Objective:To analyze the relationship between tourniquet pressure and intraoperative blood loss, systolic pressure, body mass index (BMI) and other factors during total knee arthroplasty (TKA), and to provide reference for improving the safety of tourniquet use.Methods:A retrospective study was conducted on consecutive series of primary TKA in the Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine from January 2019 to December 2019.The patients who had undergone primary total knee replacement were included, those with unicondylar knee replacement and complex secondary knee revision were excluded. Demographic data, tourniquet pressure, tourniquet time, operation time, and intraoperative blood loss were collected. (±s)or M(P25, P75)were used for data description, and Spearman's correlation analysis was used. Rank sum test (Kruskal-Wallis H test) was used for comparison of blood pressure at eight observation time points: blood pressure measured one day before surgery (T1), before anesthesia (the first time in the operating room) (T2), after anesthesia (T3), before tourniquet inflation (T4), tourniquet inflation two minutes (T5), tourniquet inflation 10 min (T6), before tourniquet deflation (T7), tourniquet deflation 10 min (T8).Results:A total of 475 patients were enrolled. The tourniquet time was 52 (41, 62) min, the operation time was 96 (85, 115) min, and the intraoperative blood loss was 50 (50, 50) ml. There was a positive correlation between tourniquet pressure and body mass index (BMI) (rs=0.283, P<0.01). The systolic pressure differences among different tourniquet pressure groups were statistically significant at T2, T4, T5 and T7 (H=11.077, P=0.004; H=19.688, P<0.001; H=10.326, P=0.006; H=9.103, P<0.01). There was no intraoperative blood transfusion, no skin or tissue compression injury, deep vein thrombosis, nor other complication occurred after the surgery.Conclusions:There is a positive correlation between BMI and tourniquet pressure, suggesting that patients' BMI should be considered in setting tourniquet pressure. Tourniquet pressure changed the distribution of blood volume in the circulatory system after the tourniquet blocked lower extremity blood flow, the level of tourniquet pressure is related to the change of systolic pressure during the operation, and attention should be paid to the changes of systolic pressure.
Objective:To evaluate the feasibility and effectiveness of a novel 3D printed femoral guide customized based on CT data to assist young orthopedic joint surgeons in performing primary total hip arthroplasty (THA).Methods:The study included patients diagnosed with hip osteoarthritis, femoral head necrosis, femoral neck fracture, and Crowe I type hip dysplasia who underwent unilateral THA performed by young joint orthopedic surgeons at Wuhan Union Hospital, from March 2020 to November 2020. Patients with a history of hip surgery, bilateral hip diseases, or severe proximal femoral deformities were excluded. Among the 122 patients screened, 100 cases were enrolled for analysis, and were divided into the conventional preoperative planning group (Con group) and the femoral guide group (PSG group) by random number table, 50 in each group. The two groups were compared for operation time, intraoperative blood loss, total blood loss, postoperative radiological data[including lower limb discrepancy(LLD), differences of anteversion angle and femoral offset], visual analogue scale (VAS) pain score, and Harris hip score (HHS). Perioperative complications were also recorded. Age, body mass index, LLD, differences of off set and anteversion angle, operation time, intraoperative and total blood loss were analysed by independent sample t test.Results:The demographics of the two groups were similar. The differences in LLD (1.6±1.2)mm vs(5.6±2.9)mm(t=9.012, P<0.001), femoral offset(3.1±1.4)mm vs(6.5±3.4)mm (t=6.538, P<0.001), and femoral anteversion (5.2±2.5)° vs(9.7±4.6)°(t=6.078, P<0.001) in PSG group were all smaller than those in the conventional group, and these differences were statistically significant. VAS scores(time effect F=249.8, P<0.001; interaction effect F=0.181, P>0.05; group effect F=6.545, P=0.011) and HSS scores (time effect F=341.1, P<0.001; interaction effect F=7.088, P<0.001; group effect F=68.91, P<0.001) in the PSG group were all better than the data in the conventional group. The perception rate of LLD in the PSG group was significantly lower than that in the conventional group at the third month (14% vs 36%, χ2=6.453, P=0.011), sixth month (10% vs 26%, χ2=4.336, P=0.037), and 12th month (6% vs 20%, χ2=4.336, P=0.037) after surgery, with statistically significant differences. Utilization of the PSG had no significant increase in operative time, intraoperative blood loss, total blood loss or postoperative complications.Conclusion:The application with the PSG could potentially provide a simple and reliable solution for young orthopedic surgeons in improving femoral prosthesis orientation during THA with high accessibility and low health-care costs, which is beneficial for rapid recovery.
