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Objective:To study the association between preoperative hemoglobin amount and incidence of lower limb deep vein thrombosis (DVT) in patients with lower limb fracture.Methods:A retrospective study was performed of the 2, 482 patients with lower limb fracture who had been treated at Department of Orthopaedics Trauma, Honghui Hospital Affiliated to Xi'an Jiaotong University from July 2014 to August 2019. They were 1, 174 males and 1, 308 females with an age of (60.6±19.3) years. Recorded were the patients' age, gender, injury time, hemoglobin amount, D-dimer measurement, combined medical conditions, time and results of ultrasound vein examination on both lower extremities. According to the ultrasound results, the patients were divided into a thrombosis group and a thrombosis-free group. The 2 groups were compared in hemoglobin amount. Logistic regression was used to analyze the relationship between preoperative hemoglobin amount and incidence of lower limb DVT. The patients were divided into 5 groups according to the quintile of hemoglobin amount; the incidences of thrombosis were compared between the 5 groups.Results:The total incidence of DVT in this cohort was 29.53%(733/2, 482). The hemoglobin amount in the thrombosis group was (116.57±19.24) g/L, significantly lower than that in the thrombosis-free group (124.76±19.79) g/L ( P<0.05). The preoperative hemoglobin amount was a risk factor for incidence of DVT after a lower limb fracture ( OR=0.985, 95% CI: 0.980 to 0.990, P<0.001). As the quintile level of hemoglobin increased, the incidence of DVT showed a downward trend. In comparison of the group with the highest DVT incidence (40.58%) and the group with the lowest DVT incidence (17.27%), the risk increased by 2.386 times (95% CI: 1.718 to 3.315). Conclusions:The preoperative hemoglobin amount can affect the DVT incidence after a lower limb fracture, and a low hemoglobin amount may more likely lead to lower limb DVT.
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Objective:To compare the clinical effect of combined anterior and posterior approach and posterior median approach to treat O'Driscoll type III b fracture of ulnar coronoid process.Methods:A retrospective case control study was made on 67 patients with O'Driscoll type III b fracture of ulnar coronoid process treated in Honghui Hospital, Xi'an Jiaotong University from January 2015 to January 2019, including 35 males and 32 females, aged from 21 to 61 years [(38.0±9.4)years]. Among them, 31 patients were treated with combined anterior and posterior approach for reduction and internal fixation (combined approach group), and 36 patients with median posterior elbow approach group for reduction and internal fixation (posterior elbow approach group). The operation time, amount of intraoperative blood loss and fracture healing time were compared between groups. The visual analogue score (VAS), elbow joint range of motion and Mayo elbow performance score (MEPS) were assessed for pain and function evaluation at postoperative 1, 3, 6 months and at the last follow-up. The occurrence of complications were observed as well.Results:All patients were followed up for 12 to 28 months [(20.1±4.2)months]. There was no significant difference in operation time and VAS between the two groups ( P>0.05). The intraoperative blood loss [(133.6±20.3)ml] and fracture healing time [(12.3±1.7)months] in combined approach group were less or shorter than those in posterior elbow approach group [(144.4±22.1)ml, (13.2±2.0)months] ( P<0.05). The range of flexion and extension of elbow joint in combined approach group [(88.7±10.8)°, (111.1±13.9)°, (121.3±14.1)°, (127.1±13.3)°] was higher than that in posterior elbow approach group [(74.5±11.8)°, (97.6±12.6)°, (111.3±13.0)°, (115.2±12.7)°] at postoperative 1, 3, 6 months and at the last follow-up ( P<0.05). The MEPS in combined approach group [(31.7±8.6)points, (55.6±9.3)points, (84.6±10.5)points, (85.0±10.3)points] was higher than that in posterior elbow approach group [(27.2±8.2)points, (50.7±8.7)points, (77.4±11.2)points, (80.1±9.4)points] at postoperative 1, 3, 6 months and last follow-up ( P<0.05). The incidence of complications in combined approach group [10%(3/31)] was lower than that in posterior elbow approach group [31%(11/36)]( P<0.05). Conclusion:Compared with the simple posterior elbow median approach, the combined anterior and posterior elbow approach for treatment of O'Driscoll type IIIb fracture of ulnar coronoid process has lower intraoperative blood loss, faster fracture healing, lower incidence of complications and better elbow function.
