The effects of a pneumatic tourniquet on blood loss in total knee arthroplasty.

OBJECTIVE: In lower-extremity surgery there are significant risks associated with the use of tourniquets. This prospective study was done to assess to what extent these risks may be offset by the potential advantages of tourniquets, namely reductions in blood loss, length of hospital stay and complication rates. DESIGN: A prospective case study. SETTING: A major urban hospital. PATIENTS: Sixty-three consecutive patients scheduled for primary cemented total knee arthroplasty (TKA) were blindly randomized into tourniqet (n = 33) and non-tourniquet (n = 30) groups. INTERVENTION: TKA during which a pneumatic tourniquet was applied or not applied to control blood loss. MAIN OUTCOME MEASURES: Perioperative blood loss, operating time, complication rates, hospital stay and transfusion needs. RESULTS: Differences in the total measured blood loss, intraoperative blood loss and the Hemovac drainage blood loss between the 2 groups were not significantly different (p > 0.25). The calculated total blood loss was actually lower in the non-tourniquet group (p = 0.02). Between the groups there were no statistical differences in surgical time, length of hospital stay, transfusion requirements or rate of complications (although there was a trend to more complications in the tourniquet group (p = 0.06)). CONCLUSION: The effectiveness of a pneumatic tourniquet to control blood loss in TKA is questionable.     

高凝血状态患者人群全膝关节置换术中应用止血带的对照研究

目的探讨高凝血状态患者人群全膝关节置换术中不同止血带应用方式对围手术期出血的影响。 方法采用随机对照研究,对比观察92例使用不同止血带应用方式的全膝关节置换术患者,纳入标准：血浆D-二聚体>1 000 μg/L(酶联免疫荧光法),随机分为半程止血带组(n＝46)和全程止血带组(n＝46),半程止血带组在安装假体时使用止血带,全程止血带组手术全程使用止血带,记录两组患者手术时间、术后引流量、隐性失血量、失血总量、血红蛋白丢失量、输血率、平均输血量、膝关节活动度、疼痛评分、膝关节活动度、肢体肿胀及并发症情况,用SPSS 19.0软件对两组结果进行比较,手术时间和引流量等计量资料采用t检验,并发症等计数资料采用χ²检验。 结果半程止血带组术后引流量、隐性失血量、总失血量、血红蛋白丢失量、疼痛评分、肢体肿胀及并发症发生率显著低于全程止血带组(t＝－7.432、－15.72、－2.205、－2.746、－3.070、－5.525,P<0.05),半程止血带组手术时间、膝关节活动度显著高于全程止血带组(t＝8.098,t＝2.290,P<0.05),两组术后输血率和平均输血量比较差异无统计学意义(χ²＝0.956,t＝－0.329,均为P>0.05)。所有患者均无症状性肺栓塞、感染及伤口皮缘坏死发生。 结论高凝血状态患者行全膝关节置换术中半程使用止血带止血效果优于全程止血带,止血带相关并发症发生率低于全程使用止血带组。     

不同止血带使用方法对TKA围手术期失血量影响的临床研究

目的研究人工全膝关节置换术（TKA）中两种不同止血带使用方法对围手术失血总量的影响。方法选取2009年1月至2010年6月60例60～75岁单侧TKA患者进行研究,随机分成A组（30例,术中采用截骨完成后使用止血带至手术结束）和B组（30例,术中采用全程在止血带下完成手术）,所有手术均由同一组医师完成,比较A、B两组患者围手术期总失血量、显性出血量、隐性失血量、输血比例、输血量及手术时间的差异。结果 A组在显性失血量、手术时间较B组明显增加,差异有统计学意义（P〈0.05）;而在围手术期总失血量、隐性失血量、输血比例、输血量A组较B组明显减少,差异有统计学意义（P〈0.05）。结论在TKA手术当中截骨完成后开始使用止血带的方法,是一种能够明显减少围手术期总失血量、降低输血比例及输血量的新手术方式,同时减少了手术后并发症的发生率。     

