Recovery Of Joint Function Research Articles

Feasibility and efficacy of knee extension training using a single-joint hybrid assistive limb, versus conventional rehabilitation during the early postoperative period after total knee arthroplasty.

Objectives: To evaluate the feasibility and efficacy of treatment for the recovery of knee joint function after total knee arthroplasty (TKA) using a robotic suit.Patients and Methods: Knee joint extension exercise sessions were started with a robotic suit (single-joint hybrid assistive limb [HAL-SJ, Cyberdyne, Inc., Tsukuba, Japan]) in one group of patients after TKA. Patients who underwent standard rehabilitation were enrolled in the control group. To evaluate feasibility and safety, we assessed the adverse events, the number of training sessions, and training time. We compared the changes in knee joint pain and extension lag (°) between the groups.Results: The average age was 71.3 ± 6.2 years in the HAL-SJ group and 74.9 ± 8.7 years in the control group. There were no severe adverse events. In the HAL-SJ group, training was performed 2.9 times, on average, and lasted 18.8 min. In the HAL-SJ group, there was a reduction in the visual analog scale (VAS) for pain after training, which was not significant. In the control group, the VAS score worsened after the sessions. The extension lag significantly improved in the HAL-SJ group after the 2nd and 3rd sessions, and this was more due to improvements in their active extension range of motion than their passive extension range of motion.Conclusions: HAL-SJ-based training is safe and effective, and leads to instantaneous improvement of extension lag, without worsening knee joint pain. HAL-SJ-based knee extension training could represent a viable novel post-TKA rehabilitation modality.

Therapeutic effect of Huzhangoside D in rats with knee osteoarthritis induced by anterior cruciate ligament transection

Background: Knee osteoarthritis (KOA) is an age-related disease. Huzhangoside D is a saponin isolated from genus Clematis L. (Ranunculaceae). The aim of this study is to explore the anti-inflammatory, apoptotic, and autophagy regulation effects of huzhangoside D on KOA in a rat model. Materials and Methods: The KOA model was established by an anterior cruciate ligament transection surgery. Huzhangoside D was administered for 4 weeks. The weight-bearing assay, morphology observation, and intrinsic mechanism exploration were performed. Results: After administration, the weight-bearing assay showed that huzhangoside D promoted joint function recovery. Hematoxylin-eosin and safranin O-Fast green staining indicated that huzhangoside D ameliorated the structural damage. The Mankin scores were decreased in the huzhangoside D groups. Huzhangoside D enhanced cartilage thickness. Enzyme-linked immunosorbent assay study revealed that huzhangoside D downregulated the proinflammatory cytokine (tumor necrosis factor alpha, interleukin-6, and interleukin-1β) levels, while it upregulated the anti-inflammatory cytokine (interleukin-10) level in rat serum. Terminal deoxynucleotidyl transferase dUTP nick end labeling assay showed that huzhangoside D downregulated the apoptosis ratio of cartilage cells. Immunohistochemical staining showed that huzhangoside D upregulated the autophagy-related protein beclin-1, ATG5, ATG7, and light chain 3 levels and downregulated the p62 level. Moreover, the AKT and mTOR signaling pathway activities were downregulated. The 3-MA combination with huzhangoside D downregulated the weight-bearing function and morphology of the knee and upregulated the proinflammatory cytokines, which showed the role of autophagy as a protective mechanism in the effect of huzhangoside D. Conclusion: This study revealed that huzhangoside D is a promising agent in KOA treatment.

Evaluation of the clinical efficacy of 3D Printing technology assisted surgery combined with early postoperative comprehensive rehabilitation in the treatment of Senile Intertrochanteric Fractures.

Objectives:To observe the clinical value of 3D printing technology assisted surgery combined with early postoperative comprehensive rehabilitation in elderly patients with intertrochanteric fractures.Methods:Sixty elderly patients with intertrochanteric fractures of the femur who were treated in our hospital from January 2018 to January 2020 were selected and randomly divided into two groups. In the experimental group, 3D printing technology assisted surgery combined with early postoperative comprehensive rehabilitation was used for treatment. While in the control group, traditional open reduction and dynamic hip screw internal fixation combined with postoperative conventional treatment was utilized. The duration of surgery, intraoperative blood loss, postoperative hospital stay, weight bearing time, fracture healing time and other surgical indicators were recorded respectively, and hip joint function recovery was evaluated prior to and 2 weeks after surgery. All patients were followed up for six months to observe the occurrence of complications within half a year, including deep vein thrombosis, incision infection, avascular necrosis of femoral head, hip joint stiffness, delayed fracture healing, etc. Subsequently, the differences in postoperative complications between the two groups were compared and analyzed.Results:The operation time, blood loss, postoperative hospital stay, weight bearing time and fracture healing time of the experimental group were better than those of the control group, and the difference was statistically significant (p<0.05). After treatment, the hip joint function of the experimental group was significantly improved compared with the control group, with a statistically significant difference(p=0.03). The incidence of operative complications in the experimental group was 10% (3/30) within six months postoperatively, significantly lower than the 33% (10/30) in the control group, with statistical significance (p=0.03).Conclusion:3D printing with early rehab proved to be effective treatment in our study. Such a combined treatment has the advantages of precise operative reduction, fast postoperative recovery, and certain safety and effectiveness.

