Meta-analysis of new intervention measures for preventing side effects of artificial joint replacement

BACKGROUND Intertrochanteric fracture of the femur occurs mostly among older people,and seriously affects daily life and quality of life.At present,physical intervention,drug treatment,routine intervention and rehabilitation training are widely used for prevention of side effects,but it is still inconclusive which intervention has the best effect.AIM To compare the effects of new intervention measures for preventing side effects of artificial joint replacement.METHODS We searched the Chinese and English literatures for comparative studies on the prevention of side effects of new interventions for artificial joint replacement from July 2013 to June 2023 in China HowNet,PubMed,Wanfang,Weipu and other databases.Study quality was evaluated by improved Jadad scoring standard,and the effects of different interventions on preventing different complications were analyzed by meta-analysis of evidence-based medicine with Review Manager 5.0 software.RESULTS Ten articles,including 869 cases,were finally included.The preventive effects of different interventions on the side effects of artificial joint replacement were studied,and valid data were extracted.There were two articles on the preventive effects of drug intervention,four on comparison of the preventive effects of combined and single interventions,and three on the preventive effects of physical intervention,rehabilitation training and routine intervention.Meta-analysis showed that the preventive effect of rivaroxaban was significantly better than low molecular weight heparin calcium[mean difference(MD)=-0.16,95%CI:-0.28 to-0.04,P<0.05].The effect of combined intervention was significantly better than that of single intervention(MD=-0.08,95%CI:-0.16 to-0.01,P<0.001).Physical intervention was significantly better than routine intervention and rehabilitation training(MD=0.26,95%CI:0.16–0.36,P<0.001).CONCLUSION Rivaroxaban combined with rehabilitation training is preferred for preventing deep vein thrombosis after artificial joint replacement.In the prevention of pulmonary embolism,rivaroxaban drug intervention is given priority.The effect of combined intervention is better than that of single intervention.

Investigation of contact behavior on a model of the dual-mobility artificial hip joint for Asians in different inner liner thicknesses

BACKGROUND The four components that make up the current dual-mobility artificial hip joint design are the femoral head,the inner liner,the outer liner as a metal cover to prevent wear,and the acetabular cup.The acetabular cup and the outer liner were constructed of 316L stainless steel.At the same time,the inner liner was made of ultra-high-molecular-weight polyethylene(UHMWPE).As this new dual-mobility artificial hip joint has not been researched extensively,more tribological research is needed to predict wear.The thickness of the inner liner is a significant component to consider when calculating the contact pressure.AIM To make use of finite element analysis to gain a better understanding of the contact behavior in various inner liner thicknesses on a new model of a dual-mobility artificial hip joint,with the ultimate objective of determining the inner liner thickness that was most suitable for this particular type of dual-mobility artificial hip joint.METHODS In this study,the size of the femoral head was compared between two diameters(28 mm and 36 mm)and eight inner liner thicknesses ranging from 5 mm to 12 mm.Using the finite element method,the contact parameters,including the maximum contact pressure and contact area,have been evaluated in light of the Hertzian contact theory.The simulation was performed statically with dissipated energy and asymmetric behavior.The types of interaction were surface-to-surface contact and normal contact behavior.RESULTS The maximum contact pressures in the inner liner(UHMWPE)at a head diameter of 28 mm and 36 mm are between 3.7-13.5 MPa and 2.7-10.4 MPa,respectively.The maximum von Mises of the inner liner,outer liner,and acetabular cup are 2.4–11.4 MPa,15.7–44.3 MPa,and 3.7–12.6 MPa,respectively,for 28 mm head.Then the maximum von Mises stresses of the 36 mm head are 1.9-8.9 MPa for the inner liner,9.9-32.8 MPa for the outer liner,and 2.6-9.9 MPa for the acetabular cup.A head with a diameter of 28 mm should have an inner liner with a thickness of 12 mm.Whereas the head diameter was 36 mm,an inner liner thickness of 8 mm was suitable.CONCLUSION The contact pressures and von Mises stresses generated during this research can potentially be exploited in estimating the wear of dual-mobility artificial hip joints in general.Contact pressure and von Mises stress reduce with an increasing head diameter and inner liner’s thickness.Present findings would become one of the references for orthopedic surgery for choosing suitable bearing geometric parameter of hip implant.

