BACKGROUND: Total hip replacement is frequently used for osteoarthritis, rheumatoid arthritis, avascular necrosis of femoral head, et al. Although the operation is effective, some complications such as dislocation are serious and arouse more attention. OBJECTIVE: To review the research status of dislocation after total hip arthroplasty. RETRIEVAL STRATEGY: A computer-based online search of PubMed was undertaken for the English articles published between January 1997 and November 2007 with"hip replacement, dislocation". 496 related articles were collected from the above-mentioned database, including 445 original articles, and 57 review articles. Only articles ①about the influential factors for dislocation of hip joint; ②about the prevention and treatment of dislocation; ③highly correlated with the objective; and ④ published in recently or in authoritative journals were selected. Repetitive studies and Meta analyses were excluded. LITERATURE EVALUATION: Thirty-five articles were included, of which 9 were review articles and the others were clinical or empirical studies. DATA SYNTHESIS: ①Posterolateral approach in total hip arthroplasty increases the dislocation rate compared to anterior lateral approach and direct lateral approach. But when posterior articular capsule and extortor are sutured using absorbable thread before wound suture in total hip arthroplasty by posterolateral approach, the dislocation rate is increased and similar to anterior lateral approach and direct lateral approach. ②Large ball head of prosthesis can decrease the incidence of dislocation. In addition, the incidence of dislocation in prosthesis with skirted is less than prosthesis with no skirt. Elevated-rim acetabular liner can decrease but small offset distance can increase incidence of dislocation. ③Close reduction can cure early dislocation. If the dislocation is caused by infection, it is necessary to clear the wound, even take out the prosthesis for revision. Prosthesis location should be adjusted and hip joint with unbalance soft tissue should be treated by another surgery. ④If patients with recurrent dislocation, weak abductor, obvious soft tissue unbalance or other reason, it is better to use constrained prosthesis. CONCLUSION: Dislocation after total hip arthroplasty is caused by lots of complicated factors. With the acquaintance of factors and development of surgery techniques, the dislocation rate is significantly reduced than before. Complicated dislocation caused by soft tissue unbalance is the focus of future research.

Objective To formulate countermeasures of improving nurses′knowledge of malignant hyperthermia by investigating theatre nurses. Methods A self-designed questionnaire was used to investigate 120 theatre nurses for awareness, demand and access about malignant hyperthermia. Results Average correct response rate on the awareness of theatre nurses about malignant hyperthermia was (17.14±9.68)%.There are differences in different education, title and seniority(F=8.002,6.509,2.643,P<0.05).100.0%(120/120)theatre nurses are interested in studying knowledge related to malignant hyperthermia, 94.2%(113/120) theatre nurses are willing to learn knowledge related to malignant hyperthermia. Conclusions The awareness of theatre nurses about malignant hyperthermia is low. It is necessary to strengthen the training of theatre nurses about the knowledge of malignant hyperthermia. A variety of forms can be adopted.

Objective:To analyze the operation technique and the methods to avoid early complications on the learning curve for bilateral direct anterior approach (DAA) total hip arthroplasty (THA).Methods: We retrospectively studied a series of continued cases with bilateral avascular necrosis of the femoral head (AVN) or degenerative dysplastic hip and rheumatoid arthritis that were treated by DAA THA in Beijing Jishuitan Hospital.A total of 22 patients with 44 hips were analyzed from June 2014 to August 2016 in this study.There were 17 males and 5 females,and the median age was 48 years(range: 34-67 years).All the surgery was done by DAA method by two senior surgeons.The clinic characters,early surgery treatment results and complications were analyzed.Results: We used the cementless stems in all the cases.The average operating time was (167±23) min;the average blood loss was (775±300) mL;the blood transfusion was in average (327±341) mL;the wound drainage in average was (111±73) mL Most of the patients could move out of the bed by themselves on the first day after operation,5 patients could walk without crutches on the first operating day,and 13 patients could squat on the third days after operation.The patients were discharged averagely 4 days after operation.We followed up all the patients for averagely 16 months (range: 8-24 months).There was no loosening or failure case in the latest follow up.In the study,2 patients had great trochanter fracture,2 patients had thigh pain,4 patients had lateral femoral cutaneous nerve palsy,and 3 patients had muscle damage.The Harris scores were improved from 29±8 preoperatively to 90±3 postoperatively (P<0.01).Conclusion: The DAA THA can achieve faster recovery and flexible hip joint after operation.However it is a kind of surgery with high technique demanding.Carefully selected patients,and skilled technique,can help the surgeon avoid the early complications.It is associated with high complication rate in the learning curve for bilateral DAA THA.

