Electromyographic biofeedback (EMG-BF) can be regarded as an adjuvant to pelvic floor muscle (PFM) training (PFMT) for the management of stress urinary incontinence (SUI). This metaanalysis aimed to compare the efficacy of PFMT with and without EMG-BF on the cure and improvement rate, PFM strength, urinary incontinence score, and quality of sexual life for the treatment of SUI or pelvic floor dysfunction (PFD). PubMed, EMBASE, the Cochrane Library, Web of Science, Wanfang, and CNKI were systematically searched for studies published up to January 2021. The outcomes were the cure and improvement rate, symptom-related score, pelvic floor muscle strength change, and sexual life quality. Twenty-one studies (comprising 1967 patients with EMG-BF ? PFMT and 1898 with PFMT) were included. Compared with PFMT,

Background: Traumatic obturator dislocation of the hip joint associated with greater trochanter fracture is a rare injury. We used the lateral approach through the rectus abdominis to remove the femoral head dislocated into the obturator, and the posterolateral approach was used for reduction and internal fixation of the femoral greater trochanteric fracture and total hip replacement (THR). Good follow-up results were achieved. To the best of our knowledge, this is the first report on this particular type of injury and on this approach to treating this type of injury. Case Report: The patient was hospitalized due to a traffic accident that resulted in the patient experiencing swelling and deformity accompanied by limited mobility of the left hip and left knee. X-ray examination and CT confirmed that the patient suffered from left hip obturator dislocation, greater trochanter fracture, pelvic fracture (Tile B), left acetabular fracture, right open tibiofibular comminuted fracture (Gustilo III), and posterior urethral injury. The femoral head was removed from the pelvic cavity through a pararectus approach under general anesthesia. A posterolateral approach was used for open reduction, and cable internal fixation for the left intertrochanteric fracture and uncemented THR were performed. Results: The ability to work was restored 6 months after the operation. The Harris hip score, reflecting joint function, was 86 points after 2 years of follow-up observation. Conclusion: A lateral approach of rectus abdominis to remove the dislocated femoral head in the pelvis from the obturator should be selected, along with the posterolateral approach for reduction and internal fixation of the intertrochanteric fracture and THR. This case also provides a new reference for the treatment of this type of hip fracture dislocation.

Objective The objective of this trial was to evaluate the efficacy and safety of topical administration of tranexamic acid (TXA) combined with diluted-epinephrine (DEP) on perioperative blood loss and transfusion in young and middle-aged patients with femoral neck fracture who did not undergo drainage. Methods Sixty patients were enrolled in this trial. In the target group(TXA/DEP group: n=30;18 men and 22 women, mean age 41.36±12.17 years), the surgical sites were injected with 50 mL normal saline mixed with 1 g of TXA with 0.25 mg of DEP at a 1:200,000 dilution (TXA/DEP).In the control group, (TXA group: n=30; 11 men and 19 women; mean age: 43.70±14.63 years), the surgical site was injected with 50 mL normal saline containing 1 g of TXA alone. The main outcome measures were total blood loss(TBL),dominant blood loss(DBL),hidden blood loss(HBL), postoperative hemoglobin (Hb) levels, hematocrit(HCT) and activated partial thromboplastin time(APTT), the secondary measures included transfusion requirements, Harris hip score, satisfactory degree and perioperative complications. Results The results showed that topical combined administration significantly reduced the decrease of hemoglobin among patients in the TXA/DEP group, measured on postoperative day 1 at 123.43±6.84 g/L vs. 118.33±6.30 g/L (TXA/DEP group vs. TXA group) , day 3 as 104.36±8.01 g/L vs. 96.83±7.56g/L, and day 5 as 115.96±6.49 g/L vs. 110.03±7.85 g/L, respectively (p<0.05). The mean HCT levels among patients in the TXA/DEP group were significantly higher than among those in the TXA group, measured on postoperative day 1 at 34.83±1.96% vs. 33.03±2.78% , day 3 as 32.40±2.83% vs. 30.83±2.65%, and day 5 as 38.63±1.56% vs. 37.06±1.99%, respectively (p<0.05). TBL, DBL, and HBL were also significantly reduced in the TXA/DEP group vs. the TXA group, measured at 333.40±42.19 ml vs. 396.30±53.54 ml, 72.33±16.28 ml vs. 91.86±20.10 ml, and 261.06±36.76 ml vs. 304.43±48.68 ml. 2 patients (6.66%) from the TXA/DEP group and 9 (30.00%) from the TXA group received blood transfusions, respectively (p<0.05).The Harris scores and satisfactory degrees among patients in the TXA/DEP group were significantly higher than among those in the TXA group, measured on postoperative day 21, respectively (p<0.05),which did not significantly differ from one another on postoperative3 months, respectively(P＞0.05).Furthermore, four cases in the TXA/DEP group and seven in the TXA group were diagnosed with subcutaneous ecchymosis, five cases in the TXA/DEP group and nine in the TXA group were diagnosed with deep vein thrombosis, and one case in the TXA/DEP group was diagnosed with adverse medicine reaction, those differences did not reach statistical significance (p>0.05). Conclusion Topical administration of TXA with DEP was safer and more effective in reducing blood loss and transfusion than the administration of TXA alone in treating young and middle-aged patients with femoral neck fracture, without increasing the risk of perioperative complications.

Purpose To retrospectively review the early- and medium-term clinical outcomes of lateral capsulorrhaphy by medial synovial flap transposition in total knee arthroplasty for the treatment of knee osteoarthritis with permanent dislocation of the patella. Method To surgically restore the patellar trajectory in 29 patients with knee osteoarthritis associated with permanent patellar dislocation undergoing total knee arthroplasty using medial synovial flap transposition to repair the lateral joint capsule. Preoperative and 2-year postoperative conditions and knee mobility were compared using the American Knee Society score function score, UCLA activity scale score, and visual analogue (VAS) pain scores. The patients were examined radiographically for full-length knee and axial patellar reduction while standing on both lower limbs. Result The patients' American Knee Society function scores improved from 40.2 ± 12.1 preoperatively to 80.5 ± 7.3 at 2 years postoperatively (P < 0.001), and their UCLA activity class scores improved from 3.9 ± 0.6 preoperatively to 6.8 ± 0.7 at 2 years postoperatively (P < 0.001). VAS pain scores decreased from 41.8 ± 6.0 points preoperatively to 10.1 ± 3.7 at two years postoperatively (P < 0.001). Knee mobility improved from 74.6 ± 8.9 degrees preoperatively to 110.5 ± 4.5 degrees at two years postoperatively (P < 0.001), and imaging showed no signs of subluxation or dislocation of the patella in any of the patients. Conclusions The correction of the patellar trajectory in patients with osteoarthritis with permanent patellar dislocation undergoing total knee arthroplasty using medial synovial flap transposition to repair the lateral joint capsule can lead to satisfactory early and medium-term clinical results.

No abstract