Tranexamic acid use decreases transfusion rate in children with cerebral palsy undergoing proximal femoral varus derotational osteotomy

Previous studies demonstrated the safety of tranexamic acid (TXA) use in cerebral palsy (CP) patients undergoing proximal femoral varus derotational osteotomy (VDRO), but were underpowered to determine if TXA alters transfusion rates or estimated blood loss (EBL). The purpose of this study was to investigate if intraoperative TXA administration alters transfusion rates or EBL in patients with CP undergoing VDRO surgery.We conducted a retrospective review of 390 patients with CP who underwent VDRO surgery between January 2004 and August 2019 at a single institution. Patients without sufficient clinical data and patients with preexisting bleeding or coagulation disorders were excluded. Patients were divided into 2 groups: those who received intraoperative TXA and those who did not.Out of 390 patients (mean age 9.4 ± 3.8 years), 80 received intravenous TXA (TXA group) and 310 did not (No-TXA group). There was no difference in mean weight at surgery (P = .25), Gross Motor Function Classification System level (P = .99), American Society of Anesthesiologist classification (P = .50), preoperative feeding status (P = .16), operative time (P = .91), or number of procedures performed (P = .12) between the groups. The overall transfusion rate was lower in the TXA group (13.8%; 11/80) than the No-TXA group (25.2%; 78/310) (P = .04), as was the postoperative transfusion rate (7.5%; 6/80 in the TXA group vs 18.4%; 57/310 in the No-TXA group) (P = .02). The intraoperative transfusion rate was similar for the 2 groups (TXA: 7.5%; 6/80 vs No-TXA: 10.3%; 32/310; P = .53). The EBL was slightly lower in the TXA group, although this was not significant (TXA: 142.9 ± 113.1 mL vs No-TXA: 177.4 ± 169.1 mL; P = .09). The standard deviation for EBL was greater in the No-TXA group due to more high EBL outliers. The percentage of blood loss based on weight was similar between the groups (TXA: 9.2% vs No-TXA: 10.1%; P = .40). The number needed to treat (NNT) with TXA to avoid one peri-operative blood transfusion in this series was 9.The use of intraoperative TXA in patients with CP undergoing VDRO surgery lowers overall and postoperative transfusion rates.Level of evidence: III, Retrospective Comparative Study.     

肱内翻的诊断和治疗（附9例报告）

我院１２年间共收治肱内翻９例，平均年龄１４．２岁。患侧上臂短缩平均５．６ｃｍ。肩关节外展受限平均４０＾ｏ。Ｘ线片肱骨上端骨骺内翻畸形，骨骺线与肱骨干长轴平行，头干角平均９６＾ｏ，合并肱骨外科髓骨折４例，６例作肱骨头下楔形外展截骨术矫正，均获满意效果。     

Der Hallux varus congenitus

Operationsprinzip Entfernung des überz?hligen Zehenstrahls und Beseitigung der Varusfehlstellung der Gro?zehe unter Berücksichtigung der individuellen anatomischen Gegebenheiten, n?mlich der Form des angrenzenden Metatarsalk?pfchens, der Sehnenanomalien oder Muskelverkürzungen und der Anlage eines “fibr?sen Stranges” als rudiment?rer, überz?hliger erster Zehenstrahl. Es k?nnen deshalb Sehnenverlagerungen, Durchtrennungen verkürzter Kapsel-Band-Strukturen, Resektionen überz?hliger und deformierter Skelettelemente und Korrekturosteotomien erforderlich werden. Ein verbleibender Hautdefekt wird mit einem Vollhauttransplantat gedeckt.      

Elimination of femoral rotation in clinical testing for varus/valgus laxity of the knee

Clinical testing of varus/valgus laxity of the knee joint has been shown to have a large interobserver variation. Part of the reason for this is the tendency for the femur to rotate during the performance of classical testing, leading to misinterpretation of the degree of joint opening. A simple adjustment in the examination technique is described which eliminates this problem, and the biomechanical principles responsible for its efficacy are outlined.     

Abductor hallucis release in congenital metatarsus varus

Summary Adduction of the forefoot diagnosed in the young child generally corrects spontaneously. Resistant forefoot adduction is usually combined with a degree of supination of the forefoot and described as congenital metatarsus varus.In true congenital metatarsus varus there is a contraction or shortening of the abductor hallucis muscle and tendon which is considered to be the primary deforming factor.In the early severe or resistant deformity correction can be achieved by either division of the tendon with release of its capsular attachment, or, in the more severe deformity, by complete release of the abductor hallucis muscle from its extensive attachment to bone and soft tissues.

