ABSTRACT
BACKGROUND:The hidden blood loss, accounted for a fairly large proportion of perioperative blood loss in total hip replacement, can seriously affect the recovery of postoperative joint function, but the specific influential factors and mechanisms remain unknown at present. OBJECTIVE:To evaluate the relative influential factors for hidden blood loss after primary total hip arthroplasty by the blood loss condition, and to analyze the association between hidden blood loss and prognosis. METHODS:Clinical data of 110 patients who underwent primary total hip arthroplasty in the Liuzhou Worker’s Hospital between April 2011 and April 2013 were retrospectively analyzed. The hidden blood loss was calculated according to Ward and Gross formula. The effects of patient’s gender, age, body mass index, type of prosthesis, presence of internal diseases, and different causes of a disease on hidden blood loss after arthroplasty were analyzed. The patients were divided into the high blood loss group (≥ 480 mL) and the low blood loss group (0.05). The hidden blood loss was correlated with postoperative functional recovery (P=0.046). Results indicated that type of prosthesis, presence of internal diseases, and different causes of a disease are main influential factors for hidden blood loss after total hip arthroplasty. The hidden blood loss has some influence on the recovery of postoperative joint function.
ABSTRACT
BACKGROUND:Clinicaly, dexamethasone-soaked gelatin sponges that are placed around the nerve root and spinal dura mater in lumbar disc excision have achieved good results. OBJECTIVE: To understand the effect of dexamethasone-soaked gelatin sponges in prevention of epidural adhesion in animals. METHODS:Forty New Zealand white rabbits were randomly divided into four groups folowed by removal of L4, L7 laminae, and a 1.0 cm×0.5 cm lamina dura area was exposed in each group. Then, the dura and nerve root were covered with dexamethasone-soaked gelatin sponges, dexamethasone, gelatin sponge and nothing (blank group), respectively. At 2, 4, 6, 8, 12 weeks after surgery, the entire operated vertebral segment and its accessories and paraspinal muscles were taken for gross and microscopic observation of nerve root and dural tissue adhesions. RESULTS AND CONCLUSION:At 12 weeks postoperatively, new bone tissue formed generaly at the site of laminectomy defect in the dexamethasone-soaked gelatin sponge group, with separable yelow-white membranous tissue around the dura; histological results showed the complete structure of fat cels, clearly distinct from the dura; there was no scar cel formation, no adhesions, no trabecular bone cartilage cels and hyperplasia. In the other three groups, a large number of peripheral epidural scar tissues were generaly seen, epidural adhesions were serious that could not be separated bluntly, and histological results showed colagenization of granulation tissue, dural thickening and serious adhesions. The findings indicate that dexamethasone-soaked gelatin sponges can synergisticaly prevent epidural adhesions.
ABSTRACT
Data of 39 patients (51 knees) undergoing total knee arthroplasty (TKA) in the Department of Orthopaedics,Fourth Affiliated Hospital of Guangxi Medical University between October 2001 and March 2008,were analyzed retrospectively,including 6 males (6 knees) and 33 females (45 knees) aged 59-72 years. Among the 39 cases,there were 35 cases of osteoarthritis,2 of rheumatoid arthritis,1 of osteoarthritis and pigmented villonodular synovitis,and 1 of advanced tuberculosis. Different degrees of pain,swelling,genu valgum,genu varumand and functional impairment of knee joints were found in all cases. The prosthesis adopted included 3 knees of DePuy,10 of Stryker,3 of Link,5 of Zimmer,7 of Taiwan Unite,and 23 of Pulus (made in China). Among all the cases,47 knees were treated by posterior stabilized prosthesis,and 4 knees were treated with posterior cruciate ligament-retaining TKA. Careful medical examination and evaluation were performed to control blood sugar level before operation; the operation duration was shortened as possible. Reasonable proposals were formulated to prevent the postoperative infection and deep venous thrombosis. Clinical data were analyzed using the HSS score standard. All patients were followed up for 6-57 months. No deep infection,prosthetic loosening or death was found. Postoperatively,2 patients (2 knees) developed cutaneous necrosis at incision margin,of which 1 patient (1 knee) was cured by changing dressings,and 1 patient (1 knee) was healed after incision of skin and relaxation suture. The range-of-motion of 51 knees all exceeded 90?. The motion of knee joint were increased from 65?(32?-95?) in average preoperatively to 96?(90?-110?) after the operation. The preoperative pain of all patients disappeared instantly after operation,beside one case (2 knees) and the other had a little pain. The Harris knee joint scores were increased from 39 points (25-53 points) in average preoperatively to 91 points (82-97 points) after the operation at the final follow-up; 25 cases (34 knees) were excellent,12 cases (15 knees) were good,2 cases (2 knees) were fair and the excellent and good rate was 96%. Although TKA has a satisfactory surgical effect,associated factors should be paid more attention.
ABSTRACT
To observe the preventive effects of flumeprednisolone and spongia gelatinosa on peridural adhesion after nucleus pulposus resection of lumbar intervertebral disc, 153 cases with lumbar intervertebral disc protrusion were selected from the Department of Orthopaedics, Fourth Affiliated Hospital of Guangxi Medical University between June 2002 and August 2006. Among them, the flumeprednisolone and spongia gelatinosa were put surrounding nerve root and dura mater of spinal cord in 83 cases. According to the Macnab criterion, the Lasegue symptom was effectively relieved after operation, and 96.4% of excellent and good result was achieved by periodic follow-up with good functional recovery and satisfactory surgical effect. It indicates that flumeprednisolone and spongia gelatinosa composite is effective in preventing peridural adhesion after intervertebral disc operation.