To investigate the clinical effect of “Chinese way” single row repair technique under arthroscopy in the treatment of massive rotator cuff injury.
Methods
The clinical data of 40 patients with massive rotator cuff injury treated by Chinese way single-row repair in Yongzhou Central Hospital from February 2021 to June 2023 were retrospectively analyzed.Inclusion criteria: the patients were consistent with a massive rotator cuff injury, no significant rupture of the biceps long head tendon (LHBT), and underwent preoperative MRI examination of shoulder joint.Exclusion criteria: combined with glenoid fracture; severe osteoarthritis; mental illness and being unable to tolerate surgery.During the operation, the LHBT was fixed by a single row of string anchors, and the remaining rotator cuff injury was repaired by bridging the anchor stitches.Paired t-tests were conducted for statistical analysis on the shoulder joint flexion and abduction, external rotation at the side of the body, pain visual analogue scale (VAS), American Shoulder and Elbow Surgeons Score (ASES), and University of California at Los Angeles (UCLA) shoulder function score of the patients at preoperative and 6-month postoperative follow-up.Preoperative general conditions, postoperative complications and imaging data of patients were recorded.
Results
A total of 40 patients were included, including 17 males and 23 females, ranging in age from 40 to 81 years, with an average age of (64±9) years.All the patients were successfully operated.There were no complications such as anchor loosening, incision infection and Popeye sign.All the patients were followed up for eight to 14 months, with an average of (10.5±1.8) months.At six months follow-up, the movements of shoulder joint flexion (t=30.32) and lateral lateral rotation (t=11.72)were better than those before surgery (P<0.05).At six months follow-up, VAS score was significantly lower than before surgery (t=33.26, P<0.05), while ASES (t=33.48) and UCLA scores (t=48.76) were significantly higher than before surgery (P<0.05).Postoperative X-ray examination indicated that there was no significant progress in shoulder joint degeneration.At the last postoperative follow-up, shoulder joint MRI indicated that seven cases had rotator cuff retear, with an incidence of 17.5% (7/40).
Conclusions
“Chinese way” singlerow repair technique under arthroscopy has a significant effect on the treatment of massive rotator cuff injury.The technique can reduce the pain symptoms and improve the functional activities of the shoulder joint.The operation is simple and the clinical effect is satisfactory.
To comparative analyze the safety and efficacy of tranexamic acid (TXA) alone versus TXA combined with fluid gelatin in total hip arthroplasty (THA).
Methods
A total of 245 patients with femoral neck fractures, admitted to the Third Hospital of Mianyang from January 2021 to December 2022, were included in this study.Inclusion criteria: patients with unilateral femoral neck fractures who underwent total hip arthroplasty.Exclusion criteria: hematological diseases or other conditions affecting coagulation function, history of hip surgery, or allergies to tranexamic acid or the raw materials of fluid gelatin (derived from pig skin).The patients were divided into two groups: the tranexamic acid group with 130 cases and the fluid gelatin group with 115 cases, based on whether they received co-administration with fluid gelatin.The perioperative blood loss,blood routine, and D-dimer levels were compared between the two groups on the day before surgery, the first day after surgery, and the third day after surgery.Independent sample t test was employed for comparisons between the two groups, while repeated measures ANOVA was performed to analyze changes in complete blood count and D-dimer levels at multiple time points in both groups.
Results
On the third day after surgery, the hemoglobin and hematocrit levels in the fluid gelatin group were significantly higher than those in the TXA group (hemoglobin:t=5.54, P<0.001; hematocrit: t=5.65, P<0.001).The rates of hemoglobin and hematocrit decreases in the fluid gelatin group were lower compared to the TXA group, with statistically significant differences (hemoglobin decrease rate: t=4.37, P<0.001; hematocrit decrease rate: t=6.36, P<0.001).The total blood loss in the fluid gelatin group (543.8±252.9) ml was less than (797.1±357.5) ml in the TXA group.The hidden blood loss in the fluid gelatin group (490.5±252.3) ml was lower than (742.8±353.3) ml in the tranexamic acid group,with statistically significant differences (t=6.32, t=6.35, P<0.001).The blood transfusion rate in the fluid gelatin group was 2.6%, and the rate in the tranexamic acid group was 9.2%, showing statistically significant difference (χ2=3.88, P=0.04).There was no statistically significant difference in the incidence of postoperative deep vein thrombosis between the two groups (P>0.05).
