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CHEN Jin- xiong, PAN Shang- xian, ZHOU Guan-ming, CHEN Xi-cong, LIU Shao-hua, ZHENG Ya-wei
2025,33(9):769-774, DOI: 10.20184/j.cnki.Issn1005-8478.110162
Abstract:
[Objective] To compare the clinical efficacy of prevention of hip dislocation in total hip arthroplasty (THA) with or without capsule repair through posterolateral approach for femoral neck fractures. [Methods] A retrospective study was conducted on 191 patients who underwent THA through the posterolateral approach for femoral neck fractures from January 2019 to December 2022. According to preoperative doctor-patient communication, 93 patients had the joint capsular repaired with a pouch suture after THA (the sutured group), while other 98 patients underwent THA without the capsule repaired, withe traditional rotator insertion reconstructed only (the traditional group). The perioperative, follow-up and imaging data of the two groups were compared. [Results] The sutured group had significantly less drainage volume 24 hours postoperatively than the traditional group [(180.2±66.8) mL vs (209.7±70.7) mL, P 0.004], although there were no significant differences in operation time, total incision length, intraoperative blood loss, walking time, dislocation occurred during hospitalization and hospital stay between the two groups (P＞0.05). The average follow-up period lasted for (15.3±4.3) months, and the sutured group proved significantly low hip dislocation incidence after discharge than the traditional group [0 vs 5.1%, P 0.027]. As time went on, the VAS score, Harris score, hip extension-flexion and internal-external rotation ROMs were significantly improved in both groups (P＜ 0.05), The sutured group proved significantly inferior to the traditional group in terms of VAS score [(5.2±1.2) vs (4.7±1.4), P=0.009], Harris score [(64.7±5.6) vs (69.3±4.8), P 0.001], extension-flexion ROM [(77.1±5.9)° vs (78.8±5.7)°, P=0.044] and internal-external rotation ROM [(46.2±4.5)° vs (47.5±4.0)°, P 0.036] 1 month postoperatively, whereas which became not statistically significant between them later (P＞0.05). As for imaging, no prosthesis loosening was observed in anyone of them, and there were no significant differences in acetabular abduction angle, anterior inclination and leg length discrepancy between the two groups at the last follow-up (P＞0.05). [Conclusion] The pouch suture for capsule repair does reduce the hip dislocation chance after THA through the posterolateral approach for femoral neck fractures
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LIU Wei-tong, LI Jin-lei, WANG Yan-bo, YANG Jing-fan.
2025,33(9):775-779, DOI: 10.20184/j.cnki.Issn1005-8478.110327
Abstract:
[Objective] To retrospectively compare the survival status of elderly patients with femoral intertrochanteric fractures treated by internal fixation of proximal femoral nail anti-rotation (PFNA) versus hemiarthroplasty (HAP). [Methods] A retrospective study was performed on 62 elderly patients who had femoral intertrochanteric fractures treated surgically in our hospital from January 2018 to January 2023. According to the preoperative communication with family members, 27 elderly received PFNA, while the other 35 cases received HAP. The perioperative data, such as operation time, intraoperative blood loss and related complications, were compared. Patients were evaluated with Harris hip score and activities of daily living (ADL) score, as well as survival condition until the end point of followup at 12 months after surgery or death. [Results] The PFAN cohort proved significantly superior to the HAP cohort in terms of operative time [(51.9± 5.2) min vs (69.3±4.8) min, P＜0.001], intraoperative blood loss [(110.9±20.3) mL vs (191.7±10.6) mL, P＜0.001], hospitalization cost [(1.3± 0.6) 10k yuan vs (1.9±0.3) 10k yuan, P＜0.001], although the former was significantly inferior to the latter in terms of walking time [(6.2±0.9) days vs (4.8±0.6) days, P＜0.001] and hospital stay [(11.5±1.1) days vs (10.1±1.8) days, P＜0.001]. A total of 17 patients died in a year after operation, with a total mortality of 27.4%. One year after operation, the PFNA group had 4 patients died with the mortality of 14.8%, whereas HAP group got 13 patients died accounting for 37.1%, and there was a significant difference in mortality between the two groups (P＜0.05). Excluding the 17 cases of death, the Harris score and ADL score in the PFAN group were significantly lower than those in HAP group one month after operation (P＜0.001), whereas which became not significantly different between them 3 months after surgery (P＞0.05). However, the Harris score and ADL score in the PFNA group were significantly better than those in the HAP group at the latest follow-up (P＜0.05). In terms of complications, there was only 1 case of loosening of internal fixation in the PFNA group, by contrast, there were 4 cases of poor incision healing, 3 cases of prosthesis dislocation and 1 case of periprosthetic fracture in the HAP group, and the difference between the two groups was statistically significant (P<0.05). [Conclusion] In this group of patients, PFNA is superior to HAP regarding surgical trauma, medical cost and survival status in a year postoperatively. It is suggested that PFAN should still be considered as an important method for the treatment of femoral intertrochanteric fractures in the elderly.
