Humeral Head Replacement in the Treatment of Comminuted Proximal Humeral Fracture.

OBJECTIVE: To investigate the outcomes of humeral head replacement in the treatment of patients with comminuted proximal humeral fracture. METHODS: Between February 2013 and September 2016, 56 patients underwent humeral head replacement in our hospital. Of them, 18 cases were diagnosed as comminuted proximal humeral fracture before the operation. The mean age of the patients was 69.5 years old (ranging from 61 to 79 years old). Of them, there were six males and 12 females. All the patients in this group had fresh fractures. They were all treated by artificial humeral head replacements. After the prosthesis was fixed by bone cement reliably, the greater or lesser trochanter and prosthesis handle were sutured and fixed firmly. The interval time from injury to operation ranged from 1 to 5 days. The Constant Functional Score, operation time, blood loss, nerve injury, joint dislocation rate, and infection rate were recorded at the final follow-up. The clinical data of these patients were retrospectively studied. All of the data were recorded in average form. RESULTS: In this study, the mean duration of follow-up was 4 years, ranging from 3 to 6 years. The operation time ranged from 75 to 120 min, with the average of 82 min. The blood loss ranged from 100 to 400 mL, with the average of 210 mL. The mean score of Constant Functional Score was 83.5 ± 3.1. Of them, 14 cases achieved excellent and good (scores of more than 80), and four cases achieved moderate and poor (scores of less than 80). No patient suffered from joint dislocation, unstable joint, or infection after the operation. There were two patients with axillary nerve injury before the operation. However, the function could be recovered within 3-6 weeks after the surgery. CONCLUSION: The artificial humeral head replacement could be applied for the treatment of patients with comminuted proximal humeral fracture. During the surgery process, the stable structure of shoulder joint could be completely restructured, and the rehabilitation plan should be adjusted reasonably and timely after the operation.

Effect of Capsular Closure on Outcomes of Hip Arthroscopy for Femoracetabular Impingement: A Systematic Review and Meta-analysis.

OBJECTIVE: To evaluate the effect of hip arthroscopy with or without capsular closure in femoracetabular impingement (FAI) by meta-analysis. METHODS: Pertinent studies were identified by searching Pubmed, EMBASE databases with the last search update on 16 February 2020. Studies that reported hip arthroscopy for FAI were collected. Meta-analysis was performed by the use of Review Manager 5.3 software. The odds ratios (OR) and mean differences (MD) were used to compare dichotomous and continuous variables. Additionally, the I2 was used to assess heterogeneity among studies, and the fixed-effects model or the random-effects model was selected for the quantitative analysis. Outcomes were evaluated by forest plots. For statistical analysis, P < 0.05 was considered significant. RESULTS: There was no significant difference among the preoperative mHHS (MD = -2.66，95% CI [-7.25, 1.92], I2 = 80%, P = 0.25), preoperative (MD = -4.94, 95% CI [-11.56, 1.67], I2 = 50%, P = 0.14) and postoperative HOS-SSS (MD = -1.00, 95% CI [-6.98, 4.98], I2 = 66%, P = 0.74), patient satisfaction (MD = 0.03, 95% CI [-0.25, 0.31], I2 = 19%, P = 0.84; OR = 0.94, 95% CI [0.59, 1.50], I2 = 0%, P = 0.78), complications (OR = 1.23, 95%CI [0.56, 2.67], I2 = 0%, P = 0.61), revisions (OR = 1.77, 95% CI [0.87, 3.60], I2 = 36%, P = 0.11), and surgery time (SMD = -0.38, 95% CI [-1.16, 0.40], I2 = 92%, P = 0.34) between the capsule closure group and the non-closure group. For the comparison of postoperative mHHS (MD = -2.66, 95% CI [-7.25, 1.92], I2 = 80%, P = 0.25) and HOS-ADL (MD = -4.20, 95% CI [-5.75, -2.65], I2 = 24%, P < 0.00001), the score of the non-closure group was significantly better than that of the closure group. CONCLUSIONS: Remain capsule unclosed after hip arthroscopy for FAI may, to some extent, has a better postoperative functional score than the non-closure treatment.

Cost-utility analysis of total knee arthroplasty for osteoarthritis in a regional medical center in China.

