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Objective:To investigate the efficacy of a proximal femoral locking plate (LPFP) versus a proximal femoral anti-rotation intramedullary nail (PFNA) in the treatment of femoral intertrochanteric fractures in older adult patients. Methods:A total of 130 older adult patients with femoral intertrochanteric fractures who received treatment in Linghu People's Hospital of Huzhou from May 2017 to June 2020 were included in this study. They were randomly assigned to undergo treatment with either a PFNA (observation group, n = 65) or an LPFP (control group, n = 65). Intraoperative blood loss, incision length, operative time, and time to fracture healing were determined in each group. At 1, 3, and 6 months after surgery, the Harris hip score was used to evaluate hip joint recovery. Coxa vara, incision infection, and internal fixation loosening were compared between the two groups. Results:Intraoperative blood loss in the observation group was less than that in the control group [(189.26 ± 48.15) mL vs. (96.47 ± 40.21) mL, t = -11.93, P < 0.001]. Incision length, operative time, and time to fracture healing in the observation group were significantly shorter than those in the control group [(4.03 ± 1.48) cm vs. (12.16 ± 1.55) cm, (72.13 ± 28.75) minutes vs. (120.34 ± 29.01) minutes, (9.89 ± 1.52) weeks vs. (13.63 ± 1.74) weeks, t = -30.59, -9.52, -13.05, all P < 0.001]. At 1 month after surgery, there was no significant difference in Harris hip score between the two groups ( t = 1.28, P > 0.05). At 3 and 6 months after surgery, the Harris hip score gradually increased in the control and observation groups ( F = 13.44, 8.26, both P < 0.001). At 3 and 6 months after surgery, Harris hip scores in the observation group were significantly higher than those in the control group [(85.17 ± 4.29) points vs. (79.50 ± 4.12) points, (95.30 ± 1.04) points vs. (87.69 ± 1.25) points, t = 7.69, 37.73, both P < 0.001]. The incidence of complications in the observation group was significantly lower than that in the control group [1.54% (1/65) vs. 10.77% (7/65), χ2 = 4.80, P = 0.029). Conclusion:Compared with LPFP, PFNA can effectively reduce intraoperative blood loss in older adult patients with femoral intertrochanteric fractures, accelerate the progress of fracture healing, promote the recovery of the hip joint, and has fewer complications. Therefore, PFNA is worthy of popularization.
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【Objective】 To explore the causes of hypothermia in patients undergoing transurethral thulium laser prostatectomy. 【Methods】 A total of 170 patients who underwent transurethral thulium laser prostatectomy in our hospital during Sep.2020 and May 2021 were prospectively enrolled in the study. The patients were divided into normal body temperature group (n=143) and hypothermia group (n=27), based on whether perioperative hypothermia happened. The clinical data were analyzed to evaluate the risk factors of hypothermia. 【Results】 Univariate analysis showed that there were statistical differences in anesthesia time, operation time, prostate size and total amount of perfusion fluid between the two groups (P<0.05). Logistic analysis showed that the size of prostate was the independent risk factor of perioperative hypothermia (P<0.05). Patients were further divided according to prostate size. For patients with prostate < 80 g, the size of prostate was the independent risk factor of perioperative hypothermia (P<0.05), while for patients with prostate ≥ 80 g, the amount of perfusion fluid was the independent risk factor (P<0.05). 【Conclusion】 Perioperative hypothermia in patients undergoing transurethral thulium laser prostatectomy is related to the anesthesia time, operation time, prostate size and total amount of perfusion fluid. It is necessary to evaluate the risk factors before operation and take effective thermal insulation measures.
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【Objective】 To investigate the safety and efficacy of flexible vacuum aspiration ureteral access sheath in ureteroscopic lithotripsy in the treatment of renal and upper ureteral calculi. 【Methods】 Clinical data of 41 cases treated in our hospital were retrospectively analyzed, including 20 cases treated with flexible vacuum aspiration ureteral access sheath (experimental group), and 21 cases treated with traditional ureteral access sheath (control group). The stone-clearance rate, operation time, postoperative fever (T>37.5 ℃), length of hospital stay and hospitalization costs were compared between the two groups. 【Results】 All operations were successful. The experimental group had significantly shorter operation time than the control group [(54.0±19.8) min vs. (76.6±20.1) min, P0.05). 【Conclusion】 Flexible vacuum aspiration ureteral access sheath in flexible ureteroscopic lithotripsy can shorten the operation time, improve stone-clearance rate and reduce incidence of postoperative fever, which is worth promoting.