Conclusion
The combined use of TXA and fluid gelatin can effectively reduce perioperative bleeding and decrease the need for postoperative blood transfusions compared to the use of TXA alone, without increasing the incidence of postoperative deep vein thrombosis in patients.
To identify risk factors affecting one-year postoperative mortality in patients aged 80 years and older with femoral neck fractures.
Methods
This study used a retrospective case-control study on the patients who underwent surgical treatment for femoral neck fractures in our hospital from January 2019 to December 2023.Inclusion criteria: patients age ≥80 years old; femoral neck fracture; no obvious surgical contraindications; independent ambulation or ambulation with assistive devices before injury; good compliance.Exclusion criteria: pathological fractures; high-energy trauma; patients with old fractures (time from injury to surgery longer than three weeks); incomplete clinical data.Baseline characteristics, medical history,and prior medication use were studied.Relevant clinical parameters, including the Charlson comorbidity index,American Society of Anesthesiologists (ASA) grading, Barthel index, and functional activity questionnaire (FAQ)score were analyzed.Clinical data and comorbidities were recorded during follow-up.The survival rate was evaluated using the Kaplan-Meier method.Variables influencing survival were assessed by Cox regression model.Hazard ratios (HR) and 95% confidence intervals (CI) for each factor were calculated.
Results
According to the inclusion and exclusion criteria, a total of 152 patients were included in this study, with 31 in the death group.The 1-year postoperative mortality rate was 20.4%, and the median survival period was 10.1 (9.2, 10.5)months.There were statistically significant differences in age (t=3.778, P<0.001), FAQ score (Z=-4.377,P<0.05), Barthel index (t=15.240, P<0.001), preoperative use of anticoagulants (χ2=4.977, P<0.05), and international normalized ratio INR (t=11.621, P<0.001) between the two groups.There was no statistically significant difference in other indicators such as ASA grading (χ²=1.127, P=0.277) between the two groups.Cox regression analysis showed that age ≥87 years ［HR=3.5, 95% CI=(1.9,7.9), P<0.001］, Barthel index<85 points ［HR=4.0, 95% CI (1.3,12.7), P<0.05］, and pre admission use of anticoagulant drugs with INR≥1.5 ［HR=3.7, 95% CI (2.1,7.7), P<0.05］ were statistically significant predictors of first-year mortality after surgery.
Conclusions
For patients aged 80 years or older undergoing surgery for femoral neck fractures, the predictive factors for death in the first year after surgery were age ≥87 years, Barthel index score ≤85, and taking anticoagulants with an INR ≥1.5 before admission.
To understand the effect of Gushukang capsule combined with antiosteoporosis drugs on clinical healing after internal fixation of fragile hip fracture in the elderly.
Methods
A total of 60 patients diagnosed with unilateral femoral intertrochanteric fracture combined with senile osteoporosis, and concurrent with internal fixation surgery in Foshan Jianxiang Orthopedics Hospital were collected from January 2022 to June 2023.Patients with other site fractures, other bone diseases, secondary osteoporosis, pathological fracture and other diseases were excluded.According to the random number, patients were divided into western medicine group (30 cases) and Gushukang capsule group (30 cases).The control group received denosumab + menatetrenone capsules + vitamin D + calcium for six months.The Gushukang capsule group received Gushukang capsule for six months on the basis of the same medicine strategy as the control group.Bone metabolism indices, fracture healing rate, visual analogue scale(VAS) and Harris hip score(HHS)were collected from both groups and statistically analyzed by t test and chi square test.
Results
The decrease in β-isomerized C-terminal telopeptide of type I collagen (β -CTX) was significant in the Gushukang capsule group than in the western medicine group at six months after treatment (t=2.04, P<0.05).The fracture healing rate in the Gushukang capsule group at three months after treatment was significantly higher than that in the western medicine group (χ2=4.32, P<0.05).The VAS score in the Gushukang capsule group at six months after treatment was significantly lower than that in the western medicine group (t=2.55, P<0.05).
Conclusion
For elderly patients after internal fixation of hip fragility fracture, Gushukang capsule combined with antiosteoporosis drug can relieve pain symptoms, improve bone metabolism, and promote clinical healing.
To analyze the information characteristics of clinical research on femoroacetabular impact syndrome (FAIS) registered on ClinicalTrials.gov in the United States and Chinese Clinical Trial Registry (ChiCTR) in China, compare domestic and international research differences, and provide reference for the good management of followed-up research.