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WANG Guan, XU Yulin, XIANG Fei-fan, ZHANG Xi-hai, TANG Lian, LI Yao
2025,33(9):780-785, DOI: 10.20184/j.cnki.Issn1005-8478.11011A
Abstract:
[Objective] To evaluate predicting value of macrophage inflammatory protein-1α (MIP-1α) and cortisol (Cor) for deep vain thrombosis (DVT) after total knee arthroplasty (TKA) for osteoarthritis. [Methods] A total of 231 patients who underwent TKA for osteoarthritis in our hospital from June 2019 to June 2023 were included in this study. According to whether DVT noted by postoperative ultrasonography, the patients were divided into DVT group and non-DVT group. The univariate comparison and logistic regression were conducted to research the related factor. In addition, the efficacy of serum MIP-1α and Cor alone, or in combination to predict DVT after TKA was analyzed by receiver operating characteristic curve (ROC). [Results] Among 231 patients, 53 (22.9%) were diagnosed with DVT. The DVT group proved significantly greater than the non-DVT group in terms of BMI [(24.0±2.1) kg/m2 vs (23.3±2.0) kg/m2 , P=0.037], diabetes rates [y/n, (10/43) vs (14/164), P=0.021], general anesthesia ratio [general anesthesia/lumbar anesthesia, (38/15) vs (92/86), P=0.010], MIP-1 alpha [(19.7±5.3) pg/mL vs (14.2±5.2) pg/mL, P＜0.001] and Cor [(305.7±51.5) nmol/L vs (255.3±44.8) nmol/L, P＜0.001]. As consequence of regression analysis, the BMI (OR=1.818, 95% CI: 1.217~2.718), diabetes (OR=1.980, 95% CI: 1.201~3.263), general anesthesia (OR=1.857, 95% CI: 1.336~2.581, MIP-1α (OR=2.042, 95% CI: 1.498-2.783), Cor (OR=1.876, 95% CI: 1.264~2.781) were the risk factors for postoperative DVT. ROC curve showed that the area under curve (AUC) of serum MIP-1α, Cor and a combination of them in predicting postoperative DVT were of 0.767, 0.778 and 0.838, respectively. [Conclusion] Elevated serum MIP-1α and Cor before operation are risk factors for DVT after TKA for osteoarthritis, and the combined detection of MIP-1α and COR has high predictive efficacy for the occurrence of DVT.
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2025,33(9):786-790, DOI: 10.20184/j.cnki.Issn1005-8478.110205
Abstract:
Shoulder arthroplasty (SA) is an effective treatment for endstage shoulder arthrosis with pain and dysfunction. With the maturation and development of surgical techniques, the number of shoulder arthroplasty surgeries has been increasing significantly, while periprosthetic humeral fracture after SA is a rare and serious complication that can lead to severe pain, loss of limb function and prosthetic failure. Treatment strategies for the periprosthetic humeral fractures include nonoperative treatment, open reduction and internal fixation, and prosthetic revision techniques. Rotator cuff status, prosthesis type, fracture timing, fracture type, prosthesis stability, and remaining bone mass are all important factors that influence periprosthetic fracture treatment. This article makes a review of the epidemiological characteristics, fracture typing and treatment options for periprosthetic humeral fractures after SA to provide a reference for clinical work.
