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Wang W.G.,Center for Osteonecrosis and Joint Preserving & Reconstruction
Orthopaedic surgery | Year: 2011

To investigate the clinical diagnosis and arthroscopic treatment of acetabular labral tears. Twenty-one patients with unilateral acetabular labral tears hospitalized from November 2008 to December 2009 were included in this retrospective study. A definitive diagnosis was made preoperatively on the basis of physical examination, plain radiography and magnetic resonance arthrography (MRA). All cases were treated with arthroscopic surgeries: labral debridement (14 cases), labral debridement plus femoral osteoplasty (5 cases), and labral repair plus osteoplasty (2 cases). All patients were followed-up and the results evaluated using the visual analogue scale (VAS) and Harris hip score. A positive flexion, abduction and internal rotation (FADIR) impingement sign was found in all 21 affected hips, a positive flexion, abduction and external rotation (FABER) impingement sign in 15, and a positive McCarthy test in 9. Plain radiography showed 11 cases had cam type impingement, in 6 of whom it was combined with pincer type impingement; and 2 cases had acetabular retroversion alone. Labral tears were observed on MRA in all cases and were all confirmed by arthroscopy. All patients were followed up for an average of 11.6 months (range, 6 to 19 months). 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 these differences were statistically significant. Acetabular labral injury is closely correlated with femoro-acetabular impingement. Impingement tests and MRA have high sensitivity and accuracy in clinical diagnosis of labral tears. Arthroscopic debridement, repair and osteoplasty for labral tears results in a good early outcome. © 2011 Tianjin Hospital and Blackwell Publishing Asia Pty Ltd. Source


Gao F.,Center for Osteonecrosis and Joint Preserving & Reconstruction | Ma J.,Peking University | Sun W.,Center for Osteonecrosis and Joint Preserving & Reconstruction | Guo W.,Center for Osteonecrosis and Joint Preserving & Reconstruction | And 2 more authors.
International Journal of Surgery | Year: 2016

Purpose Efficacy and safety of topical application of a fibrin sealant (FS) compared with intravenous administration of tranexamic acid (TXA) for reducing blood loss after total knee arthroplasty (TKA) is controversial. We undertook a meta-analysis to compare the effects of topical application of FS or intravenous administration of TXA on blood loss after TKA. Methods PubMed, Medline, Embase, Web of Science and the Cochrane Library were searched to identify studies comparing FS with TXA for TKA patients. The mean difference (MD) of blood loss, hemoglobin value, and odds ratios (ORs) of transfusion requirements and adverse events in FS and TXA groups were pooled throughout the study. Relevant data were analyzed using RevMan v5.3. Results Five studies involving 359 patients were included (181 FS vs. 178 TXA). TXA use had a significantly lower prevalence of blood transfusion (OR = 3.14; 95% confidence interval (CI), 1.67 to 5.90, P = 0.0004) and higher hemoglobin level (MD = −1.23; 95% CI, −2.19 to −0.27, P = 0.01) than FS in the early postoperative period. No significant difference was seen in total blood loss between the two groups (MD = 198.06; 95% CI, −267.45 to 663.57; P = 0.40). There were no significant differences in adverse events, superficial infections, or deep-vein thrombosis among study groups. Conclusions Our meta-analysis suggests that intravenous administration of TXA for patients undergoing TKA may reduce blood-transfusion requirements and maintain higher hemoglobin levels compared with topical application of FS in the early postoperative period. There were no significant differences in total calculated blood loss and prevalence of complications between the two groups. However, owing to the variation of included studies, no firm conclusions can be drawn. © 2016 IJS Publishing Group Ltd Source


Shi S.-h.,Aviation General Hospital | Li Z.-r.,Center for Osteonecrosis and Joint Preserving & Reconstruction | Sun W.,Center for Osteonecrosis and Joint Preserving & Reconstruction | Wang B.-l.,Center for Osteonecrosis and Joint Preserving & Reconstruction | And 2 more authors.
Chinese Journal of Tissue Engineering Research | Year: 2012