Impact of Bariatric Surgery on Inpatient Complication,Cost, and Length of Stay Following Total Hip or Knee Arthroplasty

BackgroundMorbid obesity is an important risk factor for arthroplasty and also closely associated with worse postoperative outcomes. Bariatric surgery is effective in losing weight and decreasing comorbidities associated with obesity. However, no study had demonstrated the influence of bariatric surgery on the outcome of arthroplasty in a large population.MethodsWe used 2006-2014 discharge records from the Nationwide Inpatient Sample, and identified study population and inpatient complications by International Classification of Diseases, 9th Revision, Clinical Modification diagnosis/procedure codes. Propensity score analysis was used to match total hip arthroplasty (THA) or total knee arthroplasty (TKA) patients with morbid obesity and THA or TKA patients with bariatric surgery.ResultsProportion of morbid obesity in both TKA and THA patients demonstrated a rising trend, while proportion of bariatric surgery in morbidly obese TKA and THA patients remains steady after 2007. For THA patients, there was fewer pulmonary embolism, more blood transfusion and anemia, and shorter length of stay in bariatric surgery group. For TKA patients, bariatric surgery group had a lower risk of pulmonary embolism, respiratory complications, death, and shorter length of stay, but bariatric surgery group had a higher risk of blood transfusion and anemia.ConclusionThere is evidence that bariatric surgery prior to arthroplasty, especially THA, appears to reduce rates of pulmonary complications and length of stay. But anemia and blood transfusion seem to be more common in patients with prior bariatric surgery.     

减少全膝关节置换术围手术期出血的探讨

背景：全膝关节置换术（TKA）是关节外科失血较多的手术之一,如何有效降低TKA围手术期失血一直是关节外科医师研究的重点。 目的：通过术中选择性应用止血带及术后适当关闭引流管对TKA失血量的影响,探讨减少TKA围手术期失血量的方法。方法：2013年1月至2013年5月,因膝骨关节炎拟行单膝TKA患者53例,根据术中应用止血带方式及术后引流管开放形式分为两组。观察组30例,采用截骨完成后短期应用止血带联合术后早期夹闭4 h引流管;对照组23例,术中全程使用止血带及术后引流管处于自然开放引流状态。记录术中出血量及术后引流量,根据患者身高、体重和手术前后红细胞压积（Hct）,通过Gross方程计算患者的总失血量,进而得出隐性失血量,记录两组术后输血的病例数,并计算平均输血单位,记录术后1、3、5 d的晨起体温,记录出院前后膝关节功能评分（HSS）。 结果：观察组的术中出血量明显多于对照组,术后引流量少于对照组,总出血量及隐性失血量少于对照组,均存在统计学差异（P＜0.05）;观察组的输血例数及平均输血单位均少于对照组;两组的围手术期晨起体温、膝关节HSS功能评分无统计学差异（P＞0.05）。 结论：采用截骨完成后短期应用止血带联合术后早期夹闭4 h引流管可明显减少TKA围手术期出血量。     

不同间隔时间双侧膝关节置换术的安全性与经济成本对比

目的 比较不同间隔时间的双侧全膝关节置换术(total knee arthroplasty,TKA)的安全性与经济成本.方法 回顾性分析我院2011年4月至2015年11月收治的双侧膝骨性关节炎病人155例,按照双侧TKA手术的间隔时间分为三组,一期完成手术者52例纳入一期组,非同一入院周期行分期TKA的51例纳入非同期分期组,同一入院周期行TKA的52例纳入同期分期组.记录三组病人的术前一般资料、手术时间、输血率、平均输血量、住院时间、住院费用、术后并发症、术后美国特种外科医院(the hospi-tal for special surgery,HSS)膝关节评分及疼痛视觉模拟量表(visual analogue scale,VAS)评分.结果 三组病人术后各时间点的HSS评分、VAS评分比较,差异均无统计学意义(P均>0.05);一期组的手术时间最短、住院时间最短、住院费用最低,但输血率及平均输血量最多;非同期分期组的住院时间最长、住院费用最高;同期分期组的住院时间及费用均居中.三组均无感染及死亡病例,一期组发生下肢深静脉血栓1例(1.92%)、心脑血管疾病3例(5.77%)、切口愈合不良2例(3.85%),并发症总发生率为11.54%;非同期分期组和同期分期组各发生2例切口愈合不良(3.92%、3.85%).结论 对于术前一般情况相对较差且必须行双侧TKA的病人,同一入院周期内行分期手术是一种更安全、经济的手术方式.     