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WANG Yan-ming, XIE Dai-jun, WU Meng, JIANG Jin
2025,33(9):791-795, DOI: 10.20184/j.cnki.Issn1005-8478.110316
Abstract:
In recent years, with the development of computer technology and the in-depth promotion of the intersection of medicine and engineering, the application of artificial intelligence (AI) in the medical field has gradually deepened. At present, AI has been widely used in the field of sports medicine and has good performance and high accuracy in terms of prediction of the occurrence of sports medicine diseases, diagnostic imaging, postoperative efficacy and complication prediction. However, the development and further clinical application of AI still face problems such as retrospective studies, short follow-up time, limited data sample size, and lack of external validation. This article reviews the application status of AI in the field of sports medicine, and summarizes the research progress of AI in sports medicine diseases in recent years, in order to provide a reference for clinical decision-making.
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CUI Jin- quan, MAN Zhen-tao, CHEN Haifeng, LI Wei
2025,33(9):796-800, DOI: 10.20184/j.cnki.Issn1005-8478.110816
Abstract:
Bone defect is a serious orthopaedic problem caused by multiple factors. Due to obstinacy and poor prognosis, it has become a major challenge after failed managements for fracture, bone tumor and joint replacement. Multifunctional composite scaffolds have been widely used in the treatment of bone defects due to their excellent biocompatibility, degradability and osteoinduction properties. Different scaffold materials can promote the differentiation of bone marrow mesenchymal stromal cells (BMSCs) into osteoblasts through different mechanisms. However, due to the limited capacity of single-function scaffolds to promote bone repair, it is difficult to achieve the expected therapeutic effect. Therefore, the preparation of composite scaffolds with multiple functions is expected to become a new method for the treatment of bone defects. This paper summarizes the characteristics and osteogenic manner of different scaffolds at home and abroad in recent years, and reviews the research status of multifunctional composite scaffolds for bone defects.
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2025,33(9):801-805, DOI: 10.20184/j.cnki.Issn1005-8478.110928
Abstract:
Unicameral bone cyst (UBC) is a common benign tumor-like lesion in children, which usually occurs in the metaphysis of the long bones. At present, the etiology and pathogenesis remains unclear, and there is no consensus on the optimal therapy. The elastic stable intramedullary nail (ESIN) can be widely used for UBC alone or combined with other methods, but there are differences in efficacy. In this paper, the theoretical basis, surgical details, efficacy, and complications were summarized and analyzed by reviewing the relevant literatures, aiming to provide the basis for selecting treatment plans, promoting cyst healing, reducing complications, and improving doctor-patient communication.
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SHAN Bin, WANG Jin, ZUO Zhen-bai, LI Chun-yan, ZHAO Jia-me, HUANG Yuan-xia
2025,33(9):806-814, DOI: 10.20184/j.cnki.Issn1005-8478.100953
Abstract:
[Objective] To explore the mechanism of naringin (Nar) in preventing steroid-induced osteonecrosis (ON) in rats. [Methods] Seventy-three Sprague-Dawley (SD) male rats (SPF grade) were randomly divided into four groups, including blank group (n=16), model group (n=19), low-dose group (n=19) and high-dose group (n=19). Fifty-seven SD rats in model group, low-dose group and high-dose group were intraperitoneally injected 20 μg/kg LPS twice, and intramuscularly injected 40 mg/kg MPS three times every 24 h. After the initial injection of MPS, the low-dose group and the high-dose group were given Nar at 300 mg/kg and 600 