Efficacy and safety of tranexamic acid in total hip arthroplasty via direct anterior approach

To evaluate the efficacy and safety of local application of tranexamic acid (TXA) in reducing perioperative blood loss in total hip arthroplasty via direct anterior approach (DAA). From July 2013 to September 2018, 46 patients with avascular necrosis of the femoral head were divided into tranexamic acid group (n=23) and saline group (n=23). In the tranexamic acid group, there were 14 males and 9 females, aged 52 to 72(63.70±5.34) years old. They were diluted with 3 g tranexamic acid in 50 ml normal saline and immersed in the joint cavity for 3 min after prosthesis replacement;in the normal saline group, there were 13 males and 10 females, aged 55 to 73 (61.26±5.78) years, who were treated with the sameamount of normal saline. The blood loss, hemoglobin value, number of blood transfusion cases, the time of first landing after operation, the incidence of thrombosis and incision adverse events were compared between the two groups. Harris score was used to evaluate hip joint function at 1 and 3 months after operation. The incision healed well and no obvious complications occurred in the two groups. All patients were followed up for 12 to 59 months(averaged 31.11 months). No hip pain was found in the follow-up patients. Hip joint function was improved effectively and no prosthesis loosening occurred. The total perioperative blood loss in tranexamic acid group and normal saline group was(740.09±77.14) ml and (1 069.07±113.53) ml respectively, 24 hours after operation, the drainage volume was (87.61±9.28) ml, (233.83±25.62) ml, the hidden blood loss was (409.65±38.01) ml and (588.33±57.16) ml. the difference of hemoglobin before and after operation was (24.78±2.19) g / L and (33.57±2.95) g / L, the difference was statistically significant (P<0.05). There was no significant difference in blood loss, incidence of deep vein thrombosis and pulmonary embolism, and Harris score of hip joint between the two groups (P>0.05). local application of tranexamic acid in total hip arthroplasty through direct anterior approach can safely and effectively reduce perioperative blood loss, and does not increase the risk of thrombosis, and does not affect the normal recovery of joint function.

Clinical efficacy of arthroscopy in the treatment of discoid meniscus injury and related risk factors for postoperative pain.

Discoid meniscus is an abnormal meniscus of the knee joint. This study aimed to analyze the clinical efficacy of arthroscopy in the treatment of discoid meniscus injury, and determine the related risk factors for postoperative pain. A total of 80 patients with a discoid meniscus injury who were diagnosed and treated in our hospital from May 2017 to May 2018 were selected. According to the different surgical methods, they were divided into the study group (treated with meniscus plasty) or the control group (treated with subtotal meniscectomy). Knee joint motion and knee joint function were measured at 2, 6 and 12 weeks post-surgery. Knee joint function was measured using the Lysholm Knee Scoring Scale to determine clinical efficacy. Patients with an excellent and good rating were included in the painless group, and patients with an average and poor rating were included in the pain group. The risk factors for postoperative pain were analyzed using multivariate logistic regression. Knee joint motion in the study group and the control group gradually increased and reached a peak 12 weeks after surgery (P<0.05), however, there was no significant difference between the 2 groups at each time point after surgery (P>0.05). The excellent and good rate, according to the Lysholm Knee Scoring Scale, was 84.62% in the study group and 84.38% in the control group. There was no significant difference between the 2 groups (P>0.05). There were differences between the pain group and the painless group in Watanabe classification, age, preoperative symptom time, cold compress, joint soft tissue injury, and postoperative weight-bearing time ≤1 week (P<0.05). Arthroscopy demonstrated efficacy for the treatment of patients with a discoid meniscus injury. Age, duration of preoperative symptoms, articular cartilage injury, postoperative cold compress and postoperative weight-bearing time were independent risk factors that affected postoperative pain after arthroscopic surgery. For high-risk patients, effective prevention and control measures should be taken to improve postoperative pain and promote the recovery of knee joint function.

