ObjectiveTo explore the clinical outcome of alendronate in the treatment of bone marrow edema syndrome of the hip.MethodsA retrospective analysis of 8 cases (10 hips) of bone marrow edema syndrome of the hip treated with alendronate between December 2017 and January 2020 was conducted. Harris score and MRI exam of hip were used to assess the clinical and radiographical outcomes. Clinical cure rate and length of treatment period were used to evaluate whether alendronate was benefitial for the treatment of bone marrow edema syndrome of the hip.ResultsAll the cases were followed up for at least 3 months and got complete clinical data, the mean follow-up period was (5.2±1.2) months. Seven cases (9 hips) in 8 cases (10 hips) had clinical cure, with a clinical cure rate of 90%. The length of treatment period was 1 to 2 months with a mean value of (1.7±0.2) months. The Harris score increased from 57.8±6.3 before treatment to 98.6±1.0 at the last follow-up, and the difference was statistically significant (t=18.299, P<0.001). One case (1 hip) developed osteonecrosis of femoral head at one month after the initiation of alendronate therapy, who received continuous combination therapy of alendronate, calcium and aspirin, and no collapse or expansion of necrosis was found after 12 months follow-up.ConclusionsBone marrow edema syndrome of the hip is not a self-limiting disease completely, some patients maybe develop osteonecrosis of femoral head. Alendronate is benefitial for alleviating clinical symptom, accelerating bone edema disappearance, and shortening the course of disease.
ObjectiveTo compare the clinical and radiographic results between primary total knee arthroplasty (TKA) via mini-subvastus or conventional approach through a prospective randomized controlled study.MethodsNinety-four patients (104 knees) undergoing primary TKA between January 2011 and April 2012 were evaluated and randomly divided into 2 groups. Forty-six patients (52 knees) underwent TKA via conventional approach (conventional approach group), and 48 patients (52 knees) underwent TKA via mini-subvastus approach (mini-subvastus approach group). In these patients, 45 cases (51 knees) in conventional approach group and 45 cases (49 knees) in mini-subvastus approach group were followed up and recruited in the final analysis. There was no significant difference in age, gender, body mass index, sides, osteoarthritis grading, American Knee Society Score (KSS), Hospital for Special Surgery (HSS) score, visual analogue scale (VAS), range of motion (ROM) of knee between 2 groups (P>0.05). The clinical indexes were recorded and analyzed, including the operation time, length of incision, total blood loss, blood transfusion after operation, hospital stay time, the time of performing straight leg raise, incision condition, VAS score, ROM of knee, HSS score, and KSS score, hip-knee-ankle angle (HKA), femoral anatomic axis and the femoral prosthesis joint angle (femoral angle), tibia anatomic axis and tibial prosthesis joint angle (tibial angle), femoral prosthesis flexion angle (FPFA), and posterior slope angle (PSA) of the tibial plateau.ResultsAll patients were followed up. The average follow-up time was 66.4 months (range, 60.0-72.5 months) in conventional approach group and 65.6 months (range, 60.0-71.2 months) in mini-subvastus approach group. Compared with the conventional approach group, the incision of mini-subvastus approach group shortened, the operation time prolonged, and the time when patients started straight leg raise exercises was earlier; showing significant differences between 2 groups (P<0.05). There was no significant difference in hospital stay time, total blood loss, and numbers of blood transfusion between 2 groups (P>0.05). The complication rate was 8.2% (4/49) in mini-subvastus approach group and 0 in conventional approach group, showing no significant difference between 2 groups (P=0.054). At 1 and 3 days, the VAS and the ROM of knee in mini-subvastus approach group were significantly better than those in conventional approach group (P<0.05); but there was no significant difference in above indexes between 2 groups at 14 day (P>0.05). There was no significant difference in HSS and KSS scores between 2 groups at the 1, 3, 6, 12 months and 3, 5 years (P>0.05). X-ray film showed no aseptic loosening in all cases. There was no significant difference in the measured values and incidence of abnormal patient of HKA, femoral angle, tibial angle, FPFA, and PSA at last follow-up between 2 groups (P>0.05).ConclusionTKA via mini-subvastus approach is helpful to the early function recovery of knee, but the long-term effectiveness is consistent with TKA via conventional approach. As the limited exposure, TKA via mini-subvastus spproach may has high risk of operative complications.
