Abstract: Objective To investigate the clinical effect of using zerobalanced ultrafiltration on postoperative lung function of coronary artery bypass grafting (CABG) patients under cardiopulmonary bypass (CPB). Methods Forty coronary artery bypass grafting patients in the First Affiliated Hospital of China Medical University from June 2006 to December 2008 were enrolled in this study, and were divided into two groups based on different ultrafiltration procedures. Patients in the experimental group (n=20), 14 males and 6 females, with an age of 65.43±8.31 years, underwent zerobalanced ultrafiltration and conventional ultrafiltration after CPB was carried out. Patients in the control group (n=20), 15 males and 5 females, with an age of 66.51±7.62 years, only underwent conventional ultrafiltration after temperature restoration. Preoperative pulmonary function and arterial blood gas were tested routinely. Airway resistance (Raw), oxygenation index (OI) and alveolar arterial oxygen difference ［P(Aa)O2］ were measured at the following points: before CPB, at the end of CPB, 6 hours, and 12 hours after operation. Postoperative mechanical ventilation time was also recorded. Results There was no significantly statistical difference between the two groups of patients in pulmonary function and arterial blood gas indexes before operation, and Raw, OI and P(Aa)O2 before CPB (Pgt;0.05). Nevertheless, at the points of 6 hours and 12 hours after operation, Raw ［2.22±0.31 cm H2O/(L·s) vs. 2.94±0.42 cm H2O/(L·s), F=0.061, Plt;0.05; 1.89±0.51 cm H2O/(L·s) vs. 2.52±0.29 cm H2O/(L·s), F=0.096, Plt;0.05］ and P(Aa)O2 (86.74±7.63 mm Hg vs. 111.66±7.49 mm Hg, F=0.036, Plt;0.05; 74.82±5.67 mm Hg vs. 95.23±6.78 mm Hg, F=0.059, Plt;0.05) of patients in the experimental group were significantly lower than those of patients in the control group. At the same points, OI of patients in the experimental group was significantly higher than that of patients in the control group (384.33±30.67 vs. 324.63±31.22, F=0.033, Plt;0.05; 342.24±23.43 vs. 293.67±25.44, F=0.047, Plt;005). Ventilator support time of the experimental group was shorter than the control group (15.44±3.93 h vs. 20.68±5.77 h,Plt;0.05). Conclusion Zerobalanced ultrafiltration can improve pulmonary function after coronary artery bypass grafting and shorten postoperative mechanical ventilation time.
Objective To investigate the clinical effects and the management of combined using of zerobalanced ultrafiltration(ZBUF) and modified ultrafiltration(MUF) in severe infant open heart surgery with cardiopulmonary bypass(CPB) , in order to evaluate the feasibility and clinical significance of combination of ZBUF and MUF. Methods 20 pediatric patients diagnosed as complicated congenital heart disease had been involved, which included 12 males and 8 females with 12.6±7.5months of age and 8.5±3.3 kg of weight. Gambro FH22 hemofilter was selected in all patients. The typical MUF method was chosen. ZBUF was done during CPB and MUF was performed after CPB. The variety of hemodynamics, blood gas, concentration of electrolytes, inflammatory media and change of the plasma colloid osmotic pressure(COP) were measured at several time points. Filtrate was salvaged to detect the level of tumor necrosis factor alpha (TNF-α) and interleukine-8 (IL-8). Results Mean arterial pressure(MAP) was significantly higher(P=0.001) after MUF finished in all patients. Lactate acid (LAC), TNF-α and IL-8 had no significant difference before and after ZBUF. COP was significantly higher after MUF than that after ZBUF(P=0.002). Concentration of TNF-α in MUF filtrate was significantly higher than that in ZBUF(p=0.036). Conclusion Combined using of ZBUF and MUF has the effective ability of removing the inflammatory mediators and ameliorating system immunoreaction in pediatric CPB. MUF can improve the respiratory and heart function through decreasing the body water and increasing COP and hematocrit.