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Objective:To investigate the effect of timing of rib internal fixation on early curative effect of patients with severe rib fracture complicated with respiratory failure.Methods:A retrospective cohort study was conducted on clinical data of 33 patients with multiple rib fracture complicated with respiratory failure admitted to 909th Hospital of Joint Logistics Support Force (Affiliated Dongnan Hospital of Xiamen University Medical College) from January 2018 to October 2019.There were 26 males and 7 females; aged 60-87 years [(67.9±6.7)years]. The time interval from injury to open reduction and internal fixation was within 3 days in 16 patients (early operation group) and over 3 days in 17 patients (later operation group). The number of fixed ribs, operation time, duration of mechanical ventilation, length of ICU stay, chest tube indwelling time and lenghth of hospital stay were compared in the two groups. The numeric rating scale (NRS) pain score was assessed at postoperative 1, 3 and 7 days. Postoperative complications were detected as well.Results:All patients were followed up for 8-24 months [(16.5±4.3)months]. Number of fixed ribs was not statistically different between the two groups ( P>0.05). The operation time, duration of mechanical ventilation, length of ICU stay, chest tube indwelling time and length of hospital stay in early operation group [(67.3±11.2)minutes, (103.9±28.2)hours, (5.2±1.9)days, (6.4±2.8)days, (12.5±3.5)days] were shorter than those in late operation group [(108.4±18.4)minutes, (160.8±89.3)hours, (10.1±2.3)days, (9.5±2.2)days, (18.0±4.5)days] ( P<0.05 or 0.01). The NRS score was (6.6±0.6)points, (3.3±0.6)points and (2.7±0.8)points in early operation group at postoperative 1, 3 and 7 days, significantly lower than those in late operation group [(7.4±1.1)points, (4.9±1.1)points, (3.9±0.7)points] ( P<0.05 or 0.01). The total complication rate was 25.0%(4/16) in early operation group, lower than 70.6%(12/17) in late operation group ( P<0.05). Conclusion:For severe rib fracture complicated with respiratory failure, early open reduction and internal fixation can effectively reduce operation time, duration of mechanical ventilation, lenghth of ICU stay, chest tube indwelling time and lenghth of hospital stay, early relieve pain and decrease complications rate when compared with late operation.
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Abstract Introduction Anxiety and pain levels of septoplasty patients may vary according to intraday operation time. Objective To investigate the effects of septoplasty operation and intraday operation time on anxiety and postoperative pain. Methods Ninety-eight voluntary patients filled out the hospital anxiety and depression scale to measure the anxiety level three weeks before, one hour before and one week after surgery. Forty-nine patients were operated at 8:00 am (morning group); other 49 were operated at 03:00 pm (afternoon group). We used a visual analogue scale to measure postoperative pain. Preoperative and postoperative scores were compared, as were the scores of the groups. Results Median hospital anxiety and depression scale scores one hour before the operation [6 (2-10)] were significantly higher compared to the median scores three weeks before the operation [3 (1-6)] (p < 0.001), and one week after the operation [2 (1-6)] were significantly lower compared to the median scores three weeks before the operation [3 (1-6)] (p < 0.001). Hospital anxiety and depression scale scores one hour before the operation were significantly greater in the afternoon group [8 (7-10)], compared to the morning group [4 (2-6)] (p < 0.001). Postoperative first, sixth, twelfth and twenty-fourth-hour pain visual analogue scale scores were significantly higher in the afternoon group compared to the morning group (p < 0.001). Conclusion Septoplasty might have an increasing effect on short-term anxiety and postoperative pain. Performing this operation at a late hour in the day might further increase anxiety and pain. However, the latter has no long-term effect on anxiety.
Resumo Introdução Os níveis de ansiedade e dor em pacientes submetidos à septoplastia podem variar de acordo com o tempo de cirurgia intradia. Objetivo Investigar os efeitos da cirurgia de septoplastia e do tempo de cirurgia intradia na ansiedade e dor pós-operatória. Métodos Noventa e oito pacientes voluntários preencheram a Hospital Anxiety and Depression Scale (HADS) para medir o nível de ansiedade três semanas antes, uma hora antes e uma semana após a cirurgia. Quarenta e nove pacientes foram operados às 8h (grupo da manhã) e 49 foram operados às 15h (grupo da tarde). Usamos a Escala Visual Analógica para medir a dor pós-operatória. Os escores pré e pós-operatórios foram comparados, assim como os escores dos grupos. Resultados As medianas dos escores da HADS uma hora antes da operação [6 (2-10)] foram significativamente mais altas em comparação com as medianas dos escores da HADS três semanas antes da operação [3 (1-6)] (p < 0,001) e as medianas dos escores da HADS uma semana após a operação [2 (1-6)] foram significativamente mais baixas em comparação com as medianas dos escores três semanas antes da operação [3 (1-6)] (p < 0,001). Os escores da HADS uma hora antes da operação foram significativamente mais altos no grupo da tarde [8 (7-10)], em comparação ao grupo da manhã [4 (2-6)] (p < 0,001). Os escores da EVA para dor na primeira, sexta, 12ª segunda e 24ª hora do pós-operatório foram significativamente mais altos no grupo da tarde em comparação com o grupo da manhã (p < 0,001). Conclusão A septoplastia pode ter um efeito crescente sobre a ansiedade em curto prazo e na dor pós-operatória e a feitura dessa cirurgia em hora mais tardia pode aumentar ainda mais a ansiedade e a dor. No entanto, isso não tem efeito em longo prazo na ansiedade.
