| Part I Patellar Fractures with Two Kinds of Internal Fixation TechniqueObjective: There are currently various surgical methods of patella fracture with advantages and disadvantages. To compare fixation strength of patellar conformal compression plates and tension band wire to treat patellar fracture and to provide theoretical evidence for clinical application.Methods: Knee joint specimens in eight fresh cadavers were randomly divided into two groups and the patellar transverse fracture model were established. The models were fixed with tension band wire(Group B) and patellar conformal compression plates(Group C); Biomechanical tests were carried out to compare the fixation strength.Results: Both fixations’ strength could meet the 700 N quadriceps direction contraction. The patellar conformal compression plates was superior to tension band wire fixation in the patellar isolation shift, and fixation strength. There were significant differences between the two groups(P<0.05).Conclusion: The patellar conformal compression plates are compression fixation devices. Through this biomechanical study, the fixation strength advantages of patellar conformal compression plates were proved. The result proved that the fixation technique have practicality in clinical application. Part II The Comparison of the Patellofemoral Joint Contact Biomechanics of Physiological State and Patellar Fractures with Two Kinds of Internal Fixation TechniqueObjective: As a common choice to treat patellar fracture, tension band wire still need improvement in clinical efficacy. To compare contact biomechanics of patellofemoral joint of after fixed patellar fracture with patellar conformal compression plates and tension band wire and to provide theoretical evidence for clinical application.Methods: Knee joint specimens in twelve fresh cadavers were randomly divided into three groups(Group A, Group B and Group C) and the patellar transverse fracture model were established with Group B and C. The models were fixed with tension band wiring internal fixation(Group B) and patellar conformal compression plates(Group C); Biomechanical tests were carried out to compare the contact biomechanics of patellofemoral joint.Results: The patellar conformal compression plates was superior to tension band wiring fixation in the contact biomechanics of patellofemoral joint. There were significant differences between the two groups(P<0.05).Conclusion: The patellar conformal compression plates is consistent with the anatomical structure of the patella. Through this Biomechanical study, the advantages of patellar conformal compression plates were proved in the contact biomechanics of patellofemoral joint. This internal fixation technique deserve further application. Part III Clinical Curative Effect Research on Treatment of Patellar Fractures with Two Kinds of Internal Fixation TechniqueObjective: To compare the results of treatment of patellar fractures with patellar conformal compression plates and tension band wire.Methods: Between September 2010 and June 2012, 89 patients with patella fracture were treated in the department of trauma of The Third Hospital of Hebei Medical University, which were randomly divided into two groups. Group I were treated with patellar conformal compression plates and Group II were treated with tension band wiring. The anesthetic time, the operation time, blood loss during operation, complications, postoperative knee activities and clinical duration for fracture union were compared. Bostman score was used to evaluate knee function in postoperative patients.Results: There were no statistically significant differences on anesthetic time, operation time, blood loss, and clinical duration for fracture union between the two groups(P>0.05). Group I had better knee activities and knee function than Group II at 12 months after the operations, with a significant difference between two groups(P<0.05). The complication rate of Group I was obvious lower than Group II,(P<0.05). There were no statistically significant differences on knee activities and knee function between 2 groups at 12 months after the operations in the treatment of patellar fracture of type 45 B and 45C1(P>0.05). Group I had better knee activities and knee function than Group II at 12 months after the operations in the treatment of patellar fracture of type 45C2, 45C3 and 45A(P<0.05). Group I still had better knee activities and knee function than Group II at 18 months after the operations(P<0.05).Conclusion: The method of treating patellar fracture with patella embracing fixator exhibits advantages of simple operation, reliable fixation, less postoperative complications and better knee function recovered, it is reliable in treating patellar fractures. Part IV Injection During Total Knee Arthroplasty: a Meta-analysisObjective: To conduct a meta-analysis of randomized controlled trials evaluating the efficacy and safety of intra-articular injection of tranexamic acid(TXA) for reducing blood loss and transfusion in patients undergoing total knee arthroplasty(TKA).Methods: A meta-analysis was conducted of RCTs published before March 2013, identified from the Pub Med, EMBase, Cochrane library, Science Direct and other databases. Two independent reviewers assessed the methodological quality of the studies and performed data extraction. Mean difference in blood loss and blood transfusions, risk ratios of transfusion rates and deep vein thrombosis(DVT) incidence in the TXA-treated group versus placebo group were pooled from the included studies. Data was analyzed using Stata 11.0 software.Results: Six studies were included, with a total sample size of 647 patients. The use of TXA significantly reduced total blood loss(Mean difference:-344.96; 95% confidence interval:-401.20 to-239.68; P<0.01) and the proportion of patients requiring blood transfusions(risk ratios, 0.28; 95% confidence interval: 0.19 to 0.42; P<0.01). There were no significant differences in the incidence of DVT, pulmonary embolism or other complications between the study groups.Conclusion: The present meta-analysis indicated that intra-articular injection of TXA in patients undergoing TKA may reduce total blood loss and the need for blood transfusions, particularly, when a high dosage of TXA is used, without any increase in the risk of postoperative DVT. |
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