A simulação realística como ferramenta de avaliação de re- sidentes de enfermagem: um relato de experiência / Realistic simulation as a tool for evaluating nursing residents: an experience report

Objective Structured Clinical Examination (OSCE) é um modelo de avaliação com uma série de estações, nas quais o aluno deverá executar ações específicas que englobam competências. São avaliados comportamento, domínio e habilidades. Objetivo: relatar a utilização da simulação realística como ferramenta de avaliação de residentes de enfer- magem. Método: Estudo descritivo, tipo relato de experiência, sobre o uso de um método de avaliação formativa utilizando a simulação realística em julho de 2023. Resultados: Foi realizada a observação direta das atividades desenvolvidas pelos residentes e preenchido o check list individual de cada cenário. Debriefing contribuiu com a discussão reflexiva em grupo. Conclusão: Ao acompanhar o desenvolvimento enquanto ele ocorre, a avaliação formativa com uso do método OSCE, possibilita perceber como o residente tem absorvido o saber, quais possíveis pontos de melhoria e se os objetivos estão sendo alcançados. A simulação utilizada como ferramenta pode complementar o treinamento prático em situa- ções clínicas reais.(AU)

Objective Structured Clinical Examination (OSCE) is an assessment model with a series of stations in which the student must perform specific actions that encompass competencies. Behavior, mastery and skills are assessed. Objective: To report on the use of realistic simulation as an assessment tool for nursing residents. Method: This is a descriptive experience report on the use of a formative assessment method using realistic simulation in July 2023. Results: The activities carried out by the residents were directly observed and an individual checklist was completed for each scenario. Debriefing contributed to reflective group discussion. Conclusion: By monitoring development as it happens, formative assessment using the OSCE method makes it possible to see how the resident has absorbed the knowledge, what possible points for improvement and whether the objectives are being achieved. Simulation used as a tool can complement practical training in real clinical situations.(AU)

El Examen Clínico Objetivo Estructurado (ECOE) es un modelo de evaluación con una serie de estaciones en las que el estudiante debe realizar acciones específicas que engloban competencias. Se evalúan el comportamiento, el dominio y las habilidades. Objetivo: Informar sobre el uso de la simulación realista como herramienta de evaluación para residentes de enfermería. Método: Estudio descriptivo del uso de un método de evaluación formativa mediante simulación realista en julio de 2023. Resultados: Se observaron directamente las actividades realizadas por los residentes y se cumplimentó una lista de comprobación individual para cada escenario. El debriefing contribuyó a la discusión reflexiva en grupo. Conclusión: La evaluación formativa mediante el método OSCE permite, a través del seguimiento de la evolución a medida que ésta se produce, ver cómo el residente ha asimilado los conocimientos, cuáles son los posibles puntos de mejora y si se están alcanzando los objetivos. La simulación utilizada como herramienta puede complementar la formación práctica en situaciones clínicas reales.(AU)

Comparative study of orthopaedic robot-assisted minimally invasive surgery and open surgery for limb osteoid osteoma / 中国修复重建外科杂志

OBJECTIVE@#To compare the accuracy and effectiveness of orthopaedic robot-assisted minimally invasive surgery versus open surgery for limb osteoid osteoma.@*METHODS@#A clinical data of 36 patients with limb osteoid osteomas admitted between June 2016 and June 2023 was retrospectively analyzed. Among them, 16 patients underwent orthopaedic robot-assisted minimally invasive surgery (robot-assisted surgery group), and 20 patients underwent tumor resection after lotcated by C-arm X-ray fluoroscopy (open surgery group). There was no significant difference between the two groups in the gender, age, lesion site, tumor nidus diameter, and preoperative pain visual analogue scale (VAS) scores ( P>0.05). The operation time, lesion resection time, intraoperative blood loss, intraoperative fluoroscopy frequency, lesion resection accuracy, and postoperative analgesic use frequency were recorded and compared between the two groups. The VAS scores for pain severity were compared preoperatively and at 3 days and 3 months postoperatively.@*RESULTS@#Compared with the open surgery group, the robot-assisted surgery group had a longer operation time, less intraoperative blood loss, less fluoroscopy frequency, less postoperative analgesic use frequency, and higher lesion resection accuracy ( P<0.05). There was no significant difference in lesion resection time ( P>0.05). All patients were followed up after surgery, with a follow-up period of 3-24 months (median, 12 months) in the two groups. No postoperative complication such as wound infection or fracture occurred in either group during follow-up. No tumor recurrence was observed during follow-up. The VAS scores significantly improved in both groups at 3 days and 3 months after surgery when compared with preoperative value ( P<0.05). The VAS score at 3 days after surgery was significantly lower in robot-assisted surgery group than that in open surgery group ( P<0.05). However, there was no significant difference in VAS scores at 3 months between the two groups ( P>0.05).@*CONCLUSION@#Compared with open surgery, robot-assisted resection of limb osteoid osteomas has longer operation time, but the accuracy of lesion resection improve, intraoperative blood loss reduce, and early postoperative pain is lighter. It has the advantages of precision and minimally invasive surgery.

