Objective To analyze the evolution of acetabular morphology changes of different Crowe types among adults with developmental dysplasia of the hip through standard hip 3D CT reconstruction.Methods From June 2010 to January 2013,there were 62 patients with 68 hips (8 hips of 6 male cases,56 female cases of 60 hips) diagnosed as acetabular dysplasia in our hospital,with an average age of 53.7±5.8 years old (range,47-59 years).According to Crowe classification,there were 14 cases (17 hips) of Crowe type Ⅰ,17 cases (17 hips) of Crowe type Ⅱ,15 cases (17 hips) of Crowe type Ⅲ,and 16 cases (17 hips) of Crowe type Ⅳ.Through standard hip 3D CT reconstruction,Harris nest in the pelvic side 3D image was marked,and the coronal and horizontal position of acetabular rotation center was determined by using the cross axis; secondly,in the anteroposterior 3D image (by gray level adjustment to the shape of X ray perspective effect) through Ranwant triangulation,sagittal position of the center of rotation of the hip joint was determined; finally,the acetabular rotation center in the acetabular horizontal reconstruction plane.The bone stock of anterior and posterior columns of acetabular was observed and acetabular anteversion,front cover angle,rear cover angle and medial wall thickness were measured.Results 1) With Crowe type increased,acetabular anteversion angle gradually increased as well,and there was a positive correlation between them with statistically significant (P＜0.05) except in Crowe Ⅰ and Ⅱ group.2) With Crowe type increased,anterior acetabular coverage angle was significantly decreased; the mean anterior acetabular coverage angle of Crowe Ⅲ and Ⅳ groups was less than 50°.3) With Crowe type increased,posterior acetabular coverage angle was decreased significantly as well the mean posterior acetabular coverage angle of Crowe Ⅲ and Ⅳ groups was less than 90°.4) With Crowe type increased,acetabular medial wall thickness was increased significantly.Conclusion Adult acetabular morphology changes between different Crowe types in patients with developmental dysplasia of the hip.For acetabular reconstruction of Crowe Ⅰ and Ⅱ,we could make full use of the acetabular bone stock of anterior and posterior column; for acetabular reconstruction of Crowe Ⅲ and Ⅳ,we could moderately shift the acetabular center superiorly and (or) medially.

Objective To investigate relationship between polyethylene wear and decrease of femoral offset after total hip arthroplasty (THA).Methods Ninety patients who had undergone unilateral THA were recruited in this study.Coreldraw 12.0 software was used to measure change of femoral offset on the basis of immediate anteroposterior radiographies of bilateral hip after THA.In the light of the decreasing value of femoral offset (F),all patients were equally into 5 groups:F＜2 mm,2≤F≤4 mm,4＜F≤6 mm,6＜F≤8 mm and 8＜F≤ 10 mm.At final follow up,some parameters about polyethylene wear were measured by using Coreldraw 12.0 software on the basis of anteroposterior radiographies of bilateral hip.Results The linear wear volume was 0.72±0.13 mm in group F＜2 mm,0.78±0.11 mm in group 2≤F≤4 mm,0.87±0.09mm in group 4＜F≤6 mm,0.99±0.09 mm in group 6＜F≤8 mm,and 1.17±0.15 mm in group 8＜F≤10 mm.The linear wear rate was 0.132±0.025 mm/yr in group F＜2 mm,0.139±0.019 mm/yr in group 2≤F≤4 mm,0.159±0.029 mm/yr in group 4＜F≤6 mm,0.183±0.032 mm/yr in group 6＜F≤8 mm,and 0.213±0.023 mm/yrin group 8＜F≤ 10 mm.The linear wear angle was 5.0°±3.5° in group F＜2 mm,3.2°±3.8. in group 2≤F≤4mm,-4.3°±4.9° in group 4＜F≤6 mm,-8.7°±4.1° in group 6＜F≤8 mm,and -13.0°±4.7° in group 8＜F≤ 10mm.For three parameters above,there were significant differences between groups,except between group F＜2 mm and group 2≤F≤4 mm.Conclusion The femoral offset should be restored to its anatomic status in THA to avoide superior lateral displacement of center of the femoral head,which could result in uneven stress distribution and increase polyethylene wear.

