ObjectiveTo analyze the associated risk factors of hidden blood loss in the internal fixation of intertrochanteric fracture. MethodsA retrospective analysis was made on the clinical data of 317 cases of intertrochanteric fractures which were treated by internal fixation between January 1993 and December 2008. There were 154 males and 163 females with an average disease duration of 4.58 days (range, 7 hours to 33 days); the age was (69.86±15.42) years; the average height was 1.64 m (range, 1.50-1.84 m);and the average weight was 62.26 kg (range, 39-85 kg). Of them, intramedullary fixation was used in 203 patients and extramedullary fixation in 114 patients. The operation time was (61.99±18.25) minutes. The red blood cell transfusion was given to 84 patients, and the transfusion amount was 200-1 000 mL. The drainage volume was 0-750 mL (mean, 61.85 mL). Hidden blood loss was calculated through change of hematocrit level before and after operation. The multiple linear regression was performed to analyse the risk factors of hidden blood loss. ResultsThe total blood loss was (918.60±204.44) mL, the hidden blood loss was (797.77±192.58) mL, and intraoperative visible blood loss was (257.32±271.24) mL. Single factor analysis showed hidden blood loss was significantly higher in variables as follows:gender, age, injury cause, fracture type, American anesthesiologists grading, anesthesia mode, hypertension, diabetes, disease duration, operation time, intraoperative transfusion of red blood cells, and fixation type. Multiple linear regression showed age, fracture type, anesthesia mode, and fixation type were significant risk factors. ConclusionThe risk factors of hidden blood loss are advanced age (>60 years), unstable fracture, general anesthesia, and imtramedullary fixation. Especially in elder patients with unstable fracture treated by intramedullary fixation under general anesthesia, hidden blood loss is more significant.
Objective To observe the operative technique and cl inical effects of hidden tension suture after tibiofibular fracture fixation with absorbable thread. Methods From October 2003 to October 2008, 203 patients (220 sides) with tibiofibular fracture underwent hidden tension suture (test group, 102 cases of 112 sides) and the common interrupted suture (control group, 101 cases of 108 sides), including 179 males and 24 females with an median age of 36 years (3-75 years). Fracture was caused by traffic accident in 170 cases, by heavy bruise in 21 cases, and by fall ing from height in 12 cases. Therewere 186 cases of single-side fracture, and 17 cases of double-side fracture. Of them, 127 sides were closed fracture, and 93 sides were open fracture (including 38 sides of type I, 45 sides of type II, and 10 sides of type IIIA according to Gustilo classification for the open fracture). The locations were upper tibia in 55 sides, middle tibia in 126 sides, and lower tibia in 39 sides. The X-ray films showed that there were transverse fractures in 65 sides, obl ique fractures in 53 sides, spiral fractures in 45 sides, and comminuted fractures in 57 sides. No blood vessel injury, osteofascial compartment syndrome and pressure syndrome were observed. The time from injury to operation was 2 hours to 7 days with an average of 2 days. Of 220 sides, 45 sides were fixed by interlocking nails, others by internal steel plate. Results In control group, heal ing by first intention was achieved in 70 cases (69.3%) and heal ing by secondary intention in 31 cases (30.7%); in test group, heal ing by first intention was achieved in 93 cases (91.2%) and heal ing by secondary intention in 9 cases (8.8%); and showing significant difference (P lt; 0.05). All patients were followed up for 6 months to 2 years (average 9 months). No compl ication occurred in test group, and scar was obvious in the control group. Conclusion The hidden tension suture with absorbable thread can be a good alternative for the incision heal ing after tibiofibular fracture fixation. It deals with the problems of the incision tension and difficult-to-suture, and is good for the incision heal ing after operation.
