Volume Of Blood Loss Research Articles

Anterior approach for the revision surgery following bone cement augmentation in osteoporotic vertebral compression fractures

To observe the clinical outcomes of anterior approach for the revision surgery following unsuccessful bone cement augmentation in osteoporotic vertebral compression fractures. A total of 10 patients who experienced unsuccessful bone cement augmentation underwent anterior revision surgery between January 2020 and December 2021. There were 2 males and 8 females. The age ranged from 55 to 83 years old. The reasons for revision surgery were postoperative infection in 2 cases, postoperative neurological symptoms in 3 cases, and kyphosis resulting from postoperative vertebral collapse in 5 cases. The involved segments included 2 cases of L1, 4 cases of L2, 3 cases of L3, and 1 case of L4. Among them, 2 patients underwent primary percutaneous vertebroplasty (PVP), while eight patients underwent primary percutaneous kyphoplasty (PKP). The time interval between the first and second surgeries ranged from 1 to 13 months. All patients presented with varying degrees of lumbar pain. X-ray, CT, and MRI scans were conducted prior to the revision procedure. Surgical duration, intraoperative blood loss, and any complications were documented. The surgical procedures were successful in all 10 patients, with 9 cases undergoing anterior reconstruction and posterior internal fixation through the interspace of the multifidus longissimus muscle. One patient underwent anterior reconstruction and anterior plate internal fixation. The duration of the anterior approach surgery ranged from 90 to 190 minutes, with a blood loss volume ranging from 130 to 480 ml. None of the patients experienced any intraoperative or postoperative complications such as nerve injury, cerebrospinal fluid leakage, major vessel damage, abdominal organ injury, incision infection, or bleeding. The follow-up period for 10 patients ranged from 3 to 20 months. Throughout the follow-up, none of the patients experienced complications such as displacement, cutting, or loosening of the artificial vertebral body. Prior to the operation, the visual analogue scale(VAS) ranged from 4 to 8 points, the final follow-up assessment ranged from 2 to 3 points. The Oswestry disability index (ODI) score a preoperative ranged from 17% to 37%, the latest follow-up evaluation ranged from 2% to 16%. Notably, significant correction in kyphosis angle was observed in 5 cases. Furthermore, there was notable improvement in VAS and ODI compared to preoperative values. Anterior corpectomy and artificial vertebral body implantation not only facilitate the removal of bone cement but also enable effective debridement and direct decompression. Moreover, by reconstructing anterior and middle column support, restoring vertebral height and local curvature, in combination with pedicle screw internal fixation, surgical segment stability can be achieved. Therefore, for patients requiring revision following failed bone cement augmentation, anterior surgery represents an ideal treatment option.

Comparison between minimally invasive surgery and open surgery in managing localized adrenocortical carcinoma treatment: Aretrospective propensity-matched study.

It was controversial to use open surgery or minimally invasive surgery (MIS) for adrenocortical carcinoma (ACC). This retrospective study aimed to evaluate the impact on prognosis between MIS and open surgery in patients with clinical stage I-II ACC. Patients with stage I-II ACC from December 2000 to October 2022 were retrospectively studied. The primary endpoint was recurrence-free survival time calculated by the Kaplan-Meier curves. In total, 95 patients were enrolled in this study (50 open surgery and 45 MIS). Propensity score matching identified 32 matched pairs of patients. Compared with the open surgery group, the MIS group had a shorter median operative time (150.0 vs. 120.0 min, p = 0.014), the lesser median volume of intraoperative blood loss (200.0 vs. 60.0 mL, p = 0.006), lower incidence of postoperative complications (59.4% vs. 28.1%, p = 0.023), and shorter median postoperative length of hospital stay (8.0 vs. 7.0 days, p = 0.001). After a median follow-up time of 20.5 months, no significant differences were observed in the local recurrence rate (62.5% vs. 78.1%), distant metastasis rate (15.6% vs. 6.3%), and median time to recurrence (15.0 vs. 20.0 months) between the two groups. The median recurrence-free survival time between the open surgery and MIS groups did not significantly differ (16.0 vs. 21.0 months). MIS might be a feasible option for treating localized ACC at a high patient's volume center with experienced surgeons.

Atlantodentoplasty using the anterior retropharyngeal approach for treating irreducible atlantoaxial dislocation with atlantodental bony obstruction: a retrospective study.

