Jian-xiong Ma

Topical application of tranexamic acid in primary total hip arthroplasty: A systemic review and meta-analysis

OBJECTIVEnA systematic review of randomized controlled trials (RCTs) and non-RCTs was performed to evaluate efficacy for the reduction of postoperative blood loss and transfusion requirements of topical use of tranexamic acid in patients undergoing primary total hip arthroplasty.nnnMETHODnPotential articles were identified from Medline (1966 - September 2014), Embase (1980 - September 2014), Pubmed (1980 - September 2014) and The Cochrane Central Register of Controlled Trials. Other internet databases are also searched to find trials according to the Cochrane Collaboration guidelines. Moreover, gray literatures are also selected from the reference list of the included studies. High quality randomized controlled trials (RCTs) and non-RCTs were selected. The software RevMan 5.1 was used for the mate-analysis.nnnRESULTSnFour RCTs and four non-RCT meet the inclusion criteria. There were significant differences in hemoglobin, total blood loss, transfusion requirements and postoperative drainage volume between TXA groups and control groups. There were no significant differences in length of stay, incidence of wound infection, deep vein thrombosis (DVT) and pulmonary embolism (PE) between treatment and control groups.nnnCONCLUSIONSnPresent meta-analysis indicates that the antifibrinolytic agent, also known as tranexamic acid, could reduce hemoglobin decline, volume of drainage, total blood loss and transfusion requirements after THA, and is not related to adverse reactions or complications such as wound infection, DVT and PE.

Adductor canal block versus continuous femoral nerve block in primary total knee arthroplasty: A meta-analysis

OBJECTIVEnContinuous femoral nerve block (CFNB) is considered the preferred analgesia after TKA. However, it may weaken quadriceps muscle strength, subsequently increasing the risk of falling. Adductor canal block (ACB) is a new sensory block technique that effectively relieves postoperative pain while preserving quadriceps strength. Thias meta-analysis was conducted to determine whether ACB of CFNB provides better pain relief and functional recovery after TKA.nnnMETHODnThe PubMed, Embase, Web of Science and Cochrane Library databases were comprehensively searched. Seven studies comparing ACB with CFNB in patients with TKA were enrolled in our meta-analysis. Review Manager 5.3 for Windows was used to analyse the extracted data.nnnRESULTSnCompared with the CFNB group, the ACB exhibited a significant decrease in visual analogue scale (VAS) score at rest within 24xa0h (pxa0<xa00.00001), as well as significant decreases in the length of hospital stay (Pxa0<xa00.0001) and post-operative nausea (Pxa0=xa00.03). ACB patients also exhibited greater improvements in ambulation ability (Pxa0=xa00.01) and ambulation distance (Pxa0<xa00.00001). There were no significant differences in the VAS score at rest 8 and 48xa0h following surgery, nor in the ambulation VAS score and opioid consumption two days following surgery.nnnCONCLUSIONSnCompared with CFNB, ACB provides equally effective analgesia after TKA. ACB results in fast pain relief and early ambulation while decreasing post-operative nausea. ACB thus has the potential to replace CFNB as the gold standard for pain management in TKA patients.

The efficacy of a thrombin-based hemostatic agent in primary total knee arthroplasty: a meta-analysis.

PurposeTotal knee arthroplasty (TKA) is a popular procedure in severe osteoarthritis. But perioperative bleeding remains a problem. Floseal® is a mixture of thrombin and bovine gelatin which can benefit a lot on reducing intraoperative and postoperative bleeding. However, there is no enough evidence judging its safety and efficiency. So a meta-analysis is conducted by us to evaluate the efficacy and safety of a thrombin-based hemostatic agent compared with conventional methods in TKA.MethodTwo independent reviewers selected literatures published before August 2014 from MEDLINE, Embase, and The Cochrane Central Register of Controlled Trials. Other internet databases were also performed to identify trials according to the Cochrane Collaboration guidelines. High-quality randomized controlled trials (RCTs), prospective control trials (PCTs), and case controlled trials (CCTs) were selected. The meta-analysis was undertaken using RevMan 5.1 for Windows.ResultsThree RCTs, one PCT, and one CCT met the inclusion criteria. There were significant differences in hemoglobin decline and calculated total blood loss between the Floseal® group and control group. There were no significant differences in postoperative drainage volume, rate of transfusion requirement, incidence of wound infection, deep vein thrombosis (DVT), and pulmonary embolism (PE) between treatment and control groups.ConclusionsThe present meta-analysis indicates that a thrombin-based hemostatic agent can reduce hemoglobin decline and calculated total blood loss after TKA and is not related to adverse reactions or complications such as wound infection, DVT, and PE.

