Objective To investigate the clinical diagnosis and the results of arthroscopic treatment for acetabular labrale tears. Methods From November 2008 to December 2009, 21 patients with unilateral acetabular labrale tears underwent hip arthroscopy were entered in the study, including 9 males and 12 females with an average age of 37.1 years. Physical examination, X-ray examination and magnetic resonance arthrography (MRA) were carried out preoperatively to make the definite diagnosis. Of 21 cases, including labrale debridement in 14 cases, labrale debridement plus femoral osteoplasty in 5 cases and labrale repair plus osteoplasty in 2 cases. Patients were followed-up either by telephone inquiring or out-patient interview.The visual analogue scale (VAS) and Harris hip score were recorded before operation and 6 months after operation respectively. Results All 21 patients showed a positive Fadir impingement sign on the affected hips,meanwhile 15 cases showed a positive Fabir impingement sign, and positive McCarthy test was observed in 9cases. X-ray film showed 11 cases have cam type impingement, among which 6 combined with pincer type impingement. Two cases had acetabulum retroversion alone. On MRA images, signals of contrast agent infiltration in anterior superior quadrant which indicated labrale tear were observed among all cases. All labrale tears were confirmed under arthroscopy. All patients were followed up for average 11.6 months (range, 6-19).The symptoms were obviously released after operation. The VAS decreased from (5.3±1.3) preoperatively to (1.4±-0.9) 6 months postoperatively. The mean Harris hip score improved from (63±9) preoperatively to (84±10) 6 months postoperatively. All the differences had statistical significance. Conclusion Acetabular labrale injury has a close correlation with femoroacetabular impingement. Impingement test and MRA have a high sensitivity and accuracy on clinical diagnosis of labrale tears. Arthroscopic debridement, repair and osteoplasty for labrale tears give a good early outcomes.

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.

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.

Objective To study the clinical treatment and prognosis of de novo liver cancer following renal transplantation.Methods The clinical data of 15 patients who developed de novo liver cancer after renal transplantation carried out prior to treatment of liver cancer at the First Center Hospital of Tianjin between June 2006 and June 2016 were retrospectively studied.These patients were diagnosed to have liver cancer ranging from 23 to 98 months after renal transplantations,with an average of (42.5 ± 29.7) months.Two patients were diagnosed within 2 years,7 within 5 years,and 6 over 5 years after renal transplantation.Results Three patients underwent transcatheter arterial chemoembolization (TACE) and 12 patients underwent surgical resection which included right/left hemihepatectomy (n =5),hepatic segment resection (n =4),and tumor enucleation (n =3).Postoperative histopathology confirmed hepatocellular carcinoma in 8 patients,cholangiocarcinoma in 1 patient,and mixed liver cancer in 3 patients.Among the 12 patients who initially underwent'curative'surgery,3 patients died from recurrent cancer 8,16,25 months after surgery,respectively.The remaining 9 patients were still alive with a follow-up which ranged from 0.6 to 65-month.The 3 patients who underwent TACE were alive for 4,7 and 13 months,respectively.Conclusions De novo liver cancer were usually asymptomatic and had a rapid onset.The optimal clinical management which includes early diagnosis,appropriate therapy with immunosuppression and renal function preservation can result in good long-term survival.

One hundred and fifty femoral head necrosis patients with intramedullary decompression received autologous stem cell transplantation. The blood was taken from unilateral or bilateral iliac, in each group the volumes of blood taken were 200, 300 or 400 ml respectively. The number of mononuclear cells was counted before and after centrifugation. The mononuclear cell count in subgroup of 200 ml,300 ml and 400 ml taken from unilateral iliac after centrifugation was (3. 11 ±1. 42) × 1010/L, (2. 62 ±1. 31 ) × 1010/L and(2. 13 ±. 91) × 1010/L. The concentration was significantly lower in subgroup of 400 ml than that of 200 ml (t=5. 118, P<0. 01). The mononuclear cells count in subgroup of 200 ml,300 ml and 400 ml taken from bilateral iliac was(4. 51 ±. 21) × 1010/L, (3. 89 ±. 06) × 1010/L and (2. 98 ±1. 39) × 1010/L, the concentration was significantly lower in subgroup of 400 ml than that of subgroup of 200 ml (t = 6. 446, P < 0. 01). Whether 200 ml or 300 ml or 400 ml blood were taken, the mononuclear cell count in blood taken from bilateral iliac after centrifugation was significantly higher than that from unilateral iliac(t = 3. 119,P < 0. 01; t = 5. 544, P < 0. 01 ;t = 2. 207 ,P < 0. 05). The results indicate that the concentration of isolated bone marrow mononuclear cells is higher from bilateral iliac than unilateral iliac. The concentration of isolated monocytes is reduced gradually with the increased blood volume.