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Résumé L'adduction de l'avant-pied découverte chez l'enfant jeune se corrige spontanément en règle générale. Dans le cas contraire, elle s'associe habituellement à un certain degré de supination de l'avant-pied et elle est alors décrite comme metatarsus varus congénital.Dans le véritable metatarsus varus congénital il existe une rétraction ou une brièveté du tendon et du muscle abducteur du 1 ^er orteil que l'on considère comme le facteur déterminant de la déformation.Dans les cas de déformation d'emblée sévère ou persistante, la correction peut être obtenue soit par section du tendon et de son insertion sur la capsule, soit, dans les cas les plus graves, par désinsertion complète du muscle abducteur du 1 ^er orteil, tant au niveau de l'os que des parties molles.

     

超声在跖腱膜炎诊断中的价值

目的　探讨超声测量在跖腱膜炎诊断中的价值。方法　应用超声观察和测量临床诊断为跖腱膜炎并经手术治疗证实的 46例患者的双侧跖腱膜 ,并测量 2 8例正常中年人的双侧跖腱膜作为对照。结果　患者组患侧足的跖腱膜其跟骨附着部的厚度 [(5 .7± 1.0 )mm ]较其健侧的厚度 [(3 .4± 0 .4)mm ] ,明显增加 (P <0 .0 0 1) ,亦较对照组的厚度 [(2 .9± 0 .2 )mm]明显增加 (P <0 .0 0 1)。结论　超声测量对跖腱膜炎具有明确诊断价值 ,且具有无创、便捷、价格低廉的优点     

基于CT和MRI膝关节有限元模型建立与不同载荷下生物力学特性分析

基于CT和MRI图像数据建立膝关节有限元模型,采用六面体网格对不同载荷系统下人体膝关节生物力学特性进行研究,并进行有效性验证。建立膝关节有限元模型包括:股骨、胫骨、髌骨、腓骨、股骨软骨、胫骨软骨、腓骨软骨、半月板、前后交叉韧带、内外侧副韧带、髌韧带和股四头肌腱等。对膝关节施加1 kN轴向压缩载荷、134 N后向抽屉力和5、10、15 N[?m内翻力矩和外翻力矩,分析膝关节内软骨和半月板的接触应力和接触面积,股骨内外翻倾角以及位移变化情况。在1 kN压缩载荷和134 N抽屉力作用下,股骨软骨、内外侧半月板和内外侧胫骨软骨的接触应力峰值分别为4.47、3.25、2.83、2.70、2.53 MPa,Von Mises应力峰值分别为2.22、2.44、2.25、2.07、1.64 MPa。股骨相对胫骨前向位移为4.19 mm。施加5、10、15 N[?m内翻和外翻力矩时,股骨内翻和外翻倾角分别为3.49°、4.48°、4.91°和3.22°、3.62°、4.01°。随着力矩的线性增大,膝关节各组成部分的应力呈非线性变化趋势。膝关节软骨、半月板和韧带的研究结果符合其生物力学特性,与前人数值分析和实验研究结果相一致,可为临床膝关节生理病理分析和治疗提供一定的理论依据。     

膝内翻患者全膝关节置换术后保留轻度内翻对临床效果的影响

目的 评价膝内翻患者全膝关节置换术后保留轻度内翻对临床效果的影响。方法 对2016年3月至2019年11月于武汉大学人民医院因膝内翻膝关节骨性关节炎行TKA治疗的93例（93膝）患者的临床资料进行回顾性分析。其中,男17例,女76例;年龄71 ～ 87岁,平均77岁。按患者术后下肢力线角度将患者分为中立组、轻度内翻组、严重内翻组。用ROM、HSS、AKS评分量表评价患者膝关节功能。结果 患者随访时间15 ～ 47个月,平均（24.4±8.9）个月,ROM术前平均（49.9±6.7）°,术后末次随访中立组、轻度内翻组、严重内翻组分别为平均（111.4±5.3）°、（112.2±5.0）°、（103.1±2.7）°,HSS评分术前平均（52.4±3.0）分,术后末次随访中立组、轻度内翻组、严重内翻组分别为平均（84.2±3.0）分、（87.1±2.6）分、（81.6±1.9）分,AKS功能评分术前平均（49.8±2.8）分,术后末次随访中立组、轻度内翻组、严重内翻组分别为平均（73.2±5.3）分、（80.1±3.0）分、（72.6±1.5）分,AKS活动评分术前平均（60.5±3.7）分,术后末次随访中立组、轻度内翻组、严重内翻组分别为平均（86.0±2.6）分、（89.9±2.0）分、（80.6±2.9）分,三组术后HSS、AKS评分均较术前有所提高,差异有统计学意义。结论 从短期随访来看,膝内翻患者全膝关节置换术后保持3° ～ 6°的轻度内翻会带来更好的临床疗效,但目前还不能判断内翻对齐和翻修率之间是否存在关联。