULTS: Comparison of operation time between two groups, (79.41±17.39) min of DSA group was shorter than(98.45±26.58) min of PLA group;incision length (8.33±2.69) cm was shorter than (11.18±1.33) cm of PLA group;intraoperative blood loss (138.46±71.58) ml was less than (173.51±87.17) ml of PLA group, initial landing time (3.04±0.95) d was earlier than (4.52±1.10) d of PLA group, hospitalization time (8.70±1.89) d was shorter than (10.67±2.35) d of PLA group(P<0.05). There was no statistical difference in Harris score between two groups before operation(P>0.05), but Harris score in DSA group was higher than that of PLA group at 1 month after operation(P<0.05), but at 12 months after operation, the difference was not statistically significant between two groups(P>0.05). CONCLUSION: Compared with PLA, DSA is superior in clinical indexes such as operation time, intraoperative blood loss, incision length, first landing time, length of hospitalization and Harris score in the first month after operation in hemi hip replacement, and has comparative advantages in promoting early postoperative rehabilitation of elderly patients with femoral neck.

Outcomes of direct superior approach and posterolateral approach for hemiarthroplasty in the treatment of elderly patients with displaced femoral neck fractures: A comparative study.

Hemiarthroplasty is a surgical choice for super-aged patients with a high surgical risk and a sedentary lifestyle. The direct superior approach (DSA), a minimally invasive modification of the posterior approach, is rarely studied in hemiarthroplasty. The aim of the present study was to compare the clinical outcomes in elderly patients with displaced femoral neck fractures undergoing hemiarthroplasty via DSA with the conventional posterolateral approach (PLA). A total of 48 elderly patients with displaced femoral neck fractures who underwent hemiarthroplasty between February 2020 and March 2021 were retrospectively included in the study. Of them, 24 patients (mean age 84.54 ± 2.11 years) were treated with hemiarthroplasty via DSA (DSA group), while the other 24 patients (mean age 84.92 ± 2.15 years) were treated with hemiarthroplasty via PLA (PLA group). Clinical outcomes, perioperative data, and complications were recorded. There were no obvious differences in the baseline characteristics between the DSA and PLA groups, including age, gender, body mass index, Garden type, American Society of Anesthesiologists score, and hematocrit. Perioperative data showed that the length of the incision in the DSA group was smaller than that in the PLA group (p < 0.001). However, the duration of the operation and blood loss in the DSA group were longer and higher than those in the PLA group, respectively (p < 0.001). In addition, the DSA group had a shorter hospitalization time than the PLA group (p < 0.001). The visual analog scale score and Harris score 1 month postoperatively in the DSA group were better than those in the PLA group (p < 0.001). Moreover, there were no significant differences between the two groups in Harris score (for assessment dysfunction) 6 months postoperatively (p > 0.05). DSA is less invasive and has better clinical outcomes, which can allow an early return to daily living activities in elderly patients with displaced femoral neck fractures undergoing hemiarthroplasty.

Establishment of a bipedal rat model of lumbar facet joint osteoarthritis using intraarticular injection of urinary plasminogen activator.

BACKGROUND: Previous studies have demonstrated that by injecting uPA into the lumbar facet joints (LFJ) of normal rats, a rat LFJOA animal model can be successfully established. However, there is no evidence that intraarticular injection of uPA can induce or much serious osteoarthritis in bipedal rats, which biomechanics is much more similar to human than normal rats. To investigate whether intraarticular injection of urinary plasminogen activator (uPA) can induce LFJOA and low back pain symptoms in bipedal rats. METHODS: An experimental study on the construction of a modified animal model of lumbar facet joints osteoarthritis (LFJOA) which biomechanics is similar to human. Sprague-Dawley rats were treated with intraarticular injection of uPA in the L5-L6 facet joints (uPA group, n = 15) or saline (saline group, n = 15). The forelimbs of both two group rats were amputated. Mechanical and thermal hyperalgesia in the ipsilateral hind paws were evaluated using von Frey hairs and a thermoalgesia instrument, respectively. Toluidine blue staining, hematoxylin-eosin staining, and immunohistochemical examination of the LFJ was performed. RESULTS: The saline group rats have not demonstrated significant osteoarthritis in rats LFJ after surgery. The uPA group has not been induced significantly higher mechanical and thermal hyperalgesia in comparison with the saline group. But intraarticular injection of uPA in biped rats induced significantly stronger articular cartilage damage, synovitis, and proliferation of synovial cells in the LFJ. Inflammatory factors such as iNOS, IL-1ß, and TNF-a were more significantly expressed in bipedal rat injected with uPA (p < 0.05). CONCLUSIONS: Intraarticular injection of uPA can induce LFJOA in bipedal rats, while upright posture does not induce osteoarthritis in rats LFJ in the short term.

Clinical research of percutaneous spinal nerve posteromedial ramus destruction in treatment for chronic facet arthrogenic low back pain: a randomized trial.

