OBJECTIVETo study the effects of transcutaneous electrical nerve stimulation on multimodal analgesia after total knee arthroplasty.

METHODSSixty patients diagnosed as knee osteoarthritis and suffered unilateral total knee arthroplasty in the department of orthopedics, Zhejiang Traditional Chinese Medicine Hospital from March 2009 to May 2012 were randomly divided into control group and test group, 30 cases in each group. All the patients received celecoxib preoperatively, knee periarticular injection with the drug mixture intraoperatively, and celecoxib and morphine sulfate controlled-release tablets postoperatively. The patients in the test group were also treated with transcutaneous electrical nerve stimulation each day after operation. All the patients started doing functional exercises at 24 h after operation. Postoperative visual analogue scales(VAS), passive and active range of motion of knee joint,and complications were recorded.

RESULTSThe VAS scores of test group during postoperative 24 h to 1 week were 3.39 +/- 0.69, 2.79 +/- 0.51, 2.16 +/- 0.52, and 1.07 +/- 0.57 separately,which were lower than 3.80 +/- 0.86, 3.22 +/- 0.58, 2.53 +/- 0.54 and 1.38 +/- 0.52 in the control group. The passive and active range of knee joint motion in the test group during postoperative 24 h to 2 weeks were (30.67 +/- 3.65) degrees, (39.17 +/- 3.96) degrees, (47.83 +/- 4.86) degrees, (93.67 +/- 7.30) degrees, (107.67 +/- 7.51) degrees and (29.83 +/- 5.33) degrees, (78.33 +/- 8.24) degrees, (95.17 +/- 5.94) degrees respectively,which were higher than (28.67 +/- 3.92) degrees, (36.83 +/- 4.25) degrees, (45.17 +/- 5.17) degrees, (89.83 +/- 7.25) degrees, (103.17 +/- 7.37) degrees and (24.17 +/- 10.26) degrees, (73.83 +/- 9.07) degrees, (91.33 +/- 7.42) degrees in the control group. In the test group, 19 patients had ring-shaped haemostasis impression to some extent in the skin of knee joint to different degree, and 5 patients had blister formation.

CONCLUSIONIt is meaningful to apply transcutaneous electrical nerve stimulation for treating multimodal analgesia after total knee arthroplasty,which can not only relieve patients' postoperative pain, and also promote the rehabilitation of knee function as far as possible.

Aged ; Aged, 80 and over ; Analgesia ; Arthroplasty, Replacement, Knee ; adverse effects ; Female ; Humans ; Knee Joint ; surgery ; Male ; Middle Aged ; Pain, Postoperative ; etiology ; therapy ; Transcutaneous Electric Nerve Stimulation ; Treatment Outcome

OBJECTIVETo investigate the application and effects of external fixator under the guidance of damage control therapy in limb open fracture.

METHODSFrom May 2008 to January 2013,72 cases with severe limb open fractures (Unincor- porated shock) were divided into control group and observation group (36 cases in each group). In observation group, 36 patients (including 22 males and 14 females) were treated by external fixator at stage I, as soon as possible after waiting for patients physiology conditions being stable,the stage II fracture operation was performed. In control group, 36 patients (24 males and 12 females) were treated by the first stage open reduction. The hospital admission time, open fracture severity score (OFSS),operation duration,operative blood loss,X-ray expose times, callus appear time, fracture healing time, postoperative infection rate, complications and Johner-Wruhs accceccment were recorded and evaluated.

RESULTSAll patients were followed up for 8 to 12 months (10.4 in averaged). The mean operation duration, operative blood loss, callus appear time, fracture healing time the mean operation duration reespectively were (56.79±8.87) min, (216.16±18.21) ml, (5.32±0.71) weeks, (12.79±2.52) weeks in observation group,and (104.53±9.28) min, (439.93±14.65) ml, (4.97±1.26) weeks, (14.81±2.63) weeks in control group. According to Johner-Wruhs acccecement,there were were 33 cases in excellent,2 in good,and 1 in poor in observation group,non-union of fracture in 1 case,local infection occurred in 1 cases; in control group 25 cases in excellent,6 in good, and 5 in poor, non-union of fracture in 1 case,local infection occurred in 8 cases. There were significant differences in operation duration, operative blood loss, callus appear time, fracture healing time, postoperative infection rate, complications (P<0.05). There were no significant differences in hospital admission time, open fracture severity score and X-ray expose times (P>0.05).

CONCLUSIONUnder the guidance of damage control therapy,using external fixator measures to treat patients with open fractures of limbs is worth popularizing in clinical application because it can shorten the operation time, less blood loss, reduce the infection rate and complications, improve the success rate of surgery and recovery rate.