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Humans , Rhinoplasty/adverse effects , Anxiety/etiology , Pain, Postoperative/etiology , Pain Measurement , Prospective StudiesABSTRACT
Objective:To investigate the effects of sentinel lymph node biopsy utilization on operative time, intraoperative blood loss and extubation time.Methods:Sixty-two patients with breast cancer who received treatment in the First Hospital of China Medical University from January to December 2019 were included in this study. They were randomly assigned to receive either conventional breast cancer surgery (control group, n = 31) or sentinel lymph node biopsy combined with breast cancer surgery (study group, n = 31). Extubation time, operative time, intraoperative blood loss, drainage volume, breast cosmetic effect, upper limb function and complications were compared between the two groups. Results:Extubation time and operative time in the study group were (16.3 ± 1.1) hours and (61.6 ± 11.3) minutes, respectively, and they were (28.2 ± 6.4) hours and (124.2 ± 28.5) minutes, respectively in the control group. There were significant differences in extubation time and operative time between the two groups ( t = 14.922 and 16.479, both P < 0.05). Intraoperative blood loss and postoperative drainage volume in the study group were (68.7 ± 17.9) mL and (105.9 ± 19.5) mL respectively, and they were (122.4 ± 23.1) mL and (257.2 ± 36.4) mL respectively in the control group. There were significant different differences in intraoperative blood loss and postoperative drainage volume between the two groups ( t = 15.928 and 18.797, both P < 0.05). The excellent and good rate of breast cosmetic effect in the study group was significantly higher than that in the control group (93.6% vs. 83.8% , χ2 = 5.584, P < 0.05). After treatment, the difference in the upper arm circumference between the healthy and affected sides, and shoulder abduction and shoulder function score in the study group were (0.5 ± 0.1) cm, (123.7 ± 6.6) ° and (75.9 ± 4.9) points respectively, and they were (0.7 ± 0.1) cm, (120.1 ± 6.1) °, (73.5 ± 4.4) points, respectively in the control group. There were significant differences in these indices between the two groups ( t = 11.432, 12.450, 12.647, all P < 0.05). The incidence of complications in the study group was significantly lower than that in the control group (12.9% vs. 38.8%, χ2 = 6.309, P < 0.05). Conclusion:Sentinel lymph node biopsy can help improve therapeutic effects, shorten the operative time, reduce the amount of intraoperative bleeding, shorten the extubation time, and reduce the incidence of complications in breast cancer patients.
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Objective:To investigate the success rate, operation time and complications of ultrasound combined with X-ray-guided precise implantation of totally implantable access port (TIAP) in the chest wall.Methods:A total of 623 patients who underwent implantation of totally implantable venous access ports in the chest wall in Meizhou People's Hospital, China between January 2015 and August 2018 were included in this study. In group A ( n = 320), jugular or subclavian access ports were precisely implanted in the chest wall under the guidance of ultrasound combined with X-ray. During the surgery, color Doppler ultrasound was used to guide the puncture and a C-arm machine was used to locate the position of catheter tip. In group B ( n = 303), venous access ports were implanted using the conventional method. Subclavian vein puncture was performed using anatomic landmarks and the depth of catheterization was estimated by experience. The success rate of the first implantation, operation time, and complications (pneumothorax, hemothorax, catheter displacement, poor position of catheter tip, skin infection, and thrombosis) were compared between the two groups. Results:There were no statistical differences in baseline data between the two groups ( P > 0.05). The success rate of the first implantation in the group A was significantly higher than that in the group B [100% (320/320) vs. 93.06% (282/303), χ2 = 22.95, P < 0.01]. The operation time in the group A was significantly shorter than that in the group B [(26.48 ± 5.49) minutes vs. (35.51 ± 14.37) minutes, t = -10.25, P < 0.01]. In group A, 2 patients developed pneumothorax and healed after conservative treatment, 6 patients had thrombosis, and the incidence of complications was 2.5% (8/320). In group B, complications occurred in 67 patients, including pneumothorax in 9 patients, poor catheter tip position in 17 patients, thrombosis in 36 patients, and skin infection in 1 patient, and the incidence of complications was 22.11% (67/303). There was significant difference in the incidence of complications between the two groups ( χ2 = 56.53, P < 0.01). In group B, 6 out of 9 patients developing pneumothorax were healed after closed thoracic drainage, and 4 patients underwent a secondary surgery because of catheter displacement into the internal jugular vein. Conclusion:Precise implantation of venous access ports in the chest wall guided by ultrasound combined with X-ray has the advantages including 100% success rate of first precise implantation, few complications, short operation time, high comfort, safety and efficacy.
