BACKGROUND:Computer-assisted navigation technique has been widely applied in total knee arthroplasty. However, whether computer-assisted navigation total knee arthroplasty is better than traditional total knee arthroplasty remains unclear. OBJECTIVE:To systemical y evaluate and compare the limb and prosthesis alignment restoration post computer-assisted navigation and traditional total knee arthroplasty. METHODS:The PubMed/Medline, EMBASE, Cochrane CENTRAL, ScienceDirect database were searched from established to June 2013 and the randomized control ed trials about computer-assisted navigation and traditional total knee arthroplasty were selected. Meta analysis was performed with Rev Man 5.2 software. The evaluating data included the hip-knee-ankle mechanical axis or tibiofemoral angle, femoral prosthesis coronal angle, femoral prosthesis sagittal angle, tibial prosthesis coronal angle, and tibial prosthesis sagittal angle. The malalignment was defined as a deviation 2° or 3° from the natural line. RESULTS AND CONCLUSION:19 randomized control ed trials involving 2 654 cases (3 392 knees) were included in this study. Meta-analysis showed that, the limb alignment restoration post computer-assisted navigation was significantly better than traditional total knee arthroplasty (3°, P<0.000 01 and 2°, P=0.000 8). The 3° of femoral prosthesis coronal angle deviation post computer-assisted navigation was significantly superior to traditional total knee arthroplasty (P=0.002), while the 2° deviation had no significant difference between the two surgeries (P=0.290). The 3° deviation of femoral prosthesis sagittal angle post computer-assisted navigation was significantly better than traditional total knee arthroplasty (P=0.040);however, the 2° deviation had no significant difference between the two surgeries (P=0.950). 3° and 2°tibial prosthesis coronal angle deviation post computer-assisted navigation was significantly superior to traditional total knee arthroplasty (3°, P=0.030);the 2° deviation had no significant difference between the two surgeries (P=0.260). Computer-assisted navigation has better limb alignment, femoral and tibial prosthesis alignment 3° deviation than the traditional total knee arthroplasty, but the 2° deviation of femoral prosthesis coronal angle, femoral prosthesis sagittal angle, and tibial prosthesis sagittal angle had no significant difference between the two surgeries.

Objective: To summarize the latest research progress of early postoperative rehabilitation for acute Achilles tendon rupture after surgical repair. Methods: The high-quality randomized controlled trials and systematic reviews/meta-analyses regarding early postoperative rehabilitation for acute Achilles tendon rupture in recent years were reviewed. Results: There are three functional rehabilitations after acute Achilles tendon rupture surgery, including early postoperative mobilization, early weight-bearing with immobilization, and early weight-bearing combined with mobilization. The results of randomized controlled trials show that the effectiveness of early postoperative rehabilitation is similar or better than the early postoperative immobilization. The results of systematic reviews/meta-analyses show that the early postoperative rehabilitation is beneficial to the early function recovery of the Achilles tendon, can reduce the time for functional recovery, and do not adversely affect the outcomes. Conclusion: Early postoperative rehabilitation is beneficial to the functional recovery, and do not increase postoperative complications. There is still no uniform protocol of early postoperative rehabilitation and the timing of weight-bearing, and further studies are needed in the future.

BACKGROUND:Fetal bovine serum as nutritional support is often used in the traditional cel culture. Consequently, a host of potential problems such as the spread of disease and immunological reactions exist. To find a suitable fetal bovine serum substitute and to establish a culture system of human bone marrow stromal stem cels in vitro which has been standardized, safe and efficient has just started. OBJECTIVE:To investigate the effects of different serums on proliferation of bone marrow stromal stem celsin vitro. METHODS:Bone marrow stromal stem cels were obtained from adult bone marrow, which were cultured in DMEM containing 10% AB serum, 10% autologous serum, or 10% fetal bovine serum. Cels at passage 3 were used in this study. RESULTS AND CONCLUSION:The cel confluence in the AB serum group was earlier than that in the fetal bovine serum group and autologous serum group. Human bone marrow stromal stem cels maintained the phenotypes of bone marrow stem cels in three serums detected by flow cytometry. AB serum group showed the highest fluorescence intensity and the most efficiency of cel proliferation which examined by the AlamarBlue assay. Apoptosis rate was < 5% in al the three groups, and cels grew wel in these serums. Alkaline phosphatase, calcium nodules and oil red O staining showed that the cels maintained the osteogenesis and adipogenesis capacity in the three groups. AB serum was found to have a better effect on proliferation capability of cels than fetal bovine serum and autologous serum. Taken together, AB serum is expected to be a substitute of fetal bovine serum to build anin vitro culture system of adult bone marrow stromal stem cels that accord with the clinical requirements of bone tissue engineering.

