OBJECTIVE:To observe the effects and safety of different treatment courses of rivaroxaban in prevention and treatment of deep venous thrombosis(DVT)after total hip replacement. METHODS:The clinical data of 127 patients under-went selective total hip replacement in our hospital during Dec. 2014-Dec. 2015 were selected and analyzed retrospectively. They were divided into group A [83 cases,subdivided into group A1(40 cases)and A2(43 cases)by treatment course] and group B (44 cases) according to anticoagulant duration. Group A was given Rivaroxaban tablet 10 mg,po,qd,6-8 h after surgery;the treatment course of group A1 was 5 weeks(35 d)while that of group A2 was 2 weeks(14 d). Group B was giv-en Enoxaparin sodium injection 5000 AxaIU,sc,qd,12d before surgery;and then given Enoxaparin sodium injection 5000 AxaIU,sc,qd,after surgery;the treatment course lasted for 2 weeks. The incidence of DVT were compared among 3 groups as well as thrombin time(TT),activated partial thromboplastin time(APTT),hemoglobin(Hb)content,whole blood viscos-ity,plasma viscosity,platelet count and anticoagulant safety 3 days before surgery and after treatment. RESULTS:The inci-dence of DVT in group A1 was 0,which was significantly lower than that in group A2 (9.30%) and group B (11.36%), with statistical significance(P<0.05);there was no significant differences between group A2 and group B(P>0.05). Wheth-er 3 d before surgery or after treatment,there was no statistical significance in PT,APTT,Hb content,whole blood viscosi-ty,plasma viscosity and platelet count among 3 groups (P>0.05). No major bleeding events or pulmonary embolism was found in 3 groups. The incidence of mild bleeding events in group A was 5.00%,which was slightly higher than that in group A2 (2.33%) and group B (2.27%),without statistical significance (P>0.05);there was no statistical significance between group A2 and group B(P>0.05). CONCLUSIONS:Rivaroxiban long-term anticoagulation after total hip replacement has no significant effect on coagulation function and platelet,not only decrease the incidence of DVT,but also will not increase no bleeding with good safety.

Objective To explore the proliferation and differentiation of osteoblasts from 2 sources co-cultured with SD rat Schwann cells(SCs) . Methods Bone marrow stromal cells (BMSCs) were obtained by washing the femoral and tibial bone marrow cavities in SD rats. Osteoblast differentiation of the third passage of BMSCs was induced by incubation in osteogenic medium. Primary rat calvarial osteoblasts were obtained by digestion of the calvarial bone in one day old SD rats. The cells were cultured in DMEM supplemented with 10% fetal bovine serum(FBS) . SCs of passage 2 were obtained by digestion of sciatic nerve. The SCs were identified by S-100. The proliferation of 2 kinds of osteoblasts co-cultured with SCs was tested using 96 co-culture plate by methyl thiazdyl tetrazolium(MTF). Real-time PCR was used to test the osteoblast differentiation through co-culturing with SCs in 3 d and 7 d. The osteoblasts were implanted in the subtus chamber. The SCs were implanted in the superior chamber. Results SCs enhanced significantly the proliferation of calvarial osteoblasts at 7 time points. The expression levels of OPN mRNA, OCN mRNA, ALP mRNA, and BMP-2 mRNA of the osteoblasts were significantly lower in the experiment group than in the control group in 3 d and 7 d. SCs also enhanced significantly the proliferation of the induced osteoblasts in 5 d, 7 d and 9 d. The expression levels of OPN mRNA, OCN mRNA, ALP mRNA, and BMP-2 mRNA of the induced osteoblasts were significantly higher in the experiment group than in the control group in 3 d and 7 d, except the level of ALP mRNA in 7 d.Conclusions The BMSCs-induced osteoblasts cocultured with SCs may be used as seed cells to construct neurotized tissue engineered bone.

Objective To report computer-aided three-dimensional visualization of simulated surgery for distal femoral fractures using software Unigraphics NX and Mimics. Methods The preoperative CT scans of 6 patients with distal femoral fractures were used for three-dimensional reconstruction of distal femoral fractures using software Mimics. Three-dimensional reconstruction of the surgical instruments using the modeling function of software Unigraphics NX. The assembly function of software Unigraphics NX was used to vi-sualize the simulated internal fixations of distal femoral fractures with both Less Invasive Stable System plates and the retrograde nails. The operative procedures simulated by the software Unigraphics NX were analyzed preoperatively. Results The simulated operative procedures were clearly and vividly visualized in three-dimensions, The fracture reduction and operative effects could be predicted. Conclusion This system of three-dimensional visualization of simulated surgery for distal femoral fractures using software Unigraphics NX and Mimics can help surgeons make preoperative predictions and select reliable methods to improve the reliability and effectiveness of the orthopaedic surgery.

Objective To establish three-dimensional (3D) simulation model of acetabular fracture based on Letournel-Judet classification and analyze its significance. Methods Pelvis of one healthy female volunteer was scanned with 16 slice spiral CT. Dicom format data were processed by software Mimics 10.01 to reconstruct 3D model of hip bone. Different fracture types were simulated based on Letournel-Judet classification of acetabular fracture. The fracture fragments were displayed with different color. Screen-captures of fracture model from different directions were saved and video mode of fracture model was exported. Five orthopedic doctors and 10 medical students were employed to compare 3D fracture model with two-dimensional planar schematic diagram and made preliminary evaluation. Results The 3D simulation model of acetabular fracture had realistic form and stereoscopic sense, with satisfactory visual effect. The fracture could be observed and charted from optional direction and angle. Fracture model could rotate for 360° in the corresponding video mode. Four orthopedic doctors and nine medical students considered that 3D simulation model of acetabular fracture was helpful for understanding fracture classification. Conclusion The 3D simulation model of acetabular fracture is intuitive, realistic and dynamic and is helpful for clinical work and medical teaching.

