ObjectiveTo explore the clinical outcome of alendronate in the treatment of bone marrow edema syndrome of the hip.MethodsA retrospective analysis of 8 cases (10 hips) of bone marrow edema syndrome of the hip treated with alendronate between December 2017 and January 2020 was conducted. Harris score and MRI exam of hip were used to assess the clinical and radiographical outcomes. Clinical cure rate and length of treatment period were used to evaluate whether alendronate was benefitial for the treatment of bone marrow edema syndrome of the hip.ResultsAll the cases were followed up for at least 3 months and got complete clinical data, the mean follow-up period was (5.2±1.2) months. Seven cases (9 hips) in 8 cases (10 hips) had clinical cure, with a clinical cure rate of 90%. The length of treatment period was 1 to 2 months with a mean value of (1.7±0.2) months. The Harris score increased from 57.8±6.3 before treatment to 98.6±1.0 at the last follow-up, and the difference was statistically significant (t=18.299, P<0.001). One case (1 hip) developed osteonecrosis of femoral head at one month after the initiation of alendronate therapy, who received continuous combination therapy of alendronate, calcium and aspirin, and no collapse or expansion of necrosis was found after 12 months follow-up.ConclusionsBone marrow edema syndrome of the hip is not a self-limiting disease completely, some patients maybe develop osteonecrosis of femoral head. Alendronate is benefitial for alleviating clinical symptom, accelerating bone edema disappearance, and shortening the course of disease.
ObjectiveTo review the role of dendritic cells (DC) in immune metabolism of rheumatoid arthritis (RA). MethodsLiterature on the role of DC in the immune metabolism of RA was extensively reviewed in recent years, and the metabolic characteristics of RA, the role of DC in RA, the correlation between the immune metabolism of DC and pathogenesis of RA, and the treatment were summarized and analyzed. Results DC promotes the progression of RA under hypoxia, increased glycolysis, inhibition of oxidative phosphorylation, and decreased lipid metabolism. Moreover, many DCs (especially conventional DC and monocyte-derived DC) have different functions and phenotypic characteristics in RA, which are closely related to the occurrence and development of RA. Conclusion DC plays an important role in the immune metabolism of RA, and immunometabolism therapy based on DC can provide targeted therapy for the treatment of RA.
ObjectiveTo summarize the characteristics of the occurrence and development of osteonecrosis of the femoral head (ONFH), and to review the important regulatory role of immune cells in the progression of ONFH. MethodsThe domestic and foreign literature on the immune regulation of ONFH was reviewed, and the relationship between immune cells and the occurrence and development of ONFH was analyzed. ResultsThe ONFH region has a chronic inflammatory reaction and an imbalance between osteoblast and osteoclast, while innate immune cells such as macrophages, neutrophils, dendritic cells, and immune effector cells such as T cells and B cells are closely related to the maintenance of bone homeostasis. ConclusionImmunotherapy targeting the immune cells in the ONFH region and the key factors and proteins in their regulatory pathways may be a feasible method to delay the occurrence, development, and even reverse the pathology of ONFH.
ObjectiveTo compare the clinical and radiographic results between primary total knee arthroplasty (TKA) via mini-subvastus or conventional approach through a prospective randomized controlled study.MethodsNinety-four patients (104 knees) undergoing primary TKA between January 2011 and April 2012 were evaluated and randomly divided into 2 groups. Forty-six patients (52 knees) underwent TKA via conventional approach (conventional approach group), and 48 patients (52 knees) underwent TKA via mini-subvastus approach (mini-subvastus approach group). In these patients, 45 cases (51 knees) in conventional approach group and 45 cases (49 knees) in mini-subvastus approach group were followed up and recruited in the final analysis. There was no significant difference in age, gender, body mass index, sides, osteoarthritis grading, American Knee Society Score (KSS), Hospital for Special Surgery (HSS) score, visual analogue scale (VAS), range of motion (ROM) of knee between 2 groups (P>0.05). The clinical indexes were recorded and analyzed, including the operation time, length of incision, total blood loss, blood transfusion after operation, hospital stay time, the time of performing straight leg raise, incision condition, VAS score, ROM of knee, HSS score, and KSS score, hip-knee-ankle angle (HKA), femoral anatomic axis and the femoral prosthesis joint angle (femoral angle), tibia anatomic axis and tibial prosthesis joint angle (tibial angle), femoral prosthesis flexion angle (FPFA), and posterior slope angle (PSA) of the tibial plateau.ResultsAll patients were followed up. The average follow-up time was 66.4 months (range, 60.0-72.5 months) in conventional approach group and 65.6 months (range, 60.0-71.2 months) in mini-subvastus approach group. Compared with the conventional approach group, the incision of mini-subvastus approach group shortened, the operation time prolonged, and the time when patients started straight leg raise exercises was earlier; showing significant differences between 2 groups (P<0.05). There was no significant difference in hospital stay time, total blood loss, and numbers of blood transfusion between 2 groups (P>0.05). The complication rate was 8.2% (4/49) in mini-subvastus approach group and 0 in conventional approach group, showing no significant difference between 2 groups (P=0.054). At 1 and 3 days, the VAS and the ROM of knee in mini-subvastus approach group were significantly better than those in conventional approach group (P<0.05); but there was no significant difference in above indexes between 2 groups at 14 day (P>0.05). There was no significant difference in HSS and KSS scores between 2 groups at the 1, 3, 6, 12 months and 3, 5 years (P>0.05). X-ray film showed no aseptic loosening in all cases. There was no significant difference in the measured values and incidence of abnormal patient of HKA, femoral angle, tibial angle, FPFA, and PSA at last follow-up between 2 groups (P>0.05).ConclusionTKA via mini-subvastus approach is helpful to the early function recovery of knee, but the long-term effectiveness is consistent with TKA via conventional approach. As the limited exposure, TKA via mini-subvastus spproach may has high risk of operative complications.