Development of a high-strength Zn-Mn-Mg alloy for ligament reconstruction fixation

Although various biodegradable materials have been investigated for ligament reconstruction fixation in the past decades, only few of them possess a combination of high mechanical properties, appropriate degradation rate, good biocompatibility, and osteogenic effect, thus limiting their clinical applications. A high-strength Zn-0.8Mn-0.4Mg alloy (i.e., Zn08Mn04Mg) with yield strength of 317 MPa was developed to address this issue. The alloy showed good biocompatibility and promising osteogenic effect in vitro. The degradation effects of Zn08Mn04Mg interference screws on the interface between soft tissue and bone were investigated in anterior cruciate ligament (ACL) reconstruction in rabbits. Compared to Ti6Al4V, the Zn alloy screws significantly accelerated the formation of new bone and further induced partial tendon mineralization, which promoted tendon-bone integration. The newly developed screws are believed to facilitate early joint function recovery and rehabilitation training and also avoid screw breakage during insertion, thereby contributing to an extensive clinical prospect.

Analysis of effectiveness of greater trochanteric osteotomy approach and K-L posterior approach in patients with type Ⅳ Pipkin fracture

To investigate the effectiveness of two surgical approaches in the treatment of type Ⅳ Pipkin fracture. The clinical data of 15 patients with type Ⅳ Pipkin fracture treated surgically between July 2013 and June 2018 were retrospectively analyzed. According to different surgical approaches, they were divided into group A (8 cases, using K-L posterior approach) and group B (7 cases, using greater trochanter osteotomy approach). There was no significant difference in gender, age, cause of injury, and interval from injury to operation between the two groups ( P>0.05). The incision length, operation time, intraoperative blood loss, hospital stay, fracture healing time, and complications of the two groups were recorded. Hip joint function recovery was evaluated according to Thompson-Epstein functional evaluation system. All the 15 patients were followed up 1-5 years, with an average of 2.5 years. There was no significant difference in operation time between the two groups ( t=14.681, P=0.100); the incision length, intraoperative blood loss, and fracture healing time in group A were all greater than those in group B, and the hospital stay was shorter than that in group B, showing significant differences ( P<0.05). In group A, 1 patient presented hip pain, clasthenia, and limited mobility after operation, 1 patient presented ossifying myositis, 1 patient presented osteonecrosis of the femoral head, 1 patient presented fat liquefaction of incision, and 1 patient presented sciatica, with a complication incidence of 62.5%. Postoperative hip pain occurred in 1 patient and ossifying myositis in 2 patients in group B, with a complication incidence of 42.9%. There was no significant difference in the incidence of complications between the two groups ( χ 2=-0.735, P=0.462). At last follow-up, according to Thompson-Epstein functional evaluation system, the results in group A were excellent in 3 cases, good in 2 cases, fair in 2 cases, and poor in 1 case, with an excellent and good rate of 62.5%; in group B, the results were excellent in 4 cases, good in 2 cases, and fair in 1 case, and the excellent and good rate was 85.7%. There was no significant difference in good and fair rate between the two groups ( χ 2=-0.990, P=0.322). K-L posterior approach is more convenient in the fracture treatment during operation, but it has greater trauma, greater vascular damage, and more blood loss. The greater trochanter osteotomy approach can better protect the blood supply of femoral head, shorten the operation time, reduce intraoperative blood loss, and reduce postoperative complications. It is an ideal way in the surgical treatment of type Ⅳ Pipkin fracture.

Effect of Radial Extracorporeal Shock Wave Combined With Ultrashort Wave Diathermy on Fibrosis and Contracture of Muscle.

The purpose of this study was to examine the intervention effect of radial extracorporeal shock wave combined with ultrashort wave diathermy on immobilization-induced fibrosis and contracture of muscle. The groups included male rabbits for the group (control group). To cause joint contracture, rabbits underwent plaster fixation of a left knee joint at full extension. After immobilization for 4 wks, all rabbits were randomly divided into five groups: model group, natural recovery group, radial extracorporeal shock wave treatment group, ultrashort wave diathermy group, and radial extracorporeal shock wave combined with ultrashort wave diathermy group. All intervention effects were assessed by evaluating the cross-sectional area and the collagen deposition of muscle, the knee joint range of motion and the protein levels for transforming growth factor β1 and hypoxia-inducible factor 1α. The combined treatment group got the best recovery of the knee joint function. The combined treatment was more effective than radial extracorporeal shock wave or ultrashort wave diathermy alone against the fibrosis and contracture of muscle, as well as the overexpression of transforming growth factor β1 and hypoxia-inducible factor 1α. Radial extracorporeal shock wave combined with ultrashort wave diathermy was effective in alleviating immobilization-induced contracture and fibrosis of muscle, as well as reducing the molecular manifestations of muscle fibrosis.