ObjectiveTo summarize the characteristics of the occurrence and development of osteonecrosis of the femoral head (ONFH), and to review the important regulatory role of immune cells in the progression of ONFH. MethodsThe domestic and foreign literature on the immune regulation of ONFH was reviewed, and the relationship between immune cells and the occurrence and development of ONFH was analyzed. ResultsThe ONFH region has a chronic inflammatory reaction and an imbalance between osteoblast and osteoclast, while innate immune cells such as macrophages, neutrophils, dendritic cells, and immune effector cells such as T cells and B cells are closely related to the maintenance of bone homeostasis. ConclusionImmunotherapy targeting the immune cells in the ONFH region and the key factors and proteins in their regulatory pathways may be a feasible method to delay the occurrence, development, and even reverse the pathology of ONFH.
Objective To systematically review the effectiveness and safety of total hip arthroplasty (THA) vs. total hip resurfacing arthroplasty (THRA) in patients with osteoarthritis of the hip joint. Methods We electronically searched databases including PubMed, The Cochrane Library (Issue 3, 2012), EMbase, PloS, national institutes of clinical test library of the United States, national joint replacement registration network of Australia, British national joint registration network, British orthopaedic association network (BOA), Canada orthopaedic association (COA), American Academy of Orthopedic Surgeons network (AAOS), German Institute of Medical Documentation and Information network (DIMDI) for randomized controlled trials (RCTs) on the comparison between THA and THRA for osteoarthritis of the hip joint from inception to November, 2012. References of the included studies were also retrieved. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data and assessed the quality of the included studies. Then, meta-analysis was performed using RevMan 5.1 software. Results Six RCTs (10 articles) involving 518 cases of surgery (THA: n=259; THRA: n=259) were identified. The risk of bias of 8 articles was moderate and that of the other 2 articles was low. The results of meta-analysis showed that, compared to THRA, THA brings greater improvements of femoral offset within 2 years after surgery (MD=6.60, 95%CI 5.53 to 7.68, P=0.25). There were no significant differences between the two groups in Merle d’Aubigné Postel, WOMAC score, UCLA score, SF-36 Health Survey Questionnaire, walking speed, step length, walking cadence, postoperative leg length discrepancy, and complication rates. All these conclusions are based on early postoperative results. Conclusion Current evidence shows that, THA brings greater improvements of femoral offset than THRA, and no significant differences between the two groups were found in the other indicators.
目的 探讨氨基葡萄糖联合布洛芬治疗髋关节骨关节炎的临床疗效。 方法 2011年9月－2012年1月采用前瞻性随机对照临床试验，将198例轻、中度髋关节骨关节炎患者随机分入试验组及对照组。试验组采用氨基葡萄糖（750 mg， 2次/d口服，疗程1个月）联合布洛芬（0.3 g，2次/d口服，疗程2周），对照组则单用布洛芬（0.3 g，2次/d口服，疗程2周）；分别于服药后0、2、4、8及12周时采用加拿大西安大略和麦克玛斯特大学骨关节炎指数（WOMAC）进行疗效评价。并对恶心、呕吐、皮疹等药物不良反应进行观察。 结果 试验组与对照组WOMAC各项评分从第2周开始较0周明显下降，而两组患者间在0周及2周时WOMAC评分无统计学差异：0周总评分（45.3、45.0分，P=0.225），2周总评分（37.3、37.6分，P=0.329）。但对照组WOMAC各项评分从第4周开始逐渐呈现上升趋势，而试验组到第12周仍呈现持续性下降趋势。总不良反应发生率为7.0%，其中试验组总不良反应发生率为9.5%，但不良反应轻微，未予特殊处理而自行消失。 结论 氨基葡萄糖联合布洛芬可有效缓解早、中期髋关节骨关节炎各项临床症状，疗效确切，不良反应较少，且停药后仍持续表现出治疗效果。而单用布洛芬可短期缓解骨关节炎症，但停药后症状逐渐复现。