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Objective:To explore the optimal surgical time of laparoscopic appendectomy after conservative treatment of appendiceal abscess in children.Methods:Clinical data of 86 children with appendiceal abscess diagnosed in the Department of General Surgery, Wuhan Children′s Hospital, Tongji Medical College, Huazhong University of Science and Technology from January 2016 to June 2020 were retrospectively analyzed.According to the delayed laparoscopic appendectomy interval after the appendiceal abscess was cured, 86 children were divided into group A, B and C. Briefly, patients in the 3 groups were treated with laparoscopic appendectomy 4 weeks, 8 weeks and over 12 weeks after the appendiceal abscess was cured, respectively.Children with recurrent appendicitis during delayed operation were not included.The incidence of appendicitis recurrence during delayed operation, the incidences of intraoperative complications, conversion to laparotomy, and postoperative complications, operation time, the time of postoperative intestinal function recovery, and postoperative hospital stay were compared among 3 groups.Results:There were 10, 31 and 45 cases in group A, B and C, respectively.Among them 10, 30 and 39 patients received laparoscopic appendectomy, and 0, 1 and 6 cases had appendicitis recurrence in group A, B and C, respectively.There were no significant differences in the age, gender, diameter of appendiceal abscess, inflammatory indexes at diagnosis of diagnosing appendiceal abscess, cure time of conservative treatment of abscess, and inflammatory indexes at laparoscopic appendectomy among the 3 groups (all P>0.05). The incidence of appendicitis recurrence in group C(13.33%) was significantly higher than that in group A (0) and group B (3.22%)( P<0.05). There was no significant difference in the incidence of appendicitis recurrence between group A and group B( P>0.05). The incidences of intraoperative(group A, B, C was 40.00%, 10.00%, 10.26%, respectively) and postoperative complications (group A, B, C was 40.00%, 6.70%, 5.10%, respectively), and conversion to laparotomy(group A, B, C was 20.00%, 0, 0), operation time [group A, B, C was (106.70±7.42) d, 41.40±10.44) d, (39.60±11.27) d, respectively], postoperative intestinal function recovery time [group A, B, C was(5.80±2.15) d, (0.93±0.17) d, (0.83±0.11) d], and postoperative hospital stay[group A, B, C was(12.40±4.15) d, (1.67±0.31) d, (1.58±0.44) d] in group A were significantly higher than those in group B and group C(all P<0.05), but no significant differences were found between group B and group C(all P>0.05). Conclusions:Eight weeks are the best time for laparoscopic appendectomy after conservative treatment of appendiceal abscess in children.
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Objective To investigate the risk factors and clinical prognosis of massive blood transfusion during the perioperative period of lung transplantation. Methods Clinical data of 159 lung transplant recipients were retrospectively analyzed. According to the quantity of perioperative blood transfusion, all recipients were divided into the massive blood transfusion group (n=20) and non-massive blood transfusion group (n=139). Clinical data of lung transplant recipients were statistically compared between two groups. The risk factors of perioperative massive blood transfusion were analyzed. Clinical prognosis of the recipients was observed in two groups. Results There were significant differences between the two groups in preoperative data including anticoagulant therapy, hemoglobin content, the number of recipents with idiopathic pulmonary fibrosis or idiopathic pulmonary hypertension, and intraoperative data including the number of recipents presenting with intraoperative intrathoracic adhesion, operation time and the amount of various component transfusion(all P < 0.05). Preoperative anticoagulant therapy, incidence of intraoperative intrathoracic adhesion, use of extracorporeal membrane oxygenation (ECMO) and long operation time were the risk factors of massive blood transfusion during perioperative period of lung transplantation(all P < 0.05). In the massive blood transfusion group, the incidence rate of grade Ⅲ primary graft dysfunction (PGD) and the fatality within postoperative 30 d were higher compared with those in the non-massive blood transfusion group(both P < 0.01). Low body mass index (BMI) and massive blood transfusion were the risk factors for death within postoperative 30 d(P=0.048、P < 0.001). The 1-year survival rate in the massive blood transfusion group was lower than that in the non-massive blood transfusion group(P < 0.001). Conclusions Preoperative anticoagulant therapy, incidence of intraoperative intrathoracic adhesion, use of ECMO and long operation time are the risk factors for massive blood transfusion during perioperative period of lung transplantation. Massive blood transfusion negatively affects the clinical prognosis of the recipients undergoing lung transplantation.