Effect of tranexamic acid on the timing of drainage tube removal in total knee arthroplasty

Introduction:To investigate the effect of tranexamic acid on the removal time of drainage tube in the first unilateral total knee arthroplasty.Hypotheses:The timing of removing the drinage system can be changed when using TXA.Methods:From June 2017 to December 2018, 182 patients (42 males and 140 females) who planned to undergo primary unilateral total knee replacement were included.Age (68.1±7.1) years (60-76 years).According to the random number table method, it was divided into four groups: 45 cases of Tranexamic acid group 1 (TXA1), 46 cases of Tranexamic acid group 2 (TXA2), 46 cases of Tranexamic acid group 3 (TXA3) and None Tranexamic acid group (NTXA).TXA1-3 group intraoperative intravenous infusion combined with local application of tranexamic acid;NTXA group was locally perfused in the joint cavity with 100ml normal saline only after surgery.Differences in drainage volume, total blood loss, invisible blood loss, degree of postoperative joint swelling, Hospital for special surgery (HSS) and visual analogue scale (VAS) of pain were compared among the four groups.Results:The postoperative drainage volume of TXA1˜3 groups was 85.5±34.3ml, 189.4±72.3ml and 215.3±93.4ml, respectively, which was less than that of the non-tranexamic acid group (351.3±113.5ml). The overall difference was statistically significant (F=11.5,P=0.005). The postoperative drainage volume of tranexamic acid 1 group was less than that of tranexamic acid 2 and 3 groups.The total postoperative blood loss was 699.0±255.7ml, 710.4±296.1ml, and 715.8±248.2ml in the tranexamic acid 1-3 groups, respectively, which was less than 1130.5±354.2ml in the non-tranexamic acid group, and the overall difference was statistically significant (F=13.1,P=0.001).On the 4th day after the operation, the knee swelling degree of the tranexamic acid 1- 3 groups was 1.25±0.07, 1.13±0.12, and 1.12±0.13, respectively, which were smaller than that of the non-tranexamic acid group (1.43±0.22), and the overall difference was statistically significant (F=8.23, P=0.015).There were 2 cases of positive bacterial culture in non-tranexamic acid group and tranexamic acid group.There were 3 cases of hematoma in the non-tranexamic acid group,and 1 case of delayed wound healing.Conclusion:The application of tranexamic acid after TKA can reduce postoperative drainage volume, latent blood loss and total blood loss.The removal of the drainage tube 18h after the operation can not only fully drain,relieve pain, promote the recovery of knee joint function, but also effectively reduce the risk of infection caused by the drainage tube.

The Mechanisms Underlying the Biological Response to Wear Debris in Periprosthetic Inflammation

Joint replacement surgery is the gold standard therapeutic approach to treat patients with end-stage hip and knee arthritis, providing pain relief and joint function recovery. Despite the improvements in implant design and surgical techniques, revisions after total joint replacement are expected to grow. The periprosthetic inflammation, featured by the sustained inflammatory response to the implant debris, elicits the activation of osteoclasts and consequent periprosthetic osteolysis (PPOL), ultimately leading to implant aseptic loosening (AL), which is the most common cause of long-term implant failure. There are currently no effective strategies to control periprosthetic inflammation, and long-term implant survival remains a major challenge in orthopedics. A broad knowledge of the mechanisms underlying the biological response to implant debris would support the development of novel and effective pharmacological strategies to manage PPOL and promote implant lifespan. In this review, a detailed description of the cellular and molecular mechanisms underlying the biological response to implant debris is provided, highlighting the most recent findings. Furthermore, we reviewed novel therapeutic strategies that are being investigated to prevent inflammatory periprosthetic osteolysis.

Is Supine Position Superior to Prone Position in the Surgical Pinning of Supracondylar Humerus Fracture in Children?