Objective To analyze the characteristics and changes in the disease spectrum of Air Force(AF) servicemen in order to provide reference for the determinatron of the overall level of health of AF and priorities of disease prevention and control.Methods The data of outpatient and inpatient diseases between 2009 and 2013 in AF was collected and analyzed statistically according to the International Classification of Diseases-9(ICD-9),and statistical description was performed with SPSS18.0.Results Between 2009 and 2013,unit B had the highest number of outpatients and inpatients,accounting for 47.74% and 39.64% respectively.The upper respiratory tract infections,gastroenteritis/gastritis,chronic low back pain,skin diseases,nasal sinusitis,training injury,trauma,hemorrhoids,varicocele and stone diseases were the common and frequently occurring diseases in AF,which were the top ten in the disease spectrum.Among them,the incidence and admission rate of skin diseases kept declining.However,the incidence of gastroenteritis/gastritis in unit A,the incidence and admission rate of chronic low back pain in unit B and D,the incidence of injury in unit D,as well as the incidence of neurological headache and hypertension in unit C and D were higher than in other units.Conclusion Respiratory system disease,and occupation-related diseases such as low back pain,training injuries,trauma,skin disease and digestive system disease are the focus of health care in AF.Health education and health promotion for these diseases should be improved,and health intervention for key populations should be enhanced.

Objective To investigate the effect of the application of tranexamic acid in unilateral total knee arthroplasty (TKA)with different methods .Methods Totally 120 cases of primary unilateral TKA patients admitted from June 2013 to May 2012 were studied ,including 33 males and 97 females ,with the average age of (65 ± 9) years (31 to 81 years) .Patients were divided into intravenous tranexamic acid group (group V ) ,topical tranexamic acid group (group T ) and irrigation using tranexamic acid group (group I) ,and control group (group C) .There were 30 cases in each group .Four groups of patients had no differences in age ,gender ,body mass index and disease diagnosis ,operative time ,preoperative hemoglobin ,preoperative hematocrit differences sta‐tistically(P>0 .05) .Postoperative blood loss and blood transfusion were observed .Groups were compared using one‐way ANOVA analysis .Results The total blood loss of group V was (368 ± 95)mL ,total blood loss of group T was (407 ± 118)mL ,both were less than the control group (509 ± 96)mL ,the difference was statistically significant (P<0 .05) .The differences between the blood loss of group I (491 ± 122) mL and the control group was not statistically significant (P=0 .924) .Group V showed the least a‐mount of hidden blood loss .Group T showed the least amount of visible blood loss .There were not deep vein thrombosis ,infections and other complications in any groups .Conclusion Intravenous and topical application of tranexamic acid can significantly reduce postoperative blood loss in TKA .Irrigation with tranexamic acid can not reduce the blood loss effectively .

Objective To observe the efficacy of total ankle replacement in treatment of osteoarthritis of ankle joint.Methods Between October 1999 and October 2006,42 patients with ankle osteoarthritis were admitted in Beijing Jishuitan Hospital.All the patients met surgical indications and were performed total ankle replacement with S.T.A.R.system ( Scandinavian Total Ankle Replacement) (Waldemar Link,Hamburg,Germany).The pain in patients,motion and function of joint were evaluated pre- and post-operatively according to Kofoed scoring system,and the efficacy was evaluated with the Mayo'evaluation criteria of total ankle replacement.Results According to Kofoed scoring system,the postoperative situation was obviously superior to the preoperative in pain,motion and function of joint(P ＜ 0.05 ),and the excellent and good rate was 90.32％.While,the excellent and good rate was 87.5％with the Mayo' evaluation criteria of total ankle replacement.Conclusion Total ankle replacement,which can relieve pain,restore ankle function and improve ankle activity,provides another effective method for the patients who need ankle arthrodesis.

Objective:To study the clinicopathologic characteristics and the prognostic factors of triple negative breast cancer,and to study the correlation between clinicopathologic features and EGFR expression.Methods:Clinical characteristics and prognosis of 200 breast cancer patients diagnosed between 1997 and 2004 were reviewed.The paraffin embedded tissues were selected and tissue microarray blocks were made.Immunohistochemical staining was used to evaluate the expression of ER,PR and HER2 for breast cancer molecular type.EGFR expression was evaluated to analyze its correlation with the clinical characteristics and prognosis.Results:Fourty-two cases(21%)of 200 were triple negative breast cancer(TNBC).There was no significant difference between TNBC and non-TNBC in clinicopathologic parameters such as age,tumor size,clinical stage,and lymph node status.However,there was significant difference in histological category and menostasis status between the two groups(P<0.05).Among TNBC,17 0f 42 died during the follow-up(the overall suivival rate was 59.52%),while 26 0f 158 non-TNBC died(the overall survival rate was 83.54%).EGFR was significantly overexpressed in TNBC(69.05%)and it was associated with lymph node status and histological category.Conclusion:Although the incidence of TNBC is low,it has a poorer prognosis than other subtypes.EGFR is highly expressed in TNBC and may serve as a prognostic index and an important therapatic target for breast cancer.

