BACKGROUND:As a more common method in the orthopedic field, the method of intra-articular injection drugs has distinct curative effects, but there are some complications. In a certain extent, this method caters to the psychological fear of surgery, and can serve as a kind of conservative treatment. But some experts believed that because of the limit of sterile conditions, intra-articular injection of drugs wil increase the risk of intra-articular infection and they opposed this method.
OBJECTIVE:To review the efficacy and adverse reactions of intra-articular injection drugs in recent years, and explain clinical applications of intra-articular injection drugs in orthopedics.
METHODS:A computer-based search was conducted in PubMed and Wanfang database for articles related to the application of intra-articular injection drugs in orthopedics published between January 2007 and December 2013. The English and Chinese key words were“intra-articular, injection, orthopaedics, tranexamic acid, hyaluronic acid, corticosteroid, drugs”. Data were checked in the first trial, old articles and repetitive studies were excluded. The relevant 43 articles accorded with inclusion criteria were reviewed.
RESULTS AND CONCLUSION:In orthopedics, the method of intra-articular injection drugs is simple, economic and effective, but at the same time, there are some side effects. Tranexamic acid by intra-articular injection can significantly reduce blood loss after total joint replacement, is safety and economic. Intra-articular injection joint lubricant can reduce internal friction of joints and improve the adhesion of joint cavity, can be used as a good conservative treatment for osteoarthritis. Intra-articular injection hormone drugs can treat inflammatory arthritis, and short-term curative effect is obvious, but due to large long-term side effects, the method is not recommended now. Intra-articular injection of analgesic drugs and other drugs have both advantages complications. The efficacy of intra-articular injection drugs in orthopedics is obvious;meanwhile, this method has some complications. Orthopedic surgeons should select related drugs by indications. We stil need to further make reasonable regimen with intra-articular injection drugs in future large-scale study.

BACKGROUND:Tranexamic acid has been more and more used in reducing bleeding after joint replacement, but its usage method and dosage remain controversial, and become a hot focus in recent years. OBJECTIVE:To investigate the efficacy of intra-articular injection of tranexamic acid on postoperative blood loss and limb circumference changes in patients who received unilateral total knee arthroplasty. METHODS:From March to October 2013, clinical data of 90 patients undergoing primary unilateral total knee arthroplasty were randomized to the tranexamic acid group and the control group, including 19 males and 71 females. The 30 patients in the tranexamic acid group received 50 mL of 3%tranexamic acid dilute solution inside knee joint after capsule closure, and 60 patients in the control group received the same volume of physiological saline. No significant difference in age, height, body mass index, anticoagulation, the type of prosthesis, tourniquet time and preoperative diagnosis was detected between the two groups (P>0.05). The amounts of intraoperative and postoperative blood loss and blood transfusion, postoperative drainage volume, the preoperative and postoperative limb circumference 10 cm above the operated knee were recorded. Routine blood test was reviewed after the surgery. RESULTS AND CONCLUSION:There were no significant differences in total blood loss, postoperative drainage volume and limb circumference changes between tranexamic acid and control groups (P>0.05). The amount of postoperative hidden blood loss was significantly less in the tranexamic acid group than in the control group (t=-2.683, P<0.05). These data suggested that the intra-articular injection of tranexamic acid intraoperatively in patients receiving total knee arthroplasty could significantly reduce the amounts of postoperative hidden blood loss, and did not affect the postoperative limb circumference changes.

OBJECTIVETo explore the clinical efficacy of acupoint catgut embedding therapy on chronic pelvic cavity pain syndrome differentiated as kidney deficiency and stagnation of damp heat, and explore the impacts on plasma P substance (SP), plasma beta-endorphin (β-EP).