Objective:To systematically evaluate the efficacy of external application of traditional Chinese medicine(TCM) on the recovery of arthroscopy in patients with knee osteoarthritis(KOA).Methods:Retrieved from Wanfang database, China National Knowledge Infrastructure(CNKI), Database for Chinese Technical Periodicals (VIP), Chinese BioMedical Literature Database(CBM), Cochrane library, Medline, Expecta Medica Database (Embase) and PubMed, randomized controlled trials(RCTs)of external application of TCM for the recovery of arthroscopy in patients with KOA. Inclusion criteria were patients younger than 60 years, and patients with early or mid-term KOA without obvious varus or valgus deformity. Repeated publication and incomplete research data were excluded. The quality evaluation and data extraction were performed. Meta-analysis and trials sequential analysis (TSA)were carried out using RevMan5.3 and TSA v0.9 respectively after document selection, quality evaluation and data extraction.Results:A total of 15 RCT studies were included, including 1 481 patients. The results of meta analysis suggested that external application of TCM improved the total effective rate of recovery after arthroscopic debridement in KOA patients [relative risk (RR)=1.17, 95% confidence interval (CI)(1.11, 1.22), P<0.0001]. In terms of the pain of knee joint, external application of TCM reduced the visual analogue scale(VAS) score[mean difference(MD)=-1.43, 95%CI(-2.01, -0.84), P<0.0001]. In terms of knee function, external application of TCM increased the Lysholm score [MD=8.39, 95%CI(3.77, 13.01), P=0.0004]. In terms of knee joint symptoms, external application of TCM reduced the symptom score of knee joint[MD=-3.34, 95%CI(-4.31, -2.37), P<0.0001]. In terms of postoperative inflammation indicators, external application of TCM decreased the level of interleukin 1-β[standardized mean difference(SMD)=-3.17, 95%CI(-4.21, -2.14), P<0.0001] and the level of tumor necrosis factor-α[SMD=-1.10, 95%CI(-1.93, -0.26), P=0.01].Conclusions:External application of TCM has obvious recovery effect after arthroscopic debridement in KOA patients, and the external application method and external application course may further influence the curative effect. However, more multi-center, high-quality RCTs and double-blind trials are necessary to verify the findings.
In order to promote the safe and effective intervention of osteoporosis drugs after the operation of perihip fragility fracture, the Joint Surgery Group of the Branch of Orthopedics of the Chinese Medical Association initiated and set up a related working group. Under the guidance of the latest guideline formulation manual issued by the World Health Organization (WHO), closely following the latest concept for guidelines approved by Institution of Medicine (IOM), and following the standard process of Appraisal of Guidelines Research and Evaluation(AGREE) and Reporting Items for Practice Guidelines in Healthcare (RIGHT), the guidelines was planned to write with application of the Evidence Recommendation Rating (GRADE), the International Practice Guideline Reporting Standard (RIGHT), and the Evidence Quality Evaluation tool (AGREE II).
