Analysis of the efficacy of arthroscopic transverse release of iliotibial band through peritrochanteric space for the treatment of external snapping hip / 中华骨科杂志

Objective:To analyze the clinical efficacy of arthroscopic transverse release of the iliotibial band through peritrochanteric space for the treatment of external snapping hip.Methods:A total of 30 patients (12 males and 18 females) with bilateral external snapping hip underwent arthroscopic transverse release of the iliotibial band through peritrochanteric space in Department of Sports Medicine, Senior Department of Orthopaedics, the Fourth Medical Center, Chinese PLA General Hospital were retrospectively analyzed from May 2021 and June 2022. The average age was 32.5±8.2 years (range, 17-51 years). At the same time, 30 patients who underwent arthroscopic external release of the iliotibial band through the external surface of the iliotibial band (external iliotibial band group) were selected as control group, including 13 males and 17 females, aged 29.5±6.8 years (range, 11-45 years). The visual analogue scale (VAS), modified Harris hip score (mHHS), and gluteal muscle contracture disability scale (GDS) were compared between the two groups at preoperative, 6 months postoperative, and final follow-up.Results:All patients successfully completed the operation and were followed up for 17.5±3.3 months (range, 12-25 months). The VAS scores of the two groups at the last follow-up were lower than those before operation ( P<0.05). The mHHS scores before operation, 6 months after operation and at the last follow-up in the peritrochanteric space group were 76.5 (67.0, 85.5), 98.5 (94.8, 100.0) and 100.0 (97.0, 100.0), respectively, and those in the external iliotibial band group were 80.5 (70.0, 86.0), 100.0 (96.0, 100.0) and 100.0 (99.5, 100.0). The differences in mHHS scores between the two groups were statistically significant for intragroup comparisons ( P<0.05); of these, 6 months postoperatively and at the last follow-up were greater than preoperatively, with statistically significant differences ( P<0.05); the differences at 6 months postoperatively and at the last follow-up were not statistically significant ( P>0.05). There was no significant difference in mHHS scores between groups at different time points ( P>0.05). The GDS before operation, at 6 months after operation and at the last follow-up were 47.0 (35.8, 64.5), 90.0 (81.0, 94.0) and 93.5 (89.8, 98.0) in the peritrochanteric space group, and 51.0 (38.0, 64.5), 50.0 (81.0, 94.0) and 93.5 (89.8, 98.0) in the external iliotibial band group, respectively. The differences in GDS between the two groups were statistically significant for intragroup comparisons ( P< 0.05); of these, 6 months postoperatively and at the last follow-up were greater than preoperatively, with statistically significant differences ( P<0.05); the differences at 6 months postoperatively and at the last follow-up were not statistically significant ( P>0.05). There was no significant difference in GDS between groups at different time points ( P>0.05). Conclusion:Arthroscopic transverse release of the iliotibial band through peritrochanteric space for the treatment of external snapping hip can effectively reduce hip pain and improve hip function, with satisfactory clinical results, and can be used as an alternative treatment to transverse release through the external surface of the iliotibial band.

Clinicopathological comparison of intrahepatic cholangiocarcinoma with and without viral hepatitis / 中华普通外科杂志

Objective:To analyze the different clinicopathological features of intrahepatic cholangiocarcinoma with and without viral hepatitis.Methods:The clinicopathological data of 79 intrahepatic cholangiocarcinoma cases from Mar 2012 to Sep 2018 at Henan Provincial People's Hospital were retrospectively analyzed.Results:Twenty-five of the 79 patients with intrahepatic cholangiocarcinoma were accompanied by viral hepatitis. Those with viral hepatitis had a lower mean age at onset than those without [(53±11) years vs. (60±11) years, P=0.011], higher proportion of male patients (80% vs. 52%, P=0.017), higher AFP positive rate (40% vs. 19%, P=0.041), lower CA19-9 positive rate (48% vs. 72%, P=0.036), tend to occur in the right liver lobe (76% vs. 44%, P=0.009), a lower rate of bile duct invasion (16% vs. 41%, P=0.03), and were more likely to be mass type (mass type proportion 96% vs. 72%, P=0.032). Conclusions:Viral hepatitis is common in intrahepatic cholangiocarcinoma. Intrahepatic cholangiocarcinoma with and without viral hepatitis differ in clinicopathology. Intrahepatic cholangiocarcinoma with viral hepatitis is more likely to have the characteristics of hepatocellular carcinoma, while intrahepatic cholangiocarcinoma without viral hepatitis is more likely to have the characteristics of cholangiocarcinoma.