Randomized Prospective Comparative Study of Adductor Canal Block vs Periarticular Infiltration on Early Functional Outcome After Unilateral Total Knee Arthroplasty

BackgroundTotal knee arthroplasty (TKA) is associated with significant postoperative pain. Effective pain relief is essential for early postoperative rehabilitation. Periarticular infiltration (PAI) and adductor canal block (ACB) have become popular modes of pain management after TKA. Our aim is to compare their efficacy and impact on early functional outcome in patients undergoing TKA.MethodsA single-blinded randomized controlled trial, 100 patients undergoing unilateral primary TKA for symptomatic osteoarthritis were allocated to either of the 2 groups (50 in each arm): postoperative ultrasound-guided single shot of ACB (group A) or intraoperative PAI (group B). All patients underwent TKA without patella resurfacing under spinal anesthesia. Preoperative workup, surgical technique, and postoperative management were standardized for all the patients. Patients were assessed for pain using visual analogue scale at 6, 12, and 24 hours after surgery; hemoglobin level preoperatively and postoperatively on day 1 to calculate blood loss; hospital stay; tourniquet time; operative time; and postoperative complications by an independent observer blinded to the group allocation.ResultsPatients were matched for age, gender, American Society of Anesthesiologists grade, and deformity. Visual analogue scale (scale 0-10) between PAI and ACB at 6, 12, and 24 hours were significantly different (P < .05) with higher scores seen in patients with ACB at all time points. Tourniquet time and operative time were significantly longer in the PAI than ACB. No significant difference in hospital stay was observed. No complications occurred during the study.ConclusionPAI achieves better pain control as compared to ACB in patients undergoing unilateral TKA.     

Quantification and comparison of pulmonary emboli formation after pneumatic tourniquet release in patients undergoing reconstruction of anterior cruciate ligament and total knee arthroplasty

The amount of emboli formed (percentage of total emboli area to the right atrial area [%Ae]) after tourniquet release in invasive procedures of the medullary cavity is empirically much larger than that in noninvasive procedures, even if the tourniquet duration is similar. Thus, we compared %Ae between arthroscopic reconstruction of the anterior cruciate ligament (ACL, n = 20) and total knee arthroplasty (TKA, n = 20). The right atrium was continuously monitored by transesophageal echocardiography to assess %Ae. Peak %Ae +/- SD (ACL, 4.1% +/- 3.4%; TKA, 20.7% +/- 16.7%) appeared 30-40 s after tourniquet release in both groups. However, %Ae in the TKA group was always larger than the peak %Ae in the ACL group. In addition, although the ET(CO(2)) significantly increased after tourniquet release in both groups, increase of ET(CO(2)) (1.1% +/- 0.3%) in the ACL group was significantly larger than that in the TKA group (0.5% +/- 0.2%). An increase in ET(CO(2)) was inversely proportional to peak %Ae (P < 0.01; r = 0.703). Therefore, the present data suggest that the risk of acute pulmonary embolism after tourniquet release may be more frequent during TKA than ACL. IMPLICATIONS: We compared emboli formation after tourniquet release in patients undergoing arthroscopic reconstruction of the anterior cruciate ligament (ACL, n = 20) and total knee arthroplasty (TKA, n = 20) using transesophageal echocardiography. The present data suggest that the risk of acute pulmonary embolism after tourniquet release could be more frequent during TKA than ACL.     

