Influence of obstructive sleep apnea on postoperative cognitive dysfunction in elderly patients undergoing joint replacement.

OBJECTIVE: To clarify the influence of obstructive sleep apnea (OSA) on postoperative cognitive dysfunction (POCD) in elderly patients undergoing joint replacement. METHODS: This study retrospectively enrolled130 patients who underwent joint replacement in the Department of Orthopaedics of Taizhou Municipal Hospital between January 2019 and March 2021 for analysis. According to polysomnography (PSG) results, 80 patients without OSA were included in group A and 50 with OSA were assigned to group B. The two groups were compared with respect to the following items: surgical indications (length of stay (LOS), intraoperative blood loss (IBL) and operation time (OT), incidence of postoperative delirium (POD), postoperative cognitive function (Mini-mental State Examination, MMSE), neurological function recovery (National Institutes of Health Stroke Scale, NIHSS) and (Scandinavian Stroke Scale, SSS)), mental health (Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS)), compliance, overall response rate (ORR), complications and patient satisfaction. RESULTS: The LOS and OT were shorter, and the IBL was less in group A compared with those in group B. Group A also showed reduced NIHSS and SSS scores as well as SAS and SDS scores when compared with group B. In addition, lower incidence of POD, and higher compliance, ORR and satisfaction were observed in group A than in group B. In terms of cognitive function, although the MMSE score in both groups decreased after surgery, patients in group B had a lower MMSE score and a milder form of POCD. CONCLUSIONS: OSA may affect the postoperative cognitive function and adversely influence the treatment outcome of elderly patients undergoing joint replacement.

[Effect of changes of inflammatory factors on prognosis of tibia plateau Schatzker â ¢ fractures treated under arthroscopic or open reduction and internal fixation].

OBJECTIVE: To explore changes of inflammatory factors on prognosis of tibia plateau Schatzker Ⅲ fractures treated under arthroscopic or open reduction and internal fixation. METHODS: From November 2013 to November 2016, clinical data of 30 patients with tibia plateau Schatzker Ⅲ fractures were retrospectively analyzed, and divided into minimally invasive group and control group according to different surgical methods 15 patients in each group. Minimally invasive group were treated by arthroscopic internal fixation, including 8 males and 7 females, aged from 20 to 50 years old with an average of (35.0± 14.6) years old, the time from injury to operation ranged from 7 to 15 days with an average of (11.0±4.1) days. Control group were treated by open reduction and internal fixation, including 7 males and 8 females, aged from 18 to 48 years old with an average of (33.0±13.6) years old, the time from injury to operation ranged from 6 to 14 days with an average of (10.0±3.4) days.Operation time, length of incision, blood loss, postoperative loading time and fracture healing time, complications were compared between two groups. Level of IL-1ß, IL-6, TNF-α were detected at 3 days, 6 months and 12 months after operation, Lysholm knee function score at 6 and 12 months were compared between two groups. RESULTS: Allpatients were followed up, but there was no significant difference in following up between two groups. Operation time, length of incision, blood loss, postoperative loading time, fracture healing time and cases of complications in minimally invasive group were (80.3±9.7) min ,(4.2± 1.0) cm ,(102.2±26.4) ml ,(30.0±10.0) d ,(70.0±5.0) d and 0 case respectively; while in control group were (90.3±9.1) min, (10.5±1.1) cm ,(221.1±46.8) ml ,(50.0±15.0) d ,(90.0±6.0) d and 2 cases respectively; there were significant difference between two groups. Lysholm score in minimally invasive group 89.2±5.1 was higher than that of control group 80.1±3.1; and score of swelling, squat and pain in minimally invasive group was higher than that of control group at 6 months after opertaion. While there were no significant difference in each items and total score of Lysholm score between two groups at 12 months after operation. Level of IL-1ß, IL-6, and TNF-α in minimally invasive group at 3 days and 6 months were [(52.1±20.1) pg/L, (0.9±0.1) pg/L ],[(56.1±20.1) pg/L ,(1.1±1.3) pg/L ] and [(28.3±2.5) pg/L ,(8.4±1.5) pg/L ] respectively; while in control group were [(64.8±9.1) pg/L ,(8.1±2.1) pg/L ],[(65.8±12.3) pg/L ,(9.1±5.3) pg/L ] and [(38.5±2.3) pg/L ,(26.5± 1.4) pg/L ] respectively; there were statistically difference in level IL-1ß, IL-6 and TNF-α between two groups at 3 days and 6 months after operation; while there was no difference at 12 months after operation (P>0.05) . Inflammatory cytokines level at 3 days after operation IL-1ß [OR=1.279, 95%CI (1.047, 1.512), P<0.05 ], IL-6 [OR=1.687, 95%CI (1.478, 1.888), P<0.05 ], TFN-α [ OR=2.096, 95%CI (1.863, 2.316), P<0.05 ] was an independent risk factor for Lysholm knee function score at 6 months after operation. CONCLUSION: Arthroscopic surgery and open surgery also could obtain good clinical effects in treating tibia plateau Schatzker Ⅲ fractures. Arthroscopic internal fixation could shorten operation time, lessen the mount of blooding with minimally invasive, lower occurrence of postoperative complications, faster recovery of knee function.