This was a retrospective study. The current study aimed to investigate the clinical efficacy of atlantodentoplasty using the anterior retropharyngeal approach against irreducible atlantoaxial dislocation with atlantodental bony obstruction. In cases of atlantoaxial dislocation with atlantodental bony obstruction, owing to the presence of an osteogenic mass between the atlas and odontoid process, reduction is challenging to complete using the posterior approach. Transoral odontoidectomy is technically demanding and is associated with several risks. The clinical data of 26 patients diagnosed with irreducible atlantoaxial dislocation complicated by atlantodental bony obstruction were analyzed retrospectively. All patients underwent anterior retropharyngeal atlantodentoplasty, followed by posterior occipitocervical fusion. Details including surgical duration and blood loss volume were recorded. Radiographic data such as the anterior atlantodental interval, O-C2 angle, space available for the cord, clivus-canal angle, and cervical medullary angle, and clinical data including the Japanese Orthopedic Association (JOA) score were assessed. The fusion time of the grafted bone and the development of complications were examined. In patients undergoing anterior retropharyngeal atlantodentoplasty, the surgical duration and blood loss volume were 120.1±16.4 minutes and 100.6±33.5 mL, respectively. The anterior atlantodental interval decreased significantly after the surgery (p <0.001). The O-C2 angle, space available for the cord, clivus-canal angle, and cervical medullary angle increased significantly after the surgery (p <0.001). The JOA score during the latest follow-up significantly increased compared with that before the surgery (p <0.001). The improvement rate of the JOA score was 80.8%±18.1%. The fusion time of the grafted bone was 3-8 months, with an average of 5.7±1.5 months. In total, 11 patients presented with postoperative dysphagia and three with irritating cough. However, none of them exhibited other major complications. Anterior retropharyngeal atlantodentoplasty can anatomically reduce the atlantoaxial joint with a satisfactory clinical outcome in patients with irreducible atlantoaxial dislocation with atlantodental bony obstruction.

Short-term outcomes of preoperative computed tomography angiography versus standard assessment in patients with BMI ≥ 25.0kg/m2 undergoing laparoscopic gastrectomy: the GISSG20-01 randomized clinical trial.

Laparoscopic gastrectomy lacks hand-direct tactile sense and has a limited surgical field compared to laparotomy. Apart from textbook classification, there are anatomical variations in the gastric arteries. Laparoscopic gastrectomy presents technical difficulties and necessitates a more comprehensive comprehension of regional anatomy than open surgical procedures. We aimed to compare efficacy and safety of preoperative computed tomography angiography (CTA) associated with surgical decision-making for laparoscopic gastrectomy. The GISSG 20-01 study was a multicenter, open-label, randomized clinical trial. The enrollment criteria mainly included histologically confirmed gastric cancer patients with BMI ≥ 25kg/m2. Eligible patients were randomly assigned to the CTA group or the non-CTA group in a 1:1 ratio. The primary endpoint was the volume of intraoperative blood loss. Between November 2020 and December 2021, 382 patients were enrolled and randomly assigned. After exclusion of 25 patients, 357 patients were included in the modified intention-to-treat population (179 in the CTA group and 178 in the non-CTA group). The mean intraoperative blood loss (CTA vs non-CTA; 74.2 vs 95.0mL, P = 0.005) and operation time (215.4 vs 231.2min, P = 0.004) was significantly lower in the CTA group. Total number of retrieved lymph nodes was similar in two groups (32.2 vs 30.2, P = 0.070). The CTA group had a significantly lower surgery task load index sore than the non-CTA group (36.6 vs 41.7, P < 0.001). There was no significant difference in postoperative complications rate of 14.5% in the CTA group and 22.5% in the non-CTA group (difference, -8.0% [95% CI, -16.0 to 0.1]; P = 0.053). Preoperative CTA associated with surgical decision-making could relieve surgery burden and lead to a better surgical performance compared with non-CTA support, which including decreased blood loss volume, vessel damage and operation time. NCT04636099.

A retrospective cohort study of the application of Santulli enterostomy in neonatal necrotizing enterocolitis

The use of Santulli enterostomy (SE) for necrotizing enterocolitis (NEC) has been limited to a small number of studies involving a small number of patients and no control group. Our study aimed to compare the clinical safety and efficacy of Santulli enterostomy with those of single- or double-lumen enterostomy for neonatal NEC through a retrospective cohort study. One hundred ten patients who met the criteria were divided into an SE group (64 patients) and a conventional enterostomy (CE) group (46 patients). The CE group underwent single- or double-lumen enterostomy. There were no significant differences in complication rates or prognoses between the two groups after either procedure. Although the stoma was positioned higher in the SE group, the length of the unused small intestine (USI) was not significantly different. Multivariate analysis revealed that the length of the USI influenced the likelihood of malnutrition after enterostomy (OR = 1.108, P = 0.008). After stoma closure, compared with those in the CE group, the operation time, intestinal recovery time, fasting time, hospitalization time, intraoperative blood loss volume and the incidence of complications requiring surgical reintervention was significantly lower in the SE group. In conclusion, Santulli enterostomy is not only a safe treatment option for NEC but also an effective method for increasing the length of the small intestine after enterostomy, thereby improving the patient’s postoperative nutritional status. In addition, the procedure is associated with good recovery and a reduced incidence of surgical reintervention after stoma closure.