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Objective To investigate the rationality and efficacy of enhanced recovery after surgery (ERAS) in liver transplant recipients. Methods Clinical data of 465 liver transplant recipients were retrospectively analyzed. All recipients were divided into the ERAS group (n=163) and control group (n=302) according to whether they received ERAS. The severity of disease in the ERAS group was worse than that in the control group. Operation situations including the operation time, anhepatic phase and intraoperative blood transfusion volume of the liver transplant recipients were observed and recorded. Postoperative recovery conditions including the length of intensive care unit (ICU) stay, total length of hospital stay, total ventilator removal time at postoperative 28 d and postoperative re-intubation rate were recorded. The survival rates at 90 d, 180 d and 1 year after liver transplantation were calculated. The influencing factors of survival rate of liver transplant recipients were analyzed. Results The anhepatic phase in the ERAS group was 45 (39, 53) min, significantly longer than 40 (32, 48) min in the control group (P < 0.05). The volume of erythrocyte infusion in the ERAS group was 10 (7, 13) U, significantly less than 18 (10, 28) U in the control group (P < 0.05). The length of postoperative ICU stay and total length of hospital stay in the ERAS group were 135 (84, 212) h and 24 (18, 33) d, significantly shorter than 154 (103, 253) h and 34 (20, 50) d in the control group (both P < 0.05). Total ventilator removal time at postoperative 28 d was 26 (25, 27) d, significantly longer than 26 (23, 27) d in the control group (P < 0.05). The postoperative re-intubation rate in the ERAS group was 11.0%, significantly lower than 20.8% in the control group (P < 0.05). The 90 d, 180 d and 1-year survival rates in the ERAS group were 92.8%, which were significantly higher than 81.1%, 78.1% and 75.7% in the control group (all P < 0.05). ERAS and operation time were the independent influencing factors of survival rate of liver transplant recipients (both P < 0.05). Conclusions ERAS after liver transplantation can improve the survival rate of recipient, shorten the length of hospital stay, reduce the re-intubation rate and accelerate the rehabilitation after liver transplantation.
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BACKGROUND: Hemorrhage control has been an important issue in spine surgery. The widely used gelatin sponge is limited by its long-time bleeding control and poor hemorrhage control. Therefore, new techniques are needed to control bleeding in spine surgery. OBJRCTIVE: To compare the hemostatic effect of fluid gelatin Surgiflo™ with absorbable gelatin sponge in single level posterior lumbar fusion surgery. METHODS: Ninety-eight patients consisting of 52 males and 46 females, aged 54. 32 years who received treatment between September 2017 and December 2017 in Xijing Hospital of The Fourth Military Medical University were included in this study. All patients underwent single-level L4/5 lumbar fusion. Among them, 48 patients received intraoperative hemostasis with fluid gelatin SurgifloTM and 50 patients received intraoperative hemostasis with conventional gelatin sponge. Intraoperative bleeding volume, postoperative drainage volume, success rate of hemostasis in 3 minutes and changes of hemoglobin levels in perioperative period were compared between the two groups. RESULTS AND CONCLUSIONS: The operation time in the Surgiflo™group was significantly shorter than that in the gelatin sponge group [(105±26) vs. (118±32) min, P < 0. 05]. The amount of intraoperative blood loss and total amount of drainage were (156±57) mL and (106±42) mL in the Surgiflo™group which were significantly lower than those in the gelatin sponge group [(204±62) mL, (148±35) mL, P < 0. 05]. The success rate of hemostasis within 3 minutes in the Surgiflo™ group was significantly higher than that in the gelatin sponge group (94% vs. 80%, P < 0. 05). The change in hemoglobin level during the perioperative period relative to pre-surgery level was significantly higher in the Surgiflo™ group was significantly lower than that in the gelatin sponge group [(12. 3±3. 6) vs. (22. 8±4. 3) g/L, P < 0. 05]. No complications such as anaphylaxis, immune rejection, or delayed hematoma occurred in both groups. These results suggest that fluid gelatin Surgiflo™ can significantly reduce intraoperative blood loss and postoperative drainage volume in single-level lumbar fusion surgery and exhibit better hemostatic effects.