Objective To evaluate the effectiveness of acetabulum reinforcement ring (Cage) with allograft bone for reconstructing acetabular defects in hip revision. Methods Between February 2006 and August 2010, 14 patients (14 hips) with serious acetabular bone defects after total hip arthroplasty underwent acetabular reconstruction by using Cage with allograft bone. There were 6 males and 8 females with a mean age of 59.2 years (range, 45-76 years). The mean time between first replacement and revision was 7.2 years (range, 5-12 years). The revision causes included infection in 8 cases, osteolysis and aseptic loosening in 6 cases. The hip function Harris score was 37.7 ± 5.3. According to America Association of Orthopedic Surgeon (AAOS) standard, the acetabular defect was classified as type III in 8 cases and as type IV in 6 cases. Results All incisions healed by first intention, and no complication occurred. The patients were followed up 14-62 months (mean, 44 months). The pain was relieved or disappeared. At last follow-up, the Harris score was 89.7 ± 3.2, showing significant difference when compared with preoperative score (t= — 44.40, P=0.04). No loosening of the acetabular component or osteolysis was found in 14 hips. No absorption or collapse of the allograft was observed in all patients. Conclusion Cage with allograft bone is a useful method of reconstructing acetabular bone defects in hip revision. Further follow-up is needed to assess the long-term effectiveness.
目的 探讨髋或膝关节置换术（THR/TKR）并存甲状腺功能减退症（甲减）患者围手术期的处理策略。方法 2009年1月－2011年12月收治30例行THR/TKR并存甲减患者，其中男8例，女22例，平均年龄62.4岁。处理要点包括术前纠正甲状腺激素水平；术中缩短手术时间，减少出血量，选择性应用糖皮质激素；术后补充甲状腺激素，预防感染及深静脉血栓形成，改善胃肠功能。评价指标包括围手术期血压、心率变化，胃肠功能状况，切口愈合时间，甲状腺功能水平，黏液性水肿昏迷等并发症发生率；术前及术后Harris及特种外科医院评分系统（HSS）评分等。 结果 术后心率变化大，非致命性心律失常者20例；血压控制平稳；术后甲状腺功能变化不明显，无黏液性水肿昏迷、心包积液及呼吸窘迫等严重并发症发生。随访1个月，术前HSS评分平均28分，术后86分；术前Harris评分平均32分，术后87分。 结论 术前控制血清促甲状腺素在0.5～3.0 mU/L以内，总甲状腺素、游离甲状腺素至正常水平，是有效预防甲减患者THR/TKR围手术期并发症的关键；综合应用左甲状腺素片、糖皮质激素和抗凝治疗是安全渡过围手术期的重要保证。
ObjectiveTo explore the therapeutic effect of total hip arthroplasty (THA) and hip adductor amputation (HAA) in the surgical treatment of osteonecrosis of femoral head. MethodsA total of 74 patients with osteonecrosis of femoral head with hip adduction deformity were included between June 2011 and May 2012. Among them, 38 patients had undergone THA, and 36 patients had undergone THA+HAA. Statistics about hip abductor function and Harris scores before and 1 week and 12 months after the surgery were recorded. SPSS 19.0 was used for statistical analysis. ResultsThe patients' wounds had the Ⅰ-stage healing in both of the two groups. Two patients had scrotum swelling in THA+HAA group, who left the hospital after treating. One week after the surgery, the hip passive abduction angles increased (32.1±2.8) and (19.7±3.3)°, respectively in the THA+HAA group and THA group, while the Harris hip score increased 45.8±2.8 and 40.9±2.3, respectively; 12 months postoperatively, the hip passive abduction angles increased (32.2±0.9) and (26.8±2.8)°, respectively in the THA+HAA group and THA group, while the Harris hip score increased 52.7±7.2 and 49.4±4.4, respectively. The above comparative differences was statistically significant (P<0.05). ConclusionThe surgical method of adductor amputation can improve the range of motion of the hip, raise the quality of life of the patients with osteonecrosis of the femoral head after the surgery.