Objective To investigate the effect of the sagittal alignment of the spine and pelvis after surgical posterior intervertebral fusion combined with pedicle screw fixation for low-grade isthmic lumbar spondylolisthesis, and to assess the effectiveness. Methods Between October 2009 and October 2011, 30 patients with low-grade isthmic spondylolisthesis underwent surgical posterior intervertebral fusion combined with pedicle screw fixation, and the clinical data were retrospectively reviewed. There were 14 males and 16 females with an average age of 56.7 years (range, 48-67 years). The pre- and post-operative radiographic parameters, such as percentage of slipping (PS), intervertebral space height, angle of slip (AS), thoracic kyphosis (TK), thoracolumbar junction angle (TLJ), sagittal vertical axis (SVA), lumbar lordosis (LL), spino-sacral angle (SSA), sacral slope (SS), pelvic tilt (PT), and pelvic incidence (PI) were measured. The functional evaluation was made using the Oswestry Disability Index (ODI). Pearson correlation were used to investigate the association between all parameters and ODI score. Results PS, intervertebral space height, AS, and ODI were improved significantly compared with properative ones (P lt; 0.05). Significant differences were found in the other parameters between pre- and post-operation (P lt; 0.05) except TLJ and TK. The alteration of SVA showed significant correlation with the changes of PS, PI, PT, LL, SS, AS, SSA, and ODI. The alteration of SSA showed significant correlation with the changes of PS, PI, LL, SS, AS, PT, and ODI. Conclusion Surgical posterior intervertebral fusion combined with pedicle screw fixation for low-grade isthmic spondylolisthesis can effectively improve and maintain the spinal sagittal parameters. SVA and SSA are adequate to evaluate pre-and post-operative balance. The good clinical outcome is closely related with the improved of SVA and SSA.
Objective To review the research progress of the risk factors for slip progression and the pathogenesis of lumbosacral spondylolisthesis, and to discuss the value of Spinal Deformity Study Group (SDSG) classification system for lumbosacral spondylolisthesis. Methods Recent articles about the risk factors for slip progression and the pathogenesis of lumbosacral spondylolisthesis were reviewed and comprehensively analyzed with SDSG classification system of lumbosacral spondylolisthesis. Results Pelvic incidence (PI) is the key pathogenic factor of lumbosacral spondylolisthesis. The Meyerding grade of slip, PI, sacro-pelvic balance, and spino-pelvic balance not only are the fundamental risk factors of slip progression, but also are the key factors to determine how to treat and influence the prognosis. Therefore, compared with Wiltse, Marchetti-Bartolozzi, and Mac-Thiong-Labelle classification systems of lumbosacral spondylolisthesis, SDSG classification based on these factors mentioned above, has better homogeneity between the subjects of subgroup, and better reliability, moreover, could better guide operative plan and judge the prognosis. Conclusion It is suggested that the SDSG classification system should be the standard classification for lumbosacral spondylolisthesis for the clinical and research work.
Objective To evaluate the efficacy of modified Ranawat soft tissue balance technique on total knee arthroplasty (TKA). Methods From January 2004 to June 2008, 34 cases (44 knees) of valgus deformity were treated with TKA. There were 5 males (5 knees) and 29 females (39 knees), aged 55-79 years old (average 60.3 years old) and including 18 left knees and 26 right knees. The deformity was caused by osteoarthritis in 9 cases, by rheumatoid arthritis in 19 cases, and bytraumatic arthritis in 6 cases. According to Ranawat classification, there were 5 cases (5 knees) of type I and 29 cases (39 knees) of type II. All patients were performed modified Ranawat soft tissue balance technology. Results The operative time was (65 ± 7) minutes. Burst fracture of femoral condyle occurred and internal fixation was selected in 1 case of rheumatoid arthritis. Small incision necrosis occurred and healed after debridement in 1 case of rheumatoid arthritis. Incision healed by first intention in other cases. Adhesions occurred in 1 case (1 knee) and hydrarthrosis in 4 cases (4 knees), all cured after symptomatic treatment. All patients were followed up 6 months to 5 years with an average of 2.6 years. All patients had no compl ications of deep vein thrombosis, dislocation, vascular injury and nerve injury. X-ray films showed no signs of prosthesis loosening and infection at 1 year after operation. The X-ray films showed statistically significant differences (P lt; 0.05) in anatomic valgus angulation between preoperation and 1 week after operation [(25.4 ± 3.1)° vs (3.8 ± 1.2)°]. There were statistically significant differences in modified KSS score between preoperation and 1, 2 years postoperatively (P lt; 0.05). Conclusion It is a simple and effective way to treat the valgus deformity with modified Ranawat soft tissue balance technique in TKA, which can achieve the satisfactory results in the knee stabil ity, the range of motion and the deformity correction
