To discuss the effect of dexamethasone in preventing fat embol ism syndrome (FES) in cemented hi p arthroplasty patients. Methods Forty patients scheduled for unilateral cemented hi p arthroplasty between January 2008 and December 2009 were randomly divided into trial group (n=20) and control group (n=20). In trial group, there were 6 males and 14 females with an average age of 73.2 years (range, 54-95 years), including 4 cases of osteoarthritis, 3 cases ofavascular necrosis of femoral head, and 13 cases of femoral neck fracture; the disease duration was 4 days to 6 years (median, 0.8 year). In control group, there were 10 males and 10 females with an average age of 71.9 years (range, 59-91 years), including 2 cases of osteoarthritis, 3 cases of avascular necrosis of femoral head, and 15 cases of femoral neck fracture; the disease duration was 3 days to 5 years (median, 0.6 year). There was no significant difference in gender, age, or disease duration (P gt; 0.05) between 2 groups. Cemented total or bipolar hip arthroplasty (with the same brand of cement and prosthesis) in 2 groups were performed by a group of surgeons. The patients were given intravenously injected with dexamethasone (20 mg) in trial group before 1 hour of cement injection and intravenously injected with normal sal ine (2 mL) in control group. Amount of 5 mL vein blood were withdrawn before surgery, after 4, 8, and 24 hours of cement injection to test the number and average diameter of fat droplets. According to Gurd diagnosis standard, related FES symptoms and signs were inspected. Results Primary heal ing of incision was achieved in all cases of 2 groups. According to Gurd standard of diagnosis, no FES occurred in each group at 2 weeks postoperatively; deep venous thrombosis occurred in 2 cases (10%) of trial group and in 5 cases (25%) of control group, showing significant difference (P lt; 0.05). The number and diameter of fat droplets in trial group were significantly lower than those in control group at 4, 8, and 24 hours of cement injection (P lt; 0.01). All cases were followed up 7.4 months on average (range, 3-13 months). The postoperative Harris score was 89.5 ± 6.1 in trial group and 87.9 ± 8.3 in control group, showing no significant difference (P gt; 0.05). No loosening occurred during follow-up period. Conclusion Intravenous injection withdexamethasone can effectively reduce the number and diameter of venous fat droplets in cemented hip arthroplasty, which can decrease the risk of postoperative FES.
【Abstract】 Objective To discuss the techniques and advantages of closed reduction and intramedullary nail ing intreating femoral shaft fracture without cannulated femoral reamer. Methods From January 2006 to June 2007, 24 cases offemoral shaft fracture were treated with closed reduction and intramedullary nail ing. Among them, there were 14 males and 10 females, with the average age of 38.3 years (ranging from 18 years to 63 years), with 7 left legs and 17 right legs. The average course of the disease was 7.6 days (ranging from 3 days to 20 days). According to the AO typing, there were 5 cases of type A, 6 of type B, 7 of type C1, 2 of type C2 and 4 of type C3. Closed reduction was achieved with manipulation and reaming of femoral canal was instructed by fluoroscopy. Results The operation time lasted from 100 minutes to 170 minutes, with the average time of 128.3 minutes. One patient was given a transfusion of 400 mL, and others were not. Twenty cases were followed up with the average time of 13.1 months (ranging from 6 months to 24 months). A mild to large amount of bony callus was showed on X-ray films 6 to 12 weeks postoperatively. Walking without crutches began at the average week of 22.2 (ranging from 15 to 30) postoperatively. Range of motion of the knee was 0° to 145.5°. No infection or break of the internal fixator occurred. Myositis ossificans with pain and insufficient flexion of hip (120°) happened in 1 case and the pain disappeared after non-steroid anti-inflammatory drugs were taken. Nonsymptomatic myositis ossificans occurred in 2 cases and no treatment was needed. Conclusion Closed reductionand intramedullary nail ing can help to protect the blood supply of fracture fragments and provide central fixation. The operation process will be more compl icated if cannulated femoral reamer is not available.