Incorporating laparoscopic fellowship does not increase morbidity or mortality in a university-based bariatric practice

BACKGROUND: Minimally invasive surgery (MIS) fellowship is one of the most sought-after positions after residency. The increased use of bariatric operations has provided an abundance of advanced cases. The aim of this article is to determine if the addition of an MIS fellowship program has any impact on morbidity and mortality in a university-based bariatric program. STUDY DESIGN: Data from all laparoscopic gastric bypasses (LGBs) performed by one surgeon (RHC) from September 2001 until June 2006 were prospectively entered into a database, which was reviewed for morbidity and mortality before (group 1) and after (group 2) development of the MIS program. Mean operative time, length of hospital stay, anastomotic leaks and strictures, gastrointestinal bleeds, internal hernia, and mortality were compared between the two groups of patients using t-tests with significance of p = 0.05. RESULTS: A total of 761 (group 1, n = 397; group 2, n = 364) LGBs were performed. For the total population, operating room time was 104 +/- 24 minutes and length of hospital stay was 2 +/- 0.3 days. Incidences of morbidities are as follows: leaks, 0.53%; marginal ulcer, 5.0%; anastomotic stricture, 6.7%; incarcerated internal hernia, 2.2%; gastric outlet obstruction, 0.53%; gastrointestinal bleed, 0.09%; and mortality, 0.13%. Comparing groups 1 and 2, mean operating room time was longer in group 2, but there was no marked difference between any of the other variables. CONCLUSIONS: Addition of an MIS fellowship does not change the morbidity and mortality of LGB when developed in the context of a university-based bariatric practice that uses a systematic approach to preoperative evaluation, operative technique, and postoperative management.     

腹腔镜肾上腺巨大肿瘤切除术临床分析

目的:探讨腹腔镜肾上腺巨大肿瘤切除术的临床可行性及意义。方法:应用经腹腔途径为45例肾上腺肿瘤患者行腹腔镜肾上腺肿瘤切除术。术前均经B超、CT或MRI等相关影像学检查初步确诊。45例患者分为2组,32例肾上腺肿瘤直径5cm(A组),13例肿瘤直径5cm(B组)。观察2组患者手术时间、术中出血量、住院时间、中转开放率及围手术期并发症等情况。术后常规随访,定期行B超及胸片检查。结果:45例均顺利完成腹腔镜手术,平均手术时间(A组58.6min,B组86.7min)、术中平均出血(A组31.6ml,B组84.3ml)两组差异均有统计学意义(P0.01);中转开放手术A组3例(9%),B组1例(8%),两组差异无统计学意义(P0.05)。B组术中1例需输血;术后平均住院A组5.2d,B组5.7d,两组差异无统计学意义(P0.05)。术后患者均顺利康复。结论:与腹腔镜较小肾上腺肿瘤(5cm)切除术相比,腹腔镜巨大肾上腺肿瘤(5cm)切除术手术时间长,术中出血多,但住院时间及围手术期并发症无显著差异。只要术者具备娴熟的腹腔镜操作技巧及充分的临床经验,腹腔镜较大肾上腺肿瘤切除术切实可行。     

Spinal Versus General Anesthesia in Total Knee Arthroplasty: Are There Differences in Complication and Readmission Rates?

BackgroundSpinal anesthesia (SP) utilization continues to expand in total knee arthroplasty (TKA). However, little is known regarding differences in complication rates between spinal and general anesthesia used for primary TKA. Therefore, the purpose of this study is to compare the length of stay (LOS), operative time, and readmission and revision rates between patients who received spinal and general anesthesia during TKA.MethodsThe American Joint Replacement Registry (AJRR) was used to identify primary elective TKA patients from 2017 to 2020. Patients were divided into 2 cohorts, general (GN) and SP, based on the mode of anesthesia administered during the index surgery. In total, 270,251 TKAs were identified, of which 126,970 (47.0%) received general anesthesia and 143,281 (53.0%) received spinal anesthesia. Length of stay, operative time, 90-day readmission, and 90-day revisions were compared between the 2 groups. Multivariable logistic regression analyses were used to adjust for potential confounders.ResultsAfter accounting for confounding factors, SP was associated with a lower risk of having a LOS greater than 3 days (odds ratio [OR] 0.470, 95% confidence interval [CI] 0.454-0.487, P < .0001), but a slightly higher likelihood of having a longer operative time (OR 1.075, 95% CI 1.056-1.094, P < .0001). SP was also linked to lower rates of 90-day readmission (OR 0.845, 95% CI 0.790-0.904, P < .0001) and lower risk of 90-day all-cause revision (OR 0.506, 95% CI 0.462-0.555, P < .0001).ConclusionSP was associated with a lower 90-day readmission rate and a lower risk of 90-day revision. These findings support the best practice guidelines of The Joint Commission to use spinal anesthesia when possible as part of an enhanced recovery after surgery (ERAS) pathway.     