BACKGROUND: To investigate the clinical effect of percutaneous spinal nerve posteromedial ramus destruction in treatment for chronic facet arthrogenic low back pain. METHODS: A total of 118 patients with chronic facet arthrogenic low back pain were enrolled in our hospital from October 2015 to October 2018 and randomly divided into two groups. Of these patients, 59 received conservative treatment as the control group while 59 patients were treated with percutaneous spinal nerve posteromedial ramus destruction as the observation group. Pain score (Visual Analogue Scale, VAS), functional score (Oswestry Disability Index, ODI), treatment score (Japanese Orthopaedic Association, JOA), life quality score (Short Form 36-item Health Survey, SF-36), and lumbar mobility (range of motion, ROM) were evaluated before and after treatment. The treatment effect between two groups was compared. RESULTS: The VAS score and ODI score at 2, 4, and 12 weeks after treatment and last follow-up in the observation group were lower than those of the control group (P<0.05). JOA score, SF-36, and ROM were higher than those of the control group (P<0.05). CONCLUSIONS: Percutaneous spinal nerve posteromedial ramus destruction has a significant effect in treatment for chronic facet arthrogenic low back pain, which can relieve pain, improve function, and enhance quality of life.

[Different skin-stretching devices for the treatment of skin and soft tissue defects].

OBJECTIVE: To compare clinical effects of tension-relief system(TRS) and self-made skin-stretching devices in treating skin and soft tissue defects caused by trauma. METHODS: Totally 41 patients with skin and soft tissue defects caused by trauma treated by skin-stretching devices were retrospectively analyzed from June 2015 to October 2016, including 28 males and 13 females, aged from 22 to 64 years old with an average of(43.2±10.4) years old. The patients were divided into two groups according to therapeutic methods, 18 patients were treated by TRS, including 11 males and 7 females, aged from 22 to 61 years old with an average of (41.7±9.5) years old; 5 patients injured on the upper limb, 11 patients on lower limb and 2 patients on the back; the area of defect ranged from 42 to 160 cm² with an average of(78.6±17.4) cm². Twenty-three patients were treated by self-made skin stretching device, included 17 males and 6 females, aged from 25 to 64 years old with an average of (44.4±12.7) years old; 6 patients injured on the upper limb, 13 patients on lower limb and 4 patients on the back; the area of defect ranged from 54 to 175 cm² with an average of(75.2±14.3) cm². Primary closure at stage I, blood loss, operation time, healing time of wound, complications between two groups were compared, VAS score was used to evaluate pain relief, vancouver scar scale(VSS) was used to assess recover of postoperative scars. RESULTS: Forty-one patients were followed up ranged from 3 to 12 months with an average of(16.2±3.7) months. There were no significant difference between two groups in blood loss and operation time(P>0.05). In TRS group, 16 patients' injury were closured directly, wound healing time of 16 patients were over 3 about weeks, VAS score was 3.9±1.1, VSS score was 3.5±1.2, and 1 patient occurred complication; In self-made skin stretch group, 12 patients' injury were closured directly, wound healing time of 9 patients were over 3 about weeks, VAS score was 4.8±1.4, VSS score was 5.3±1.6, and 9 patients occurred complication; there were no statistical differences between two groups in these items. CONCLUSIONS: Compared with self-made skin stretch, TRS has advantages of good effect of wound, minimal trauma, short healing time, less pain, good outlook, and less complication.

Replacement or repair of terrible triad of the elbow: A systematic review and meta-analysis.

BACKGROUND: Surgical treatment for terrible triad injuries remains a challenging clinical problem, and controversy exists of whether it is better to repair or replace the radial head. The objective of this systematic review was to evaluate the clinical outcomes of repair and arthroplasty replacement of the radial head in patients with terrible triad injury. METHODS: Medline, Cochrane Library, EMBASE, and Google Scholar were searched up to July 30, 2018 to identify the relevant studies, which included patients who had received treatments of the terrible triad of the elbow and also had reported with the quantitative outcomes. Outcomes of interest were functional outcomes. RESULTS: Four studies with a total of 115 patients were included in the systematic review. Most patients were type II or III radial head fractures based on the Mason classification systems. Fifty-one patients received radial head repair surgery and 64 underwent replacement. Two studies had indicated that patients in the replacement group were significantly associated with better treatment outcome assessed by DASH (Disabilities of the Arm, Shoulder and Hand) and MEPS (Mayo Elbow Performance Score) scores. The meta-analysis indicated that patients with the arthroplasty replacement were associated with significantly better ROM outcomes in flexion, extension, pronation than those with radial head repaired. In addition, patients in the replacement group showed fewer post-surgery complications than those in the repair group. CONCLUSIONS: Our review had indicated that patients with terrible triad injuries undergo arthroplasty replacement have better clinical outcomes and fewer post-surgery complications than those received the repair surgery. Radial head replacement might be a more effective treatment approach with good clinical outcomes for patients with a terrible triad of the elbow.