The use of gabapentin in the management of postoperative pain after total hip arthroplasty: a meta-analysis of randomised controlled trials.

BackgroundPain management after total hip arthroplasty (THA) varies and has been widely studied in recent years. Gabapentin as a third-generation antiepileptic drug that selectively affects the nociceptive process has been used for pain relief after THA. This meta-analysis was conducted to examine the efficacy of gabapentin in THA.MethodsAn electronic-based search was conducted using the following databases: PubMed, EMBASE, Ovid MEDLINE, ClinicalTrials.gov, and Cochrane Central Register of Controlled Trials (CENTRAL). Randomised controlled trials (RCTs) involving gabapentin and a placebo for THA were included. The meta-analysis was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement.ResultsFive trials met the inclusion criteria. The cumulative narcotic consumption and the visual analogue scale (VAS) scores at 24 and 48xa0h postoperatively were used for postoperative pain assessment. There was a significant decrease in morphine consumption at 24xa0h (Pu2009=u20090.00). Compared with the control group, the VAS score (at rest) at 48xa0h was less in the gabapentin group (Pu2009=u20090.00).ConclusionThe administration of gabapentin is effective in decreasing postoperative narcotic consumption and the VAS score.

Comparison of oral versus intravenous application of tranexamic acid in total knee and hip arthroplasty: A systematic review and meta-analysis

BACKGROUNDnTranexamic acid (TXA) is regarded as one of the most important drugs in reducing blood loss and hemoglobin (Hb) drop after total knee arthroplasty (TKA) or total hip arthroplasty (THA). Treatment with tranexamic acid (TXA) by intravenous application has been discussed extensively. Recently, several studies have reported that oral administration has an effect on blood sparing. Therefore, we performed a meta-analysis to investigate the efficacy and safety between oral TXA and intravenous TXA (IV-TXA) for blood sparing in total knee and hip arthroplasty.nnnMETHODSnRandomized controlled trials (RCTs) or retrospective cohort studies (RCSs) about relevant research were searched for by using PubMed (1996-April 2017), Embase (1980-April 2017), and the Cochrane Library (CENTRAL, April 2017). Five studies that compared oral with IV administration of TXA were included in our meta-analysis. Meta-analysis results were collected and analyzed by the software Review Manager 5.3 (Copenhagen: The Nordic Cochrane Center, The Collaboration, 2014).nnnRESULTSnFive studies containing 3474 patients met the inclusion criteria. Our pooled data analysis indicated that oral TXA was as effective as the IV-TXA in terms of the average Hb drop (Pxa0=xa00.88), total Hb loss (Pxa0=xa00.57), total blood loss (Pxa0=xa00.42), transfusion rate (Pxa0=xa00.16), complications (Pxa0=xa00.61), and length of hospital stay (Pxa0=xa01.00).nnnCONCLUSIONSnCompared with the IV-TXA method, oral TXA shows similar blood-sparing efficacy for preventing hemoglobin drop, total hemoglobin loss, and total blood loss following TKA or THA. In addition, no significant differences of transfusion rate, complications, or length of hospital stay were found between the 2 groups. However, because of the limited number of included studies, more studies of high quality are needed to further identify the optimal administration time for oral TXA.

