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2024 Vol. 30, No. 4
Published: 2024-04-28
 
298 A Study of ASA Classification Predicting Hospital-acquired Infection After Hip Fracture Surgery in Elderly Patients
Wang Jun，Wang Hao
Objective To investigate the correlation between the American society of anesthesiologists(ASA) classification and the occurrence rate of postoperative hospital acquired infections(HAI)，as well as the duration of hospital stay，ICU stay，and hospitalization expenses in elderly patients with hip fractures；and to assess the utility of ASA classification in predicting postoperative HAI.Methods The data of elderly postoperative hip fracture patients admitted to ICU of Beijing Jishuitan Hospital from October，2021 to April，2022 were retrospectively analyzed.According to ASA grade，the patients were divided into ASA Ⅱ group and ASA Ⅲ group.There were 32 males and 51 females in ASA Ⅱ group，with a median age of 87 years old.There were 28 males and 35 females in the ASA Ⅲ group，with a median age of 86 years old.Gender，age，fracture site，anesthesia method，operation method，incidence of postoperative HAI，length of hospital stay，ICU stay and hospitalization cost were compared between the two groups.Multivariate Logistic regression analysis was used to explore the relationship between ASA grade and postoperative HAI.According to receiver operating characteristic(ROC)curve，the value of ASA classification in predicting postoperative HAI after hip fracture in elderly patients was obtained。Results A total of 146 subjects were included in the study，of which 13 had postoperative HAI(8.90%).Compared with ASA Ⅱ group，patients in ASA Ⅲ group had higher incidence of postoperative HAI，longer stay in ICU and more hospitalization costs，and there were statistical differences between the two groups (P＜0.05).Multivariate Logistic regression analysis showed that ASA classification was an independent risk factor for postoperative HAI.ROC curve showed that ASA classification could predict the occurrence of postoperative HAI after hip fracture in elderly patients，and the area under the curve was 0.770 (P＜0.05).Conclusion For elderly patients after hip fracture surgery，the incidence of postoperative HAI is higher in those with ASA Ⅲ，the length of ICU stay is longer，and the hospitalization cost is higher.ASA grade has a good predictive value for the occurrence of postoperative HAI.
2024 Vol. 30 (4): 298- [Abstract] ( 93 ) HTML (1 KB)  PDF (546 KB)  ( 60 )
302 A Study on the Correlation Between Knee Osteoarthritis Score Index and Coronary Biomechanics
Chen Lianwei，Li Xiao，Yin Shilin，Sun Zhipeng，Tian Xinyu，Du Shuangqing
Objective To analyzes the correlation between the Western Ontario and McMaster universities (WOMAC) arthritis index，coronary lower limb force line angle，and lumbar biomechanical factors in knee osteoarthritis (KOA) patients，providing new ideas for clinical diagnosis and treatment of KOA.Methods 267 KOA patients who visited the Department of Orthopedics and Traumatology at the First Affiliated Hospital of Hebei University of Chinese Medicine from October 2022 to May 2023 and met the inclusion criteria were selected.This group included 49 males and 218 females，aged 50~83 years，with an average age of (61.55±8.72)years old.X-rays of the lumbar spine combined with the full length of both lower limbs in a weight-bearing position were taken.The direction of lumbosacral deviation was observed，and the force line angle of the lower limbs in a coronal position was measured：hip-knee-ankle angle (HKA)，mechanical axis deviation (MAD)，joint line convergence angle (JLCA).Lumbar biomechanical factors were also measured：lumbosacral offset distance (LOD)，waist-knee offset distance (WKOD).The WOMAC score and baseline data of the subjects were recorded to analyze their differences.The correlation between coronal force line angle and lumbar biomechanical factors was then evaluated.Results There is a correlation between the direction of lumbosacral deviation and the severity of KOA pain (P＜0.05，r＝0.569).Furthermore，there is a correlation between LOD，WKOD，HKA，MAD，JLCA，disease duration，and WOMAC score (P＜0.05，r values are 0.585，0.579，－0.156，0.173，0.175，0.189，respectively).Conclusion There is a correlation between joint pain and functional limitation in KOA patients and the shift of the lumbar center of gravity and lower limb force line angle.The degree of joint stiffness in KOA patients is correlated with the duration of the disease，and the shift of the lumbar coronal center of gravity is one of the risk factors for inducing or exacerbating KOA.