ObjectiveTo introduce the etiology and prevention of bone cement implantation syndrome (BCIS). Methods The literature about BCIS at home and abroad in recent years was extensively reviewed, and the incidence, clinical manifestations, etiology, and prevention of BCIS were summarized and analyzed. Results The clinical manifestations of BCIS are diverse. The etiology of BCIS is not completely clarified, and it may be related to circulating methyl methacrylate-mediated model, embolus-mediated model, histamine release and hypersensitivity response, complement activation and multimodal model. BCIS prevention begins with the identification of high-risk patients in preoperative evaluation and communication between surgeon and anesthesiologist about the choice of implant type, surgical procedure, and technique to minimize the risk of cardiovascular complications in high-risk patients with multiple or severe risk factors or comorbidities. Preoperative assessment and optimization of a patient’s cardiovascular reserve is also critical to prevent BCIS. ConclusionBCIS is a possible complication after hip joint arthroplasty, and its pathogenesis needs to be further research in order to provide new ideas for prevention and treatment.
Objective To systematically review the effectiveness and safety of total hip arthroplasty (THA) vs. total hip resurfacing arthroplasty (THRA) in patients with osteoarthritis of the hip joint. Methods We electronically searched databases including PubMed, The Cochrane Library (Issue 3, 2012), EMbase, PloS, national institutes of clinical test library of the United States, national joint replacement registration network of Australia, British national joint registration network, British orthopaedic association network (BOA), Canada orthopaedic association (COA), American Academy of Orthopedic Surgeons network (AAOS), German Institute of Medical Documentation and Information network (DIMDI) for randomized controlled trials (RCTs) on the comparison between THA and THRA for osteoarthritis of the hip joint from inception to November, 2012. References of the included studies were also retrieved. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data and assessed the quality of the included studies. Then, meta-analysis was performed using RevMan 5.1 software. Results Six RCTs (10 articles) involving 518 cases of surgery (THA: n=259; THRA: n=259) were identified. The risk of bias of 8 articles was moderate and that of the other 2 articles was low. The results of meta-analysis showed that, compared to THRA, THA brings greater improvements of femoral offset within 2 years after surgery (MD=6.60, 95%CI 5.53 to 7.68, P=0.25). There were no significant differences between the two groups in Merle d’Aubigné Postel, WOMAC score, UCLA score, SF-36 Health Survey Questionnaire, walking speed, step length, walking cadence, postoperative leg length discrepancy, and complication rates. All these conclusions are based on early postoperative results. Conclusion Current evidence shows that, THA brings greater improvements of femoral offset than THRA, and no significant differences between the two groups were found in the other indicators.
Objective To summarize research progress on application of Cup-cage reconstruction in revision of chronic pelvic discontinuity (CPD) in patients undergoing total hip arthroplasty (THA). Methods Relevant literature at home and abroad in recent years was reviewed to summarize the principles of the Cup-cage reconstruction, preoperative patient assessment, intraoperative skills, clinical and radiological effectiveness, limitations, and postoperative complications. Results For the treatment of CPD, the Cup-cage reconstruction achieved long-term acetabular cup bone ingrowth, CPD healing, and biologic fixation of the prosthesis by restoring pelvic continuity. Preoperative evaluation of the surgical site and general condition is necessary. The main intraoperative objectives are to reconstruct pelvic continuity, restore the center of rotation of the hip, and avoid neurovascular injury. Current studies have demonstrated significant clinical and radiological effectiveness as well as acceptable prosthesis survival rates after operation. Nevertheless, there is a lack of evidence regarding the staging of CPD, the optimal surgical approach and internal fixation, and the factors influencing postoperative prosthesis survival remain undefined. Conclusion Cup-cage reconstruction can be an effective treatment for CPD after THA, but there is still a need to explore CPD staging, Cup-cage approach and internal fixation, and influencing factors on prosthesis survival.
