Adaptation to hypoxia promotes fracture healing. However, the underlying molecular mechanism remains unknown. Increasing evidence has indicated that long non-coding RNAs (lncRNAs) play crucial roles in several diseases, including fracture healing. In the present study, lncRNA microarray analysis was performed to assess the expression levels of different lncRNAs in MC3T3-E1 cells cultured under hypoxic conditions. A total of 42 lncRNAs exhibited significant differences in their expression, including metastasis associated lung adenocarcinoma transcript 1 (MALAT1), maternally expressed 3, AK046686, AK033442, small nucleolar RNA host gene 2 and distal-less homeobox 1 splice variant 2. Furthermore, overexpression of MALAT1 promoted osteoblast differentiation, alkaline phosphatase (ALP) activity and matrix mineralization of MC3T3-E1 cells, whereas its knockdown diminished hypoxia-induced cell differentiation, ALP activity and matrix mineralization in these cells. Moreover, functional analysis indicated that MALAT1 regulated the mRNA and protein expression levels of CCAAT/enhancer binding protein δ by competitively binding to microRNA-22-3p. Adenoviral-mediated MALAT1 knockdown inhibited fracture healing in a mouse model. Taken together, the results indicated that MALAT1 may serve a role in hypoxia-mediated osteogenesis and bone formation.

目的 探讨在低氧环境中,miR-429对MC3T3-E1细胞成骨分化的影响.方法 在体内、外用氯化钴(CoCl2)模拟低氧环境,采用免疫蛋白印迹(western blot,WB)检测低氧诱导因子(hypoxia inducible factor,HIF)-1α的表达验证低氧情况,通过实时荧光定量聚合酶链式反应(real time-quantitative polymerase chain reaction,RT-qPCR)观察骨折部位及细胞组织中miR-429的表达情况,同时检测MC3T3-El细胞在低氧状态下的增殖与凋亡情况;通过慢病毒转染技术在MC3T3-El细胞中过表达miR-429作为实验组,对照组为转染空载质粒细胞,采用碱性磷酸酶(alkaline phosphatase,ALP)活性检测、茜素红染色、WB等方法观察细胞中ALP活性、矿物质含量以及多种成骨标志物蛋白表达情况,对比两组MC3T3-El细胞的成骨分化;在骨折模型局部注射过表达miR-429的慢病毒载体,通过Micro-CT及qRT-PCR观察骨折愈合情况.结果 在低氧环境MC3T3-E1细胞中HIF-1α高表达的同时上调了 miR-429 的表达,对MC3T3-E1细胞转染miR-429过表达病毒后,细胞中ALP的活性、细胞基质矿化水平以及成骨标志物Runt 相关转录因子 2(Runt related transcription factor 2,RUNX2)和骨钙素(osteocalcin,OC)的水平均高于对照组;体内注射过表达miR-429的慢病毒试剂后,骨折Micro-CT愈合情况、骨组织中miR-429的表达均高于对照组.结论miR-429在低氧环境中呈高表达,在诱导MC3T3-El细胞成骨分化中起到促进作用.

目的 评价外固定架融合和加压空心钉融合治疗终末期踝关节骨关节炎的临床疗效.方法 选取首都医科大学宣武医院2016年7月至2018年9月收治的62例终末期踝关节骨关节炎患者,采用随机数表法分为两组,分别应用踝关节融合外固定架固定(观察组)和踝关节融合空心钉固定(对照组).观察比较两组患者术前、术后美国足踝外科医师协会(American Orthopaedic Foot and Ankle Society,AOFAS)踝-后足功能评分、生活质量改善情况(SF-36生活质量量表)、视觉模拟评分(visual analogue score,VAS),以及早期临床疗效和并发症情况.结果 观察组34例,对照组28例,所有患者随访时间为6～34个月,平均(18±5)个月.两组患者术后AOFAS踝-后足评分、SF-36、VAS较术前均明显改善,差异有统计学意义(P＜0.05).观察组和对照组的术后AOFAS评分、VAS差异无统计学意义,但前者SF-36评分显著优于对照组(P=0.01).观察组踝关节均达骨性融合,出现针道红肿2例,换药后愈合;自身免疫性皮炎1例,经皮肤科处理后好转;并发症发生率为8.8％.对照组融合失败1例,其他病例获得骨性融合,伤口愈合不良2例,1例换药后好转,1例再次缝合处理后愈合;并发症发生率为10.7％.结论 踝关节融合外固定架治疗终末期踝关节骨关节炎可获得满意疗效,能更快地改善患者的生活质量,部分负重时间更短.

