Objective1.To investigate patients'perceptions of rehabilitation treatment and functional recovery following distal radius fragility fractures through semi-structured interviews. 2.To provide novel insights for establishing best practice guidelines for conservative treatment and early postoperative rehabilitation of distal radius fragility fractures.MethodsA sample of 23 cases diagnosed with distal radius fragility fractures was collected from the Departments of Rehabilitation Medicine and Orthopedics at Peking University Third Hospital between October 2022 and January 2023.Using a semi-structured interview guide developed based on a review of relevant literature， semi-structured interviews were conducted with the sample.Audio and textual data were collected and subsequently transcribed and analyzed using MAXQDA2022 software for qualitative data analysis.The aim was to explore patients'perceptions regarding rehabilitation treatment and functional recovery post-fracture.ResultsThe study included a total of 23 participants，comprising 2 males（aged 53-56）and 21 females（aged 49-78）.Through three levels of coding analysis，50 initial categories，14 main categories，and 5 themes were identified（1.The importance of fall risk assessment and prevention in middle-aged and elderly individuals；2.The significance of early intervention and continuous guidance in rehabilitation treatment；3.The importance of active participation by patients and their families in rehabilitation treatment；4.The necessity of providing psychological support therapy for middle-aged and elder-ly patients with DRF；5.The necessity of regularly assessing the functional status of the affected shoulder joint）.ConclusionsThis study indicates that early rehabilitation intervention and continuous guidance are perceived by middle-aged and elderly patients with distal radius fragility fractures as significantly beneficial for functional recovery and quality of life improvement. It is recommended that rehabilitation treatment for these patients comprehensively consider multiple factors， including pain， wrist joint function， psychological aspects， patient engagement， and shoulder joint function.Additionally， fall risk assessment and stratification should be conducted，and a multidimensional，personalized rehabilitation strategy should be employed to promote comprehensive recovery and facilitate an early return to normal life.
Objective:To compare the efficacy of intraarticular injection of platelet-rich plasma (PRP) and hyaluronic acid (HA) in the treatment of K-L stage Ⅰ-Ⅲ knee osteoarthritis (KOA).Methods:A total of 100 patients with stage Ⅰ-Ⅲ KOA admitted to the joint department of the Third Hospital of Hebei Medical University were prospectively collected and divided into 2 groups by random number table method between January 2020 and August 2021. Finally, 96 patients in PRP group (n=46 cases) and HA group (n=50 cases) met the atretic criteria. The patients of two groups received intra-articular injection of PRP (5 ml) or HA (2 ml) once a week for 4 consecutive times. All patients received the same rehabilitation training and life guidance after treatment, and received regular follow-up for at least 12 months. The demographic data of the enrolled patients were recorded, and were divided into 2 subgroups: <30 kg/m2 and ≥30 kg/m2 according to the BMI. The VAS, WOMAC, HSS scores and 2-minute walking test (2MWT) were used to evaluate the clinical efficacy of the two groups before treatment and 1, 3, 6 and 12 months after treatment, respectively.Results:The degree of knee pain and function were improved in both groups after intraluminal injection of PRP or HA. In the subgroup of BMI<30 kg/m2, there were statistically significant differences in VAS score at 6 and 12 months after PRP injection compared with HA injection (1.4±0.8 vs. 1.9±0.7, P=0.014; 1.0±0.6 vs. 1.4±0.8, P=0.028); The WOMAC (45.4±7.7 vs. 28.3, P<0.001; 19.6±5.1 vs. 25.5±3.5, P<0.001; 19.6±5.1 vs. 18.5±4.5, P=0.002), HSS scores (80.9±6.3 vs. 76.2±6.7, P=0.001; 86.3±5.4 vs. 80.4±5.9, P<0.001; 91.4±3.5 vs. 88.6±4.2, P=0.001) and 2MWT results (134.6±15.5 vs. 122.5±20.4, P=0.002; 134.6±15.5 vs. 129.0±23.2, P=0.041; 139.8±12.6 vs. 130.8±20.3, P=0.012) at 3, 6 and 12 months after treatment were better than those in HA group, with significant differences. In the subgroup of BMI≥30 kg/m2, there were no significant differences in VAS, WOMAC, HSS scores and 2MWT results between patients receiving PRP injection and patients in HA group at all treatment stages (P>0.05).Conclusions:Intraarticular injection of PRP in knee joint has a good therapeutic effect on non-obese KOA patients of stage Ⅰ to Ⅲ, and can improve pain and knee joint function in effective patients. Compared with patients treated with HA, PRP treatment can improve knee joint function more significantly after 3 months and relieve pain more significantly after 6 months, which is worthy of clinical application.