Investigation for use of(GB/T 12346-2006), national standard / 中国针灸

To understand the use in recent 10 years of(GB/T 12346-2006),a standard of The People's Republic of China,so as to provide the evidence for its further establishment and revision,we investigated and analyzed the application ofthrough relevant literature and the textbook. It is found that making use of the standard is being realized in various types of articles and it is described in almost all the textbooks. Implementing the standard intensively promotes the standardization of acupuncture-moxibustion education and clinical manipulation as well as the academic exchange domestically and overseas. In turn,its scientificalness and authority are further strengthened.

Mathematical analysis of the influences of femoral and tibial bone cuts on the dynamic alignment in total knee arthroplasty / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the influences of the distal femoral cut, the anterior and posterior femoral cuts, the proximal tibial cut on the dynamic alignment of the lower extremity in total knee arthroplasty.</p><p><b>METHODS</b>Based on the three-dimensional geometric model, imitating the flexion movement of the knee without axial rotation after total knee arthroplasty, the influence of each of the three bone cuts on the dynamic alignment was analyzed with the assumption of standard bone cuts of the other two and equality of the medial and lateral soft tissue balancing. The dynamic alignment was defined as the angle between the mechanical axis of the tibia and the sagittal plane of the body when the knee was in any angle of flexion. With two of the three major bone cuts standard, the track of the tibial movement was established when the other one bone cut deviated from the ideal section of angle A. Based on the principle of geometry, the mathematical formula were established to present the influences of three bone cuts on the dynamic alignment of the lower extremity.</p><p><b>RESULTS</b>All of the three kinds of bone cuts in total knee arthroplasty influenced the dynamic alignment of the lower extremity not just in one static position, but during the whole range of motion. At the θ angle of knee flexion, the alignment of the lower extremity was arcsin(cosθsinA) when the varus/valgus femoral component alignment was A; the alignment of the lower extremity was arcsin(sinθsinA) when the rotational femoral component alignment was A; the alignment of the lower extremity was A when the varus/valgus tibial component alignment was A.</p><p><b>CONCLUSION</b>The influences of the distal femoral cut, the anterior and posterior femoral cuts, the proximal tibial cut on the dynamic alignment of the lower extremity in total knee arthroplasty are dynamically changed during the flexion movement of the knee.</p>

IPC devices combined with anticoagulants for the prevention of deep vein thrombosis in TKA and THA patients: A prospective randomized control study / 中华骨科杂志

Objective To investigate the effectiveness of intermittent pneumatic compression (IPC) devices combined with anticoagulants for the prevention of deep vein thrombosis (DVT) after joint replacement surgery.Methods All of 400 patients were involved in this prospective randomized control study with 100 total knee arthroplasty (TKA) patients and 100 total hip arthroplasty (THA) patients in each group.All patients were operated under the general anesthesia.Patients in the control group received 10 mg of rivaroxaban per day beginning 6-8 hours after the surgery.Besides the prescription of rivaroxaban, IPC devices were used just after the anesthesia in the operating theater and lasted for 48 hours in the experimental group.The diagnosis of DVT in the lower extremities was made by color Duplex sonography on the second postoperative day.The incidence rate of DVT and symptomatic pulmonary embolism was recorded.The incidence rates of total DVT, proximal DVT (p-DVT, proximal to the trifurcation of the popliteal vein), distal DVT (d-DVT, in the anterior tibial vein, posterior tibial vein or peroneal vein) and intermuscular DVT were recorded.CT pulmonary angiography was used to confirm the pulmonary embolism if it was suspected.Results The incidence rates of overall, proximal, distal and intermuscular DVT were 9.5％, 0.5％, 0.5％, 8.5％ in the experimental group and 30％, 0.5％, 5.5％, 24％ in the control group respectively.The incidence rates of total DVT, distal DVT and intermuscular DVT were significantly lower in the experimental group.The incidence rate of DVT in TKA patients and THA patients were significantly lower in the experimental group than in the control group respectively.For patients with DVT, enoxaparin was used instead of rivaroxaban, and DVT was found disappeared by color Duplex sonography 10-12 days postoperatively.Conclusion Compared with the use of rivaroxaban alone, IPC devices combined with anticoagulants can significantly reduce the incidence rate of distal DVT and intermuscular DVT in the early postoperative period after joint replacement surgery.