Investigating the Effects of Performing the Early Mobilization Protocol on Postoperative Hemorrhaging in Cardiac Surgery Patients

Background: Most adverse effects following cardiac surgery, including hemorrhaging, are related to immobility. The early mobilization of the patient in enhanced recovery after surgery (ERAS) can counteract these adverse effects. Despite the awareness, however, the protocol has a low performance rate due to numerous barriers. The present research aims to investigate the effectiveness of performing the early mobilization protocol on hemorrhaging in cardiac surgery patients. Methods: This research is a clinical trial study conducted in 2023-2024 at Ali Ibn AbiTalib Hospital in Zahedan, Iran, on 100 patients undergoing cardiac surgery. Purposive sampling was used based on the inclusion criteria. Hemorrhaging risk assessment in patients was evaluated according to the preoperative checklist. The early mobilization protocol was performed on day 2 after surgery on patients in the intervention group with mild to low risk of hemorrhage. The statistical tests of repeated measures, chi-square, and independent t-test were used for data analysis in SPSS 26. Results: There were no statistically significant variations in the demographic characteristics of patients in the intervention and control groups. The mean and standard deviation (SD) of the blood volume loss in patients over three different time periods (days 2, 3, and 4 after surgery) were 326.500±16.81, 69.300±11.41, and 51.200±3.82 in the intervention group, respectively, and 350.00±16.81, 325.00±11.41, and 82.10±3.82 in the control group, respectively, indicating the effectiveness of performing the early mobilization protocol (P ˂ 0.001). Conclusion: Performing the early mobilization protocol can reduce the volume of bleeding after cardiac surgery and the early discharge of patients, thus leading to reduced complications. Nurses as the main care providers in intensive care units play a key role in performing the protocol.

Severe maternal morbidity contributed by obstetric hemorrhage: Maryland, 2020-2022.

Obstetric hemorrhage is the leading cause of maternal mortality and severe maternal morbidity (SMM) in Maryland and nationally. Currently, through a quality collaborative, the state is implementing the Alliance for Innovation on Maternal Health (AIM) patient safety bundle on obstetric hemorrhage. To describe SMM events contributed by obstetric hemorrhage and their preventability in Maryland. This cross-sectional study used data from hospital-based SMM surveillance and review program in Maryland. Hospital-based SMM criteria include admission to an intensive care unit and/or transfusion of 4 or more units of blood products (of any type) during pregnancy or within 42 days postpartum. A total of 193 obstetric hemorrhage events that met the surveillance definition were identified in hospitals participating in SMM surveillance since inception on August 1, 2020 until December 31, 2022. We compared patient and delivery characteristics, practices done well, and recommendations for care improvement among patients with severe obstetric hemorrhage deemed preventable and non-preventable by hospital-based review committees. For obstetric hemorrhage events deemed preventable, we further identified factors that contributed to the SMM outcome at the provider, system, and patient levels. Uterine atony was the leading cause of obstetric hemorrhage events (37.8%), followed by uterine rupture, laceration and intra-abdominal bleeding (23.8%). Sixty-six (34.2%) obstetric hemorrhage events were preventable. Patients with preventable obstetric hemorrhage were significantly more likely to have an emergency than planned cesarean delivery and less likely to have a placental complication or >1500 mL blood loss volume. Hospital-based review committees determined that 81.8%, 30.3%, and 22.7% of preventable events could have been prevented or made less severe through changes to provider, system, or patient factors, respectively. Recommendations following event reviews aligned with the Alliance for Innovation on Maternal Health Obstetric Hemorrhage Patient Safety Bundle, particularly regarding elements in the Recognition and Prevention and Response domains. About one-third of SMM events contributed by obstetric hemorrhages were deemed preventable. Of AIM bundle elements, assessing hemorrhage risk on admission to labor and delivery, peripartum, and upon transition to postpartum care together with rapid, unit-standardized management of hemorrhage are likely to benefit more than half of patients with preventable SMM contributed by obstetric hemorrhage.