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BACKGROUND: Acetabular fracture is considered to be one of the most challenging fractures because of its complex anatomical structure, which makes it more difficult to treat. At present, open reduction and internal fixation are still the standard treatment methods for displaced acetabular fractures. The patient-specific pre-contour reconstruction template made by three-dimensional (3D) printing technology combined with preoperative virtual surgery plan can reduce the invasiveness of surgery and simplify the operation process. OBJECTIVE: To evaluate the effect of 3D printing combined with virtual surgical planning in the treatment of acetabular fractures compared with traditional reduction and reconstruction of acetabular fractures. METHODS: Totally 25 patients were selected from Affiliated Hospital of Chengde Medical College from October 1, 2017 to March 1, 2018, including 14 males and 11 females, at the age of 21-60 years old. They were divided into experimental group (n=12) and control group (n=13) by computer random grouping method. In the experimental group, printing technology combined with virtual pre-contour reconstruction plate fixation was performed. In the control group, intraoperative contour reconstruction plate fixation was conducted after reduction. Postoperative X-ray and non-contrast CT scan was used to analyze fracture reduction in two groups. After the operation, the patients in the two groups were followed up for visual analogue scale score, Majeed function score and complications. This study was approved by the Ethics Committee of Affiliated Hospital of Chengde Medical College (approval No. LL007). RESULTS AND CONCLUSION: (1) X-ray films showed that the reduction effect of the experimental group was better than that of the control group (P=0.038). Non-contrast CT images showed that the reduction displacement difference of the experimental group was better than that of the control group before and after operation [(12.43±7.58) mm, (9.408±8.27) mm, P < 0.05]. (2) At 6-12 months after surgery, visual analogue scale scores were lower in the experimental group than in the control group [(1,6±0.6), (3.3±1.3), P < 0.05], There were no significant differences in Majeed function scores between the two groups in the final follow-up (P=0.079). (3) Complications, such as delayed healing, failure of internal fixation or deep vein thrombosis, were not found; and no biocompatibility adverse reactions related to the implanted device occurred in the two groups after surgery. (4) Results suggested that 3D printing technology assisted virtual operation plan can improve the reduction quality in the fixation of acetabular fracture, improve the operative effect of acetabular fracture, and reduce the postoperative pain of patients.
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BACKGROUND: The number of rheumatoid arthritis patients undergoing total knee arthroplasty is increasing, but the postoperative early complications and related risk factors have not been reported. OBJECTIVE: To investigate the early acute complications and the risk factors after primary total knee arthroplasty in patients with rheumatoid arthritis. METHODS: Data of 300 patients (337 knees) with rheumatoid arthritis who received primary total knee arthroplasty at Affiliated Hospital of Qingdao University from September 2013 to May 2019 were retrospectively analyzed. There were 62 males and 238 females, with an age of (65.61±8.40) years old. All patients signed the informed consent, and the study was approved by the ethics committee of the hospital. The baseline data, comorbidities, preoperative examination, surgical data, other data of hospitalization and follow-up data were recorded. The risk factors of complications were analyzed. The receiver operating characteristic curve was used to assess the predictive value of risk factors for postoperative complications within 30 days after surgery in rheumatoid arthritis patients. RESULTS AND CONCLUSION: (1) Nine cases (3.33%) affected acute complications within 30 days after surgery. (2) Multivariate Logistic regression analysis showed that operation time, age, duration of disease and preoperative cerebrovascular disease were independent risk factors for postoperative complications within 30 days after total knee arthroplasty in rheumatoid arthritis patients. (3) Compared with the non-complication group, in the complication group, the operation time was longer (OR=1.023, 95%CI: 1.001-1.045, P=0.037), the age was increased (OR=1.163, 95%CI: 1.025-1.319, P=0.019), the duration of disease was longer (OR=1.110, 95%CI: 1.031-1.195, P=0.006), and the proportion of preoperative cerebrovascular disease was increased (OR=31.736, 95%CI: 4.053-248.517, P=0.001). (4) The receiver operating characteristic curve to predict the complications in patients with rheumatoid arthritis within 30 days after total knee arthroplasty showed that the area under the curve of age, duration of disease and operation time were 0.693, 0.865 and 0.685, respectively.