A Sole Thromboprophylactic in Prescription of Postoperative Orthopedic Patients – A Review

Background: Venous thromboembolism (VTE) is one of the most well-known and feared sequelae of orthopaedic surgery. VTE is relatively common after arthroplasty, prophylaxis has been prescribed. The frequency of postoperative thromboembolic events increased in the absence of primary prevention. Following operations, immobilisation of a lower limb that restricts calf muscle contraction has been shown to be a key risk factor for VTE. VTE is the most frequent source of readmission in orthopaedic patients who have undergone major procedures. It should be emphasized that the best mechanical method for preventing VTE is early walking. Medication for VTE prophylaxis is prescribed more often than mechanical prophylaxis. After major orthopaedic surgery, anticoagulant treatment is essential for reducing morbidity and death. Following hospital discharge, prophylactic drug therapy aims to reduce the morbidity and mortality episodes associated with DVT and PE occurrences. Aspirin use for prevention of VTE following THA and TKA has gained popularity, especially among orthopaedic surgeons due to a minimal risk of postoperative haemorrhage, it also reduces the incidence of recurrent DVTs. Conclusion: Due to its low cost and easy administration without the requirement for regular blood testing, aspirin thromboprophylaxis following knee surgery appears promising. Aspirin saved more QALYs and was cost-effective. Aspirin was demonstrated to have a higher VTE prophylaxis profile than other medications with a time-related association to early mobilisation, healthier patients and medication compliance.

Orthopaedic Specialty Committee Exit Examination Amidst the COVID-19 Pandemic in Malaysia- Experiences and Reflections from the Candidates

@#Introduction: The emergence of the COVID-19 pandemic had affected the Orthopaedic Specialty Committee (OSC) Exit Examination candidates. The objective of this study was to evaluate the impact of this pandemic on the candidates’ teaching and learning, mental well-being, and personal experience during the examinations. Methods: A cross-sectional study was conducted from 1st to 31st January 2021. 103 candidates for the OSC Exit Examination November 2020 were asked to answer a questionnaire. Wilcoxon signed-rank tests were used to compare differences in the frequencies before and during the pandemic. A p-value of less than 0.05 was taken as significant. Results: There was a significant reduction in the number of classes (P-value < 0.001) and examination preparatory courses conducted, reduced number and variety of patients attended and limited exposure in the operation theatre. Most candidates had virtual and physical classes, and agreed virtual clinical teaching was less effective. A majority had increased caffeine intake and smoking habits, decreased time spent with family and sports activities and no impact on sleeping hours, alcohol and analgesic usage. During the examinations, most candidates felt disturbed by the COVID-19 safety protocol and worried about the risk of contracting the infections. Conclusion: The effect of this pandemic on the post-graduate Orthopaedics students teaching and learning is massive. Virtual teaching programmes or applications that can replace the traditional clinical teaching methods should be explored and developed for the benefit of our education system.

Discussion and Concern on Animal Study for Orthopaedic Implantable Devices / 中国医疗器械杂志

In recent years, new orthopaedic implantable devices continue to emerge, which require higher requirements for technical evaluation. Animal study is an important part of the research and development process for the new orthopedic implantable devices, which provides relevant evidence for product design and stereotyping. By introducing the purpose of animal study, and the application of 3R principle (replacement, reduction, refinement) in this field, we summarize the concern on the animal study, in order to provide reference for the development and research of new orthopedic implantable devices and biomaterials. At the same time, the application of evidence-based research methods such as systematic review in the field is introduced, which provides new tools and approaches for the technical review and regulatory science.

