BACKGROUND:With the increased number of patients with total hip arthroplasty, blood source became less gradual y. Simultaneously, the risk of a variety of serious diseases infected by blood transfusion troubled the patients. Thus, it is very important to find a method that can reduce blood transfusion and did not increase risk. There are reports addressing the application of tranexamic acid to reduce bleeding during total knee, total hip arthroplasty and spinal surgery.
OBJECTIVE:To explore the effects of injection with tranexamic acid through articular cavity and discontinuous clip pipe on blood loss, functional recovery and complication after total hip arthroplasty.
METHODA total of 99 patients, who received total hip arthroplasty because of femoral fracture or coxarthropathy from January 2011 to February 2014, were selected in this study. They were divided into tranexamic acid group (n=55) and control group (n=44). After skin suture, patients in the tranexamic acid group were injected with 2.0 g tranexamic acid dissolved in 20 mL physiological saline through articular cavity. After replacement, the drainage was opened after 2 hours of interval. From then on, the drainage was opened for 10 minutes every 4 hours. Patients in the control group received discontinuous clip pipe. Negative pressure drainage tube was pul ed out at 48 hours after replacement. Blood loss, the number of blood transfusion, blood transfusion volume, 24-hour postoperative hemoglobin and hematocrit, preoperative, 3-hour postoperative fibrinogen, prothrombin time and activated partial thromboplastin time, 6-month postoperative hip Harris score and lower extremity deep vein thrombosis or pulmonary embolism were compared between the two groups.
RESULTS AND CONCLUSION:Significant differences in blood loss, the number of blood transfusion, blood transfusion volume, 24-hour postoperative hemoglobin and hematocrit were visible after replacement in patients of both groups (P<0.05). Blood loss, the number of blood transfusion, blood transfusion volume, 24-hour postoperative hemoglobin and hematocrit were better in the tranexamic acid group than in the control group. No significant difference in preoperative, 3-hour postoperative fibrinogen, prothrombin time and activated partial thromboplastin time was detectable between the two groups (P>0.05). No significant difference in 6-month postoperative hip Harris score was found between the two groups (P>0.05). No lower extremity deep vein thrombosis was observed using Doppler ultrasonography at 3, 10 and 14 days after replacement in 99 patients. Lower extremity deep vein thrombosis or pulmonary embolism was not detected at 6 months after replacement. Above data indicated that injection with tranexamic acid through articular cavity and discontinuous clip pipe after total hip arthroplasty could obviously decrease postoperative blood loss and blood transfusion, and did not increase the risk of lower extremity deep vein thrombosis.

To observe the efficacy of infiltrating injection of local anesthetic and oral NSAIDs for postoperative pain of total knee arthroplasty(TKA). 50 patients undergoing TKA were randomly assigned to two groups. The study group received intraoperative infiltrating injection of ropivacaine around knee and perioperative oral celecoxib. The control group received intravenous analgesia pump. The VAS scores in postoperative 3 days of the study group (4.2±0.6 ,4.6±0.8 ,4.6±1.1 ) were lower than the control group ( 6.5 ±0.7 ,6.4 ±1.0 ,6.1 ±0.9 ) . The differ-ence was statistically significant(P<0.05),and the dose of remedial morphine of the study group (10.6±7.7)mg was less than the control group (18.4±10.3) mg. The difference was statistically significant(P<0.05). Infiltra-ting injection of ropivacaine and oral celecoxib could effectively relieve postoperative pain of TKA which was better than intravenous analgesia pump.

The left clavicle of a healthy female was scanned by CT and serial sections were obtained. The CT images were fed into the Mimics and Ansys 10.0 software to construction a three-dimensional and finite element modeling of clavicle. Through meshing, assigning the material attribution, restricting the freedom and stimulating loading which effect to the vertical area of the acromion surface of clavicle, the result of stress and strain distribution and response of the model was obtained. Under the loading, the stress and strain mainly concentrated within the middle 1/3 part of the clavicle, and the stress on the superior surface was obviously highter than inferior surface. But the highest strain concentrated within the inferior surface of the middle 1/3 part of clavicle. The stress on superior surface of the middle 1/3 part of the clavicel was mainly tensile stress,or the inferior surface was compression stress. The stress and strain distribution didn't changed when the coracoclaviculare ligamenta was constructed. The result of finite element analysis of clavicle explains the reason why the middle 1/3 part of clavicle is prone to fracture, and the stress and strain distribution didn't changed when the coracoclaviculare ligamenta was constructed. Also, finite element analysis can be used to effectively understand the biomechanical characteristics of clavicle.

ObjectiveTo explore the efficacy of external fixation in treatment of unstable distal radius fractures. Methods33 patients with distal radius fracture were treated by external fixation or Kirschner wire supplemented,and absorbable screw fixation.The clinical efficacy was observed. Results33 patients were followed up for 4 ～24 months(mean 12 months).All fractures were healed,the average healing time was 8 weeks.Wrist function were assessed according to Sarmiento standard,excellent in 20 cases,good in 9 cases,3 cases and poor in 1 case,good rate of 87.87%. ConclusionThe external fixation in treatment of distal radius fractures had reliable efficacy,and early exercise could be taken after operation,and it was worthy of promotion.