Objective:To explore the clinical predictive effect of the preoperative ratio of C reactive protein to albumin (CAR) on perioperative delirium (POD) in geriatric patients with femoral intertrochanteric fracture.Methods:The clinical data were analyzed retrospectively of the 398 patients who had undergone surgery for femoral intertrochanteric fractures at Department of Orthopedics, Xuanwu Hospital from January 2013 to March 2016. According to the presence or absence of POD, all the patients were divided into 2 groups: a delirium group and a normal group. The 2 groups were compared in terms of general clinical data like gender, age, body mass index, blood routine, CAR, biochemical indicators, blood coagulation indicators and concomitant internal diseases. After a single factor logistic regression analysis of the general clinical data of the patients, factors with P<0.10 were introduced into the multivariate logistic binary regression model to screen out the risk factors for POD in geriatric patients with femoral intertrochanteric fracture. The receiver operating characteristic (ROC) curve was drawn to analyze the predictive value and optimal cut-off point of CAR for POD in geriatric patients with femoral intertrochanteric fracture. Results:The incidence of POD in this cohort was 14.32%(57/398). The age, C-reactive protein, CAR, platelet and probability of pulmonary infection in the delirium group were significantly higher than those in the normal group, but the hemoglobin, albumin and prealbumin in the former were significantly lower than those in the latter ( P< 0.05). The multivariate logistic binary regression analysis showed that hemoglobin ( OR=0.975, 95% CI: 0.957 to 0.993, P=0.006) and CAR( OR=53.713, 95% CI: 17.713 to 162.876, P<0.001) were risk factors for POD in geriatric patients with femoral intertrochanteric fracture. The area under ROC of CAR in predicting POD in geriatric patients with femoral intertrochanteric fracture was 0.906 (95% CI: 0.873 to 0.933, P<0.001), and the cut-off point was 2.06. When CAR>2.06, its predicted incidence of POD was 50.50%, with a sensitivity of 89.47% and a specificity of 85.34%. Conclusion:As CAR is a risk factor for POD in geriatric patients with femoral intertrochanteric fracture, it can be used as an effective indicator to predict POD.

Objective: To explore the influence of lateral patellofemoral joint degeneration on the treatment of anteromedial osteoarthritis of knee joint by Oxford medial unicompartmental knee arthroplasty. Methods: The clinical data of 73 patients (73 knees) with knee osteoarthritis underwent unicompartmental knee arthroplasty at Department of Orthopaedic Surgery, Xuanwu Hospital, Capital Medical University from March 2016 to December 2017 were analysed respectively.There were 18 males and 55 females, aged (68.6±7.5) years(range: 53 to 89 years).The lateral patellofemoral joints of patients were evaluated by Ahlback grading system. Patients with Ahlback 0 andⅠ were in the non degenerative group (37 cases), and those with Ahlback Ⅱ and above were in the degenerative group (36 cases). Hospital for special surgery knee score(HSS) and the Western Ontario and McMaster Universities(WOMAC) osteoarthritis index, as well as the condition of kneeling, sit to stand movement, up stair and down stair were recorded. The data before and after operation were compared by paired sample t test, and the data between groups were compared by independent sample t test. χ(2) test was used for counting data. Pearson correlation analysis was used to compare the correlation between ahlback score, HSS and WOMAC osteoarthritis index. Results: The follow-up time was (35.1±6.6) months (range: 25 to 47 months).The knee function of the patients improved significantly after operation.The HSS score increased from 57.7±11.8 preoperative to 81.8±7.8 postoperative (t=16.64, P=0.00) and WOMAC osteoarthritis index decreased from 48.9±13.4 preoperative to 15.6±8.8 postoperative (t=20.48, P=0.00). There was no statistical difference in the change of HSS between the degenerative group and the non-degenerative group before and after surgery(27.5±12.2 vs. 22.5±12.3, t=-1.65, P=0.10) as well as the change of WOMAC osteoarthritis index(31.8±14.0 vs. 36.4±13.7, t=-1.35, P=0.18), but the lateral patellofemoral joint degeneration was related to inability to complete squats (χ(2)=5.17, P=0.04) and sitting up (χ(2)=7.22, P=0.01). Conclusion: The degeneration of lateral patellofemoral joint has no effect on the early functional recovery of patients with anteromedial knee osteoarthritis after Oxford medial unicompartmental knee arthroplasty.