Objective To investigate the preliminary clinical outcome following PCL-retaining total knee arthroplasty (TKA) with 0°or 5°posterior tibial slope. Methods From Jan 2008 to Mar 2009, 84 patients (84 knees) with osteoarthritis (OA) underwent primary PCL-retaining TKA operations by the same surgical team. Among them, 27 patients (7 males, 20 females, with the average age of 69.5 years) underwent TKA using a cutting block and intramedullary cutting guide designed to impart a 5° posterior tibial slope (group A); 57 patients (15 males, 42 females, with the average age of 67.4 years) underwent TKA using a cutting block and intramedullary cutting guide designed to impart a 5°posterior tibial slope (group B). The preoperative demographic data and functional data had no statistical differences. The postoperative tibial posterior angle, maximum extension, maximum flexion and Knee Society Score (KSS) were compared between the two groups. Results All patients were followed up 12～24 months with an average of 15.7 months. No paralysis, wound infection, prosthesis dislocation and loosening were found. The postoperative tibial posterior angle was 5.7°±2.1° in group A and 0.9°±0.6°in group B (P＜ 0.05). The postoperative maximum extension was 0.8°±0.3°in group A and 1.2°±0.4°in group B (P ＞0.05). The postoperative maximum flexion was 115.7°±4.8°in group A and 101.1°±5.6°in group B (P＜ 0.05). The postoperative KSS was 87.6±5.9 in group A and 83.3±7.2 in group B (P ＞0.05). Conclusion Increasing tibial posterior slope improved the postoperative maximum flexion, but not the maximum extension and KSS, in PCL-retaining TKA.

Objective To investigate the predictive value and clinical significance of dynamic monitoring of thromboelas?tography (TEG) and D?dimer on anticoagulation therapy concurrenting DVT in the perioperative period of arthroplasty replace?ment. Methods All of 60 patients of total knee arthroplasty (TKA) were selected as patient group from 2011 to 2013. They were divided into low molecular weight heparin (LMWH) group and rivaroxaban group according to random number table. LM?WH group was given LMWH (xi fu quan) 4250 IUAXa 12 h after knee replacement, im, qd for 7 days, then rivaroxaban 10 mg, qd for 7 days. Rivaroxaban group was given rivaroxaban 10 mg 6 h after knee replacement, qd for 14 days. Meanwhile, 42 health examination participants were selected as control group. The parameters of TEG were detected by TEG 5000 thrombo?elastograph hemostasis system (American Haemoscope Corporation). Results D?dimer levels of postoperative before anticoagu?lation therapy were highest and there was statistical difference, while other parameters had no statistical difference. Intra?group comparison:the levels of R, K, Alpha, CI of TEG and D?D in LMWH group and the levels of Alpha, MA, CI of TEG and D?D in ri?varoxaban group had statistical difference, while other parameters' levels showed no statistical difference. At anticoagulation treat?ment endpoint, DVT occurred in 8 cases with an incidence of 13.3%(8/60). 7 cases were intramuscular vein thrombosis, and 1 case was popliteal vein thrombosis. The levels of Alpha, MA, CI of TEG and D?D in DVT group were higher than no DVT group, and there was statistical difference. TEG's CI, MA, Alpha and D?dimer had better clinical diagnostic value on DVT, whose area un?der receiver operating characteristic cure (ROC) respectively was 0.746, 0.733, 0.707 and 0.644, with sensitivity of 75%, 75%, 62.5%and 62.5%, specificity of 80.8%, 76.9%, 78.8%and 71.1%, positive predictive value of 37.5%, 33.3%, 31.3%and 25.0%, and negative predictive value of 95.4%, 95.2%, 93.2%and 93.1%. MA=68.35 mm was the best clinical diagnosis of critical point on DVT at anticoagulation treatment endpoint. Conclusion CI, MA, Alpha of TEG are better than D?dimer in predicting the inci?dence of DVT in the perioperative period of orthopaedics major operation. If these indexes are detected, the diagnosis value ’s ac?curacy of DVT will be improved.