Objective To determine the total blood loss and hidden blood loss associated with surgery for lumbar spinal stenosis and to identify risk factors for blood loss. Methods From September 2002 to July 2006, the cl inical data from 138 patients with lumbar spinal stenosis undergoing initial operation were analysed prospectively. There were 44 males and 94 females, aging 56-78 years (mean 66.7 years). A simple posterior lumbar spinal decompression was used in 26 cases;posterior spinal canal decompression, interbody distraction Cage, and bone graft between transverse process was used in 54 cases; pedicle screw fixation, posterior decompression and bone graft between transverse process was used in 32 cases; posterior decompression, pedicle screw fixation, interbody Cage, and graft between transverse process was used in 26 cases . Before operation, 23 patients took aspirin, and after operation 15 patients had gastrointestinal bleeding. Intraoperative blood loss was calculated by the aspirator and observed blood loss intraoperation. The whole estimated blood loss was calculated according to the level of hemoglobin, blood volume and blood transfusion at the time of admission and after 3 and 4 days of operation. Results The blood loss intraoperation was (485.51 ± 143.75) mL. The estimated blood loss was (1 218.60 ± 306.86) mL, which was significantly higher than the intraoperational blood loss (P lt; 0.001). There was significant difference between the estimated blood loss and observed blood loss during surgeries (P lt; 0.001). There were significant differences in the estimated blood loss and observed blood loss during surgery between patients treated with aspirin and without aspirin (P lt; 0.001), between patients with gastrointestinal bleeding and whiout gastrointestinal bleeding (P lt; 0.001). Conclusion The total blood loss after surgery for lumbar spinal stenosis is much greater than that of observed intra-operation. The type of surgery, treatment with aspirin and gastrointestinal bleeding or ulceration can all independently increase blood loss.
ObjectiveTo summarize the experience in management of occult cerebrospinal fluid leakage (CSFL) in posterior thoracolumbar surgeries, and to explore the best drainage duration, as well as to analyse the ways to reduce the risk of CSFL. MethodsA retrospective analysis was made on the clinical data of 26 patients with occult CSFL in posterior thoracolumbar surgeries between January 2011 and January 2013. There were 15 males and 11 females, with the average age of 48.7 years (range, 36-59 years). Headache occurred in 19 cases, and 5 cases had nausea with 3 cases also having vomiting after operation. Drainage tube unobstructed and no CSFL from the skin incision were observed in 23 cases at the postoperative 2nd day, and the drainage pipe clamp test was performed at the 3rd day. Twenty-one patients had no CSFL and were given extubation; 2 cases having CSFL were given extubation after conservative treatments for 10 days. Three patients had CSFL with ineffective conservative treatments at the postoperative 2nd day, then received reoperation, incision suture, and drainage. At the postoperative 3rd day, if no CSFL was observed, these patients were given extubation and stayed in bed for 3-5 days. ResultsAll incisions healed and the healing time was 7-15 days (mean, 8 days). No incision infection, persistent CSFL, and other complications occurred. After extubation, headache, nausea, vomiting, and other symptoms were alleviated immediately. All patients were followed up 12-24 months (mean, 16 months). MRI at the postoperative 6th month showed no subcutaneous epidural pseudocyst. ConclusionThe quality of suturing is the key factor to prevent occult CSFL in posterior thoracolumbar surgery. Under the premise of good suture quality, extubation can be given at the postoperative 3rd day. Before extubation, the drainage pipe clamp test can be performed to make sure no CSFL and to reduce the risk of CSFL from the surgical incision after extubation.
Objective During primary total knee arthroplasty (TKA), anticoagulant drugs are used for prevention of major venous thrombosis of lower limbs, and this often leads to the increase of perioperative blood loss. To retrospectively analyse the impact of low molecular weight heparin on hidden blood loss and transfusion rate after primary TKA by comparing with the use of aspirin. Methods Between October 2007 and August 2009, the clinical data from 286 patients undergoing primary TKA surgery were retrospectively analyzed. In accordance with different anticoagulation methods, the cases were divided into 2 groups, the trial group (n=166) and the control group (n=120). In the trial group, the patients received low molecular weight heparin (4 000-6 000 U/day) from 8-12 hours after TKA for 14 days; there were 27 males and 139 females with an average age of 66.1 years (range, 22-82 years); the body mass index (BMI) was 26.79 ± 3.87; and the locations were the left knee in 99 cases and the right knee in 67 cases with an average disease duration of 4.1 years (range, 1.8-8.6 years). In the control group, the patients received aspirin (150 mg/day) for 14 days; there were 21 males and 99 females with an average age of 64.9 years (range, 40-84 years); the BMI was 27.87 ± 3.62; and the locations were the left knee in 78 cases and the right knee in 42 cases with an average disease duration of 4.9 years (range, 1.5-8.2 years). There was no significant difference in the general data between 2 groups (P gt; 0.05). Results The incisions healed by first intention in all patients. Postoperative deep venous thrombosis occurred in 37 patients of the trial group and in 28 cases of the control group. All the patients were followed up 12-34 months (mean, 21.6 months). There were significant differences in the United States Hospital for Special Surgery (HSS) score of 2 groups between before surgery and after surgery (P lt; 0.05). The hidden blood loss was (40.55 ± 37.75) g/L in the trial group and (32.52 ± 40.13) g/L in the control group, showing significant difference (t=3.387, P=0.001); the dominant blood loss was (24.08 ± 14.63) g/L and (27.91 ± 18.47) g/L respectively, showing no significant difference (t= —1.899, P=0.059). The blood transfusion rates were 40.4% (67/166) in the trial group and 30.0% (36/120) in the control group, showing no significant difference (χ2=2.771, P=0.081); the transfusion volumes were (1.44 ± 4.03) U and (0.97 ± 3.50) U respectively, showing significant difference (t=2.071, P=0.039). Conclusion The low molecular weight heparin has effect on the hidden blood loss after primary TKA, which may increase postoperative blood loss and blood transfusion rate. The changes in hemoglobin should be monitored during the anticoagulant therapy, and the blood volume should be added promptly.