ObjectiveTo explore the surgical technique and effectiveness of sliding osteotomy of medial femur condyle in handling soft tissue balance of severe valgus deformity in total knee arthroplasty (TKA). MethodsBetween June 2008 and February 2014, 18 cases (19 knees) of severe valgus knees undergoing sliding osteotomy of medial femur condyle in primary TKA were included. Of the 18 patients, 6 were male and 12 were female with an average age of 52.3 years (range, 29-72 years), including 3 cases (3 knees) of osteoarthritis, 11 cases (12 knees) of rheumatoid arthritis, 3 cases (3 knees) of post-traumatic arthritis, and 1 case (1 knee) of deformities in skeletal dysplasia. Before surgery, the tibial-femur angle (TFA) was (33.0±2.9)°; the Hospital for Special Surgery (HSS) score was 41.6±7.7; the Knee Society Score (KSS) lateral stability score was 6.0±5.4. All cases were rated as type II according to Krackow classification of valgus knee. During primary TKA, sliding osteotomy of medial femur condyle was performed via a medial parapatellar approach. ResultsIncision healed by first intention in all cases. Peroneal nerve palsy occurred in 1 patient, which was cured after 6 months of conservative treatment. Eighteen cases were followed up 19 months to 7 years, with an average of 5.7 years. All patients had no complications of deep vein thrombosis, deep infection, and prosthesis loosening. X-ray films showed that bone healing was achieved in all cases at 6 months. At last follow-up, the TFA was (4.8±1.8)°, showing significant difference when compared with preoperative value (t=62.61, P=0.00). The HSS score was 87.2±10.5 and the KSS lateral stability score was 12.4±3.1, all showing significant differences when compared with preoperative scores (t= —33.35, P=0.00; t= —6.83, P=0.00). ConclusionSliding osteotomy of medial femur condyle is effective for correcting severe valgus knee deformity during TKA. Satisfactory joint function and stability may be achieved.
Objective To compare the analgesia effect and clinical rehabilitation between continuous adductor canal block (ACB) and single shot ACB in total knee arthroplasty (TKA)． Methods Between October 2016 and February 2017, 60 patients with severe knee osteoarthritis undergoing primary unilateral TKA were prospectively recruited in the study. All the patients were randomly allocated into 2 groups and received ultrasound-guided continuous ACB (group A, n=30) or single shot ACB (group B, n=30), respectively. There was no significant difference in gender, age, body mass index, nationality, American Society of Anesthesiology (ASA) grading, and preoperative knee range of motion and quadriceps strength between 2 groups (P>0.05). After operation, the tourniquet time, postoperative drainage volume, hospitalization time, and adverse events in 2 groups were recorded. Visual analogue scale (VAS) scores at rest and during activity, the quadriceps strength, the knee range of motion, and the time of 90° knee flexion in 2 groups were also recorded and compared. Results There was no significant difference in tourniquet time, postoperative drainage volume, and incidence of adverse events between 2 groups (P>0.05). But the hospitalization time was significant shorter in group A than in group B (P<0.05). VAS scores at rest and during activity were lower in group A than in group B, with significant differences in VAS score at rest after 12 hours and in VAS score during activity after 8 hours between 2 groups (P<0.05). The quadriceps strength was higher in group A than in group B, with significant difference at 24, 48, and 72 hours (P<0.05). The knee range of motion was significantly better in group A than in group B at 24, 48, 72 hours and on discharge (P<0.05). The time of 90° knee flexion was significantly shorter in group A than in group B (t=–2.951, P=0.016). There were 4 patients in group A and 7 patients in group B requiring meperidine hydrochloride (50 mg/time) within 24 hours, and 3 patients in group A and 7 patients in group B at 24 to 48 hours, and 1 patient in group A and 3 patients in group B at 48 to 72 hours. Effusion in the catheter site occurred in 2 cases of group A, but no catheter extrusion occurred. Conclusion Continuous ACB is superior in analgesia both at rest and during activity and opioid consumption compared with single shot ACB after TKA. And the quadriceps strength could be reserved better in continuous ACB group, which can perform benefits in early rehabilitation.