mg/kg daily for 6 weeks, respectively, while the blank group and the model group were given normal saline. Serum marks, bone mineral density of femur and histological observation were assayed. The rat BMSCs were isolated and cultured, and ALP activity, calcium deposition, RT-qPCR and Western-blot were tested. [Results] The incidence of ON was ranked as model group ＞ lowdose group ＞ highdose group (89.5% vs 63.2% vs 26.3%, P 0.001), while the necrotic focus was concentrated in metaphysis, and there was no a significant difference in the severity of ON among all the groups (P＞0.05). The trabecular bone area ratio [(0.41±0.04) vs (0.37±0.03) vs (0.35±0.02) vs (0.30± 0.03), P 0.001] and microvascular density [(2.90±1.20) vs (1.90±1.30) vs (1.50±1.10) vs (1.00±0.60), P 0.001] were ranked up-down as blank group ＞ high-dose group ＞ low-dose group ＞ model group. However, bone marrow fat cells diameter [(136.60±9.60) μm vs (158.40±5.50) μm vs (184.40±8.00) μm vs (223.60± 11.60) μm, P 0.001] and fat cell density [(29.70±2.70) /mm2 vs (33.70±1.60) /mm2 vs (36.60±2.10) /mm2 vs (40.70±2.00) /mm2 , P 0.001] were of blank group ＜ highdose group ＜ lowdose group ＜ model group. The Nar restored abnormal thrombomodulin, activated partial thromboplastin time (APTT) and thrombomodulin, tissue plasminogen activator (t-PA), tissue plasminogen activator inhibitor-1 (plasminogen activator inhibitor-1, PAI-1), lowdensity lipoprotein (LDL), highdensity lipoprotein (HDL), glutathione (GSH), and lipid peroxide (LPO) all in the dose-dependent manner, with high-dose group close to the blank group (P＜0.05). Nar inhibited PPARγ2-induced lipotropic differentiation of BMSCs and enhanced osteogenic mRNA and protein expression in the dose-dependent manner (P＜0.05). [Conclusion] Natural ligand Nar uses PPARγ as a key target to promote bone repair and inhibit fat hyperplasia, which is helpful for early intervention of steroid-induced femoral head necrosis involving multiple mechanisms.
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WANG Shuai, CHEN Weiyang, JI Feng, WANG Shou-guo
2025,33(9):815-824, DOI: 10.20184/j.cnki.Issn1005-8478.110786
Abstract:
[Objective] To investigate the protective effect of 4-octyl itaconate (4OI) on oxidative damage of mouse nucleus pulposus cells induced by IL-1 and its mechanism. [Methods] Mouse nucleus pulposus cells were isolated and cultured, while CCK8 method was used to detect the viability of the cells. The effects of 4OI and IL-1 on Nrf2 pathway were detected by luciferase reporter gene method, immunoprecipitation, RT-qPCR and WB method. In addition, JC-1 assay, ssDNA ELISA and TBAR were used to detect oxidative damage, LDH ELISA, Trypan blue staining, TUNEL assay and Annexin V flow cytometry were used to detect apoptosis. The effect of silencing Nrf2 and Keap1 on apoptosis inhibition by 4OI was studied by lentiviral shRNA transfection and CRISPR/Cas9 technique. [Results] The 4OI promoted the dissociation of KEap1-NRF2 in mouse nucleus pulposus cells, and Nrf2 re-entered the nucleus to regulate downstream gene transcription. The 4OI significantly inhibited ROS levels and improved IL-1-induced oxidative damage of mouse nucleus pulposus cells. 4OI reversed IL-1-induced decline in nucleus pulposus cell viability, increased LDH and increased dead cells. Furthermore, 4OI significantly inhibited IL-1-induced nucleus pulposus cell death, inhibited the increase of IL-1-induced Caspase-3 and Caspase-9 activities, as well as the increase of protease PARP1 cleavage fragment and cytochrome C content, and significantly inhibited IL1-induced apoptosis. However, silencing the expression of Nrf2 and Keap1 in mouse nucleus pulposus cells negated the protective effect of 4OI on IL-1-induced cell damage. [Conclusion] 4OI protects nucleus pulposus cells from IL-1-induced oxidative damage by activating the Nrf2 pathway, providing a new strategy for the treatment of intervertebral disc degeneration.