Objective To investigate the effect of thrombelastography ( TEG ) monitoring on anticoagulation therapy in deep vein thrombosis ( DVT ) in the perioperative period of arthroplasty replacement through dynamic detecting of TEG.Methods 60 patients under went total knee arthroplasty ( TKA) were selected as the patient group from 2011 to 2013, Including 22 men and, 38 women, aging from 50 to 74 years old.These patients were divided into low molecular weight heparin ( LMWH ) group and rivaroxaban group according to random number table.Each group had 30 cases.Patients in both were all given routine dose anticoagulant drugs to prevent DVT.Other treatment were the same as conventional therapy for both group patients.Meannhile, 42 health examination participants were selected as the control group, 24 men and 18 women, aging from 45 to 75 years old.The parameters of TEG were measured by TEG@5000 thromboelastograph hemostasis system ( American Haemoscope Corporation).DVT was diagnosed by LOGIQ 7 color Doppler ultrasonic diagnostic apparatus of American GE Corporation. Data were analyzed by SPSS17.0.The predictive value of TEG on DVT was evaluated by receiver operating characteristic cure (ROC),sensitivity,specificity,positive predictive value (PPV) and negative predictive value (NPV). Results Abnormal detection rates of Angle,MA,CI in rivaroxaban group(36.7%,46.7%,36.7%) were higher than LMWH group ( 10.0%, 20.0%, 13.3%) , and the differences between both groups all had statistical significance between both group(χ2 =5.963,P=0.015;χ2 =4.800,P=0.028;χ2 =4.356,P=0.037).CI , MA and Angle had better clinical diagnostic value on DVT.Their sensitivity was 75.0%, 75.0% and 62.5%, specificity respectively was 80.8%, 76.9%and 78.8%respectively.MA=68.35 mm
could be the best clinical diagnosis of critical point on DVT at anticoagulation treatment endpoint.Conclusion TEG can monitor coagulation state of TKA patients, TEG′R can evaluate the safety and effectiveness of anticoagulation therapy on DVT.(Chin J Lab Med, 2015, 38:333-336)

Aged ; Arthroplasty, Replacement, Knee ; methods ; Female ; Humans ; Knee Joint ; abnormalities ; surgery ; Male ; Middle Aged

OBJECTIVE: To investigate the prevalence of lower extremity work-related musculoskeletal disorders(WMSDs) among manufacturing workers, and to explore the association of lower extremity WMSDs and different types of working. METHODS: A total of 7 908 workers were selected as study subjects from four manufacturing factories in China using the cluster sampling method. The Musculoskeletal Disorders Investigating Questionnaire was adopted to investigate the prevalence of lower extremity WMSDs and the distribution of types of working. The prevalence ratio(PR) of WMSDs, calculated by log-binomial model, was used to estimate the correlation of WMSDs in different parts of lower extremity. The multi-factor logistic regression was used to analyze the association of lower extremity WMSDs and different types of working. RESULTS: The total annual prevalence of lower extremity WMSDs was 41.0%(3 241/7 908) among manufacturing workers. The annual prevalence of WMSDs of different parts in lower extremity from high to low were knee(29.5%), ankle/foot(23.9%) and hip/thigh(16.7%). The correlation of WMSDs of the three parts in lower extremity was close, and the range of PR values was 2.21-3.88. The result of logistic regression analysis showed that the workers who frequently sat for long periods had higher risk of lower extremity WMSDs than those who never/rarely sat for long periods(odds ratio=1.39, P<0.01). The higher the frequency of standing, kneeling/squatting for long periods, carrying heavy loads ≥5 kg and driving, the higher the risk of lower extremity WMSDs(the odds ratios were 1.33, 1.41, 1.16 and 1.12, respectively, P<0.01). CONCLUSION: The prevalence of lower extremity WMSDs was relatively high among manufacturing workers. There is a dose-effect relationship between the types of working and lower extremity WMSDs.