Multi-field, multi-aspect and muti-level progress has been involved in the development of orthopedic surgery. However, clinical orthopedists in the front line are still facing severe challenges due to the diversity and complexity of orthopedic diseases. Hence, orthopedists should consider clinical practice as the starting point and ultimate purpose of all their work, helping patients regain the living ability and labor capacity by recognizing problems, proposing solutions and solving the conundrums. In this issue, latest research findings in the fields of microcirularization of diabetic foot, perioperative period management of perihip fracture surgery in elderly patients, diagnosis and management of chronic infection after long bone fracture, diagnosis and management of bone and soft tissue trauma of extremities, and evaluation and plastic surgical strategies of limb deformities have been reported concentratedly, in order to provide an opportunity for authors to follow recent research progress. Based on the themes and topics of these articles, summaries and comments are documented hereafter to discuss the important role that clinical practice plays in the progress of orthopedic surgery.
Objective:To investigate the clinical effect of reaming and debridement combined with unilateral external fixator in the treatment of chronic infection after intramedullary nailing of long bone fractures.Methods:The data of 22 patients with chronic infection after treatment with intramedullary nails for long bone fractures of the lower extremity who were treated from January 2014 to January 2018 were retrospectively analyzed. There were 16 males and 6 females; age ranged from 21 to 62 years, with an average of (38.4±9.3) years old; 12 cases of femoral infection and 10 cases of tibial infection. Fifteen of the initial injuries were closed fractures; seven were open fractures. According to the Cierny-Mader classification of bone infection, there were 10 cases of type I (intramedullary type), 7 cases of type Ⅰ+ type Ⅲ (focal type), and 5 cases of type Ⅰ+ type Ⅱ (diffuse type). The intramedullary nails were removed from all 22 patients, and the pulp was reamed, meanwhile the pulp cavity was flushed. The infected and necrotic tissue inside and outside the pulp cavity was completely removed. For those with sinus tract and abscess at the same time, the infected soft tissue should be completely removed together; for those with focal infection, the infected and necrotic bone should be partially excised, and the local bone defect should be rebuilt after the infection was controlled in two stages. Bone transfer treatment were conducted in large bone defect. All patients received intravenous infusion of sensitive antibiotics for 2 weeks, and then changed to oral administration for 4 weeks, for a total of 6 weeks.Results:Twenty-two patients were followed up for 16-36 months, with an average of (24.5±4.1) months. There was no recurrence of infection or residual infection in 20 patients. One patient had skin and soft tissue infection, and the wound healed after dressing change. One patient had bone exposure and partial skin defect, and the wound improved after local skin flap was transferred to cover the wound. 12 patients with bone defect after infection and debridement, 10 patients underwent bone grafting after infection control to reconstruct bone defect, and 2 patients underwent bone transfer. All patients achieved fracture union.Conclusion:Reaming and debridement combined with external fixation is an effective method for chronic infection after intramedullary nailing of long bone fractures.
Objective:To analyze the risk factors related to perioperative hidden blood loss in elderly patients with intertrochanteric fractures treated with proximal femoral nail antirotation (PFNA).Methods:The clinical data of elderly patients with intertrochanteric fractures who underwent PFNA in Dingzhou People's hospital from January 2018 to December 2019 were retrospectively analyzed. The dynamic changes of hemoglobin and hematocrit on the day before and the third day after surgery were recorded, and the total blood volume and hidden blood loss were calculated using Nadler and Gross formulas, respectively. Pearson correlation single factor analysis and multiple linear regression were used to analyze the risk factors for hidden blood loss during perioperative period.Results:A total of 156 elderly patients with intertrochanteric fractures were included, including 68 males and 88 females, and all included patients were followed up with a mean follow-up time of (40.2±3.41) months. The mean age was (78.8±5.2) years (65-92 years), the mean height was (1.65±0.07) m, the mean weight was (61.1±9.8) kg, and the Body Mass Index (BMI) was (22.4±3.1) kg/m2. The total blood loss was (912.4±167.0) mL, the apparent intraoperative blood loss was (232.5±82.0) mL, and the hidden blood loss was (649.3±130.9) mL, accounting for 74.1%±21.9% of the total blood loss. Univariate analysis showed that fracture type, BMI, anesthesia style, gender, and hypertension were significantly associated with an increase in hidden blood loss during perioperative period. Multiple linear regression analysis showed that unstable fractures, BMI<25 kg/m2, general anesthesia, and hypertension were independent risk factors for hidden blood loss in elderly patients with intertrochanteric fractures treated with PFNA.Conclusions:Hidden blood loss is the main cause of perioperative blood loss in intertrochanteric fractures of the femur, and its independent risk factors include unstable fractures, BMI<25 kg/m2, general anesthesia, and hypertension. Correctly understanding the risk factors of hidden blood loss during perioperative period of PFNA can help improve the prognosis of elderly patients with intertrochanteric fractures and reduce the occurrence of complications.
