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OBJECTIVE@#To investigate the efficacy and safety of multiple-dose intravenous tranexamic acid (TXA) for reducing blood loss in complex tibial plateau fractures with open reduction internal fixation by a prospective randomized controlled trial.@*METHODS@#A study was conducted on patients with Schatzker type Ⅳ-Ⅵ tibial plateau fractures admitted between August 2020 and December 2022. Among them, 88 patients met the selection criteria and were included in the study. They were randomly allocated into 3 groups, the control group (28 cases), single-dose TXA group (31 cases), and multiple-dose TXA group (29 cases), using a random number table method. There was no significant difference ( P>0.05) in terms of age, gender, body mass index, the Schatzker type and side of fracture, laboratory examinations [hemoglobin (Hb), activated partial thromboplastin time (APTT), prothrombin time (PT), fibrinogen (Fib), international normalized ratio (INR), D-dimer, and interleukin 6 (IL-6)], and preoperative blood volume. The control group received intravenous infusion of 100 mL saline at 15 minutes before operation and 3, 6, and 24 hours after the first administration. The single-dose TXA group received intravenous infusion of 1 g TXA (dissolved in 100 mL saline) at 15 minutes before operation, followed by an equal amount of saline at each time point after the first administration. The multiple-dose TXA group received intravenous infusion of 1 g TXA (dissolved in 100 mL saline) at each time point. The relevant indicators were recorded and compared between groups to evaluate the effectiveness and safety of TXA, including hospital stays, operation time, occurrence of infection; the occurrence of lower extremity deep vein thrombosis, intermuscular vein thrombosis, and pulmonary embolism at 1 week after operation; the lowest postoperative Hb value and Hb reduction rate, the difference (change value) between pre- and post-operative APTT, PT, Fib, and INR; D-dimer and IL-6 at 24 and 72 hours after operation; total blood loss, intraoperative blood loss, hidden blood loss, drainage flow during 48 hours after operation, and postoperative blood transfusion.@*RESULTS@#① TXA efficacy evaluation: the lowest Hb value in the control group was significantly lower than that in the other two groups ( P<0.05), and there was no significant difference between the single- and multiple-dose TXA groups ( P>0.05). The Hb reduction rate, total blood loss, intraoperative blood loss, drainage flow during 48 hours after operation, and hidden blood loss showed a gradual decrease trend in the control group, single-dose TXA group, and multiple-dose TXA group. And differences were significant ( P<0.05) in the Hb reduction rate and drainage flow during 48 hours after operation between groups, and the total blood loss and hidden blood loss between control group and other two groups. ② TXA safety evaluation: no lower extremity deep vein thrombosis or pulmonary embolism occurred in the three groups after operation, but 3, 4, and 2 cases of intermuscular vein thrombosis occurred in the control group, single-dose TXA group, and multiple-dose TXA group, respectively, and the differences in the incidences between groups were not significant ( P>0.05). There was no significant difference in the operation time between groups ( P>0.05). But the length of hospital stay was significantly longer in the control group than in the other groups ( P<0.05); there was no significant difference between the single- and multiple-dose TXA groups ( P>0.05). ③ Effect of TXA on blood coagulation and inflammatory response: the incisions of the 3 groups healed by first intention, and no infections occurred. The differences in the changes of APTT, PT, Fib, and INR between groups were not significant ( P>0.05). The D-dimer and IL-6 in the three groups showed a trend of first increasing and then decreasing over time, and there was a significant difference between different time points in the three groups ( P<0.05). At 24 and 72 hours after operation, there was no significant difference in D-dimer between groups ( P>0.05), while there was a significant difference in IL-6 between groups ( P<0.05).@*CONCLUSION@#Multiple intravenous applications of TXA can reduce perioperative blood loss and shorten hospital stays in patients undergoing open reduction and internal fixation of complex tibial plateau fractures, provide additional fibrinolysis control and ameliorate postoperative inflammatory response.