[Analysis of hidden blood loss after percutaneous kyphoplasty for osteoporotic vertebral compression fracture and its influencing factors].

OBJECTIVE: To investigate the hidden blood loss and related risk factors of osteoporotic vertebral compression fractures after percutaneous kyphoplasty. METHODS: The clinical data of 153 patients with osteoporotic vertebral compression fractures who underwent percutaneous kyphoplasty from March 2015 to December 2017 were retrospectively analyzed, including 55 males and 98 females, aged 68 to 87(78.6±11.4) years old. Erythrocyte specific volume was collected before and after operation to calculate the hidden blood loss. The influence of sex, age, body mass index, bone mineral density, diabetes mellitus and hypertension, operation mode (unilateral or bilateral), operation time, operative segment and number, loss height of vertebral body and recovery height ratio on hidden blood loss was analyzed by multiple linear regression model. RESULTS: Postoperative hidden blood loss was (287.7±68.5) ml. Multivariate linear regression analysis showed that the history of diabetes mellitus (ß=2.405, P=0.012), the mode of operation(ß=3.042, P<0.001), the time of operation (ß=2.043, P=0.038), the operative segment (ß=1.993, P=0.043), the number (ß=0.374, P<0.001), the loss of vertebral height (ß=2.785, P=0.003) and the recovery ratio(ß=7.301, P<0.001) were correlated with occult hemorrhage. CONCLUSIONS: There is a certain degree of occult hemorrhage in kyphoplasty for osteoporotic vertebral compression fractures. The risk factors of hidden hemorrhage are diabetes history, operation method, operation time, operative segment and number, loss of vertebral height and recovery ratio.

[Clinical applications of sternoclavicular hook plate for the treatment of sternoclavicular joint dislocation].

OBJECTIVE: To observe the clinical therapeutic effects of sternoclavicular hook plate for the treatment of sternoclavicular joint dislocation. METHODS: From June 2010 to June 2012, 7 patients with sternoclavicular joint dislocation were treated with sternoclavicular hook plate fixation. Among the 7 patients, 5 patients were male and 2 patients were female, and the average age was 42.3 years, ranging from 38 to 54 years. The course of the disease ranged from 1 to 4 weeks. All the patients had trauma history. The clinical manifestations included: obvious swelling and pain of sternoclavicular joint, restricted shoulder joint activity. The sternoclavicular joint dislocation was proved by preoperative X-ray and CT. The postoperative curative effect was evaluated according to Rockwood scoring method. RESULTS: According to Rockwood scoring method, the excellent results obtained in 6 cases, good in 1. There were no complications such as internal fixation loosening or broken, second dislocation, pain in the sternoclavicular joint, and deformity. The function of shoulder joint was good, and the limb activity was free and no pain appeared. CONCLUSION: The sternoclavicular hook plate for the treatment of sternoclavicular joint dislocation has follow advantages: simple procedure, stable fixation, definite therapeutic effects.

[Experimental study on treatment of femoral head necrosis with arterial perfusion of marrow stem cells].

OBJECTIVE: To explore the effect of arterial perfusion of marrow multifunctional stem cells (MFSC) in treating femoral head necrosis and its mechanism. METHODS: The rabbit model of femoral head necrosis was established by large dose of methyl-prednisone through Shwartzman response. Bone marrow was extracted from femoral bone of model rabbit and isolated in vitro for culturing and proliferating MFSC. The experimental rabbits were randomly divided into 4 groups, treated with normal saline (A), Salvia + urokinase (B), MFSC (C) and MFSC + Salvia + urokinase (D), respectively, they were sacrificed in batches at 2 and 4 weeks after treatment, and changes in various parameters, including molybdenum target roentgenogram, routine pathology with HE staining, tetracycline labeled fluorescent microscopy and ultrastructure alteration by scanning electron microscope (SEM), were observed. RESULTS: Typical appearance of femoral head necrosis was shown in the successfully modeled rabbits. Two and 4 weeks after treatment by high selective drug via medial and lateral femoral circumflex arterial perfusion, the X-ray examination showed significant improvement of bone density; pathohistologic manifestation showed decrease of empty bone lacuna, increase of osteoblast and new bone formation; tetracycline fluorescent labeled microscopic picture showed bright fluorescent band of increased osteoblasts in necrosis repairing region with widened border; SEM displayed irregularly arranged fibrosis in necrosis region, abundant organelles in osteoblasts with few empty bone lacuna. The above-mentioned improvement was more significant in rabbits treated by MFSC. CONCLUSION: High selective femoral drug arterial perfusion in treating femoral head necrosis could accelerate the process of revascularization and re-ossification in rabbits. As compared with Salvia, MFSC showed quicker and more potent effect.