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OBJECTIVE@#To investigate the relationship between serum matrix metalloproteinase-1(MMP-1) and matrix metalloproteinase-2(MMP-2) and the formation of deep venous thrombosis(LDVT) in lower extremity patients after surgery for lower extremity fracture, and to analyze the value of MMP-1 and MMP-2 in predicting the occurrence of LDVT after lower extremity fracture.@*METHODS@#From June 2018 to December 2021, 352 patients who planned to receive surgical treatment of lower limb fracture in our hospital were selected as the research objects. Venous blood was collected at 1, 2 and 3 days after surgery, respectively, and serum MMP-1 and MMP-2 levels were detected. The incidence of LDVT during hospitalization was analyzed, and the risk factors of postoperative LDVT in patients with lower limb fracture surgery and the predictive value of MMP-1 and MMP-2 for LDVT were analyzed.@*RESULTS@#LDVT occurred in 40 patients (LDVT group), the incidence of LDVT was 11.36%, and 312 patients did not occurred(no occurred group). The serum levels of MMP-1 and MMP-2 in LDVT group increased gradually after surgery; the serum levels of MMP-1 and MMP-2 in the no occurred group increased slightly after surgery at 2 days and then decreased at 3 days after surgery (P<0.01);the serum levels of MMP-1 and MMP-2 in LDVT group were higher than those in the no occurred group at 2 days and 3 days after surgery (P<0.05). Serum levels of MMP-1 and MMP-2 were positively correlated with serum levels of interleukin-6 (IL-6), IL-8 and tumor necrosis factor -α (TNF-α) in LDVT patients at 2 days and 3 days postoperatively (P<0.05). Operative time, MMP-1 and MMP-2 postoperative 3 days were related to the occurrence of LDVT after lower limb fracture (P<0.01). The area under the curve(AUC) predicted by MMP-1 and MMP-2 postoperative 3 days for LDVT after lower limb fracture was 0.738 and 0.744 respectively, and the AUC predicted by combined MMP-1 and MMP-2 was 0.910, which was higher than that predicted by single indicator(Z=2.819 and 2.025, P<0.05).@*CONCLUSION@#High levels of MMP-1 and MMP-2 after lower extremity fracture are closely related to the occurrence of LDVT, and 3 d mMP-1 and MMP-2 after surgery maybe used as evaluation indexes for LDVT risk prediction.
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Humans , Lower Extremity/surgery , Matrix Metalloproteinase 1/blood , Matrix Metalloproteinase 2/blood , Risk Factors , Venous Thrombosis/etiology , Fractures, Bone/surgeryABSTRACT
Objective:To investigate serum C-reactive protein (CRP) , procalcitonin (PCT) and neutrophil CD64 in predicting early infection after internal fixation of limb fractures.Methods:A total of 2 572 patients with limb fractures undergoing internal fixation in Taishun County People’s Hospital from January 2016 to December 2022 were enrolled. Postoperative infection occurred in 121 cases (infected group) and did not occur in 2 451 cases (uninfected group). Serum levels of PCT, CRP and CD64 were tested at admission and d1, d3, d5 and d7 after operation. Repeated measurement analysis of variance was used to compare the serum levels of PCT, CRP and CD64 at different time points between two groups, the receiver operating characteristic curve (ROC) was used to evaluate the predictive value of each index or in combination for early infection after internal fixation of limbs fractures.Results:The early infection rate after internal fixation was 4.70% (121/2 572). The levels of PCT, CRP and CD64 in the infection group began to rise after operation and decreased on d7; there were significant differences in PCT, CRP and CD64 levels between the two groups on d3, d5 and d7 after operation (PCT: Ftime=678.607, Fintergroup=2 218.323, Finteraction=653.150; CRP: Ftime=392.724, Fintergroup=1 812.502, FInteraction =379.577; CD64: Ftime=373.686, Fintergroup=4 817.438, Finteraction=528.353, all P< 0.001) . The area under the ROC curve of combined detection of PCT, CPR, and CD64 for predicting early infection was 0.856; the sensitivity and specificity of combined detection were 69.2% and 94.7%, respectively. The combined detection of three indicators showed better prediction values than PCT, CRP and CD64 alone ( Z=6.176, 3.838 and 2.431, P<0.01 or <0.05), and also better than combined detection of PCT and CRP ( Z=2.875, P=0.019). Conclusions:The combined detection of CD64, PCT and CRP is of value in prediction of postoperative infection after internal fixation of limb fractures, which is worthy of clinical application.