Subject(s)
Humans , Tranexamic Acid/therapeutic use , Blood Loss, Surgical/prevention & control , Interleukin-6 , Prospective Studies , Tibial Plateau Fractures , Tibial Fractures/surgery , ThrombosisABSTRACT
Objective:To explore the clinical features and treatment strategies of the transsyndesmotic ankle fracture dislocation.Methods:Data of 26 patients of transsyndesmotic ankle fracture dislocation who were treated in our hospital from December 2013 to November 2020 were retrospectively analyzed. There were 16 men and 10 women with an average age of 49.54±12.81 years (range, 26-68 years). Open injuries in 17 cases, of which the Gustilo-Anderson II type in 6 cases, IIIA type in 11 cases, closed injuries in 9 cases. According to the AO/OTA fracture classification, 44B type in 4 cases, 44C type in 22 cases. According to the Lauge-Hansen classification, there were 16 cases of pronation-abduction, 10 cases of pronation-external rotation, including 4 cases of Maisonneuve fractures, and of the 4 cases of Maisonneuve fractures, there were 3 cases of double Maisonneuve fracture. The talar dislocation was anterior, neutral, and posterior within the distal tibiofibular joint in 10 cases, 7 cases, and 9 cases. Fibular fractures in 26 cases, medial malleolar fractures in 24 cases, deltoid ligament rupture in 2 cases, posterior malleolar fractures in 13 cases, and anterior malleolar fractures in 8 cases. All closed injuries were closed reduction and plaster fixation and all open injuries were emergently debridement and reduced under the tibial plafond in the emergency department. Surgical treatment was taken until the soft tissue conditions to be allowed. The reduction quality was assessed by postoperative radiography according to the criteria proposed by Burwell-Charnley. The function of the ankle joint was assessed by the ankle-hindfoot rating system of the American Orthopaedic Foot and Ankle Society (AOFAS), and the posttraumatic arthritis and objectively quantified was assessed using the Kellgren-Lawrence grading scale.Results:There were 4 cases were unreduced due to the tibial posterior tendon to flip through the ankle joint and dislocate anterior to the tibia through the interosseous membrane. Stabilization of fibular fractures were achieved with plate in 25 cases. There were 24 cases of medial malleolar fractures, and the fixation were achieved with cannulated screws in 23 cases and with K-wire fixation in 1 case. There were 12 cases of posterior malleolar fractures treated with open reduction and internal fixation including cannulated screws in 9 cases and antiglide plates in 3 cases. There were 7 cases of anterior malleolar fractures treated with open reduction and internal fixation including suture anchors in 1 case and cannulated screws in 6 cases. Stabilization of syndesmosis was achieved with syndesmotic screws in 14 cases and with TightRope in 2 cases. All patients were followed up for 20.23±9.70 months (range, 12-60 months). According to the Burwell-Charnley criteria of reduction quality, anatomic reduction was obtained in 22 cases, and satisfactory reduction was gained in 4 cases. All fractures healed in 16.31±3.64 weeks (range, 10-24 weeks). Functional examination of the ankle joint (angle measurement method): dorsiflexion average angle 10.38°±6.66°, plantarflexion average angle 34.04°±7.20°. At latest follow up, the AOFAS score was 83.30±13.94 (range, 24-100). Ten (38%) of 26 patients had radiographic evidence of posttraumatic ankle arthritis. According to the Kellgren-Lawrence grading scale criteria, there were grade I in 5 cases, II in 2 cases, III in 2 cases, and IV in 1 case. 2 cases of wound dishence were recovered through changing dressing and 2 cases of skin necrosis were recovered by skin graft and flap transposition respectively. There were no significant complications such as infection, nonunion, or implant failure.Conclusion:The transsyndesmotic ankle fracture dislocation, represents an exceptional pattern of high-energy fractures with significant syndesmotic disruption, and potential soft tissue compromise. Careful attention to radiographic findings can identify unique fracture characteristics relative to operative decision-making. Tibialis posterior tendon dislocation, a rare complication in the transsyndesmotic ankle fracture dislocation injuries, can impede anatomical reduction of the ankle mortise. The open reduction and internal fixation may be an optimal approach to treat transsyndesmotic ankle fracture dislocation injuries. However, the rate of posttraumatic arthritis is relatively high.
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BACKGROUND: Studies have found that chondroitin sulfate proteoglycans degradation with chondroitinase canpromote the migration of Müller cells on the retina, but whether it could promote the migration of adipose-derivedmesenchymal stem cells in retinal degeneration rats is unclear.OBJECTIVE: To investigate the effect of chondroitin sulfate proteoglycans degradation with chondroitinase on adipose-derived mesenchymal stem cell treatment for retinal degeneration in rats.METHODS: Human adipose-derived mesenchymal stem cells were isolated and cultured. A retinal degeneration ratmodel was established followed by administration of adipose-derived mesenchymal stem cells+chondroitinase into thesubretinal space. The migration of adipose-derived mesenchymal stem cells and retinal cell apoptosis in rats aftertransplantation were observed.RESULTS AND CONCLUSION: The human adipose-derived mesenchymal stem cells could be successfully cultured.The labeling rate of BrdU to the human adipose-derived mesenchymal stem cells was more than 90.0%. At 7 days aftermodeling, the outer nuclear layer of the retina was collapsed, and a large amount of photoreceptor cells were dissected.The outer nuclear layer was attached to the Bruch''s membrane, and the retina was arched. The central retina andperipheral retina were damaged. In normal rats, the retinal layers were clear, and the photoreceptor cells arrangedregularly; and the retinal pigment epithelium was complete. The migration rate of adipose-derived mesenchymal stemcells in adipose-derived mesenchymal stem cells+chondroitinase group was higher than that in adipose-derivedmesenchymal stem cells group (P 0.05). These experimental findings show that chondroitin sulfate proteoglycans degradationwith chondroitinase can enhance the migration ability of human adipose-derived mesenchymal stem cells on the retina.