Objective:To evaluate the postoperative clinical efficacy and meniscus healing of knee anterior cruciate ligament(ACL) injury with lateral meniscus posterior horn tear by different treatment methods with different tear lengths, and to provide basis and reference for clinical decision-making of knee ACL injury with lateral meniscus posterior horn tear.Methods:A retrospective analysis was carried out on 113 patients with ACL injury accompanied with lateral meniscus posterior angle tear who were admitted to the Sports Medicine Department of Qingdao University Affiliated Hospital from 2010 to 2019. Inclusion criteria: ACL injury with lateral meniscus posterior angle tear; the distance between the tear edge of the meniscus and the synovial margin was within 5 mm during surgery; the postoperative follow-up time was 12 months. Exclusion criteria: multiple ligament injuries in the knee joint; inner meniscus injury; accompanying knee joint fractures; the duration was more than six months after trauma. According to the posterior horn tear length of the lateral meniscus and whether it had been sutured for repair, the patients were divided into two groups: the small tear group in which the posterior horn tear length was less than 15 mm and no popliteal tendon involved (33 cases were not sutured for repair in the small tear group A; 27 cases were fully sutured in the small tear group B); the moderate tear group in which the posterior horn tear length was larger than 15 mm but less than 20 mm, and no popliteal tendon involved (28 cases were not sutured for repair in the moderate tear group A, while 25 cases were fully sutured in the moderate tear group B). Lysholm score, International Knee Joint Documentation Committee (IKDC) score, and imaging MRI examination before surgery and at 12 months follow-up after surgery were recorded. The data were analyzed by repeated measurement analysis of variance, chi square test, and histogram format.Results:All the patients were followed up and showed improvement in their clinical functional scores at the last follow-up compared to the scores before surgery. For patients with lateral meniscus tear length less than 15 mm, there was no statistically significant difference in postoperative Lysholm functional score and IKDC score between suture repair and non-suture repair (F=0.49, 2.21, all P>0.05). For lateral meniscus tear-length of 15 to 20 mm, the postoperative Lysholm functional score and IKDC score of the suture repair group were significantly improved compared to the non-suture repair group (F=189.21, 41.08, all P <0.05). MRI results at follow-up showed that all patients in small tear group achieved satisfactory healing; the healing rates of the two subgroups in the moderate group was 96.4% and 96.0% respectively, which showed no statistically significant difference(χ2=0.94, P>0.05).Conclusions:For patients with ACL injury accompanied with posterior horn tear of lateral meniscus, if the popliteal tendon is not involved and the tear length is less than 15 mm, the posterior horn of lateral meniscus can be healed without repair, which may achieve the equal clinical efficacy as suture repair of meniscus and simple ACL reconstruction. If the popliteal tendon is not involved and the tear length is larger than 15 mm and less than 20 mm, suture repair of the posterior horn of the lateral meniscus tear is stronly recommended.
Objective:To explore the application effect of health education based on protective motivation theory(PMT) in rehabilitation exercise of patients after total knee arthroplasty.Methods:Seventy-two patients with knee osteoarthritis who underwent unilateral total knee arthroplasty in Guangdong Second Traditional Chinese Medicine Hospital from July 2021 to February 2022 were selected and randomized to control group and experimental group according to random number table, 36 patients in each group. The control group received routine health education, while the experimental group received health education based on PMT besides the routine health education. The rehabilitation self-efficacy score, rehabilitation exercise compliance score and knee joint function score of the two groups were compared. The independent sample t test was used for measurement data, and chi square test was used for counting data.Results:There was no significant difference in the scores of rehabilitation self-efficacy, rehabilitation exercise compliance or knee function between the two groups before intervention (all P>0.05). After intervention, the scores of all dimensions of rehabilitation self-efficacy, rehabilitation exercise compliance and knee joint function of patients in the experimental group were higher than those in the control group, and the difference was statistically significant (t=4.865, 3.984, 5.901, 5.514, 5.304, 4.183, all P<0.05).Conclusion:Health education based on PMT can improve the sense of rehabilitation self-efficacy and rehabilitation exercise compliance of patients after total knee arthroplasty, and effectively promote the recovery of knee joint function.
The treatment of osteoarthritis still one of the major clinical challenges. With the accumulation of research evidence, the concept of early diagnosis and treatment has received increasingly attention in osteoarthritis, which has been one of the potential research hotspots in this field.Under such a circumstance, the concept of diagnosis and treatment for osteoarthritis is shifting from the traditional late stage, reactive to early stage, preventive.The continuous improvement of criteria for early diagnosis and classification of osteoarthritis and treatment strategies will help build a more scientific and higher cost-benefit ratio osteoarthritis diagnosis and treatment system, ultimately, benefiting more patients.This article aims to review the research progress of early diagnosis and treatment in osteoarthritis.
With the continuous upgrading of global aging process, the number of osteoporosis patients is also increasing year by year. At present, the treatment of osteoporosis and related orthopedic diseases is complex and varied, but there is a lack of ideal early or conservative intervention. Exosomes, as the key medium of signal communication between cells, carry proteins, nucleic acids, lipids and other substances that can mediate tissue metabolism. In recent years, relevant studies have demonstrated that exosomes play a very important role in the formation, metabolism and pathological changes of bone and cartilage. Exosomes can not only be used as a substitute for traditional orthopedic diseases, but also as an important marker for the identification of orthopedic diseases due to their advantages of small size, rich source and low immunogenicity. This paper reviewed the research progress of exosomes from various cell sources in the diagnosis and treatment of osteoporosis and related orthopedic diseases, providing theoretical basis for further research and clinical application of exosomes in related orthopedic diseases, so as to open up a new road in the field of clinical prevention and treatment.
