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BACKGROUND:How to effectively reduce al ogeneic blood transfusion volume after knee arthroplasty has become a new clinical problem, but predictors of perioperative blood loss and al ogenic blood transfusion after replacement have not been wel defined. OBJECTIVE:To establish the prediction model of al ogeneic transfusion volume after total knee arthroplasty by analyzing the preoperative and intraoperative related factors that influence the postoperative al ogeneic transfusion volume, so as to provide a theoretical basis for the clinical selective application of the autologous blood retransfusion device. METHODS:The materials of 120 postoperative al ogenic transfusion patients who treated with unilateral total knee arthroplasty at Baodi Clinical Col ege of Tianjin Medical University from January 2012 to December 2013 were retrospectively analyzed. Each patient’s gender, age, height, body weight, preoperative hemoglobin value, operation time, intraoperative blood loss volume and postoperative al ogeneic transfusion volume were recorded in detail, and accordingly a prediction model of al ogeneic transfusion volume was established after total knee arthroplasty. From January 2014 to December 2014, we applied this model in clinic. A total of 90 patients who predicted need for al ogeneic transfusion after unilateral total knee arthroplasty were randomly divided into two groups. Autologous blood retransfusion device was used in the observation group. Conventional drainage was used in the control group. The blood transfusion volume of patients in these two groups was analyzed, and the prediction accuracy of the prediction model in these two groups was detected. RESULTS AND CONCLUSION:Al patients completed the experimental observation. Pearson analysis showed that the patient’s age, height, body weight, preoperative hemoglobin values, operation time and intraoperative blood loss volume associated with postoperative al ogeneic transfusion volume (P0.05). There were significant differences in al ogeneic transfusion volume and total blood transfusion volume (including autologous and allogeneic blood transfusion volume) of patients in these two group (P<0.01). The al ogeneic transfusion volume in the observation group was significantly lower than that in the control group. These results suggest that the prediction model can successful y predict the al ogeneic transfusion volume after total knee arthroplasty. The application of autologous blood retransfusion device in those patients who predicted need for postoperative al ogenic transfusion after the replacement can effectively reduce the al ogenic transfusion volume.
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Objective To evaluate the clinical outcomes and correction accuracy of posttraumatic varus and valgus knee deformities using the Taylor Spatial Frame (TSF).Methods From June 2006 to December 2010,26 patients with posttraumatic varus and valgus knee deformities who had been treated with the TSF combined with less invasive high tibial osteotomy (HTO) or supracondylar femur osteotomy (SFO) were retrospectively analyzed,including 19 males and 7 females with an average age of 39 years.There were 20 cases of posttraumatic varus knees and 6 valgus knees.Twenty one patients were treated with HTO and 3 with SFO,2 with HTO and SFO simultaneously.During the operation,the TSF was firstly assembled and then the parameters of the frame were measured followed by less invasive percutaneous osteotomy.Correction was started seven to ten days after the operation following the time schedule provided by the computer program.Correction of the struts were performed 3 times per day,with a total movement of 0-3 mm.Results Through 7-35 days frame adjustments,20 cases of deformities were fully corrected.X-ray showed that the mechanical axis deviations of the tibia and femur all were recovered to normal range,and the deformity of rotation,angulation and crispation were fully corrected.Six cases had residual slight angulation or crispation deformity ( ＜ 4° or ＜ 10 mm).Through the second 4-10 days frame adjustments,these 6 cases of deformities were fully corrected finally.New bone formation and consolidation on the osteotomy site were good.The fixators were removed from 2.5-6.0 months after surgery and the appearance of the limbs and the patients' gait recovered to normal and the keen pain disappeared.All patients were followed up for 12-60 months and without the recurrence of the deformity.Eleven cases occured pin site infection and were controlled by use of the sensitive antibiotics.One case occured refracture of the distal femur osteotomy site 1.5 months after frame removal.Through conservative treatment,the fracture finally healed.Conclusion Posttraumatic varus and valgus knee deformities can be effectively corrected by using TSF and with a high accuracy.
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[Objective]To observe the clinical effect of proximal humeral fractures treated with locking proximal humerus plate.[Method]From April 2004 to August 2008,21 patients with proximal humeral fractures were all treated with locking proximal humerus plates,the average age of the patients was 51 years(range 35-78).According to Neer classification:two-part fracture 7,three-part fracture 12,four-part fracture 2.[Result]Twenty-one patients were all followed up for 6-24 months(average 14 months),all fractures occurred bony union.Clinical effect was evaluated by Neer functional assessment system:excellent 14,good 5,fare 2.[Conclusion]Application of locking proximal humerus plates in treating proximal humeral fractures can obtain satisfactory therapeutic result and is a more ideal method of internal fixation of proximal humeral fractures at present,attaching importance to injury of shoulder sleeve and early exercise,most patients can acquire satisfactory clinical effect.
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[Objective]To investigate the clinic application of the reversed sural neurocutaneous island flap in repairing the soft tissue defect of the foot and ankle.[Method]From June 1997 to December 2007,38 cases of the lower leg,around the ankle and the heel soft tissue defects were treated with the reversed sural neurocutaneous island flap.The average of the patients was 38.3 years(range 5 to 65).The longest medical history was 11 years.The lagest area of flap was 17 cm?12 cm and the smallest was 5 cm?4 cm.[Result]Thirty-three flaps were completely survived,there were 5 cases with distal edge of the flaps partially necrosis and healed after short time dressing change.The patients were followed up for half a year to 10 years and the curative effect was satisfactory.[Conclusion]The reversed sural neurocutaneous flap is simple to harvest and its blood supply is reliable without the sacrifice of a major blood vessel.So it is an ideal method for repairing the soft tissue defect of the foot and ankle.