目的 探讨补肾活血方对大鼠骨折愈合的作用和影响机制.方法 选用60只SD大鼠,制作右侧胫骨干骨折模型后随机分为对照组和实验组,实验组术后连续灌胃补肾活血方28 d[20 g/(kg·d)].骨折后第14、28、42天行X线片及Micro CT检查,通过观察X线评分及测量骨痂大小评估骨折愈合情况,应用蛋白质印迹(Western blotting)检测成骨性标志物Runx2以及骨钙素(osteocalcin,OC)的表达情况,同时通过三点弯曲试验检测右侧胫骨的最大载荷、最大载荷恢复率.结果 术后第42天X线片显示实验组骨折基本愈合,对照组仍可见模糊的骨折线;第28、42天的Lane-Sandhu X线评分,实验组均显著高于对照组[(5.67±0.61)分比(4.34±0.32)分,(6.91±0.56)分比(5.49±0.48)分;P均＜0.05].第14、28天CT测量骨痂量,实验组均显著高于对照组[(81.23±5.38)mm3比(63.58±6.12)mm3,(53.85±4.92)mm3比(42.76±6.25)mm3;P均＜0.05].在实验组骨痂组织细胞中,OC及Runx2表达较对照组高,在骨折后第7天时明显升高,并持续高表达至第14天.骨折术后第42天,实验组的最大载荷、最大载荷恢复率明显均优于对照组[(46.99±5.88)N比(36.41±4.26)N,(82.68±7.81)％比(67.63±5.43)％;P均＜0.05].结论 在大鼠骨折模型中,补肾活血方能显著提高Runx2和OC的表达,可促进骨折愈合.

目的 探讨为防止人工全膝关节置换术后深静脉血栓的形成及相关并发症应用利伐沙班的治疗价值.方法 选取自2016年7月至2017年12月因膝关节骨关节炎于首都医科大学宣武医院骨科关节组行人工全膝关节置换术的患者,按照随机对照的原则抽取作为研究对象.排除有凝血功能障碍、血栓栓塞性病史或出血性病史,共84例患者,分为实验组和对照组各42例.实验组患者在术后给予利伐沙班抗凝治疗,对照组患者在术后给予依诺肝素抗凝治疗.比较两组患者术后深静脉血栓形成、肺栓塞及出血并发症(切口瘀斑、出血事件)的发生率,比较两组患者术后血液学指标的差异,比较两组患者引流量、输血量等相关指标.计量资料采用独立样本t检验;计数资料采取卡方检验.结果 实验组患者术后早期深静脉血栓形成与对照组相比差异无统计学意义(χ2=0.933,P>0.05),两组患者均未发生肺栓塞;实验组早期出血并发症事件多于对照组(χ2=6.574,P<0.05).而两组患者术后血红蛋白、血小板、活化的部分凝血活酶时间、纤维蛋白原、D-二聚体相比差异均无统计学意义(P>0.05);两组患者术后的引流量基本相同,两组的输血量、总失血量、隐性失血量相比均无统计学意义(P>0.05).结论 人工全膝关节置换术后应用利伐沙班作为抗凝药物,提供了抗凝治疗的便捷性,但其相关的出血并发症略高于依诺肝素,临床工作中可考虑分阶段使用以使得患者的受益最大化.

