Objective To study the clinical efficacy of Bikini incision minimally invasive total hip arthroplasty on elder patients with femoral head necrosis and its effect on bleeding.Methods Seventy-six elder patients with femoral head necrosis in Sanmenxia Central Hospital from January 2015 to December 2016 were randomly divided into the study group(38 cases)and the control group(38 cases).The patients in the study group were treated with Bikini incision minimally invasive total hip arthroplasty by anterior approach,while the control group underwent total hip arthroplasty by anterolateral approach.Harris score and WOMAC score were used to evaluate the clinical function of hip joint.The operation time,length of incision,intraoperative blood loss, blood transfusion,hospitalization time,hemoglobin level at 72 h after surgery,the first ambulation time,the lower limb length discrepancy,postoperative complication were recorded and compared between two groups.Results The Harris scores at 1,2,4 months after operation in the two groups were significantly improved(P<0.05), while WOMAC scores of patients at 1,2,4 months after operation were significantly lower than those before treatment(P<0.05).However,there were no significant differences at different time between the groups(P>0.05).The hospitalization time and the first ambulation time in the study group were significantly shorter than those in the control group((6.1±2.8)d vs.(7.9±3.2)d,P=0.011;(5.3±1.5)d vs.(6.4±1.7)d,P=0.004).After 4 months of treatment,the lower limb length discrepancy in the study group was less than that of the control group((6.5 ± 2.3)mm vs.(10.4 ± 3.5)mm,P<0.01).In addition,there were no significant differences between two groups in the operation time,length of incision,complication occurrence,intraoperative blood loss and blood transfusion(P>0.05).Conclusion Treating femoral head necrosis with Bikini incision minimally invasive total hip arthroplasty can achieve favorable effectiveness,with no increase in intraoperative blood loss and rapid recovery of postoperative joint function,but further follow-up is needed.

OBJECTIVETo analyze the percutaneous kyphoplasty (PKP) data statistically to predict the bone cement volume (CV).

METHODSRetrospective analysis of 93 patients with 154 vertebrae of osteoporotic vertebra compressed fracture, who received PKP from January 2012 to December 2013 in Beijing Tian Tan Hospital, Capital Medical University. All procedures were bilateral and non-high-pressure polymethyl methacrylate injection. The balloon volume (BV), balloon peak pressure (Pmax), CV and the ratio of Pmax to BV (P/BV) were documented. The data was analyzed by correlation analysis and linear regression analysis to reveal the correlation between BV and CV.

RESULTSSeven vertebrae had bone cement leakage, no intraspinal leakage, no neuro-deficit. Visual analogue scale was 0-2 of all patients on 3 d postoperation. The data of 147 vertebrae without leakage: BV was 2.1-6.3 ml, Pmax was 130-359 psi, CV was 2.8-8.5 ml, and the ratio of Pmax to BV (P/BV) was 25-263 psi/ml. The data analysis showed there was no high correlation between BV and CV as one group (R<0.75). However if divided the data into three groups by the value of P/BV, group A (P/BV<100), group B (100≤P/BV<200), group C (P/BV≥200), there was high correlation and linear relationship between BV and CV in each group (R>0.75, P<0.01). CV was 0.9-1.1 times of BV in group A; CV was 1.4-1.6 times of BV in group B; and CV was 2.0-2.2 times of BV in group C.

CONCLUSIONCV is predictable by the BV and the ratio of Pmax to BV. It can reduce the rate of the leakage, and also can prevent the unsatisfactory results by insufficient bone cement volume.

Beijing ; Bone Cements ; Fractures, Compression ; surgery ; Humans ; Injections ; Kyphoplasty ; Pain Measurement ; Postoperative Period ; Pressure ; Retrospective Studies ; Spinal Fractures ; surgery

OBJECTIVE: To investigate the effect of folic acid coated-crosslinked urethane-doped polyester elastomer (fCUPE) nerve conduit in repairing long distance peripheral nerve injury. METHODS: Thirty-six 3-month-old male Sprague Dawley rats weighing 180-220 g were randomly assigned to 3 groups, each consisting of 12 rats: CUPE nerve conduit transplantation group (group A), fCUPE nerve conduit transplantation group (group B), and autologous nerve transplantation group (group C), the contralateral healthy limb of group C served as the control group (group D). A 20-mm-long sciatic nerve defect model was established in rats, and corresponding materials were used to repair the nerve defect according to the group. The sciatic function index (SFI) of groups A-C was calculated using the Bain formula at 1, 2, and 3 months after operation. The nerve conduction velocity (NCV) of the affected side in groups A-D was assessed using neuroelectrophysiological techniques. At 3 months after operation, the regenerated nerve tissue was collected from groups A-C for S-100 immunohistochemical staining and Schwann cell count in groups A and B to compare the level of nerve repair and regeneration in each group. RESULTS: At 3 months after operation, the nerve conduits in all groups partially degraded. There was no significant adhesion between the nerve and the conduit and the surrounding tissues, the conduit was well connected with the distal and proximal nerves, and the nerve-like tissues in the conduit could be observed when the nerve conduit stents were cut off. SFI in group A was significantly higher than that in group C at each time point after operation and was significantly higher than that in group B at 2 and 3 months after operation ( P<0.05). There was no significant difference in SFI between groups B and C at each time point after operation ( P>0.05). NCV in group A was significantly slower than that in the other 3 groups at each time point after operation ( P<0.05). The NCV of groups B and C were slower than that of group D, but the difference was significant only at 1 month after operation ( P<0.05). There was no significant difference between groups B and C at each time point after operation ( P>0.05). Immunohistochemical staining showed that the nerve tissue of group A had an abnormal cavo-like structure, light tissue staining, and many non-Schwann cells. In group B, a large quantity of normal neural structures was observed, the staining was deeper than that in group A, and the distribution of dedifferentiated Schwann cells was obvious. In group C, the nerve bundles were arranged neatly, and the tissue staining was the deepest. The number of Schwann cells in group B was (727.50±57.60) cells/mm ², which was significantly more than that in group A [(298.33±153.12) cells/mm ²] ( t=6.139, P<0.001). CONCLUSION The fCUPE nerve conduit is effective in repairing long-distance sciatic nerve defects and is comparable to autologous nerve grafts. It has the potential to be used as a substitute material for peripheral nerve defect transplantation.
Rats ; Animals ; Male ; Rats, Sprague-Dawley ; Polyesters ; Peripheral Nerve Injuries/surgery* ; Elastomers ; Urethane ; Sciatic Nerve/injuries* ; Carbamates ; Nerve Tissue ; Nerve Regeneration/physiology*