Background: Supracondylar humerus fracture (SCHF) is a frequent injury in pediatric ages. Closed reduction and percutaneous pin fixation is a common treatment of displaced SCHF. Surgery is usually performed in the supine position; otherwise the prone position allows an easier fracture reduction and a safe placement of pins. The aim of study is to compare the clinical and radiographic results of the treatment of displaced SCHF, comparing two different intra-operative positionings. Methods: 59 SCHF affected children were retrospectively divided into supine (Group 1; n = 34) and prone (Group 2; n = 25), according to intraoperative position. All treated subjects were clinically evaluated according to Flynn’s criteria and Mayo Elbow Performance Score, and radiographically, including the measurement of the Baumann angle. Results: Clinically, Group 1, according Flynn’s criteria, had excellent cosmetic outcome in 32 subjects (94.1%). Mean MAYO Score was 96.0 ± 3.8. Group 2, according Flynn’s criteria, had excellent cosmetic outcomes in 23 subjects (92.0%). Mean MAYO Score was 97.8 ± 3.3. Radiographically, mean difference of Baumann’s angle between the injured limb and the normal limb was 5.5° ± 1.0° in Group 1 and 5.1° ± 1.1° in Group 2. Conclusion: Both supine and prone positioning achieved a satisfying outcome with similar results in joint function recovery and complications.

Clinical diagnosis and treatment features of Maisonneuve fracture and analysis of clinical outcome of 15 patients

To explore clinical diagnosis and treatment features of Maisonneuve fractures (maisonneuve fractures of the fibula, MFF), and evaluate its clinical effects. From March 2017 to June 2018, 15 patients with MFF were treated with operation, including 9 males and 6 females, aged from 27 to 54 years old with an average of (35.00±7.46) years old, the time from injury to operation ranged from 5 to 8 days with an average of (6.33±1.04) days. All the fractures were fresh and closed injury. The time of bone union and postoperative complications were observed, and AOFAS score was used to evaluate recovery of ankle joint function at 12 months after operation. All patients were followed up from12 to 28 months with an average of (17.00±3.79) months. Four patients were misdiagnosed. All fractures were obtained bone union from 4 to 6 months with an average of (4.80±0.94) months. No postoperative complications such as infection, delayed union or nonunion occurred. Postoperative AOFAS score at 12 months was 90.23±7.27, among which 9 patients got excellent result, 3 good, and 3 fair. Maisonneuve fracture is an unstable fracture. High fibular fracture and the separation of the lower tibia and fibula could be easily neglected, which could lead to misdiagnosis and missed care. Surgical treatment could recover anatomical relation of the lower tibia and fibula and ankle mortise, and obtain satisfying clinical effect.

Comparative Study of the Reconstruction of Anterior Cruciate Ligament with Peroneal Longus Tendon and Hamstring Tendon Based on Magnetic Resonance Imaging

Objective: To compare the effect of reconstruction of anterior cruciate ligament (ACL) with peroneal longus tendon (PLT) and hamstring tendon (HT) using magnetic resonance image (MRI). Methods: Fifty-six patients with ACL rupture were treated with ACL reconstruction. Among them, 28 patients were treated with PLT reconstruction (treatment group) and 28 patients were treated with HT reconstruction (control group). There were no significant differences in gender, age, injury side, course of disease, preoperative Lachman test, Lysholm score, IKDC score, joint mobility, MRI image between the two groups (P &gt; 0.05). Result: The incision healed in the first stage after operation in both groups, and there were no significant neurovascular injuries and knee synovitis complications. Comparing the MRI of the two groups after operation, the effect of the treatment group was better than that of the control group. There were no complications in both groups. The Lysholm score and IKDC score of the treatment group were better than those of the control group at 6 and 12 months after operation (P &gt; 0.05). There was no significant difference in Lachman test between the two groups at 6 and 12 months after operation (P &gt; 0.05). At 3 and 12 months after operation, the joint activity of the treatment group was better than that of the control group, with no significant difference (P &gt; 0.05). The degree of tibial anterior displacement decreased significantly in both groups before and after operation (P &lt; 0.05), but there was no significant difference between the two groups (P &gt; 0.05). Discussion: MRI scanning technology can significantly expand the scope of human body examination, improve the detection rate and diagnostic accuracy of lesions. In traditional surgery, HT is often used as reconstruction material. However, there are many factors to be considered in the formulation of operation plan for double cruciate ligament injury, such as limb blood supply, accompanied by a variety of structural injuries, so the requirement for reconstruction is high. There was no significant difference in the recovery of knee stability between the two groups, but in terms of early recovery of knee function and subjective satisfaction of patients, the reconstruction of PLT was superior to that of HT. Conclusion: Magnetic resonance imaging can effectively diagnose the curative effect, and it is worth popularizing and applying widely. Compared with HT, ACL reconstruction with PLT is easier to operate, and the early recovery of knee joint function and it is worth popularizing and applying widely.