Objective To explore the clinical risk factors on cerebral infarction in progressing after transient ischemic attact (TIA) in a short time (in 30 days). Methods A total of 162 cases of TIA administrated in our hospital were per-formed to retrospective analyze. All cases were divided into two groupsCIP group and non-CIP group, and gender, age, the history of tobacco, alcohol, family history of cerebral infarction, cerebral infarction, hypertension, systolic pressure, diastolic pressure, diabetes and heart disease, fasting blood glucose level, hyperlipoidemi, hyperhocysteinemia, duration of TIA>30 min, frequent attacks>3 times, carotid atheroscalerotic plaques, intracal angiostenosis of two groups were an-alyzed. The progressing to cerebral infarction of the different ABCD2 scores in 30 days were observed. Results The his tory of hypertension, history of diabetes, duration of TIA>30 min were more in CIP group than in non-CIP group(P<0.05). Fasting blood glucose level were more in CIP group than in non-CIP group (P<0.05). The scores of ABCD2 was high, the possibility of progression to cerebral infarction was increased (P<0.05). Conclusion History of hypertension, diabetes, level of fasting blood glucose, duration of TIA>30 min and the ABCD2 scale are related factors for CIP.

Objective:To investigate the effect of stroke center on the treatment time and short-term prognosis in patients with ultra-early acute cerebral infarction (ACI) within 6 h treated with intravenous thrombolysis.Methods:The clinical data of 113 patients with ultra-early ACI treated with intravenous thrombolysis from July 2017 to July 2019 in Chaoyang City Central Hospital, Liaoning Province were retrospectively analyzed. Among them, 40 patients who received intravenous thrombolysis before the establishment of the stroke center (from July 2017 to July 2018) were enrolled as control group, and 73 patients who received intravenous thrombolysis after the establishment of the stroke center (from August 2018 to July 2019) were as study group. The treatment time nodes were recorded, including the time of onset, time of ACI initial diagnosis, time of completing blood collection and index reporting, time of completing CT examination and diagnosis, time of informed consent and time of onset of intravenous thrombolysis. The short-term prognosis indexes were recorded, including the mortality rate, effective rate of intravenous thrombolysis, improvement rate of neurological deficit at discharge and length of stay.Results:The time of ACI initial diagnosis, time of informed consent and time of onset of intravenous thrombolysis in study group were significantly shorter than those in control group: (5.16 ± 1.97) min vs. (10.23 ± 7.80) min, (36.26 ± 21.89) min vs. (56.23 ± 40.97) min and (85.12 ± 35.46) min vs. (126.28 ± 50.14) min, and there were statistical differences ( P<0.01); there were no statistical difference in the time of onset, time of completing blood collection and index reporting and time of completing CT examination and diagnosis between 2 groups ( P>0.05). The mortality rate in study group was significantly lower than that in control group: 1.4% (1/73) vs. 12.5% (5/40), the effective rate of intravenous thrombolysis and improvement rate of neurological deficit at discharge were significantly higher than those in control group: 84.9% (62/73) vs. 67.5% (27/40) and 76.7% (56/73) vs. 55.0% (22/40), and there were statistical differences ( P<0.05); there was no statistical difference in length of stay between 2 groups ( P>0.05). Conclusions:The establishment of standard stroke center can shorten the treatment time and improve the prognosis of patients with ultra-early ACI.

Femoral neck fracture (FNF) in the elderly patients is currently a major health challenge worldwide, with excessive consumption of medical resources, high incidence of complications as well as suboptimal outcome and prognosis. Hip joint arthroplasty (HJA) has been the mainstream treatment for FNF in the elderly, but the conventional surgical approaches and techniques are still confronted with a series of bottlenecks such as dislocation, limp and limb length discrepancy. In recent years, direct anterior approach (DAA) for HJA (DAA-HJA) has been a major new choice in the field of joint replacement, which achieves improved clinical effectiveness of HJA in the treatment of elderly FNF, due to the fact that DAA approach involves the neuromuscular interface and accords with the idea of soft tissue retention and enhanced recovery after surgery. However, there is still a lack of unified understanding of standard technique and procedure of DAA-HJA in the treatment of elderly FNF. Therefore, relevant experts from the Hip Joint Group of Chinese Orthopedics Association of Chinese Medical Association, Youth Arthrology Group of Orthopedic Committee of PLA, Orthopedic Committee of Chongqing Medical Association, Branch of Orthopedic Surgeons of Chongqing Medical Doctor Association and Sport Medicine Committee of Chongqing Medical Association were organized to formulate the " Chinese expert consensus on the technical standard of direct anterior hip arthroplasty for elderly femoral neck fracture ( version 2023)" based on evidence-based medicine. This consensus mainly proposed 13 recommendations covering indications, surgical plans, prosthesis selections, surgical techniques and processes, and postoperative management of DAA-HJA in elderly patients with FNF, aiming to promote standardized, systematic and patient-specific diagnosis and treatment to improve the functional prognosis of the patients.