Design and Mechanics Simulation of Bionic Lubrication System of Artificial Joints

We propose a new structure for artificial joints with a joint capsule which is designed to overcome the drawback of current prostheses that omit many functions of the lubricant and the joint capsule. The new structure is composed of three components： lubricant, artificial joint and artificial joint capsule. The lubricant sealed in the capsule can not only reduce the wear of the artificial joint but also prevents the wear particles leaking into the body. So unexpected reactions between the wear particles and body can be avoided completely. A three-dimensional （3-D） finite element analysis （FEA） model was created for a bionic knee joint with capsule. The stresses and their distribution in the artificial capsule were simulated with different thickness, loadings, and flexion angles. The results show that the maximum stress occurs in the area between the artificial joint and the capsule. The effects of capsule thickness and the angles of flexion on stress are discussed in detail.

The Anatomic Study on Replacement of Artificial Atlanto-odontoid Joint through Transoral Approach

In order to provide anatomical basis for transoral approach （TOA） in dealing with the ventro lesions of craniocervical junction, and the design and application of artificial atlanto-odontoid joint, microsurgical dissecting was performed on 8 fresh craniocervical specimens layer by layer through transoropharyngeal approach. The stratification of posterior pharyngeal wall, course of vertebral artery, adjacent relationship of atlas and axis and correlative anatomical parameters of replacement of artificial atlanto-odontoid joint were observed. Besides, 32 sets of atlanto-axial joint in adults＇ fresh bony specimens were measured with a digital caliper and a goniometer, including the width of bony window of anterior arch of atlas, the .width of bony window of axis vertebra, the distance between superior and inferior two atlas screw inserting points, the distance between two axis screw inserting points etc. It was found that the width of atlas and axis which could be exposed were 40.2±3.5 mm and 39.3±3.7 mm respectively. The width and height of posterior pharyngeal wall which could be exposed were 40.1±5.2 mm and 50.2±4.6 mm respectively. The distance between superior and inferior two atlas screw inserting points was 28.0±2.9 mm and 24.0±3.5 mm respectively, and the distance of bilateral axis screw inserting points was 18.0±1.2 mm. The operative exposure position through TOA ranged from inferior part of the clivus to the superior part of the C3 vertebral body. Posterior pharyngeal wall consisted of 5 layers and two interspaces： mucosa, submucosa, superficial muscular layer, anterior fascia of vertebrae, anterior muscular layer of vertebrae and posterior interspace of pharynx, anterior interspace of vertebrae. This study revealed that it had the advantages of short operative distance, good exposure and sufficient decompression in dealing with the ventro lesions from the upper cervical to the lower clivus through the TOA. The replacement of artificial atlanto-odontoid joint is suitable and feasible. The design of artificial atlanto-odontoid joint should be based on the above data.

Uni- and multidirectional wear resistance of different crosslinking degrees in UHMWPE for artificial joints

The aim of this work was to study the effect of UHMWPE crosslinking on wear performance. Differently treated UHMWPEs were studied by means of unidirectional and multidirectional wear tests. Unidirectional tests simulate total knee replacement and multidirectional tests simulate total hip replacement movements. The samples tested were observed by optical and scanning electron microscopy in order to determine wear mechanisms that explain the dif-ferent results obtained in the uni- and multidirectional wear tests performed.