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Background: Open fractures of leg classified under type IIIB, those requiring free flap cover could be done as emergency procedure. The ideal timing has still remained controversial. Although it appears imperative to operate early and reduce length of hospital stay, costs, disability adjusted life years and put the patient back on his feet, our study was necessitated in the context of differing views regarding ideal timing of free flap.Methods: The prospective observational study was conducted for duration of 4 years between October 2015 to September 2019. Patients were taken up for free flap cover after optimization for the major surgery. Details of flap complications and the procedures for salvage were noted. At the end of one year following the injury, patient quality of life (PQOL) was tabulated for all patients.Results: Most common mode of injury was road traffic accidents. Early flaps were done in 28 and primary flaps in 22 patients. One patient had partial flap necrosis while 7 others had sub flap collections and partial flap necrosis. Duration of hospitalization was significantly lower in early flap cover group. PQOL measured with EQ-5D (EuroQol 5D) was significantly higher in the early flap covers.Conclusions: From our study we concluded that timing of free flap cover positively influenced clinical outcome of reduced hospitalization, although there was no relation of timing of free flap to flap or bone complications. The functional outcome measured by PQOL was significantly higher in patients who had microvascular reconstruction early.
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Objective To explore the application of ultrasound-guided femoral and sciatic nerve blocks combined with general anesthesia in lower limb fracture surgery.Methods Sixty four patients who received orthopaedics surgerywere randomly divided into two groups including combined group(n =32),control group (n =32).Control group was given general anesthesia alone,combined group was givengeneral anesthesia combined with ultrasound-guided femoral and sciatic nerve blocks.The intraoperative hemodynamic state at different time,anesthetic dosage,and agitation after waking upbetween two groups were compared.Results Compared with T1 moment,HR and MAP at T2 moment in both groups were significantly decreased (P ＜ 0.05),while all these indicators at T3-T5 moment had no significant difference compared with the T1 moment in combined group (P ＞ 0.05),while the difference was significant in control group (P ＜ 0.05).Compared with control group,combined group had less intraoperative propofoland fentanyl dosage during the surgery,shorter awakening timeand extubation time,and the difference had statistical significance (P ＜ 0.05).The incidence of agitation after waking up and degree of agitation was significantly decreased in combined group than that in control group (P ＜ 0.05).Conclusion Ultrasound-guided nerve blockade combined with general anesthesia for lower limb fracture surgery,canmaintain the stability of intraoperative hemodynamics,reduce the dosage of analgesic drugs,and promote early awakening and extubation.
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Objective To observe the effects of general anesthesia and combined spinal epidural anesthesia in elderly patients with lower limb fracture surgery, and to evaluate the effect of postoperative cognitive function and pain score.Methods Retrospective analysis, screening of intraoperative anesthesia, postoperative change lost invalid cases, from November 2012 to October 2015 in our hospital accepted surgical treatment of 180 patients with lower limb fracture surgery were selected according to different patients with different anesthesia methods can be divided into treatment group and control group, 90 cases each group of patients.Patients in the treatment group were treated with combined spinal epidural anesthesia , while the control group received general anesthesia.The incidence of cognitive dysfunction and postoperative pain scores were compared between the two groups. Results the incidence of cognitive dysfunction after surgery in 90 cases of observation group was lower than that of the control group , and the difference was statistically significant (P<0.05).The evaluation of two groups of postoperative chronic pain for 3 days, 6 days, 10 days, 15 days, the incidence rate of VAS score and the character, whether the impact on the daily life and the rest, the patients in the treatment group pain scores were significantly lower than the control group, the difference was significant (P <0.05).Conclusion After lumbar epidural anesthesia in elderly lower limb fracture surgery effect on cognitive function in patients with small, and can reduce the pain of patients, in the actual work according to the actual situation of different specific problems in different specific analysis.