Knee osteoarthritis is a common disease that affects the activities and participation of the elderly. At present, its clinical diagnosis and follow-up mainly rely on X-ray and Kellgren/Lawrence (K/L) grade, and lack of follow-up and scientific research of biomechanical dimensions, which is difficult to predict the progression and functional changes of knee osteoarthritis. The paper reviewed contribution of the distance and angle measurement based on X-ray, X-ray image processing and the biomechanical markers based on biomechanical parameters for prediction of knee osteoarthritis progress. To show the biomechanical markers' effectiveness and limitations to predict knee osteoarthritis progress and effectiveness of the current limitations and help for further research.
Objective:To detect the expression of cytokines corresponding to lymphocyte subpopulations in patients with osteoporosis and further investigate their correlation with osteoporosis, and to explore the predictive value of interleukin-17 (IL-17) and interleukin-2 (IL-2) of osteoporosis.Methods:Serum samples were collected from 40 cases (13 males and 27 females, 75.58±1.90 years) of osteoporosis and 35 healthy subjects (10 males and 25 females, 71.67±1.99 years) of similar age, and their lymphocyte subpopulation corresponding cytokine levels, type I collagen carboxy-terminal prepeptide (PINP) and β-collagen degradation product (β-CTX) levels were measured using flow cytometry and chemiluminescence, respectively; BMD of the patients was measured using dual-energy X-ray bone densitometry; the working curves of the subjects were used to evaluate the predictive efficacy of IL 17 and IL-2 predictive efficacy by subject work curves.Results:Compared to healthy controls (386.9±39.81 pg/ml), β-CTX expression was up-regulated in osteoporosis patients (563.7±57.25 pg/ml) with statistically significant differences (P<0.05), and PINP expression had a tendency to be up-regulated without statistically significant differences; in addition, IL-2, IL-10 and IL-17 showed significantly high expression (P<0.05), while only the expression of IL-2 and IL-17 correlated with BMD (r=-0.272, r=-0.380, P<0.05); further the ROC curve calculated that the area under the curve of IL-17 and IL-2 were 0.874 and 0.625, respectively.Conclusions:IL-17 and IL-2 expression levels were significantly up-regulated in osteoporotic patients, and IL-17 can be used as a predictor for the diagnosis of osteoporosis.
Objective:The article investigates the clinical effectiveness of extracorporeal shock wave treatment for non-specific low back pain through Meta-analysis, with a view to providing evidence-based evidence for clinical treatment.Methods:Computer searches of PubMed, Web of science, Embase, Cochrane Library and China Knowledge Network, Vipshop and Wanfang databases were conducted to collect randomized controlled trials of extracorporeal shock wave for low back pain, and the search time frame was from the establishment of each database to March 12, 2023, and the Cochrane Risk of Bias Tool and Jadad were used to The quality of the included literature was evaluated using the Cochrane Risk of Bias Tool and Jadad scale, and Meta-analysis was performed using Revman 5.4 software.Results:14 eligible randomized controlled trials involving 642 patients were included, including 324 in the intervention group and 318 in the control group. Meta-analysis results showed that compared with the control group, extracorporeal shock wave significantly improved pain levels in patients with low back pain (SMD=-0.90, 95% CI: -1.07, -0.74, P<0.001), the Oswestry Dysfunction Index (MD=-6.61, 95% CI: -9.19, -4.03, P<0.001), Beck Depression Scale score (MD=-3.84, 95% CI: -5.37, -1.97, P<0.001) and 36-item Brief Health Survey scale score (MD=8.51, 95% CI: 7.82, 9.20, P<0.001), but did not significantly improve patients' finger-ground distance (MD= -2.65, 95% CI: -7.57, 2.26, P=0.29).Conclusions:Extracorporeal shock waves can improve the level of pain, dysfunction, depression and quality of life in patients with low back pain, but further studies are needed to prove the improvement effect on low back flexibility.