Objective To investigate the relative motion between the femoral component and the tibial insert through the technology of fluoroscopy and digital model.Methods Sixteen female patients (16 knees) with knee osteoarthritis were performed TKA (GENESIS Ⅱ) from July 2007 to June 2008.The mean age was 66.4 years (range from 56 to 76 years).All patients were followed up 48 months to 60 months,with the mean of 56±3 months.The postoperative clinical function was evaluated by Knee Society Score (KSS).To match the digital model to the imaging data of fluoroscopy using 2D-3D automatic registration technology and reconstruct motion of the knee after TKA.The movement of contact position between femoral medial and lateral condyle and tibial insert and tibial internal rotation during flexion were measured.The contact time and range between femoral cam and tibial post were analyzed.Results The cases were statistically improved in KSS postoperatively,knee score was 93±5 and function score 88±13.The range of movement for femoral medial condyle was 8.5±2.5 mm,and the lateral condyle was 9.5±4.8 mm,the range of tibial internal rotation was 2.5°±8.4°.The contact of cam and post was observed after 30°-40° flexion of the knee,and the range was 8.0±1.8 mm.The greater tilting angle of the tibial plateau was,the later contact between cam and post happened.Conclusion The kinematics of tibiofemoral joint after TKA is different from the kinematics of normal knee.With knee flexion within 10°-30°,femoral medial condyle moves forward.When flexion is greater than 40°,medial and lateral condyle begins rollback.The time of contact of cam and post is relative to tibial prosthesis slope.

Objective To investigate the clinical efficacy of treating injury to the upper cervical spine with posterior internal fixation without bone graft fusion.Methods Included in this retrospective study were 35 patients with upper cervical injury who had been treated at Department of Orthopedics,The Second Affiliated Hospital to Soochow University from June 2010 to August 2017.They were 21 males and 14 females with an average age of 44.1 years (from 26 to 56 years).They were all treated firstly by posterior occipitocervical internal fixation or internal fixation with atlantoaxial pedicle screws without bone graft fusion.The internal fixation was then removed after a solid bone union was confirmed by X-ray.The scores of Japanese Orthopedic Association (JOA),visual analogue scale (VAS),Neck disability index (NDI) and neck stiffness were used to evaluate the functional recovery of the upper cervical spine.We also observed the rotational range of the upper cervical spine using functional CT scan of C 1-C2.Results All the pedicle screws were successfully implanted after satisfactory intraoperative reduction,leading to no injury to the vertebral artery or spinal cord.All patients were followed up for an average of 18.1 months (from 7 to 28 months).At preoperation,post-implantation and final follow-up,the JOA scores were 6.5 ± 1.4,7.7 ± 1.5 and 16.1 ± 0.8 points,the VAS scores 6.1 ± 1.6,2.8 ± 0.8 and 1.1 ± 0.9 points,and the NDI scores 37.9 ± 2.6,20.3 ± 3.8 and 3.7 ± 1.7 points,showing significant improvements after internal fixation and after removal of internal fixation (P ＜ 0.05).Serious neck stiffness was observed in none of the 35 patients,mild neck stiffness in 12 patients and freedom from neck stiffness in 23 patients.The postoperative radiological analysis revealed fine fracture reduction and bony union in all.After 6 to 12 months the rotation of upper cervical spine was obviously improved and the left-to-right range of rotation of C 1-C2 was 35.4° ± 2.6° as revealed by functional CT scan.Conclusion For the middle aged and young patients with new injury to the upper cervical spine,the posterior occipitocervical internal fixation or internal fixation with atlantoaxial pedicle screws can be performed without bone graft fusion at the first stage and removal of internal fixation can be done at the second stage so that the atlantoaxial rotation can be preserved to ensure satisfactory clinical efficacy while bone union can be also ensured and pain reduced.

Objective To investigate the cognition status and possible ways of patients′ privacy divulgence among medical staffs and patients, and to explore feasible strategies to protect the privacy. Methods A self-designed questionnaire about privacy cognition was used to investigate 92 patients and 59 medical staffs on one day in July 2014. Results The majority of patients had certain cognition of individual privacy;34. 8%, 30. 4% and 28. 3% of the patients thought the test outcomes, history of infection, illness conditions were private issues;63. 0%, 39. 1% and 31. 5% of the patients thought the perineum, pygal and chest were private parts. Medical staffs had significant higher privacy cognition compared with the patients ( P<0. 05);86. 4%, 86. 4% and 78. 0% of the staffs thought the emotional experiences, the history of infection, test outcomes were private issues;100. 0%, 89. 8% and 86. 4% of the staffs thought the perineum, pygal and chest were private parts. The private information of the patients would be divulged during the medical care such as:patient rounds and physical examinations, asking for the history of the illness, nursing, room layout, and talking between the medical staffs. Conclusions The medical staffs should enhance and motivate the concept of privacy among the patients in order to reduce the differences between these two groups and to improve the relationship between doctors and patients.