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Objective To study the effect of glycerin fructose combined with mannitol in the treatment of postoperative swelling of extremities fractures.Methods In Yiwu Central Hospital from February 2015 to February 2017 treated 100 cases of limb fracture surgery patients as the research object in the course of the study, were randomly divided into control group and experimental group two were 50 cases each.The patients in control group were treated with mannitol after fracture surgery, and the patients in the experimental group were treated with glycerol fructose and mannitol.Comparative analysis of the experimental group and control group of patients with limb swelling degree.Results After different treatment, the experimental group of patients with adverse reactions occurred in 0 cases, the probability was 0.0%, the control group of patients with adverse reactions in the number of cases in the case of the number of patients with adverse reaction probability of 10.0%, the number of patients with adverse reactions in the control group was 5.As a result, the incidence of adverse reactions in the experimental group was significantly lower than that in the control group, with statistical difference(P<0.05).In the experimental group, 6 days after surgery, on the 7 day, the 8 day and the 9 day, the forearm circumference was significantly lower than that of the control group, with statistical difference(P<0.05).On the 8 day after surgery and after 8 days, the leg circumference of the experimental group was significantly lower than that of the control group, with statistical difference(P<0.05).Conclusion The clinical effect of glycerol and fructose combined with mannitol in treatment of limb swelling after surgery for fracture, high safety, reduce the probability of occurrence of adverse reactions to a great extent, is further applied in clinical significance.
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Objective To access the efficacy of oximeter in blood oxygen saturation monitoring in limb fracture patients. Method Monitor the blood oxygen saturation level in 200 patients with limb fractures , and determine whether blood circulation disorders exist in these patients accordingly. Results Within the 200 patients, 107 had normal blood oxygen saturation level, 50 patients had possible blood circulation disorder , 40 patients had blood circulation disorder, 3 patients had critical limb ischemia among which 2 were diagnosed as osteofascial compartment syndrome , and one as partial breakage of arteriovenous vessels. All the patients recovered well after prompt and proper treatment. Conclusion Blood oxygen saturation monitoring in post-limb- fracture patients using a oximeter can discover blood circulation disorders promptly , thus ensure proper treatment and avoid mal-practice and missed diagnosis.
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Objective To observe The clinical effect of Xingqihuoxue granule combined with low molecular weight heparin to prevent deep vein thrombosis after operation of lower limb fracture surgery.Methods60 patients from February 2014 to February 2015, were randomly divided into observation group 30 cases and the control group 30 cases.The control group received low molecular weight heparin, the observation group received Xingqihuoxue granule.Two groups of patients were followed up and recorded the changes related indicators.ResultsThe level of capillary plasma viscosity, hematocrit, red blood cell and aggregation index values of observation group patients after treatment were (1.52±0.11,41.78±2.30%, 2.19±0.16 points), than the control group (1.42±0.14,39.02±2.07%, 2.01±0.23 points), and the difference was significant (P<0.05).The level of platelets of observation group patients was (189.4±37.0)×10.9 / L, than the control group (259.3±40.1) × 10.9/L, and the difference was statistically significant (P<0.05).The level of PT and APTT of the observation group after treatment were (16.0±2.79,36.78±4.59) s, than the control group (13.96±2.94,33.14±4.47) s, and the difference was statistically significant (P<0.05).The adverse reaction ratio of observation group after treatment was 6.67%, lower than the control group 30.00%, and the difference was statistically significant (P<0.05).ConclusionsThe clinical treatment of Xingqihuoxue granule combined with low molecular weight heparin was better than low molecular weight heparin alone, and the side effects was lower.It is worthy of further research and application.