METHODSOne hundred and eighty cases were randomly divided into a catgut embedding group (90 cases) and a western medication group (90 cases). In the western medication group, tamsulosin capsules 0. 2 mg were prescribed for oral administration, once a day; indometacin sustained release tablets, 25 mg, three times a day. Totally, the oral administration for 8 weeks was required. In the catgut embedding group, the acupoint catgut embedding therapy was applied to Qugu (CV 2), Shenshu (BL 23), Zhibian (BL 54), Huiyin (CV 1) and Sanyinjiao (SP 6), once every two weeks; the treatment of 4 weeks made one session, and two sessions were required. Before and after treatment, TCM symptom score, NIH-CPSI (the National Institute of Health Chronic Prostatitis Symptom Index) score, lecithin body numbers in prostatic fluid, score in SAS (self-rating anxiety scale), score in SDS (self-rating depression scale), the levels of SP and β-EP, etc. were observed in the two groups, and the clinical efficacy was assessed in the two groups.

RESULTS(1) Ten cases were dropped in either group. The total effective rate was 91. 25% (73/80) in the catgut embedding group, higher than 78. 75% (63/80) in the western medication group (P<0. 05). (2) After treatment, TCM symptom score, total score in NIH-CPSI, pain score and the scores in SAS and SDS were all reduced as compared with those before treatment in the two groups (all P<0. 05). After treatment, TCM symptom score, total score and pain score in NIH-CPSI, and the scores in SAS and SDS in the catgut embedding group were both lower than those in the western medication group (all P<0. 05). (3) After treatment, the lecithin body numbers were both increased as compared with those before treatment in the two groups (both P<0. 05), and the result in the catgut embedding group was higher than that in the western medication group (P<0. 05). (4)After treatment, the SP level was lower than that before treatment in the two groups (both P<0. 05); the level of p-EP was increased as compared with that before treatment (both P<0. 05). The SP level in the catgut embedding group was lower than that in the western medication group (P<0. 05); the level of β-EP was higher than that in the western medication group (P<0. 05).

CONCLUSIONThe acupoint catgut embedding therapy apparently relieves the clinical symptoms of chronic pelvic cavity pain syndrome differentiated as kidney deficiency and stagnation of damp heat as well as the condition of anxiety and depression, increases lecithin body numbers in prostatic fluid and β-EP level and reduces SP level.

Acupuncture Points ; Acupuncture Therapy ; Adolescent ; Adult ; Catgut ; utilization ; Chronic Disease ; therapy ; Humans ; Male ; Pelvic Pain ; etiology ; metabolism ; therapy ; Prostatic Diseases ; complications ; metabolism ; Young Adult ; beta-Endorphin ; metabolism

Objective To investigate the effects of remifentanil on lipid peroxidation druing hemorrhagic shock-induced acute lung injury (ALI) in rabbits. Methods Thirty-two healthy adult rabbits weighing 2.0-2.5 kg were randomly divided into 4 groups (n = 8 each): sham operation group (group S); ALI group; low-dose remifentanil group (group LR); high-dose remifentanil group (group HR). The left femoral artery was cannulated for blood-letting and blood sampling. The right femoral artery was cannulated for remifentanil administration. The model of hemorrhagic shock was established by modified Wigger' s methods. In group S, only cannulation was performed. In group LR and HR, remifentanil was infused intraperitoneally at 0.66 and 1.32 μg·kg-1 ·min-1 15 min before blood-letting respectively, while group ALI received equal volume of normal saline instead. Arterial blood samples were taken at 0, 20,70 and 100 min after blood-letting (T1-4) for blood gas analysis. The animals were then sacrificed and the lungs were immediately removed for histological examination with light microscope and determination of W/D lung weight ratio, MDA content and SOD activity. Results W/D ratio and MDA content were significantly increased, while SOD activity was significantly decreased in group ALI compared with group S (P ＜0.05). The pH value at T2 and PaO2 at T2-4 in group LR and the pH value and PaCO2 at T2-4 in group HR were significantly higher than those in group ALI (P ＜ 0.05). W/D ratio and MDA content were significantly lower,while SOD activity was significantly higher in group LR and HR than in group ALI, and in group HR than in group LR (P ＜ 0.05). Remifentanil infusion significantly attenuated the pathologic changes in a dose-dependent manner. Conclusion Remifentanil pretreatment can attenuate hemorrhagic shock-induced ALI through inhibiting lipid peroxidation in rabbits.