Objective To study the technique, clinical effect and safety of endoscopic calcaneoplasty for Haglund disease. Methods Clinical data of 12 patients with Haglund disease having underwent endoscopic calcaneoplasty were collected and retrospectively reviewed. All the patients experienced conservative treatment for 3 to 6 months which was failed and then turned to endoscopic calcaneoplasty. The American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score before and after operation, patient′s satisfaction and complication were recorded. Postoperative complications were also observed. Results All the patients underwent the operation successfully within 70 min, with 42 min on average, and no complications occurred. All the patients were followed up for 12.4 (8-16) months, the AOFAS ankle-hindfoot score after operation was significantly higher than before operation:94.6 (86-100) scores vs. 58.6 (32-72) scores, and there was statistical difference (P<0.05). After operation, 10 cases were excellent, and 2 cases were good. All patients were satisfied with the surgery, and no recurrence occurred during the follow-up period. Conclusions Endoscopic calcaneoplasty appears to be a safe, minimal invasive and effective surgical procedure for the treatment of Haglund disease.

Objective To evaluate the surgical treatment of complex acetabular fractures through the lateral-rectus approach with pelvic reconstructive plate and antegrade posterior-column lag screws.Methods Between January 2014 and April 2018,29 patients were surgically treated for complex acetabular fractures at Department of Orthopaedic and Trauma,Taihe Hospital.They were 22 males and 7 females,aged from 19 to 72 years(mean,41.7 years).According to the Letournel-Judet classification,there were 4 transverse fractures,7 T-shape fractures,15 both column fractures and 3 anterior plus posterior hemitransverse fractures.In all the patients,the lateral-rectus approach was adopted;their anterior column fractures were fixated with pelvic reconstructive plate and screws and their posterior column fractures with antegrade lag screws.The operation time,intraoperative bleeding,fracture reduction,fracture union time,function of the affected hip and complications were recorded.Results The operation time ranged from 50 to 140 min,averaging 85 min;the volume of intraoperative bleeding ranged from 150 to 1,100 mL,averaging 315 mL.By the Matta criteria,the reduction was rated as excellent in 21 cases,as good in 7 and as poor in one,giving an excellent to good rate of 96.6％.The average follow-up was 16.2 months (from 6 to 30 months) for the 29 patients.Their fractures got united after an average of 11 weeks (from 7 to 13 weeks).According to the Merle d'Aubigné & Postel scoring system at the last follow-up,the function of the affected hip was excellent in 20 cases,good in 7 and fair in 2,yielding an excellent to good rate of 93.1％.There was one case of vasospasm of external iliac artery.No such complications were observed by follow-up as infection,deep venous thrombosis,heterotopic ossification,osteoarthritis or avascular necrosis of the femoral head.Conclusions The lateral-rectus approach with pelvic reconstructive plate and antegrade posterior-column lag screws is a suitable surgical treatment for complex acetabular fractures,leading to satisfactory clinical results.The lateral-rectus approach provides adequate exposure of the quadrilateral surface and facilitates insertion of the posterior column antegrade lag screws.