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Objective To investigate the safety and effect of tranexamic acid combined with drainage tube clamping to reduce perioperative blood loss of Schatzker Ⅴ and Ⅵ tibial plateau fracture.Methods A prospective case-control study was performed on 87 patients with Schatzker Ⅴ and Ⅵ tibial plateau fracture admitted from March 2018 to January 2019 in Honghui Hospital,including 53 males and 34 females,aged 24 to 69 years [(39.05 ± 2.7) years].All patients underwent tibial plateau reduction and internal fixation.According to the random number table method,the patients were divided into intravenous group (27 cases),articular cavity group (30 cases) and control group (30 cases).The intravenous group were given a total of 1 g of tranexamic acid intravenously 5-10 minutes before loosening the tourniquet,the joint cavity group were perfused with 1 g of tranexamic acid before closing the incision,and the control group were given the same amount of normal saline.The drainage tube was temporarily clamped for 4 hours in the three groups.Data were recorded and compared among the groups,including the surgical limb side,tourniquet use time,hemoglobin (Hb),D-dimer level,drainage,total blood loss,number of allogeneic blood transfusions,postoperative complications,and presence or absence of deep vein thrombosis (DVT) of the lower extremities at 72 hours after discharge.Results There was no significant difference in baseline data between the three groups (P ＞ 0.05).There were no significant differences in the extremity side,tourniquet use time,and number of allogeneic blood transfusions among the three groups (P ＞ 0.05).At postoperative 24 hours,the Hb was (112.7 ± 11.8) g/L in the intravenous group,(107.7 ± 16.1) g/L in the articular cavity group,At (100.0 ± 10.4) g/L in the control group.At postoperative 24 hours,the D-dimer vein was (5.5 ± 2.9) mg/L in the intravenous group,(5.9 ± 2.5) mg/L in the joint cavity group,and (7.5 ± 3.6) mg/L in the control group.At postoperative 24 hours,the drainage volume was (62.8 ± 20.5) ml in the intravenous group,(60.2 ± 17.4) ml in the articular cavity group,and (81.2 ± 21.1)ml in the control group.The hidden blood loss was (577.1 ± 212.1)ml in the intravenous group,(634.2 ± 139.8)ml in the articular cavity group,(750.3 ±124.1)ml in the control group.The total blood loss was (950.1 ± 170.5)ml in the intavenous group,(1 005.4 ± 179.8)ml in the articular cavity group,and (1 148.8 ± 129.1)ml in the control group.The incidence of postoperative wound swelling and exudation was 1 case (4％) in the intravenous group,0 cases in the articular cavity group,5 cases (17％) in control group.The above indexes showed significant differences between the three groups (P ＜ 0.05 or 0.01),but there was no significant difference between the intravenous group and the articular cavity group (P ＞ 0.05).The Hb at 72 hours postoperatively,total drainage,number of allogeneic blood transfusions,lower extremity DVT and incidence of skin ecchymosis had no significant difference among the three groups (P ＞ 0.05).No pulmonary embolism occurred after the operation.Conclusions For patients with Schatzker Ⅴ and Ⅵ tibial plateau fracture,tranexamic acid combined with drainage tube clamping is safe and effective when used perioperatively.Either intravenous infusion or local joint cavity injection of tranexamic acid can effectively reduce the drainage volume at 24 hours postoperatively,hidden blood loss and total blood loss without increasing the risk of postoperative DVT.Tranexamic acid can reduce the and exudation after operation.
