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Objective To use estimation of physiologic ability and surgical stress (E-PASS) to assay operative risks in patients with hip fracture and to discuss its application value.Methods Sixtyfour patients with hip fractures were subjected to the retrospective review.There were 38 males and 26 females,at mean age of 54.3 years (range,19-84 years).The operative risk was assayed by E-PASS and postoperative complications as well as case fatality were detected and compared.Results Postoperative complications developed in 16 patients (25％).E-PASS score was significantly higher for the patients with postoperative complications than in those without [(0.64 ± 0.31) points vs (0.22 ± 0.31) points,P ＜ 0.05].Incidence of complications was significantly lower for patients with a E-PASS score ＜ 0.6 than for those with a E-PASS score ＞ 0.6 (19％ vs 50％,P ＜ 0.01).There were 2 deaths among 16 patients with a E-PASS score ＞ 0.6.The remaining 48 patients with a E-PASS score ＜ 0.6 obtained satisfactory recovery.Conclusion E-PASS is effective for predicting operative risk and is instructive for surgery decision in treatment of hip fractures.
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ObjectiveTo discuss the correlation of the surgical risk score with the change of T cell subsets and the occurrence of postoperative complications. MethodsA total of 260 patients with hip fractures treated in our department were enrolled in this study and divided into high-risk group ( Group A) and low-risk group (Group B) based on the surgical risk score. The fasting peripheral venous blood was taken in the morning at one day before surgery and at days 1,3, 5, 7 and 14 after surgery for measuring CD3, CD4 and CD8 levels respectively in two groups.In the meantime, the correlation of level changes with risk score and postoperative complications was observed in two groups. ResultsThere were two patients with lung infection in the Group B, with no death. There were two patients with pulmonary infection, one with wound infection and two with deep vein thrombosis, with one death. The postoperative levels of CD3 and CD4 in the Group A and Group B were significantly lower than those in the control group (P ＜ 0.01 ), which reached the lowest level at day 1 after operation and recovered to normal at day 5 after operation. The postoperative levels of CD3 and CD4 in the Group A recovered near to normal at day 7 and to normal at day 14. While the postoperative levels of CD3 and CD4 in the Group B remained low level even at day 14. The level of CD8 decreased at days 1 and 5 in the Group A, then increased and remained relatively stable, while the level of CD8 increased in the Group B. The T cell subsets in both groups recovered from low to high trend at days 1-7 after surgery. The higher preoperative score had more obvious decrease and slower recovery of the T cell subsets. ConclusionsSurgical risk score has positive correlation with the change of T cell subsets and postoperative complications, which can more accurately predict the postoperative outcome of the old patients.
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Objective To develop a new scoring system,Daping orthopedics operation risk scoring system for senile patient(DORSSSP),for preoperative evaluation of operative risks in the elderly patients with hip fractures based on acute physiology and chronic health evaluation(APACHE)Ⅱ scoring system and physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM)and compare the new scoring system with APACHE Ⅱ and POSSUM in assessing surgical risks and predicting postoperative complications and mortalities.Methods A total of 260 patients with hip fractures treated in our department in recent five years were retrospectively and respectively evaluated with DORSSSP,POSSUM,progressed POSSUM(P-POSSUM)and APACHE Ⅱ scoring system to compare the value of three scoring systems in preoperative evaluation of operative risks and prediction of postoperative mortality and complications.Results POSSUM and DORSSSP predicted complications in 119 and 92 patients respectively,while the actual complication occurred in 84 patients.The prediction value of POSSUM was significantly higher than the actual value,while the prediction value of DORSSSP showed no statistical difference compared with the actual value.POSSUM,P-POSSUM and APACHEⅡ scoring systems predicted 16,10 and 12 deaths respectively,but there were six deaths in fact,with prediction value obviously higher than the actual value.DORSSSP predicted nine deaths,the closest value to the actual.Conclusions DORSSSP has good correlation with postoperative complications and mortalities.Compared with POSSUM and APACHE Ⅱ scoring system,more simple and practicable DORSSSP can more accurately evaluate the preoperative risks and predict the postoperative complications and mortalities in the elderly patients with hip fractures.
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Objective To evaluate the role of mangled extremity severity score(MESS)in res-ervation and amputation of crush lower limbs in earthquake. Methods There were 122 patients with crush lower limb injuries,with MESS≥8 points in 34 patients who were primarily amputated,M ESS 5-7points in 19 who were principally preserved and MESS＜5 points in 69 who were preserved by means of debridement,external fixators,plast splints and vaeuum sealing drainage technique.Results All pa-tients were survived.with amputation rate of 29.5%. Conclusion MESS is an important reference for evaluation of reservation and amputation of crush limb injuries caused by earthquake.
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Objective To observe the effects of early rehabilitation training on sensory restoration after the median nerve injuries. Methods Seventy patients with median nerve injuries were randomly divided into two groups: the rehabilitation group ( n =32), in which the patients received sensory reeducation two weeks after surgical treatment; and the control group ( n =38),in which the patients only received surgical treatment. After 6 8 weeks of treatment, reassessment were performed and the results were compared between the two groups. Results The excellent and effective rates of functional recovery in sensation in the rehabilitation group were 88% and 97%, respectively. A comparison showed that there was significant difference between the two groups. Conclusion Sensory reeducation could accelerate the restoration of sensation in patients with median nerve injury.
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In our 6 years experience of clinical education,we think that sufficient preparation of the teachers and the interaction with the students is very important.Especially,the improvement on education method and the applications of multimedia are also a helpful technique.