OBJECTIVETo explore the molecular mechanism of moxibustion at stomach meridian acupoints for precancerous lesions of chronic atrophic gastritis (CAG).

METHODSFifty male SD rats were randomly divided into a normal group, a model group, a stomach meridian group, a control point group and a vitacoenzyme group, 10 rats in each group. The CAG precancerous lesion model was made in all the groups except the normal group. The rats in the normal group and model group were bundled for 30 min per day; the rats in the stomach meridian group and control point group were bundled and treated with moxibustion at stomach meridian acupoints or control points for 30 min per day; the rats in the vitacoenzyme group were treated with intragastric administration of vitacoenzyme, once per day. All the treatment was given for 20 weeks. The pathological morphological change of gastric mucosa was observed under optical microscope; the expression of epidermal growth factor (EGF), transforming growth factor alpha (TGF-alpha), vascular endothelial growth factor (VEGF), gastric mucosal proliferatig cell nuclear antigen (PCNA), argyrophilic protein of nucleolar organizer regions (Ag-NORs) in gastric mucosal cells were detected by enzyme linked immuno sorbent assay (ELISA).

RESULTSCompared with the normal group, in the model group the gastric mucosal cells showed dysplasia and the expression of EGF, TGF-alpha, PCNA, VEGF, Ag-NORs in gastric mucosa cells in the model group was increased significantly (all P < 0.05). Compared with the model group, the gastric mucosa lesion gradually recovered and the expression of EGF, TGF-alpha, PCNA, VEGF, Ag-NORs in gastric mucosal cells was gradually decreased in the stomach meridian group, control point group and vitacoenzyme group, in which the stomach meridian group had the most significant effects (all P < 0.05).

CONCLUSIONMoxibustion at stomach meridian acupoints can obviously decrease the expression of cell proliferative factors in gastric mucosa in rats with CAG precancerous lesions, inhibit the gastric mucosal cell dysplasia, and promote the recovery of gastric mucosa.

Acupuncture Points ; Animals ; Cell Proliferation ; Epidermal Growth Factor ; genetics ; metabolism ; Gastric Mucosa ; cytology ; Gastritis, Atrophic ; genetics ; metabolism ; physiopathology ; therapy ; Humans ; Hyperplasia ; genetics ; metabolism ; physiopathology ; therapy ; Male ; Moxibustion ; Proliferating Cell Nuclear Antigen ; genetics ; metabolism ; Rats ; Rats, Sprague-Dawley ; Vascular Endothelial Growth Factor A ; genetics ; metabolism

Objective Large-conductance culcium-activated potassium (BKCa) channel modulates vascular smooth muscle tone. In the present study, we tested the hypothesis that salt, one of the factors which significantly influence bleed pressure (BP), can regulate BKCa activity and then elevate blood pressure. Methods Male Spragne-Dawley rats aged 6 weeks were randomized into high salt diet group (HS) and control group, fed with high salt diet (containing 5% NaCi) and standard rat chow (containing 0.4% NaCl) respectively for 16 weeks. Tail systolic blood pressure (SBP), body weight (BW) and 24-hour urinary output were tested every 4 weeks. Content of urinary Na+ was detected using flame spectrophotometrical method. At the end of 16 weeks, all the rats were killed, the mesenteric arteries were obtained, and single mesenteric smooth muscle cells were isolated at once. The resting membrane potential (Em), the total potassium currents and the currents after perfusion with TEA solution of the cells were all recorded by whole cell patch clamp. The transcriptions of BKCa channel α and β1 sobunits in mesenteric arterial vascular smooth muscle cells (VSMC) of each group were calculated by real-time RT-PCR. Results There was no difference in SBP and BW at each stage between control group and HS group; the urinary Na+ level in HS animals was elevated significantly after 4 weeks.The negative values of Em in HS group VSMCs were reduced compared with these in the control group. Transcriptions of β1 subanit of BKCa channels were decreased in HS group, but α subunit transcriptions did not differ between the two groups. Whole cell potassium currents did not differ hetween HS and control groups, but BKCa currents of HS group VSMCs were lower than these of control group ones. Conclusion Even without elevating SBP, salt-loading can still modulate the expression and activity of BKCa channel in the mesenteric arterial VSMC and elevate vascular tone.

