Fifteen cases of periprosthetic femoral fractures of after total hip arthroplasty (THA) in Department of Orthopedic Surgery, Guangdong People’s Hospital between May 1997 and May 2007 were retrospectively analyzed. According to the classification of Vancouver, there was 1 case of type AG, one of type AL, 3 of type B1, 5 of type B2, 3 of type B2, and 2 of type C. Two cases of type A were treated with conventional method, and cases of type B1 and C were treated with open reduction and internal fixation. Cases of type B2 and B3 were treated with a long-stem cemented prosthesis revision plus allograft cortical strut bone. Through 3-12 months follow-up, all the fractures were healed, and bone allografting was successful, but with high rate of complications which were curable. The new prosthesis stem was fixed well. Excellent and good rate of Harris scores for hip joint was 73.3%. Therapy selection based on Vancouver classification for periprosthetic femoral fracture after total hip arthroplasty is an effective method.

Objective To compare the analgesia effect and the safety of Flurbiprofen Axetil (FA) and Parecoxib Sodium (PS) after posterior lumbar fusion surgery. Methods 90 patients undergoing internal fixation of lumbar spine randomly assigned to 3 groups:those in Group A(n = 30) received 100 mg of FA; those in Group B (n=30) received 40 mg of PS and those in Group C received saline.The VAS scores of 2, 6, 12, 24, 48, 72 h after operation and the dose of tramadol hydrochloride (TH) used and the side effect was recorded respectively. Results Group A and B had significantly better analgesic effect than Group C(P<0.05). Group A and B had lower average dose of TH than Group C (P<0.05). The VAS scores in Group A was lower than that in Group B in 2 h after the surgery. The VAS scores after the surgery showed no significant difference between Group A and B in 6 , 12, 24 h after the surgery. The VAS scores in Group A was higer than that in Group B in 48,72 h after the surgery. Conclusion Both PS and FA can alleviate postoperative pain and have fewer adverse reactions.

Objective To evaluate the clinical effectiveness of 3?dimensional scaffold of typeⅠcollagen based autolo?gous chondrocyte implantation (ACI). Methods Nine patients of knee articular cartilage defect treated with 3?dimensional scaf?fold of type Ⅰcollagen based ACI from January 2013 to March 2014 was analyzed retrospectively, including 6 males and 3 fe?males with an average age of 30 years old. 4 defects located in femoral condyle, 4 in trochlea and 1 in patellae with a mean size of 4.9 ± 2.1cm2 (range, 2.5-10). ACI comprises 2?stage procedure:chondrocytes were first harvested from non?load bearing area of femoral condyle, then chondrocytes expand in vitro for 8-14 days to get enough cells. On second stage, cartilage defects were cov?ered by the grafts and fixed with fibrin albumen glue. All patients received strict rehabilitation protocol. International Knee Docu?mentation Committee (IKDC) scores and Lysh?lm scores were compared pre?operatively and 3, 6, 12 months post?operatively. MR and magnetic resonance observation of cartilage repair tissue (MOCART) scores were analyzed within 3 days, 3, 6, 12 months post?operatively. Results All the patients were followed up. IKDC score was 52.7 ± 6.9 pre?operatively and respectively 71.1 ± 6.6, 83.3±2.9 and 92.0±3.6 3, 6, 12 months post?operatively with significant differences. The Lysh?m score was 55.8±8.7 pre?oper?atively and respectively 74.8±7.0, 84.8±4.8 and 93.1±5.7 3, 6, 12 months post?operatively with significant differences. 8 patients had MRI. The mean MOCART score 3 days, 3, 6, 12 months post?operatively was respectively 43.6±6.0, 47.8±5.8, 57.8±5.8, 64.3± 4.8 and 72.1±4.9 with significant differences. T2 value of transplanted area was 48.7±3.2 12 months post?operatively with no sig?nificant differences compared to normal area. Conclusion Three?dimensional scaffold of typeⅠcollagen based ACI could re?pair knee articular cartilage defect. It may be a good choice for treating articular cartilage defect which shows satisfactory results.