Artificial Intelligence Rehabilitation Evaluation and Training System for Degeneration of Joint Disease

Degeneration of joint disease is one of the problems that threaten global public health.Currently,the therapies of the disease are mainly conservative but not very effective.To solve the problem,we need to find effective,convenient and inexpensive therapies.With the rapid development of artificial intelligence,we innovatively propose to combine Traditional Chinese Medicine(TCM)with artificial intelligence to design a rehabilitation assessment system based on TCM Daoyin.Our system consists of four subsystems:the spine movement assessment system,the posture recognition and correction system,the background music recommendation system,and the physiological signal monitoring system.We incorporate several technologies such as keypoint detection,posture estimation,heart rate detection,and deriving respiration from electrocardiogram(ECG)signals.Finally,we integrate the four subsystems into a portable wireless device so that the rehabilitation equipment is well suited for home and community environment.The system can effectively alleviate the problem of an inadequate number of physicians and nurses.At the same time,it can promote our TCM culture as well.

The role of hardness and roughness on the wear of different CoCrMo counterfaces on UHMWPE for artificial joints

Wear tests were carried out to study the effect of the hardness and roughness with various counterface materials on UHMWPE wear behaviour. The materials used as counterfaces were based on varieties of CoCrMo: 1) forged (hand-polished) CoCrMo, 2) forged (mass-finished) CoCrMo, and 3) cast (mass-finished) CoCrMo. Additionally, two coatings were proposed: 1) a CoCrMo coating applied to the forged CoCrMo alloy by means of physical vapour deposition (PVD), and 2) a ZrO2 coating applied to the forged CoCrMo alloy by means of plasma-assisted chemical vapour deposition (PACVD). The reciprocating pin-on-flat (RPOF) device for pin-on-disk wear testing was used for this study. The worn surfaces were observed using optical, atomic force and scanning electron microscopes.

Influence of different CoCrMo counterfaces on wear in UHMWPE for artificial joints

Wear tests were carried out to study the effect of various counterface materials in the wear behaviour of Ultra High Molecular Weight Polyethylene (UHMWPE). The materials used as counterfaces were based on varieties of CoCrMo: 1) forged (hand-polished) CoCrMo, 2) forged (mass-finished) CoCrMo, and 3) cast (mass-finished) CoCrMo. Addi-tionally, two coatings were proposed: 1) a CoCrMo coating applied to the forged CoCrMo alloy by means of physical vapour deposition (PVD), and 2) a ZrO2 coating applied to the forged CoCrMo alloy by means of plasma-assisted chemical vapour deposition (PACVD). The reciprocating pin-on-flat (RPOF) de-vice for pin-on-disk wear testing was used for this study. The worn surfaces were observed using optical, atomic force and scanning electron microscopes.

Organizing of Virtual Enterprise for Customized Artificial Joint and Scheduling of Manufacturing Resources Based on Manufacturing Grid

In order to improve efficiency of developing customized artificial joint, a virtual enterprise is organized based on the manufacturing grid. The application-oriented framework of the virtual enterprise is created for organization of the virtual enterprise. The manufacturing system of the virtual enterprise is built up based on the exterior grid and manufacturing subsystems of member enterprises are set up based on the interior grid. Furthermore, according to characteristic matching of manufacturing resources, the scheduling flow is studied in detail and the related scheduling strategies are established. The scheduling procedure is divided into distributed scheduling stage and local scheduling stage.Based on the manufacturing grid, the organization of the virtual enterprise for customized artificial joint and the corresponding scheduling strategies can be utilized to shorten developing cycle and reduce produce cost.

Technical Patents for Artificial Intelligence Are Growing Rapidly——The Hurun Research Institute and WTOIP jointly released AI Intellectual Property in China 2019

Recently,the Hurun Research Institute and WTOIP jointly released AI Intellectual Property in China 2019,which shows that in the last five years the global figure of artificial intelligence(AI)patent applications grew rapidly,and were led by China,especially in the fields of vision,robotics and language.