Methods
All the clinical research on FAIS were searched on ClinicalTrials.gov and ChiCTR.Inclusion criteria：FAIS clinical researches first posted on the above databases with complete information from inception to December 31st, 2023.Exclusion criteria：non-.clinical researches and clinical researches with incomplete information.The registration characteristics of research, such as number, country distribution, status, funder, study types, enrollment, interventions and study designs, etc., were summarized.IBM SPSS 22.0 software was used to perform descriptive statistics and inductive analysis on frequency and composition comparison data.
Results
Since 2012, FAIS clinical research had been registered and posted on ClinicalTrials.gov.A total of 88 clinical studies were collected.Among them,31 studies were completed and 17 studies were recruiting, eight studies were industry-sponsored and 80 studies were investigator-initiated, 58 studies were interventional studies and 30 were observational studies.The sample size is mainly less than 200 cases.The research intervention methods mainly focused on surgery, medication,and medical devices.Randomized, masking, parallel assignment, and treatment purpose study designs were mainly adopted.Common outcome measures included pain score, International Hip Outcome Tool-33, quality of life, etc.Only eight studies posted results.China first posted FAIS clinical studies on ClinicalTrials.gov in 2020, and a total of eight studies were registered, fouth in the world.Among them, mainly were observational and single center studies, and completed by one hospital in Beijing.On ChiCTR,China first posted FAIS clinical studies in 2019, and a total of three studies were registered.
Conclusions
Clinical research on FAIS in our country started relatively late, and there are few institutions conducting FAIS research.Evidence will be obtained through scientific protocol design based on evidence-based medicine, such as multicenter, randomized controlled studies, etc., to improve research quality and facilitate clinical practice.
To explore the effect of different protocol “cocktail” on early pain control after total knee arthroplasty.
Methods
A total of 114 patients undergoing total knee arthroplasty for osteoarthritis in Shenzhen People's Hospital from January 2023 to June 2024 were enrolled, and the patients with bilateral concurrent replacement were excluded.The patients were divided into four groups according to the intraoperative cocktail formula and administration routes: with morphine + intra-articular perfusion group(morphine perfusion group); with morphine + periarticular injection group (morphine injection group); without morphine + intra-articular perfusion group (perfusion group); without morphine + peri-articular injection group(injection group).Analysis of variance (ANOVA) was used to analyze the intraoperative “cocktail” operation time,visual analog scale (VAS) at 24 h and 72 h after surgery, knee joint range of motion (ROM) at 24 h and 72 h after surgery, the proportion of additional analgesic drugs at 72 h after surgery and the occurrence of adverse reactions at 72 h after surgery were analyzed by chi square test.
Results
There was no statistically significant difference inVAS score at 24 h and 72 h after surgery (F=0.363, 0.474), ROM of knee joint at 24 h and 72 h after surgery (F=0.719, 1.606), and the proportion of additional analgesics administered within 72 h (χ2=0.259)(all P>0.05) However, intra-articular perfusion “cocktail” took significantly less operative time (9.5±1.8) s than periarticular injection (41.2±4.9) s (t=-47.60, P<0.01).The overall incidence of adverse reactions within 72 h after surgery was significantly lower in the two groups without morphine than in the two groups with morphine(χ2=8.961, P=0.027), The main manifestations were nausea and vomiting (χ2=7.917, P=0.046).There was no statistically significant difference in incidence of urinary storage, deep vein thrombosis (DVT) or peripheral nerve injury (P>0.05).
Conclusion
Intra-articular perfusion without morphine ＂cocktail＂, which is not only effective for early pain control after TKA, but also has shorter intraoperative operation time and lower incidence of early postoperative complications, is worthy of clinical promotion.
To compare the therapeutic effect of knee arthroscope-assisted surgery and conventional surgery on patients with tibial plateau fractures (TPF).
Methods
Clinical data of patients with TPF in department of orthopedics of the First People’ s Hospital of Liangshan Yi Autonomous Prefecture from September 2020 to March 2023 were retrospectively analyzed.TPF patients age over 18 years who were diagnosed as Schatzker type I to III fractures by X-ray examination were included, and the patients with open fractures, comminuted complex fractures, surgical contraindications, concurrent severe soft tissue and nerve injuries or mental disorders were excluded.According to different treatment methods, the patients were divided into open reduction and internal fixation (ORIF) group and arthroscopically assisted reduction and internal fixation (ARIF) group.The propensity score matching method was used to exclude the confounding bias caused by the differences in baseline data between the two groups, and 44 patients were included in each group, but one patient in ORIF group was not included in the study due to the lack of follow-up data.Finally, there were 43 cases in ORIF group and 44 cases in ARIF group.Perioperative indicators of the two groups were compared by paired sample t test, and Hospital for Special Surgery (HSS) knee scores, joint range of motion (knee extension and flexion angles) were compared between groups at six months after surgery, and chi square method was used to compare the excellent and good rate of knee treatment and complications within six months after surgery.