BACKGROUND:Ischiogluteal bursitis has been recognized for a long time, but its treatment stil limits to local blocking injection and surgery methods that were developed 40 years ago. OBJECTIVE:To observe the efficacy of platelet-rich plasma on ischiogluteal bursitis. METHODS:Data of 15 patients with ischiogluteal bursitis were colected. Al the patients with ischiogluteal bursitis were treated with bilateral platelet-rich plasma (n=10) or local blocking injection (n=5). Patients’ outcomes were assessed by visual analogue scale, the Treatment Satisfaction Questionnaire for Medication (TSQM) Version II and recurrence rate. The folow-up time was from 6 to 14 months. RESULTS AND CONCLUSION: There was no statistical difference in visual analogue scale score between the platelet-rich plasma group and local blocking group (F=0.219,P=0.643), but the score of visual analogue scale in the platelet-rich plasma group was higher during short-term folow-up (within 1 week after treatment), but lower in the long-term folow-up. In the aspects of overal satisfaction score, clinical effectiveness and side effects, the platelet-rich plasma group was inferior to the local blocking group at short-term folow-up, especialy at 1 week after treatment; however, these scores became better in the platelet-rich plasma group than the local blocking group during the long-term folow-up period. In addition, no statistical difference in the convenience score was found between the two groups. At the last folow-up, the recurrence rate in the platelet-rich plasma group was lower than that in the local blocking group. Both the platelet-rich plasma and local blocking injection can significantly reduce the pain of patients with ischiogluteal bursitis. Local blocking injection has better short-term effectiveness. Platelet-rich plasma injection works moderately, but its effectiveness can last for longer time, and the recurrence rate is lower.

BACKGROUND:The preemptive analgesia is stil a controversial issue. Existing studies have not paid much attention to effects of preoperative factors on the hypersensitivity of peripheral and central mechanisms. Visual analog scale scores cannot subjectively and repeatedly reveal patient’s pain.
OBJECTIVE:To investigate the validity of the preventive analgesia effect of Celebrex in patients with total knee arthroplasty.
METHODS:Patients with osteoarthritis of the knee who received total knee arthroplasty were accessed by Pittsburgh sleep quality index, self-rating depression scale and self-rating anxiety scale. In al , thirty patients were enrol ed in the study. They were randomized into Celebrex group and vitamin C group, and each group had 15 patients. The patients in the Celebrex group and vitamin C group took 200 mg Celebrex and vitamin C, respectively, twice a day from day 2 to day 4. Both of their knees were evaluated by resting visual analogue scale and moving visual analogue scale in the evening of day 1 before treatment and day 3 after treatment. Meanwhile, the pain threshold and pain tolerance were accessed by a pain-threshold machine.
RESULTS AND CONCLUSION:No statistical significance of the changes of resting and moving visual analogue scale scores was found in both knees in the Celebrex group (P>0.05). The pain threshold of both knees were significantly increased (P<0.05), and the severe knee, which had less visual analogue scale scores than the minor one, turned out to increase more obviously than the minor knee (P>0.05). There were no significant changes in the pain tolerance in both knees (P>0.05). The changing values of resting or moving visual analogue scale were not significantly correlated with the pain threshold and pain tolerance (P>0.05). There were no significant changes in visual analogue scale scores, pain threshold and pain tolerance in both knees of the vitamin C group (P>0.05). Celebrex could increase the pain threshold of patients receiving total knee arthroplasty, especial y the severe knee, which indicates that the Celebrex is good for the preventive analgesia. Comparatively speaking, the pain threshold might be more sensitive than visual analogue scale in revealing the change of pain after analgesia. There is no significant correlation between visual analogue scale score and the hypersensitivity of pain.