Objective:To explore the early clinical effect of synchronous total and unicompartmental knee arthroplasty in the treatment of bilateral knee osteoarthritis in the same patient.Methods:From January 2018 to December 2020, 16 patients with bilateral knee osteoarthritis who underwent total and unicompartmental knee arthroplasty at the same time were analyzed retrospectively. The operation time, tourniquet time, hospitalization time and blood transfusion rate were recorded. The hip-knee-ankle (HKA) angle and lower limb length of patients after bilateral surgery were compared, and the leg length discrepancy (LLD) was calculated. Knee society score-function (KSS-f), Oxford knee score (OKS), EuroQol Five Dimensions Questionnaire (EQ-5D) and Forgotten joint score (FJS) at 2 years after operation were counted, and Knee society score-clinic (KSS-c) on both sides were recorded.Results:All patients were followed up for an average of (34.81±6.01) months. The average operation time was (118.63±5.54) minutes, the total tourniquet time was (84.88±5.63) minutes, and the hospital stay was (7.25±1.65) days. No patient needed blood transfusion. The HKA angle and lower limb length on TKA side were similar to those on UKA side, with no significant difference. The change of HKA on TKA side was (7.25±4.33)°, and that on UKA side was (4.17±4.20)°. The change of HKA angle on TKA side was more significant (Z=2.275, P=0.023). The length variation of lower limb on TKA side was (12.66±6.29)mm, while that on UKA side was (5.30±3.05)mm. The length of lower limb on TKA side increased more, with a statistically significant difference (Z=3.103, P=0.002). Two years after operation, the KSS-f score was (82.63±4.70) points, the OKS score was (17.31±3.70) points, the KSS-c score on the TKA side was (78.94±7.41) points, and the UKA side was (83.88±5.77) points, both of which were significantly higher than those before operation (P<0.001). The FJS score was (69.81±4.64), and the EO-5D score was (73.88±8.21). None of the patients had occurred complications, as pulmonary embolism, symptomatic deep vein thrombosis, knee stiffness, joint infection, and the progression of reserved compartmental osteoarthritis.Conclusions:At the same time, one side of TKA and the other side of UKA are effective methods for the treatment of knee osteoarthritis, which can achieve satisfactory clinical effects, and will not lead to differences in the length of lower limbs after surgery.
Objective:To explore the effects of 3D printing digital technology-assisted modified cross percutaneous vertebroplasty (PVP) on the spine-pelvic sagittal balance of patients with severe osteoporotic vertebral compressive fracture (SOVCF).Methods:The patients with SOVCF (166 cases) admitted to Guanghua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine from March 2017 to May 2020 were retrospectively analyzed, and according to the treatment protocol, the patients were divided into modified PVP group (83 cases) and PVP group (83 cases). The effect of 3D printing digital technology-assisted modified cross-PVP and its effect on the patient's spine-pelvic sagittal balance state were analyzed by the contrast method.Results:The operation time, puncture positioning time and times of fluoroscopy in the modified PVP group were shorter than those in the PVP group (P<0.05); The total effective probability of patients in the modified PVP group was greater than that in the PVP group (P<0.05). Compared with before operation, the VAS score and ODI score of the two groups decreased significantly 12 months after operation (P<0.05). Compared with before operation, the JOA score of the two groups increased significantly 12 months after operation (P<0.05); At 12 months after operation, compared with the PVP group, the TK, C7-S1SVA and PT of the modified PVP group were smaller (P<0.05), and the SS was larger (P<0.05); At 12 months after operation, compared with the PVP group, the PF, PR, GH, VT and SF of the modified PVP group were all larger (P<0.05), and the BP was smaller (P<0.05); The proportion of patients with a small amount of bone cement leaking to the paracone and anterior cone in the modified PVP group was smaller than that in the PVP group (P<0.05).Conclusions:3D printing digital technology assists the improvement of cross PVP in the treatment of SOVCF patients, which can shorten the operation and puncture positioning time, reduce the number of fluoroscopy, significantly reduce pain, restore lumbar spine function well, significantly improve the spine-pelvic sagittal balance and the quality of life, and reduce the probability of bone cement leakage.