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TANG Ke- xing, FANG Xiaoxiang, GAO Peng, CHEN Kun, OUYANG Pan, LI Zong- chao, DAI Ao- nan, YANG Ming, LI Liang- jun
2025,33(9):825-828, DOI: 10.20184/j.cnki.Issn1005-8478.110282
Abstract:
[Objective] To introduce the surgical technique and preliminary clinical outcome of arthroscopic repair of bony Bankart injury combined with rotator cuff tear with anchors. [Methods] From February 2018 to February 2022, a total 8 patients had bony Bankart injury and ipsolateral rotator cuff tear treated by arthroscopic repair with anchors. The posterior, anteroinferior and anterosuperior portals were established to repair the bony Bankart injury first. Single-row direct suture for small bone fragment and double-row double-pulley fixation for larger bone fragment were conducted with anchor sutures. After that, the anterolateral and posterolaterl portals were created to access the subacromial space, rotator cuff tear was repaired by single row suture with anchor. [Results] All patients had operations performed successfully and followed up for (39.7±4.6) months in a mean. Compared with those preoperatively, the VAS score [(6.9±1.2), (0.9±0.8), P 0.001], Constant-Murley score [(27.4±8.2), (90.8±5.2), P 0.001], ASES score [(35.2±9.6), (88.5±4.9), P 0.001], Rowe's score [(28.1± 6.6), (90.4±2.7), P 0.001] were significantly improved at the latest follow-up. The radiographs showed that the anchor was not loosened, the fracture fragment healed well, and the rotator cuff regain proper continuity. [Conclusion] The one-stage arthroscopic anchor fixation of bony Bankart injury and rotator cuff tear is reliable technique, achieves satisfactory medium-term clinical consequence.
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LI Zheng, LI Chang-shu, LIN Bo-ying, YI Xiao-you, LI Li, LUO Jia-xuan
2025,33(9):829-833, DOI: 10.20184/j.cnki.Issn1005-8478.110233
Abstract:
[Objective] To introduce the surgical technique and preliminary clinical outcome of arthroscopic triple fixation for posterior cruciate ligament (PCL) tibial avulsion fracture. [Methods] From January 2022 to January 2023, 18 patients received abovementioned surgical treatment for PCL tibial avulsion fracture. After anterolateral, anteromedial and posteromedial portals were created, the intraarticular exploration and debridement were conducted. As the fracture fragment was reduced with PCL tibial guider, a bone tunnel was established anteroposteriorly through the fracture fragment. Grabing 2 high-strength sutures into the joint, passing through and around the PCL to form a "pocket ring", and introducing ends of the high-strength suture and double-button loop sutures into the bone tunnel to tibial front side, tighten the tail end of the high-strength suture to assist the bone fragment reduction, tightening the double-button loop to until the both buttons firmly seated on the bone to fix the fracture fragment, and tied the high strength suture with the button loops suture. Finally, the assisted traction suture of button-loop system on the posterior side was passed around the PCL, and then lead to the front side through the bone tunnel, tightened and knotted to accomplish the triple fixation with the high-strength suture, double-button loop and auxiliary wire in sequence under arthroscope. [Results] All patients had operation performed successfully with operation time of (67.0±22.5) min, and followed up for (12.5±2.7) months. Compared with that preoperatively, the pain VAS score was declined significantly 3 months and postoperatively [(5.8±1.4), (0.7±0.6), P＜0.001]. In addition, compared with those preoperatively, the HSS score [(46.4±9.8), (94.8±3.8), P＜0.001] and Lysholm score [(49.4±9.5), (93.4±4.1), P＜0.001] increased significantly 12 months after operation. All patients got fractures healed well on X ray by 3 months postoperatively. [Conclusion] This arthroscopic triple fixation for PCL tibial avulsion fracture is a safe, reliable and minimally invasive technique, providing stable and reliable fracture healing conditions.
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ZUO Wei, XIAO Fei, HUANG Yu-cheng, JIAO Jing, WANG Jun-wen, CHENG Wen-jun
2025,33(9):834-837, DOI: 10.20184/j.cnki.Issn1005-8478.100791
Abstract:
[Objective] To evaluate the clinical efficacy of 3D printing-assisted bridging combination fixation of Vancouver type B1 and C periprosthetic fractures of the femur. [Methods] A retrospective study was conducted on 27 patients who had Vancouver type B1 and type C periprosthetic fractures fixed by 3D printing assisted bridging combination fixation from March 2016 to May 2022. The clinical and imaging documents were evaluated. [Results] Of the 27 patients, there were 15 cases of Vancouver type B1 fractures and 12 cases of Vancouver type C fractures. There were no significant differences in operation time [(107.3±18.7) min vs (119.2±19.3) min, P=0.713] and intraoperative bleeding [(385.3±114.1) mL vs (420.8±160.2) mL, P=0.381] between the two groups. No complications such as wound infection, loose internal fixation, fracture nonunion or malunion occurred in anyone of them during follow-up. There were no significant differences in fracture healing time [(3.8±1.3) months vs (4.2±1.6) months, P=0.258], Harris score before injury [(86.3±3.5) vs (86.9±3.3), P= 0.903] and Harris score 12 months after revision [(84.3±3.4) vs (85.2±3.1), P=0.785] between the two types of the fractures. [Conclusion] 3D printing-assisted bridging combination fixation of Vancouver type B1 and C periprosthetic fractures of the femur after THA achieves satisfactory short-medium term clinical consequence, and there is no significant difference in the treatment outcome between the two fracture types.