Comparison of robotic revisional weight loss surgery and laparoscopic revisional weight loss surgery using the MBSAQIP database

BackgroundThe most common bariatric operation in the United States is sleeve gastrectomy. The second and third most common bariatric operations are gastric bypass and revisional bariatric surgery, respectively.ObjectiveThe objective of the study was to assess the differences between laparoscopic revisional weight loss surgery (LRWLS) and robotic revisional weight loss surgery (RRWLS).SettingUniversity hospital, United States.MethodsData were extracted from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database spanning 2015 to 2016 to look at demographic characteristics, operative time, co-morbidities, and length of stay. Using the specified Current Procedural Terminology codes, patients who underwent bariatric procedures and required a revisional procedure were identified.ResultsA total of 354,865 patients were included in this study; 37,917 (11.9%) patients required revision after undergoing a bariatric procedure. Of these revisions, 94.9% (n = 35,988) were LRWLS, and 5.1% (n = 1929) were RRWLS. There were no differences in patient characteristics between the LRWLS and RRWLS groups. There was a significant difference between the RRWLS and the LRWLS groups in operative time, with the RRWLS group taking 167 minutes and the LRWLS group taking 103 minutes (P < .001). There was a statistically significant increase in length of stay for RRWLS, 2.3 days versus 1.7 for LRWLS (P < .005). In terms of postoperative complications, there were no significant differences between the 2 groups.ConclusionsRRWLS is as safe as LRWLS in the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database. There is an increase in operative times and length of stay for robotic cases.     

Recurrent hip arthroplasty dislocation: good outcome after cup augmentation in 20 patients followed for 2 years

Recurrent posterior dislocation occurs after primary total hip arthroplasty at rates of up to 7%. Component revision is regarded as standard management, but this major surgery may be unsuitable for elderly patients. We have developed a congruent polyethylene acetabular posterior lip augmentation device (PLAD) with a stainless steel backing plate. This can be used when there is no gross malalignment, wear or loosening of the primary components. We retrospectively compared 20 patients who had revision surgery with twenty patients who had been treated with the PLAD for recurrent posterior dislocation after primary Charnley total hip arthroplasty. In the PLAD group, the mean operative time, intraoperative blood loss, time spent in the high-dependency unit (HDU), transfusion requirements and the duration of hospital stay were all less than that in the revision group. There was no difference in the Oxford Hip Score between the groups at latest review 2 years after surgery. None of the patients in either group had suffered another dislocation.     

保留十二指肠胰头勺式切除与Whipple术治疗慢性胰腺炎并胰头结石的对比研究

目的探讨保留十二指肠胰头勺式切除术在慢性胰腺炎并胰头结石治疗的价值。方法胰头部结石患者64例,行保留十二指肠胰头勺式切除24例(Ⅰ组)和Whipple术40例(Ⅱ组)。比较两种方法在手术时间、术中出血量、术后血糖及胆红素水平、疼痛缓解、住院时间及并发症等指标的差异。结果两组手术时间、术中出血量均有统计学差异(P<0.05);术后血糖、胆红素变化及腹痛缓解率比较无统计学差异(P>0.05);而住院时间、并发症发生率两组比较有统计学差异(P<0.05)。结论保留十二指肠胰头勺式切除在慢性胰腺炎并胰头部结石术中是安全可行的,相对胰十二指肠切除术,其创伤相对小,术后恢复快,住院时间短,并发症发生率低。     