目的 探讨促红细胞生成素(erythropoietin,EPO)联合应用铁剂对不同年龄髋膝关节置换术患者术后贫血的影响.方法 回顾性分析2013年5月至2014年12月于我院治疗的全髋关节置换术(total hip arthroplasty,THA)和全膝关节置换术(total knee arthroplasty,TKA)患者149例;男42例,女107例;年龄51～92岁,平均(72.8±8.52)岁.髋关节置换术74例,膝关节置换术75例.根据患者年龄分为老年组121例(≥65岁)和非老年组28例(＜65岁),两组患者围术期均采用EPO联合应用铁剂的血液管理方法.记录患者基本信息和围手术期化验指标、手术前后贫血率、异体输血率、失血量等数据,利用Nadler方程计算患者血容量、Gross方程计算患者隐性失血量,进行统计学分析比较.结果 术前贫血率:老年组24.0％,高于非老年组的7.1％,差异有统计学意义(P＜0.05);手术后1、3、5d血红蛋白(hemoglobin,Hb)下降水平:老年组23(12,30)g/L、29(18,38)g/L、26(15,37)g/L,均低于非老年组的30(22,36)g/L、38(29,49)g/L、32(23,45)g/L,差异均有统计学意义(P＜0.05);异体输血率:老年组为43.8％,显著高于非老年组的21.4％,差异有统计学意义(P＜0.05);失血情况:老年组总失血量1 120(831,1 483)mL、隐性失血量686(430,1 066)mL、隐性失血比例61(51,75)％、显性失血量400(300,500) mL,非老年组分别为1 087(821,1 480) mL、505(414,1 116)mL、61(45,74)％、440(205,558)mL,两组比较差异均无统计学意义(P＞0.05).结论 老年关节置换患者术前贫血率、异体输血率及输血量相比非老年患者较高;EPO联合铁剂的血液管理效果对老年人不佳.

背景:单髁关节置换术是治疗膝关节前内侧骨关节炎的重要手术方法.相对于全膝关节置换术,围手术期疼痛程度有所降低,但仍是患者和骨科医师关注的重点问题.目的:探讨围手术期疼痛管理对膝关节单髁置换术后患者疼痛和早期功能恢复效果的影响.方法:60例单髁关节置换患者分为3组:无神经阻滞组、股神经阻滞组和收肌管阻滞组,每组20例.所有患者术前均给予塞来昔布进行超前镇痛;术中给予局部关节囊“鸡尾酒”阻滞,按照分组给予或者不给予神经阻滞;术后常规给予非甾体镇痛药物.比较三组的疼痛视觉模拟评分(VAS)、患者首次直腿抬高时间、主动屈膝时间和下地活动时间、术后膝关节活动度(ROM)、特种外科医院膝关节评分(HSS).结果:三组患者一般情况无统计学差异(P＞0.05).股神经阻滞组和收肌管阻滞组术后24 h和48 h疼痛评分均显著低于无神经组滞组(P＜0.05).首次直腿抬高时间,三组比较无统计学差异(P＞0.05).术后主动屈膝时间和首次下地活动时间,三组比较差异具有统计学意义(P＜0.05).术后第3天的ROM,三组比较差异具有统计学意义,收肌管阻滞组优于股神经阻滞组和无神经阻滞组(P＜0.05).术后2周的ROM和HSS评分,三组比较均无统计学差异(P＞0.05).结论:膝关节单髁置换术患者实施围手术期疼痛管理,能够有效减轻术后疼痛,有利于患者早期开展膝关节功能锻炼.