Adult ; Aged ; External Fixators ; Extremities ; injuries ; surgery ; Female ; Fracture Healing ; Fractures, Open ; surgery ; Humans ; Male ; Middle Aged ; Operative Time ; Postoperative Complications ; epidemiology

Hip fracture patients preoperative and postoperative exist hidden blood loss which often affect patients' wound healing, increase the probability of infection, prolong rehabilitation exercise, influence postoperative effect. At the same time, the body's blood loss increase the activation of the blood clotting mechanism, promote the incidence of deep vein thrombosis, bleeding and deep vein thrombosis has become the main causes of high risk in hip operation. It is very important to stop bleeding, anticoagulation should not be ignored, so how to effectively deal with the prominent contradiction between the postoperative anticoagulation and bleeding or looking for a best balance has become a intractable problems in hip fracture treatment.
Anticoagulants ; therapeutic use ; Blood Loss, Surgical ; prevention & control ; Hip Fractures ; complications ; surgery ; Humans ; Intraoperative Complications ; drug therapy ; etiology ; prevention & control

OBJECTIVETo explore the clinical effects of internal fixation with lag screws plus an anti-sliding plate for the treatment of Hoffa fractures of the lateral femoral condyle.

METHODSFrom May 2006 to May 2014, 17 patients with Hoffa fractures of the lateral femoral condyle were treated with lag screws plus an anti-sliding plate. There were 13 males and 4 females, ranging in age from 27 to 59 years, with a mean of 32.5 years. All the fractures were fresh and closed fractures. According to the Letenneur's classification, 8 cases were type I, 4 cases were type II, 5 cases were type III. All the patients had no injuries of the cruciate ligament and the another part of the knee. Operative incision and fracture healing time were observed, knee joint function was evaluated by Letenneur system and HSS standard.

RESULTSThe patients were followed up from 10 to 24 months with a mean of 14.6 months. All incisions achieved primary healing, and no internal fixation breakage, malunion, femoral candyle necrosis, deep vein thrombosis of lower extremity were found. Fracture healing time was from 4 to 9 months with an average of 4.7 months. According to Letenneur's functional assessment, 10 patients got an excellent results, 4 good, 3 fair. Total HSS score was 91.1 +/- 4.7 on average,15 cases obtained excellent results, 2 good.

CONCLUSIONInternal fixation with lag screws and an anti-sliding plate can result in excellent effects for Hoffa fractures of the lateral femoral condyle. The key to a successful surgery is an anatomic reduction and rigid fixation of the fracture.

Adult ; Bone Plates ; Bone Screws ; Female ; Femoral Fractures ; physiopathology ; surgery ; Femur ; injuries ; surgery ; Fracture Fixation, Internal ; Fracture Healing ; Fractures, Closed ; physiopathology ; surgery ; Humans ; Ligaments, Articular ; surgery ; Male ; Middle Aged

Diagnostic Errors ; Female ; Femoral Neck Fractures ; diagnosis ; diagnostic imaging ; Femur Neck ; diagnostic imaging ; injuries ; Humans ; Radiography ; Young Adult

OBJECTIVETo evaluate the therapeutic effects of percutaneous kyphoplasty (PKP) for the treatment of osteoporotic vertebral compression fracture (OVCF) with degenerative scoliosis.

METHODSFrom March 2009 to March 2014,121 patients undergoing PKP for the treatment of osteoporotic vertebral compression fracture (OVCF) with degenerative scoliosis were retrospective analyzed. There were 41 males and 80 females,ranging in age from 56 to 92 years with an average of 73.2 years. Preoperative and postoperative 3 d respectively pain visual analogue scale (visual analogue score, VAS) and Oswestry Disability Index assessed pain and functional recovery of patients and preoperative and postoperative 3 d lumbar lordosis, scoliosis Cobb angle were analyzed.

RESULTSAll the patients were followed up, and the duration ranged from 6 to 24 months, with a mean time of 11 months. All the patients achieved success in operation without serious complications. The operation time ranged from 30 to 65 min with an average of 42.2 min. Local leakage of bone cement was not found in canal. The VAS and Oswestry Disability Index at the 3rd day after operation decreased significantly compared with those of the preoperative (P < 0.05), and the lumbar lordosis and scoliosis Cobb angle also improved significantly compared with those of the preoperative (P < 0.05).

CONCLUSIONPercutaneous kyphoplasty (PKP) for the treatment of thoracolumbar scoliosis osteoporotic fracture can significantly improve patients spinal deformity, pain relief, which is worth of recommending.

