ABSTRACT
Objective:To investigate the effect of intraoperative blood transfusion on postoperative deep vein thrombosis in patients with orthopedic trauma.Methods:A retrospective analysis was conducted of the 502 patients who had been treated operatively at Department of Orthopaedics and Trauma, Xi＇an Honghui Hospital from January 2015 to September 2018. They were divided into 2 groups according to the use of intraoperative blood transfusion. In the observation group of 203 cases who had received intraoperative blood transfusion, there were 98 males and 105 females with an age of (61.0±20.7) years; in the control group of 299 cases who had not received intraoperative blood transfusion, there were 166 males and 133 females with an age of (57.7±19.0) years. Blood coagulation series such as D-dimer and fibrinogen were measured at admission, 1 day pre-operation, 1 day and 3 days postoperation. After operation, venous ultrasound examination of both lower limbs was performed to observe postoperative DVT in the patients. The 2 groups were compared in changes in coagulation series and occurrence of postoperative DVT.Results:There was no statistically significant difference in the preoperative general data between the 2 groups ( P>0.05), showing they were comparable. There was no significant difference between the observation group and the control group in the D-dimer level at admission or 1 day pre-operation ( P>0.05), but the D-dimer levels at 1 day and 3 days postoperation in the observation group [4.18 (2.35, 7.08) mg/L and (6.20±3.77) mg/L] were significantly higher than those in the control group [3.41 (1.91, 5.63) mg/L and (4.05±2.62) mg/L] ( P<0.05). There was no statistically significant difference in fibrinogen between the 2 groups at different time points ( P>0.05). The incidence of DVT in the observation group was 43.3% (88/203), significantly higher than that in the control group (32.8%, 98/299) ( P<0.05). Conclusion:As intraoperative blood transfusion can increase the level of D-dimer and thus the incidence of postoperative venous thrombosis in patients with orthopaedic trauma, we should pay more attention to the risk of postoperative DVT in patients receiving intraoperative blood transfusion.
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Objective:To explore the clinical efficacy of proximal femoral anatomical locking plate and autogenous iliac graft for failed primary internal fixation in treatment of femoral intertrochanteric fracture.Methods:A retrospective analysis was conducted of the 29 patients with femoral intertrochanteric fracture who had been treated after failed primary internal fixation at Department of Orthopaedics and Trauma, Xi'an Honghui Hospital between January 2014 and March 2017. They were 17 men and 12 women, aged from 35 to 83 years (mean, 68.7 years). Their primary internal fixation involved dynamic hip screw in 12 cases, proximal femoral locking plate in 13 cases, and intramedullary nail in 4 cases. The causes for their internal fixation failure included head cutting in 8 cases, fracture nonunion in 10 cases, plate or screw breakage in 6 cases, intramedullary nail breakage in 3 cases, and hip varus in 2 cases. Their revision surgery was performed with anatomical proximal femoral locking plate and autogenous iliac bone graft. Their fracture union time, and visual analogue scale (VAS), hip Harris score, SF-36 health survey scale and complications at the final follow-ups were recorded.Results:All the 29 patients were followed up for 12 to 24 months (18 months on average). Bony union was eventually achieved in all the 29 patients after an average time of 4.5 months (from 3 to 7 months). There were no such complications as nonunion, re-fracture or internal fixation failure. The VAS pain score at the final follow-up(4.6±1.6) was significantly lower than that before surgery(7.1±2.1), and the Harris hip score(85.2±8.2) and SF-36 score(75.9±15.5) at the final follow-up were significantly higher than those before surgery (48.0±12.7 and 48.7±18.8) (all P<0.05). According to their hip Harris scores at the final follow-ups, the therapeutic efficacy was rated as excellent in 9 cases, as good in 15 cases and as poor in one, yielding an excellent and good rate of 82.8%. Conclusion:For patients with femoral intertrochanteric fracture whose primary internal fixation has failed, especially those with fine femoral head and neck and hip joint, proximal femoral anatomic locking plate and autogenous iliac bone graft can result in satisfactory clinical efficacy.
ABSTRACT
Objective To evaluate the feasibility, effectiveness and clinical application of B ultrasound/CT-guided percutaneous radiofrequency ablation (RFA) in treating hypersplenism due to portal hypertension. Methods B ultrasound/CT-guided percutaneous radiofrequency ablation was carried out in 28 patients with hypersplenism associated with portal hypertension. Routine blood counts, liver functions and prothrombin time were determined before RFA and 2 days, 2 weeks, one, 3, 6 and 10 months after RFA separately. The results were analyzed and compared. Enhanced CT scanning reexamination was performed immediately after RFA and one week, one, 3 and 10 months after RFA separately. The volume of ablated spleen tissue was calculated with CT post-processing software. Results The mean operation time was (3.8 ± 1.1) hours and the mean ablation time was (2.7 ± 0.8) hours. The ablated volume of the spleen accounted for 20% - 80% of the whole spleen, with a mean of 50.5% ± 10.3%. Two days after RFA, the platelet count decreased to (19.5 ± 12.1) × 109/L, while the white blood cell count reached its peak value of (5.4+0.2) × 109. From two weeks to 10 months after RFA the white blood cell counts and platelet counts, the liver function, and the prothrombin time were significantly improved when compared with preoperative ones, and the differences were statistically significant (P < 0.05). Pathologically, hepatic proliferation could be seen within the cirrhotic liver after RFA. Child-Pugh score was grade A in all patients except one patient with Child-Pugh grade C who developed abdominal distention and bloody ascites after RFA. No other severe complications occurred. Conclusion For hypersplenism due to portal hypertension, B ultrasound/CT-guided percutaneous radiofrequency ablation is a safe, effective and minimally - invasive treatment.