Objective To analyze the impact of ivaroxaban on hidden blood loss and blood transfusion rate after primary total knee arthroplasty (TKA) by comparing with the use of low molecular weight heparin. Methods Between December 2009 and January 2011, the clinical data from 90 patients undergoing primary TKA were retrospectively analyzed. At 12 hours after operation, 45 patients were given ivaroxaban (10 mg/d) in the trial group and low molecular weight heparin injection (0.4 mL/d) in the control group for 14 days, respectively. There was no significant difference in gender, age, disease duration, or range of motion between 2 groups (P gt; 0.05). Results The operation time was (92.32 ± 23.13) minutes in the trial group and (89.81 ± 18.65) minutes in the control group, showing no significant difference (t=0.26, P=0.79). The hidden blood loss was (40.18 ± 14.85) g/L in the trial group and (34.04 ± 12.96) g/L in the control group, showing significant difference (t=2.09, P=0.00); the dominant blood loss was (30.60 ± 2.89) g/L and (28.85 ± 8.10) g/L respectively, showing no significant difference (t= 1.37, P=0.17). The blood transfusion rate was 73.33% (33/45) in the trial group and 55.56% (25/45) in the control group, showing no sigificant difference (χ2=3.10, P=0.08); the transfusion volume was (1.44 ± 1.09) U and (1.06 ± 1.17) U respectively, showing no significant difference (t=1.58, P=0.11). Stress ulcer occurred in 1 case of the trial group; symptomatic deep vein thrombosis of lower extremity and asymptomatic muscular venous thrombosis developed in 1 case and 4 cases of the control group respectively. Conclusion Ivaroxaban has effect on the hidden blood loss after primary TKA, which may increase postoperative blood loss and blood transfusion rate. The changes in hemoglobin should be monitored during the anticoagulant therapy, and the blood volume should be added promptly.
ObjectiveTo evaluate the effectiveness of anterior lumbar interbody fusion (ALIF) with self-locked Cage in the treatment of central type lumbar intervertebral disc protrusion and recessive lumbar segmental instability. MethodsBetween March 2010 and February 2012, 31 patients with central type lumbar intervertebral disc protrusion and recessive lumbar segmental instability were treated with decompression and ALIF assisted by self-locked Cage through the mini-incision and retroperitoneal approach. There were 20 males and 11 females with the mean age of 46 years (range, 34-58 years). And the disease duration ranged from 5 to 32 months (mean, 16 months). The lesion located at the L3,4 level in 2 cases, L4,5 in 20 cases, and L5, S1 in 9 cases. The operation time, intraoperative blood loss, bedridden time, hospitalization time, and complications were recorded. The effectiveness was evaluated by Oswestry disability index (ODI) and visual analogue scale (VAS). Lumbar X-ray films and three-dimensional CT scan were taken to evaluate the fusion and the variation of the height and Cobb angle of intervertebral space. ResultsThe mean operation time was 102 minutes; the mean intraoperative blood loss was 121 mL; the mean bedridden time was 5 days; and the mean hospitalization time was 11 days. Intraoperative peritoneum tear and ascending lumbar vein tear, postoperative cerebrospinal fluid leakage, pain at donor site, and asymmetric elevated skin temperature of the lower extremity occurred in 2 cases, 1 case, 1 case, 4 cases, and 2 cases respectively, which were relieved after symptomatic treatment. All cases were followed up 12-28 months (mean, 20 months). No infection, recurrence, deep venous thrombosis, or retrograde ejaculation was observed after operation. MRI showed complete decompression at 3 months after operation. At last follow-up, the scores of ODI, VAS of lumbars and lower limbs, the intervertebral height, and Cobb angle were significantly improved when compared with preoperative ones (P<0.05); CT scan showed bone fusion in all cases. ConclusionThe clinical outcome of ALIF with self-locked Cage through mini-incision and retroperitoneal approach is satisfactory in treatment of central type lumbar intervertebral disc protrusion and recessive lumbar segmental instability. It can retain the posterior spinal construction and has the advantages of less trauma and bleeding, immediate stability, high bone fusion rate, and so on.