BACKGROUND: Whether the quality and quantity of blood taken from unilateral and bilateral iliac would affect the concentration of bone marrow mononuclear cells? OBJECTIVE: To observe the efficacy of mononuclear cells concentration on early femoral head necrosis treated by autologous bone marrow mononuclear cells transplantation. METHODS: The clinical data of 120 patients of 168 hips with femoral head necrosis were retrospectively analyzed, and all the patients were processed with core decompression plus autologous mononuclear cells transplantation. This study included 27 cases (39 hips), who were taken blood about 200 mL from the unilateral iliac, 29 cases (40 hips), who were taken blood about 300 mL from the unilateral iliac, 30 cases (42 hips), who were taken blood about 200 mL from the bilateral iliac, 34 cases (47 hips), who were taken blood about 300 mL from the bilateral iliac. After the blood was taken from lilac, the bone marrow blood gradient centrifugation was performed by cell segregating, and the mononuclear cells count was observed before and after separation; the mononuclear cells were injected into the bone necrosis area after core decompression. All the patients were followed-up for 12-36 months, and the CT imaging and the Harris score of the hips in the patients before and after treatment were observed. RESULTS AND CONCLUSION: There was no significant difference of the mononuclear cells count between subgroup of 200 mL and 300 mL taken from unilateral and bilateral iliac (P > 0.05), but the mononuclear cells count taken from the bilateral iliac was significantly higher than that taken from the unilateral iliac (P < 0.01). There was no significant difference of the Harris score between groups before transplantation (P > 0.05), and compared with before transplantation, the Harris score and the hip fineness rate was significantly increased after transplantation (P < 0.05, P < 0.01). In short, core decompression plus autologous bone marrow mononuclear cell transplantation is an easy and safe method for the treatment of early femoral head necrosis. The concentration of mononuclear cells after centrifugation when taken from bilateral iliac is significantly higher than that taken from unilateral iliac, and the better follow-up the higher concentration. Source


Gao F.-Q.,Center for Osteonecrosis and Joint Preserving & Reconstruction | Sun W.,Center for Osteonecrosis and Joint Preserving & Reconstruction | Ma J.-H.,Chinese Institute of Clinical Medical Sciences | Li Z.-R.,Center for Osteonecrosis and Joint Preserving & Reconstruction
Chinese Journal of Tissue Engineering Research | Year: 2014

Background: The swelling of limbs after total joint arthroplasty is associated with the hidden blood loss. The main component of horse chestnut seed extract is Aescine, which can protect blood vessels, increase vascular tension, reduce capillary permeability, and exert anti-edema, anti-inflammation, and anti-exudation effect. This extract can prevent and treat post-traumatic swelling of the limbs. OBJECTIVE: To investigate the pathological mechanisms and effects of horse chestnut seed extract on early hidden blood loss and limb circumference changes after total knee arthroplasty. Methods: A total of 150 patients undergoing total knee arthroplasty from January 2013 to September 2013 were retrospectively analyzed. The involved cases were divided into two groups. The test group of 85 cases received oral administration of 0.3 g horse chestnut seed extract, three administrations per day, from the first day after total knee arthroplasty. The administration was given for 14 days. Control group of 65 patients received no detumescence drugs. There were no significant differences in patient’s age, body height and body mass index between two groups (P > 0.05). Blood routine examination was performed at 1-3 days after total knee arthroplasty. The amounts of intraoperative blood loss, postoperative blood loss, and postoperative blood transfusion were recorded. The hidden blood loss was calculated according to the Gross formula. Perioperative limb circumference above the knees was observed and measured. Two-independent-sample t-test was used to compare the difference between the two groups. Results And Conclusion: Hidden blood loss between the test group and control group was (590.6±214.2) and (821.2±457.30) mL, respectively, the difference was significant (t=3.238, P=0.021). The postoperative total blood loss and the thigh circumference changes above knee in test group were less significantly than that in control group within 2 and 3 days after surgery (P < 0.05). And there was no statistically significant difference in thigh circumference changes on postoperative 1 day and drainage between the two groups (P > 0.05). Experimental findings indicate that, early application of horse chestnut seed extract can significantly reduce hidden blood loss, significantly relieve postoperative limb swelling, and promote the recovery of limb function after primary total knee arthroplasty. The mechanism of detumescence might be due to the decrease of hidden blood loss and the promotion of venous return. © 2014, Journal of Clinical Rehabilitative Tissue Engineering Research. All rights reserved. Source

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