BACKGROUND: To analyze the cost-effective ratio of total knee arthroplasty (TKA) in the osteoarthritis (OA) treatment of at a regional medical center in China. METHODS: One hundred thirty-nine patients with osteoarthritis who underwent TKA at the Department of Osteoarthritis in Luhe hospital (Tongzhou, Beijing) from January 2011 to January 2012 were followed up. Their health-related quality of life (HRQoL) was evaluated using Short-Form Health Survey (SF) -36 Chinese version, and compared with those of the normal population to assess quality-adjusted life years (QALYs) gained after surgery for its effectiveness of the treatment. The total expense was the cost of patient hospitalization. The cost per QALY was calculated. The cost-benefit ratio (CBR) was expressed as a ratio of each QALY's expenditure to per capita gross domestic product (GDP). Factors affecting the cost, including age, gender, length of stay, and ICU experience, were also considered. RESULTS: The total hospitalization fee was Ò°8,053,736.68, Ò°57,940.55 in average, of which, 81.59% constituted out-of-pocket expenses. The SF-36 scores were as follows: Physical Function: 25.14, Role Physical: 7.12, Bodily Pain: 9.60, Role emotional: 5.58, Vitality: 19.9, Mental Health: 25.84, Social Function: 9.86 and General Health: 21.15. Compared with normal people of the same age and sex, a total of Ò°2487.74 QALYs and Ò°3237.37/QALY were gained, 10% less than the regional GDP per capita. The cost-effective ratio of TKA for osteoarthritis in China was 1: 10.78. The main cost of the patient was the cost of prosthesis (61.78%). The average cost afforded by patients' themselves was Ò°47,242.64 after the deduction of government subsidies. There were Ò°31,306.64 difference compared with the annual average income of the local people. The cost might be affected by length of stay and ICU experience. Longer stay caused more cost of treatment. Patients who remained in ICU after surgery had higher overall costs and blood transfusion costs. CONCLUSION: The factors that affect TKA cost are hospital and postsurgical ICU stay. It is cost-effective for regional medical care center to treat osteoarthritis using TKA economically. However, considering the average income of patients in the area, it is necessary to reduce the cost of the treatment.

[Mid-term therapeutic effect analysis of cementless total knee arthroplasty without patella replacement].

OBJECTIVE: To explore the flexibility and reliability of cementless total knee arthroplasty (TKA) without patella replacement through a retrospective study of the mid-term therapeutic effect of the treatment of the patients. METHODS: From June 1997 to March 2000, a consecutive series of 152 (152 knees) cementless TKA performed in Hessing-Stiftung was studied. Among them, there were 63 males and 89 females, with 70 left knees and 82 right knees. Their ages ranged from 51 years to 72 years, with an average of 59 years. There were 146 cases of osteoarthritis and 6 cases of traumatic arthritis. The course of the disease lasted for 1.0 years to 3.5 years. The EFK prostheses of German Plus company were used in all the cases. The HSS score before the operation was 41.5 +/- 12.3, and the average range of motion was 55 degrees (ranging from 30 degrees to 90 degrees). RESULTS: Five patients underwent anterior knee pain, and the pain was released after the appropriate treatment. No deep infection happened in all cases. A total of 145 patients (145 knees) were followed up for 5 years to 8 years. The HSS score was 87.5 +/- 8.2 at the end of the follow-up, showing significant difference (P < 0.05). The average range of motion was 95 degrees (ranging from 90 degrees to 110 degrees). Partial radiolucencies occurred at the tibia side in 18 knees 3 to 6 months after the operation. Among them, the width was less than 2 mm in 15 knees without symptom, and more than 2 mm in 3 knees. There were 2 of the 3 knees which were revised at the tibia side because of the aseptic loosing, while 1 patient had only mild pain in the knee during the follow-up, with no sign of loosing. CONCLUSION: The mid-term effect of cementless TKA is satisfactory. The ingrowth of femur and tibial bones is reliable. The early stage migration of the component is the main reason of loosing. Satisfying outcomes can also be achieved without patella replacement during TKA.

[Changes in tumor necrosis factor-alpha mRNA expression in peripheral polymorphonuclear leukocyte and tissues during posttraumatic sepsis].

OBJECTIVE: To evaluate the changes in tumor necrosis factor-alpha (TNF-alpha) mRNA expression in peripheral polymorphonuclear leukocyte (PMNs) and tissues after cecal ligation puncture (CLP) in rats. METHODS: Reverse transcription-polymerase chain reaction (RT-PCR) was used to detect TNF-alpha mRNA expression in peripheral PMNs and tissues. RESULTS: The TNF-alpha mRNA expression in peripheral PMNs rose gradually after CLP, and it began to decrease after reaching the peak at 48 hours, but it was still higher than normal. The elevation of TNF-alpha mRNA expression was first limited in the regional tissues (P<0.01 at 12 hours after CLP and peaked at 24 hours in the intestine), then it entered the blood circulation later to affect the sensitive organs--lungs and livers (P<0.01 at 24 hours after CLP and peaked at 48 hours in the lung; P<0.05 at 24 hours after CLP and peaked at 48 hours in the liver). CONCLUSION: The rise of TNF-alpha mRNA expression plays an important role in pathogenesis of sepsis.