2024 Vol. 30 (4): 302- [Abstract] ( 122 ) HTML (1 KB)  PDF (1981 KB)  ( 112 )
306 Effect of Different Anesthesia Modalities on Perioperative Blood Loss and Postoperative Complications in Total Knee Arthroplasty
Liao Yuanping，Cao Guorui，Shi Xiaotao，Wang Xiao，Deng Jie，Wang Yixuan，Tan Honglue
Objective To evaluate the effect of combined spinal epidural anesthesia and general anesthesia，on perioperative blood loss and postoperative complications in patients undergoing initial total knee arthroplasty(TKA).Methods The medical records of 3 568 patients who underwent initial unilateral TKA at Luoyang Orthopedic Hospital in Henan Province from January 2015 to December 2019 were collected for retrospective analysis.Of these，966 patients were in the combined spinal epidural anesthesia group，with 210 males and 756 females.Their ages ranged from 45 to 85 years old，with a mean age of (66.69±7.70)years old.Additionally，2 602 patients were in the general anesthesia group，including 597 males and 2 005 females.Their ages also spanned from 46 to 85 years old，averaging (66.63±7.56)years old.We further compared the general baseline indicators，encompassing diagnosis，coexisting diseases，blood volume，preoperative hemoglobin levels，preoperative haematocrit values，surgical side，and operation time.The objective was to analyze the total perioperative blood loss，intraoperative blood loss，allogeneic transfusion rate，drainage volume，as well as changes in hemoglobin and haematocrit levels in both groups.Furthermore，we documented the occurrence of postoperative complications，such as deep vein thrombosis，pulmonary embolism，nausea and vomiting，and electrolyte imbalances.Lastly，we evaluated the duration of postoperative hospitalization，rehabilitation outcomes including knee 〖CM(50〗mobility at one month postoperatively，and the cost of inpatient treatment in both anesthesia groups.Results Theperioperative total blood loss，maximum change in haemoglobin，and maximum change in haematocrit were (743.67±546.36)mL，(27.94±17.85)g/L，and (0.14±0.05)L/L in the combined spinal epidural anesthesia group，and (800.47±564.95)mL，(29.86±17.37)g/L，and (0.14±0.06)L/L in the general anaesthesia group.The former values were lower than the latter，and the difference was statistically significant (P＜0.05).However，there was no statistically significant difference in intraoperative blood loss，allogeneic transfusion rate，and drainage volume between the two groups (P＞0.05).The postoperative hospital stay of patients in the combined spinal epidural anesthesia group was slightly shorter than that of the general anaesthesia group (P＝0.04)，while the differences between the two groups were not statistically significant in terms of joint mobility and treatment costs at 1 month after operation (P＞0.05).The incidence of postoperative complications was also not statistically significant between the two groups (P＞0.05).Conclusion In patients undergoing initial unilateral TKA，combined spinal epidural anesthesia was more advantageous in controlling total perioperative blood loss and in shortening the postoperative recovery time.However，there were no significant advantages in terms of postoperative joint mobility and postoperative complication rates.
2024 Vol. 30 (4): 306- [Abstract] ( 107 ) HTML (1 KB)  PDF (834 KB)  ( 65 )
311 Comparison of the Application of Six-Axis External Fixator Based on CT Data and Internal Fixation in the Correction of Tibial Deformity
Xu Zhaochen，Chen Yongcheng，Zhang Baogang，Zhang Meng，Qiao Feng
Objective To investigate the clinical efficacy of six-axis external fixator based on CT data and internal fixation in the correction of tibial deformity.Methods The clinical data of 60 patients who underwent tibial deformity correction from January 2019 to January 2023 were retrospectively analyzed.According to the choice of operation，they were divided into internal fixation group(30 cases) and external fixation group(30 cases).There were 9 males and 21 females in the internal fixation group，with an average age of (32.83±7.73) years old.There were 15 males and 15 females in the external fixation group，with an average age of (31.17±8.43) years old.The surgical conditions，osteotomy healing time，postoperative complications and postoperative follow-up imaging measurement indicators were compared between the two groups.Results All patients were followed up for 6~15 months，with an average of (6.97±1.69) months.Compared with the internal fixation group，the incision length of the external fixation group was shorter (P＜0.05)，and the healing time of the osteotomy was longer (P＜0.05).There was no significant difference between the two groups in operation time，blood loss，ambulation time，hospitalization time and complications (P＞0.05).There was no significant difference in mechanical axis deviation(MAD)，femoro tibial angle(FTA)，medial proximal tibial angle(MPTA)，lateral distal tibial angle(LDTA)，lateral distal femoral angle(LDFA)，joint line convergence angle(JLCA)，and leg length discrepancy(LLD) between the two groups before operation(P＞0.05).There was no significant difference in FTA，MPTA，LDTA，LDFA and JLCA between the two groups after operation (P＞0.05).The MAD and LLD of the external fixation group were smaller than those of the internal fixation group，and the difference was statistically significant (P＜0.05).Comparison with preoperative，there were statistically significant differences in MAD，FTA，MPTA，LDTA and JLCA after operation in the internal fixation group (P＜0.05)，and there were statistically significant differences in MAD，FTA，MPTA，LDTA，JLCA and LLD after operation in the external fixation group (P＜0.05).Conclusion External fixator and internal fixation have the same clinical efficacy in the correction of tibial deformity，but external fixator has the advantages of small incision，small trauma，high accuracy and multiple adjustment after operation.It is especially suitable for patients with LLD and is worthy of clinical application.