Objective To analyze the predictive value of preoperative C-reactive protein(CRP)to albumin(Alb)ratio(CRP/Alb)for postoperative mortality within 1 year in elderly patients(≥ 80 years)with hip fracture.Methods The medical records of 401 patients aged ≥80 years who underwent surgical treatment for hip fracture in Affiliated Hospital of Xuzhou Medical University from January 2017 to December 2019 were retrospectively analyzed.There were 134 males and 267 females.The age was 80-99 years,and the aver-age age was 85.27±4.02 years.The mortality of the patients 1 year after operation was calculated by telephone follow-up or outpatient reexamination,the patients were divided into survival group(314 cases)and death group(87 cases).Factors that may affect patient sur-vival,including age,gender,operation mode,fracture type,American Society of Anesthesiology(ASA)grade,number of preoperative medical complications and preoperative laboratory indicators,including red blood cell count,white blood cell count,platelet count,hemo-globin,CRP and Alb were collected,and the CRP/Alb was calculated.Univariate analysis was performed for the above factors,and then the factors with statistically significant differences were further included in multivariate Logistic regression analysis,and area under the curve(AUC)of CRP,Alb and CRP/Alb were compared.Results A total of 401 patients in the group,87 patients died within 1 year after operation,the mortality rate was 21.70％.Univariate analysis showed that age,ASA grade,number of preoperative medical compli-cations,hemoglobin,white blood cell count,CRP,Alb,and CRP/Alb were the risk factors for death within 1 year after operation in eld-erly patients with hip fracture.Multivariate Logistic regression analysis showed that CRP,Alb,CRP/Alb,age,ASA grade and the num-ber of medical complications were independent risk factors for death within 1 year after operation in elderly patients with hip fracture(OR were 1.016,0.918,1.603,1.095,2.915,3.371,P＜0.05).The AUC of CRP,Alb and CRP/Alb for predicting postoperative death within 1 year in elderly patients with hip fracture were 0.783,0.719 and 0.814,respectively.Conclusion Compared with CRP and Alb,CRP/Alb is more valuable in predicting postoperative death in elderly patients(≥ 80 years)with hip fracture.

OBJECTIVE: To explore the better management of the stoma in endoscopic dacryocystorhinostomy. METHOD: To review the 102 chronic dacryocystitis patients (109 eyes), who underwent the endoscopic dacryocystorhinostomy surgery with silver clips used to maintain the stoma. They were given combined therapy after the surgery, and were followed up for a period range from 3-73 months. RESULT: 99/109 eyes (91%) were cured, 5/109 eyes (4.5%) were improved, and the total effective rate reached to 104/109 (95.5%). CONCLUSION The application of silver clip in endoscopy dacryocystorhinostomy surgery and combined therapy after the surgery can effectively prevent the stoma stenosis or atresia.
Adolescent ; Adult ; Aged ; Child ; Dacryocystitis ; surgery ; Dacryocystorhinostomy ; methods ; Endoscopy ; Female ; Humans ; Male ; Middle Aged ; Treatment Outcome ; Young Adult

OBJECTIVE: Tried to find the relationship between tinnitus and each testing method, provided information for objective diagnosis and treatment for tinnitus patients with sensorineural hearing loss. METHOD: The characteristics of audiology tests, including pure tone audiometric, acoustic immittance, middle ear muscle reflexes, matching test, distortion products otoacoustic emission(DPOAE) were compared in 79 ears of 69 tinnitus patients with sensorineural hearing loss. RESULT: The RI positive rate was higher in Convergence curve in tinnitus patients of sensorineural hearing loss, with the rate being 51.3%. The detection rates of DPOAE were 15.2% in patients of sensorineural hearing loss tinnitus groups, which were significant lower than those in control group. CONCLUSION Psychoacoustic techniques can produce a useful amount of clinical data regarding tinnitus in different aspects, these data can help clinicians design needed based managements. DPOAE test is helpful for the diagnosis of lesions in some tinnitus patients.
Audiometry, Pure-Tone ; Hearing Loss, Sensorineural ; complications ; physiopathology ; Hearing Tests ; methods ; Humans ; Otoacoustic Emissions, Spontaneous ; Psychoacoustics ; Tinnitus ; complications ; physiopathology