Objective:To determine the main risk factors for early postoperative contralateral radicular pain in patients after transforaminal interbody fusion (TLIF) who often suffer from contralateral radicular pain.Methods:Patients who underwent TLIF surgery in the Department of Spinal surgery of Changzhou second people's Hospital affiliated to Nanjing Medical University were collected and divided into asymptomatic group and symptomatic group according to whether they had early contralateral nerve root pain after operation. A total of 170 patients underwent TLIF surgery in our department from January 2020 to January 2022, of which 66 patients met the inclusion and exclusion criteria and 33 patients developed early postoperative contralateral nerve root pain. The patients of the two groups were followed up after operation, the general data and operation-related indexes were collected, and the concentration of inflammatory factors in wound drainage fluid 3 days after operation were compared and analyzed by regression analysis.Results:Finally, 66 patients were included in the study, and the follow-up time was (26.6±1.1) days. There were 36 males and 30 females with an average age of (66±8) years. Univariate analysis showed that the concentration of PGE2 in drainage fluid in symptom group was lower than that in asymptomatic group, and the concentrations of HIS and BK in drainage fluid in symptom group were higher than those in asymptomatic group. The differences between groups in univariate analysis were included in multivariate regression analysis. The results showed that HIS (OR=4.384) and BK (OR=10.921) in drainage fluid were the influencing factors of contralateral early nerve root pain after TLIF.Conclusion:The levels of HIS and BK in the drainage fluid of patients after TLIF are independent risk factors for the occurrence of contralateral early nerve root pain, which can be used as a reference basis for managing patients with early contralateral nerve root pain after operation, and provide new ideas for clinical treatment of this kind of patients.
Objective:Study on the effectiveness of arthroscopy for high tibial osteotomy (HTO).Methods:A retrospective study of patients who underwent HTO at the First Affiliated Hospital of Shandong First Medical University from 2018.01-2022.03, and a total of 142 patients were included according to the inclusion and exclusion criteria, of whom 70 (49.3%) were male and 72 (50.7%) were female, with a mean age of 53.62±0.388 years and 168 affected limbs. Patients were divided into two groups (HTO group; HTO combined with arthroscopy group) according to whether they underwent HTO with or without combined arthroscopy. The medial proximal tibial angle (MPTA), joint line convergence angle (JLCA), hip-knee-ankle (HKA) angle, femoral tibial angle (FTA), weight-bearing line (WBL) ratio of the knee joint, opening gap, opening angle, US Hospital for Special Surgery (HSS) score, American Knee Society score (KSS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Lysholm score. The effect of arthroscopy in HTO surgery was studied by logistic regression analysis to determine whether arthroscopy is an influential factor in the outcome of HTO surgery.Results:Both groups of patients with and without HTO combined with arthroscopy showed significant improvement in functional scores and imaging indexes after surgery compared with preoperative scores(Postoperatively, MPTA increased compared to preoperative, JLCA decreased, FTA decreased, HKA angle increased, and WBL% increased; postoperatively, HSS score, KSS score, and Lysholm score increased significantly, and WOMAC score decreased). Multifactorial analysis showed that both arthroscopic and preoperative WOMAC scores were independent influences on the outcome of the procedure, and the probability of Lysholm score being classified as excellent after surgery in the HTO combined arthroscopy group was 4.037 times greater than that in the HTO group postoperatively [OR=4.037, 95% CI: 1.555, 10.480, P=0.004]; each unit increase in preoperative WOMAC score was associated with 0.939 times greater probability of postoperative Lysholm score being classified as excellent [OR=0.939, 95% CI: 0.906, 0.973, P=0.000].Conclusions:Functional scores and imaging indexes were significantly improved after HTO combined with arthroscopy compared with preoperative scores. Arthroscopic and preoperative WOMAC scores were influential factors in the outcome of HTO surgery; patients with higher preoperative WOMAC scores had poorer postoperative functional recovery of the knee, and patients in the HTO combined arthroscopy group had better postoperative functional scores and functional recovery than those in the non-combined arthroscopy group.