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WANG Jin, WANG Hu-lin, PU Yan-ch? uan, LI Zi-cai, XU Duo-hui, XU Zhi-bin
2025,33(9):838-842, DOI: 10.20184/j.cnki.Issn1005-8478.100828
Abstract:
[Objective] To investigate the clinical effect of the hook plate pre-shaped based on preoperative CT for internal fixation of acromioclavicular dislocation. [Methods] A retrospective study was conducted on 60 patients who had acute closed acromioclavicular dislocation treated surgically in our hospital from January 2020 to December 2022. According to the doctor-patient communication, 30 patients were treated with the pre-shaped hook plate (HP group), while other 30 patients were treated with loop plate to reconstruct coracoclavicular ligament (LP group). The clinical and imaging documents of the two groups were compared. [Results] The HP group proved significantly superior to the LP group in terms of operation time [(40.5±8.7) min vs (61.9±11.4) min, P＜0.001), incision length [(6.3±1.6) cm vs (7.5±2.2) cm, P＜0.001] and intraoperative blood loss [(52.6±14.8) mL vs (75.4±13.2) mL, P＜0.001]. Compared with those 3 months after surgery, the VAS for pain, Constant score and shoulder forward flexion and upward range of motion (ROM) remained unchanged at the latest follow-up in both groups (P＞0.05), which were not significantly different between the two groups at any corresponding time points (P＞0.05). As for imaging, the acromioclavicular distance (ACD) and coracoclavicular distance (CCD) in both groups decreased significantly at 6 months after surgery compared with those preoperatively (P＜0.05), whereas which were not significantly different between the two groups at any time points accordingly (P＞0.05). [Conclusion] This pre-shaped hook plate based on preoperative CT for the treatment of acromioclavicular dislocation is simple and inexpensive, achieves satisfactory clinical consequence.
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2025,33(9):843-847, DOI: 10.20184/j.cnki.Issn1005-8478.12006A
Abstract:
[Objective] To introduce the technique and clinical consequence of fracture matching recognition technique in repairing severe foot and ankle wound. [Methods] From March 2015 to August 2020, 27 patients with severe foot and ankle wound were treated with the "fracture-matching recognition technique" to effectively identify the tissue in situ. On basis of thorough debridement, the multi-tissue integration reconstruction procedures combined with new method searching vascular vessels and innovative tissue survival promoting ways were adopted for repair. [Results] All the patients had surgical procedures performed smoothly without serious complications such as limb necrosis. Except early flap swelling occurred in 4 cases, which basically subsided 7 days later, and delayed wound healing happened in another patient, who got healed gradually after dressing change, all patients had the recipient and donor areas of the skin flap healed well. The followup period lasted for (23.8±7.5) months in a mean. With time elapsed before discharge, 3 months after surgery and at the last follow-up, the VAS score [(4.0±1.3), (2.30±1.1), (1.6±0.8), P＜0.001], AOFAS score [(54.3±3.2), (71.0±3.0), (83.9±3.3), P＜0.001], dorsal-plantar flexion range of motion (ROM) [(42.7±2.9)°, (52.6±2.6)°, (64.2±3.2)°, P＜0.001], inversion-eversion ROM [(34.7±3.6)°, (40.7±3.6)°, (53.6±3.9)°, P＜ 0.001]，Highet grade distal to the wound [S0/S1/S2/S3/＞S3, (2/9/11/3/2), (1/6/9/7/4), (0/2/3/6/16), P＜0.001]，static 2-point discrimination (2PD) [(38.0±4.7) mm, (32.3±2.2) mm, (19.0±0.6) mm, P＜0.001]，and moving 2-point discrimination (m2PD) [(10.1±0.6) mm, (8.4±0.9) mm, (5.5±0.3) mm, P＜0.001] were significantly improved. [Conclusion] The applying "fracture matching recognition technique" combined with microsurgical technique to repair severe foot and ankle wound does save the limb function to the maximum extent and reduce the disability rate.