Results
The surgical incision length［(6.0±1.2) cm vs (8.3±1.6) cm］, surgical time［(81.3±14.9) min vs(94.3±18.3) min］, length of hospital stay ［(9.4±3.1) d vs (12.5±3.9) d］, fracture healing time ［(8.3±1.0)weeks vs (9.8±1.3) weeks］ and postoperative drainage volume ［(108.1±18.4) ml vs (135.6±22.4) ml］ all showed better results in ARIF group than in ORIF group (t=7.550, 3.637, 4.224, 6.062, 6.266, all P<0.05).The HSS scores in ARIF group at six months after surgery were higher than those in ORIF group (t=2.540, 4.187,3.235, 4.761, 2.695, 5.743, all P<0.05).At six months after surgery, the knee extension and flexion angles in ARIF group were larger than those in ORIF group (t=6.844, 6.890, both P<0.05).The excellent and good rate of knee function in ARIF group was 90.9%, which was significantly higher than 72.1% in ORIF group(χ2=5.130, P<0.05).Six months after surgery, the total incidence rate of complications such as postoperative infection, knee stiffness and knee pain was 4.5% in ARIF group, which was lower than 18.6% in ORIF group(χ2=4.225, P<0.05).
Conclusion
Knee arthroscope-assisted surgery in treating TPF can shorten length of the hospital stay, promote the early rehabilitation, and improve the knee function and joint range of motion with few postoperative complications and is worthy of clinical application.
To explore the effect of arthroscope-assisted minimally invasive percutaneous plate osteosynthesis (MIPPO) in the treatment of SchatzkertypeⅡ-Ⅳof tibial plateau fractures.
Methods
From March 2021 to March 2024, 135 patients who were diagnosed with tibial plateau fractures and no open fractures and were able to tolerate surgery and anesthesia in department of orthopaedics of the First Affiliated Hospital of the PLA Air Force Military Medical University were selected and divided into traditional surgery group (traditional incision internal fixation, 64 cases) and minimally invasive surgery group (knee arthroscopy-guided MIPPO technique reduction internal fixation,71 cases) by means of different treatment methods.The efficacy of the two groups was compared by rank sum test.The normal measurement data such as pain stress indicators ［substance P (SP), neuropeptide Y (NPY) and prostaglandin E2 (PGE2)］ and functional recovery (walking frequency, walking speed and walking amplitude) were measured by t test.Enumeration data such as occurrence of complications were detected by chi square test.
Results
The excellent and good rate of treatment in minimally invasive surgery group was 92.8%, which was higher than 82.9% in traditional surgery group (χ2=6.084, P<0.05).At 10 days after surgery, the levels of SP, NPY and PGE2 in the two groups were reduced (traditional surgery group t=9.106, 32.697, 18.370, minimally invasive surgery group t=14.371, 45.266, 25.712, all P<0.05), and the levels in minimally invasive surgery group were lower than those in traditional surgery group (t=9.120, 11.640,9.336, all P<0.05).At six months after surgery, the walking frequency, walking speed and walking amplitude were higher in minimally invasive surgery group than in traditional surgery group (t=3.674, 3.275, 3.273, all P<0.05).The incidence of surgical complications in minimally invasive surgery group with 3.2% was lower than 15.6% in traditional surgery group (χ2=5.026, P<0.05).
Conclusions
Knee arthroscopy-guided MIPPO technique reduction internal fixation has significant efficacy in the treatment of tibial plateau fractures.It can significantly improve the pain stress response, promote the recovery of joint function, and reduce the incidence of complications.
To evaluate the efficacy of Wangbi Capsules combined with leflunomide in treating rheumatoid arthritis (RA) of the damp-heat obstruction type and the changes in serum granulocytemacrophage colony-stimulating factor (GM-CSF), tumor necrosis factor-alpha (TNF-α), T cell subsets, etc.before and after treatment.