Objective:To explore the clinical outcomes of combination of Ilizarov technique and composite surgeries for treatment of congenital fibula hemimelia, and to summarize the key points of limb reconstruction management for such deformity.Method:Twenty patients with congenital fibula hemimelia were treated surgically and retrospectively studied in Department of Orthopedics, Shanghai Jiao Tong University affiliated Sixth People's Hospital since 2014. Patients included 12 males and 8 females, with an age of (17.5 ± 7.0) y (4 to 26 y). According to Achterman classification, there were 14 cases of type IA and 6 cases of type IB. Single Ilizarov technique or combined intramedullary assistance was applied for limb length deficiency; For genu valgus or valgus ankle deformities, close-wedge osteotomy and internal fixation were applied for adult patients, and hemiepiphysiodesis for pediatric patients; Contracted iliotibial band, fibular tendons and Achilles' tendon were released and elongated; Overlapping toes were corrected by tendon transfer.Results:Twenty patients were followed up for (36.1±8.7) months. The limb was lengthened for (7.2±1.0) cm, with average EFI (15.9±6.3) d/cm and average HI (21.7±2.8) d/cm. All obvious limb length discrepancy, genu valgus [GVA: (14.9±3.4)° and (2.1±1.7)° preoperatively and at last follow-up, t=13.510, P<0.05], tibial angulation [TBA: (3.3±3.3)° and (0.8±0.7)° preoperatively and at last follow-up, t=3.490, P<0.05] and ankle and foot deformities [VAA: (9.2±3.4)° and (1.2±1.3)° preoperatively and at last follow-up, t=9.785, P<0.05] were corrected at the final follow-up. Clinical outcomes indicated significantly improved limb function compared with preoperative grading. [LLRS AIM: (10.1±1.2) points and (2.0±1.4) points preoperatively and at last follow-up, t=21.140, P<0.05].Conclusion:Congeinital fibular hemimelia is a rare and complicated syndrome with co-exist limb length deficiency, abnormal alignment of lower-limb and foot and ankle deformities. Combination of Ilizarov technique and composite surgeries can bring satisfying outcomes for treatment of congenital fibula hemimelia and improve the quality of life of the patients.
Cellular senescence refers to the irreversible cell cycle arrest process of cells, which is one of the focus in disease research in recent years. The main cause of cellular senescence is the activation of the tumor suppressor gene p16, p21 or p53 caused by DNA damage or epigenetic changes, resulting in growth arrest and the senescence-associated secretory phenotype, which leads to the release of inflammatory factors and extracellular matrix degradation proteases or hydrolases. Evidences have indicated that cellular senescence is important in maintaining normal embryonic development and mediating bone diseases in aging. Studies have shown that the clearance of senescence cells help delay the progression of age-related diseases in bone such as osteoarthritis and osteoporosis. Here, we reviewed recent studies on cellular senescence and SASP, and summarized the literature on the beneficial and adverse role of cellular senescence in different physiological stages. We also discussed the role of cellular senescence in maintaining the homeostasis of musculoskeletal system and mediating age-related degenerative bone and joint disorders. Although research on cellular senescence has made some progress, there are still some limitations. The purpose of this literature review is to provide a general picture on cellular senescence on bone development and bone-related diseases and to further facilitate understanding of the molecular mechanism of cell senescence and provide theoretical basis and ideas for understanding bone development as well as preventing degenerative bone and joint diseases from the cellular senescence perspective.
Objective:To investigate the effect of electroacupuncture combined with isokinetic muscle training on hip joint function in patients undergoing total hip arthroplasty under the ERAS concept.Methods:72 eligible patients were randomly divided into an observation group and a control group, with 36 cases in each group (one case was lost in the observation group). The observation group received electroacupuncture combined with isokinetic muscle training therapy, while the control group received traditional rehabilitation training. The Harris Hip Score, the atrophy index of the affected side thigh muscle, the Barthel Index score of the patients were measured and recorded at postoperative day 1, 2 weeks, and 3 months, and the therapeutic and safety effects were evaluated.Results:All enrolled patients were followed up for 3 months. The Harris Hip Score and Barthel Index score of the observation group at 2 weeks after surgery were superior to those of the control group, with positive atrophy index values in the observation group and negative atrophy index values in the control group. At 3 months after surgery, the Harris Hip Score of the observation group was better than that of the control group, and the atrophy index was lower than that of the control group. The excellent rate was also better than that of the control group, and the differences were statistically significant. The repeated measures analysis of variance of the Harris Hip Score, Barthel Index score, and atrophy index of the observation and control groups before surgery, at 2 weeks and 3 months after surgery showed that there was a statistically significant difference between the two groups. There was an interaction effect between group and time point, and the differences between the two groups were statistically significant at all time points except the first time point. The differences within the observation and control groups at each time point were also statistically significant.Conclusions:Electroacupuncture combined with isokinetic muscle training can help improve hip joint function and daily living ability, alleviate postoperative edema, and prevent muscle atrophy of the affected limb in patients after total hip arthroplasty. The clinical efficacy, especially the early postoperative efficacy, is significant, and the safety is good.