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Objective To evaluate the risk factors for surgical site infection(SSI)following limb fracture surgery, and provide basis for making prevention and control measures.Methods Clinical data of 1 453 patients undergoing limb fracture surgery in 16 hospitals between January 1,2014 and June 30,2014 were collected,risk factors for SSI were analyzed by univariate and multivariate logistic regression analysis.Results Among 1 453 patients undergoing limb fracture surgery,12 developed SSI(0.83%).Univariate analysis showed that risk factors for SSI following limb fracture surgery were infection at the other sites 7 days before operation,time from injury to operation,opera-tion opportunity, duration of operation,open fracture, wound type, and anesthesia type ( all P < 0.05 ). Multivariate logistic regression analysis showed that independent risk factors were wound type,anesthesia type, open fracture,time from injury to operation,and duration of operation,OR(95% CI)were 12.47(2.78-15.88), 11.55(2.84 - 17.02),10.79 (2.72 - 11.13 ),2.35 (2.12 - 6.81 ),and 3.07 (1.88 - 4.13 )respectively. Conclusion Risk factors for SSI following limb fracture surgery are multiple,the key to the prevention and control of SSI are identifying risk factors and strengthening the management of key points.
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Objective To introduce a self- assembled adjustable traction frame for the patients with severe trauma and lower limb fracture in ICU, compared with Brawns traction frame. Methods 96 patients with severe trauma and lower limb fracture diagnosed by clinical signs and X-ray who had to be transferred to ICU were randomly divided into the study group (46 cases) and the control group (50 cases) by sealing letters method.The study group were tracted by the self-assembled adjustable traction frame, and the control group were tracted by the Brawns traction frame. The fracture alignment, degree of pain, incidence of pressure ulcers, nursing limit time of changing the sheets of the two groups were observed. Results The results declared that 37 cases with 2 pain score points, 9 cases with 0-1 points in the study group and 19 cases with 2 pain score points, 3 cases with 0-1 points, 28 cases with Grade 3 in the control group (χ2=38.683, P<0.01). In the control group, pressure ulcer were occurred, 5 of them at Level one, 1 of them at Level two, 1 of them at Level three and the incidence rate was 14.00% (7/50). In the study group, pressure ulcer were occurred, 1 of them at Level two and the incidence rate was 2.17%(1/46). The pain level and incidence of pressure sore in the study group were decreased and the difference between the two groups was significant (χ2=8.197, P < 0.05). Conclusions The self-assembly adjustable traction rack can not only ensure the same effect as the Brawns traction frame but also reduce the deficiency caused by Brown traction frame. It is safer and more comfortable for the patients and can reduce nursing complications and improve the quality and efficiency of the nursing work.
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To explore the clinical medication rules in the patients with limb fractures, and provide guidance for clinical practice. Data of 48 398 patients with limb fractures from 2001 to 2011 was extracted from the hospital information system(HIS) established by the institute of basic research in clinical medicine, China academy of Chinese medical sciences. The gender and age distribution of patients and clinical medication characteristics were described. Apriori algorithm was adopted to analyze the common drug combinations of Chinese medicine(CM) and western medicine(WM). The study results showed that the ratio of included males and females was 1.83∶1. There was a high peak of incidence for the patients from 18 to 44 years. Apriori algorithm showed that the usage of WM was more frequent than that of CM. The most commonly used CM was Lugua polypeptide and sodium aescinate injection. Blood-activating and stasis-resolving medicines, as well as tendons and bones-strengthening medicines were the commonly used CM types. In addition, WM antibiotics plus blood-activating and stasis-resolving CM, or antibiotics plus tendons and bones-strengthening CM was the most commonly used drug combination. Based on the analysis of available data, the prevalence of limb fracture was higher in men than in women; more in young and middle-aged patients; the common drug combination was antibiotics plus blood-activating and stasis-resolving CM, or antibiotics plus tendons and bones-strengthening CM. More prospective and high-quality clinical trials are necessary to evaluate the effect of CM or integrative medicine treatment for limb fracture in the future research.