Correction of tibial multiplanar deformities using single Taylor external fixator combined with biplanar osteotomy / 中国修复重建外科杂志

OBJECTIVE@#To investigate the effectiveness of single Taylor external fixator combined with biplanar osteotomy on correction of tibial multiplanar deformities.@*METHODS@#Between October 2016 and December 2021, 11 patients with tibial multiplanar deformities (20 sides) were treated with single Taylor external fixator and biplanar osteotomy. Of them, 4 were male and 7 were female; the average age ranged from 13 to 33 years (mean, 21.9 years). Diagnosis included rickets severe genu varum deformity (7 cases, 14 sides), rickets severe genu valgum deformity (2 cases, 4 sides), multiple osteochondromatosis calf deformity (1 case, 1 side), neurofibromatosis medial lower leg anterior arch deformity with short of leg (1 case, 1 side). After fibular osteotomy and tibial multiplanar osteotomy, a Taylor external fixator was installed. After operation, the deformities were corrected successively and fixed completely. The osteotomy healed, then the external fixator was removed. Before operation and at 12 months after operation, the full-length X-ray films were taken. The leg-length discrepancy, medial proximal tibial angle (MPTA), lateral distal tibial angle (LDTA), posterior proximal tibial angle (PPTA), anterior distal tibial angle (ADTA), and tibial rotation angle were measured. The degree of lower limb deformity was scored with reference to a customized tibial mechanical axis scoring table.@*RESULTS@#Osteotomy was successfully completed without neurovascular injury and other complications. The external fixator was adjusted for 28-46 days, with an average of 37 days, and the external fixator was worn for 136-292 days, with an average of 169 days. Mild needle infection during the fixation period occurred in 3 sides, refracture at the distal tibial osteotomy in 1 side after removing the external fixator, and nonunion of the distal fibular osteotomy in 1 side. All patients were followed up 369-397 days (mean, 375 days). At 12 months after operation, the lower limb discrepancy decreased, but there was no significant difference ( P>0.05). MPTA, LDTA, PPTA, ADTA, and tibial rotation angle improved, and the differences in LDTA, ADTA, and tibial rotation angle were significant ( P<0.05). The score of lower limb deformity was significantly higher than that before operation ( P<0.05), and the results were excellent in 9 sides, good in 8 sides, fair in 3 sides, with the excellent and good rate of 85%.@*CONCLUSION@#Single Taylor external fixator combined with biplanar osteotomy is effective in the correction of tibial multiplanar deformities.

Intervention effect of injury control orthopedic strategy on fat embolism syndrome associated with long shaft fracture of lower limb / 中国骨伤

OBJECTIVE@#To observe the intervention effect of damage control orthopaedic(DCO) strategy on fat embolism syndrome(FES) associated with long shaft fracture of lower limbs.@*METHODS@#Retrospective analysis was made on the clinical data of 163 patients with FES associated with lower limb long shaft fractures admitted from January 2015 to May 2021. They were divided into two groups based on the time point of implementing DCO strategy in January 2018. Total of 92 patients were admitted from January 2015 to December 2017 as the control group, and other 71 patients were admitted from January 2018 to May 2021 as the intervention group. The hospital mortality, arterial oxygen saturation (SaO2), arterial partial pressure of oxygen (PaO2) and oxygenation index (OI), hemoglobin (Hb), platelet count(PLT), Harris score of hip joint, HSS score of knee joint, AOFAS score of ankle joint, clinical efficacy and complications were observed and compared between two groups.@*RESULTS@#Total of 163 patients were followed up for 12 to 18 months with an average of (16.91±1.22) months. The in-hospital mortality rate in the intervention group was 2.82% (2/71), and that in the control group was 16.30% (15/92), the difference between two groups was statistically significant(χ2=6.455, P<0.05). After the intervention, SaO2, PaO2 and OI in two groups were higher than those before the intervention(P<0.05), and after the intervention, SaO2, PaO2 and OI in two groups were statistically significant(P<0.05). Hb and PLT in two groups after intervention were higher than those before intervention (P<0.001), and there was statistically significant difference in Hb and PLT between two groups after intervention (P<0.05). The Harris score of hip joint, HSS score of knee joint and AOFAS score of ankle joint in both groups after 3 months of treatment were better than those before treatment (P<0.05). The total clinical effective rate of the intervention group was higher than that of the control group(χ2=4.194, P<0.05). The total incidence of complications in the intervention group was lower than that in the control group(χ2=4.747, P<0.05).@*CONCLUSION@#DCO strategy is helpful to reduce the in-hospital mortality of patients with FES associated with long shaft fracture of lower extremities, eliminate FES symptoms and stabilize vital signs, gain time advantage for phase Ⅱ definitive surgery, and has significant clinical intervention effect, which is worth popularizing.

