Use of tranexamic acid in corrective surgery for adolescent idiopathic scoliosis:effectiveness and safety / 中国脊柱脊髓杂志

Objectives:To assess the efficacy and safety of intravenous use of tranexamic acid(TXA)in re-ducing blood loss during correction surgery for patients with adolescent idiopathic scoliosis(AIS).Methods:The clinical data of 759 AIS patients who underwent posterior corrective fusion surgery at Nanjing Drum Tower Hospital between November 2016 and May 2022 were reviewed retrospectively.There were 544 females and 215 males,with an average age of 14.7±2.1 years.Among the patients,369 patients receiving intra-venous use of TXA during surgery were included in the TXA group,while the other 390 patients receiving the same volume of saline but not TXA were included in the control group.The baseline data(age,gender ratio,Cobb angle,and scoliosis type),pre-and postoperative blood laboratory parameters[hemoglobin(Hb),hematocrit(Hct),platelet count(PLT),prothrombin time(PT),D-dimer,activated partial thromboplastin time(APTT),and fibrinogen(FIB)],blood management indicators(intraoperative blood loss,intraoperative blood trans-fusion,postoperative drainage volume and removal time of drainage tube),and correction-related indicators(pre-and postoperative scoliosis degree,correction rate)and postoperative complications were compared be-tween the two groups.Results:There were no significant differences in baseline data and preoperative blood laboratory parameters between the groups(P>0.05).In TXA group,the intraoperative blood loss(551.7±130.3mL),intraoperative blood transfusion volume(551.3±96.3mL),postoperative drainage volume(468.3±162.5mL),and postoperative drainage time(2.8±0.4d)were all significantly lower than those in the control group(666.7±166.8mL,650.0±138.3mL,550.0±135.1mL,3.1±0.8d,P<0.05).Postoperative D-dimer and PLT in the TXA group were significantly lower than those in the control group(P<0.05),while other blood laboratory parameters showed no significant differences between the two groups(P>0.05).There were no statistically significant differ-ences in scoliosis correction rates,postoperative complication rates between the two groups(P>0.05).Conclusions:The use of TXA in surgery can reduce the perioperative blood loss and transfusion,and improve coagulation status in AIS patients,without increasing the incidence rates of complications.

The chain mediating effect of perceived overqualification and job crafting on the relationship between platform leadership and career calling of clinical nurses / 中国实用护理杂志

Objective:To explore the relationship between platform leadership, perceived overqualification, job crafting and career calling of clinical nurses, and provide references for formulating occupational calling strategies for clinical nurses.Methods:A total of 488 clinical nurses from Qingdao Hiser Hospital Affiliated of Qingdao University(Qingdao Traditional Chinese Medicine Hospital), Shandong University Qilu Hospital, and Qingdao Municipal Hospital were selected as the study subjects by the convenience sampling method from April to May 2023. A general data questionnaire, Platform Leadership Scale, Perceived Overqualification Scale, Job Crafting Scale, and Career Calling Scale were used to conduct a cross-sectional investigation on the research objects, and the relationship and mediating effect between platform leadership, perceived overqualification, job crafting, and career calling were analyzed.Results:Among the 488 clinical nurses, 79 were males and 409 were females, aged 23-51 (30.37 ± 6.40) years old. The scores of platform leadership, perceived overqualification, job crafting and career calling of clinical nurses were (86.12 ± 9.99), (21.79 ± 7.29), (70.61 ± 14.54) and (38.70 ± 7.54) points, respectively. The total effect of platform leadership on work engagement was 0.316. The mediating path of platform leadership to career calling included platform leadership→perceived overqualification→career calling; platform leadership→job crafting→career calling; platform leadership→perceived overqualification→job crafting→career calling. Three mediating effects accounted for 17.99%, 9.50% and 4.56% of the total effect, respectively.Conclusions:There is a chain-mediating effect of perceived overqualification and work remodeling on the relationship between platform leadership and the career calling of clinical nurses. Nursing managers should implement platform leadership to alleviate clinical nurses ′ perceived overqualification, improve job crafting, and then improve the level of clinical nurses ′ career calling.