滑膜切除对全膝关节置换术治疗骨性关节炎临床效果的影响

目的探讨滑膜切除对全膝关节置换术治疗骨性关节炎临床效果的影响。方法回顾性分析自2011-07—2014-12诊治的105例膝关节骨性关节炎,分为试验组和对照组,试验组(56例)行膝关节置换术与滑膜切除术,对照组(49例)只行膝关节置换术。记录并比较2组手术时间、术后引流量、隐性失血量、输血率及住院时间等,术前和术后随访时进行VAS评分、KSS评分及测量关节活动度。结果试验组获得随访(17.0±4.2)个月,对照组获得随访(15.0±3.1)个月。试验组手术时间、隐性失血量、术后引流量较对照组多,差异均有统计学意义(P0.05),2组住院时间及输血率差异无统计学意义(P0.05)。2组术后4周及1年随访时VAS评分、KSS临床评分、KSS功能评分差异无统计学意义(P0.05)。2组术后3 d及术后7 d关节活动度比较差异无统计学意义(P0.05)。结论与单纯行膝关节置换术相比,膝关节置换同时行滑膜切除术在治疗骨性关节炎上无优势,然而行滑膜切除术会导致更多的体内失血,延长手术时间,从而增加了手术风险。     

同期和分期手术在全髋关节置换术中的治疗效果比较

目的 比较同期和分期手术在全髋关节置换术的治疗效果,以期为全髋关节置换术式的选择提供依据.方法 回顾性分析资阳市第一人民医院于2009年10月至2015年6月行双侧全髋关节置换术163例病人的临床资料.按照治疗的不同选择分为同期髋关节置换术组(同期组,103例)、分期髋关节置换术组(分期组,60例).比较两组病人手术时间、出血量、术中输血量、住院费用、住院时间、手术前后Harris评分及术后并发症等情况.结果 同期组病人的平均手术时间为(171.5±1.2)min,平均出血量为(1231.2±3.1)ml,平均术中输血量为(1056.1±7.5)ml,并发症发生率为14.56%(15/103),手术前Harris评分为(23.3±1.0)分、术后为(87.9±2.5)分;分期组病人的平均手术时间为(191.8±2.3)min,平均出血量为(1372.3±4.8)ml,平均术中输血量为(978.9±6.5)ml,并发症发生率为23.33%(14/60),手术前Harris评分为(24.8±3.9)分、术后为(84.1±3.6)分.两组病例以上指标比较,差异均无统计学意义(均P>0.05).但是同期组病人住院费用为(3.9±0.6)万元、住院时间为(15.1±1.3)d,均优于分期组的(5.6±1.3)万元、(28.7±2.5)d,差异均有统计学意义(均P<0.05).结论 对于双侧全髋关节置换术病人,同期手术与分期手术治疗效果无明显差异,但同期手术可以明显降低病人住院费用、住院时间,减轻病人负担.     

General vs Spinal Anesthesia for Revision Total Knee Arthroplasty: Do Complication Rates Differ?

BackgroundThe incidence of both primary total knee arthroplasty (TKA) and revision TKA is increasing. Data from primary arthroplasty patients suggest a risk reduction with the use of spinal anesthesia when compared with general anesthesia. However, the same relationship has not been examined in the revision knee arthroplasty patient.MethodsThis is a retrospective cohort study using the American College of Surgeons-National Surgical Quality Improvement database. Patients undergoing revision TKA with either spinal or general anesthesia were identified from the database. Baseline characteristics were compared, and ultimately patients were matched using coarsened exact matching. Multivariate analysis was then performed on matched cohorts controlling for baseline patient and operative characteristics. This model was used to look for any differences in rates of complications, operative time, length of stay, and readmission.ResultsPatients undergoing revision TKA with general anesthesia had increased risk of several postoperative complications, even after controlling for baseline patient characteristics. Specifically, there were significantly increased rates of the following: unplanned readmission (OR = 1.43, 95% confidence interval [CI] = 1.18-1.72, P < .001), nonhome discharge (OR = 1.60, 95% CI = 1.46-1.76, P < .001), transfusion (OR = 1.63, 95% CI = 1.41-1.88, P < .001), deep surgical site infection (OR = 1.43, 95% CI = 1.01-2.03, P = .043), and extended length of stay (OR = 1.22, 95% CI = 1.11-1.34, P < .001). General anesthesia was additionally associated with increased operative time.ConclusionGeneral anesthesia is associated with increased risk of numerous postoperative complications in patients undergoing revision TKA. This study is retrospective in nature, and while causality cannot be definitively determined, the results suggest that spinal anesthesia is preferential to general anesthesia in the revision TKA patient.     