Prevalence of preoperative anxiety and its contributing factors in adult patients undergoing elective orthopaedic surgery at an academic hospital in South Africa: a pilot study

Preoperative anxiety potentially results in perioperative anaesthetic complications. This study aimed to determine the prevalence of preoperative anxiety in adult patients scheduled to undergo elective orthopaedic surgery at an academic hospital in South Africa and identify contributory factors. Methods: This cross-sectional study included all patients scheduled for elective orthopaedic surgery the following day from 25 July to 3 November 2021. An adapted version of the Amsterdam Preoperative Anxiety and Information Scale (APAIS) was used. Four questions determined the patients' anxiety and two questions their desire for more information about their forthcoming anaesthesia and surgery. A 5-point Likert scale was used to capture the patients' responses to the APAIS questions. Data on other possible contributory factors to preoperative anxiety were collected using a questionnaire. Results: Of the 88 patients, 82 (93.2%) were included in the study. A total of 40 (48.8%) patients had an APAIS score of ≥ 11, indicating anxiety. A high need-for-information score (≥ 8) was found in 31 (37.8%) patients. A significant association between patients with a higher anxiety score and a higher need-for-information score (p = 0.0063) was identified. Other non-significant factors associated with a higher anxiety score included a lower level of education and no postoperative home support. Conclusion: Patients with a high need for information tended to be more anxious on the day before surgery. The APAIS could be introduced in preoperative ward admissions to identify these patients and provide an appropriate level of counselling about their planned procedure. Counselling might reduce their preoperative anxiety, but further research needs to confirm this assertion. Larger studies are recommended to determine the influence of other factors contributing to preoperative anxiety

Application and prospect of machine learning in orthopaedic trauma / 中国修复重建外科杂志

OBJECTIVE@#To review the current applications of machine learning in orthopaedic trauma and anticipate its future role in clinical practice.@*METHODS@#A comprehensive literature review was conducted to assess the status of machine learning algorithms in orthopaedic trauma research, both nationally and internationally.@*RESULTS@#The rapid advancement of computer data processing and the growing convergence of medicine and industry have led to the widespread utilization of artificial intelligence in healthcare. Currently, machine learning plays a significant role in orthopaedic trauma, demonstrating high performance and accuracy in various areas including fracture image recognition, diagnosis stratification, clinical decision-making, evaluation, perioperative considerations, and prognostic risk prediction. Nevertheless, challenges persist in the development and clinical implementation of machine learning. These include limited database samples, model interpretation difficulties, and universality and individualisation variations.@*CONCLUSION@#The expansion of clinical sample sizes and enhancements in algorithm performance hold significant promise for the extensive application of machine learning in supporting orthopaedic trauma diagnosis, guiding decision-making, devising individualized medical strategies, and optimizing the allocation of clinical resources.

A Review on Medico legal and Ethical aspects of Orthopaedic Practice

Medico-legal issues in orthopaedic practice are increasing day by day. With the tremendous metamorphosis in the healthcare sector, incidents of lawsuits against orthopaedic surgeons and hospitals, in the name of medical negligence is on the rise. With every consumer redress forum being more inclined in protecting the consumers, it is imperative for practising Doctors to be more informed on the Medico-legal aspects of their field of practice. Most orthopaedic cases that lead to medico-legal cases result from trauma. Besides, these cases are seen in the Emergency Room, thereby resulting in critical and uncertain decisions. Unlike in other fields where the patient has an existing relationship before any complications occur, rapport-building has to begin much after the treatment has begun. Technological advances in the orthopaedic field, availability of online information on platforms like Google, lack of communication, cutthroat competition among orthopaedic surgeons, awareness about the consumer protection act, mob psychology, interference by anti-social elements and local politicians etc have brought orthopaedic practice at this stage. Following ethical aspects, keeping good repo with patients and society, keeping our documentation perfect and precise, and doing transparent and honest practice can save orthopaedic surgeons in long run. Having empathy towards patients and society, keeping workload in our control, helping each other in crisis, and no medical jousting are also important measures to do safe medical practice in the present era. Keeping in mind the mantra of coming together, working together, and working in harmony is of utmost importance for an orthopaedic practice in recent times.