Methods
A total of 90 patients in the Rheumatology and Immunology Department of the First Affiliated Hospital of Hebei North University from February 2022 to October 2023 who met the diagnostic criteria for RA in the Guidelines for the Diagnosis and Treatment of Rheumatoid Arthritis in China and whose traditional Chinese medicine (TCM) dialectical theory was damp-heat blocking collateralcollateral syndrome were selected as the study objects.Patients who were intolerant to methotrexate therapy，recently received biologic agents or immunosuppressant treatment, with contraindications to the drugs of this study and had diseases affecting the observational indicators of this study were excluded.The enrolled patients were divided into two groups by random number table method, 45 cases each.The control group were treated with leflunomide for 12 weeks, and the observation group additionally accepted Zobi capsules based on this treatment.Serum GM-CSF, tTNF-α, T cell subsets, visual analogue sale (VAS), 28 joint disease activity score(DAS28), number of tenderness joints, number of swollen joints, erythrocyte sedimentation rate (ESR) and Creactive protein (CRP) were compared between the two groups before treatment and 12 weeks after treatment.The main disease and secondary disease scores were statistically analyzed.The measurement data of nonnormal distribution were described by M (P25, P75) and rank sum test was used.The measurement data of normal distribution are described by (±s) and t test was used.
Results
After 12 weeks of treatment, VAS score,DAS28, number of tender joints and swelling joints in both groups were lower than before treatment; the levels of GM-CSF, TNF-α, ESR and CRP were all lower than the data before treatment, and the differences were statistically significant (observation group t=7.206, 5.402, 16.808, 8.153, 17.283, 15.279, 22.604, 20.716;control group t=4.826, 3.282, 9.117, 6.305, 5.279, 9.462, 9.206, 8.715, all P<0.05); After 12 weeks of treatment, VAS score, DAS 28 score, number of painful joints, number of swollen joints, GM-CSF, TNF-α,ESR, CRP levels and score differences in the observation group were lower than those in the control group, and the differences were statistically significant (t=3.782, 3.827, 4.280, 4.106, 8.226, 9.254, 6.118, 5.742;score differences t=4.193, 4.106, 5.394, 4.908, 9.240, 10.143, 7.506, 11.628; all P<0.05).After 12 weeks of treatment, the scores of main symptoms (joint swelling, adverse extension and flexion, morning stiffness and fever) in both groups were lower than before treatment; the scores of secondary symptoms (thirst, yellow urine,dry stool) in the observation group were lower than the data before treatment (observation group Z=11.076, 9.359,9.517, 4.938, 5.014, 4.017, 4.362; control group Z=4.271, 5.824, 4.293, 4.156; all P<0.05).After 12 weeks of treatment, the scores and differences of the main symptoms and secondary symptoms of the observation group were lower than those in the control group, and the differences were statistically significant (Z=7.626,3.527, 4.942, 3.642, 7.282, 4.722, 1.916; score differences Z=7.620, 3.426, 4.728, 3.517, 7.406, 4.826,4.806; all P<0.05).After 12 weeks of treatment, the ratios of cluster differentiation (CD)3+, CD4+, natural killer(NK) cells and CD4+/CD8+ in observation group were higher than before treatment, and CD8+ was lower than before treatment; after 12 weeks of treatment, the ratios and differences of CD3+, CD4+, NK cells and CD4+/CD8+in the observation group were higher than those in the control group, and the absolute values and differences of CD8+ were lower than those in the control group (observation group t=24.806，17.443，16.624，22.550，15.744；inter-group level t=9.557, 9.127, 7.014, 8.146, 7.682； difference between groups t=10.529，9.280，8.106，9.280，8.206；all P<0.05).The incidence of adverse reactions was 13.3% in the observation group and 15.6% in the control group, and the difference was not statistically significant (χ2=0.683, P>0.05).
Conclusion
Wangbi Capsules combined with leflunomide can reduce the immune inflammatory response in patients with damp-heat obstruction type RA, alleviate joint pain and primary and secondary symptoms, improve curative effect, and do not increase adverse reactions.
To investigate the relationship between differences in pain duration and pathological mechanisms of cartilage degeneration in osteonecrosis of femoral head (ONFH).