Objective To report the clinical treatment of chronic malunited ankle fractures by fibular osteotomy and distal tibiofibular joint fusion.Methods A retrospective analysis was done of the 36 patients with chronic malunited ankle fracture who had been treated from March 2013 to January 2016 in our hospital.They were 20 men and 16 women,aged from 25 to 59 years (average,36.7 years).They were treated by open reduction,fibular osteotomy to correct their rotation deformity,and distal tibiofibular joint fusion.The therapeutic efficacy was assessed postoperatively by the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score.Results They were followed up for 10 to 36 months (average,26.5 months).No nonunion,implant failure or infection was observed.The AOFAS ankle-hindfoot score increased significantly from preoperative 36.4 ± 7.8 to 82.1 ± 9.4 at the final follow-up (t =73.379,P =0.000).An excellent and good rate of 86.1％ was achieved,giving 9 excellent,22 good and 5 fair cases.Mild limitation in ankle flexion and extension was observed in 5 cases.No significant differences were found between final follow-ups and preoperation regarding the ankle plantar flexion (32.0°± 2.4° versus 31.8° ± 3.5°) or the ankle dorsal extension (18.2° ± 1.7° versus 17.4° ± 2.4°) (P ＞ 0.05).Conclusion Fibular osteotomy and distal tibiofibular joint fusion can result in fine clinical effects in the treatment of chronic malunited ankle fractures.

Objective To evaluate the influence of fast track surgery on the early outcomes of thoracoscopic and laparoscopic minimally invasive esophageal cancer operation for thoracic segment esophageal cancer.Methods The inpatients with thoracic segment esophageal squamous cancer in this hospital from January 2012 to June 2016 were retrospectively analyzed,who in the same operation group performed thoracoscopic and laparoscopic minimally invasive esophageal cancer resection,gastroesophageal left neck anastomosis and two-field lymphadenectomy.Among them,the conventional group had 156 cases from January 2012 to December 2014 and the fast track surgery group had 93 cases from January 2015 to June 2016.Their perioperative related indicators were recorded and analyzed.Results The age,sex,BMI,complications index,ASA score,tumor segment,pathological stage had no statistical difference between the fast track surgery group and conventional group;the postoperative pain score in the fast track surgery group was significantly lower than that in the conventional group(on 1 d:5.13±1.16 vs.5.69±1.17,P=0.000;on 3 d:2.63±0.76 vs.2.86±0.78,P=0.032;on 7 d:1.82±0.71 vs.2.56±0.47,P=0.005);the pneumonia occurrence rate in the fast track surgery group was much lower(7.5％ vs.17.3％,P=0.030) and sacrococcygeal skin injury was much less(4.3％ vs.12.2％,P=0.038);the occurrence rates of pulmonary atelectasi,ARDS,re-tracheal intubation,neck anastomosis fistula,atrial fibrillation and re-operation had no statistical difference between the two groups;the hospitalization stay time in the fast track surgery was shorter than that in the conventional group[(13.89 ±7.36)d vs.(17.41±6.77)d,P=0.000].Conclusion Implementing fast-track surgery measure intervention during perioperative period in the patients with thoracic segment esophageal cancer resection can alleviative postoperative pain,decreases postoperative complications and shortens the hospitalization length.