Repair of skin and soft tissue defects in shoulder and elbow with rotator scapular artery perforator flap, lateral thoracic perforator flap, or medial brachial artery perforator flap

From January 2014 to June 2018, 12 patients with skin and soft tissue defects in shoulder and elbow were admitted to General Hospital of Ningxia Medical University with skin and soft tissue defect size of 6 cm×5 cm to 11 cm×8 cm, including 9 males and 3 females aged 15-56 years. Wounds of 5 patients were repaired with rotator scapular artery perforator flap (flap area of 8 cm×7 cm to 12 cm×6 cm), and the donor flap area was sutured directly. Wounds of 3 patients were repaired with lateral thoracic perforator flap (flap area of 8 cm×7 cm to 13 cm×9 cm). The donor flap area of two patients was sutured directly, the majority of the donor flap area of one patient was sutured directly, and a small part was covered by split-thickness skin graft from ipsilateral thigh. Wounds of 4 patients were repaired with medial brachial artery perforator flap (flap area of 6 cm×5 cm to 12 cm×10 cm). The donor flap area of two patients was sutured directly, and two patients were covered with split-thickness skin graft from left chest wall. The flaps of 11 patients survived after surgery. Blood flow disorder at the distal end of the flap was observed in one patient. After treatment, the distal end of the flap presented 3 cm×2 cm necrosis, and the skin graft survived after second skin grafting and debridement. During the follow-up of 6 to 24 months post surgery, all patients had good texture of flap, with light scar hyperplasia in the donor flap area, and good recovery of elbow and shoulder joint function. The rotator scapular artery perforator flap, lateral thoracic perforator flap, and medial brachial artery perforator flap with the advantages being of relatively simple operation, high survival rate, and good surgical outcome, are good choices for repairing the skin and soft tissue defects in shoulder and elbow.

Accuracy and Safety of Robot‐Assisted Drilling Decompression for Osteonecrosis of the Femoral Head

ObjectiveTo investigate the safety and superiority of robot‐assisted femoral head drilling decompression in the treatment of femoral head necrosis.MethodsA total of 63 patients who underwent borehole decompression of the femoral head in our hospital from January 2016 to March 2019 were recruited. Patients were divided into two groups for comparison according to surgical methods. In the robot‐assisted surgery group, there were 30 cases with 41 femoral heads. The conventional group had 33 cases and 46 femoral heads. All patients signed the consent form before the operation. The follow‐up time was 6 months. The incision lengths, operation times, intraoperative blood loss, intraoperative fluoroscopies, guide needle punctures, postoperative Harris scores, and postoperative complications of the two groups were compared.ResultsThe incision length of the robot surgery group was 5.16 ± 0.41 cm, while that of the traditional surgery group was 7.42 ± 0.50 cm. The operation time of the robot surgery group was 46.99 ± 4.94 min, while that of the traditional surgery group was 55.01 ± 6.19 min. The fluoroscopy frequency of the robot surgery group was 10.50 ± 1.78 times, while that of the traditional surgery group was 17.91 ± 2.20 times. The intraoperative blood loss in the robotic surgery group was 20.62 ± 2.52 mL, while that in the conventional surgery group was 52.72 ± 3.39 mL. In the robot operation group, each femoral head guide needle was punctured three times, and the puncture was successful one time. The number of guided needle punctures in the traditional group was 8.02 ± 1.73. The difference between the two groups was statistically significant (P < 0.05). The Harris score was 69.53 ± 7.51 in the robot surgery group and 68.38 ± 7.26 in the traditional surgery group one month after surgery, 78.52 ± 6.49 in the robot surgery group and 76.41 ± 7.95 in the traditional surgery group three months after surgery, and 83.32 ± 8.62 in the robot surgery group and 81.74 ± 6.20 in the traditional surgery group six months after surgery. There was no significant difference between the two groups (P > 0.05). In the traditional group, there was one case of incision infection and one case of femoral head collapse during follow‐up. In the robot group, there were no complications, such as incision infection and deep vein thrombosis. No collapse of the femoral head was found in the robot group during follow‐up.ConclusionThe positioning system of the orthopaedic robot is an ideal method for the treatment of femoral head necrosis. This method has the advantages of simple operation, accurate drilling, a short operation time, less surgical trauma, less radioactivity, and good recovery of hip joint function.

