[Clinical effects of tranexamic acid in arthroscope for femoroacetabular impingement].

OBJECTIVE: To evaluate the clinical effects of tranexamic acid in arthroscope for femoroacetabular impingement. METHODS: Totally 34 patients (34 hips) with femoroacetabular impingement underwent hip arthroscopy from June 2016 to December 2018, were randomly divided into two groups named as tranexamic acid group and control group, 17 patients in each group. In TXA group, there were 10 males and 7 females, aged from 20 to 49 years old with an average of (32.1±7.6) years old;15 mg/kg TXA was intravenous drops before operation incision performed at 10 min. In control group, there were 11 males and 6 females, aged from 20 to 49 years old with an average of (30.9±6.2) years old;100 ml normal saline was intravenous drops before operation incision performed at 10 min. Introopertaive and total bloodloss between two groups were compared. Visual analogue scale (VAS) at 3 and 7 days after opertaion were used to evaluate pain relief of hip joint. Modified Harris Hip Score(mHHS) of hip joint at 3, 6, 9 and 12 weeks after oeprtaion were applied to evaluate clinical effects. RESULTS: All patients were obtained follow up over 12 weeks. Incision healed well without infection and deep vein thrombosis. There were no statistical difference in opertaion time bewteen two groups(P>0.05) . Total blood loss and introopertaive blood loss in TXA group were (0.47±0.20) L and (0.18±0.08) L, while (0.66±0.22) L and (0.24±0.01) L in control group;there were statical differences between two groups (P<0.05). There were no dierences in VAS before opertaion and 7 days after opertaion between two groups (P>0.05);VAS at 3 days after opertaion in TXA group was 2.35±1.12 and 3.12±0.70 in control group, and had difference (P< 0.05). There were significance in VAS at 3 and 7 days after opertaion compared with preopertaive between two groups (P< 0.05). Postopertaive mHHS in TXA group at 3 and 6 weeks were 87.72±1.95 and 91.92±2.32, respectively;while 84.08±1.21 and 89.77±3.30 in control group;there were difference between two groups at 3 and 6 weeks after operation (P<0.05);there were no significant difference in mHHS between two groups at 9 and 12 weeks after operation(P>0.05). CONCLUSION: Preoperative application of tranexamic acid could effectively reduce blood loss in arthroscopy for femoroacetabular impingement, thereby improving surgical field of vision, reducing difficulty of surgical operation, which could promote early and rapid rehabilitation of hip function.

Autologous platelet lysates local injections for treatment of tibia non-union with breakage of the nickelclad: a case report.

BACKGROUND: Nonunions of the tibia represent challenging orthopedic problems, which require the surgeon to analyze numerous factors and choose an appropriate treatment. This article presents a case report of tibia and fibula fracture patient who failed the internal fixation surgery and successfully recovered after one course of percutaneous autologous platelet lysates injection. CASE DESCRIPTION: The patient received an internal nickelclad breakage at 9 months post-surgery but reluctant to accept a second surgery, then autologous platelet lysates (APL) injection which is a less invasive method was recommended. The injections were carried once a week for three times. Radiologic evaluation was conducted every month until recovery. DISCUSSION AND EVALUATION: To the best of our knowledge, this is the first reported case of tibia delayed union with breakage of the plate resolved with APL injection. Improved clinical evidence was observed at 4 and 6 months after injection. The patient got good bony union at 8 months post-injection. The patient didn't feel any discomfort postinjection, no complications such as infection, refracture etc. were observed. CONCLUSIONS: APL percutaneous injection could be a new therapeutic option for the treatment of nonunion or delayed healing fractures.

Clinical evaluation following the use of mineralized collagen graft for bone defects in revision total hip arthroplasty.

Revision total hip arthroplasty (THA) with massive bone loss has been a real challenge for orthopaedic surgeons. Here we describe an approach using mineralized collagen (MC) graft to reconstruct acetabulum and femur with massive bone defects. We identified 89 patients suffering acetabular or femoral bone defects after primary THA, who required revision THA for this study. During the surgery, MC was applied to reconstruct both the acetabular and femoral defects. Harris hip score was used to evaluate hip function while radiographs were taken to estimate bone formation in the defect regions. The average follow-up period was 33.6 ± 2.4 months. None of the components needed re-revised. Mean Harris hip scores were 42.5 ± 3.5 before operation, 75.2 ± 4.0 at 10th month and 95.0 ± 3.6 at the final follow-up. There were no instances of deep infection, severe venous thrombosis or nerve palsy. The present study demonstrated that MC graft can serve as a promising option for revision THA with massive bone deficiency. Meanwhile, extended follow-up is needed to further prove its long-term performance.