Total hip arthroplasty is currently an important surgical method for the treatment of hip diseases.The modular design of the head and neck taper facilitates the adjustment of limb length and femoral offset during surgery,however,complications such as wear,corrosion and looseness of the modular interface are also inevitable old problems.In recent years,with the changes in the design of prostheses,the trend that patients becomes younger and active,and the development of minimally invasive surgery,taper corrosion has again become a problem that needs to be solved and cannot be ignored,which is causing the attention of joint surgeons.There have been many studies on the complications associated with metal-on-metal prosthesis modular interfaces,such as increased metal ion level,taper corrosion and adverse local tissue reactions,while there are few studies on the complications of metal-on-polyethylene total hip arthroplasty,and metal-on-polyethylene prosthesis has similar problems such as increased local metal ion level and adverse tissue reactions caused by taper corrosion,which may also lead to complications such as prosthesis loosening,dislocation and fracture.Currently there are few reports about head and neck taper corrosion of metal-onpolyethylene prosthesis in China and there are still controversies about its manifestation and mechanism.In this paper,we summarized the above problems through literature reviewto expound the concept,research history,assessment methods,and incidence of metal-on-polyethylene prosthesistaper corrosion and the effect of material composition,diameter of the metal head,neck length,femoral offset,geometry of the taper,surgical factors,in vivo time,and patient factors on taper corrosion are analyzed.In summary,there are still many problems in the researches about the specific forming mechanism that have not been solved,thus it is very important for the prevention of taper corrosion:choosing the same material or ceramic material,avoiding overlarge diameter of the femoral head and femoral offset,avoiding too small taper degree,paying attention to the strength of tapping and cleaning of the taper are the current viable options.

目的 探讨一期临时外固定结合二期切开复位内固定治疗复杂Pilon骨折的疗效.方法 回顾性分析2014年12月至2017年12月首都医科大学宣武医院采用一期临时外固定架+二期切开复位内固定方式治疗的36例AO/OTAC1-C3型复杂Pilon骨折患者的临床资料.骨折术后复位情况采用Burwell-Charnley标准评定,末次随访时采用踝关节Mazur评分评估踝关节功能.结果 30例患者获得随访,平均随访14个月.术后骨折复位情况的Burwell-Chamley评定结果:解剖复位22例,复位可7例,复位差1例.骨折临床愈合时间平均4.2个月.末次随访踝关节功能的Mazur评分:平均85.2(56～93)分,优19例,良6例,可4例,差1例,优良率83.33％.术后1例出现切口浅表的感染,积极换药后愈合.结论 复杂Pilon骨折采用一期临时外固定架二期切开复位内固定符合创伤控制原则,治疗效果满意.早期外固定架能为骨折提供良好稳定,有利于软组织条件的恢复,并为二期骨折的良好内固定创造有利条件.

目的 探讨全膝关节置换术中膝关节内侧副韧带损伤原位修复的疗效.方法 回顾性分析自2013-01-2014-06收治的94例老年膝关节置换患者的资料,根据术中是否出现内侧副韧带损伤分为:损伤组(5例)和非损伤组(89例).结果 所有患者术后获得随访,随访时间41.3～77(60.3±11.1)个月.术后活动度、HSS评分和WOMAC评分2组比较,差异均无统计学意义(P＞0.05),损伤组无明显冠状面不稳.结论 膝关节置换术中MCL损伤,采用原位修复法治疗可以获得良好的关节活动度和满意的临床功能.

Anticoagulant drugs can prevent deep vein thrombosis and related complications after total knee arthroplasty. Traditional anticoagulant drugs (unfractionated heparin, low molecular weight heparin, warfarin, etc.) take preventive effects. At present, some new oral anticoagulants (rivaroxaban, apixababan) have been widely used in clinical practice to provide patients with a safer, more convenient and effective option for the prevention of postoperative venous thrombosis. This review focuses on the advantages and disadvantages of traditional anticoagulants such as low molecular weight heparin, vitamin K antagonists, and novel oral anticoagulants rivaroxaban, apixaban. Clinical comparison of traditional anticoagulant drugs with novel oral anticoagulants is taken to provide a reference.

There are an increasing number of vascular complications after hip replacement, some of which can be life-threatening. However, there are few reports of lower limb ischemic symptoms after undergoing an otherwise uncomplicated classic total hip replacement. We report a patient with low weight who developed postoperative limb ischemia resulting from blood clots caused by insertion of a Hohmann retractor close to small anterior acetabular osteophytes. Ultrasonography and angiography revealed her symptoms to be the result of femoral artery intimal injury with lower extremity arterial thrombosis, which led to pain, numbness, and decreased skin temperature. The patient underwent timely percutaneous intervention with a femoral artery stent, which relieved her symptoms. The discussion reviews femoral artery injury during total hip arthroplasty.