Osteoarthritis (OA) was a chronic degenerative joint disease that often occurred in elders. Knee osteoarthritis (KOA) was the most common type. Along with the population aging, the morbidity of KOA increased year by year and caused great healthy and economic burdens on society. At present, KOA could not be completely cured clinically. With the development of the modern medical model, the introduction of the rehabilitation concept provided a more comprehensive and multifaceted idea for KOA treatment. In reference to literature published worldwide, this review analyzed the current situation of KOA rehabilitation, compared the clinical effects of different therapy, and discussed the prospect of rehabilitation of KOA in order to provide new ideas for the design of the KOA rehabilitation scheme.
Objective:To explore the structural characteristics of doctors in secondary hospitals and above in Hebei Province, and to provide reliable reference for the team construction, evaluation and demand of medical professionals in Hebei province.Methods:The method of cluster random sampling was used to randomly select 7 hospitals in Hebei Province (including 3 tertiary hospitals and 4 secondary hospitals), collect statistical statements of health human resources of traditional Chinese medicine hospitals, analyze the overall structure of doctors in hospitals at all levels in Hebei Province, describe and compare the distribution characteristics of doctors at different levels in terms of gender, age, educational background and professional title.Results:A total of 2, 548 physicians were collected, including 1, 230 males and 1, 318 females, with an average age of (41.0±9.2) years. There were 945 cases in provincial hospitals, 854 in municipal hospitals and 749 in county-level hospitals. The proportion of physicians aged 31 to 40 years old was the highest (43.8%), and the proportion of female physicians under 40 years old (40.5%) was higher than that over 40 years old (68.26%, χ2=70.986, P<0.01). Most of the physicians were male in provincial hospitals (51.1%), and female in municipal hospitals (52.0%) and county-level hospitals (55.0%). The proportion of doctors under 40 in provincial hospitals (57.1%) was higher than that in municipal hospitals (55.7%) and county-level hospitals (51.0%, χ2=6.758, P=0.034).In terms of educational background, bachelor degree was the largest (1, 295 cases, 50.8%), followed by master degree (747 cases, 29.3%). The proportion of bachelor degree or below in county-level hospitals (95.7%) was higher than that in city-level hospitals (83.1%) and provincial hospitals (9.7%, χ2=1578.567, P<0.01).In terms of professional titles, intermediate titles were the most common (41.4%), followed by associate senior titles (24.0%). The proportion of senior titles in provincial hospitals (41.4%) was higher than that in municipal hospitals (37.0%) and county-level hospitals (27.4%, χ2=113.136, P<0.01).Conclusions:In Hebei Province, the majority of physicians are between 31 and 40 years old, women under 40 years old, and men over 40 years old. The majority of physicians are men with graduate degrees in provincial hospitals and women with bachelor's degrees in city and county hospitals.Most of the doctors with intermediate titles in hospitals at all levels.
Objective:The aim of this study was to investigate the effect of a cyclic progressive rehabilitation strategy on quadriceps strength and knee function recovery after anterior cruciate ligament (ACL) reconstruction.Methods:Ninety-eight patients who had undergone ACL reconstruction with autologous hamstring tendons were divided into test group (n=52) and control group (n=46) according to the rehabilitation strategy received by the patients. The control group followed the conventional postoperative rehabilitation strategy, and the experimental group received the cyclic progressive individualized rehabilitation strategy developed by our group. Maximal voluntary isometric contraction (MVIC) of the quadriceps femoris muscle was measured at 4, 12, and 24 weeks after surgery. The One-Leg Hop for Distance Test (OLHDT), International Knee Documentation Committee 2000 Subjective Knee Form (IKDC), and Lysholm knee function scores were used to assess knee function at 24 weeks.Results:The MVIC of the quadriceps femoris muscle at 12 weeks after surgery was significantly higher in the test group than in the control group (P<0.001). At 24 weeks after surgery, the strength of the quadriceps femoris muscle in the test group was significantly greater than that in the control group (P<0.001). The OLHDT, IKDC score and Lysholm score at 24 hours after surgery in the test group were significantly higher than those in the control group (all P<0.05). In terms of the excellent and good rate of knee joint function recovery, the excellent and good rate was 92.31% (48/52) in the test group and 76.09% (35/46) in the control group, and the excellent and good rate in the test group was significantly higher than that in the control group (P=0.026).Conclusions:The cyclic progressive individualized rehabilitation strategy developed by our group is beneficial to the recovery of quadriceps strength and knee joint function. This rehabilitation strategy has been proven to be a safe and effective rehabilitation modality in ACLR rehabilitation, especially in the early stages of rehabilitation.
