BACKGROUND: The application of tranexamic acid in knee and hip arthroplasty can reduce blood loss safely and effectively. As a kind of hemostatic agent for strengthening blood vessels, the hemostasis process of carbazochrome sodium sulfonate does not depend on the coagulation system of human body, so it has better security. OBJECTIVE: To explore the safety and blood loss of tranexamic acid combined with carbazochrome sodium sulfonate in total knee arthroplasty. METHODS: From July 2018 to December 2019, 67 patients with knee osteoarthritis were selected from the Affiliated Hospital of Xuzhou Medical University, including 18 males and 49 females. They were randomly divided into two groups. The observation group (n=32) received intravenous injection of tranexamic acid before total knee arthroplasty, followed by intravenous injection of carbazochrome sodium sulfonate after total knee arthroplasty. The control group (n=35) received intravenous injection of tranexamic acid before total knee arthroplasty, followed by intravenous injection of saline after total knee arthroplasty. The total blood loss, hidden blood loss, maximum hemoglobin drop, blood transfusion rate, incidence of thrombotic events (lower limb intermuscular vein thrombosis, deep vein thrombosis and pulmonary embolism), perioperative fibrinolytic parameters (fibrin and fibrinogen degradation products, D-dimer), inflammation markers (C-reactive protein, interleukin-6) were compared between the two groups. The study was approved by Medical Ethics Committee of Affiliated Hospital of Xuzhou Medical University. RESULTS AND CONCLUSION: (1) The decrease of total blood loss, hidden blood loss and maximum hemoglobin drop in the observation group was less than those in the control group (P <0.05). (2) The levels of fibrin and fibrinogen degradation products, D-dimer in the observation group 1 day after surgery were lower than those in the control group (P < 0.05), and there was no significant difference between the two groups on day 3 after operation (P > 0.05). (3) The C-reactive protein level of the observation group was lower than that of the control group on day 1 and day 3 after surgery (P < 0.05), and the level of interleukin-6 on day 1 after surgery was lower than that of the control group (P < 0.05). There was no significant difference in the level of interleukin-6 between the two groups on day 3 after surgery (P > 0.05). (4) There was no blood transfusion, deep venous thrombosis of lower limbs or pulmonary embolism in the two groups during their hospitalization. (5) The results showed that tranexamic acid combined with carbazochrome sodium sulfonate can further reduce the total blood loss, hidden blood loss and hemoglobin drop of patients after total knee arthroplasty, reduce the inflammatory reaction, and do not increase the risk of thrombosis, so it was safe.

Objective To evaluate the efficacy and safety of total knee arthroplasty (TKA) with 3D printing guild plate by comparing with conventional TKA. Methods From May 2014 to September 2014, 40 patients suffered primary unilateral TKA were received, in which there were 11 males and 29 females, aged from 57 to 82 years with an average age of 68.5±6.3 years. The subjects were divided into two groups randomly. One group was treated with TKA with 3D printing guild plate while the other group was treated with the conventional TKA. The blood loss, operation time, post?operative Hospital for Special Surgery (HSS) score, range of motion (ROM), lower limb mechanical alignment and incidence of complication were compared with insignificant differences. Results The operation time in the 3D printing TKA group (103.4±11.7 min) was lower than that in the conventional TKA group (124.5±21.6 min), which was statistically significant (t=3.838, P=0.000). The blood loss in the 3D printing TKA group (370.2±96.0 ml) was lower than that in the conventional TKA group (510.0±235.9 ml), which was statistically significant (t=2.454, P=0.019). The post?operative ROM of knee in the 3D printing TKA group was 104.3° ± 15.5° and that in the conventional TKA group was 103.5° ± 12.5° (t=0.169, P=0.867). HSS scores in the 3D printing TKA group and in the conventional TKA group were 88.5±5.7 and 89.4±4.8, which was statistically insignificant (t=-0.633,P=0.530). Mechanical alignment in the 3D printing TKA group was 2.9°±1.1° and that in the conventional TKA group was 3.0°±0.9°, which was not statistically significant (t=-0.317, P=0.753). No obvious complication occurred in two groups. Conclusion TKA with 3D printing guild plate has similar results to conventional TKA in HSS score, mechanical alignment and ROM of knee, but it shortens operation time and decreases the blood loss.

Objective To analyze the epidemiology,mechanisms of injury,type of fracture,clinical and radiological feature of acetabular fractures in patients aged 60 years and older.Methods Retrospectively analyzed the clinical data of patients with acetabular fractures between Janurary 1990 and December 2013 in Orthopaedic Department of the First Affiliated Hospital of Soochow University.According to certain inclusion and exclusion criteria,a total of 637 patients (637 hips) with acetabular fractures were included in the study.The patients were divided into 2 group acetabular fractures in elderly (≥60 years) and acetabular fractures in younger patients (＜ 60 years).Analysis of mechanism of injury,fracture pattern,the annual incidence of fracture,radiological features,associated injuries.Results 133 patients were ≥60 years and the remaining 504 were ＜ 60 years.We identified a significant increase in the incidence of elderly with acetabular fractures between 1990 and 2013 (6.7％ in 1990 vs.40.0％ in 2013).The incidence of associated injuries were significant lower in the elderly than younger (27.1％ vs.48.8％).The most common mechanism of injury in the elderly was a fall (36.1％),but this accounted for only 0.2％ of the younger with fractures.The incidence of anterior wall,anterior column,anterior and posterior hemitransverse were significant higher in the elderly than younger.The incidence of radiological features were significant higher in the elderly than younger,including quadrilateral plate fracture,Gull sign,anterior dislocation of hip,femoral head injury,comminuted posterior wall fracture and posterior wall marginal impaction,except posterior dislocation of hip which was significant lower in the elderly than younger.Conclusion There was an increasing trend of the proportion of elderly in acetabular fractures and the mean age of patients with fractures during the period of study.The older had a different incidence of associated injuries,mechanism of injury,fracture pattern,and radiological features compared with the younger.