Objective:To investigate the iodine nutritional status of adults and pregnant women in Jianshui County and Zhenxiong County, Yunnan Province.Methods:From May to August 2021, one urban area and one rural area in Jianshui County and Zhenxiong County, Yunnan Province were selected as investigation sites. At least 100 adults (half male and half female) and 100 pregnant women were selected as survey subjects in each investigation site. Random urine samples were collected from all survey subjects once to detect urine iodine, creatinine and sodium contents. Venous blood samples of all pregnant women were collected to detect the serum iodine content, and the 95% medical reference range of serum iodine was established using the percentile method.Results:The medians urinary iodine, creatinine and sodium of adults in Jianshui County and Zhenxiong County were 184.7 μg/L ( n = 432), 12 355.0 μmol/L ( n = 431) and 156.5 mmol/L ( n = 420), respectively. The median urinary iodine of adults in Jianshui County was higher than that in Zhenxiong County (197.3 vs 170.2 μg/L), the difference was statistically significant ( Z = - 2.90, P = 0.003). The median serum iodine of pregnant women in Jianshui County and Zhenxiong County was 92.1 μg/L ( n = 412), with a 95% medical reference value ranged from 45.3 to 183.5 μg/L; the medians urinary iodine, creatinine and sodium of pregnant women were 138.6 μg/L ( n = 413), 12 173.0 μmol/L ( n = 408) and 152.2 mmol/L ( n = 409), respectively. The urinary iodine (154.1 vs 115.8 μg/L), urinary creatinine (13 216.0 vs 11 376.0 μmol/L) and urinary sodium (161.8 vs 141.8 mmol/L) of pregnant women in Jianshui County were higher than those in Zhenxiong County, with statistical differences ( Z = - 5.12, - 2.29, - 4.30, P < 0.05). Conclusion:Adults in Jianshui County and Zhenxiong County are at an appropriate level of iodine, but pregnant women in Zhenxiong County are at an iodine deficiency level.

Objective:To investigate the orthopedists' cognition on Chinese Osteoarthritis Guideline (2018 Edition).Methods:Questionnaire about Chinese Osteoarthritis Guideline (2018 Edition) was developed and sent to orthopedists via an invitation link to fill out after authorization from Chinese Osteoarthritis Association. The content of the questionnaire included the basic personal information of the physician, the awareness rate of the guidelines, the evaluation of the guidelines, and its application effects. The survey duration was from September 2019 to December 2019. Multivariate logistic regression and linear regression analysis were performed for the guideline awareness rate and comprehensive score, respectively.Results:A total of 628 physicians completed the questionnaire, of which 623 of 628 (99.2%) were available. About 72.4% of the orthopedists knew the guideline. The awareness rate was statistically related to the education of the physicians ( P<0.05). Respondents' overall score for the guideline was 8.39 with methodological score 8.28. A total of 41.2% of orthopedists thought that the guideline was very good compared with the European and American guidelines, and the clinical problem coverage rate was 78.6%. There is a statistically significant difference in the appraisal of the recommendations ( χ2=138.9, P<0.05) . More than 40% of orthopedists believed that the guidelines were of great help to orthopedists and patients, and that the guide could be promoted to the primary hospitals. Conclusion:After one year publication of Chinese Osteoarthritis Guideline (2018 Edition), most orthopedists have understood the present guideline and applied recommendations in clinical practice. However, the guideline need to be further promoted and disseminated in the future.

Objective To investigate the risk factors for postoperative deep wound infection after open reduction and internal fixation for closed calcaneal fractures.Methods From January 2014 to January 2017,190 patients with closed calcaneal fracture were treated at Department of Traumatic Orthopaedics,Taihe Hospital.They were 118 males and 72 females with an average of 39.8 years (range,from 18 to 73 years).They were divided into a deep infection group and a non deep infection group according to the presence or absence of deep wound infection in the follow-up period.The 2 groups were compared in the general clinical data.In statistical analysis,the related risk factors were first screened by single factor analysis and followed by multivariate logistic regression analysis to identify the independent risk factors associated with the postoperative deep wound infection in patients with closed calcaneal fracture.Results The 190 patients were followed up for an average of 21.3 months(range,from 13 to 31 months).Postoperative deep wound infection occurred in 11 patients,giving an overall incidence of 5.7％ (11 / 190).The single factor analysis showed that the deep infection group incurred significantly longer time for tourniquet and used significantly more conventional extensile lateral approach than the non deep infection group (P ＜ 0.05).There were no significant differences between the 2 groups in general data,injury cause,fracture type,drainage,or incision closure technique (P ＞ 0.05).The multivariate logistic regression analysis revealed that tourniquet time ＞ 80 min (OR=5.949,95％ CI:1.216～ 29.108,P=0.028) and conventional extensile lateral approach (OR =5.414,95％ CI:1.507 ～ 19.452,P =0.01) were independent risk factors fo r the postoperative deep wound infection in patients with closed calcaneal fracture after open reduction and internal fixation.Conclusions Tourniquet time and conventional extensile lateral approach may be the independent risk factors for postoperative deep wound infection in patients with closed calcaneal fracture after open reduction and internal fixation.Therefore,it is important to adopt the sinus tarsi approach and control tourniquet time within 80 minutes for prevention of deep wound infection as long as the surgical quality is ensured.