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Objective:To investigate the risk factors of deep venous thrombosis in patients before hip arthroplasty, and to explore the possible causes of postoperative thrombosis.Methods:The clinical data of 361 patients with hip arthroplasty treated in the Department of Orthopaedic Trauma of Xi′an Honghui Hospital from September 2015 to December 2019 were studied retrospectively, including 102 males and 259 females, aged 65 to 94 years, and the average age was 72.25 years old. All fracture patients were given subcutaneous injection of low molecular weight heparin calcium to prevent lower extremity thrombosis. The deep veins of both lower extremities were examined before and after operation. The general data of the two groups of patients were collected and recorded, including age, sex, whether complicated with medical diseases (essential hypertension, type 2 diabetes, coronary heart disease), serological indexes, time from injury to admission, and time from admission to operation. The software of SPSS 19.0 was used for statistical analysis.Results:The incidence of lower limb DVT, before operation was 29.92%, including 26 males (24.07%) and 82 females (75.93%). The results of multivariate logistic regression analysis showed that diabetes mellitus ( OR=2.127, 95% CI: 1.134-3.989, P=0.019), coronary heart disease ( OR=1.692, 95% CI: 1.056-2.713, P=0.029) and the time from injury to admission ( OR=1.677, 95% CI: 1.037-2.712, P=0.035) were independent risk factors for DVT in elderly patients undergoing hip arthroplasty. The incidence of lower limb DVT, after operation was 46.54%. After operation, proximal thrombus were occurred in 2 cases (1.19%), distal thrombus in 143 cases (85.12%), and mixed thrombus in 23 cases (13.69%). Postoperative thrombus was ipsilateral to the fracture limb in 84 cases (50.00%), thrombus was located in the healthy side of the fracture in 19 cases (11.31%), and DVT occurred in 65 cases (38.69%) in both lower limbs. Conclusions:Delayed admission longed than 48 hours, coronary heart disease and diabetes mellitus are the risk factors for the formation of DVT. The thrombus that existed before operation and did not disappear after operation accounted for 48.81% of the total incidence of postoperative thrombosis, and the new thrombus accounted for 51.19% of the total incidence of postoperative thrombosis. For the elderly patients with femoral neck fracture undergoing hip arthroplasty, ultrasonic examination of both lower limbs should be performed before and after operation to find the changes of thrombus in time and do a good job of prevention and treatment.
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Objective@#To investigate the safety and effect of tranexamic acid combined with drainage tube clamping to reduce perioperative blood loss of Schatzker V and VI tibial plateau fracture.@*Methods@#A prospective case-control study was performed on 87 patients with Schatzker V and VI tibial plateau fracture admitted from March 2018 to January 2019 in Honghui Hospital, including 53 males and 34 females, aged 24 to 69 years [(39.05±2.7)years]. All patients underwent tibial plateau reduction and internal fixation. According to the random number table method, the patients were divided into intravenous group (27 cases), articular cavity group (30 cases) and control group (30 cases). The intravenous group were given a total of 1 g of tranexamic acid intravenously 5-10 minutes before loosening the tourniquet, the joint cavity group were perfused with 1 g of tranexamic acid before closing the incision, and the control group were given the same amount of normal saline. The drainage tube was temporarily clamped for 4 hours in the three groups. Data were recorded and compared among the groups, including the surgical limb side, tourniquet use time, hemoglobin (Hb), D-dimer level, drainage, total blood loss, number of allogeneic blood transfusions, postoperative complications, and presence or absence of deep vein thrombosis (DVT) of the lower extremities at 72 hours after discharge.@*Results@#There was no significant difference in baseline data between the three groups (P>0.05). There were no significant differences in the extremity side, tourniquet use time, and number of allogeneic blood transfusions among the three groups (P>0.05). At postoperative 24 hours, the Hb was (112.7±11.8)g/L in the intravenous group, (107.7±16.1) g/L in the articular cavity group, At (100.0±10.4) g/L in the control group. At postoperative 24 hours, the D-dimer vein was (5.5±2.9)mg/L in the intravenous group, (5.9±2.5)mg/L in the joint cavity group, and (7.5±3.6)mg/L in the control group. At postoperative 24 hours, the drainage volume was (62.8±20.5)ml in the intravenous group, (60.2±17.4)ml in the articular cavity group, and (81.2±21.1)ml in the control group. The hidden blood loss was (577.1±212.1)ml in the intravenous group, (634.2±139.8)ml in the articular cavity group, (750.3±124.1)ml in the control group. The total blood loss was (950.1±170.5)ml in the intavenous group, (1 005.4±179.8)ml in the articular cavity group, and (1 148.8±129.1)ml in the control group. The incidence of postoperative wound swelling and exudation was 1 case (4%) in the intravenous group, 0 cases in the articular cavity group, 5 cases (17%) in control group. The above indexes showed significant differences between the three groups (P<0.05 or 0.01), but there was no significant difference between the intravenous group and the articular cavity group (P>0.05). The Hb at 72 hours postoperatively, total drainage, number of allogeneic blood transfusions, lower extremity DVT and incidence of skin ecchymosis had no significant difference among the three groups(P>0.05). No pulmonary embolism occurred after the operation.@*Conclusions@#For patients with Schatzker V and VI tibial plateau fracture, tranexamic acid combined with drainage tube clamping is safe and effective when used perioperatively. Either intravenous infusion or local joint cavity injection of tranexamic acid can effectively reduce the drainage volume at 24 hours postoperatively, hidden blood loss and total blood loss without increasing the risk of postoperative DVT. Tranexamic acid can reduce the and exudation after operation.