Objective:To analyze the influencing factors of postoperative constipation in elderly patients with hip fracture, and construct a nomograph model of postoperative constipation in elderly patients with hip fracture, so as to provide help for personalized prevention and treatment of postoperative constipation in elderly patients with hip fracture.Methods:A total of 131 patients with hip fracture admitted to The Second People's Hospital of Huai'an Hospital from February 2020 to February 2022 were selected by inclusion and exclusion criteria. Inclusion criteria: age≥60 years, ambulatory before bone fractures, falling height ≤body height, admission is within 24h. Exclusion criteria: multiple fractures or pathologic fractures, patients in critical condition, multiple organ injuries. The enrolled patients were grouped into constipation group and non constipation group according to whether they were constipation after operation. The general data [gender, age, body mass index (BMI)], past medical history (hypertension, heart disease, diabetes, cerebrovascular disease), operation methods (bone nail repair, total hip replacement, partial hip replacement), intraoperative conditions (anesthesia mode, operation methods, operation duration, intraoperative blood loss), time in bed after operation, use of probiotics and other data were compared between the two groups. According to the logistic regression analysis, the influencing factors of postoperative constipation in elderly hip fracture patients were analyzed, the R language was applied to construct an nomograph model to evaluate the risk of postoperative constipation in patients with hip fracture according to the influencing factors screened by the statistics, and the model discrimination and accuracy were evaluated.Results:Sixty-seven of 131 patients had constipation, and the incidence of constipation was 51.2%; there was no obvious difference between constipation group and non constipation group in gender, BMI, smoking, drinking, hypertension, heart disease, diabetes, cerebrovascular disease, operation mode, anesthesia mode, operation duration and intraoperative blood loss (all P>0.05). Compared with the non-constipation group, age, proportion of constipation before surgery, and time in bed after surgery increased, and the proportion of probiotics usage decreased in the constipation group (t=6.816, χ2=35.503, t=15.956, χ2=40.663, all P<0.05). Advanced age, constipation before surgery, prolonged bed rest after surgery, and no probiotics were risk factors for postoperative constipation in patients with hip fracture [odds ratio(OR)=1.251, 22.365, 10.220, 0.030, all P <0.05]. The nomogram model based on age, bed time after operation, probiotics use, and preoperative constipation had a high discrimination and accuracy.Conclusions:The nomograph model which is based on the age of patients with hip fracture, time in bed after operation, use of probiotics and constipation before operation, has a high predictive value for whether constipation will occure after hip fracture. The nomograph model can provide help for the screening of postoperative constipation in patients with hip fracture.
Objective:To explore the occurrence of phobia in knee replacement patients and its effect on rehabilitation exercise compliance and rehabilitation effect.Methods:A total of 372 patients with knee osteoarthritis who received total knee arthroplasty(TKA) at the First Central Hospital of Baoding from December 2020 to December 2021 and met the inclusion and exclusion criteria were selected for postoperative evaluation using the Tampa scale of kinesiophobia (TSK) for fear of movement. Inclusion criteria: the patients meet the diagnosis of knee osteoarthritis, primary TKA, age is from 50 to 75 years. Exclusion criteria: osteoarthritis of other joints, mental disorders, combining neuropathy or other skeletal muscular diseases, severe dysfunction of organs, prosthesis loosening, infection or bone fractures after surgery. They were divided into a fear group (TSK >37 points) and a non fear group (TSK ≤ 37 points). The general information and rehabilitation effectiveness indicators of the two groups were compared by chi square test and t test, including visual analogue scale (VAS), American Knee Association rating scale (AKSS), knee range of motion (ROM), Berg balance scale, and social support rating scale (SSRS). The correlation between the occurrence of anxiety disorder and rehabilitation outcomes as well as social support were analyzed.Results:Among the 372 patients undergoing TKA surgery, 108 patients developed fear of movement, while 264 patients did not. The incidence of fear of movement was 29.03%. The average score of the TSK scale in the panic group (42±3) was higher than that in the non panic group (21±6)( t=36.061, P<0.001). VAS score of the motor phobia group was higher than that of the non motor phobia group, while the AKSS, ROM, Berg balance scale and SRSS scores were lower than those of the non motor phobia group, with statistically significant differences (t=41.772, -21.384, -34.295, -22.906, -26.374, all P<0.05). TSK score was positively correlated with VAS score (r=0.860, P<0.001), negatively correlated with AKSS, ROM, Berg balance scale and SRSS scores (r =-0.499, -0.664, -0.529, -0.574, all P <0.001), negatively correlated with VAS score (r =-0.639, P <0.001), and positively correlated with AKSS, ROM, Berg balance scale score (r =0.842, 0.864, 0.849, all P<0.001). The results of binary logistic regression analysis