This retrospective study was to compare the clinical effects of arthroscopie drilling with arthroscopic microfracture technology on full-thickness chondral defects in 68 patients treated between March 2003 and June 2005. The patients were followed up for an average of (20 ± 5 ) months. Lysholm score and Tegner scale were used to evaluate the efficacy. For the arthrescopic drilling group (n = 15 ) and the microfracture surgery group (n =27) , total effective rates were 12/15 and 85% (23/27), respectively. Our data suggest that those two methods provide simple and effective surgical procedure for the treatment of chondral defects of the knee; the results of arthroscopic microfracture were significantly better than arthroscopic drilling.

OBJECTIVETo perform a meta-analysis on clinical outcomes of minimally invasive percutaneous plate osteosynthesis (MIPPO) or open reduction and internal fixation (ORIF) for distal tibial fractures in adults.

METHODSPubmed database (from 1968 to March 2014), Cochrane library and CNKI database (from 1998 to March 2014) were searched. Case-control study on minimally invasive percutaneous plate osteosynthesis (MIPPO) or open reduction and internal fixation (ORIF) for distal tibial fractures in adults were chosen,and postoperative infection, operative time, blood loss, fracture nonunion rate, delayed union,fracture malunion rate were seen as evaluation index for meta analysis. The system review was performed using the method recommended by the Cochrane Collaboration.

RESULTSTotally 5 studies (366 patients) were enrolled. Meta-analysis showed that there were significant meaning in postoperative infection between MIPPO and ORIF [OR = 0.23,95% CI (0.06,0.92), P = 0.04]; fracture nonunion rate in MIPPO was lower than in ORIF group [OR = 0.16, 95% CI (0.03,0.76), P = 0.02]; operative time in MIPPO was shorter than in ORIF group, and had significant difference [MD = -14.42, 95% CI (-27.79, -1.05), P < 0.05]; blood loss in MIPPO was less than in ORIF group [MD= -87.17,95%CI (-99.20, -75.15), P < 0.05]; there was no obviously meaning in delayed union between two groups.

CONCLUSIONFor distal tibial fractures in adults, MIPPO has, advantages of short operative time, less blood loss, lower incidence of infection and fracture non-uniom, but with high fracture malunion rate. MIPPO for distal tibial fractures in adults is better than ORIF, and the best treatment should choose according to patient's condition.

Bone Plates ; Fracture Fixation, Internal ; methods ; Fracture Healing ; Humans ; Minimally Invasive Surgical Procedures ; methods ; Operative Time ; Tibial Fractures ; surgery

Objective To evaluate the results of acromioclavicukr crook plate in treatment of acromioclavicular joint dislocation and distal clavicular fracture and discuss causes for complications and preventive measures.Methods From September 2003 to April 2007,open reduction and acromiocla vicular crook plate fixation was done on 38 patients with acromioclavicular joint dislocation and distal clavicular fracture including 17 with acromioclavicular dislocation and 12 with distal clavicle fractures.Postoperative rehabilitation began early.Results Of all,27 patients were followed up for mean 21 months (3-37 months) and obtained bone healing.The internal fixation was removed at 6-8 months postoperatively and the outcome was evaluated with Karlsson rating system,which showed 22 patients at grade A,four at grade B and one at grade C.There was no dislocation or fracture after the internal fixation was removed ranging.Three patients with limited abduct motion <90° during certain movements got better after plate removal.One patient had acromio clavicular erosion.Conclusions The application of acromioclavicular crook plate provides accurate anatomical reduction and early rehabilitation and enables fast functional recovery.Technically,the implant needs to be used precisely.It is better to get appropriate early exercise and remove plate as early as possible.