Artificial Noise Based Security Algorithm for Multi-User MIMO System

The existing physical layer security algorithm, which is based on artificial noise, could affect legitimate receivers negatively when the number of users is no less than sending antennas in multi-user MIMO system. In order to improve security of multi-user MIMO system under this scenario, we propose a new multi-user MIMO system physical layer security algorithm based on joint channel state matrix. Firstly, multiple users are processed together, thus a multi-user joint channel state matrix is established. After achieving Singular Value Decomposition (SVD) of the joint channel state matrix, the minimum singular value is obtained, which can be utilized for precoding to eliminate the interference of artificial noise to legitimate receivers. Further, we also present an approach to optimize the power allocation. Simulation results show that the proposed algorithm can increase secrecy capacity by 0.1 bit/s/HZ averagely.

人工关节集采对DRG IC29组病例住院费用的影响分析

[目的]研究集中带量采购对人工关节置换术患者住院费用的影响,为深化高值耗材持续改革提供依据。[方法]收集某三级医院集采前后DRG分组IC29组病例的DRG结算数据和医保信息系统的相关信息,进行倾向得分匹配后,采用描述性分析、非参数检验、结构变动度进行费用变化分析。[结果]集采政策实施后的各项费用中位数显示,IC29组病例次均费用下降了33445元,其中材料费下降了34835元;DRG统筹金额下降了13705元,个人自付金额下降了24550元。集采前后的结构变动度为60.52%,材料费呈负向变动,医疗服务费、检查化验费、药品费及其他费呈正向变动。结构变动贡献率前三位为材料费50.00%、医疗服务费26.04%、检查化验费16.36%。[结论]集采后IC29组病例的次均费用、材料费、医保支付和个人负担费用均明显降低,费用结构得到优化,人工关节集中带量采购成效明显。建议持续进行高值耗材集采工作,并协同推进医疗服务价格和医院薪酬制度等其他医改配套政策。

罗斯曼指数对老年髋膝关节置换后非计划再入院和并发症的影响

背景:人工髋膝关节置换术在老年群体中有广泛应用,但临床中缺乏对患者非计划再次入院和术后并发症的准确预测方法。目的:探讨罗斯曼(Rothman)指数对老年髋膝关节置换患者术后非计划再入院和并发症的影响。方法:选择遵义市第一人民医院骨科一病区2020年12月至2022年12月接受择期髋、膝关节手术患者153例为研究对象,根据出院后90 d内是否非计划再次入院分为再入院组(n=21)和非再入院组(n=132)。通过电子病历系统统计所有患者一般性资料,包括性别、年龄、体质量指数、合并糖尿病、合并高血压、手术关节类型等,参照文献评估Rothman指数,统计患者术后并发症。结果与结论:①再入院组和非再入院组患者性别、体质量指数、手术关节类型、住院时长比较差异无显著性意义(P>0.05),两组共病数量、年龄、Rothman得分比较差异有显著性意义(P<0.05);②多因素Logistics回归分析结果显示,共病数量、年龄和Rothman得分均是老年髋、膝关节疾病患者术后90 d再入院的独立影响因素(P<0.05);③受试者工作特征曲线分析结果表明,Rothman指数预测人工髋膝关节置换术后90 d再入院曲线下面积为0.824,敏感度为80.85%,特异度为78.85%,最大youden指数为0.597,最佳截断值为46分;④Rothman<46分的老年患者总并发症发生率高于Rothman≥46分的老年患者(P<0.05);⑤提示Rothman指数可较为准确地预测老年髋、膝关节疾病患者术后非计划再入院,同时Rothman指数低于46分者发生并发症总体风险较高,关节恢复较差,可用于临床中改善患者术后管理。

康复机器人PVDF柔性关节设计与驱动特性研究

针对康复机器人本体柔顺性差的问题,提出了一种新型的聚偏氟乙烯(Polyvinylidene Fluoride,PVDF)凝胶基人工肌肉,将其作为康复机器人柔性关节致动器,期望实现类人动作。介绍了PVDF凝胶制备和电致变形机制,并由此设计了具备收缩和伸张功能的单体肌肉,进而将多个单体肌肉上下串联,组合构成层级人工肌肉;基于康复机器人柔性关节3层级人工肌肉,辨识其驱动数学模型,并进行了仿真与实验。结果表明,该人工肌肉能够有效地实现位置控制,具备电致收缩和扩张能力,作为致动器应用于柔性关节是可行的。

