Vascular surgical audit-arterial reconstructions and amputations for lower limb ischaemia

There were 750 arterial reconstructions and 2134 major amputations in hospitals within the South West Regional Health Authority (SWRHA) from 1974-1978, according to a Hospital Activity Analysis (HAA) based survey of all patients undergoing these operations for atherosclerotic limb ischaemia. Those undergoing arterial reconstruction fared better than amputees in terms of hospital mortality (5.2% vs. 21%) and length of hospital stay (21.4 days vs. 47 days). Comparison of the HAA results with case records and operating theatre books at Bristol Royal Infirmary showed a failure-of-inclusion rate of 10% for arterial reconstructions and 9.3% for amputations. There was a difference in the proportion of arterial reconstructions to major amputations (2.5:1) at Bristol Royal Infirmary compared with SWRHA hospitals (1:3), but hospital stay and operative mortality were similar.     

Vascular diseases in orthopedic practice

From 1.4.1995 to 30.3.1997 1861 patients had been treated in orthopedic practice. In 52 cases deep vein thrombosis was detected. We found severe varicosis in 169 legs. A complete occlusion of the arteria femoralis superficialis or arteria popliteal was found in 16 legs, an aneurysm of the femoral or popliteal artery was seen in 5 legs.     

Vascular complications in orthopedic surgery

Vascular complications may be seen secondary to trauma or in the perioperative period following elective surgery. Prompt recognition and correction of these problems are of utmost importance to assure functional viability of the affected extremity. Evaluation may be complicated by the presence of preexisting atherosclerotic occlusive disease in the elderly patient. Relevant points in the history and physical examination include mechanism of injury, preexisting disease, evaluation of motor and sensory function, and presence and character of pulses. Noninvasive vascular studies should be obtained in all patients. Absolute indications for angiography include absent pulses, signs and symptoms of ischemia, a bruit, and a posterior knee dislocation; decreased pulses, a significant hematoma, and proximity of the fracture fragment are relative indications. Controversial issues in the management of combined orthopedic and vascular injuries include the use of internal versus external fixation, the use of prosthetic versus autogenous material, and the need for venous reconstruction. Popliteal artery trauma is still associated with a high limb loss rate, and careful evaluation of knee injuries is necessary. Vascular compromise may also complicate joint replacement surgery. These complications are preventable, and management is greatly simplified by a detailed preoperative evaluation.     

Fever following orthopedic operations in children

One hundred fifty-three orthopedic operations in 129 children were analyzed for the significance of postoperative fever (POF) as a predictive factor for possible complications. In 72% of the operations, a temperature of greater than 37 degrees C was recorded. In 63 operations (41%), the temperature was greater than 38 degrees C. Sixteen children had positive clinical signs that might explain the fever, and all of them had a temperature of greater than 38 degrees C. Duration of operation of greater than 1 h, clubfoot releases, open reduction of fractures, and spine fusion operations gave higher incidences of POF. POF indicates a complication only when associated with positive physical findings. A postoperative temperature of greater than 38 degrees C, therefore, mandates repeated physical examination, which is the most reliable method of discovering the presence of complications.     

Practical application of computer-generated three-dimensional reconstructions in orthopedic surgery

There are some special technical requirements of CT scans used in producing three-dimensional reconstructions. There are few purely diagnostic applications for this technique, but there will be many future applications in the realm of surgical planning once reasonably priced, interactive systems are available.     

Vascular operations in nonagenarians

This is a retrospective study describing our experience with vascular surgical procedures performed in patients 90 years of age or older. Thirty-four procedures, including major and minor vascular reconstruction and amputation, were performed in 20 patients. The 30-day mortality rate was 6% for planned surgical procedures. The 24-month survival rate was 82% for elective major revascularizations and limb salvage was 80% in these patients. We believe that vascular reconstruction can be carried out with acceptable morbidity and mortality when the operations are planned and the patients have been chosen carefully.Presented at the International Society for Cardiovascular Surgery, Twenty-first World Congress, Lisbon, Portugal, September 12–15, 1993.     

围术期自体输血综合措施在骨科手术中的应用

目的：观察骨科重大手术围术围术期综合应用自体血回输措施的适用价值。方法：20例骨科重大手术,包括脊柱侧弯矫治术,髋,膝关节置换术等。均于全麻后手术前行急性等容血液稀释（ANH）,采血200－400ml,术中使用洗涤式血液回收机回收术野出血,以洗涤红细胞的形式回输,术后除脊椎侧弯矫治术外,其余病例均回收手术创面引流血经过滤后回输,结果：除3例脊 侧弯矫治术术中输入库血外,其他病例均可做到不输库血,ANH期间血液动力学稳定,术中自体血回收后以洗涤红细胞回输及术后创面引流血回输,均未见输血并发症。结论：应用ANH,术中自体血及术后引流回收的综合措施可有效地减少输入库血。     

Cost effectiveness of blood substitution in elective orthopedic operations

Cost effectiveness was compared between substitution with autologous blood, implying no risk of transmission of diseases, and homologous blood, with a definite risk of transmission. Primary and revision hip arthroplasties were included in this study, as well as scoliosis operations. The risk of contracting chronic non-A, non-B hepatitis (NANBH) was included in the calculations of the long-term economic consequences of a transmittable disease. Our study showed that predonated blood alone, with a donation of up to four units, was the most suitable and cost-effective method for substitution of blood losses up to about 2.5-3 liters A combination of predonated blood and intraoperative autotransfusion was more suitable and less expensive for substituting blood losses of 2.5 liters or more. Homologous blood was the least cost-effective alternative considering the influence of non-A, non-B hepatitis.     

Cost effectiveness of blood substitution in elective orthopedic operations

Cost effectiveness was compared between substitution with autologous blood, implying no risk of transmission of diseases, and homologous blood, with a definite risk of transmission. Primary and revision hip arthroplasties were included in this study, as well as scoliosis operations. the risk of contracting chronic non-A, non-B hepatitis (NANBH) was included in the calculations of the long-term economic consequences of a transmittable disease.

Our study showed that predonated blood alone, with a donation of up to four units, was the most suit-able and cost-effective method for substitution of blood losses up to about 2.5-3 liters A combination of predonated blood and intraoperative autotransfusion was more suitable and less expensive for substituting blood losses of 2.5 liters or more. Homologous blood was the least cost-effective alternative considering the influence of non-A, non-B hepatitis.     

Conduction anesthesia in orthopedic operations in injuries of the extremities

An analysis of results of using conduction anesthesia for various operations on extremities of 274 patients of different age groups has been made. Complete effects were achieved in 91% of the patients, 5% of the patients were potentiated with neuroleptanalgesia drugs because of insufficient anesthesia, in 2% of the patients general anesthesia was used. The method of conduction anesthesia makes it possible to use a conveyer method of bringing patients to the operating room. It is more economical as compared with narcosis, easy in use. It may be recommended for wider use.     

Simultaneous operations in surgical practice

Simultaneous operations (SO) is an actual problem of abdominal surgery. Two-three surgical diseases can be treated simultaneously thus shortening the total period of the patient's staying at hospital, increasing the economical efficiency of the treatment. An analysis of 192 SO on 94 patients and of 42 laparoscopic SO has been made. Considerable difficulties in performing planned surgical care due to specific conditions of the region make the SO in the Amur regional clinic a perspective method of improving the population health and prophylactics of progressing surgical diseased in the Amur oblast.