Interleukin-23 may contribute to the pathogenesis of lumbar disc herniation through the IL-23/IL-17 pathway

BackgroundStudies have indicated that interleukin 23 (IL-23) plays an important role in many inflammatory- and autoimmune-related diseases. However, there is little knowledge about IL-23 in lumbar disc herniation (LDH). Thus, in this study, we aimed to find out whether IL-23 is expressed in intervertebral discs (IVDs) and what roles it may play.MethodsHuman IVD tissues were collected from 29 LDH patients and 8 vertebral fracture patients (normal control, NC group). According to the integrity of annulus fibrosus, LDH patients were divided into two groups: R group (ruptured group, nu2009=u200916) and NR group (non-ruptured group, nu2009=u200913). Morphological changes of IVDs were assessed by hematoxylin and eosin (HE staining), and expression of IL-23 in IVD tissues was detected by immunohistochemical staining. Besides gene expression of IL-23, IL-17, IL-6, IL-1β, and TNF-α was also evaluated by reverse transcription polymerase chain reaction (RT-PCR).ResultsThe results showed that the R group was more degenerated than the other two groups and NC group showed the least degenerated performance; stronger positive IL-23 expression was observed in herniated IVDs, especially in the R group. Meanwhile, higher gene expression of IL-23, IL-17, IL-6, IL-1β, and TNF-α was found in the tissues from LDH patients and a positive correlation between IL-17 and IL-23 gene expression was also observed.ConclusionsTaken all above results together, it may be deduced that higher expression of IL-23 may contribute to the deterioration of IVDs through the IL-23/IL-17 pathway.

Biomechanical comparison of mono-segment transpedicular fixation with short-segment fixation for treatment of thoracolumbar fractures: A finite element analysis

Mono-segment transpedicular fixation is a method for the treatment of certain types of thoracolumbar spinal fracture. Finite element models were constructed to evaluate the biomechanics of mono-segment transpedicular fixation of thoracolumbar fracture. Spinal motion (T10–L2) was scanned and used to establish the models. The superior half of the cortical bone of T12 was removed and the superior half of the cancellous bone of the T12 body was assigned the material properties of injured bone to mimic vertebral fracture. Transpedicular fixation of T11 and T12 was performed to produce a mono-segment fixation model; T11 and L1 were fixed to produce a short-segment fixation model. Motion differences between functional units and von Mises stress on the spine and implants were measured under axial compression, anterior bending, extensional bending, lateral bending and axial rotation. We found no significant difference between mono- and short-segment fixations in the motion of any functional unit. Stress on the T10/T11 nucleus pulposus and T10/T11 and L1/L2 annulus fibrosus increased significantly by about 75% on anterior bending, extensional bending and lateral bending. In the fracture model, stress was increased by 24% at the inferior endplate of T10 and by 43% at the superior endplate of L2. All increased stresses were reduced after fixation and lower stress was observed with mono-segment fixation. In summary, the biomechanics of mono-segment pedicle screw instrumentation was similar to that of conventional short-segment fixation. As a minimally invasive treatment, mono-segment fixation would be appropriate for the treatment of selected thoracolumbar spinal fractures.

Efficacy and safety of intraarticular hyaluronic acid and corticosteroid for knee osteoarthritis: A meta-analysis

OBJECTIVEnA meta analysis to compare efficacy and safety of intraarticular hyaluronic acid (HA) and intraarticular corticosteroids (CS) in patients with knee osteoarthritis.nnnMETHODnPotential studies were searched from the electronic databases included PubMed, Embase, web of science and the Cochrane Library up to August 2016. High quality randomized controlled trials (RCTs) were selected based on inclusion criteria. RevMan 5.3 were used for the meta-analysis.nnnRESULTSn12 RCTs containing 1794 patients meet the inclusion criteria. Visual analog scale (VAS) score in CS group decrease more than HA group up to 1 month (pxa0=xa00.03) and it shows equal efficacy at 3 months (pxa0=xa00.29); HA is more effective than CS at 6 months (pxa0=xa00.006). To Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, there is no significant difference for two groups at 3 months (pxa0=xa00.29); HA shows greater relative effect than CS at 6 months (pxa0=xa00.005). No significant difference is found on proportion of rescue medication use after initiation of treatment (pxa0=xa00.58) and proportion of withdrawal for knee pain (pxa0=xa00.54). HA and CS exhibit equal efficacy on improvement of active range of knee flexion at 3 months (pxa0=xa00.73) and 6 months (pxa0=xa00.43). More topical adverse effects occurred in intraarticular HA group when compared with intraarticular CS group.nnnCONCLUSIONnIntraarticular CS is more effective on pain relief than intraarticular HA in short term (up to 1 month), while HA is more effective in long term (up to 6 months). Two therapies benefit similarly for knee function improvement. Both two methods are relatively safe, but intraarticular HA causes more topical adverse effects compared with intraarticular CS.