Objective To explore the cause of haematoma after the cemented total hip arthroplasty (THA) and find out the way to decrease the incidence of haematoma perioperatively. Methods From March 2000 to October 2006, 103 patientswere treated with the cemented THA. Among the patients, 44 were males and 59 were females with their ages ranging from 36 to 89 years, averaged 55.3 years.The femoral neck fracture (Garden 4) was found in 49 patients, avascular necrosis of the femoral head (Ficat 4) in 26, and osteoarthritis of the hip joint (Tonnis 3) in 28. Their illness course ranged from 1 day to 8 years. The average Harris score preoperatively was 36 (range, 1948). The patients were divided into Group A (n=43) and Group B (n=60). The patients in Group A underwent the conventional surgical operations from March 2000 to December 2003; the patients in Group Bunderwent the same surgical procedures combined with additional procedures (e.g., ligation of the external rotators before incision, use of plastic bandage after the drainage tube was pulled out, prolonged stay period in bed postoperatively) from January 2004 to October 2006. Results In Group A, postoperative haematoma occurred in 9 patients and the averaged 317.8±75.3 ml(range,110-410 ml) of the accumulated blood was drained with a syringe. An average amount for the firstdrainage of the accumulated blood was 86.7±30.7 ml(range, 50-125 ml)， and an average drainage time was 4.2(range, 2-7). In Group B, postoperative haematoma occurred in 2 patients, with an amount of 110 ml and 160 ml of the accumulated blood and an amount of 40 ml and 60 ml of the drained blood at thefirst drainage. There was statistical difference in the amount of heamotoma between two groups(P＜0.05). The followup of 91 patients (39 in Group A, 52 in Group B) for 1.2-5.5 years (average, 3.7 years) revealed that the Harris scores were 78 in Group A and 85 in Group B on average.The Harris score for pain was 44 (Grade A) in 16 patients, 40 (Grade B) in 24 patients, and 30 (Grade C) in 3 patients in Group A; Grade A in 48 patients,Grade B in 12 patients, and Grade C in none of the patients in Group B. There was no statistical difference in Harris score between the two groups (P＞0.05). Conclusion Additional surgical procedures for the cemented THA, such as ligation of the external rotators before incision, use of plastic bandage afterthe drainage tube is pulled out, and prolonged stay in bed postoperatively, can greatly help to reduce the incidence of postoperative haematoma and the amount of the accumulated blood.
ObjectiveTo systematically review the postoperative infection-related complications between cemented and cementless hemiarthroplasty in elderly patients with femoral neck fracture.MethodsCochrane Library, PubMed, Embase, China Biology Medicine Database, Chongqing VIP China Science and Technology Journal Database, China National Knowledge Infrastructure, and Wanfang Database were searched to collect randomized controlled trials of postoperative infection-related complications between cemented and cementless hemiarthroplasty in elderly patients with femoral neck fracture from inception to January 2018. A systematic review was performed to compare the postoperative deep infection, superficial wound infection, pneumonia infection, and urinary tract infection between cemented and cementless hemiarthroplasty. Analyses were conducted using Review Manager version 5.2.0 software.ResultsA total of 11 studies were included in the Meta-analysis, including 1 533 patients. There was no significant difference in the incidence of deep infection [odds ratio (OR)=1.62, 95% confidence interval (CI) (0.66, 3.94), P=0.29], superficial wound infection [OR=1.17, 95%CI (0.56, 2.47), P=0.68], pneumonia infection [OR=0.73, 95%CI (0.47, 1.13), P=0.16], or urinary tract infection [OR=1.10, 95%CI (0.65, 1.86), P=0.73] between the two groups.ConclusionWhen selecting a fixation method for hemiarthroplasty to treat eldly patients with femoral neck fracture, infection-related postoperative complications are not the determinant factor to consider.
Objective To evaluate the effectiveness and safety of intraoperative tranexamic acid use in total shoulder arthroplasty. Methods By searching Cochrane Library, PubMed, Embase, Chongqing VIP, Chinese National Knowledge Infrastructure, Wanfang Database from the establishment of the database to September 2021, randomized controlled trials of intraoperative tranexamic acid use in total shoulder arthroplasty were collected. Outcome indicators were total blood loss, postoperative drainage, hemoglobin reduction, length of operation, length of hospital stay, and formation of hematoma. RevMan 5.3 software was used for meta-analysis. Results Meta analysis results showed that the use of tranexamic acid can reduce total blood loss [weighted mean difference = −246.55 mL, 95% confidence interval (−335.36, −157.75) mL, P<0.000 01], reduce postoperative drainage [weighted mean difference = −134.05 mL, 95% confidence interval (−161.72, −106.38) mL, P<0.000 01], reduce hemoglobin reduction [weighted mean difference = −0.64 g/dL, 95% confidence interval (−0.91, −0.36) g/dL, P< 0.000 01], reduce hematoma formation [risk ratio=0.41, 95% confidence interval (0.22, 0.77), P=0.005]. There was no statistically significant difference in the length of operation and length of hospitalization between patients who used tranexamic acid and those who did not use tranexamic acid (P>0.05). Conclusions Tranexamic acid is effective and safe for patients undergoing total shoulder arthroplasty. It can reduce perioperative bleeding and hematoma formation without increasing the length of surgery and hospitalization.