2024 Vol. 30 (4): 311- [Abstract] ( 75 ) HTML (1 KB)  PDF (1613 KB)  ( 105 )
317 Comparison on the Clinical Efficacy of Two Locking Plates in the Treatment of Rüedi Ⅲ Pilon Fractures
Hu Dong，Shu Weiping，Chen Zhijun，Gong Bizhou，Zhou Lijian
Objective To compare the clinical effect of variable angle locking compression plate (VA-LCP) and a common locking compression plate (LCP) in the treatment of Rüedi Ⅲ Pilon fractures.Methods A retrospective analysis was conducted of the clinical data of 48 patients with Rüedi-Ⅲ Pilon fractures treated at the People's Hospital of Danyang from January 2018 to December 2020.Of these，17 patients received VA-LCP-based internal fixation (study group)，consisting of 11 males and 6 females，aged between 31 and 62 years old，with a mean age of (46.3±6.7)years old.Additionally，31 patients underwent traditional LCP-based internal fixation (control group)，including 22 males and 9 females，aged from 36 to 67 years old，with a mean age of (48.7±7.6)years old.Data on operation time，hospital stay，incision healing，fracture healing，and complications were collected during follow-up.Postoperative X-rays were used to determine the Burwell-Charnley radiological score，and the American orthopaedic foot and ankle society(AOFAS) ankle-hindfoot score was employed to assess ankle joint function at the final follow-up.Results All patients were followed up for 12 to 18 months，with an average follow-up time of (15.2±4.4)months.There were no significant differences between the two groups in terms of age，gender，fracture side，preoperative waiting time，operation time，and fracture healing time，as well as postoperative radiological evaluation of Burwell-Charnley fracture reduction (P＞0.05).In the study group，the AOFAS score at the last follow-up ranged from 70 to 95，average (85.4±11.3)，with 11 excellent cases，4 good cases，2 fair cases，resulting in an excellent and good rate of 88.2%.Ankle plantar flexion was 36 ° to 51 °，average (40.3±7.5)°，and dorsiflexion was 16 ° to 25 °，average (20.7±3.6)°.In the control group，the AOFAS score ranged from 56 to 94，average (81.2±14.6)，with 18 excellent cases，8 good cases，5 fair cases，resulting  in an excellent and good rate of 83.9%.Ankle plantar flexion was 32 ° to 50 °，average (37.4±8.5)°，and dorsiflexionwas 13 ° to 22 °，average (18.1±3.6)°.There was no significant difference in ankle function between the two groups.The incidence of soft tissue complications in the study group was better than that in the control group，and the difference was statistically significant (P＜0.05).In the study group，there was 1 case of grade B healing of the incision.In the control group，there were 1 case of incision infection，5 cases of grade B healing，1 case of nerve irritation，and 4 cases of tendon irritation.Conclusion Both VA-LCP and LCP can achieve good clinical efficacy in the fixation of Rüedi-Ⅲ pilon fractures，and be selected on the condition of the fracture.
2024 Vol. 30 (4): 317- [Abstract] ( 92 ) HTML (1 KB)  PDF (2080 KB)  ( 155 )
322 Finite Element Study on the Effect of Acetabular External Edge Defect on the Initial Stability Of Acetabular Prosthesis
Gu Bin，Wang Yue
Objective To explore the critical condition of initial stable acetabular defect in total hip arthroplasty (THA) by using three-dimensional finite element method.Methods The three-dimensional pelvic model was reconstructed by computer software，and different external defects of acetabulum were designed.The coverage rate of acetabulum cup under different defect models and the critical frettage displacement of acetabulum cup relative to host bone were calculated.Results When α=－25 °，the maximum displacement of acetabulum relative to host bone was 39 μm，〖JP〗and the acetabulum coverage was 67.1%，which reached the critical value of acetabulum stability.Conclusion During total hip replacement with biological prosthesis，the bone coverage of the acetabular cup should be maintained at least 67.1% without additional fixation to ensure the initial stability of the acetabular cup implantation with normal gait.
2024 Vol. 30 (4): 322- [Abstract] ( 89 ) HTML (1 KB)  PDF (2007 KB)  ( 80 )
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