The efficacy of intraoperative autologous platelet gel in total knee arthroplasty: A meta-analysis

PURPOSEnAutologous platelet gel, developed from fresh autologous blood, is a breakthrough in the promotion and acceleration of soft tissue and bone repair. The application of autologous platelet gel has been reported to improve haemostasis and promote function recovery. We screened the randomized controlled trials and controlled clinical trials of high quality to investigate whether autologous platelet gel makes a better performance for postoperative bleeding and functional recovery in patients after total knee arthroplasty.nnnMETHODnThe Web of Science, the Cochrane Library, EMBASE, and PubMed databases were comprehensively searched. A total of 1234 patients with 1333 knees were included in the twelve studies. The PRISMA guidelines and Cochrane Handbook were applied to appraise the results published in all included studies. Review Manager 5.3 for Windows was used to analyse the extracted data.nnnRESULTSnCompared with the placebo group, the autologous platelet gel group showed a significant decrease in visual analogue scale. No significant differences were found in the drop of haemoglobin, knee society score, Western ontario mcmaster osteoarthritis index, length of hospital stay, postoperative narcotics, and range of motion during post-operative follow-up.nnnCONCLUSIONSnCompared with placebo, APG offers superior pain control after total knee arthroplasties. However, APG has no advantage in blood loss, functional recovery, postoperative narcotics and length of stay. The use of autologous platelet gel is not worthy of being recommended as a bioactive autologous material to improve the clinical outcomes in total knee arthroplasty patients.

Effectiveness of surgery versus conservative treatment for lumbar spinal stenosis: A system review and meta-analysis of randomized controlled trials

PURPOSEnLumbar spinal stenosis (LSS) was a common degenerative disease that affected the lumbar spine function and quality of life, which can be treated both surgery and conservative treatment. We did this study to compare the effectiveness of surgery versus conservative treatment for LSS.nnnMETHODSnWe searched PubMed as well as other databases in September.18th.2016. Randomized controlled trials compared surgery versus conservative treatment for patients with LSS were enrolled. Outcomes and complications were collected with data selection criteria and analyzed with Review Manager Version 5.3.nnnRESULTSnNine RCTs (14 articles) and 1658 patients were included, and three of them were high-quality studies. At first 6 months after treatment, there were no significant differences for ODI scores between two therapeutic groups (Pxa0>xa00.05), however, surgery group showed significant higher ODI scores at one year (Pxa0<xa00.05) and two years (Pxa0<xa00.05). Two studies reported no significant difference between laminectomy and conservative treatment for the SF-36 physical function scores at 3 months, 6 months, 12 months and 24 months (Pxa0>xa00.05) and two studies reported patients were satisfied with X-STOP implanted at six weeks, six months, and one year. No statistical differences for the adverse events intra-operation or within 72xa0h (Pxa0>xa00.05) between surgery and non-surgery groups. Moreover, subgroup analysis showed there were no safety differences between laminectomy and conservative treatment, X-STOP and conservative treatment at early stage of duration. However, the surgical groups had higher complication rates than non-surgery groups throughout the follow-up duration.nnnCONCLUSIONnSurgery groups showed better late clinical outcomes after one year and higher complication rate throughout the follow-up duration, although it had no significant differences compared with conservative groups in the first six months post-treatment. However, there was no evidence that a definitive method could be firmly recommended to LSS patients. Further researches were needed to achieve high quality and credible results.