A new type of adjustable weight bearing rehabilitation brace for lower limbs in postoperative rehabilitation of proximal femoral nail anti-rotation

To study and analyze the clinical effect of the self-developed new adjustable weight-bearing rehabilitation brace in the rehabilitation of the femoral intertrochanteric fracture after the operation of PFNA. From July 2015 to June 2017, 62 patients with typeⅡ (Evans-Jensen classification) intertrochanteric fracture of femur were treated with PFNA internal fixation. There were 11 males and 19 females in the routine rehabilitation group, with an average age of (70.73± 6.09) years;17 males and 15 females in the brace rehabilitation group, with an average age of (71.25±6.60) years. Among them, the patients in the routine rehabilitation group recovered according to the routine method, and the patients in the support rehabilitation group used the self-developed new adjustable weight-bearing rehabilitation support of lower limbs to assist the early rehabilitation. The pain intensity(VAS score), weight-bearing of affected limb, clinical healing time of fracture, Harris score and complications were recorded and analyzed. Nine patients lost their visit half a year later, the other 53 patients were followed up for 9 to 18 months. The VAS score at 1, 3, 6 months after operation of brace rehabilitation group was lower than that of routine rehabilitation group(P<0.05). The weight bearing of the limbs in the rehabilitation group was significantly higher than that in the conventional rehabilitation group(P<0.05), but the clinical healing time of fracture in the brace rehabilitation group was shorter than that in the routine rehabilitation group(P<0.05). In addition, the Harris score of the postoperativebrace rehabilitation group was better than that of the conventional rehabilitation group(P<0.05). The incidence of complications was lower than that of the conventional rehabilitation group(P=0.048). In the rehabilitation of Evans Jensen typeⅡintertrochanteric fracture after PFNA internal fixation, the new self-developed adjustable weight-bearing rehabilitation brace can significantly relieve postoperative pain, regulate and moderately increase the stress stimulation at the fracture end, so as to promote fracture healing, accelerate the recovery of hip joint function, reduce the incidence of complications, and its clinical effect is safe and reliable.

Clinical Application of 3-Dimensional Printed Navigation Templates in Treating Femoral Head Osteonecrosis With Pedicled Iliac Bone Graft.

ObjectiveThe aim of the study was to explore the feasibility and early effect of digital design combined with 3-dimensional (3D) printing technique in the transplantation of vascular pedicled iliac bone flap in the treatment of avascular necrosis of the femoral head.MethodsThe navigation template was designed according to computed tomography scan and printed in 3D printing technique before operation, which was used to guide the localization and clearance of osteonecrosis of the femoral head in vascular pedicled iliac bone flap transplantation. In blank control group, 28 cases (32 hips) of osteonecrosis of the femoral head were treated with vascular pedicled iliac bone flap without the assistance of 3D navigation template from February 2002 to February 2009, including 19 males (21 hips) and 9 females (11 hips), with an average age of 37 years (range, 20–61 years). There were 12 cases of left hip, 16 cases of right hip, and 4 cases of double hip. According to the International Association of Bone Circulation staging, there were 8 hips in stage II B, 9 hips in stage II C, 8 hips in stage III B, and 7 hips in stage III C. In the experimental group, from February 2014 to June 2014, 15 patients (24 hips) with avascular necrosis of the femoral head were treated with vascular pedicled iliac bone flap with the aid of 3D navigation template. There were 11 males (17 hips) and 4 females (7 hips) with an average age of 38 years (range, 18–56 years). There were 2 cases of left hip, 4 cases of right hip, and 9 cases of double hip. According to the International Association of Bone Circulation staging, there were 5 hips in stage II B, 8 hips in stage II C, 6 hips in stage III B, and 5 hips in stage III C. The operation time, bleeding volume, and postoperative Harris score of the experimental group and the control group were statistically analyzed.ResultsThe incisions in both groups healed in the first stage, and there were no operation-related complications such as deep venous thrombosis and infection of lower extremities. All patients were followed up for 12 to 16 months (with an average of 14 months). On the second day after operation, X-ray and computed tomography showed that the necrotic focus of the femoral head and the surrounding sclerotic bone was completely removed, and the position of the vascular pedicled iliac bone flap was satisfactory and did not penetrate the articular surface. The iliac bone flap and bone graft achieved bony fusion. In the navigation template group, the mean ± SD operation time was 135.38 ± 9.49 minutes, the mean ± SD blood loss was 225.13 ± 13.41 mL, the mean ± SD postoperative Harris score was 89.53 ± 5.83, 12 hips were excellent, 10 hips were good, and 2 hips were moderate, whereas in the group without navigation template, the mean ± SD operation time was 151.00 ± 15.28 minutes, the mean ± SD blood loss was 283.56 ± 30.60 mL, the mean ± SD postoperative Harris score was 83.32 ± 3.75, 15 hips were excellent, 14 hips were good, and 3 hips were fair. By independent sample t test, there were significant differences in average operation time, average blood loss, and postoperative Harris score between the 2 groups (P < 0.05).ConclusionsCompared with not using navigation template, vascular pedicled iliac bone flap combined with navigation template in the treatment of osteonecrosis of femoral head could locate the area of osteonecrosis of femoral head more accurately, shorten the time of operation, and reduce the amount of bleeding during operation. Postoperative hip joint function recovery was better, and the early effect was satisfactory.