人工智能辅助压缩感知技术在肩关节MRI中的应用

目的:探讨人工智能辅助下的压缩感知(Artificial intelligence compressed sensing,ACS)技术在肩关节MRI成像中对图像质量和缩短扫描时间的应用价值。方法:招募健康志愿者27例,应用联影3.0T MR行肩关节MRI扫描,对受试者均应用并行采集技术(PI)以及ACS技术扫描肩关节横轴位PDWI、矢状位PDWI、冠状位T2WI、冠状位T1WI序列,4个序列使用PI技术的综合加速因子分别为1.77、1.72、1.60、1.87,使用ACS技术的综合加速因子分别为3.23、3.01、2.81、2.86。由两名医师从关节图像结构显示情况、脂肪抑制情况、伪影及图像整体情况四方面进行评分。在两组图像相同层面位置测量冈上肌、肱骨头均匀组织的信号强度(SI)和噪声值(SD),计算冈上肌和肱骨头SNR和CNR。采用配对样本t检验和Mann-Whitney U检验对主观评分和客观评价指标进行统计学分析。结果:PI在横轴位PDWI、矢状位PDWI、冠状位T2WI、冠状位T1WI的主观评分别为4.89±0.33、4.85±0.46、4.85±0.46、4.85±0.46,ACS为4.92±0.27、4.92±0.27、4.88±0.33、4.92±0.27,差异无统计学意义(P>0.05)。PI在横轴位PDWI、矢状位PDWI、冠状位T2WI、冠状位T1WI测量冈上肌SNR分别为25.08±4.08、30.40±6.93、10.37±1.95、17.53±3.17,低于ACS的31.77±6.83、38.95±7.05、13.22±2.47、20.09±5.95,差异有统计学意义(P<0.05)。ACS组总扫描时间为241 s,较PI组(438 s)比较,减少了45%。结论:应用ACS技术扫描肩关节MRI,可以在保证图像的质量的前提下,大幅减少扫描时间,为临床提供高效的检查。

临床管理路径对人工膝关节置换术后患者生活质量、膝关节功能及康复锻炼依从性的影响

目的探讨人工膝关节置换术患者应用临床管理路径对其术后患者生活质量、膝关节功能及康复锻炼依从性的影响。方法纳入2021年2月至2022年2月收治的行人工膝关节置换术治疗的患者110例,随机分为对照组和研究组,每组55例。对照组接受常规干预,研究组采用临床管理路径进行干预,比较2组干预效果。结果2组美国特种外科医院膝关节量表(HSS)评分均高于干预前(P<0.05),且研究组高于对照组(P<0.05)。2组的康复锻炼依从性评分均高于干预前(P<0.05),且研究组高于对照组(P<0.05)。2组康复自我效能量表(SER)评分均高于干预前(P<0.05),且研究组高于对照组(P<0.05)。2组干预后的生活质量评分均高于干预前(P<0.05),研究组高于对照组(P<0.05)。2组的并发症差异有统计学意义(P<0.05)。结论人工膝关节置换术患者应用临床管理路径进行干预,可有效提高患者的康复锻炼依从性和自我效能水平,有助于患者膝关节功能改善和生活质量提升,还能降低术后并发症。

人工智能数字骨科技术在关节置换中的应用

人工智能(artificial in-telligence,AI)数字骨科技术(digital orthopaedic technology,DOT)是将计算机数字技术与骨科临床相结合,即通过计算机进行数字和图像处理,分析、建模、模拟或参与手术,解决骨科基础与临床中的实际问题[1-2]。DOT主要包括以下几个方面:(1)有限元分析(finite element analysis,FEA)。(2)三维重建(three-dimensional reconstruction,TDR)。(3)3D打印(three-dimensional printing,TDP)。(4)计算机辅助设计(computer assisted design,CAD)与计算机辅助制造(computer assisted manufacturing,CAM)。(5)计算机导航辅助手术(computer navigation assisted surgery,CNAS)。