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@#AIM: To evaluate the clinical efficacy of heads-up 3D vision system in surgery for proliferative diabetic retinopathy with traction retinal detachment. <p>METHODS: We retrospectively reviewed 32 patients(38 eyes)of PDR complicated with local TRD(no traction retinal hole)who underwent 25G minimally invasive vitrectomy in our hospital from August 2018 to March 2019. The patients were divided into two groups according to the observation system during the operation. 19 eyes of 16 patients in the experimental group were operated with heads-up 3D vision system, and 19 eyes of 16 patients in the control group were operated with traditional microscope. The operation time, iatrogenic retinal hole and silicone oil injection were recorded in the two groups. The patients were followed up for at least 6mo to observe the best corrected visual acuity and the occurrence of postoperative complications. <p>RESULTS: In the experimental group, iatrogenic retinal hole and silicone oil injection occurred in 1 eye during operation. The retina was completely reattached after operation. One day after operation, vitreous hemorrhage occurred in 4 eyes, which was self-absorbed after 2-4wk. Intraocular hypertension occurred in 6 eyes in postoperative 2wk, which could be controlled by drug treatment. Vitreous hemorrhage occurred in 2 eyes after 6wk and the best corrected visual acuity of 6mo was more than 0.3 in 15 eyes. In the control group, iatrogenic retinal hole occurred in 4 eyes, silicone oil was injected in 5 eyes during operation. The retina was completely reattached after operation. One day after operation, vitreous hemorrhage occurred in 6 eyes, which was self-absorbed after 2-4wk. Intraocular hypertension occurred in 5 eyes in postoperative 2wk, which could be controlled by drug treatment. Vitreous hemorrhage occurred in 3 eyes after 6wk, and the best corrected visual acuity of 6mo was more than 0.3 in 14 eyes. The operation of all patients was completed successfully, and no serious complications such as endophthalmitis occurred, but the operation time of the experimental group was significantly shorter than that of the control group(37.3±4.8min <i>vs</i> 41.2±5.1min, <i>P</i>=0.020).<p>CONCLUSION:Application of heads-up 3D vision system in PDR combined with TRD vitrectomy can shorten the operation time and improve the operation efficiency.
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Objective@#To explore the clinical application value of closed negative pressure drainage technique in the treatment of external foot injury.@*Methods@#Sixty-eight patients with hand and foot trauma admitted to the Enze Hospital of Taizhou Enze Medical Center (Group) from November 2017 to November 2018 were randomly divided into the control group and the observation group according to the digital table, with 34 cases in each group.The control group underwent routine skin grafting.The observation group underwent closed vacuum drainage.The therapeutic effects, wound healing rate and clinical observation indicators were compared between the two groups.@*Results@#The total effective rate (88.24%) and the overall wound healing rate (100.00%) in the observation group were significantly higher than those in the control group (64.71%, 79.41%) (χ2=5.231, 7.803, P=0.022, 0.005). The operation time[(5.92±1.02)h], wound healing time[(16.65±8.01)d] and hospitalization time[(31.42±13.05)d] in the observation group were significantly shorter than those in the control group[(8.33±1.65)h, (23.51±12.12)d, (46.35±18.89)d](t=7.244, 2.753, 3.792, P=0.001, 0.008, 0.001).@*Conclusion@#Application of closed negative pressure drainage technique in hand and foot trauma surgery can effectively improve clinical efficacy, accelerate the healing speed of wounds, and reduce the operation time and hospitalization time of patients.It is worthy of promotion.
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Objective@#To investigate the risk factors of operation time of endoscopic submucosal dissection (ESD) for superficial gastric lesions.@*Methods@#Clinicopathologic data of 193 patients (195 lesions) diagnosed with early gastric cancer preoperatively who received ESD in Beijing Friendship Hospital from January 2015 to December 2017 were retrospectively collected, including basic information (age, gender, body mass index, comorbidities), lesion characteristics (size, location, morphology), the operators′ experience of ESD, operation time, and postoperative pathology, etc. Univariate analysis was performed to find the risk factors of ESD operation time, and logistic regression analysis was performed on the factors with statistical differences in univariate analysis to find the independent risk factors of ESD operation time over 120 min.@*Results@#The mean age of the patients was 63.34±9.11 years. The median time of ESD operation was 120.00 (95.00, 165.00) min and the median size of the lesions was 1.50 (1.00, 2.38) cm. Early gastric cancer was diagnosed by postoperative pathology in 164 lesions (84.10%), among which 162 lesions (98.78%) achieved en bloc resection, and 148 lesions (90.24%) achieved curative resection. The gender (P=0.018), location(P<0.001) and size (r=0.209, P=0.007) were risk factors of the operation time by univariate analysis, while age, body mass index, American Society of Anesthesiologists (ASA) grade, roughness of lesion surface, presence or absence of white moss and ulcer, depth of lesion invasion, operative period, gross shape of lesion, degree of differentiation, and experience of operator were not associated with operation time (all P>0.05). Multivariate analysis showed that the lesion located in cardia/fundus of stomach (OR=5.656, 95%CI: 2.291-13.964, P<0.001), body of stomach (OR=2.667, 95%CI: 1.048-6.785, P=0.040) and >2 cm in size (OR=2.761, 95%CI: 1.229-6.205, P=0.014) were independent risk factors for the operation time longer than 120 min.@*Conclusion@#Lesions located in the cardia/fundus, body of stomach and >2 cm in size are independent risk factors for long operation time of ESD.
