Objective To analyze the role of Clinical Pathway in controlling hospitalization cost and to provide the basis for reasonable control of medical cost.Methods The data of patients undergoing unilateral and bilateral total hip replacement in 2005 and 2010 in Arthritis Clinical and Research Center of Peking University People's Hospital were retrospectively analyzed.There were 70 unilateral and 14 bilateral total hip replacement cases in 2005,whereas the number of those in 2010 was 173 and 46 respectively.All charges were assigned to 1 of 9 categories:hospital room,nursing,radiology and laboratory,prosthesis,blood transfusion,surgery,pharmacy,treatment,diagnosis.We compared the total costs and cost of each category between 2005 and 2010.Results There was no statistical significant difference between 2005 and 2010 in terms of age,gender distribution,pri mary disease and type of prosthesis.The total costs for unilateral and bilatcral total hip replacement was 40 852.72 yuan and 73 020.28 yuan in 2010,respectively.They were both significantly lower than those of 2005 (49 371.35 yuan and 80 962.61 yuan respectively).The charge for each category of total hip replacement in 2010 was 585.88,145.38,2 885.47,3 222.32,1 776.15,3 805.29,132.79,4 100.88,and 3 0953.75 yuan.Compared with 2005,each category of charge dropped in 2010,especially the cost of surgery,treatment,diagnosis and hospital room,which decreased by 35.11％,31.76％,31.40％ and 30.67％ respectively.The tendency of each category change in charge of unilateral and bilateral total hip replacement was similar to the overall costs.Conclusion The total costs for total hip replacement (unilateral and bilateral total hip replacement) in 2010 were lower than those of 2005,which might be the result of adopting Clinical Pathway since 2010.Nevertheless,the prosthesis cost accounted for a large proportion in both years.Therefore,controlling the prosthesis cost might be an effective way to reduce medical costs for total hip replacement.

Kashin-Beck disease is a chronic, endemic and deformable osteoarthropathy that mainly occurs in children and adolescents in many areas of China, whose main pathological changes are multiple symmetrical degeneration, necrosis, and secondary degeneration of epiphyseal cartilage, epiphyseal plate cartilage and articular cartilage. Patients with Kashin-Beck disease mainly present with joint pain, thickening, deformation, restricted movement, and muscle atrophy. In severe cases, Kashin-Beck disease can cause short fingers, short limbs, and even short deformities. However, there is no specific treatment for Kashin-Beck disease currently. Common treatment methods include non-steroidal anti-inflammatory drugs, cartilage protecting drugs, traditional Chinese medicine, arthroscopy and arthroplasty. This article reviews the treatment methods and research progress of Kashin-Beck disease, aiming to provide a more comprehensive reference for the treatment of Kashin-Beck disease.

Objective: Through comparing the hospitalization costs of total knee replacement (TKR) in People’s Hospital of Peking University in 2005 and 2010, to investigate the changing status of hospitalization costs on this operation and the impact of clinical pathway ( CP ) on controlling the hospitalization costs during 5 years , and provide references for controlling medical treatment cost reasonably. Methods: The patients are grouped into undergoing unilateral and bilateral TKR. The total hospitalization cost and cost of each category during 5 years are compared, and SAS 9.2 statistic software is applied to deal the data. Results: Compared with 2005, the total cost for TKR in 2010 decreased. All the charging items decreased, except implant material increased, especially the cost of surgery, hospital room, nursing and pharmacy. Specific to one knee replacement group and both knees replacement, the changing trend of cost is coincident with the total cost. Conclusion: The total cost for TKR in 2010 was lower than that of 2005, which might be the result of adopting CP since 2010. Nevertheless, the implant material cost accounted large proportion of hospitalization cost in 2010, and it has obvious increasing trend compared to 2005. This result is related the increasing application of the new edition of Artificial knee joint prosthesis. Controlling implant material cost is the effective method of decreasing medical costs for TKR.