Objective:To explore the learning curve of SuperPATH minimally invasive total hip arthroplasty and evaluate its clinical application value.Methods:A retrospective study was conducted of consecutive 85 osteoporotic femoral neck fracture patients who had been treated with SuperPATH minimally invasive total hip arthroplasty from August 2014 to December 2018 at Department of Orthopedic, Affiliated Hospital/Clinical Medical Collage of Chengdu University. There were 24 males and 61 females, with an average age of (62±3.3) years (57-70 years). All operations were completed by the same medical group.The patients were divided into 4 groups (n=85) according to the date of operations: group A (n=21), group B (n=21), group C (n=21) and group D (n=22). The operative time, incision length, intraoperative hemorrhage, perioperative complications, anteversion of acetabular prosthesis and Harris hip score at 6 weeks were statistically analyzed and compared between 4 groups. The Log curve regression analysis was used to reflect the change trend of operation time with the number of operation cases. [y=aln(x)+b, x indicating the number of surgical cases, y operation time].Results:85 patients were fully followed up, with a follow-up rate of 100%. The follow-up time was 5 to 12 months, with a median follow-up time of 8 months. The 4 groups were comparable due to insignificant difference in age, gender, fracture type, time from injury to operation. There was no sciatic nerve injury in the four groups (n=0) but one hip prosthesis dislocation in group A and one incision infection in group B showing no significant difference in each group (9.5%, 4.7%, 0%, 0%) (P>0.05). There was no significant difference in Harris hip score between 4 groups at six weeks after operation. The operation time for the 4 groups respectively (122.05±6.13)min,(115.43±9.22)min, (106.71±7.23)min, (98.64±4.46) min showing significant differences between 4 groups (P<0.01) and significant differences between group A and B versus group C and D (P<0.01) but no significant differences between group C and D (P>0.05). The Log curve regression analysis showed that the operation time [y=8.778ln(x)+141.11, r2=0.5158, P<0.01] decreased significantly with the increase of operation number but stable in group C and D. There were significant differences among the four groups in the intraoperative hemorrhage (ML), incision length (CM) and the anteversion of acetabular prosthesis (P<0.01).Conclusions:The perioperative complications rate and postoperative hip Harris score of SuperPATH minimally invasive total hip arthroplasty does not change with the number of cases increased but the operation time, incision length and intraoperative hemorrhage decreased significantly with the increase of the number of cases.The anteversion angle of acetabulum prosthesis was close to the ideal anteversion angle of 20° with the increase of the number of cases. The SuperPATH minimally invasive total hip arthroplasty has learning curve but becomes stable very fast, indicating the technique is easy to learn.
Objective:To investigate the long-term clinical effect of long segment cortical bone track screw fixation for thoracolumbar tuberculosis.Methods:The data of 76 patients with thoracolumbar tuberculosis who received posterior vertebral body fixation combined with anterior debridement and bone grafting from June 2015 to June 2019 were retrospectively collected. They were divided into CBT group and PS group according to different surgical methods (42 cases in CBT group and 34 cases in PS group). The intraoperative bleeding volume, operation time, visual analogue score (VAS) of incision pain and leg pain, bone graft fusion and complications, preoperative and postoperative Cobb angle in sagittal position, and postoperative JOA score of the two groups were observed and compared.Results:All 76 patients were followed up for (31.8±7.8) months in CBT group and (30.5±7.3) months in PS group. In CBT group, there were 23 males and 19 females, with an average age of (39.8±12.2) years; There were 19 males and 15 females in PS group, with an average age of (43.5±11.3). The bleeding volume (172.0±70.7 ml), fixed segment (243.0±75.4 ml) and hospital stay (8.9±2.9 days) in CBT group were significantly lower than those in PS group (11.4±1.7 days) (all P<0.05). The VAS score of low back pain in the two groups was significantly better than that before operation and at the 3rd, 7th, 3rd and last follow-up. The JOA scores of the two groups were significantly better than those before operation and 1, 3, 6 months after operation and at the last follow-up. The sagittal Cobb angle in the CBT group was better than that in the PS group at postoperative and final follow-up (postoperative: F=3.541, P=0.041; final follow-up: F=2.341, P=0.046).Conclusion:Both groups have achieved the effect of correcting kyphosis deformity and significantly improve the quality of life of patients after operation. CBT screw has the advantage of preserving the motor unit of the spine.