Aged ; Aged, 80 and over ; Female ; Fractures, Compression ; surgery ; Humans ; Kyphoplasty ; methods ; Male ; Middle Aged ; Osteoporotic Fractures ; surgery ; Scoliosis ; surgery ; Spinal Fractures ; surgery ; Visual Analog Scale

Chronic osteomyelitis is one of the most common disorder in clinic. In recent years due to diabetes, peripheral vascular disease and trauma induced disease increased, the prevalence rate increased. With the development of magnetic resonance imaging and CT imaging technology, it greatly improved the accuracy of clinical diagnosis of chronic osteomyclitis and ability to describe the infection characteristics, and provide a reliable basis for clinical treatment. The current research on chronic osteomyelitis mainly concentrated on the aspects of imaging applications and ways of using antibiotic optimization control inflammation, defect restoration and reconstruction of blood supply and treatment. But the best time to the antibiotic therapy and the use of program is still uncertain, for after debridement, bone grafting time and defect repair function of fast recovery still need further research.
Anti-Bacterial Agents ; therapeutic use ; Chronic Disease ; Humans ; Osteomyelitis ; diagnosis ; therapy

OBJECTIVETo explore the diagnostic value of the radiologic characteristics of osteoporotic Kummell's disease.

METHODSTotal 16 patients with pathologically confirmed osteoporotic Kummell's diseases were reviewed from May 2010 to May 2012, including 4 males and 12 females with the mean age of 73.4 years (ranged, 67 to 83 years old). Radiologic imagings of all patients, including X-ray, CT and MRI, were analyzed retrospectively.

RESULTSIntravertebral linear clefts could be seen on the AP and lateral X-ray films of vertebrae. Sagittal and axial CT scans demonstrated the vacuum cleft phenomenon with liquid and air was identified within the vertebral body. Sagittal MRI showed the callapsed vertebral segment and the area of fluid signal with clear and intact border within the vertebral body. The fluid signal was low on T1-weighted images and high on T2-weighted images and stir images, which was corresponding to an intravertebral vacuum cleft.

CONCLUSIONThe radiologic characteristics of Kurmmell's diseases can provide valuable evidences for the early diagnosis.

Aged ; Aged, 80 and over ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Osteonecrosis ; diagnosis ; diagnostic imaging ; pathology ; Retrospective Studies ; Spinal Fractures ; diagnosis ; diagnostic imaging ; pathology ; Tomography, X-Ray Computed

Knee osteoarthritis is one of the common type of arthropathy, the clinical stage of the typical patients belongs to the middle-late stage, so it urges to improve the early diagnosis. At present, magnetic resonance imaging is most used in clinical diagnosis of knee osteoarthritis, and with the development of different MRI sequences, the sequences of early articular cartilage lesions are used in clinic. In the early diagnosis of knee osteoarthritis, the simple and practical methods such as ultrasonography is becoming a trend, and the specific biomarkers of early knee osteoarthritis have become the hot research. This overview article outlined the methods of early diagnosis from the ultrashort echo time MRI, ultrasonography and biomarkers.
Biomarkers ; analysis ; Early Diagnosis ; Humans ; Magnetic Resonance Imaging ; Osteoarthritis, Knee ; diagnosis ; diagnostic imaging ; metabolism ; Radiography ; Ultrasonography

OBJECTIVETo compare the differences between computer aided identification and ultra-thin layer slicing in measuring the lesions of femoral head necrosis,and to confirm the accuracy and practicability of computer aided method.

METHODSFrom June 2012 to December 2013, the X-ray and MRI of 24 patients (24 hips on unilateral) were reviewed, who had avascular necrosis of the femoral head (ANFA) at late stage (stage III and IV) according to the ARCO international staging system. There were 15 males and 9 females, with an average age of (65.1 ± 8.8) years old, ranged 33 to 74 years old. Based on the software system with seeds point identification, the ragional adaptive search method with computer aid was used to calculate the volume of necrotic lesion in femoral on MRI. Then the pathological slices of those intraoperative femoral heads were made to measure the gross volume of necrotic lesion in femoral head,and the values were compared with the data in the computer.

RESULTSFor 24 hips, by the calculation of computer, the necrotic volume was (20.00 ± 3.04) cm (ranged, 18.72 to 21.29 cm³). Under the pathological section, the necrotic volume of the femoral head was (19.89 ± 3.17) cm³ (ranged, 18.55 to 21.23 cm³). In computer and pathology two kinds of measurement, the two entire femoral head volume had no significant difference using these two measurements (t = -1.227, P = 0.232).

CONCLUSIONComputer aided identification for necrotic area of femoral head adaptive can demonstrate the morphology of femoral head necrosis accurately and reliably, which will help surgeon better understand the morphology and orientation in femoral head.

Adult ; Aged ; Diagnosis, Computer-Assisted ; Female ; Femur Head Necrosis ; pathology ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged