BACKGROUND:As a more common method in the orthopedic field, the method of intra-articular injection drugs has distinct curative effects, but there are some complications. In a certain extent, this method caters to the psychological fear of surgery, and can serve as a kind of conservative treatment. But some experts believed that because of the limit of sterile conditions, intra-articular injection of drugs wil increase the risk of intra-articular infection and they opposed this method.
OBJECTIVE:To review the efficacy and adverse reactions of intra-articular injection drugs in recent years, and explain clinical applications of intra-articular injection drugs in orthopedics.
METHODS:A computer-based search was conducted in PubMed and Wanfang database for articles related to the application of intra-articular injection drugs in orthopedics published between January 2007 and December 2013. The English and Chinese key words were“intra-articular, injection, orthopaedics, tranexamic acid, hyaluronic acid, corticosteroid, drugs”. Data were checked in the first trial, old articles and repetitive studies were excluded. The relevant 43 articles accorded with inclusion criteria were reviewed.
RESULTS AND CONCLUSION:In orthopedics, the method of intra-articular injection drugs is simple, economic and effective, but at the same time, there are some side effects. Tranexamic acid by intra-articular injection can significantly reduce blood loss after total joint replacement, is safety and economic. Intra-articular injection joint lubricant can reduce internal friction of joints and improve the adhesion of joint cavity, can be used as a good conservative treatment for osteoarthritis. Intra-articular injection hormone drugs can treat inflammatory arthritis, and short-term curative effect is obvious, but due to large long-term side effects, the method is not recommended now. Intra-articular injection of analgesic drugs and other drugs have both advantages complications. The efficacy of intra-articular injection drugs in orthopedics is obvious;meanwhile, this method has some complications. Orthopedic surgeons should select related drugs by indications. We stil need to further make reasonable regimen with intra-articular injection drugs in future large-scale study.

BACKGROUND:Tranexamic acid has been more and more used in reducing bleeding after joint replacement, but its usage method and dosage remain controversial, and become a hot focus in recent years. OBJECTIVE:To investigate the efficacy of intra-articular injection of tranexamic acid on postoperative blood loss and limb circumference changes in patients who received unilateral total knee arthroplasty. METHODS:From March to October 2013, clinical data of 90 patients undergoing primary unilateral total knee arthroplasty were randomized to the tranexamic acid group and the control group, including 19 males and 71 females. The 30 patients in the tranexamic acid group received 50 mL of 3%tranexamic acid dilute solution inside knee joint after capsule closure, and 60 patients in the control group received the same volume of physiological saline. No significant difference in age, height, body mass index, anticoagulation, the type of prosthesis, tourniquet time and preoperative diagnosis was detected between the two groups (P>0.05). The amounts of intraoperative and postoperative blood loss and blood transfusion, postoperative drainage volume, the preoperative and postoperative limb circumference 10 cm above the operated knee were recorded. Routine blood test was reviewed after the surgery. RESULTS AND CONCLUSION:There were no significant differences in total blood loss, postoperative drainage volume and limb circumference changes between tranexamic acid and control groups (P>0.05). The amount of postoperative hidden blood loss was significantly less in the tranexamic acid group than in the control group (t=-2.683, P<0.05). These data suggested that the intra-articular injection of tranexamic acid intraoperatively in patients receiving total knee arthroplasty could significantly reduce the amounts of postoperative hidden blood loss, and did not affect the postoperative limb circumference changes.

Objective: To localize the functional areas related to music processing with fMRI,and to discuss the possible neural mechanism underlying emotion experience and music therapy.Methods: Thirty healthy non-musicians underwent fMRI study.Experimental tasks included listening passively to instrumental pieces of scale,pleasant classic music and scary music(3 pieces each),which were given in block design.Conjunction analysis was performed with SPM99 to render the mean functional images.Results: Both the pleasant music and the scary music activated the neural substrates underlying affective processing;the former mainly included bilateral lateral prefrontal cortex(left advantage),the left orbitofrontal cortex,the anterior cingulate cortex,the left anterior part of insula,the right thalamus and the left lenticula;the later mainly included bilateral lateral prefrontal cortex(right advantage),bilateral orbitofrontal cortex,bilateral medial frontal gyri,bilateral anterior cingulate cortex and bilateral amygdaloid complex.Conclusion: Passively listening to pleasant and scary music could strongly activate distinct emotion processing substrates,and the positive emotion processing system activation during pleasant music listening may be one of the neural mechanisms of music therapy.

Objective To observe responses of brain evoked by somatic stimuli in healthy subjects with blood oxygenation level-dependent functional magnetic resonance imaging.Methods There were 30 healthy subjects in the study. Block design was used infunctional MR imaging. In experimental tasks somatic stimuli was executed to the hands of every subject at duration 1000 ms,interstimulus intervals 1000 ms.The professional software-SPM99 was performed to process the images.Results For healthy subjects to somatic stimuli, significant activation was observed in bilateral primary and secondary somatic cortex of precentral gyri and postcentral gyri, and temporallobes. Scattered activations could be seen in frontal lobes, supramarginal gyri and hemisphere of cerebella. There was more intensiveactivation in right hemisphere than that in left. There was no significant difference between the activation evoked by somatic stimuli of leftand right extremities. Conclusion somatic stimuli can evoke significant activations in bilateral primary and secondary somatic cortex.Temporal lobes and other brain areas join in the process of somatic stimuli.