目的 比较单髁置换术和胫骨高位截骨术治疗膝单间室骨关节炎的术后早期临床疗效,为临床选择适当的治疗方法提供参考.方法 选择2016年3月至2017年3月收治并符合纳入排除标准的51例膝关节内侧间室骨关节炎患者,根据患者意愿分为两组.其中,单髁置换术(unicompartmental knee arthroplasty,UKA)组35例,胫骨高位截骨术(high tibial osteotomy,HTO)组16例.记录并比较两组患者手术时间、止血带时间、围手术期总失血量、术后早期疼痛视觉模拟量表、术前和术后3个月美国特种外科医院(the hospital special surgery,HSS)评分和西安大略和麦克马斯特大学骨关节炎指数评分(the western Ontario and McMaster universities osteoarthritis index,WOMAC)等指标.结果 两组患者均获随访,单髁置换术组随访时间6～24个月,平均15.3个月;胫骨高位截骨术组随访时间7～22个月,平均14.5个月.两组患者一般资料和随访时间差异无统计学意义.两组患者手术相关因素比较,手术时间、止血带时间差异均无统计学意义;UKA组在失血量、术后16 h疼痛视觉模拟量表评分优于HTO组;两组组内HSS评分、WOMAC评分术前和术后比较差异均有统计学意义,组间比较差异均无统计学意义.结论 采用单髁置换术和胫骨高位截骨术治疗膝关节单间室骨关节炎均可以获得良好的早期疗效.

Objective To evaluate the efficacy of Oral Hydrolyzed Protein in patients undergoing total knee arthroplasty (TKA).Methods A prospective randomized controlled trial was conducted in 80 patients with TKA who were randomly divided into experimental group and control group,each with a total of 40 cases.The experimental group received conventional nutritional support and orally 309 hydrolyzed protein every day.After 5 day continuous nutrition support,related indexes between the two groups were tested and compared.Results After nutritional treatment,the total bilirubin,direct bilirubin,indirect bilirubin and albumin were increased in experimental group,compared with those before treatment,and the difference was statistical (P ＜ 0.05).In experimental group,the hemoglobin,lymphocyte count,hematocrit,globulin,total cholesterol values was statistically declined after treatment (P ＜ 0.05).There was no statistical difference in the remaining indicators before and after treatment (P ＞ 0.05).In control group,total bilirubin,direct bilirubin,indirect bilirubin,ALT,AST had a tendency to improve,there was statistical significance of total bilirubin,direct bilirubin,indirect bilirubin before and after treatment (P ＜ 0.05),while no statistical difference in ALT and AST (P ＞ 0.05).Conclusion Conventional nutritional support combined with Oral Hydrolyzed Protein has good compliance and tolerance in patients with TKA,and can improve the nutritional status of patients.

Fracture healing in elderly patients is an emerging public health concern. As non‑drug treatments, intermittent hypoxia training (IHT) and remote ischemic preconditioning (RIPC) are considered to have substantial advantages and to aid fracture healing in elderly patients. The purpose of the present study was to evaluate and compare the effects of IHT and RIPC on fracture healing. Micro‑computed tomography (micro‑CT) and biomechanical testing were used to assess the morphology and structural properties of bone callus dissected from aged rats with tibial fractures. In addition, hypoxia‑inducible factor‑1α (HIF‑1α) and its target gene, associated with the healing process, were investigated by reverse transcription‑quantitative polymerase chain reaction and western blot analyses. The micro‑CT‑based parameters, including bone mineral density and trabecular number, were measured, and significant differences were identified between the experimental and control groups. The IHT group exhibited superior bone formation and mineralization rates compared with the RIPC group. The biomechanical testing revealed that the ultimate loading and stiffness values were significantly higher in the IHT group compared with those in the RIPC group. In accordance with previous studies, RIPC exerted a similar effect in increasing the expression of HIF‑1α, and its downstream genes, throughout the course of healing. In addition, the IHT group exhibited increased expression levels of HIF‑1α compared with the RIPC group. Taken together, the results suggested that IHT and RIPC significantly enhanced fracture healing; however, IHT exhibited superior bone formation and healing effects compared with RIPC.