Knowledge expectation satisfaction and its influencing factors of orthopedic patients during hospitalization / 中国实用护理杂志

Objective:To investigate the current status of knowledge expectation satisfaction of orthopedic patients during hospitalization, and to analyze the main influencing factors.Methods:From March 2021 to July 2021, a total of 320 orthopedic inpatients from Affiliated Hospital of Qingdao University were selected by convenient sampling method, who were investigated by the general information, Patient Participation Ability Questionnaire, Excepted Knowledge of Hospital Patients and a self-designed questionnaire of actual accepted knowledge on the basis of this scale.Results:The highest level of knowledge expectation satisfaction in the functional dimension (-0.40 ± 0.32), and the lowest level in the economic dimension (-1.27 ± 0.38) ( t=22.45, 59.64, both P<0.01). Knowledge expectation difference was positively correlated with information acquisition ability ( r=0.802, P<0.01) and emotion management ability( r=0.671, P<0.01). Multiple linear regression analysis showed that education level, hospitalization experience, information acquisition ability and ability to manage emotions were the main influencing factors for this difference ( t values were -6.40-13.17, all P<0.05). Conclusions:The level of knowledge expectation satisfaction of orthopedic patients′ needs to be further improved. According to the level of education, hospitalization experience, information acquisition ability and emotion management ability of patients, nurses should formulate measures to improve the level of knowledge expectation satisfaction.

Application progress in TiRobot-assisted fracture surgery / 中华创伤骨科杂志

With technological innovations in computer, navigation and robotics, more and more robot-assisted orthopaedic surgeries have been put into clinical practice, such as joint replacement surgery, spine surgery, bone tumor surgery, arthroscopy and fracture fixation surgery, providing a new direction for minimally invasive, precise and personalized treatment of diseases in clinic. TiRobot, an orthopedic robotic system independently developed by China, has been widely used in spine and trauma orthopedic surgery. This article reviews the applications of TiRobot in fracture surgery and in remote surgery, and introduces the progress in application of TiRobot to assist treatments of spinal and cervical fractures, thoracolumbar fractures, pelvic and acetabular fractures, hip fractures, and hand and foot fractures.

Effect of One Year COVID-19 on Trauma of Lower Extremity at Orthopaedic Service in Prof Soeharso Orthopaedic Hospital, Indonesia: A Cross-sectional Study

@#Introduction: The World Health Organization announced the COVID-19 outbreak as a global pandemic on March 11, 2020. Despite the fact that orthopaedic departments are not considered first-line department in the war against pandemic, the pandemic has had a big effect on orthopaedic services. A few studies have found the pandemic effect on the orthopaedics field, but none have found the effect of a one-year pandemic, especially in Indonesia. This study aimed to know the effect of one-year COVID-19 on trauma of lower extremity at Orthopaedic Service in Prof Soeharso Top Referral Orthopaedic Hospital, Indonesia Materials and methods: It is a cross-sectional study. The study compared the population group during one year of the COVID-19 pandemic in Indonesia to the same period one year before. This study was conducted in Prof. Dr. R. Soeharso Orthopaedic Hospital, Surakarta, Indonesia from March 2019-February 2021. The subjects were patients of lower extremity trauma both surgical procedure and outpatient visit. Patients recorded on other orthopaedic service support installations like radiology, laboratory, or physiotherapy were excluded. Results: There was a significant reduction (54.9%) in total trauma of lower extremities patients in Prof Dr R Soeharso Orthopaedic Hospital, Surakarta, from 2146 (pre-COVID-19)to 968 (during COVID-19) in the March 2019-February2021 period. There was also a significant reduction (90.9%)in total cases outpatient visit in pre-COVID-19 compared toduring COVID-19 (p<0.05) and surgical procedures (39%)in pre-COVID-19 compare to the COVID-19 period(p<0.05). Conclusion: There was a significant reduction on trauma oflower extremities patients both outpatient visits and surgicalprocedures during pandemic COVID-19 than before the COVID-19 occurred.