Objective To explore the technique of the soft tissue balancing in the total knee arthroplasty (TKA) for the patients of rheumatoid arthritis with flexion contracture. Methods From November 1997 to May 2006, 38 patients with rheumatoid arthritis with flexion contracture underwent primary bilateral TKA and balancing of the soft tissues, among whomthere were 8 males and 30 females, aged 48-71 years old (58.2 on average). The course of disease was 28 months-16 years (7.6 years on average). The preoperative flexion contracture was (38.2 ± 11.3)°. The average range of motion (ROM) and HSS score were (49.1 ± 17.8)° and 23.9 ± 16.9, respectively. According to the preoperative flexion-contracture degree of the knees, these patients were divided into 3 levels: 5 patients with ≤ 20°, 26 patients with 20-60° and 7 patients with ≥ 60°. During the TKA procedure, based on the correct osteotomy, different methods of soft tissue balancing were used for different degrees of flexion contracture. The TKA soft tissue treatment was summed up as the releasing of posterior structures and the balancing between medial collateral ligaments (MCL) and lateral collateral ligaments (LCL), etc. Results The flexion contractures in 38 cases were all improved after the operation, among which 33 patients had a complete correction and only 5 patients had a residual flexion contracture of 5-10°. Eight knees suffered from complications within 1 week after operation, among which 3 had subcutaneous superficial infection and 5 had deep vein thrombus (DVT). These patients obtained good heal ing after active treatment. All the 38 patients were followedup for 10 months to 8 years with the median time of 37 months. The postoperative flexion deformity declined to (2.4 ± 5.7)°, and the ROM and HSS scores were (96.3 ± 14.6)° and 81.7 ± 10.4, respectively. There was statistical difference (P lt; 0.05). According to the HSS score, 27 patients (71.05%)were rated as excellent, 6 good (15.79%) and 5 fair (13.16%), and the choiceness rate was 86.84%. Conclusion The balancing of the soft tissue is a major treatment for correction of the flexion contracture, which can avoid bone over-resection during the surgery of TKA. The proper balancing of the soft tissue can not only achieve an obvious correction of the flexion contracture but also effectively improve the range of motion and the functional recovery of the knee joint after TKA.
Objective To explore the technique of the soft tissue balancing inthe total knee arthroplasty (TKA) for the patients with the knees of varus deformity and flexion contracture. Methods From January 2001 to December 2005, 86 patients (19 males, 67 females; age, 57-78 years;average, 66 years) with the knees of varus deformity and flexion contracture underwent primary TKA and the balancing of the soft tissues. All the patients had suffered from osteoarthritis. The unibilateral affection was found in 68 patients and the bilateral affection in 18. The varus deformity angle was averaged 12.3° (range, 6-34°). The soft tissue varus accounted for 56.7% and the bony varus accounted for 43.3%. The flexion contracture lt; 10° was found in 21 knees, 10-19° in 45 knees, 20-29° in 22 knees, and gt;30° in 16 knees, with an average angle of 18.9°. Results The flexion contractures were improved. Before operation the average angle ofthe flexion contracture was 18.9° but after operation only 4 patients had a residual flexion contracture of 5° and the remaining patients had a complete correction. The follow-up for 37 months (range, 6-72 months) in all the patients revealed that only 6 patients had a residual flexion contracture of 5-10° and the others had a full extension. Before operation the average varus angle was 12.3°(range, 6-34°) and the average tibiofemoral angle was 174.7° (range, 70.3-175.6°), but after operation the residual varus angle gt; 3° was only found in 2 patients. The complications occurring during operation and after operation were found in 6 patients, injuries to the attachment of the medial collateral ligaments in 2, patellar clunk syndromes in 2, cerebral embolism in 1, and lacunar infarction in 1, with no nerve disorders left after the medical treatment. No skin necrosis, the cut edge infection or deep infection occurred. Conclusion The balancing of the soft tissues is a major management for correction of the varus deformity and the flexion contracture. The proper balancing of the softtissues can achieve an obvious recovery of the function and correction of the varus deformity after TKA.
Objective To investigate a modified robotized hydraulictensor for management of the ligament balance in the total knee arthroplasty. Methods The effect of the modified robotized hydraulic tensor on the mechanical behaviour of the ligament system balance in the total knee arthroplasty was analyzed andthe related information was obtained. Results The robotized hydraulic tensor acted as a tensorsensor system, which could assist the surgeon by providing thequantitative information to align the lower limb in extension, equalize the articular spaces in extension and flexion, balance the internal and external forces, and define the femoral component rotation, and by providing the information toplan the releasing of the soft tissues and the rotating of the femoral component. Conclusion The modified robotized hydraulic tensor can enable the surgeon to properly manage the ligament balance in the total knee arthroplasty.