OBJECTIVE: To compile the Chinese Musculoskeletal Questionnaire(CMQ) and test its reliability and validity. METHODS: The initial CMQ was formed through studying literatures, interviewing professional workers who have work-related musculoskeletal disorders(WMSDs) and investigation with occupational health and ergonomics experts. Then, 436 and 443 manufacturing workers were selected as prediction and verification samples respectively by convensence sampling method. The reliability and validity of the CMQ were tested by item analysis, exploratory factor analysis and confirmatory factor analysis. RESULTS: i) The CMQ composed of 48 items with item analysis. ii) Nine common factors of CMQ were extracted using exploratory factor analysis, which explained 70.721% of WMSDs variance. iii) The results of confirmatory factor analysis showed that the ratio of chi-square to degree of freedom was 3.380, the comparative fit index was 0.781, the Tucker-Lewis index was 0.764, the root mean square error of approximation was 0.073, and the standardized root mean square residual was 0.068. iv) The results showed that the item reliabilities of the 9 common factors of CMQ such as upper and lower limbs posture load, neck posture load, back posture load, job demand, social support, job control, job environment, job system and job facilities were 0.205-0.841, the composite reliabilities were 0.545-0.894, and the convergence efficiencies were 0.377-0.834. The correlation coefficients between the common factors were less than its square root of the convergence validities. CONCLUSION: The CMQ has good reliability and validity, and is a reliable and effective tool for evaluating WMSDs.

OBJECTIVE：To study the improvement effect of Shenling baizhu p owder on irritable bowel syndrome with diarrhea（IBS-D）model mice with anxiety ，and to elucidate its mechanism from the point of view of intestinal microecology. METHODS：C57 BL/6 mice were randomly divided into blank control group ，model group ，Shenling baizhu powder group （3.6 g/kg），with 8 mice in each group. Except for blank control group ，IBS-D model with anxiety was established in model group and Shenling baizhu powder group by giving corticosterone subcutaneously combined with intragastric administration of Folium Sennae decoction and chronic restraint treatment. After modeling ， blank control group and model group were given intragastric administration of normal saline ，and Shenling baizhu powder group was given relevant medicine intragastrically ，for consecutive 4 weeks. After last medication ，loose stools rate ，diarrhea index ，body weight ，sugar water preference percentage ，the times of crosssing open field center area and minimum pain threshold as well as the levels of BDNF in hippocampal tissue and 5-HT in serum were detected in each group. The cecal contents of mice in each group were extracted for microbial DNA extraction and sequencing； the abundance and diversity of intestinal microorganisms were analyzed by Alpha and Beta diversity analysis. RESULTS ： Compared with blank control group ，body weight ，sugar water preference percentage ，the times of crossing open field center area and minimum pain threshold as well as the levels of BDNF in hippocampal tissue ，relative abundance of Firmicutes phylum microorganism in intestine ， relative abundance of Lachnospiraceae_NK4A136_group genus microorganism were decreased significantly （P＜0.05）；loose stools rate，diarrhea index ，serum level of 5-HT，relative abundance of Verrucomicrobia phylum microorganism and relative abundance of Ackermann phylum microorganism were increased significantly （P＜0.05），and there were great differences in the types of intestinal microorganisms. Compared with model group ，body weight ，sugar water preference percentage ，the times of crossing open field center area ，minimum pain threshold ，BDNF level of hippocampus ，relative abundance of Firmicutes phylum microorganism，relative abundance of Lachnospiraceae_NK4A136_group genus microorganism were increased significantly （P＜ 0.05 or P＜0.01）；loose stools rate ，diarrhea index ，serum level of 5-HT，relative abundance of Verrucomicrobia phylum microorganism and relative abundance of Ackermann phylum microorganism were decreased significantly （P＜0.05），and and there were great differences in the types of intestinal microorganisms. CONCLUSION ：Shenling baizhu powder can improve the diarrhea and anxiety behavior of IBS-D model mice with anxiety ，increase the level of BDNF in hippocampus and decrease serum level of 5-HT. Its mechanism may be related to decreasing relative abundance of Verrucomicrobia phylum microorganism and Ackermann phylum microorganism ，increasing the relative abundance of Firmicutes phylum and Lachnospiraceae_NK4A136_group genus microorganism.