ObjectiveTo analyze the effectiveness of fast track protocol of geriatric intertrochanteric fracture on operative waiting time, operation time, perioperative blood loss, providing data support for clinical therapy.MethodsThe clinical data of 240 elderly patients with intertrochanteric fracture admitted between January 2015 and December 2018 were retrospectively analyzed. They were divided into traditional protocol group (148 cases, group A) and fast track group (92 cases, group B). All patients were treated with closed reduction intramedullary nail (proximal femoral nail antirotation) surgery. There was no significant difference in gender, age, sides, fracture classification, fracture type, complications, the proportion of patients with more than 3 kinds of medical diseases, and the time from injury to admission between the two groups (P>0.05). Analysis index included operative waiting time (hospitalization to operation time), operation time, percentage of operation performing in 48 and 72 hours, percentage of transfusion, changes of hematocrit (Hct) at different stage (admission, operation day, and postoperative 1, 3 days), blood loss by fracture and cephalomedullary nail, intraoperative dominant blood loss, total blood loss in perioperative period were recorded and compared.ResultsThe operative waiting time, operation time, Hct on operation day and postoperative 3 days, blood loss by fracture, transfusion volume, and total blood loss in perioperative period in group B were significantly less than those in group A (P<0.05), and the percentage of operation performing in 48 and 72 hours in group B were significantly higher than those in group A (P<0.05). There was no signifcant difference in Hct on admission and postoperative 1 day, intraoperative dominant blood loss, percentage of transfusion, blood loss by cephalomedullary nail between the two groups (P>0.05).ConclusionFast track can shorten the operative waiting time of geriatric intertrochanteric fracture, reduce the blood loss by fracture, total blood loss in perioperative period, and transfusion volume. Early operation is conducive to improve the anemia status of patients during perioperative period.
Objective To evaluate the effect of pneumatic tourniquet on perioperative period of total knee arthroplasty (TKA). Methods The perioperative period data of 116 patients over 60 years old with severe knee osteoarthritis treated with TKA between January 2018 and January 2019 were retrospectively analyzed. According to whether pneumatic tourniquet was used during operation, the patients were divided into trial group (49 cases, pneumatic tourniquet was not used during operation) and control group (67 cases, pneumatic tourniquet was used during operation). There was no significant difference in gender, age, body mass index, lesion side, disease duration, and preoperative hemoglobin between the two groups (P>0.05). The operation time, actual total blood loss, overt blood loss, hidden blood loss, and percentage of hidden blood loss, knee swelling at 3 days after operation, and range of motion of knee at 2 weeks after operation were recorded and compared between the two groups. Results The operation time of the trial group was significantly longer than that of the control group (t=14.013, P=0.000). The actual total blood loss, hidden blood loss, and percentage of hidden blood loss in the trial group were significantly lower than those in the control group (P<0.05); there was no significant difference in the overt blood loss between the two groups (t=?1.293, P=0.200). The knee swelling degree in the trial group was significantly slighter than that in the control group at 3 days after operation, and the range of motion of knee in the trial group was significantly better than that in the control group at 2 weeks after operation (P<0.05). Conclusion Pneumatic tourniquet can reduce the operation time of TKA significantly. However, it may increase the hidden blood loss and knee swelling, and negatively impact the recovery of knee function in the early postoperative stage of TKA.
ObjectiveTo compare the effectiveness of endoscopic anterior cervical discectomy and fusion (Endo-ACDF) and microscope-assisted ACDF (Micro-ACDF) in the treatment of single-level cervical spondylotic myelopathy (CSM). MethodsA retrospective analysis was conducted on the clinical data of 44 patients with single-level CSM who underwent ACDF between February 2022 and January 2024 and met the selection criteria. These patients were divided into Endo-ACDF group (22 cases) and Micro-ACDF group (22 cases). There was no significant difference (P>0.05) between the two groups in baseline data, including gender, age, body mass index, disease duration, surgical level, and preoperative Japanese Orthopaedic Association (JOA) score, Cobb angle, and the degree of prevertebral soft tissue swelling (PSTS) at C2-6. The operation time, postoperative hospital stay, intraoperative blood loss, postoperative drainage volume, total blood loss, and hidden blood loss were recorded and compared between the two groups. The Cobb angle and PSTS degree at C2-6 were measured based on X-ray films at 2-3 days after operation. The JOA score was used to assess spinal cord function at 1 year after operation. The differences between pre- and post-operation (change values) in these indicators were calculated and compared between groups. Results All operations in both groups were successfully completed. Compared to the Micro-ACDF group, the Endo-ACDF group had significantly longer operation time and significantly lower total blood loss and hidden blood loss (P<0.05). No significant difference was found between the two groups in intraoperative blood loss, postoperative hospital stay, or postoperative drainage volume (P>0.05). No operation-related complication occurred during or after the procedures. All patients were followed up 12-16 months (mean, 13.9 months). At 1 year after operation, the JOA scores and Cobb angles in both groups showed significant improvement compared to preoperative values (P<0.05). However, the change values for JOA scores and Cobb angles showed no significant difference between the groups (P>0.05). The postoperative PSTS degree at C2-6 was significantly different from preoperative values in both groups (P<0.05), but the change value did not differ significantly between the two groups (P>0.05). The imaging re-examination showed the satisfactory positioning of the cages and internal fixation.ConclusionBoth Endo-ACDF and Micro-ACDF provide satisfactory effectiveness in treating single-level CSM, with no significant difference in the PSTS degree. Furthermore, Endo-ACDF is associated with less hidden blood loss.