Examination of a Regression Model to Quantify the Severities of Low Back Pain and Lower Limb Symptoms in Patients with Lumbar Spinal Stenosis / The Japanese Journal of Rehabilitation Medicine

Objective：The Japanese Orthopaedic Association Low Back Pain Evaluation Questionnaire (JOABPEQ) consists of 25 questions, which allows for the multifaceted evaluation of patients with low back pain. In this study, we aimed to investigate whether the JOABPEQ could be used to construct a regression model to quantify low back pain, lower limb symptoms, and hip range of motion (ROM) in patients with lumbar spinal stenosis.Methods：We evaluated 115 patients with lumbar spinal stenosis scheduled to undergo surgery at our hospital. We measured the degrees of low back pain, lower leg pain, and lower leg numbness using the visual analog scale before the surgery. In addition, we measured the ROM of the hip joint during flexion, external rotation, and internal rotation. All responses of the JOABPEQ and physical function data were subjected to a partial least-squares (PLS) regression analysis.Results：Low back pain, lower limb pain, lower limb numbness, and hip ROM during flexion could each be used for significant regression models with JOABPEQ items. However, the hip ROMs during external and internal rotation could not be used for regression models with the JOABPEQ.Conclusion：On the basis of the results of the PLS regression analysis in this study, the degree of pain symptoms in patients with lumbar spinal stenosis may be quantified with the JOABPEQ items. Furthermore, the flexion angle of the hip ROM was quantified using the JOABPEQ items. The results of this study may indicate an effective means for establishing treatment plans for physical therapy.

Explaining Osteomyelitis and Prosthetic Joint Infections (PJI) in terms of Biofilm – A Review

@#Osteomyelitis is a chronic infection of bones. Eradication of bone infection is usually with antibiotics and debridement, but it is slow and the infection can recur even after many years. It is now established that osteomyelitis is due to biofilm and a better understanding of the process is required. We review the development of biofilm and apply it to osteomyelitis management. The planktonic microbes' response to adverse conditions is the formation of biofilm. Bacterial infections in planktonic forms cause infections that can be controlled with antibiotics and immunisation, however the same microbe when its phenotype becomes biofilm is more resilient. The understanding of how planktonic bacteria convert to biofilm is one of the aims set out for this article.

Impact of COVID-19 on Clinical Practices during Lockdown: A pan India Survey of Orthopaedic Surgeons

@#Introduction: The social lockdown measures imposed to contain the COVID-19 pandemic, have had profound effects on the healthcare systems across the world and India has been no exception to it. The study was aimed to evaluate the impact of COVID-19 on orthopaedic practice in India during the lockdown period and assess the preparedness of orthopaedic surgeons for resuming clinical practice after the initial lockdown was lifted. Materials and Methods: An online survey of 35 questions was conducted to evaluate impact on (i) general orthopaedic practice (ii) hospital protocols (iii) out-patient practice (iv) surgical practice (v) personal protective equipment (PPE) use and (vi) post-lockdown preparedness. Results: A total number of 588 practising orthopaedic surgeons from India completed the survey. Majority (88.3%) found severe impact (>50%) on trauma surgery and nontrauma surgery with significant reduction in out -patient attendance compared to corresponding time in 2019. There were significant changes made in individual hospital protocols (91.7 %). Appropriate required PPE was available in majority of the hospitals (74.3%). No remodelling or upgrading of the existing operating theatre infrastructure was done by most surgeons (89.5%). Conclusion: This pan India survey of orthopaedic surgeons has indicated that COVID-19 has had a profound impact on their outpatient and surgical trauma and non-trauma practice, due to the lockdown and resulted in significant changes to hospital protocols. Preparedness to resume clinical and surgical practice was associated with anxiety in two-thirds of the respondents. Majority of the orthopaedic practitioners felt that they would continue to conduct pre-operative COVID-19 screening and use PPE even after the lockdown is over.