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Objective To investigate the clinical effect of honghua injection on hemorrheology in the prevention of deep venous thrombosis ( DVT) after operation of lower limbs fractures.Methods 100 cases with operation of lower limb fracture meeting the inclusion critera were randomly divided into two groups equally.Besides conventional treatment, the control group was treated with rivaroxaban, while the observation group was treated with honghua injection and rivaroxaban.The incidence of DVT, pro-inflammatory factors, hemorheology indices and adverse reactions were observed and compared. Results The observation group had a total DVT incidence of 10.0%, which was statistically lower than that of 28.0% in the control group(P<0.05). Three days after the operation, pro-inflammatory factors of TNF-α, IL-6 and IL-8 in the observation group was respectively statistically lower than that in the control group(P<0.05).As to hemorheology indices, in comparison with the control group, hematocrit, whole blood viscosity and fibrinogen in the observation group were statistically lower (P<0.05).During the treatment, there were no case of severe adverse reactions, and the incidence of adverse reactions in the two groups were statistically same.Conclusion Treatment of honghua injection in combination with rivaroxaban in the prevention of DVT is reliable, which could significantly reduce the incidence of DVT, alleviate inflammatory reaction and improve blood hypercoagulable state with minor adverse reactions.
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Objective To discuss the efficacy and safty of sodium β-aescin in the treatment of swelling after lower limb fracture operation.Methods From February 2011 to February 2014 in Minda Hospital Affiliated to Hubei Minzu University,patients with swelling limb after lower limb fracture operations were selected as research subjects.The patients were divided into experimental group and control group randomly.The experimental group were received sodiumβ-aescin,the control group were received mannitol.After 4 days treatment,limb circumference,swelling score and pain score in two groups were compared. Results Compared with control group,the limb circumference,swelling score and pain score in experimental group significantly reduced after 4 days treatment(P<0.05 );the therapeutic effect in experimental group was significantly better than that in control group(P<0.05).The incidence of adverse reaction in two groups had no significant difference.Conclusion Application of sodiumβ-aescin on lower limb fracture shows good therapeutic effect.
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Objective To observe the effect of injectable tissue-engineered bone in treating periarticular bone fracture nonunion under arthroscopy. Methods Selected 6 patients with intra-articular bone fracture nonunion:3 cases of humerus intercondylar fracture;2 cases of femoral condylar fracture and 1 cases of tibial plateau fracture. All of the 6 patients have undergone arthroscopic debridment and tissue-engi-neered bone injection in the the fracture ends with puncture needle under direct vision. Percutaneous needle internal fixation were performed if necessary. All the patients have got regular follow-up after the operation process. Check their healing condition with X-ray examination, and the healing of the bone and its complications have also been monitored. Reexamination were made 3, 6, 9, and 12 months after surgery. Results All the patients have experienced successful operation and all the fracture have healed up. The X-ray review showed that the callus healing time was (8. 34 ± 2. 4) weeks and fracture healing time was (18. 2 ± 3. 3) weeks. Accordong to Johner-Wruhs functional category, there were 5 cases of excellent recovery and 1 case of medium recovery. Among these patients, inflammatory reaction occurred in 1 case, and the symptoms disappeared after 2 weeks of Vancomycin anti-inflammatory treatment; deep venous thrombosis occurred in 1 case, and the symptoms disappeared after systematic anticoagulant therapy. Conclusion It’ s safe and effective to treat periarticular bone fracture nonunion with injectable tissue-engineered bone under arthroscopy.
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Objective To study the influence of early dynamization of interlocking intramedullary nail on the treatment effect of the patients with lower limb fracture .Methods 62 patients with lower limb fracture treated with interlocking intramedullary nail in our hospital from June 2010 to March 2012 were selected as the research subjects and divided into the control group and the obser-vation group with 31 cases in each group according to random number table .The control group was treated with routine treatment method ,while the observation group was treated with early dynamization .Then the Johner-Wruch score ,healing time ,rate of ad-verse fracture healing ,incidence rate of complications and fracture healing related factors before and after the treatment were ana-lyzed and compared .Results The Johner-Wruch score excellent and good rate of the observation group was higher than that of the control group ,the healing time was shorter than that of the control group ,the rate of adverse fracture healing and the incidence rate of complications were lower than those of the control group ,the fracture healing related factors after treatment were all better than those of the control group ,the differences had statistical significance (all P<0 .05) .Conclusion The early dynamization of interloc-king intramedullary nail has the better effect for treating lower limb fracture and its influence on the fracture healing related factors is better too .