Objective To investigate the effect of our self-developed acetabular reduction clamp in the treatment of fractures of acetabular posterior column.Methods The data were retrospectively analyzed of the 32 patients who had been treated for acetabular posterior column fractures using our self-developed acetabular reduction clamp at Department of Minimally Invasive Surgery,Zhengzhou Orthopaedics Hospital from August 2016 to June 2018.They were 17 males and 15 females,aged from 18 to 62 years (average,41.3 years).According to the Letournel-Judet classification,there were 9 simple posterior column fractures,14 posterior column plus posterior wall fractures,4 T-shaped fractures and 5 double column fractures.The Kocher-Langenbeck (K-L) incision was used for simple posterior column and posterior column plus posterior wall fractures,and the K-L combined with anterior ilioinguinal approach for T-shaped and double column fractures.The displaced posterior column fracture was repositioned with our novel reduction clamp before pelvic reconstruction plate was used for fixation.The quality of fracture reduction,fracture union time,complications and hip function score at the last follow-up were recorded.Results This series of 32 patients were followed up for 7 to 20 months (average,12.9 months).According to the Matta scores for fracture reduction at the last follow-up,15 cases were excellent,16 good and one poor,yielding an excellent and good rate of 96.9％.The fracture union time ranged from 3 to 6 months (average,4.7 months).According to the modified Merle d'Aubign scores at the last follow-up,hip function was excellent in 18 cases,good in 11 and fair in 3,yielding an excellent and good rate of 90.6％.Postoperative symptomatic distraction injury to the sciatic nerve appeared in 2 patients,postoperative wound lipid liquefaction developed in one and heterotopic ossification of Brooker grade Ⅱ was observed in 2 patients during follow-up.Conclusion In the treatment of acetabular posterior column fracture with open reduction and internal fixation with pelvic reconstruction plate through the K-L approach,our novel acetabular reduction clamp can be used safely and effectively to assist fracture reduction,leading to satisfactory results.

Objective To evaluate distractor-assisted reduction for Lisfranc injury complicated with compressive fracture of lateral foot column.Methods A retrospective study was conducted of the 18 patients who had been treated surgically at Department of Foot and Ankle Surgery,Zhengzhou Orthopaedics Hospital between May 2014 and March 2017 for Lisfranc injury complicated with compressive fracture of lateral foot column.They were 10 males and 8 females,with an average age of 38.4 years (from 25 to 65 years).The injury involved the right foot in 11 cases and the left foot in 7.Their concomitant injuries were 12 compressive cuboid fractures and 6 compressive fractures of the calcaneal anterior process.According to the Chiodo-Myerson classification,there were 13 cases of three-column injury,3 ones of middle-lateral column injury and 2 ones of medial-lateral column injury.All the injuries were closed.After the condition of foot soft tissues permitted,open reduction assisted by a distractor and internal fixation with a mini locking plate was performed.Functional outcomes were assessed according to the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot-ankle scores and visual analogue scale (VAS) at the final follow-ups and complications during follow-up.Results The 18 patients were followed up for one to 4 years (average,2 years).Their AOFAS hindfoot-ankle scores ranged from 55 to 96 points (average,80.4 points);their VAS ranged from 0 to 6 points (average,1.5 points).Radiographic evidence of degeneration was noted in 10 patients.Of them,2 reported persistent pain which was cured by arthrodesis after conservative therapy failed and one presented with symptoms of injury to sural and cutaneous nerves which disappeared after oral administration of neurotrophic drugs for half a year.No such complication as skin necrosis,infection or implant failure occurred in other patients.Conclusion Open distractor-assisted reduction and internal fixation of lateral foot column with a mini locking plate,combined with bone graft if necessary,is an effective treatment for Lisfranc injury complicated with compressive fracture of lateral foot column,because it can effectively restore the alignment of lateral column and result in satisfactory therapeutic effects.