Clinical efficacy and prevention of adjacent segment degeneration in the treatment of lumbar degenerative diseases through decompression and fusion preserving proximal upper laminae / 中华骨科杂志

Objective:To investigate the clinical results of decompression preserving proximal upper laminae combined with lumbar instrumental fusion in the treatment of lumbar degenerative diseases and the prevention of adjacent segment degeneration (ASD).Methods:A retrospective analysis was conducted on 124 patients (the reserved group) with lumbar degeneration who underwent compression preserving proximal upper laminae combined with fusion surgery involving upper half of the lamina, upper half of the spinous process, adjacent facets, and interspinous ligament at Nanjing Drum Tower Hospital between March 2018 and February 2020. These patients were followed up for more than 2 years. Additionally, 130 patients who underwent traditional total laminectomy decompression combined with fusion surgery from January 2016 to February 2018 were selected as the control group (total laminectomy group). In the reserved group, there were 60 males and 64 females, aged 58.3±10.3 years, including 50 cases of giant lumbar disc herniation, 11 cases of lumbar disc herniation with ossification, 10 cases of simple lumbar spinal stenosis, and 53 cases of degenerative lumbar spondylolisthesis. Total laminectomy group comprised 62 males and 68 females, aged 59.6±9.2 years, with 51 cases of giant lumbar disc herniation, 13 cases of lumbar disc herniation with ossification, 11 cases of simple lumbar spinal stenosis, and 55 cases of degenerative lumbar spondylolisthesis. The number of operative segments, operative time, intraoperative blood loss, postoperative hospital stay, complications, extent of laminectomy, dural sac area, and sagittal spinopelvic parameters were compared between the two groups. Fusion status, adjacent segment stability, and the incidence of ASD were assessed at the last follow-up. Oswestry disability index (ODI) and visual analogue scale (VAS) for back and leg were used to evaluate clinical effectiveness.Results:The follow-up time was 30.5±5.4 months in the reserved group and 31.0±5.8 months in total laminectomy group, and the difference was not statistically significant ( t=0.63, P=0.528). In patients undergoing single segment surgery, the operation time (173.6±47.3 min), blood loss (351.7±102.0 ml) and postoperative hospital stay (7.8±3.1 d) in the reserved group were lower than those in total laminectomy group (196.2±34.2 min, 401.9±97.2 ml, 9.9±3.6 d, respectively), and the differences were statistically significant ( t=2.93, P=0.004; t=2.69, P=0.008; t=3.26, P<0.001). The dural sac area in both groups was significantly improved after surgery, but the extent of laminectomy in the reserved group (22.8±4.5 mm) was smaller than that in total laminectomy group (29.5±4.8 mm), and the difference was statistically significant ( t=7.62, P<0.001). The above indicators of the patients with two segment or three segments in the reserved group were better than those in total resection group, with a statistically significant difference ( P<0.05). PI, PT, SS, and LL showed significant improvement in both groups compared to preoperative values ( P<0.05), with no statistically significant differences between the groups ( P>0.05). At the last follow-up, both groups achieved Bridwell I or II fusion level. The proportion of adjacent vertebral instability in the reserved group (11.3%, 14/124) was lower than that in total laminectomy group (22.3%, 29/130), and the difference was statistically significant (χ 2=5.48, P=0.019). The total incidence of ASD in the reserved group (20.9%, 26/124) was lower than that in total laminectomy group (36.2%, 47/130), and the difference was statistically significant (χ 2=7.15, P=0.008). R-ASD (16.9%, 21/124), S-ASD (4.0%, 5/124) and O-ASD (0, 0/124) in the reserved group were lower than those in total laminectomy group [(25.4% (33/130), 9.3% (12/130) and 1.5% (2/130), respectively)], and the difference was statistically significant (χ 2=8.20, P=0.027). ODI and VAS of back and leg were significantly reduced in both groups compared to preoperative values, and the differences were statistically significant ( P<0.05). There were no significant differences in ODI and VAS scores of back and leg in the reserved group compared with total laminectomy group at 3 months, 1 year, and the last follow-up ( P>0.05). Conclusion:Decompression with preservation of the upper half of the lamina can reduce intraoperative blood loss, shorten operation time and postoperative hospital stay, achieve comparable decompression effects to traditional decompression surgery, and effectively reduce the occurrence of adjacent segment instability and ASD.