[Analysis on related factors of perioperative total blood loss in unilateral total hip arthroplasty].

OBJECTIVE: To investigate the influential factors of total blood loss during unilateral artificial total hip arthroplasty (THA). METHODS: From January 2014 to July 2016, 131 patients undergwent primary unilateral total hip arthroplasty, including 55 males and 76 females, ranging in age from 40 to 89 years old, with an average of 64.5 years old. The data of patients with unilateral total hip arthroplasty were collected, and the data of hemodynamics, coagulation function, hemoglobin and hematocrit values were recorded according to the observation data. The blood loss of the patients was calculated by Gross equation, and the data were analyzed by a statistical software. RESULTS: The total blood loss of the patients was significantly affected by the factors of pathogenesis and deep venous thrombosis of the lower limbs. The results were statistically significant(P<0.05). The gender, age, body mass index, prosthesis and anesthesia had little effects on the blood loss volume after replacement. CONCLUSIONS: The data in this study indicate that the volume of actual blood loss can be controlled by adjusting non-surgical factors such as gender, age, body mass index, prosthetic material, and risk factors, and surgical factors(postoperative complications, anesthesia).

Treatment of Intercondylar Humeral Fractures With 3D-Printed Osteosynthesis Plates.

The aim of the study was to evaluate the efficacy custom 3D-printed osteosynthesis plates in the treatment of intercondylar humeral fractures.Thirteen patients with distal intercondylar humeral fractures were randomized to undergo surgery using either conventional plates (n = 7) or 3D-printed plates (n = 6) at our institution from March to October 2014. Both groups were compared in terms of operative time and elbow function at 6 month follow-up.All patients were followed-up for a mean of 10.6 months (range: 6-13 months). The 3D-printing group had a significantly shorter mean operative time (70.6 ±â€Š12.1 min) than the conventional plates group (92.3 ±â€Š17.4 min). At the last follow-up period, there was no significant difference between groups in the rate of patients with good or excellent elbow function, although the 3D-printing group saw a slightly higher rate of good or excellent evaluations (83.1%) compared to the conventional group (71.4%).Custom 3D printed osteosynthesis plates are safe and effective for the treatment of intercondylar humeral fractures and significantly reduce operative time.

Meta-analysis of reamed versus unreamed intramedullary nailing for open tibial fractures.

BACKGROUND: Open fractures of the tibial diaphysis are usually caused by high-energy trauma and associated with severe bone and soft tissue injury. Reamed and unreamed intramedullary nailing are often used for treatment of tibial injury. The purpose of this study was to investigate the clinical efficacy of reamed versus unreamed intramedullary nailing for open tibial fractures (OTF). METHODS: A meta-analysis was conducted according to the guidelines of the Cochrane Collaboration using databases containing the Cochrane Library, PubMed, EMbase, Chinese Biomedical Database, Chinese VIP information, and WanFang Database. Randomized and semi-randomized controlled clinical trials of both reamed and unreamed intramedullary nailing for OTF treatment were analyzed using Reviewer Manager (RevMan5.0) software. RESULTS: A total of 695 references were initially identified from the selected databases. However, only four studies were assessed, matching all the eligibility criteria conducted by two independent reviewers. The result showed that there was no statistical difference in healing rate, secondary surgery rate, implant failure rate, osteofascial compartment syndrome, and infection during the postoperative period between reamed and unreamed nails in OTF. CONCLUSIONS: Findings of this study suggest that there was no statistical difference between reamed and unreamed intramedullary nailing in clinical treatment of OTF. However, the result of this meta-analysis should be cautiously accepted due to some limitations, and further studies are still needed.

Destrin deletion enhances the bone loss in hindlimb suspended mice.

Destrin, also known as actin depolymerizing factor (ADF), is a member of the ADF/Cofilin/destrin superfamily that has the ability to rapidly depolymerize F-actin in a stoichiometric manner. Remodeling of the actin cytoskeleton through actin dynamics (assembly and disassembly of filamentous actin) is known to be essential for numerous basic biological processes including bone formation. The aim of current study was to elucidate whether destrin was involved in the progression of bone loss induced by modeled microgravity. We used the hindlimb suspension (HLS) mice model to simulate microgravity in vivo. Exposure to HLS in mice enhanced femur destrin expression. Destrin deletion in Dstn (-/-) mutant mice enhanced HLS-induced reduction of BMD, ultimate load, stiffness, trabecular thickness, trabecular number, and bone volume fraction in femur, but did not affect them under control static condition. The Rotary wall vessel bioreactor was used to model microgravity in vitro. Exposure to modeled microgravity in cultured 2T3 murine osteoblast precursor cells upregulated destrin expression. RNAi-mediated destrin knockdown enhanced the microgravity-induced reduction of osteoblastic proliferation and differentiation significantly. In conclusion, for the first time we demonstrated that destrin deletion enhances the bone loss in hindlimb suspended mice. Destrin may be a potential target for the prevention or management of microgravity-induced bone loss.