showed that age[odds ratio(OR) =1.695, 95%confidence interval(CI)(1.513, 1.899)], gender[OR=0.257, 95%CI(0.149, 0.441)], body mass index[OR=6.342, 95%CI(4.308, 9.335)], years of pain[OR=5.390, 95%CI(3.597, 8.075)], VAS[OR=2.510, 95%CI(1.872, 3.366)], Berg balance scale[OR=0.477, 95%CI(0.391, 0.581)] and SRSS scores[OR=0.594, 95%CI(0.523, 0.675)] were independent influencing factors on the occurrence of motor phobia(all P<0.05).Conclusions:Knee arthroplasty has a higher incidence of phobia, and its rehabilitation effect and social support are worse than those of non phobia patients. The occurrence of ADHD is closely related to rehabilitation effect and social support, and there is a positive correlation between rehabilitation effect and social support. The intervention of postoperative rehabilitation effect and social support of patients undergoing knee arthroplasty should be enhanced.
Platelet-rich plasma (PRP) is used in surgical procedures such as rotator cuff repair, Achilles tendon repair and anterior cruciate ligament reconstruction as an aid of treatment for healings of bone and cartilage as well as chronic inflammation of tendon. It has been mentioned in many literatures that white blood cells play an important role in the efficacy of PRP. In the treatment of osteoarthritis, increasing white blood cell concentration can promote the expression of inflammatory factors and cell death, thus affecting the therapeutic effect. Reducing white blood cell concentration is more conducive to the recovery treatment of osteoarthritis patients. In the treatment of tendon diseases, increasing the concentration of white blood cells is more conducive to the treatment of acute tendon diseases, and reducing the concentration of white blood cells is more conducive to the treatment of chronic tendon diseases. In terms of wound healing, increasing white blood cell concentration has stronger antibacterial effect and is also more conducive to wound healing, while decreasing white blood cell concentration may lead to wound infection and thus affect the healing effect. This paper reviewed the current literatures about the effects of leukocyte content on PRP in the treatment of bones, joints and soft tissue injuries.
Objective:To investigate the effect of platelet rich plasma combined with high tibial osteotomy in the treatment of knee osteoarthritis.Methods:Sixty-one patients with knee osteoarthritis admitted to Hebei Eighth People's Hospital from April 2017 to October 2020 were selected as research subjects, which all met the relevant diagnostic criteria of knee osteoarthritis; grade Ⅱ~Ⅳof Kellgren-Lawrence grading scale (K-L) for osteoarthritis; normal meniscus function and lateral cartilage of the knee joint, etc.. Exclusion criteria: instable knee joint, multiple compartment cartilage lesions, loose body in knee joint, other arthritis diseases, severe cerebral-cardiovascular diseases or hepatic-renal insufficiency, severe osteoporosis. The patients were divided into two groups according to the random number table method: 31 cases in the combined group were treated by high tibial osteotomy combined with platelet-rich plasma, while the other 30 cases in the osteotomy group were treated by high tibial osteotomy. Perioperative indicators and postoperative complication rates between the two groups were compared. Repeated measurement analysis of variance was used to analyze the American Hospital for Special Surgery (HSS) scores, Western Ontario and McMaster Universities (WOMAC) osteoarthritis index, visual analogue scale (VAS), the femoral tibial angle (FTA), the posterior tibial slope (PTS), the proximal medial tibial angle (MPTA), and the knee varus angle (KVA) of the two groups before operation, at one month and six months after operation; fibrinogen (FIB), D-dimer (D-D), thromboxane (TXA2) and the expression of miR-140 and miR-155 in knee joint fluid before and one month after operation were also analyzed.Results:There was no statistically significant difference in the operating time, intraoperative blood loss, postoperative drainage and the ambulant time between the two groups (t=1.095, 0.900, 0.313, 0.698, all P>0.05). Six months after surgery, the HSS score and WOMAC score in the combined group were higher than those in the osteotomy group, and the VAS score was lower than those in the osteotomy group, and the differences were statistically significant (F=6.426, 6.514, 6.552, all P<0.05). Compared with preoperative data, both groups showed a significant decrease in FTA and PTS at one and six months after surgery, while MPTA and KVA increased significantly (F=5.528, 5.556, 5.506, 5.223, all P<0.05). There was no statistically significant difference in FIB, D-D, and TXA2 between the two groups before and one month after surgery (all P>0.05). At six months after surgery, the miR-155 in the knee joint fluid of the combined group was lower than that of the osteotomy group, and the expression of miR-140 was higher than that of the osteotomy group, with statistically significant differences (t=2.198, 4.622, both P<0.05). The difference in complication incidence between the two groups was not statistically significant (χ2=0.601, P>0.05).Conclusion:High tibial osteotomy combined with platelet-rich plasma in the treatment of knee osteoarthritis can improve the coagulation function of patients, regulate the expression of miR-140 and miR-155 in knee joint fluid, improve knee joint function and relieve pain, and is worthy of clinical promotion and application.