An Analysis for the application of rapid rehabilitation surgery concept in the nursing satisfaction of the perioperative period of the elderly’s hip arthroplasty

Objective To explore the application of rapid rehabilitation surgery concept in the nursing satisfaction of the perioperative period of the elderly’s hip arthroplasty. Methods To select 58 cases of elderly patients undergoing hip arthroplasty in our hospital from March 2017 to February 2018 as the research subjects. The patients were randomly divided into the experimental group and the control group by number table method and there were 29 cases per group. The patients in the experimental group were in the nurse of the concept model of rapid rehabilitation surgery, while the patients in the control group were in the routine nurse of perioperative period. Results After the comparison of hip joint function recovery score, operation time and hospitalization time between the two groups of patients, the advantages of hip function recovery score, operation time, and hospitalization time in the experimental group were obvious statistically significant(P&lt;UNK&gt; 0.05). Compared with the patients in the control group, the nursing satisfaction of the patients in the experimental group was higher and statistically significant(P&lt;UNK&gt; 0.05). Conclusion The concept of rapid rehabilitation surgery is effective for the elderly patients with hip arthroplasty, which can promote the rehabilitation of patients and improve the nursing satisfaction of patients. It is of great significance to improve the relationship between nursing patients.

A simultaneous bilateral quadriceps and patellar tendons rupture in patients with chronic kidney disease undergoing long-term hemodialysis: a case report

BackgroundThe incidence of rupture of the quadriceps or patellar tendon s is low, especially that of bilateral quadriceps tendon rupture, and it is generally considered a complication secondary to chronic systemic disorders. We report two rare cases of simultaneous bilateral tendon rupture affecting the extensor function of the knee in patients with chronic kidney disease who have been treated with long-term haemodialysis.Case presentationTwo young males with a history of chronic kidney disease who were being treated with long-term haemodialysis presented to our hospital with clinical signs of disruption of the extensor mechanism of the knee. One patient was diagnosed with bilateral quadriceps tendon rupture, and the other patient had bilateral patellar tendon rupture. They underwent surgical repair of the tendons, and their knees were actively mobilized during physiotherapy.ConclusionBilateral quadriceps or patellar tendons rupture is a rare occurrence in patients with chronic kidney disease who are being treated with long-term haemodialysis. Timely surgical treatment and scientific physiotherapy can lead to good recovery of knee joint function.

Open reduction and internal fixation for multiple injuries of superior shoulder suspensory complex with coracoid process fracture

To investigate the effectiveness of open reduction and internal fixation for multiple injuries of superior shoulder suspensory complex (SSSC) with coracoid process fracture. Between January 2014 and October 2018, 22 patients with multiple injuries of SSSC with coracoid process fracture were treated by open reduction and internal fixation. There were 16 males and 6 females, aged from 24 to 72 years with an average age of 36.6 years. There were 10 cases of falling injury, 5 cases of traffic accident injury, and 7 cases of falling from height injury. All of them were fresh closed injuries. The time from injury to operation ranged from 2 to 17 days with an average of 6.9 days. Both X-ray film and CT showed the coracoid process fracture complicated with clavicular fracture in 14 cases, acromioclavicular joint dislocation in 12 cases, and acromioclavicular fracture in 5 cases. There were 14 cases of two places of SSSC, 7 cases of three places of SSSC, and 1 case of four places of SSSC. All incisions healed in primary stage after operation. All patients were followed up 10-24 months with an average of 14.1 months. X-ray films showed that all fractures healed and the acromioclavicular joint was normal. The healing time ranged from 6 to 12 months, with an average of 6.2 months. No complications such as internal fixation failure and nonunion occurred. According to University of California Los Angeles (UCLA) shoulder scoring system, the shoulder joint function was rated as excellent in 15 cases, good in 5 cases, and poor in 2 cases at last follow-up. The excellent and good rate was 90.9%. Open reduction and internal fixation for treatment of multiple injuries of SSSC with coracoid process fracture is firm and reliable. Combined with active postoperative rehabilitation program intervention, it can accelerate the recovery of shoulder joint function and achieve satisfactory effectiveness.