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BACKGROUND:Autologous hard palate mucosa has been validated to be a substitute of the tarsal conjunctival. OBJECTIVE:To investigate the treatment outcomes of autologous hard palate mucosa applied in the eyelid reconstruction. METHODS:180 patients (180 eyes) with eyelid defects aged 10-63 years old were recruited, including 122 males and 58 females, and subjected to the transplantation of autologous hard palate mucosa. In the same time, flaps were designed and transferred into the defected eyelid soft tissues. All patients were followed up for over 3 months to observe the treatment outcomes. RESULTS AND CONCLUSION:Three months after surgery, viscous secretions were found in the implanted region and conjunctival sac, which were relieved and eliminated by usage of antibiotic drops. All implanted hard palate mucosa survived within 1 year, neither infections nor falling off occurred, and blood vessels growth into the implant-tissue conjugation that inosculated with the host vessels presenting no rejection. The implants revealed different degrees of shrink in 132 patients, but the eye function was normal. During the hospitalization, some uncomfortable feeling such as eye pain had been relieved, and the wound showed no infections and healed well. During the follow-up, there were eight patients with slight lower eyelid ectropion and three with hypophasis. The length or height difference of both eyelids was within 2 mm, except those who lost eye bal s. These results suggest that autologous hard palate mucosa achieve satisfactory outcomes in the eyelid reconstruction and possesses good histocompatibility.
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BACKGROUND: Spherical Toric intraocular lens can effectively correct the preoperative astigmatism of cataract patients, but it is unclear whether the aspheric Toric lens is better than the spherical Toric lens to improve the quality of vision. OBJECTIVE: To evaluate the optical quality after implantation of aspheric toric intraocular lens in cataract surgery. METHODS: Seventy-three cataract patients with corneal astigmatism (80 eyes) were enrol ed, including 37 males and 36 females, aged 47-83 years. Among them, 36 cases were implanted with aspheric Toric intraocular lens (test group), and the other 37 cases were implanted with spherical Toric intraocular lens (control group). Postoperative examinations were performed at 3 months, including axial intraocular lens, uncorrected visual acuity, corrected visual acuity, residual astigmatism, contrast sensitivity, and wavefront aberration. RESULTS AND CONCLUSION: Three months after implantation, the axial view, uncorrected visual acuity, corrected visual acuity and residual astigmatism showed no differences between the two groups; no shape deviation and lens decentration occurred; there was no case required to remove the lens or subjected to secondary adjustment. In the test group, the moderate and high spatial frequency contrast sensitivity at the scotopic or scotopic glare state was significantly higher than that in the control group (P < 0.05), the total higher order aberrations and spherical aberrations at a pupil diameter of 5.0 mm and spherical aberration at a pupil diameter of 3.0 mm were significantly less than those in the control group (P < 0.05). Additional y, there were no differences in scattering index, cut-off frequency of the modulation transfer function, Strehl ratio and visual acuity at 9%, 20% and 100% contrast between the two groups. These findings indicate that the aspheric and spherical toric intraocular lenses have similar effects in improving the astigmatism and raising the uncorrected visual acuity, but the former one is superior to the latter one in improving scotopic vision, and total higher order aberrations and spherical aberrations.
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BACKGROUND:Monofocal and multifocal Toric intraocular lens that have been widely used in clinic exhibit xcelent biological and optical characteristics and have good safety and stability after implantation. OBJECTIVE:To compare the outcomes and rotation stability in patients with cataract and astigmatism after implantation of monofocal and multifocal intraocular lens. METHODS:A total of 210 patients with cataract and astigmatism who received phacoemulsification and intraocular lens implantation were included in this study. Of them, 105 patients were assigned to monofocal intraocular lens implantation and the other 105 patients to multifocal intraocular lens implantation. Uncorrected visual acuity, best corrected visual acuity, residual astigmatism were reexamined at 1, 3 weeks and 1 month after surgery. The rotation of Toric intraocular lens was determined. The incidence of complications and spectacles- independent rate were recorded. RESULTS AND CONCLUSION:Visual acuity and residual astigmatism in each group were significantly improved after 1 week of intraocular lens implantation (P < 0.05); furthermore, these two indicators became better over time. Improvement of visual acuity and residual astigmatism in multifocal intraocular lens group was more obvious than that in monofocal intraocular lens group. Postoperative intraocular lens rotation at < 5° occurred in both groups. The intraocular lens rotation degree in multifocal intraocular lens group was higher than that in monofocal intraocular lens group at different time points (P < 0.05). There were no significant differences in incidence of complications and spectacles-independent rates between two groups at 1 month after surgery. These results demonstrate that multifocal Toric intraocular lens provides better visual acuity and residual astigmatism improvement, while monofocal Toric intraocular lens provides better rotation stability.