Objective To study the role of prefrontal cortex in maintenance of working memory(WM)using event-related functional MRI(ER-fMRI).Methods Twenty healthy subjects completed a relative lower,high load version of the sternberg item recognition task during ER-fMRI.The brain areas showing activity on average across the two loads for maintenance phase were obtained with group analysis.Load dependent activity was identified with inter-group analysis.Results The maintenance phase were relevant to the activity in dorsolateral prefrontal cortex(DLPFC),ventrolateral prefrontal cortex(VLPFC),parietal lobe,supplementary motor area(SMA)and premotor cortex(PMA).Brain regions including VLPFC showed increased activation for high load level.Conclusion Functional difference but not anatomic difference between maintenance and manipulation in brain may be exist.

Objective To evaluate the CT findings of invasive pulmonary aspergillosis(IPA) in patients with leukemia.Methods Plain CT scanning of chest was performed in 9 cases of leukemia in company with IPA proved by sputum culture.5 of them underwent over twice CT re-scanning,CT findings of IPA were analysed.Results The lesions were seen more common in the bilateral upper lobe and dorsal segment of lower lobe,mainly located in the peripheral and sub-pleural lung field.Of the 9 cases,the lesions appeared as multi-nodular shadows in 5,single nodule in 2 and sub-pleural consolidation with ground-glass opacity around them in 2,of these 2 cases,one accompanied by multi-nodules.Halo-sign around the nodules in 6 cases and air cresent sign or cavity in 6 were seen.There were scattered ground-glass opacities and patchy attenuations in the bilateral lung in 4 cases.The adjacent pleura of lesion was slightly thinkened in 5 cases.Conclusion The incidence of IPA in leukemia patients is rather high,and CT features of IPA are of certainly characteristics.

Objective:To study the effect of midnight-noon ebb-flow acupoint selection on rheumatoid arthritis. Methods:120 cases of patients with rheumatoid arthritis were randomly divided into three groups:midnight-noon ebb-flow acupoint selection group,acupuncture by differentiation of symptoms and signs group,integrative group of midnight-noon ebb-flow acupoint selection and acupuncture by differentiation of symptoms and signs group. Results:In the midday-midnight flowing of qi-blood acupuncture group of 40 cases,11 cases were improved obviously,11cases were improved,9cases were improved slightly,9 cases were ineffective,the total effective rate was 77.5%. In the acupuncture by differentiation of symptoms and signs group of 40 patients,10 cases were improved significantly,11 cases were improved,11 cases were improved moderate,8 cases were ineffective,the total effective rate was 80.0%. In integrated group of midnight-noon ebb-flow acupoint selection and acupuncture by differentiation of symptoms and signs group of 40 patients,15 cases were improved significantly,13 cases were improved,10 cases were improved moderate,2 cases were ineffective,the total effective rate was 95.0%. Curative effect of the integrative group was better than that of other two groups(P

Objective To evaluate the activation of premotor area (PMA) in verb generation task, and to discuss the possible function of PMA in language expression. Methods Block-designed fMRI with verb generation task was performed on 23 subjects with GE 1.5T MR Scanner. During the test, the subjects were asked to generate a verb based on a given noun word. The white + appeared on the center of the black screen was used as control. The fMRI data were processed with SPM 2. Group analysis was performed with single sample t-test. Average mapping was obtained and overlapped onto standard MNI template. Activation of the PMA was analyzed. Results The fMRI data of eleven subjects were selected for group analysis after head motion effect was ruled out. Average mapping showed activation in the Broca's area, posterior part of the right inferior frontal gyrus, bilateral PMA and supplemental areas (SMA), left posterior parietal cortex, right thalamus, left basal ganglions, right cerebellum, and posterior part of the right temporal lobe. The area with the greatest activated intensity in the brain was the left PMA. Conclusion PMC is important in verb generation and may be responsible for voice processing, motor imagery, word extracting as well as advanced regulation of information.

Objective To discuss the MRI characteristics of pituitary abscess,so that to improve the diagnosis of it.Methods MR imaging data in 8 cases with pituitary abscess proved by operation and pathology,and antibiosis therapy were retrospectively analyzed in combination with review of literatures.Of 8 cases,3 were male and 5 were female,the mean age was 53.3 years(ranged 36~62 years).Results MRI findings included hypophysis enlargement,isointensity in 6 cases and slight hyperintensity in 2 cases on T1WI;isointensity in 4,hyperintensity in 2 and mixed iso-and hyperintensity in 2 on T2WI;hyperintensity in one on DWI.On contrast-enhanced scan,all pituitary masses showed ring enchancement,6 cases showed thickened walls which were slightly lamellar;7 cases demonstrated pituitary stalk thickening and enchancement.Conclusion Pituitary abscesses are of certain typical MRI characteristics.

Objective To study the imaging features of the pleomorphic adenomas of the minor salivary glands in the palate and to improve its diagnostic validity. Methods CT and MRI manifestations of 6 patients with palatal pleomorphic adenomas confirmed pathologically were analyzed retrospectively. There were 2 males and 4 females, and their age ranged from 19 to 54 years, with the mean age of 36.3 years. Results Among 6 cases, 5 tumors located in hard palate, and 1 in soft palate. 4 lesions were round like, and 2 were lobulated. Most tumors showed soft tissue density on CT, slightly long T 1 and slightly long T 2 signal intensity on MRI. Cystic degeneration could occur in the central part in some lesions, which appeared as much lower density or obviously long T 1 and long T 2 signal intensity. On post contrast MR scans, the lesions usually showed slightly homogeneous enhancement. Conclusions Pleomorphic adenomas of the minor salivary glands were the most common benign tumors in the palate. Combined with the clinical history, typical CT and MRI appearances, a definitive diagnosis can be made.