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FENG Lei, LIU Juan, ZHAO Ying, YAN Liang, SONG Shi-peng, SUN Xin-hong, SONG Tao
2025,33(9):848-851, DOI: 10.20184/j.cnki.Issn1005-8478.11064A
Abstract:
[Objective] To investigate the effect of intraarticular infusion of hemostatic-anesthetic-steriod mixture in total hip arthroplasty (THA). [Methods] A retrospective study was done on 92 patients who received the primary unilateral THA from October 2022 to March 2024. According to preoperative doctor-patient communication, 46 patients in the drug group had 120 mL of hemostatic-anestheticsteriod mixture infused intraarticularly after THA, while the other 46 patients in the control group had no drugs used with same volume of normal saline intraarticular infusion. The perioperative clinical and laboratory data of the two groups were compared. [Results] All patients had THA performed successfully without complications, such as nerve and vascular injuries. Although there were no significant differences in operation time, incision length, intraoperative blood loss and incision healing grade between the two groups (P＞0.05), the drug group proved significantly superior to the control group in terms of postoperative drainage volume [(216.3±32.4) mL vs (387.4±45.9) mL, P＜0.001] and total dominant blood loss [(451.6±54.1) mL vs (625.5±63.3) mL, P＜0.001]. In addition, the drug group had significantly lower incidence of postoperative deep venous thrombosis (DVT) than the control group (2.2% vs 15.2%, P=0.026). The pain VAS score was significantly decreased (P＜ 0.05), while the 6-minute walking distance was significantly increased in both groups over time postoperatively (P＜0.05). The drug group was significantly lower than the control group in VAS score [(4.0±1.3) vs (6.7±1.4), P＜0.001; (4.1±1.2) vs (7.3±1.3), P＜0.001] 1 and 2 days postoperatively, whereas the former was significantly higher than the latter in the 6-minute walking distance [(53.4±7.2) m vs (36.7±2.5) m, P＜0.001; (154.0±14.1) m vs (124.8±14.0) m, P＜0.001] 3 and 7 days after surgery. As for blood test, there was no significant difference in Hct and D-D between the two groups before operation (P＞0.05). Compared with those preoperatively, the Hct was significantly decreased (P＜ 0.05), while the D-D was significantly increased 3 days after surgery in both groups (P＜0.05). The drug group had significantly highe Hct than the control group [(38.1±1.3)% vs (36.2±0.5)%, P＜0.001], whereas the former measured significantly lower D-D than the latter [(325.8± 42.9) μg/L vs (377.8±53.3) μg/L, P＜0.001] 3 days postoperatively. [Conclusion] Intraarticular infusion of mixture, containing tranexamic acid, ropivacaine and dexamethasone, does reduce postoperative pain, decline postoperative blood loss, decrease occurrence of DVT, and is conducive to the functional recovery of the affected limb.after THA.
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LI Qing-mei, CHEN Yuan-yuan, LIU Tong- xin, WANG Lin, XU Nan
2025,33(9):852-855, DOI: 10.20184/j.cnki.Issn1005-8478.11060A
Abstract:
[Objective] To investigate the clinical outcome of the integrated rehabilitation based on fast track surgery (FTS) after anterior cruciate ligament reconstruction (ACLR). [Methods] A total of 85 patients who were undergoing ACLR were included in this study and divided into two groups by random number table method. Of them, 43 patients received integrated rehabilitation under the concept of FTS (the intervention group), while other 42 patients were given conventional rehabilitation and nursing care (the routine group). The clinical data were compared between the two groups. [Results] The VAS and HSS scores, as well as knee range of motion and 8 dimensions of SF-36 score were significantly improved in both groups 8 weeks postoperatively compared with those before intervention (P＜0.05). There was no statistical significance in the above indexes between the two groups before intervention (P＞0.05), however, the intervention group proved significantly superior to the conventional group in terms of VAS score [(4.0±0.5) vs (5.0±0.5), P＜0.001], Lysholm score [(68.7±9.3) vs (57.9±6.4), P＜0.001], knee range of motion (ROM) [(59.2±8.4)° vs (51.9±6.9)°, P＜0.001] and SF-36 score for quality of life in 8 dimensions 8 weeks after intervention. The intervention group was also sigificantly better than the conventional group in term of satisfaction to nursing care at the last follow-up (P＜0.05). [Conclusion] The rehabilitation integration intervention based on fast track surgery does promote the rapid recovery after anterior cruciate ligament reconstruction.