Objective:To explore the surgical technique and clinical efficacy of suture anchor combined with suture binding for the fixation of comminuted fractures of the inferior pole of the patella.Methods:A total of 19 patients treated with suture anchor and suture binding at Chengdu First People's Hospital from January 2019 to January 2022 were selected as the experimental group, while 20 patients treated with vertical intermittent steel wire fixation were selected as the control group. The postoperative range of motion(ROM) of knee joint, Bostman score, anterior knee pain, and bone healing time between two groups were evaluated and compared. The measurement data were analyzed by t test; counting data were analyzed by chi square test.Results:No bone non-union or knee pain occurred in the experimental group; the average bone healing time was (2.5±0.5) months, which was shorter than (3.2±0.7) months of the control group(t=3.577, P<0.05). At the last follow-up, the average ROM of the experimental group patients was (131.7±5.6)°, which was larger than(116.5±7.0)°of the control group(t=7.481, P<0.05). The average Bostman score of the experimental group was(27.3±2.1), which was higher than(22.5±2.9)of the control group(t=5.922, P<0.05).Conclusion:The combination of suture anchor and suture binding is a simple and effective surgical method for the fixation of comminuted fractures of the lower pole of the patella, which can achieve good clinical efficacy without the need for secondary surgical removal and internal fixation.
Objective:To investigate the value of peripheral blood cell count ratio in evaluating disease activity and efficacy in patients with rheumatoid arthritis (RA).Methods:The clinical data of 116 patients with RA who met the diagnostic criteria and did not receive relevant treatment in the First People's Hospital of Suqian City from October 2019 to October 2020 were retrospectively analyzed as the observation group, cardiac or hepatic-renal insuffiencies, hematological or immune system diseases, and malignant tumors were excluded; 96 healthy volunteers were selected as the control group at the same time. Neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR) and lymphocyte/monocyte ratio (LMR) were calculated. According to the 28 joint disease activity score (DAS28), patients were divided into the remission group and active group; then the patients in remission group were divided into effective group and invalid group according to the therapeutic effects after treatment. Variance analysis was used for comparison between multiple groups, and independent sample t test was used for comparison between two groups. Logistic regression was used to analyze clinical data to determine the influencing factors of RA disease activity, and the correlation between NLR, PLR, LMR and disease activity and the changes before and after treatment were analyzed. Receiver operating characteristic curve (ROC) and area under curve(AUC) of it was used to evaluate the predictive value of NLR, PLR and LMR in RA disease activity and outcomes.Results:According DAS28, 32 patients were in remission group and 84 were in active group. The levels of NLR and PLR in active group were higher than those in remission group, while the levels of LMR were lower than those in remission group, with statistically significant differences (t=3.957, 6.336, 3.696, all P<0.001). The AUC of NLR, PLR and LMR for disease activity in RA patients were 0.835, 0.810 and 0.812, respectively. The sensitivities were 88.9%, 69.1% and 67.9%, and the specificities were 74.3%, 77.1% and 85.7%, respectively. According to therapeutic effects, 53 patients were in effective group and 31 were in invalid group. The NLR and PLR values of the effective group were lower than those of the ineffective group, and the LMR values were higher than those of the ineffective group, with statistical significance (t=3.493, 4.536, 3.742, all P<0.01). The AUC of NLR, PLR and LMR for RA patients was 0.777, 0.749 and 0.783 respectively; the sensitivity was 65.6%, 59.4% and 65.7%, and the specificity was 85.7%, 85.7% and 77.5%, respectively.Conclusions:NLR, PLR and LMR are independent influencing factors of disease activity in patients with RA. They are effective and simple in evaluating disease activity and efficacy, and can be used as reference index for long-term clinical monitoring of RA disease.