Objective To explore the relationship between the osteonecrotic volume (lesion size), angle and the index of necrotic extent on the femoral head. Methods Fifty-one hips in 39 patients with non-traumatic avascular osteonecrosis on the femoral head were divided into 12 equal segments from the head to the neck junction (a turning point of the spherical curve of the head) with whole hip displacement, each with 30 degrees on a coronal plane of weight-bearing surface. The osteonecrotic angle of the arc of each necrotic segment from the center of the femoral head was measured at the point of one- to 12-o'clock on imaging of two dimensional reconstruction of computerized tomography (CT) scans and anteroposterior and lateral radiographs. Necrotic volume on each segment of the femoral head was calculated with fluid displacement method. The index of osteonecrotic extent on the femoral head was calculated using direct anatomical measurements. Results Osteoneerotic volume on the femoral head at the point of 12- to one-o'clock on coronal plane was (74. 5 ± 7.4)% of the sphere equivalent of the whole femoral head, which was positively correlated to its necrotic angle [ (41.9±8. 3) degrees] at the point of one-o'clock on the plane, with a coefficient of correlation of 0. 843, and that at the point of one- to two-o'clock on the plane was (73.7 ±0. 4) %, which was positively correlated to its necrotic angle [ (41.9 ± 1.8) degrees] at the point of two-o'clock, with a coefficient of correlation of 0. 543. Osteonecrotic volume on the point of 11- to 12-o'cleck was (83.6±8.6)%, and the necrotic angle at the point of 12-o'clock was (44. 9±3.9) degrees, which were positively correlated each other, with a coefficient of correlation of 0. 701 (P <0. 01 ). Osteonecrotic volume on the femoral head was positively correlated to its necrotic angle , modified index of necrotic extent, index of necrotic extent and Kerboul conjugated necrotic angle, with coefficients of correlation of 0. 798, 0. 701, 0. 377 and 0. 398 ( P < 0. 01 ), respectively, at the point of one o' clock. Conclusions Measurements of osteonecrotic volume was positively correlated to the index of necrotic extent and necrotic angle on the femoral head, respectively. Necrotic angle on the plane at 30-degree of the trochanter on the femoral head can well reflect its necrotic volume.

Objective To evaluate the early and middle-term results of in-situ single-screw fixation and subtrochanteric osteotomy of femur with external fixator for slipped capital femoral epiphysis(SCFE).Methods From June 1998 to July 2008, eleven patients (12 hips) with SCFE were treated, including 7males (8 hips) and 4 females (4 hips) with an average age of 14.3 years (range, 9-18). The average BMI was 31.1 g/m2. According to the Southwick measurement, mild (＜30°) in 6 cases (7 hips), moderate (30°-50°) in 2 cases (2 hips), and severe (＞50°) in 3 cases (3 hips). All the mild and moderate cases were undergone insitu single screw fixation, and three severe cases were performed subtrochanteric osteotomy of femur with external fixator. All the cases were evaluated at 3 months, 6 months and every year postoperatively. Results All the cases were followed up for average 5.6 years (range, 2-12). The Harris hip score increased from mean 74.8 points preoperatively to 90.6 points postoperatively, with 10 hips excellent, 1 hip good, 1 hip fair and 0 hip poor. The excellent and good rate was 91.7% (11/12). The X-ray showed the epiphyseal closure in in-situ single screw fixation cases, and no further increase in epiphyseal-shaft angle. Partial reduction of slipped epiphysis with normal joint spaces was observed in subtrochanteric osteotomy of femur with external fixator cases. Conclusion In-situ single screw fixation provides a surgical treatment option to treat mild and moderate SCFE with satisfactory clinical outcome, and profit to the prevention further slip. Subtrochanteric osteotomy of femur with external fixator is suitable for severe SCFE with late deformity. The realignment procedure can correct deformity and postpone or avoid the occurrence of osteoarthritis.