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.