Objective To evaluate the effect of pneumatic tourniquet on perioperative period of total knee arthroplasty (TKA). Methods The perioperative period data of 116 patients over 60 years old with severe knee osteoarthritis treated with TKA between January 2018 and January 2019 were retrospectively analyzed. According to whether pneumatic tourniquet was used during operation, the patients were divided into trial group (49 cases, pneumatic tourniquet was not used during operation) and control group (67 cases, pneumatic tourniquet was used during operation). There was no significant difference in gender, age, body mass index, lesion side, disease duration, and preoperative hemoglobin between the two groups (P>0.05). The operation time, actual total blood loss, overt blood loss, hidden blood loss, and percentage of hidden blood loss, knee swelling at 3 days after operation, and range of motion of knee at 2 weeks after operation were recorded and compared between the two groups. Results The operation time of the trial group was significantly longer than that of the control group (t=14.013, P=0.000). The actual total blood loss, hidden blood loss, and percentage of hidden blood loss in the trial group were significantly lower than those in the control group (P<0.05); there was no significant difference in the overt blood loss between the two groups (t=−1.293, P=0.200). The knee swelling degree in the trial group was significantly slighter than that in the control group at 3 days after operation, and the range of motion of knee in the trial group was significantly better than that in the control group at 2 weeks after operation (P<0.05). Conclusion Pneumatic tourniquet can reduce the operation time of TKA significantly. However, it may increase the hidden blood loss and knee swelling, and negatively impact the recovery of knee function in the early postoperative stage of TKA.
ObjectiveTo observe the gene mutations and clinical phenotypes in patients with Usher syndrome type 2 (USH2) and retinitis pigmentosa (RP).Methods From August 2018 to January 2019, 4 patients and 11 normal family members from 3 families of USH2 and RP who visited Henan Eye Hospital were enrolled in the study. Detailed medical history was obtained and visual acuity, fundus color photography, OCT, visual field, full field ERG examination were performed. Among the three families, pedigree 1 was diagnosed with USH2, pedigree 2 and pedigree 3 were diagnosed with RP. The peripheral venous blood of patients and their family members were collected, and the whole genomic DNA was extracted. Targeted capture next generation sequencing analysis was performed on these members, and Sanger sequencing and family co-segregation were verified.ResultsIn the family F1, the proband had symptoms of RP and sensorineural deafness. Sequencing revealed two heterozygous frameshift variants: c.13877-13880 del AGAC (p. Q4626P) in exon 64 and c.798 del T (p. F266L) in exon 5 of USH2A. Both patients of family 2 and 3 showed RP signs without deafness. Two heterozygous variants c.15178T＞C (p. S5060 P) in exon 70 and c.6986C＞A (p. P2329H) in exon 37, and a pathogenic heterozygous variant c.5836C＞T (p. R1946X) in exon 29 of USH2A were identified in family F2. A heterozygous missense variant c.14951C＞T (p. P4984L) in exon 68 and a variant c.11156G＞A (p. R3719H) in exon 57 of USH2A were found in family F3. The results of conservation analysis showed that the corresponding amino acid sites of USH2A p.Q4626P, p.F266L, p.S5060P, p.P2329H and p.P4984L were highly conserved in many species. Among these 7 pathogenic variants detected, M1-M4 and M6 were novel.ConclusionsMutation USH2A gene are the main cause of USH2 and non-syndromic RP. Different variants affect protein translation and synthesis, consequently causing different clinical phenotypes.