Objective To analyze formation of the varus angle of the knee dueto osteoarthritis and to explore techniques of the soft tissue balance in the total knee arthroplasty(TKA). Methods One hundred patients with145 varus knees (18 males, 25 varus knees; 82 females, 120 varus knees) underwent TKA from January 1999 to December 2003. Their ages averaged 62.4 years (range, 45.80 years), and their HSS（hospital of special surgery）scores were 38.0±3.2 points. Before operation，all the patients were measured in the alignment of the lower extremity, accurate bonecutting was performed, and their static alignment was achieved. Then, the soft tissue release was made. The release performance consisted of 3 steps: release before the bone-cutting, release during the bone-cutting, and release after the bonecutting. Release of themedial ligament and capsule, elimination of the osteophytes, and release of thelateral patellar retinaculum were more important. Results The varus angles in these patients were 9.2±3.1° before operation. Among them,the varus angles caused by the soft tissue imbalance accounted for 53.2%，and caused by the bone structure accounted for 46.8%； and the latter caused by thetibia varus, 22.8%, and by the tibia plateau destruction, 24.0%. There was nosignificant difference between the varus angles caused by the soft tissue imbalance and the varus angles caused by the bone structure deformity (P＞0.05). According to the postoperative imaging studies, the correction degree for the varus angles by the bone-cutting was 4.3°, which represented 27.9% of the total corrected angles, and the correction degree for the varus angles corrected by the soft tissue balance was 10.7°, which represented 72.1% of the total corrected angles. The HSS scores were 87.0±4.5 points after operation, and the difference between preoperation and postoperation was significant. Conclusion The varus knee due to osteoarthritis results from the varus angle in the bone structure and the angles caused by the imbalance of the collateral ligaments and the soft tissues around the knee. The latter causative factor is more important in the formation of the varus knee and should only be corrected through the soft tissue release. The more important part to be released isthe attachments of the medial ligament and the posterior capsule. The release performance should be followed by the principles, i.e., step by step, tests at all the time, and avoidance of the excessive release.
Objective To investigate effectiveness of applying the Bone Morphingbased image-free computer-assisted system for the ligament balancing managementin the total knee arthroplasty (TKA). Methods Between November 2002 and June 2003, twenty-one posterior stabilized total knee prostheses (Ceraver, France) were implanted in 21 patients using the Bone Morphing based image-free Ceravision system.This cohort included 5 men and 16 women with an average age of 72.4 years, two undergoing high tibial osteotomy and 1 undergoing distal femoral osteotomy before. The preoperative deviation was measured by the full-length AP X-rays. The knees were in varus deviation in 14 patients and in valgus deviation in 7 patients, with an average of 2.36°(varus 13°-valgus 13°). The frontal X-rays ofthe knee were assessed, the mean value of the varus force-stress test was 8.47°(varus 2°-varus 20°), and the mean value of the valgus forcestress test was 3.63°(varus 7°-valgus 12°). Results With the Ceravisionrecorded data, the intraoperative alignment was assessed, the mean lower limb axis was 3.33°(varus 12°-valgus 10°),and compared with the preoperative data, the difference was significant (Plt;0.05); the mean value of the varus force-stress test was 6.47°(varus 0°-varus 24°), the mean value of the valgus force-stress test was 4.32°(varus 8°- valgus 15°), and compared with the preoperative data, the difference was significant (Plt;0.05). The post-prosthetic alignment on Ceravision with a deviation of 0.175°(varus 2°- valgus 3°) was compared with the postoperative alignment by the full-length AP X-rays, with a deviation of 0.3°(varus 3.5°-valgus 1.5°), the difference wasn’t significant(Pgt;0.05).The clinical check-up performed 3 months after operation showed that the average range of movement (ROM) was 115°(105-130°), the mean frontal laxity was 0.27 mm(0.2-0.5 mm). The femoral and tibial components were implanted in the satisfactory 3 dimensional position without ligament imbalance in all the patients, andthere were no instability or patella complications.Conclusion Utilization of the Bone Morphing based image-free computer-assisted system can achieve an accurate component 3 dimensional alignment, optimal bone resection, optimal control of surgical decision in releasing the soft tissues, rotating the femoral component to gain an extension/flexion rectangular gap, and managing theligament balancing so as to achieve a satisfactory initial clinical outcome. This system can be routinely used in the TKA.