Total knee arthroplasty is the most effective way to treat end-stage knee osteoarthritis. Successful total knee arthroplasty is influenced by a combination of axis of the lower limb, prosthesis selection, patellar management, osteotomy, and soft tissue balance. A good patellar tracking is crucial. Poor patellar tracking can affect patellofemoral stress and may lead to complications such as anterior knee pain and patellar dislocation. This article reviewed the research progress of patellar tracking in total knee arthroplasty, and discussed the factors affecting patellar tracking, the methods of assessing patellar tracking and adjusting patellar tracking.
The knee joint is one of the most important joints in the human body, and the diagnosis and treatment of related diseases has been a hot research topic in the field of bone and joint surgery. Deep learning technology has the advantages of high efficiency, low cost and high consistency, and can theoretically solve a series of pain points in clinical treatment. However, as a new technology that has not yet fully matured, deep learning technology faces the obstacles of insufficient interpretability and lack of high-quality datasets in the process of clinical extension. This paper attempted to provide a brief overview of the current state of research on deep learning technology in knee diseases in terms of its current strengths, weaknesses and future directions.
Objective:To compare the occurrence of DVT and identify the risk factors in patients after arthroscopic surgery for upper and lower limbs, providing reliable clinical reference for the evaluation and prevention of DVT after arthroscopic surgery.Methods:Retrospective analysis was conducted to collect general information and relevant laboratory indicators of patients undergoing arthroscopic surgery in Jinjiang Hospital from October, 2021 to October, 2022. The patients with DVT displayed by color ultrasound before operation were excluded. According to different exposure factors, they were divided into DVT group and non-DVT group. To explore the risk factors that cause DVT after arthroscopic surgeries in upper and lower limbs, independent sample t test was used for measurement data of exposure factors, and chi square test was applied for counting data to identify potential risk factors. Modified Poisson regression analysis was performed on potential risk factors with statistically significant differences between the two groups.Results:A total of 232 patients were enrolled. Among them, 25 (10.8%) had postoperative DVT in lower limb, and all were distal DVT. Among these 25 patiens, 24 cases were intermuscular veins in the calf, one case was posterior tibial vein combined with anterior tibial vein, and no postoperative pulmonary embolism (PE) occurred. There was no statistically significant difference in the incidence of DVT between upper and lower limb arthroscopy surgerie. Compared with the non-DVT group, there were statistically significant differences in age(t=-2.140), BMI(t=-2.592), postoperative Caprini score(t=-6.410), the duration of operation(χ2=12.262), the duration of using tourniquet(χ2=6.812), and postoperative D-dimer(χ2=7.719)(all P<0.05 ). Modified Poisson regression analysis showed that increased BMI [relative risk(RR)=1.235, 95%confidence interval(CI) (1.084, 1.408), P<0.01), postoperative Caprini score (RR=1.080, 95%CI(1.062, 1.312), P<0.01) and postoperative D-dimer increase (RR=3.657, 95%CI(1.465, 9.130), P<0.01) were risk factors for postoperative DVT.Conclusions:The incidence of DVT after arthroscopy in upper limb is not lower than that after arthroscopy in lower limb, which should be taken seriously by clinical doctors. An increase in BMI, postoperative Caprini score, and postoperative D-dimer elevation are important risk factors for the occurrence of DVT.