老年初发非嵌顿性腹股沟疝开放性手术患者的麻醉

目的研究老年原发非嵌顿性腹股沟疝开放性手术患者的最佳麻醉方式及临床意义。 方法选取2014年11月至2016年11月,湛江市第二人民医院接受手术治疗的老年原发非嵌顿性腹股沟疝患者662例,其中男性604例,女性58例,平均年龄（68.8±5.4）岁。将全部患者随机分为3组并各自采用全身麻醉（全麻组221例）、椎管内麻醉（椎管内组221例）以及局部麻醉（局麻组220例）。对比3组患者的手术时间、手术加麻醉时间和术中出血量;对比3组患者术后并发症发生情况及并发症率;对比3组患者的术后住院时间以及住院总费用。 结果全麻组、椎管内组、局麻组手术时间分别为（95.32±32.07）、（90.24±28.17）、（89.41±27.52）min,差异无统计学意义（P>0.05）;手术加麻醉时间上局麻组（101.29±32.71）min则显著低于椎管内组的（129.62±39.75）min和全麻组的（149.67±51.38）min,差异有统计学意义（P<0.05）;局麻组的尿潴留发病率3.63%（8/220）显著低于椎管内组13.12%（29/221）和全麻组23.53%（52/221）,差异有统计学意义（P<0.05）;局麻组在术后住院时间及住院总费用（4.35±2.41）d、（6 259.76± 773.59）元显著低于椎管内组（6.53±3.25）d、（7 653.26±861.27）元和全麻组（6.82±2.94）d、（9 135.32±896.81）元,差异均有统计学意义（P均<0.05）。 结论局部麻醉是老年原发非嵌顿性腹股沟疝开放性手术患者最佳的麻醉方式。     

Recurrent hip arthroplasty dislocation: Good outcome after cup augmentation in 20 patients followed for 2 years

Recurrent posterior dislocation occurs after primary total hip arthroplasty at rates of up to 7%. Component revision is regarded as standard management, but this major surgery may be unsuitable for elderly patients. We have developed a congruent polyethylene acetabular posterior lip augmentation device (PLAD) with a stainless steel backing plate. This can be used when there is no gross malalignment, wear or loosening of the primary components.

We retrospectively compared 20 patients who had revision surgery with twenty patients who had been treated with the PLAD for recurrent posterior dislocation after primary Charnley total hip arthroplasty.

In the PLAD group, the mean operative time, intraoperative blood loss, time spent in the high-dependency unit (HDU), transfusion requirements and the duration of hospital stay were all less than that in the revision group. There was no difference in the Oxford Hip Score between the groups at latest review 2 years after surgery. None of the patients in either group had suffered another dislocation.     

Short term outcomes of long duration versus short duration tourniquet in primary total knee arthroplasty: A randomized controlled trial

Introduction

A tourniquet is used during the total knee replacement surgery to improve the visibility, to reduce the blood loss and for better cementation. Indirectly it decreases the duration of surgery and enhances the recovery of the patient. Their use however is controversial due to some side effects associated with the use of tourniquet. They may increase the risk of deep vein thrombosis and pulmonary embolism by causing venous stasis, endothelial damage and increased platelet adhesion secondary to distal limb ischemia.