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BACKGROUND: Previous studies on the clinical efficacy of total knee arthroplasty in the treatment of rheumatoid arthritis have been reported, but the effects of total knee arthroplasty on joint function and related biochemical parameters in patients with rheumatoid arthritis are little reported. Thereafter, more clinical evidence is needed. OBJECTIVE: To analyze the effect of total knee arthroplasty on joint function and related biochemical indicators in patients with rheumatoid arthritis. METHODS: Clinical data of 64 patients with 64 knees who underwent total knee arthroplasty were retrospectively analyzed. Comparative analysis of Hospital for Special Surgery, range of motion of the knee joint and quality of life scores before and 1 year after surgery was conducted. Changes of biochemical indicators such as C-reactive protein, rheumatoid factor and erythrocyte sedimentation rate were detected. The incidence of complications at 1 month after surgery was recorded. The study was approved by the Ethical Committee of Changzhou Traditional Chinese Medicine Hospital, and all patients signed the informed consents. RESULTS AND CONCLUSION: (1) Compared with the baseline levels, the Hospital for Special Surgery score, range of motion of the knee joint and quality of life scores at 1 year after surgery was significantly increased (P < 0.01), and the levels of C-reactive protein, rheumatoid factor and erythrocyte sedimentation rate were significantly decreased (P < 0.01). (2) One patient developed infection and two patients developed deep vein thrombosis of the lower extremity, which was relieved after symptomatic treatment. These results imply that total knee arthroplasty has a good clinical effect on rheumatoid arthritis, which can improve knee function and reduce the levels of C-reactive protein, rheumatoid factor and erythrocyte sedimentation rate, and has good safety.
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Objective: To analyze the early clinical effects of acute deep venous thrombosis (DVT) of the lower extremities through a contralateral femoral vein approach by percutaneous mechanical thrombectomy (PMT) combined with catheter-directed thrombolysis (CDT) therapy. Methods: A retrospective analysis about 45 patients (from September 2016 to August 2017) was conducted to analyze the success rate of the technique, the degree of thrombolysis in different venous segments, and the incidence of complications during the treatment of PMT+CDT. Results: Technique successful rate was 100%. 86.7% of lower extremity thrombosis (LET) segments (calf veins), 82.2% of LET Ⅱ segments (femoral and popliteal veins) and 71.1% of LET III segments (common iliac and femoral veins) were completely dissolved. No serious complications occurred. Conclusion: It is feasible, safe and effective to use PMT+CDT in acute DVT.
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BACKGROUND@#The Previous study has indicated that the incidence of venous thromboembolism (VTE) after lung cancer surgery is not uncommon. The aim of this study is to analyze the risk factors of postoperative VTE in lung cancer patients and provide a clinical basis for further prevention and treatment of VTE.@*METHODS@#This study was a single-center study. From July 2016 to December 2017, all patients with lung cancer who underwent surgery in our department were enrolled into this study. Except routine preoperative examinations, lower extremity Doppler ultrasound was performed in all patients before and after surgery to determine whether there was any newly developed deep venous thrombosis (DVT). Patients did not receive any prophylactic anticoagulant therapy before and after surgery. Patients were then divided into VTE group and control group according to whether VTE occurred after operation. Baseline data, surgical related data (surgery type, surgical procedure, etc.) and tumor pathological data (pathological type, vascular infiltration, pathological staging, etc.) were compared between the two groups.@*RESULTS@#According to the inclusion criteria, a total of 339 patients undergoing lung cancer surgery were analyzed. There were 166 males and 173 females with an age range of 23-86 years. A total of 39 patients developed VTE after surgery, the incidence rate of postoperative VTE was 11.5%. Comparing the age, gender, body mass index (BMI), American Society of Anesthesiologists (ASA), smoking status, underlying diseases, etc, there were no significant differences in other indicators except for significant differences in age; comparison between preoperative blood routine, blood biochemistry, coagulation, tumor markers, lung function, lower extremity venous ultrasound, preoperative carcinoembryonic antigen (CEA) levels, preoperative D-dimer levels, there were significant differences in lung function and lower extremity intermuscular vein expansion ratio. There were no significant differences in other indexes between the two groups. The duration of surgery, surgical procedure, bleeding volume, pathological type, pathological stage, vascular invasion, were compared between the two groups. There were statistical differences in surgical methods (thoracic vs thoracoscopic) and bleeding volume. There were no significant differences in other indicators. Univariate analysis showed that age, preoperative CEA level, preoperative D-dimer level, poor pulmonary function, lower extremity intermuscular vein dilation ratio, thoracotomy rate, length of surgery, and amount of bleeding were significantly risk factors (P<0.05). There were no significant correlations between pathological stage and pathological type and VTE. Multivariate logistic regression analysis showed that forced expiratory volume in one second (FEV1), surgical approach, and lower extremity intermuscular vein dilatation were independent risk factors for postoperative VTE in patients with lung cancer (P<0.05).@*CONCLUSIONS@#The results of this study suggest that FEV1, surgical procedures, and lower extremity intermuscular vein dilation are independent risk factors for postoperative VTE in patients with lung cancer.
