ObjectiveTo discuss the effectiveness and safety of intravenous application of tranexamic acid in reducing the blood loss in the perioperative period of lumbar fusion surgery. MethodsA retrospective study of 68 patients with degenerative lumbar spinal stenosis with lumbar instability who were treated with lumbar fusion surgery from March 2013 to March 2014 in West China Hospital was carried out. The patients were divided into tranexamic acid group and control group according to whether tranexamic acid was used. After induction of anesthesia, tranexamic acid was given by intravenous drop to patients in the tranexamic acid group, while the control group did not receive any hemostatic drug. The red blood cell count, hemoglobin, mean corpuscular volume, prothrombin time, activated partial thromboplastin time, fibrinogen metaglobulin, intraoperative blood loss, postoperative blood loss, and blood transfusion volume before and after operation were compared. And we also observed whether there was pulmonary embolism or deep vein thrombosis incident. ResultsIt showed no significant difference in intraoperative blood loss between the two groups, but the tranexamic acid group had less blood loss after operation than that of the control group (P<0.05). The tranexamic acid group had a higher red blood cell count, hemoglobin and mean corpuscular volume after operation than that of the control group (P<0.05). There was no significant difference between the two groups in prothrombin time, activated partial thromboplastin time, fibrinogen metaglobulin before and after operation (P>0.05). The pulmonary embolism and deep vein thrombosis were not found in the two groups. ConclusionIntravenous application of tranexamic acid is safe and effective in posterior lumbar fusion surgery. It can reduce the postoperative blood loss significantly, without increasing the risk of pulmonary embolism and deep vein thrombosis.
ObjectiveTo summarize the progress on the distal interlocking screw of cephalomedullary nail for intertrochanteric fractures. MethodsRelated literature concerning the distal interlocking screw of cephalomedullary nail was reviewed and analyzed in terms of biomechanics, clinical application, operating difficulties, and complications. ResultsDistal interlocking screw can provide extra torsional stiffness in both short and long cephalomedullary nail. It is applied in most clinical cases. In long cephalomedullary nail, placing the distal interlocking screw increases the operative time for fixation and the amount of radiation exposure notably. In short cephalomedullary nail, placing the distal interlocking screw can cause adjacent vascular injury, stress concentration, and secondary fracture around the screw. ConclusionWhen the fracture is stable (type A1, type A2.1), it can be fixed solidly without the distal interlocking screw, but prefers to use a long nail. In unstable fracture, the distal interlocking screw should be used to prevent rotational displacement of the femur shaft and the failure of the nail.
ObjectiveTo review the current progresses in purification strategies, biological characters, and functions of endothelial progenitor cells (EPCs) derived extracellular vesicles (EVs) (EPC-EVs). MethodsRecent relevant publications on the EPC-EVs were extensively reviewed, analyzed, and summarized. ResultsEPC-EVs are usually isolated by differential centrifugation and exhibit a homogenous pattern of spheroid particles with a diameter ranging from 60 to 160 nm under transmission electron microscopy. EPC-EVs are positive for cell-surface markers of EPCs (CD31, CD34, and CD133), and negative for markers of platelets (P-selectin and CD42b) and monocytes (CD14). Recent studies have shown the effectiveness of EPC-EVs in ischemic injuries, anti-Thy1 glomerulonephritis, and cardiomyocyte hypertrophy, and also shown their predictive role in cardio-cerebral-vascular diseases. ConclusionAn alluring prospect exists on the EPC-EVs-related research. Further studies are required to decipher the composition of EPC-EVs and their precise role in pathophysiological processes, and to investigate the molecular mechanisms for their targeting and function.
ObjectiveTo evaluate the effectiveness of spinal wedged osteotomy and total hip arthroplasty (THA) for treatment of kyphosis and severe hip flexion contracture caused by ankylosing spondylitis (AS). MethodsBetween December 2008 and November 2011,25 patients (37 hips) with kyphosis and severe hip flexion contracture caused by AS were treated.There were 22 males and 3 females,aged 29-38 years (mean,35.6 years).The disease duration was 8-16 years (mean,13.2 years).Of them,18 cases had complete limitation of hip motion,and 16 cases had severe spine deformity (Cobb's angel ≥60°).All 25 cases underwent spinal wedged osteotomy at first,and then received THA after 8 weeks.The effectiveness was evaluated by Harris hip score,range of motion (ROM) of the hip,visual analogue scale (VAS) score,Cobb's angle,and information and data exchange system (IDES) criteria for aseptic loosening,respectively. ResultsThe patients were followed up 12-14 months (mean,13 months).Spondylolisthesis (Ⅱ degree) occurred in 1 case spinal after wedged osteotomy,and was corrected after second operation.No vascular injury or spinal cord injury was observed.Bony fusion was obtained at osteotomy ends at 6 months after operation.The Cobb's angle was significantly corrected from (83.5±10.4)° preoperatively to (25.4±5.5)° (t=24.63,P=0.00) 12 months postoperatively.One case had traction injury of the femoral nerve after THA,and the muscle function recovered at 9 months after operation.According to IDES criteria,up-displacement of cup (<5 mm) was observed in 1 patient,who had no obvious clinical symptoms; periacetabular osteolysis occurred in 1 patient,with no displacement of cup.No obvious radiolucent was seen in 37 hips.The Harris hip score was significantly improved from (26.87±4.23) preoperatively to (85.92±6.04) (t=28.72,P=0.00) 3 months postoperatively; the VAS score was significantly decreased from (6.71±1.14) preoperatively to (2.31±0.82) (t=42.26,P=0.00) 3 months postoperatively; and the flexion-extension ROM of the hip was significantly improved to 60-100° (mean,72.0°) at post-operation,and the abduction ROM of the hip was improved to 20-40° (mean,28.7°). ConclusionSpinal wedged osteotomy combined with THA is an efficient treatment for kyphosis and severe hip flexion contracture caused by AS.