Objective:To explore the changes in ankle mortise morphology and the influencing factors of ankle joint function after open reduction and internal fixation surgery for ankle joint fractures.Methods:The patients with ankle fractures and accepted open reduction and internal fixation in the orthopedics d epartment of Nantong Hospital Affiliated to Shanghai University from January 2018 to June 2021 were selected and divided into the excellent group, the good group, and the fair to poor group based on the American Foot and Ankle Association ankle and posterior foot function score (AOFAS). Multiple factor linear regression analysis was used to analyse the relationship between AOFAS score and morphological indices of ankle joint( including the width, depth, coronal and sagittal angles).Results:A total of 98 patients were enrolled. Changes in ankle morphology: (1) compared with the healthy side, the width, depth, and coronal and sagittal angles of the ankle on the affected side of patients with ankle fracture after open reduction and internal fixation were significantly increased(t=6.835, 3.523, 6.105, 10.670, all P<0.05). (2)AOFAS score of ankle joint function in patients with ankle fracture after open reduction and internal fixation surgery was (77±9). The differences in ankle shape indices between the healthy and sick sides of the three groups were statistically significant (F=396.749, 136.520, 59.694, 406.548, all P< 0.05). (3) The difference in morphological indices of ankle joint between the healthy and sick sides of postoperative patients was significantly negatively correlated with the AOFAS score of ankle joint function (r=-0.368, -0.398, -0.208, -0.423, all P< 0.05). Factors influencing ankle joint function: (1) comparison of AOFAS for different ages, start of rehabilitation, and adherence to functional training showed statistically significant differences (t=2.460, 3.549, both P<0.05). (2) Age[B=0.386, 95%CI(0.207, 0.565), P<0.001], adherence to functional training[B=-9.623, 95%CI(-15.118, -4.129), P=0.001], and the differences in ankle width between the affected and healthy sides [B=-1.200, 95%CI(-1.785, -0.614), P<0.001] were the main influencing factors on postoperative AOFAS scores of ankle joint function.Conclusion:There is a significant negative correlation between the changes in ankle morphology and ankle joint function in patients after open reduction and internal fixation for ankle joint fractures.
Objective:To explore the clinical efficacy of Danggui Sini Tang combined with methotrexate in the treatment of rheumatoid arthritis.Methods:A retrospective analysis was conducted on the clinical data of 120 patients who were diagnosed as rheumatoid arthritis and as arthralgia by traditional Chinese medicine in the Second Affiliated Hospital of Shandong First Medical University from February 2020 to February 2022. Patients who were unable to communicate, had gouty arthritis or joint tuberculosis were excluded. According to different treatment methods, the patients were divided into the experimental group (n=60) and the control group (n=60). Both the two groups were treated with methotrexate, and the experimental group accepted Danggui Sini Tang aditionally. The clinical efficacy, laboratory indicators, and incidence of adverse reactions of the two groups of patients were compared. The measurement data were described as(±s) and analyzed by t test. The count data were described as [ n ( % ) ] and analyzed by chi square test.Results:The total effective rate in the experimental group was 95.0%, which was higher than that in the control group (χ2=9.412, P<0.05). After treatment, the erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) of the experimental group were (18.3±3.2) mm/h and (18.3±1.2) mg/L, respectively, which were lower than (30.2±4.3)mm/h and (18.3±1.2)mg/L of the control group, the difference was statistically significant (t=17.084, 30.787, both P<0.001). Serum interleukin (IL)-1 and tumor necrosis factor-α (TNF-α) in the experimental group after treatment were lower than the control group (t=39.036, 22.102, both P <0.001); IL-10 was (6.98±0.24) ng/L, which was higher than(5.99±0.25)ng/L of the control group; the difference was statistically significant (t=22.128, P<0.001). There was no statistically significant difference in the incidence of adverse reactions between the two groups of patients (χ2=0.240, P>0.05).Conclusion:The combination of Danggui Sini Tang and methotrexate in the treatment of rheumatoid arthritis has ideal safety, and the inflammatory symptoms could be significantly improved, which is worth promoting in clinical practice.
There are debates in residual end preservation technique in anterior cruciate ligament reconstruction whether it would promote the bone-tendon healing, knee proprioception recovery, vascularization of synovial membrane and transplanted ligament. This article retrieved the literatures from January 2018 to September 2022, and provided induction, summary and discussion of the influence of residual preservation in anterior cruciate ligament reconstruction on bone tunnel, proprioception recovery, vascularization of synovial membrane and transplanted ligament, and early knee function recovery. Preservation residual anterior cruciate ligament reconstruction shows advantages in promoting early tendon bone healing and vascularization of synovial membrane and transplanted ligament, and is also conducive to the recovery of proprioception, which in turn accelerate the knee joint function recovery. Clinical doctors should base on the residual type of the anterior cruciate ligament rupture in patients, for patients who meet the conditions of residual reserves, surgeons shall retaine the tissue as far as possible during anterior cruciate ligament reconstruction.
