ABSTRACT
PURPOSE: To compare and analyze the rate of prevention of two venous thromboembolism prophylaxis guidelines in patients with artificial joint arthroplasty and hip joint fracture. Proper prophylaxis for preventing thromboembolism in orthopedic surgery is significant because of this fetal complication. MATERIALS AND METHODS: This study compared and retrospective analyzed the rate of prevention using the medical records and radiographs of patients who underwent orthopedic surgery from March 2009 to February 2011 according to the American College of Chest Physicians (ACCP) guidelines and from March 2012 to February 2014 according to the American Academy of Orthopedic Surgeons (AAOS) guidelines. RESULTS: The guidelines for venous thromboembolism prophylaxis have been applied to patients with artificial joint replacement and hip joint fracture, the compliance rate of the ACCP guidelines was 56.0% before surgery, 67.0% after surgery with chemical prophylaxis, and 80.5% with mechanical prophylaxis. In addition, the compliance rate of the AAOS guidelines was 74.1% with chemical prophylaxis, and 88.3% with mechanical prophylaxis, which was higher than the ACCP guidelines. The compliance rates of mechanical and chemical prophylaxis before and after surgery of the ACCP guidelines, and the compliance rate of mechanical and chemical prophylaxis of the AAOS guidelines were compared and analyzed. The results revealed statistical significance (p<0.05) before and after total knee replacement arthroplasty and hip joint fracture internal fixation and total high risk orthopedic surgery. CONCLUSION: Raising the compliance rate of prophylaxis of venous thromboembolism in high risk orthopedic surgery is necessary and people should follow the guidelines for a unified direction depending on which situation they are in.
Subject(s)
Humans , Arthroplasty , Arthroplasty, Replacement, Knee , Compliance , Hip Joint , Joints , Medical Records , Orthopedic Procedures , Orthopedics , Retrospective Studies , Surgeons , Thorax , Thromboembolism , Venous ThromboembolismABSTRACT
American Society of Anesthesiologists (ASA) physical status Ⅰ or Ⅱ patients,aged 11-18 yr,scheduled for elective posterior orthopedic surgery for adolescent idiopathic scoliosis from November 2011 to October 2015 in our hospital,were selected,and a total of 834 patients were included in the study.Data including age,gender,body height,body weight,Cobb angles,ASA physical status,osteotomy procedure,use of dexmedetomidine,the number of operation segments,duration of operation,intraoperative blood loss,volume of blood transfused and volume of fluid infused,volume of postoperative drainage and length of postoperative hospital stay were recorded.The patients were divided into dexmedetomidine group (group D,n =508) and non-dexmedetomidine group (group ND,n =326) depending on whether or not dexmedetomidine was used.Age,gender,body mass index,Cobb angles,ASA physical status,the number of operation segments,duration of operation,osteotomy procedure and use of dexmedetomidine were served as independent variables and analyzed using Stepwise multivariate linear regression.The results of Stepwise multivariate linear regression showed that osteotomy procedures,the number of operation segments,duration of operation and Cobb angles were positively correlated with intraoperative blood loss,and use of dexmedetomidine and body mass index were negatively correlated with intraoperative blood loss.Compared with group ND,the intraoperative blood loss,volume of crystalloid solution infused,volume of blood transfused and volume of postoperative drainage were significantly reduced in group D (P＜0.05).After a propensity score matching analysis,the intraoperative blood loss and volume of crystalloid solution infused were significantly reduced in group ND when compared with group D (P＜0.05).In conclusion,intraoperative use of dexmedetomidine is helpful in reducing intraoperative blood loss during orthopedic surgery for adolescent idiopathic scoliosis.
ABSTRACT
Objective To introduce calcaneal osteotomy without subtalar fusion for calcaneal malunion and to discuss its indications, advantages and disadvantages. Methods From November 1998 to May 2003, 24 cases with 26 calcaneal malunion for 1 to 9 months were treated by calcaneal osteotomy without subtalar fusion. The average age was 32.6 years (range, 28 to 42 years). All patients underwent radiography including plain, axial and lateral views for calcaneus, oblique view for foot and three-dimensional CT imaging reconstruction. According to Sanders classification, 13 cases were of type Ⅱ(9Ⅱb, 4Ⅱc), 13 of type Ⅲ(8 Ⅲac, 5 Ⅲbc). Through the modified lateral L-shaped approach, the protruding lateral wall of calcaneus was resected and the posterior subtalar facet was reduced by elevating the fragment of the posterior subtalar facet upwards and backwards. The defect of calcaneus was filled with bone autografts. Iliac crest bone graft was used in 19 feet and the bone graft resected from the extruding lateral wall of calcaneus in 7 feet. The calcaneus was fixed with plate and screw. Results 21 feet were followed up for an average of 14.5 months (range, 9 to 22 months). No complications such as wound infection, screw breakage and calcaneum varus were found postoperatively. The average time for bone healing was 11.2 weeks (range, 10.5 to 13.3 weeks). The postoperative functional evaluation by Maryland foot score system revealed excellent result in 8 feet, good in 10, fair in 3. The rate of excellent to good results was 86%. Plain radiographs showed the nearly complete restoration of Bhler angle, Gissane angle, talus inclining angle, calcaneal width and height of the calcaneal thalamus. Conclusion Calcaneal osteotomy without subtalar fusion is an effective method for calcaneal malunion with advantages of correcting deformity markedly, restoring the function and the outer aspect of hindfoot satisfactorily.
ABSTRACT
Objective To investigate the surgical treatment of congenital vertical talus (CVT). Methods Ten feet in six patients (4 girls and 2 boys) with CVT were reviewed. Four of the feet were associated with neuromuscular disorders(Ⅱ), five with malformation syndromes. one foot was idiopathic. The age at surgery ranged from 13 to 39 months with an average of 16.5 months. All were operated with a single-stage soft tissue procedures by using double of posterior and dorsal incisions. Elongation of tendo Achillis and capsulotomy of the ankle and subtalar joints were performed through a straight posterior incision. The dorsal approach was made over the anterior inferior ankle crease from the tip of fibula to talonavicular joint laterally. The extensor digitorum longus and peroneal tendons were lengthened, whereas the peroneus tertius was always tenotomized. The calcaneocuboid capsule, subtalar capsule, and talonavicular capsule also were released. The tibilis anterior tendon was placed through a drill hole in the neck of the talus. One K-wire was passed through the navicular and then retrograde across the talonavicular joint to maintain the reduced position. The other K-wire drove from the heel pad across the subtalar joint. A cast was applied with the ankle in slight plantarflexion for 3 months. Then special shoe was applied for 12 months. Results Six cases (10 feet) were available for follow-up from 6 to 33 months (mean, 23.1 months). The postoperative clinical outcome was evaluated by using a version of Adalaar score. All patients got good cosmetic appearance of the feet and the medial longitudinal arch of feet, had no prominent talar head, and had no the ankle and subtalar motion loss. The presence of mild hindfoot valgus on weight-bearing was noted in only two feet. Seven of ten feet were wearing special shoes. Radiographically, two parameters-talar and calcaneal axis-first metatarsal base angles (TAMBA and CAMBA) were measured from the lateral view of the feet. Preoperative and final follow-up radiographs were obtained. None had avascular necrosis of the talus. TAMBA changed from 66?(range, 50?-98?) to 1.6?(range, -11?-16?), CAMBA changed from 26.1?(range, 14?-60?) to -5.45?(range, -13?-3?). Conclusion Operative reduction has been advocated as the only effective treatment for CVT. It is the best choice to use a single-stage soft tissue surgery for infants with CVT. It is concluded that the results of this procedure are satisfactory.