目的 探討氨基葡萄糖聯合布洛芬治療髖關節骨關節炎的臨床療效。 方法 2011年9月－2012年1月采用前瞻性隨機對照臨床試驗，將198例輕、中度髖關節骨關節炎患者隨機分入試驗組及對照組。試驗組采用氨基葡萄糖（750 mg， 2次/d口服，療程1個月）聯合布洛芬（0.3 g，2次/d口服，療程2周），對照組則單用布洛芬（0.3 g，2次/d口服，療程2周）；分別于服藥后0、2、4、8及12周時采用加拿大西安大略和麥克瑪斯特大學骨關節炎指數（WOMAC）進行療效評價。并對惡心、嘔吐、皮疹等藥物不良反應進行觀察。 結果 試驗組與對照組WOMAC各項評分從第2周開始較0周明顯下降，而兩組患者間在0周及2周時WOMAC評分無統計學差異：0周總評分（45.3、45.0分，P=0.225），2周總評分（37.3、37.6分，P=0.329）。但對照組WOMAC各項評分從第4周開始逐漸呈現上升趨勢，而試驗組到第12周仍呈現持續性下降趨勢。總不良反應發生率為7.0%，其中試驗組總不良反應發生率為9.5%，但不良反應輕微，未予特殊處理而自行消失。 結論 氨基葡萄糖聯合布洛芬可有效緩解早、中期髖關節骨關節炎各項臨床癥狀，療效確切，不良反應較少，且停藥后仍持續表現出治療效果。而單用布洛芬可短期緩解骨關節炎癥，但停藥后癥狀逐漸復現。
目的 探討髖或膝關節置換術（THR/TKR）并存甲狀腺功能減退癥（甲減）患者圍手術期的處理策略。方法 2009年1月－2011年12月收治30例行THR/TKR并存甲減患者，其中男8例，女22例，平均年齡62.4歲。處理要點包括術前糾正甲狀腺激素水平；術中縮短手術時間，減少出血量，選擇性應用糖皮質激素；術后補充甲狀腺激素，預防感染及深靜脈血栓形成，改善胃腸功能。評價指標包括圍手術期血壓、心率變化，胃腸功能狀況，切口愈合時間，甲狀腺功能水平，黏液性水腫昏迷等并發癥發生率；術前及術后Harris及特種外科醫院評分系統（HSS）評分等。 結果 術后心率變化大，非致命性心律失常者20例；血壓控制平穩；術后甲狀腺功能變化不明顯，無黏液性水腫昏迷、心包積液及呼吸窘迫等嚴重并發癥發生。隨訪1個月，術前HSS評分平均28分，術后86分；術前Harris評分平均32分，術后87分。 結論 術前控制血清促甲狀腺素在0.5～3.0 mU/L以內，總甲狀腺素、游離甲狀腺素至正常水平，是有效預防甲減患者THR/TKR圍手術期并發癥的關鍵；綜合應用左甲狀腺素片、糖皮質激素和抗凝治療是安全渡過圍手術期的重要保證。
ObjectiveTo compare the cost changes of total knee arthroplasty (TKA) before and after the cancellation of medical consumables addition, so as to provide reference for the national medical reform policy.MethodsThe patients treated with TKA between September 2018 and February 2019 were admitted as objects of study, and 372 of them met the selection criteria and were finally included in the study. According to the time node of cancelling the medical consumables addition (December 24, 2018), all patients were allocated to pre-cancelling and post-cancelling groups (n=186). The clinical data of patients (gender, age, length of stay, disease classification), and various treatment costs (the costs of diagnosis and treatment, examination, laboratory, material, anesthesia, bed, nursing, operation, drug, and others) were collected. And the changes of various costs and proportions before and after cancelling the medical consumables addition were compared.ResultsThere was no significant difference in gender, age, and disease classification between the two groups (P>0.05); the length of stay after cancelling the medical consumables addition was significantly longer than that before cancelling (t=2.114, P=0.035). There was no significant difference in the total cost of TKA before and after cancelling the medical consumables addition (t=0.214, P=0.831). Compared with that before cancelling the medical consumables addition, the cost of material was significantly reduced, and the costs of diagnosis and treatment, anesthesia, nursing, and operation were significantly increased (P<0.05); the costs of examination, laboratory , bed, drug, and others were basically stable, and the differences were not significant (P>0.05).ConclusionThe total cost of TKA is stable, the proportion of material cost is significantly reduced, the proportion of diagnosis and treatment cost reflecting the technical content of medical staff is significantly increased, which is in line with the expectation of the national policy of cancelling the medical consumables addition.