BACKGROUND: There is not any experimental model that can reflect the pathological change of hormone-induced avascular necrosis of the femoral head in a good way nowadays, which is unfavourable to the further observation of its pathogenesis. OBJECTIVE: The model of the avascular necrosis of the femoral head is induced by giving a large dose of dexamethasone into rabbits, which provides the animal experimental models for the study of clinical pathogenesis. DESIGN, TIME AND SETTING: The randomized controlled animal experiment was performed at the Animal Laboratory, Affiliated Hospital of Anhui Medical University from June 2004 to August 2005. MATERIALS: Sixteen healthy adult New Zealand albino rabbits (50% female and 50% male), weighing 3.0-3.2 kg were selected for this study. Dexamethasone was provided by Jiangsu Lianshui Medical Co., Ltd. etalon: 5 g/L. METHODS: Rabbits were randomly divided into two groups: model and control groups. Dexamethasone of 2.5 mg/kg per day was injected into each rabbit of the model group, and saline of 2 mL was injected into each rabbit of the control group for 6 weeks. MAIN OUTCOME MEASURES: Serum lipid and prothrombin time (pt) were tested before and after the experiment, and the histopathological change was observed with radiography, optical microscrope and transmission electron microscopy at 2, 4 and 6 weeks of dexamethasone administration. RESULTS: Compared with the control group, in the model group cholesterin levels were significantly increased at 2 weeks (P

BACKGROUND:Cervical kyphosis post laminectomy is a common iatrogenic,and progressive abnormality of the curvature of cervical spine,and can influence the function of cervical spine of children and adults.OBJECTIVE:To explore the effect of multiple levels of laminectomies on the curvature of cervical spine,and analyze the role of the elastic modulus of cervical intervertebral disc and ligaments on maintaining curvature of postlaminectomy cervical spine.DESIGN,TIME AND SETTING:Three-dimensional finite element analysis was performed in Changzheng Hospital,Second Military Medical University of Chinese PLA between January 2003 and January 2004.MATERIALS:The highly resolution pictures of the cross-section of cervical spine(interval distance of layer 1 mm) were came from male cross-section of cervical spinal of American visible human project,which was freely downloaded from The Visible Human Project.METHODS:The highly resolution pictures of cervical spinal cross-section were used as data to reconstruct the three-dimensional multiple levels postlaminectomy cervical spine models including all structure of spine from cranial base to the first thoracic vertebrae except the vertebral lamina,spinous process,ligamentum flavum,interspinous and supraspinous ligament from the second to the seventh cervical spine.The finite element and elastic modulus of the structures of cervical spine were defined according to previous reports.With this model and Ansys6.1 finite element analysis software,the effect of laminectomy on the curvature of cervical spine and impact of the elastic modulus of intervertebral disc and ligament to the curvature of postlaminectoy cervical spine were analyzed.MAIN OUTCOME MEASURES:The influence of the elastic modulus of cervical intervertebral disc and ligament(anterior and posterior longitudinal ligaments) on the curvature of the postlaminectomy cervical spine.RESULTS:The physical lordosis of multiple levels postlaminectomy cervical spine was reduced after multi-level loading,and the physical lordosis of the superior cervical spine disappeared with only slightly kyphosis.The kyphosis was aggravated after reducing the elastic modulus of intervertebral disc and ligament(anterior and posterior longitudinal ligaments).Following increased elastic modulus of intervertebral disc and ligament,the kyphosis of cervical spine was reduced even disappeared,and gradually regained the normal lordosis of cervical spine.CONCLUSION:Multiple levels cervical laminectomy can significant reduce the physical lordosis of cervical spine,and convert the physical cervical lordosis to cervical kyphosis.The elastic modulus increase of cervical intervertebral disc and ligament can inhibit kyphosis formation post laminectomy.

BACKGROUND:During total hip arthroplasty, placement angle of acetabular prosthesis is significant for clinical curative effects. OBJECTIVE:To investigate the abduction angle and anteversion angle of acetabular prosthesis at different positions during total hip arthroplasty and related influential factors. METHODS:Thirty-five patients undergoing total hip arthroplasty were included in this study, containing 21 males and 14 females, at the age of 51-75 years old. Thesame patient at different positions underwent X-ray examination, including standing anteroposterior pelvis radiographic imaging, standing lateral radiographic imaging and supine anteroposterior pelvis radiographic imaging. Abduction angle and anteversion angle of acetabular prosthesis were measured. RESULTS AND CONCLUSION:(1) Abduction angle and anteversion angle at standing positionwere bigger than that at supine position (48.47°, 45.89°; 12.44°, 6.17°;P< 0.05). (2) The change in anteversion angle wasassociated with pelvic incidenceangleand pelvic tiltangle. The change in abduction angle was associated with pelvic obliquity. (3) The range of abduction angle (40±10)° and anteversion angle (15±10)° of acetabular prosthesis was identified as securityzone. (4) Results suggested that there were changes in acetabular abduction angle and anteversion angle between supine anteroposterior pelvis radiographic imaging and standing anteroposterior pelvis radiographic imaging after total hip arthroplasty. Acetabular angle was associated with pelvic obliquity, pelvic incidence and pelvic tilt.