OBJECTIVE: To explore the role of the inducible nitric oxide synthase (iNOS) in the physiological mechanism of chronic rhinosinusitis (CRS), and to elucidate the relationship between the expression of iNOS in nasal mucosa and the outcome of endoscopic sinus surgery (ESS). METHOD: Thirty-one patients of CRS were divided into two groups according to the levels of IgE in blood serum: Group A with high levels of serum TIgE (TIgE > or = 90 kU/L) and Group B with low levels of serum TIgE (TIgE < 90 kU/L). Immunohistochemical procedures were taken to determine the expression of iNOS in the nasal mucosa of each CRS patient, and the CT scans of sinuses were evaluated by the Lund-Mackay CT staging system. The time of the operative cavity epithelialized (OCE) was recorded by the unit of week. Associated between time of OCE and the the expression of iNOS or the CT staging was analyzed. RESULT: The time of OCE was positive correlated with the expression of iNOS in Group A (P < 0.05) and did not show a clear correlation with the CT staging, while in Group B it was positive correlated with the CT staging (P < 0.05) and did not correlate with the expression of iNOS. CONCLUSION iNOS may be a predictive factor in the outcome of ESS. In cases of CRS patients with high levels of TIgE, time of OCE is positive correlated with the expression of iNOS in the nasal mucosa.
Adolescent ; Adult ; Endoscopy ; Female ; Humans ; Immunoglobulin E ; blood ; Male ; Middle Aged ; Nasal Mucosa ; metabolism ; pathology ; surgery ; Nitric Oxide Synthase Type II ; metabolism ; Paranasal Sinuses ; surgery ; Postoperative Period ; Prognosis ; Treatment Outcome ; Young Adult

Objective: To investigate the early clinical effects of tantalum augment assisted with 3D technology in treating acetabular bone defects of Paprosky type III in revision total hip arthroplasty (THA). Methods: From May 2013 to July 2017, a total of 16 patients (18 hips) undergoing revision THA were retrospectively analyzed, including 11 males and 5 females aged 58.06±8.29 years (range 44-69 years). There were 3 cases with infective loosening and 15 cases with aseptic loosening, 13 cases with Paprosky IIIA type bone defects and 5 cases with IIIB type bone defects. 3D technology was used for precise planning before operation. The tantalum augment and cup were used to repair acetabular bone defects during operation. Cup anteversion, abduction angle, ratio of the lateral and contralateral vertical distance of the center of rotation, ratio of the lateral and contralateral horizontal distance of the center of rotation and femoral offset were measured preoperatively and postoperatively. The percentages of hips located in Lewinnek safe zone were calculated preoperatively and postoperatively. Postoperative radiographic evidence of loosening and Harris score were collected at the end of the follow-up. Results: The percentage of the hips located in Lewinnek safe zone increased from 22% (4/18) preoperatively to 61% (11/18) postoperatively. The mean anteversion of the operative side was 11.99°±6.91° (range 1.71°-26.36°) postoperatively. The mean abduction angle of the operative side was 44.91°±5.93° (range 35.6°-56.0°). The mean ratio of the lateral and contralateral vertical distance of the center of rotation was 1.10±0.20 (range 0.87-1.62). The mean ratio of the lateral and contralateral horizontal distance of the center of rotation was 1.00±0.18 (range 0.69-1.46) and the mean ratio of the lateral and contralateral femoral offset was 1.01±0.66 (range 0.51-3.56). All the patients were followed-up for an average of 27.72±12.18 months (range 14-53 months). No complications, such as periprosthetic joint infection, dislocation or aseptic loosening, were observed in all patients. The mean Harris score was 77.28±4.80 (range 65-85) at 6 months postoperatively and 80.9±5.2 (range 69-89) at the end of the follow-up. Conclusion Using tantalum augmentassisted with 3D technology to re construct Paprosky type III severe bone defects of the hip can increase the accuracy of the acetabular cup positioning. The short-term outcomes are satisfying and no early prosthetic loosening was observed.