[Objective]To discuss the midterm effects of bipolar artificial femoral head arthroplasty in treatment of elder femoral neck fracture.[Method]From September 1995 to Febuary 2005,73 elderly patients with femoral neck fracture were operated with domestic bipolar artificial femoral head arthroplasty (average 74 years old).Forty-seven cases had been followed up for average 65 months.Harris score system and X-ray had been used for evaluation.[Result]There was no vessel and nerve injury,no infection and dislocation,no perioperative death.The complications included one greater trochanteric fracture,3 cases with pneumonitis,2 urinary infection,1 cerebral infarction,1 dysfunction in central nerve system and 1 case with deep venous thrombosis.Of all the 36 X-rays there were 3 cases with prosthesis subsidence,lucent line lesser 2mm in 2 cases,narrow joint space in 21 cases,protrusion in 1 case.According to the Harris scoring system,there were excellent in 12,good in 26,fair in 7,poor in 2.[Conclusion]Bipolar artificial femoral head arthroplasty are reasonable choice for treatment of femoral neck fracture in the elderly.Proper indication and perioperative management is critical to get good results.

Objective To investigate clinical value of diagnostic blocking test of knee joint for diagnosis and treatment of knee osteoarthritis complicated with degenerative lumbar disease. Methods Thirty-two outpatients of knee osteoarthritis complicated with degenerative lumbar disease were selected from September 2003 to June 2004. There were 10 males and 22 females with an average of 71.5 years old (range, 55 to 78 years). After routinely sterilizing and drapping aseptic towel, knee joint was placed in 60?-90? flexion position, and punctured at the medial or lateral patellar tendon parallellizing with the superior edge of tibial plateau. Fluidity was draw-off, 10 ml lidocaine(1% concentration) and 1 ml Diprospan were injected. All patients were performed diagnostic blocking test of knee joint. Let outpatients record the symptoms of lower limb through inquiry papers at 1 hour, 1 day, 2 days, 1 week after injection. The VAS pain score of knee joint was recorded before injection and 1 week after injection. Furtherly consulted the outpatients and recorded the VAS pain score of knee joint 1 week after injection. Then determine treatment procedure after integrative evaluation. Results The pain around the knee joint obviously decreased in 21 patients (lenitive rate, 75.6% to 100%), moderately decreased in 8 patients(lenitive rate, 51.3% to 73.5%), mildly or less decreased in 3 patients(lenitive rate, 0% to 34%). After integrative evaluation, 22 patients were performed with TKA, 3 patients were performed with lumbar spine operation, and 7 patients were treated conservatively. The results of operation treatment were satisfactory. The sensitivity of diagnostic blocking test was 86%. Conclusion Diagnostic blocking test of knee joint is a kind of simple, safe and effective differential method for patients of knee osteoarthritis complicated with degenerative lumbar disease, and also a kind of objective observation method for prognosis, and provide necessary reference criteria for operation sequence of lumbar spine and knee joint.