目的:评估连续股神经组滞(CFNB)相对于传统的病人自控静脉镇痛(PCIA),对单髁关节置换术(UKA)术后的镇痛效果及早期功能锻炼的影响.方法:选择宣武医院骨科收治的行UKA的膝关节骨关节炎患者40例,随机分为CFNB组和PCIA组,每组20例.记录并比较两组患者术后6、12、24 h的静息和活动疼痛评分、术后患肢关节活动情况和镇痛相关不良反应情况.结果:两组患者的一般资料无明显差异.CFNB组术后12 h静息痛和术后12、24 h活动疼痛评分低于PCIA组,差异具有统计学意义(P＜0.05).两组在术后首次直腿抬高时间、术前和术后膝关节活动度方面差异无统计学意义,但CFNB组首次主动屈膝时间优于PCIA组.在术后镇痛相关不良反应方面,CFNB组出现2例渗液,PCIA组出现4例恶心呕吐和1例皮肤瘙痒,两组不良反应发生率比较差异无统计学意义.结论:CFNB可以有效缓解患者术后疼痛,无明显不良反应,有利于患者术后早期进行功能锻炼.

Background: The main objective of total knee arthroplasty is to relieve pain, restore normal knee function, and improve gait stability. Significant flexion contractures can severely impair function after surgery. The purpose of this study is to evaluate the efficacy of implementing a continuous proximal sciatic nerve block in conjunction with aggressive physical therapy to treat patients with persistent flexion contractures that were recalcitrant to rehabilitation efforts following primary total knee arthroplasty (TKA). Methods: From December 2012 to January 2016, the following subjects were enrolled in this study: 20 patients (15 females and 5 males aged between 62 and 78 years old; median age = 65.7 y) with flexion contractures ranging from 15 degrees to 25 degrees (19.2 degrees +/- 5.6 degrees) that persisted for at least 1.5 months following total knee arthroplasty and showed no significant improvement in response to conventional therapeutic methods. Demographic data, the passive range of motion, flexion contracture, pain score during stretching, and the Hospital for Special Surgery knee score were recorded. A portable motion analyzer was used to obtain the corresponding gait parameters from the flexion contractures group and control group. Repeated measurement ANOVA was used to compare the clinical results. Results: In combination with 2 to 4 (2.5 +/- 1.3) months of aggressive knee stretching exercises, 16 out of 18 knees achieved full extension, and 2 out of 18 improved to within 5 degrees of the full extension. An average of the 12 to 48 (26.6 +/- 10.7) month follow-up showed that this improved range of motion was maintained for all the corresponding patients, and that there were no reoccurrences of deformity. The mean Hospital for Special Surgery knee scores improved from 61.2 to 93.2 points (p < 0.001). After six months of continuous proximal sciatic nerve blockage, all gait parameters for the flexion contractures group exhibited significant improvement. Conclusion: A continuous proximal sciatic nerve block could be a useful adjunct to a physical therapy regimen for patients with knee flexion contractures, especially for patients with difficult-to-treat cases of knee flexion contracture that are recalcitrant to conservative therapy.

Objective To evaluate the clinical significance and safety of erythropoietin in the treatment of geriatric patients with intertrochanteric fracture.Methods Eighty patients with femoral intertrochanteric fracture who were treated with closed reduction and intramedullary nail fixation were included and randomly divided into 2 groups.Forty patients in the EPO group were treated with EPO subcutaneously after admission.And another 40 patients in the control group were treated without EPO.Hemoglobin and hematocrit in 1 day preoperative and 1 day 3 day,5 day postoperative,,blood pressure,blood platelet and transfusion of both groups were recorded and compared with each other.Results In this study,ASA,Fracture types,pre-injury activity,hemoglobin level,hematocrit,the number of chronic diseases,blood pressure and blood platelet of EPO group and control group were not different.Hemoglobin in 1 day preoperative and 5day postoperative,hematocrit,blood pressure,blood platelet was not significantly different.In the two groups,hemoglobin in 1 day,3 day,postoperative total blood loss,average transfusion volume and transfusion rate was significantly different.Conclusion Perioperative erythropoietin in the treatment of geriatric patients with intertrochanteric fracture,could induce early mobilization of red blood cells,improve the degree of anemia,and reduce the amount of blood transfusion.No adverse reactions are observed.