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Aged , Female , Humans , Male , Middle Aged , Lung Neoplasms , General Surgery , Multivariate Analysis , Postoperative Complications , Risk Factors , Venous ThromboembolismABSTRACT
Objective To investigate the clinical efficacy and safety of reteplase(rPA)adminis-tration in treating acute deep venous thrombosis(ADVT)of lower extremity.Methods A total of 1 87 pa-tients with ADVT were randomly divided into two groups,with 85 patients in rapid intravenous dripping group and 1 02 patients in 24-hour venouspumping group.Their effects on limb swelling,thrombolysis,and complicationswere compared for analysis.Results The differences in the curative effectsof reducingswell-ingand thrombolysis effect between the two groups werenot significant(P >0.05).Thethrombolysis time in the 24-hour venouspumping group was shorter than that of the rapid intravenous dripping group [(4.76 ± 1 .56)days vs(6.56 ±0.83)days,P <0.05],indicating 24-hour venouspumping was more effective than rapid intravenous dripping.Complication incidence in the 24-hour venouspumping group was less than that of the rapid intravenous dripping group(3.90% vs 1 7.6%,P <0.05).Conclusion rPA is a goodvenous thrombolytic agentwith rapid effect in treating ADVT.The 24-hour venouspumping was more effective and safe than the rapid intravenous dripping.
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Objective To investigate the effect of intermittent pneumatic pressure pump on the formation of deep venous thrombosis of lower extremity in elderly patients undergoing thoracotomy. Methods Fifty patients undergoing thoracic surgery were managed with intermittent pressure inflation pump besides general preventive measures. The pre-and postoperative blood flow in the lower extremity and incidences of deep venous thrombosis were compared. Result The differences in blood flow in the lower extremity and incidences of deep venous thrombosis were not statistically significant (P>0.05). Conclusion Intermittent pneumatic pressure pump can promote pulsatile blood flow in the lower extremity so as to effectively prevent formation of deep venous thrombosis in elderly patients after thoracotomy.
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Objective To investigate the therapeutic efficacy of Aegisy retrievable filter in inferior vena cava interventional treatment for acute deep venous thrombosis of lower extremity. Methods Acute or sub acute unilateral lower extremity deep vein thrombosis ( deep vein thrombosis, DVT) patients in our hospital were selected, and Aegisy filter was put into the inferior vena cava through the femoral, and thrombolytic therapy was carried out in the next day. Limb conditions was observation after 10 to 15 days, confirmed by vascular ultrasound and angiography of lower limb vein after no fresh or free thrombus. The filter was removed with protector, anticoagulant therapy after review the venography of lower limb postoperative. Results All Aegisy filter were put into patients, and there were no obvious forward jumping and drawing back occurred during the release of the filters, and all Aegisy filter had a better position. Placement of a filter everage time was (16. 8 ± 1. 3) days, 89 cases were successfully recovery filter. The effct of Aegisy filter on the patients with lower extremity deep venous thrombosis after treatment is obvious effect, no pain, and no symptom of pulmonary embolism. Conclusion Aegisy retrievable inferior vena cava filter has many advantages in clinical use. The filter can be placed to the scheduled position accurately,and it is very powerful in captu-ring the thrombus,it can be hold in the inferior vona cava for long time before it is planed to be retrieved,and its retrieval success is very high. Moreover,with high technieal successful rate the implantation of Aegisy retrievable inferior vena cava filter is very safe and effective for the interventional treatment of acute deep venous thrombosis of lower extremity.
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Objective To discuss the optimal retrieval time of the indwelling Gunther Tulip and Cook Celcet inferior vena cava filters (VCF). Methods During the period from March 2013 to April 2015 at Shengli Oilfield Central Hospital, the implantation of retrievable inferior vena cava filter was performed in 58 patients. Among the 58 patients, Gunther Tulip VCF was used in 13 and Cook Celcet VCF was employed in 31. Twenty-one patients followed the doctor's advice to receive retrieval procedure of VCF within three months after the implantation. Results Among the 21 patients, successful retrieval of VCF was obtained in 19. The mean indwelling time of Gunther Tulip VCF was 54.4 days, the longest time being 79.0 days. Gunther Tulip VCF was successfully removed in 3 patients and retrieval of VCF failed in 2 patients, with a retrieval success rate of 60%. The mean indwelling time of Cook Celcet VCF was 37.6 days, the longest time being 67.0 days. Cook Celcet VCF was successfully removed in 16 patients, with the success rate of retrieval being 100%. Conclusion Despite many VCFs that have been indwelled for a long time can be safely retrieved, retrieval procedure should be performed as early as possible in order to improve the retrieval success rate of VCF. It seems that the use of Cook Celcet VCF is a better choice although it is more expensive.