Objective:To understand the contents of edible salt iodine and urinary iodine of children and pregnant women in Yunnan Province, and to evaluate the iodine nutrition status, so as to provide a basis for scientific prevention and treatment of iodine deficiency disorders (IDD).Methods:From November to December 2020, one county (city) was selected from each prefecture (city), two townships (towns and streets) were selected from each county (city) and two villages (neighborhood committees) were selected from each township (town and street) from each of the 16 prefectures (cities) in Yunnan Province as the investigation sites. A total of 20 non-boarding children (male and female balanced) aged 8 - 10 years old were selected from each primary school in each village (neighborhood committee) to collect salt and urine samples. A total of 80 children were investigated in each county (city). A total of 20 pregnant women were selected from each township (town and street) to collect salt and urine samples. A total of 40 pregnant women were investigated in each county (city). All salt samples and urine samples were tested for iodine contents.Results:A total of 2 009 salt samples and 2 041 urine samples (1 375 for children, 666 for pregnant women) were collected from children aged 8 - 10 years old and pregnant women in 16 counties (cities) of Yunnan Province. Among them, the median salt iodine was 26.0 mg/kg, the coverage rate of iodized salt was 100.0% (2 009/2 009), the qualified rate of iodized salt was 98.7% (1 982/2 009), and the consumption rate of qualified iodized salt was 98.7% (1 982/2 009). The difference of salt iodine content in key populations in different counties (cities) was statistically significant ( H = 258.98, P < 0.01). The median urinary iodine of children aged 8 - 10 years old was 188.5 μg/L. There was statistically significant difference in urinary iodine content among children of different ages ( H = 29.45, P < 0.01), but there was no statistically significant difference in urinary iodine content among children of different genders ( H = 1.43, P > 0.05). In addition, the median urinary iodine of pregnant women was 141.9 μg/L, 52.1% (347/666) was < 150 μg/L. There was statistically significant difference in urinary iodine content of pregnant women in different counties (cities, H = 88.32, P < 0.01). Conclusions:The qualified rate of iodized salt, the coverage rate of iodized salt and the consumption rate of qualified iodized salt in key populations of Yunnan Province are more than 90%, and the iodized salt supply is good. Iodine nutrition of children aged 8 - 10 years old is at an appropriate level (100 - 199 μg/L); iodine nutrition of pregnant women is in an state of iodine deficiency ( < 150 μg/L). It is suggested to strengthen IDD monitoring and health education among key populations, improve residents' awareness of disease prevention, and make scientific iodine supplementation.

Objective:To analyze the influencing factors of thyroid volume in children aged 8 - 10 in Yunnan Province, and provide scientific basis for improving iodine deficiency disorders monitoring.Methods:From March to July 2020, in 129 counties (cities, districts) under the jurisdiction of Yunnan Province, each county (city, district) was divided into 5 sampling areas based on east, west, south, north, and middle. One township was selected from each area, and 40 non-boarding children aged 8 - 10 from one primary school were selected from each township (age balanced, half male and half female) as survey subjects. One random urine sample and household edible salt samples were collected for urine iodine and salt iodine testing, and physical examination and thyroid volume measurement were conducted for children. The influencing factors of thyroid volume were analyzed using Pearson correlation.Results:A total of 24 934 urine samples were collected from children, with a median urine iodine of 233.2 μg/L. A total of 24 933 household edible salt samples were collected from children, the median salt iodine was 24.17 mg/kg, and the qualified rate of iodized salt was 96.63% (24 003/24 839); A total of 24 937 children were examined of their thyroid gland, with a median thyroid volume of 2.62 ml and a goiter rate of 1.12% (280/24 937). Among them, there were 12 410 boys and 12 527 girls, with thyroid volumes of 2.61 and 2.64 ml, respectively. The thyroid volume of boys was positively correlated with age, height, weight, body mass index, body surface area, and salt iodine ( r = 0.15, 0.21, 0.26, 0.18, 0.25, 0.03, P < 0.001). The thyroid volume of girls was positively correlated with age, height, weight, body mass index, and body surface area ( r = 0.17, 0.26, 0.28, 0.17, 0.27, P < 0.001). Conclusion:Children aged 8 - 10 in Yunnan Province are at an iodine excess level; the age, weight, height, body mass index, and body surface area are influencing factors of thyroid volume.