Objective To discuss the characteristics of non?traumatic meniscus injury in patients with different age ob?served under the arthroscopy. Methods All non?traumatic meniscus injury patients operated during 2012 were included. The name, age, symptoms, signs, Lysholm score before surgery, meniscus injury location, type, and concomitant damage were collect?ed. The inclusive criteria were 1) III degree meniscus tear confirmed by MRI,2) typical symptom of meniscus injury,3) no acute symptom and history of acute injury,4) conservative treatment failed,5) and confirmed subsequently by the surgery. SPSS19.0 (SPSS Inc., USA) was used for statistical analysis. Disease frequencies were calculated for different ages in patients, and gender, disease side (left or right), the type of meniscus injury and the concomitant injury in patients of different ages were compared with the chi square test. Results All the 201 patients were divided into two groups due to whether the patients were older than 45 years. The age of surgery was bimodal distribution (20 yrs and 60 yrs). There were more lateral meniscus tears in the younger group(merely LM 56.10%), and more medial meniscus tears in the older group(merely MM 66.90%). The major type of medial meniscus tear in young patients were longitudinal(27.80%), beak sample tear(38.90%)and horizontal tear(27.80%); in old patients the main type were beak sample tear(20.60%), horizontal tear(27.20%), tear of root(19.10%)and complicated tear (31.60%). But in lateral meniscus, there were more beak sample tear(45.50%)and complicated tear(22.70%)in young pa?tients, and more than 70%were complicated tear in old patients. There were more ACL tear(34.15%), discoid lateral meniscus (21.95%)and cyst of menisci(9.76%)in young patients, but more cartilage injury(81.25%)in the old patients. Conclusion Non?traumatic meniscus tear in younger patients happened more in lateral meniscus, with more concomitant ACL tear, lateral dis?coid meniscus and cyst,but in the older group, there are more medial tear and concomitant with more cartilage injury. And the types of tear are different in the two groups.

Objective To explore the classification of degenerative medial meniscus injury under arthroscopy and its clinical significance.Methods This study involved 122 patients who underwent arthroscopic operation because of degenerative medial meniscus injury from January 2012 to December 2012,eliminating patients who received synovectomy for severe synovitis.There were 27 males and 95 females,with 63 left knees and 59 right knees.The average age was 61.8±8.9 years.The average BMI was 26.5±3.4 kg/m2,while the average preoperative Lysholm score was 47.2± 15.0.The cartilage injury was estimated by Outerbridge classification system during arthroscopic surgery.Both the difference of the preoperative Lysholm score and the number of articular surfaces with Ⅳ degree of cartilage injury were compared among different types of degenerative medial meniscus injury.Resuits The horizon tear of posterior horn group included 33 patients.The average number of articular surfaces with Ⅳ degree of cartilage injury was 1.24± 1.48 while the average preoperative Lysholm score was 52.5± 14.4 points,with pain score of 7.7±6.5.The root injury of posterior horn group included 16 patients,whose average number of articular surfaces with 1Ⅳ degree of cartilage injury was 1.13±1.26 and average preoperative Lysholm score was 37.5±8.4 points,with pain score of 3.1±4.0.The complex serious injury group included 73 patients.The average number of articular surfaces with Ⅳ degree of cartilage injury was 2.26±1.61 and the average preoperative Lysholm score was 46.9±15.3 points,with pain score of 6.8±5.4.Both the preoperative Lysholm score and pain score of the root injury of posterior horn group was significantly lower than that of the horizon tear and the complex serious injury group.The average number of articular surfaces with Ⅳ degree of cartilage injury between the root injury and the horizon tear of posterior horn group had no significant difference.The number of these two groups was less than the complex serious injury group,with statistically significant difference.Conclusion The arthroscopic classification of degenerative medial meniscus injury could be classified into three types.The degenerative cartilage injury of root injury of posterior horn and horizon tear of posterior horn is relatively mild,which are the early stages of joint degeneration.However,the clinical symptoms and disability caused by root injury of posterior horn are more severe.On the other hand,the degenerative cartilage injury of complex serious injury is relatively severe,which belongs to the late stage,while the clinical symptoms and disability are relatively mild.