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Objective To study the application of remifentanil combined with brachial plexus block using in the operation of children with upper limb.Methods A total of 40 children,aged 4～10 years,undergoing arm-fracture operation,breathing oxygen with opening veil,were randomly divided into two groups.The children were administered basal anesthesia before brachial plexus block.During the operation,the study group(n=20)was infused remifentanil，the initial rate was 0.05μg·kg-1·min-1，and the control group was infused ketamine to reinforce the analgesia.Results All patients finished the surgery safely.In study group,children recovery time[(14.0±4.8)min]Was more quickly than that of control group[(30.4±10.3)min](t=6.5 88,P＜0.01).Conclusion Remifentanil could efficiently assistant brachial plexus block in the operation of children with upper limb.
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@#Most of patients received in hospital with the upper and lower extremity fracture are caused by the earthquake.These fractures have apparent characters,such as:the serious situation,complexity and lots of complications which can be divided two periods:the early and the late.These complications include shock,the nerve and vascular injury,the acute kidney failure,fat embolism,infection,deep venous thrombosis,decubitus ulcer and so on.These complications should be known completely and the therapy should be given early.Practice can not be taken because of pain and some other reasons,and this will lead to the muscle atrophy,adynamia and the joint disfuction.Finally the abilty to work was lost partly or completely.If some measures about rehabilitation were taken early,we can reduce the complication and the disability possibly.
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@#Most of patients received in hospital with the upper and lower extremity fracture are caused by the earthquake.These fractures have apparent characters,such as:the serious situation,complexity and lots of complications which can be divided two periods:the early and the late.These complications include shock,the nerve and vascular injury,the acute kidney failure,fat embolism,infection,deep venous thrombosis,decubitus ulcer and so on.These complications should be known completely and the therapy should be given early.Practice can not be taken because of pain and some other reasons,and this will lead to the muscle atrophy,adynamia and the joint disfuction.Finally the abilty to work was lost partly or completely.If some measures about rehabilitation were taken early,we can reduce the complication and the disability possibly.
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[Objective]To discuss the failure and countermeasure of Ni-Ti shape memory alloy fixer for treatment of limb fracture.[Method]A retrospective survey was performed in 259 cases with fracture treated by Ni-Ti shape memory alloy fixer.Eight cases of the fixer had been ruptured,risen,loosen after operation.[Result]The failure case of Ni-Ti shape memory alloy fixer for treatment of limb fracture were 8 case in 259 case.There were one case of ulna and two cases of femur fracture had be ruptured after the first operation,healing up after the second operation.The fixer has been risen of shoulder bone and femur fracture in each one and two cases of clavicle,the fracture has be malformation concrescence.One case of patella fracture was loosn after concrescence.[Conclusion]The requisite for Ni-Ti shape memory alloy fixer is needed for treatment of limb fracture,the right operation's condition,the best type and length are selected for different part,the convalescent exercise is regnired after operation to avoid failure of treatment.
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PURPOSE: To evaluate the results and the usefulness of the external fixator for the treatment of the lower limb fractures in children. MATERIALS AND METHODS: We used 22 children fractures of lower limb treated with external fixator. There were 14 isolated femur or tibia fractures, 2 both femur and tibia fractures, 1 bilateral tibial fractures, 5 fractures associated with others, and were 10 open and 16 closed fracture. We assessed the axial alignment and leg-length discrepancy, and the range of motion of the joints and complications. RESULTS: The average union and fixation time were 8.1 and 9.5 weeks. Average of 2.4 degrees of varus or valgus and 3.8 degrees of anterior or posterior angulation were obtained. At follow-up, the range of LLD was -1.3 to +1.5cm. CONCLUSION: External fixator in lower limb fractures of children is useful to open fractures, multiple fractures, and unstable fractures to minimize complications.