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Objective To compare the effect of closed reduction internal fixation and open reduction and internal fixation on the recovery of double ankle joint function and the degree of pain in patients with comminuted double malleolus fracture after operation.Methods From June 2015 to March 2017,78 patients with comminuted malleolus fracture in the Department of Orthopedics from Changzhi People's Hospital Affiliated to Shanxi Medical University were randomly divided into two groups according to the digital table ,with 39 cases in each group.The control group was treated with open reduction and internal fixation ,and the study group was treated with closed reduction and internal fixation.The amount of bleeding ,operation time,time of hospitalization were compared between the two groups.Six months after operation,the ankle function and pain score were used to evaluate the clinical efficacy.Results All the operations of 78 patients were successfully performed.The operative blood loss,operative time and hospitalization time in the study group were significantly lower than those in the control group (t＝4.65,14.63,7.83,all P＜0.05).Six months after operation,the excellent and good rate of the double ankle function in the study group (97.44%) was significantly higher than that in the control group (74.36%)(χ2＝6.77,P＝0.01).The pain scores of the two groups were significantly lower than those before treatment (t＝24.84,33.81,all P＜0.01).Six months after treatment,the pain score in the study group[(1.74 ±0.55)points]was significantly lower than that of the control group [(2.78 ± 0.80)points] (t＝6.69,P＜0.01).Conclusion Closed reduction and internal fixation for the patients with commi-nuted malleolus fracture after the operation of the joint without reduction ,are beneficial to promote the recovery of the double ankle joint function and reduce the pain degree ,and have the advantages of small wound ,less bleeding in the operation,short operation time and short hospitalization time.The clinical application should be popularized.
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[Objective] To investigate the perioperative risk of different operation times on renal angiomyolipoma (AML) patients with rupture and hemorrhage.[Methods] From January 2006 to December 2016,AML patients with rupture and hemorrhage who receiving surgical treatment were recruited.According to the operation time,patients receiving surgery within 7 days after the hemorrhage were classified as short-term operation group.Patients receiving surgery exceeded 30 days after the hemorrhage were classified as long-term operation group.The general and perioperative data were compared between the two groups.[Results] There were no statistically significant differences in age,tumor size,clinical symptoms and operative methods between the two groups.However,as compared to the long-term operation group,the hemorrhage during surgery [(780±451) vs.(572±913) mL,P=0.029],the volume of transfused blood [(2600 ± 1733) vs.(820±582) mL,P=0.027],the nephrectomy rate (60.0％ vs.22.6％,P=0.027) were significantly increased in the short-term operation group.[Conclusions] A long-term operation group for AML patients with rupture and hemorrhage could have a lower perioperative risk.
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Objective To compare the coronary incision with the sagittal incision in transaxillary breast augmentation.Methods A total of 60 patients who underwent transaxillary subpectoral breast augmentation with round breast implants were randomly allocated into two groups:Group A (30 patients) received coronary incision,while Group B received sagittal incision.The operative time of implant insertion,the distinction of scar and the repair rate of scar were compared between the two groups.Results The mean operative time of implant insertion in group A was (14.55±3.79)s,and that in group B was (27.38±6.79) s,with statistically significant difference (t =9.03,P＜0.05).But there was no statistical significance in the difference in the degree of scar (x2 =0.26,P＞0.05) or the repair rate of scar (x2=0.35,P＞0.05) between two groups.Conclusions As for the operative time of implant insertion,the coronary incision is better than the sagittal incision.
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Objective To discuss the proper operation time of patients with encapsulated empyema secondary to tubercu-lous pleurisy by review the clinical characteristics and duration of these patients.Methods From December 1995 to May 2017, 235 patients with encapsulated empyema and pleural decortication were operated.The course of disease and preopera-tional data were collected.Patients were divided into three groups according to the duration of disease(group A with 113 cases,≤12 months; group B with 53 cases, 12 -24 months; group C with 69 cases, >24 months).Propensity score matching (PSM) was used to decrease the baseline difference among three groups.Preoperational features, such as operation time, bleeding, complications were compared between groups.Results PSM were conducted between group A and group B (45 paired patients), group B and group C(29 paired patients), respectively.The length of operation, amount of bleeding and blood transfusion in group B were significantly higher than those in group A and group C .The days with tube and hospitalization in group B were significantly longer than group A, but they were insignificantly different compared with group C(P>0.05). Postoperative complications were similar between the three groups(P>0.05).Conclusion Encapsulated empyema in early stage(within 1 year of onset) or after the maturation of the fibrous plate(over 2 years) is less difficult for surgical intervention, and try to avoid surgical treatment at high risk(1 to 2 years).