Objective To identify the diagnostic criteria and investigate the incidence and distribution of the patellofemoral arthritis in aged people in Wuchuan region of the Inner Mongolia of China. Methods A population-based cross-sectional survey was conducted among 1030 residents aged 50 years and over of Wuehuan County, Inner Mongolia. Survey participants, mostly farmers, reported heavy physical activity, completed an interview-based questionnaire and Skyline View weight-bearing films were evaluated for KeU-gren and Lawrence (K/L) grade. Radiological patellofemoral arthritis (RPFA) and symptomatic patellofemoral arthritis (SPFA) were defined. Statistical package SPSS 14.0, crosstabs chi-squae test and Excel were adopted for statistical analysis. Results One thousanod and twenty-five participants were included in this study and 2050 knee joint Skyline View weight-bearing films were analyzed. The incidence of RPFA was 8.72%(6.8% in men, and 10.5% inwomen). The incidence of SPFA was 6.33% (4.8% in men, and 8.0% in women).The RPFA incidence of age groups 50～, 60～,≥70 was 3.8%, 10.6%, 22.9% respectively, while the incidence of SPFA was 2.7%, 7.7%, 17.3% respectively. The Three age groups' SPFA/RPFA was 71.7%, 72.0%, 75.6% respectively. The incidence of RPFA was 6.00/0, 7.3%, 11.0%, 11.3%, and the incidence of SPFA was 4.2%,5.2%, 7.3%, 9.6% and the four SPFA/RPFA was 70.0%, 71.3%, 66.7%, 84.8% in people whose BMI was less than 18.5, 18.5～, 23.0～ and higher than ≥25.0 kg/m~2 respectively, 73.6% people had joint pain among RPFA.Conclusion The prevalence of symptomatic patellofemoral arthritis in the rural areas of China is 6.8%, the incidence of that in women is higher than in men, and elder people suffer a high incidence. And the heavier the people are, the higher the incidence of patellofemoral arthritis.

With the increasing number of hip arthroplasty and the extension of implant survival,the risk of periprosthetic femoral fractures are gradually growing.The technical challenge of the surgical management of periprosthetic femoral fractures leads to poor functional outcome,implant survival and patient satisfaction compared to primary hip arthroplasty.The risk factors of periprosthetic femoral fractures involve both of the bone quality of the patient and the surgical techniques of the primary surgery,including age and gender of the patient,osteoporosis,previous surgical history and the type of the components.In order to avoid the occurrence of periprosthetic fractures,precautions including the assessment of the patient status and bone quality as well as the selection of proper prosthesis and surgical procedures should be taken before the primary surgery.During the primary surgery,more attention should be paid to prevent the damage of host bone and make sure the correct placement of the implants.The aseptic loosening should be detected and treated as early as possible in the regular post-operative follow up.The diagnosis of periprosthetic femoral fracture mainly bases on the detailed history,symptoms,signs and serial X-rays after operation.The most extensively used classification system of the periprosthetic femoral fracture is the Vancouver classification.For the treatment of different types of fractures,conservative therapy is recommended for most Vancouver type A fractures.The surgical management is the best choice for most Vancouver type B fractures.Whether the stem revision is necessary or not depends on the stability the component.The treatment of Vancouver type C fractures should be in accordance with the principles of regular femur fractures.However,more attention should be paid to choose proper device according to the existence of the femoral component in the proximal part of the fracture.Through the analysis of the pathogenesis and risk factors of periprosthetic femoral fractures and the discussion of the diagnosis,classification and treatment principles,we expect to provide a standard treatment protocol for the periprosthetic femoral fractures following hip arthroplasty.

Objective To determine whether LTB4 could indirectly stimulate human osteoclast differentiation in RA through increasing RANKL expression of RAFLs. Methods We utilize the coculture model of RAFLs and monocyte which were stimulated in the presence of 2.5 ng/ml M-CSF in the control group, 2.5 ng/ml M-CSF +10-8 mol/L LTB4 in the experimental group A, 2.5 ng/ml M-CSF+10-8 mol/L LTB4+100 ng/ml OPG in the experimental group B. After culture for 3 weeks, through TRAP staining we counted the number of multinucleated TRAP staining positive osteoclast-like cells stained with TRAP to evaluate the differentiation effect in each group. Results There was almost no osteoclast-like cell in the control group and the experimental group B. Whereas there were many osteoclast-like cells in the experimental group A. Conclusion LTB4 can indirectly stimulate human osteoclast differentiation in RA through increasing RANKL expression of RAFLs.