BACKGROUND:Now, domestic total knee arthroplasty surgeries mainly use medial parapatel ar approach, with the disadvantages of large trauma and slower recovery. The quadriceps sparing approach is more accorded with normal anatomy, which can keep the knee extension system intact. The clinical comparison between quadriceps sparing approach and medial parapatel ar approach is rare.
OBJECTIVE:To compare the early effect of total knee arthroplasty through quadriceps sparing approach and medial parapatel ar approach.
METHODS:From January 2009 to January 2010, 55 patients (70 knees) were randomly divided into quadriceps sparing approach group (n=26, 35 knees) and medial parapatel ar approach group (n=29, 35 knees). Patients in two groups received total knee arthroplasty through quadriceps sparing approach and medial parapatel ar
approach respectively. The incision length, operative time, postoperative drainage volume, additional amount of etoricoxib tablets, pain degree, straight leg raising time, start walking time, hospitalization time, range of motion of knee joint, Hospital for Special Surgery Knee Score, radiographic alignment of al components and complications were compared between two groups. Al the prostheses used in this study were the Sigma type prostheses
provided by the rotation platform of Johnson&Johnson Company.
RESULTS AND CONCLUSION:Al the patients were fol owed-up for 12-24 months without infections, deep vein thrombosis, neurovascular injury, prosthesis instability, prosthesis loosening or displacement. Position of al the
prostheses was normal in patients. The operative time in the quadriceps sparing approach group was longer than that in the medial parapatel ar approach group (P=0.00), while the incision length, postoperative drainage volume, additional
amount of etoricoxib tablets, visual analog scale, straight leg raising time, start walking time, hospitalization time, range of motion of knee joint at 3 days after replacement and Hospital for Special Surgery Knee Score in the quadriceps
sparing approach group were better than those in the medial parapatel ar approach group (P<0.05). There were no
significant differences in range of motion of knee joint at 3 days after replacement and Hospital for Special Surgery Knee Score between two groups. The early effect of total knee arthroplasty through quadriceps sparing approach is better than the medial parapatel ar approach, and there is no significant difference in prosthesis alignment between two methods.

This study was aimed to investigate the efficacy, acceptance, complications / adverse events treated with traditional manipulation and bed rest for patients with acute nonspecific low back pain (ANLBP). A total of 60 ANLBP patients were distributed into the Group A/B randomly and equally. Patients in Group A were treated by bed rest absolutely for one week; meanwhile patients in Group B were treated by traditional manipulation for one week. IBM SPSS20.0 was used to analyze the Visual Analogue Scale (VAS), Chinese Oswestry Disability Index (ODI), acceptance, complications / adverse events and others. The results showed that VAS and ODI reduced after one-week treatment in Group A and B (t = 14.67, 11.55, allP < 0.001 andt = 24.80, 15.35, allP <0.001). Differences of VAS and ODI were with significant difference between Group A and B (t = 3.24, 2.75,P =0.002, 0.009). Scores of acceptance and complications / adverse events were with significant difference between Group A and B (t = 2.65,P = 0.01 andχ2= 10.00,P = 0.002). It was concluded that both manipulation and bed rest can alleviatepain due to ANLBP, promote functional recovery. However, traditional manipulation can better improve symptoms, easier to be accepted by patients with less complications / adverse events.

Objective To investigate the clinical efficiency of Huayu Xiaozhong Decoction (HXD) on preventing peri-operative deep venous thrombosis (DVT) in lower limbs following artificial total hip replacement. Methods Ninety cases following artificial total hip replacement were randomized into blank control group, Rivaroxaban group and HXD group, 30 cases in each group, and were treated with brown sugar water, Rivaroxaban, HXD respectively. Before operation, and one, 3 and 14 days after operation, we monitored the changes of bleeding volume, DVT incidence, hemoglobin, prothrombin time ( PT) , activated partial thromboplastin time ( APTT) , international normalized ratio (INR), and D-dimer (DD) in the three groups. Results (1) Fifteen cases had DVT, with a total incidence rate of 16.67%. Of the 15 cases, 10 were from blank control group, 2 from Rivaroxaban group, and 3 from HXD group. ( 2) The amount of bleeding volume of Rivaroxaban group was larger than that of the blank control group and HXD group (P<0.05), but the bleeding was mild. (3) One, 3 and 14 days after operation, PT and APTT were shortened in blank control group (P<0.01 compared with those before operation). PT, APTT and INR were prolonged, and coagulation function was improved in Rivaroxaban group and HXD group, the differences being significant as compared with the blank control group ( P<0.05). HXD group had better effect on improving INR than Rivaroxaban group ( P<0.05). ( 4) In the three groups, hemoglobin level began to decrease on postoperative day one, arrived to the bottom on postoperative day 3 (P<0.05), and rose up near to the normal level on postoperative day 14; HXD group had higher hemoglobin level than blank control group and Rivaroxaban group on postoperative day 3 and 14 ( P<0.05). The 3 groups had higher plasma DD level than the normal level before the operation, arrived to the highest level on postoperative day one and 3 ( P<0.05) , and fell down near to the normal level on postoperative day 14. The inter-group comparison results showed that Rivaroxaban group and HXD group had lower DD level than the blank control group on postoperative day 3 and 14 ( P<0.05). Conclusion HXD is effective on preventing DVT in the peri-operation period through reducing bleeding, increasing hemoglobin level and improving postoperative anemia. The efficiency and safety of HXD are similar to Rivaroxaban.

Objective:To evaluate the health related quality of life (HRQoL) of hip fracture patients after surgery and build a prediction model to identify high-risk patients with HRQoL decline.Methods:A cross-sectional research method was applied to select 135 patients with unilateral hip fractures from January 2020 to June 2021 in Hainan Provincial Hospital of Traditional Chinese Medicine using convenience sampling as the study population. HRQoL was self-assessed using the European Five-Dimensional Health Scale (EQ-5D).Logistic regression models were used to identify risk factors for HRQoL decline. The columnar plots′ predictive accuracy and net clinical benefit were assessed using calibration curves, ROC curves, and decision curve analysis (DCA).Results:The final number of patients with valid follow-up was 122.At 6 and 12 months postoperatively, the EQ-5D index was lower than before the fracture in 41(33.6%) patients, showing a strong correlation with the Barthel index ( r=0.833, 0.705, both P<0.05). Nutritional Risk Screening 2002 (NRS-2002) ( OR=1.352), Charlson Comorbidity Index (CCI) ( OR=1.121), hip replacement ( OR=0.795), and lung infection ( OR=1.328) were independently associated with a decrease in HRQoL in patients with hip fracture (all P<0.05). The consistency index (C-index) of the column line plot was 0.889 (0.791 to 0.955), and the area under the curve (AUC) was 0.871 (0.784 to 0.947). The DCA results showed that the model provided good net clinical benefit. Conclusions:The model can effectively identify patients at high risk of declining HRQoL, which is helpful to determine priority patients to provide nursing strategies.