Methods
The femoral head specimens were collected from patients who underwent total hip arthroplasty at the First Affiliated Hospital of Guangzhou University of Chinese Medicine between January 2020 and June 2023.The patients who could provided informed consent and met the diagnostic criteria for ONFH, with hip dysplasia complicated by osteoarthritis or femoral neck fractures were enrolled; those with a history of previous hip surgery were excluded.A total of 39 patients (40 hips) were included and categorized into four groups: the short-term pain group(14 hips with ONFH of Association Research Circulation Osseous stage (ARCO) Ⅲ and pain duration≤ six months),the long-term pain group(15 hips with ONFH of ARCO stage Ⅲ and pain duration > six months), the OA group(six hips with hip dysplasia complicated by osteoarthritis) and the normal group(five hips with femoral neck fractures).Gross specimen observations and safranin O-fast green staining were performed.Western blot was used to detect the expression of matrix metalloproteinase 9 (MMP9), hypoxia-inducible factor-1α (HIF-1α), superoxide dismutase 1 (SOD1) and type Ⅱ collagen (Col2).Pairwised comparisons of cartilage stateand modified Mankin scores among the four groups were performed using independent samples t test or Mann-Whitney U test, and the significance level was adjusted for multiple comparisons using the Bonferroni method(adjusted P<0.0083).
Results
Gross observation: the hip OA group predominantly exhibited cartilage wear and integrity destruction, the cartilage damage score was (13.50±0.56).ONFH cartilage showed structural integrity with characteristic surface wrinkles and indentations; cartilage damage scores of the short-term pain and long-term pain groups were (4.07±0.92) and (8.53±0.77), the difference was statistically significant(U=28.00, P<0.001).As pain duration increased, ONFH cartilage exhibited dull color, reduced elasticity,and thinning.Histopathology: the hip OA group showed progressive cartilage matrix degradation and cell death from the superficial to the calcified cartilage layer, with significant cartilage wear and vertical fissures reaching deep cartilage；the Mankin score was (10.94±0.76).The ONFH group presented intact cartilage structure,with longer pain durations correlated with more pronounced matrix degradation and apoptotic-like changes such as pyknotic nuclei and reduced cell numbers.These changes were more severe in the deep radial layer and progressively worsened from the calcified to the superficial layer.Superficial cartilage wear and small fissures were observed in the ONFH group; Mankin scores oftheshort-term pain and long-term pain groups were (2.16±0.43) and (5.28±0.55), the difference was statistically significant (t=-4.489, P<0.001).Western blot: compared to the short-term pain group, the long-term pain group showed reduced expression of HIF-1α, SOD1 and Col2 in the femoral head cartilage, indicating the disruption of the hypoxic environment and exacerbated cartilage degradation.The decreased Col2 protein expression and increased MMP9 levels mirrored the pathological manifestations of chondrocyte death and cartilage matrix degradation.
Conclusions
Unlike the cartilage degeneration seen in OA, ONFH cartilage degeneration progresses from the subchondral layer to the superficial layer.The duration of pain can indirectly reflect the cartilage condition in ONFH, with its degeneration mechanism linked to the disruption of the hypoxic environment in the cartilage layer.
Osteoarthritis is a chronic disease characterized by degenerative changes in articular cartilage and osteophyte formation at the joint margins.Its pathogenesis is complex and intricate.Under physiological conditions, the activity of matrix metalloproteinases (MMPs) is strictly regulated.However, in the pathological state of osteoarthritis, the expression and activity of MMPs are abnormally elevated, becoming a key factor in the degradation of articular cartilage.Therefore, treatment strategies targeting MMPs are particularly important in the treatment of osteoarthritis.In recent years, hydrogels and nano platforms as responsive materials of MMPs have shown great potential in the field of osteoarthritis treatment.Therefore, this article aimed to summarize and discuss the application of both in the treatment of osteoarthritis, and evaluate their potential as novel therapeutic tools.
Three dimentional (3D) printing technology has been gradually applied in the clinical treatment of orthopedics at home and abroad, which has a positive effect on perfecting the surgical plan,improving the doctor-patient communication effect and improving the efficacy of complex surgery.In particular,3D printed metal implants have made important progress in individualized treatment and enriched the content of precision medicine.Through literature review, this article reviewed the principle of 3D printing, the key content of in vitro preparation of individualized metal implants, and its application in bone defect, internal fixation and joint function reconstruction, and summarizes the innovation and development of 3D printing technology in orthopedic implant surgery.
Unicompartmental knee arthroplasty (UKA) is an optimal treatment for unicompartmental osteoarthritis due to its advantages of minimal invasiveness, rapid recovery, and low incidence of complications.However, the progression of osteoarthritis in the contralateral compartment is the most common complication and the predominant cause of failure in UKA during the middle and late stages.This article presented a comprehensive review of the latest research advances on the etiology, risk factors, diagnosis, and treatment of contralateral compartment progression of osteoarthritis as a complication of UKA.
To investigate the differences about the efficacy of single-row(SR), modified Mason-Allen (MA) and suture bridge(SB) in the treatment of rotator cuff injury with adhesive capsulitis in the elderly.
Methods
A prospective study was conducted in the 72 patients with rotator cuff injury combined with adhesive capsulitis treated with operation in the Civil Aviation General Hospital from February 2022 to February 2023.The patients were divided into three groups according to the suture methods, 24 patients were enrolled in each group.One-way ANOVA and pairwise q test were used to compare the tendon healing tissue thickness, active shoulder range of motion before and one year after operation, as well as Constant-Murley score,University of California Los Angeles score (UCLA) and visual analogue scale (VAS) before operation and two weeks, six weeks, three months, six months, one year after operation among the three groups.The smoking and diabetes mellitus prevalence, re-tear and stiffness rate were compared by chi square test and Fisher's exact test,and the preoperative tear degree was compared by rank sum test.
Results
There was no significant difference among the groups in active shoulderrange of motion, smoking and diabetes prevalence before and one year after operation, nor in the preoperative tear degree, re-tear or stiffness rates one year after operation (F=0.689,0.380, 0.175, 0.968, 2.074, 0.994, 2.352, 0.549; χ2=0.453, 1.125; H=0.231; all P>0.05).There were no significant differences in Constant-Murley, UCLA or VAS scores among three groups before operation and in two weeks, six weeks, and three months after operation (F=0.174, 0.267, 1.800, 0.574, 2.355, 0.158, 2.61,0.207, 2.826, 1.397, 0.012, 0.1.265, all P>0.05).The UCLA of SB group was significantly higher than those of SR and MA groups at six months and one year after operation (P=0.020, 0.008).The UCLA of MA group was significantly higher than that of SR group at one year after operation (P=0.030).The thickness of tendon healing tissue of SB and MA groups at one year after operation were thicker than that of SR group (F=4.106, P=0.021).
Conclusions
SR, MA and SB are all effective surgical methods to rotator cuff injury combined with adhesive capsulitis in the elderly.There is no significant difference in the early recovery of shoulder function among three groups.SB and MA are better than SR at one year after operation, which are more conducive to the healing of rotator cuff tissue.
To evaluate the clinical efficacy of a new assembly locking compression plate in the treatment of femoral nonunion after intramedullary nailing.
Methods
Twenty-two patients with nonunion following femoral intramedullary nailing surgery were divided into an observation group and a control group according to different treatment approaches.In the observation group, 11 cases were treated with the new assembly locking compression plate (NALCP) fixation, while 11 cases in the control group received treatment with the locking compression plate (LCP).The following parameters were recorded and compared: number of inserted screws, cortical fixation layers achieved by screws, intraoperative blood loss, fracture healing time,lower limb function scores (assessed at one, three, and six months postoperatively), visual analog scale (VAS)scores at one month after operation, final Hospital for Special Surgery (HSS) knee scores, and Harris hip scores(HHS) to evaluate clinical outcomes.Statistical analyses were performed as follows: comparisons across different time points between the two groups were analyzed using repeated measures ANOVA followed by Bonferroni post hoc test; comparisons of continuous data between groups was conducted by independen t test, while categorical data were assessed using Fisher’s exact test.
Results
Patients were followed up postoperatively at one, three,and six months, and one year.The observation group demonstrated a greater number of inserted screws (t=19.030,P<0.001) and cortical fixation layers achieved by screws (t=12.245, P<0.001) compared to the control group,with both differences reaching statistical significance.The observation group exhibited less intraoperative blood loss (t=-10.564, P<0.001) and shorter fracture healing time (t=-30.869, P<0.001) compared to the control group.Compared to the control group, the observation group showed higher lower limb function scores at one, three, and six months after operation (t=27.111, 61.968, 9.553, all P<0.001).The observation group exhibited lower VAS scores at one month after operation compared to the control group (t=-6.847, P<0.001).No statistically significant differences were observed between the two groups in the final HSS knee scores or HHS (t=1.580, 0.830, all P>0.05).
Conclusions
Compared to LCP, NALCP as an adjunctive fixation for femoral nonunion following intramedullary nailing demonstrates superior clinical efficacy.By retaining the original intramedullary nail, NALCP provides enhanced fracture stability through multi-dimensional fixation while preserving local blood supply due to its anatomical design.This approach minimizes surgical trauma,accelerates fracture union, improves lower limb functional recovery, reduces early postoperative pain, and enhances patients’ quality of life.
To explore the application effect of ultrasound-guided iliofascial space block combined with general anesthesia in elderly patients with total hip replacement.
Methods
A total of 98 elderly patients undergoing hip arthroplasty admitted to Jianyang City Hospital of Traditional Chinese Medicine from January 2019 to December 2022 were prospectively selected.The enrolled patients were randomly divided into the experimental group and the control group by blocked randomization, 49 cases each.The surgical indices (awake time, autonomous breathing time, extubation time, time to get out of bed and activity time, 48 h self-controlled intravenous analgesia sufentanil dosage), analgesic effect ［visual analogue scale (VAS)］, stress indices ［lactic acid lactate (LAC), glucose (GLU), cortisol (Cor)］, and incidence of postoperative cognitive dysfunction (POCD) ,as well as total incidence of adverse effects were compared between the two groups by chi square test and t test.
Results
The experimental group’s time to wakefulness, time to voluntary breathing, time to extubation, time to get out of bed, and 48-h self-controlled intravenous analgesia sufentanil dosage were all smaller than those of the control group (t=4.916, 6.316, 8.134, 14.147, 22.537, all P<0.05).The differences in VAS scores at the comparisons of time point, between-group and interaction were statistically significant (F=107.483, 46.779,65.498, all P<0.05); the postoperative VAS scores at 4 (t=9.139, 4.239), 12 (t= 20.791, 13.736), and 24 h(t=19.031, 17.982) were lower than the data before surgery in both groups (all P<0.05); the experimental group’s postoperative 4, 12, and 24 h VAS scores were lower than the control group’s (t=7.542, 12.092, 4.864,all P<0.05).The differences at time points, between groups, and in interaction between the two groups in LAC(F=1125.988, 26.250, 47.356), GLU (F=62.906, 22.722, 13.733), and Cor (F=146.894, 12.875, 46.328)data were statistically significant (all P<0.05).LAC, GLU, and Cor were higher than preoperative data in the control group at 4 h (t=21.634, 9.724, 3.923) and 24 h after surgery (t=22.919, 6.015, 8.402）, the differences were statistically significant (all P<0.05); in the study group, LAC was higher than preoperative data at 4 h and 24 h after surgery (t=21.649, 16.227, both P<0.05), and data of GLU and Cor at 24 h after surgery were higher than the preoperative data (t=2.331, 2.651, both P<0.05).The LAC, GLU, and Cor in the experimental group were lower than those in the control group at 4 h (t=3.470, 7.464, 2.684) and 24 h after surgery (t=7.084,3.327, 5.652) (all P<0.05).The incidence of POCD in the experimental group at two weeks, three weeks and one month after surgery were lower than that in the control group (χ2=7.184, 7.900, 10.261, all P<0.05).There was no statistically significant difference in the incidence of urinary tract infection, pulmonary infection, nausea and vomiting, cardiac arrhythmia, hypotension, or somnolence between the two groups (all P>0.05).The total incidence of adverse reactions in the experimental group was 10.2% lower than 26.5% in the control group(χ2=4.356, P<0.05).
Conclusion
The application of ultrasound-guided iliofascial space block in elderly patients with total hip replacement can effectively relieve pain, improve stress level, reduce the incidence of POCD, and promote early recovery.
To perform total knee arthroplasty using robot-assisted total knee arthroplasty for patients with osteoarthritis of the knee with moderate valgus knee, and to evaluate the advantages of functional alignment of the prosthesis.
Methods
One patient with osteoarthritis of the knee with moderate valgus knee was collected from the Second Traditional Chinese Medicine Hospital of Guangdong Province,and the osteotomy parameters were calculated using CT data before surgery, and total knee arthroplasty was performed with robot assistance, and the prosthesis functional alignment technique was used during surgery to balance the medial and lateral knee joint gaps by adjusting the osteotomy volume only, and the force line of the lower limb was assessed by X-ray after surgery.
Results
Total knee arthroplasty was performed with robotic assistance, and the amount of femoral and tibial osteotomies could be dynamically adjusted intraoperatively according to the neutral osteotomy parameters set preoperatively with a three degrees joint line inclination and intraoperative pressure on the medial and lateral soft tissues.The lower limb force line was restored postoperatively with high patient satisfaction.
Conclusion
Robot-assisted total knee arthroplasty has high precision and reproducibility, which can reduce the surgical difficulty and postoperative complications for young surgeons and improve the quality of life of patients.