Examination of a Regression Model to Quantify the Severities of Low Back Pain and Lower Limb Symptoms in Patients with Lumbar Spinal Stenosis / The Japanese Journal of Rehabilitation Medicine

Objective：The Japanese Orthopaedic Association Low Back Pain Evaluation Questionnaire (JOABPEQ) consists of 25 questions, which allows for the multifaceted evaluation of patients with low back pain. In this study, we aimed to investigate whether the JOABPEQ could be used to construct a regression model to quantify low back pain, lower limb symptoms, and hip range of motion (ROM) in patients with lumbar spinal stenosis.Methods：We evaluated 115 patients with lumbar spinal stenosis scheduled to undergo surgery at our hospital. We measured the degrees of low back pain, lower leg pain, and lower leg numbness using the visual analog scale before the surgery. In addition, we measured the ROM of the hip joint during flexion, external rotation, and internal rotation. All responses of the JOABPEQ and physical function data were subjected to a partial least-squares (PLS) regression analysis.Results：Low back pain, lower limb pain, lower limb numbness, and hip ROM during flexion could each be used for significant regression models with JOABPEQ items. However, the hip ROMs during external and internal rotation could not be used for regression models with the JOABPEQ.Conclusion：On the basis of the results of the PLS regression analysis in this study, the degree of pain symptoms in patients with lumbar spinal stenosis may be quantified with the JOABPEQ items. Furthermore, the flexion angle of the hip ROM was quantified using the JOABPEQ items. The results of this study may indicate an effective means for establishing treatment plans for physical therapy.

Evaluation of Role of Tranexamic Acid in Reducing Blood Loss and Transfusion Rate in Patients Undergoing Lower Limb Orthopaedic Surgeries.

Major surgeries like hip arthroplasty, knee arthroplasty etc.; are associated with excessive bleeding. Uncontrolled bleeding can lead to increased morbidity and mortality and may necessitate blood transfusions. This prospective, randomized study was designed to evaluate the efficacy and safety of injection tranexamic acid in reducing blood loss and rate of blood transfusion in lower limb orthopaedic surgeries without tourniquet under subarachnoid block.METHODSAfter approval from institutional ethical committee, the study was carried out on 80 patients who were divided into two groups of 40 patients each. Patients in group T received a bolus dose of 10 mg/Kg injection tranexamic acid 10 minutes before induction of anaesthesia and patients in group C received 0.9% 10 ml normal saline. Intraoperative and postoperative blood loss were recorded and added together for total blood loss. Postoperative haemoglobin and haematocrit were evaluated 24 hrs. after surgery. The number of patients who received blood transfusion and the number of units of blood transfused postoperatively were recorded. Early adverse reactions of tranexamic acid were recorded and treated. p<0.05 was considered significant.RESULTSMean intraoperative blood loss in group C (489.75+123.63 ml) was more than group T (450 + 138.66 ml) (p> 0.05). Postoperative blood loss was significantly less in group T (163.67 ± 44.13 ml) as compared to group C (205.43 ± 63.31 ml) (p<0.05). The mean total blood loss was significantly less in group T (613.67 ± 167.40 ml) as compared to group C (695.2 ± 162.44 ml) (p< 0.05). The drop in postoperative haemoglobin and haematocrit was significantly higher in group C as compared to group T (p < 0.0001). Significantly higher number of patients in group C (15) received postoperative blood transfusion as compared to group T (7) (p< 0.05). Acute adverse effects of tranexamic acid and complication of blood transfusion were not seen.CONCLUSIONSInjection tranexamic acid in a bolus dose of 10 mg/Kg is an effective and safe strategy to reduce blood loss and to minimise the rate of blood transfusions in lower limb orthopaedic surgeries without tourniquet under spinal anaesthesia.

Application of Achilles Tendon Total Rupture Score in Acute Achilles Tendon Rupture / 中国康复理论与实践

Objective:To explore the validity of Achilles Tendon Total Rupture Score (ATRS) for rehabilitation after Achilles tendon rupture. Methods:From January, 2012 to December, 2016, 50 patients with acute Achilles tendon rupture were enrolled. The original table of ATRS was translated, organized and evaluated to obtain the ATRS consensus version. At the 1st month, 2nd month, 3rd month, 6th month and 12th month follow-up, the scores of American Orthopaedic Foot and Ankle Society Ankle-hindfoot scale (AOFAS-AH) and ATRS were recorded. Results:Three patients were dropped out. The scores of both AOFAS-AH and ATRS increased with time, and gradually became flat. The total score of AOFAS-AH was significantly positively correlated with the total score of ATRS (ρ = 0.961, P < 0.001). Conclusion:ATRS can be used in evaluating the functional recovery of Achilles tendon repair.