Effect of body mass index on short-term effectiveness of high tibial osteotomy in treatment of varus knee arthritis / 中国修复重建外科杂志

OBJECTIVE@#To investigate the effect of body mass index (BMI) on the short-term effectiveness of high tibial osteotomy (HTO) in the treatment of varus knee arthritis.@*METHODS@#The clinical data of 84 patients (84 knees) with varus knee arthritis treated with HTO between May 2016 and August 2020 were retrospectively analyzed. According to BMI, the patients were divided into normal group (32 patients in group A, BMI<25 kg/m 2), overweight group (27 patients in group B, BMI>30 kg/m 2), and obese group (25 patients in group C, BMI>30 kg/m 2). The BMI of groups A, B, and C were (23.35±0.89), (26.65±1.03), and (32.05±1.47) kg/m 2, respectively. There was no significant difference ( P>0.05) in gender, age, surgical side, disease duration, and preoperative Hospital for Special Surgery (HSS) score, visual analogue scale (VAS) score, knee range of motion, and hip-knee-ankle angle (HKA) between groups. The operation time, intraoperative dominant blood loss, and the decrease of hemoglobin on the 3rd day after operation were recorded and compared between groups. The improvement of knee joint function and pain status were evaluated by knee joint HSS score, knee range of motion, and VAS score before and after operation, and measuring the HKA of patients on X-ray film. During the follow-up, the X-ray films of the knee joint were reexamined to observe the position of the internal fixator and the healing of osteotomy.@*RESULTS@#All patients completed the operation successfully and were followed up 8-40 months (mean, 19.3 months). There was no significant difference in follow-up time, operation time, intraoperative dominant blood loss, and the decrease of hemoglobin on the 3rd day after operation between groups ( P>0.05). No operative complications such as severe vascular or nerve injury occurred. After operation, deep venous thrombosis of lower extremities occurred in 1 case in groups A and B respectively, and fat liquefaction of surgical incision occurred in 2 cases in group C. There was no significant difference in the incidence of perioperative complications between groups (3.1% vs. 3.7% vs. 8.0%) ( P=0.689). During the follow-up, there was no bone nonunion, plate fracture or loosening. At last follow-up, HSS score, VAS score, knee range of motion, and HKA significantly improved in the 3 groups when compared with those before operation ( P<0.05), but there was no significant difference in the differences of the above indexes between groups before and after operation ( P>0.05).@*CONCLUSION@#BMI does not affect the short-term effectiveness of HTO in the treatment of varus knee arthritis. HTO can be selected for overweight and obese patients after standard medical treatment is ineffective.

Incidence of deep venous thrombosis before hip arthroplasty and possible causes of postoperative thrombosis / 国际外科学杂志

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.