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Comparison of preoperative MRI measurements and intraoperative findings of supraspinatus tendon tear
SUN Hai-tao, FENG Yin-bo, ZHAN De-ping, CHU Wei, WANG Wei-miao, TANG Peng, CHU Xu-dong, XU Bin
2025,33(9):856-860, DOI: 10.20184/j.cnki.Issn1005-8478.120043
Abstract:
[Objective] To evaluate the value of MRI in diagnosis of supraspinatus tendon tear by comparing preoperative MRI measurements with intraoperative findings. [Methods] A retrospective study was done on 41 patients who had total supraspinatus tendon tear treated surgically from January 2017 to December 2023. Based on the intraoperative tear length, the patients were divided into the severe group with tear length ≥3 cm, and mild to moderate group with tear length ＜3 cm. The preoperative MRI and intraoperative findings were compared between the two groups. ROC analysis was performed for MRI predicating severity of tendon tear using the parameters statistically significant between the two groups. [Results] According to the extent of rotator cuff tear found during operation, 14 patients fall into the severe group, while the remaining 27 paitents were in the mild to moderate group. The severe group proved significantly greater than the mild to moderate group in terms of tear length intraoperatively measured [(40.0±7.8) mm vs (17.9±4.2) mm, P 0.001], as well as preoperative MRI measurments, including coronal length (CL) of tendon tear [(13.6±5) mm vs (6,6.2±3.1) mm, P 0.001], horizontal length (HL) of tendon tear [(16.1± 5.5) mm vs (9.0±2.3) mm, P 0.001], combined length (CoL) of tendon tear [(21.8±5.3) mm vs (11.1±3.1) mm, P 0.001], and the subacromial thickness of fluid accumulation (STFA) [(4.1±2.1) mm vs (2.7±1.7) mm, P 0.033]. However, there were no significant difference in the incidence of anteromedial glenohumeral effusion, acromiohumeral interval distance (AHID), and coracohumeral distance (CHD) between the two groups (P＞0.05). As results of ROC analysis, the area under curve (AUC) of CoL, CL, HL and STFA measured by preoperative MRI in predicting intraoperative tear extent was 0.950, 0.878, 0.865 and 0.694, respectively. [Conclusion] Combining two or more MRI measurements can accurately predict the severity of supraspinatus tendon tears, and the diagnostic efficacy of the combined length measured in preoperative MRI is the highest
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ZHANG Yuan-yuana, HAN Qi-caib, ZHANG Weia, WANG Li-pinga
2025,33(9):861-864, DOI: 10.20184/j.cnki.Issn1005-8478.100469
Abstract:
[Objective] To investigate the value of clinical nursing pathway based on the King standard theory in magnetic resonance imaging (MRI) examination of patients with osteoporotic thoracolumbar fracture (OTLF). [Methods] A total of 201 OTLF patients who received MRI examination from March 2021 to January 2023 were divided into King group (n=101) and routine group (n=100) by random number table method, and were respectively provided with clinical nursing pathway and routine clinical nursing pathway based on King standard theory. The indexes of psychological pressure and perceived control were compared. [Results] After intervention, the King group was marked significantly lower CPSS score and negative coping score than the routine group (P＜0.05), while the former got significantly greater CAS-R score, active coping score and MRI compliance score than the latter (P＜0.05). In addition, the King group had significantly lower overall incidence of nursing adverse events than the routine group (0% vs 5.0%, P＜0.05), whereas the former got significantly higher nursing satisfaction score than the latter [(87.9±9.6) vs (71.4±5.7), P＜0.05]. [Conclusion] The clinical nursing pathway based on King standard theory can effectively reduce the psychological pressure of OTLF patients during MRI examination, improve their perceptual control extent and positive coping style, which is conducive to improving patients' examination compliance and nursing satisfaction, and declining nursing adverse events.