语义编码与经典信道编码融合研究

目前的语义通信研究尚未阐明语义编码与经典信道编码之间的关系、语义编码在现有通信框架中的可行性,以及影响语义编码的关键因素等。对基于联合信源信道编码的语义通信系统进行了理论分析,设计了语义编码与经典信道编码的融合实验,展示了语义编码的潜在优势,探索了语义编码与经典信道编码之间的关系,研究了后续将语义通信应用于经典通信框架的基础方法。

CHS-DRG和耗材集采下关节置换病组费用结构变化研究

目的:研究CHS-DRG付费联合人工关节集采改革措施实施前后关节置换病组(IC29)住院患者费用结构变化情况及影响因素,揭示改革给医院运营带来的影响。方法:分析北京某三级医院改革实施前后IC29病组住院患者的信息以及住院费用变化情况;运用结构变动度分析法,分析病组费用变化的主要类别和方向。结果:改革前后IC29病组次均住院费的结构变动度为39.4%,其中耗材费、手术费是影响住院费用变动的主要项目,累计贡献率为80.15%。改革后月均住院患者人次增加,次均住院费与耗材费下降,手术费占比升高,DRG医保盈余升高。结论:改革措施推进了CHS-DRG落地实施,使IC29病组住院费用结构趋于合理化,增加了医院可支配收入,降低了患者就医负担。但体现医务人员劳动技术价值的手术治疗费增幅有限,改革面临可能出现的诸多负性问题,需要进一步研究制定配套政策。

机器人辅助全膝关节置换技术的应用与前景

背景:目前用于全膝关节置换的机器人系统设计的基本原理是将三维手术规划、术中危险区预警、实时数据反馈及机械臂辅助截骨等技术相结合,以实现全膝关节置换的精准化、个性化,这也恰好是它最大优势所在,因此近年来成为关节外科领域热点话题,备受关注。目的:文章将从机器人辅助全膝关节置换在关节外科领域的发展现状及其与传统全膝关节置换优劣势对比进行概述,此外,还将对机器人辅助全膝关节置换技术未来的发展进行展望。方法:应用计算机检索PubMed、中国知网、万方和维普数据库的相关文章,英文检索词:“robot OR robotic OR robotics OR robotically OR computer,total knee arthroplasty OR total knee replacement,TKA OR TKR”,中文检索词:“机器人辅助,计算机导航,全膝关节置换术”,最终纳入64篇文献进行综述分析。结果与结论:①用于辅助全膝关节置换的机器人系统根据其自由度分为主动式、半主动式和被动式。半主动式系统是目前使用最为广泛的机器人系统,该系统有效提高了全膝关节置换手术的精准性和个性化程度,但其高昂的使用成本与较长的学习曲线仍是在该领域内推广时需要权衡的主要因素。②机器人辅助全膝关节置换可实现膝关节局部三维空间的精准截骨、正确安置假体,已被广泛证明可以提供更好的假体植入精准度,减少影像学异常值,在术中可获得良好的软组织平衡,最终改善术后膝关节运动及功能状态。③但目前的机器人辅助系统依然存在客观的不足之处,包括不同机器人设备与术者之间的学习曲线问题、额外增加的安装和维护成本以及与机器人手术相关的潜在并发症,所以其能否让医疗系统及患者真正受益仍需要更长期的研究予以证明,机器人辅助系统也仍需进行更多实质性的改进。④机器人辅助全膝关节置换技术在临床上仍然处于初步研究阶段,并没有大范围地应用到临床,更加明确该技术的用法、完善该技术的临床操作规范和安全性成为了未来对该技术的研究侧重点。