Design and practice of orthopedic clinical practice teaching based on WeChat platform / 中华医学教育探索杂志

Objective To evaluate the effect of orthopedic clinical practice teaching design based on WeChat platform.Methods From September 2015 to August 2017,62 undergraduate students majoring in clinical medicine in the department of orthopedics of our hospital were selected as the study subjects,and randomly divided into the experimental group and the control group.With 31 interns in each group,the control group implemented the traditional teaching method according to the requirements of the syllabus.The experimental group was attached to WeChat production,push notification and communication of related courses on the basis of the traditional teaching methods.At the end of the teaching,the theoretical and operational tests,the comprehensive quality assessment,the evaluation for teachers' teaching work and the questionnaire survey of the two groups were administrated to evaluate the teaching effect.SAS 9.0 was used to do t-test and CMH-chi-square test.Results The score of the experimental group in the theoretical test [(87.52 ± 5.45) vs.(82.61 ± 7.70)],operational test [(94.36 ± 2.60) vs.(92.26 ± 3.01)],comprehensive quality assessment [(95.94 ± 1.61) vs.(93.42 ± 2.81)] and the evaluation for teachers' teaching work [(94.58 ± 2.06) vs.(92.55 ± 1.69)] were better than those of control group,and there were statistically significant differences.P values were 0.005,0.005,0.000 and 0.000 respectively.The questionnaire survey results show that the experimental group was better than the control group in learning motivation (P=0.035),literature study (P=0.013),curriculum arrangement (P=0.007),teaching satisfaction (P=0.029) and professional recognition (P=0.040).Conclusions The clinical practice teaching method based on WeChat platform is effective and feasible to the orthopedic medical students,which is helpful to improve students' learning initiative and master effective learning strategies.The application is worth promoting.

Analysis on microstructure and biomechanical properties in different regions of osteoporotic femoral head / 医用生物力学

Objective To investigate the structure and biomechanical property differences in different regions of the femoral head for elderly patients with femoral neck fractures,and to study its influence on internal fixation for fracture.Methods Twenty femoral head specimens were collected from elderly patients with femoral neck fracture after joint replacement.The femoral head was divided into 3 parts (lateral,inferior and medial region) with reference to anatomical markers on surface of the femoral head.After the position and drilling direction of the ring drill were determined,a circular drill was used to obtain the cylindrical cancellous bone columns with 10 mm in diameter and 10 mm in height.The data of cancellous bone columns in different regions were analyzed by Micro-CT scanning system,including bone volume fraction (BVF),trabecular space (Tb.Sp),trabecular thickness (Tb.Th),the number of trabecular number (Tb.N),the bone surface volume ratio (bone surface/bone volume,BS/BV),structural model index (SMI).Mechanical property differences of bone tissues in different regions were calculated by micro-finite element analysis.Results Bone mass in the elderly osteoporotic femoral head decreased,and there were significant differences in bone microstructure and mechanical properties in different regions of the femoral head.Bone microstructure and mechanical properties in medial region were obviously superior to those in lateral and interior region.Conclusions The bone structure and mechanical strength in medial region of the femoral head are obvious superior to those in lateral and inferior regions.The position for internal fixation should be fully considered during treatment of osteoporotic femoral neck fracture in clinic.

Correlation of senile hip fracture type with expressions of insulin-like growth factor and its binding proteins / 中华创伤杂志

Objective To study the expression difference of the insulin-like growth factor-I (IGF-I)and IGF-binding proteins-3,4,5(IGFBP-3,4,5)in the peripheral and local areas in senile hip fracture and discuss the correlation between the expression and the fracture types. Methods The study involved the senile patients (over 65 years) with hip fractures to compare the expressions of peripheral and local IGF-I and IGFBP-3,4,5 and observe the correlation between expression and fracture type.Results The serum and local specimens of 46 patients were collected,with lower level of BMD,IGF-I and IGFBP-3,5 in the intertrochanteric fracture group than the femoral neck fracture group(P<0.001)and with higher level of serum and local IGFBP-4 in the intertrochanteric fracture group than the femoral neck fracture group (P<0.001).Only local IGFBP-4 mRNA had positive correlation with serum markers (R=0.544,P<0.001). Conclusions The expression difference of IGF-I and IGFBP in the peripheral and local serum may be one of pathogenesis leading to different types of hip fractures.Except for the IGFBP-4,the other factors may affect the bone metabolism of the senile hip fractures through different regulatory mechanisms.