Objective To evaluate the efficacy and safety of tranexamic acid in arthroscopic anterior cruciate ligament reconstruction by meta-analysis. Methods The databases searched included Embase, PubMed, Cochrane Library, Wanfang, China National Knowledge Infrastructure and Chongqing VIP. The search time range was from the establishment of the databases to September 2022. All randomized controlled trials using tranexamic acid in arthroscopic anterior cruciate ligament reconstruction were collected. The outcome indicators were postoperative blood loss, postoperative joint cavity puncture rate, postoperative hematoma rate, postoperative Visual Analogue Scale score, and postoperative knee joint range of motion. RevMan 5.3 analysis software was selected for meta-analysis. Results A total of 6 articles were included, including 660 patients. Meta-analysis showed that the postoperative blood loss in the tranexamic acid group was lower than that in the control group [weighted mean difference (WMD)=−24.32 mL, 95% confidence interval (CI) (−33.73 mL, −14.91 mL), P<0.000 01]. The postoperative Visual Analogue Scale score in the tranexamic acid group was lower than that in the control group [WMD=−0.69, 95%CI (−1.21, −0.18), P=0.009]. The postoperative knee joint range of motion in the tranexamic acid group was higher than that in the control group [WMD=2.88°, 95%CI (0.55°, 5.21°), P=0.02]. The postoperative joint cavity puncture rate in the tranexamic acid group was lower than that in the control group [risk ratio (RR)=0.25, 95%CI (0.12, 0.53), P=0.0003]. The postoperative hematoma rate in the tranexamic acid group was lower than that in the control group [RR=0.40, 95%CI (0.21, 0.78), P=0.007]. Conclusion The patients who used tranexamic acid in in arthroscopic anterior cruciate ligament reconstruction have less postoperative bleeding, lower knee joint puncture rate and hematoma formation rate, which are conducive to pain relief and functional rehabilitation.
Objective To compare the efficacy and safety of aspirin and rivaroxaban in the prevention of venous thromboembolism (VTE) after total knee arthroplasty (TKA). Methods Eight databases were searched, including Cochrane Library, Embase, Web of Science, PubMed, SinoMed, Wanfang, Chongqing VIP, and China National Knowledge Infrastructure. The search period was from the establishment of databases to June 2023. All randomized controlled trials of aspirin and rivaroxaban for the prevention of VTE after TKA were collected, and meta-analysis was conducted using RevMan 5.3 software. Results A total of 7 articles were included, with a publication period from 2014 to 2022, including a total of 714 patients, including 356 in the aspirin group and 358 in the rivaroxaban group. The meta-analysis results showed that the incidence of deep venous thrombosis in the lower limbs of the aspirin group was higher than that of the rivasarb group [relative risk (RR)=1.53, 95% confidence interval (CI) (1.09, 2.16), P=0.01], and the incidence of bleeding complications was lower than that of the rivaroxaban group [RR=0.66, 95%CI (0.52, 0.82), P=0.0003]. There was no statistically significant difference in the incidence of wound complications between the two groups (P>0.05). Conclusion The efficacy of rivaroxaban in preventing VTE after TKA is better than that of aspirin, but there is an increased risk of bleeding complications.
ObjectiveTo investigate the clinical features of elderly hip fracture in Leshan area in China. MethodsThe clinical data of patients with hip fractures from June 2006 to January 2013 were retrospectively analyzed. Gender, age, fracture type, injury causes, activities before injury and treatment were analyzed. ResultsThe mean age of patients with a hip fracture was 76.5 years. The overall male to female ratio with hip fracture was 1:1.44. There were 154 patients (50.0%) with femoral neck fracture, 138 patients (44.8%) with intertrochanteric fracture, and 16 patients (5.2%) with subrtrochanteric fracture. A total of 248 patients (77.3%) were poorly educated, and 210 patients (68.2%) had basic medical insurance. The mean time between being injured and hospitalized after injury was 3 days. There were 257 patients (83.4%) with fall damage. ConclusionFemale patients with hip fracture are more than male patients. Fall damage is the main injure type. The features of elderly hip fracture in Leshan include retardation to consult a doctor, poor education of the patients, dependence primarily on basic medical insurance and under-emphasis of anti-osteoporosis therapy.
ObjectiveTo introduce the clinical pathway for geriatric hip fracture regulated by our hospital and report the five-year outcomes after the implementation of the pathway. MethodsThe geriatric hip fracture patients treated between September 2003 and August 2012 were followed up. We did not implement the clinical pathway until January 2007. Statistical analysis was done to evaluate the effect of the clinical pathway on patient outcomes by comparing rate of complication, mortality, and length of hospital stay before and after the implementation of the clinical pathway. ResultsAfter the implementation of the pathway, the in-hospital mortality, one-year mortality and the rate of complication were significantly lower. Besides, the time from admission to operation and the total length of stay in hospital were obviously shortened. ConclusionThe use of clinical pathway for geriatric hip fracture can reduce the rate of complication and mortality, and shorten hospital stay, and the five-year outcomes after the implementation of the pathway are satisfying.