ОСОБЕННОСТИ ИНФУЗИОННО-ТРАНСФУЗИОННОЙ ТЕРАПИИ ПРИ АНЕСТЕЗИОЛОГИЧЕСКОМ ОБЕСПЕЧЕНИИ ОПЕРАЦИЙ НА ГРУДНОМ ОТДЕЛЕ АОРТЫ

Objective: to determine the volume of blood loss and the volume of infusion-transfusion therapy in the intraoperative and early postoperative periods during operations on the thoracic aorta. Material and methods. 38 medical records of hospital patients who were treated in healthcare institutions from 2011 to 2024 for acute dissection of the ascending aorta and aortic arch type A have been analyzed. The age of the patients was 58 (52; 65.5) years, distribution by gender: men – 20 (51%), women – 18 (49%); height – 170 (166; 176) cm, body weight – 85.0 (76; 100) kg, body mass index – 27.9 (24.3; 30.9) kg/m2. All patients underwent cardiac surgery under artificial blood circulation. The volumes of blood loss from infusion-transfusion therapy in the intraoperative and early postoperative periods have been analyzed for each patient. The hemoglobin balance method was used to assess intraoperative blood loss. Results. The volume of blood loss in patients undergoing thoracic aorta surgery, evaluated by the hemoglobin balance method, was 2530 (2540; 3180) ml. The total volume of infusion-transfusion therapy in the groups is as follows: blood loss less than 40% of the circulating blood volume (CBV) – 2000 (1300; 2395) ml (p&lt;0.001), 40-80% of the CBV – 3360 (2590; 4330) ml, more than 80% of the CBV – 4270 (3490; 6100) ml (p&lt;0.001). The ratio of infusion therapy to transfusion therapy with blood loss less than 40% of the CBV is 1: 0.3; more than 80% – 1: 1.6. Conclusion. The work has analyzed the volume of blood loss and infusion-transfusion therapy during anesthesia for operations on the ascending aorta. That will help in further determining the optimal tactics, which may increase the survival rate of these patients.

Clinical efficacy of electrosurgery and steel scalpel surgery for umbilical herniorrhaphy in bovine calves: A comparative analysis.

Electrosurgery (ES) offers a promising alternative to conventional steel scalpel surgery (SSS), providing superior hemorrhage control and efficient tissue dissection with minimal invasiveness. Given the limited literature, this study aims to compare the clinical efficacy of ES with that of SSS in bovine umbilical herniorrhaphy. Fourteen crossbred male calves with reducible umbilical hernias, aged less than one month and weighing 25-47kg, were randomly assigned to two experimental groups: group A (ES) and group B (SSS), each containing seven calves. Clinical parameters, such as temperature, heart rate, respiratory rate, and SpO2, were recorded 10min preoperatively, intraoperatively at 20 and 40min, and 10min postoperatively. Hematobiochemical parameters, including total erythrocyte count, hemoglobin, packed cell volume, total serum protein, blood urea nitrogen, and creatinine, were also assessed at these intervals. Skin incision length, volume of blood loss, surgical duration, healing time, postoperative complications, and postoperative pain response were documented. Furthermore, a sonographic evaluation of postoperative wound healing was conducted. The clinical and hematobiochemical parameters did not vary significantly between the groups. However, significant variations (p<0.05) were noted in skin incision length, volume of blood loss, surgical duration, and healing time between the groups. Group A calves experienced smaller incisions, reduced blood loss, shorter surgical duration, quicker recovery, and fewer postoperative complications and pain. The ultrasonographic evaluation revealed superior postoperative wound healing in group A compared to group B. These findings suggest that ES is a more effective clinical approach than traditional SSS for umbilical herniorrhaphy in bovine calves.

Achıevements in the Surgıcal Treatment of Aneurysms of the Infrarenal Regıon of the Abdomınal Aorta

The article’s topic is devoted to the surgical treatment of aneurysms of the infrarenal aorta, the achievements we have achieved in the perioperative period, and the prevention of possible complications that may arise in the postoperative period. For this purpose, clinical materials from 125 patients were analyzed. Operation “Resection of the aneurysm using a synthetic aortic prosthesis” in 34 patients; “thromboendarterectomy from the abdominal aorta, biiliac bifemoral synthetic aortic prosthesis” was performed on 91 patients. In patients, the operation was performed using combined epidural intubation anesthesia. The duration of the operation was 293.0±11.87 minutes. The Cell-Saver apparatus was used for autotransfusion. The average volume of blood loss was 3252.5±219.12 ml. Mortality in the postoperative period occurred in 3.2% of patients. Cause of death; “Thrombohemorrhagic syndrome” developed as a result of internal bleeding in 1 patient; 1 patient had “intestinal obstruction”, and 2 patients had “acute myocardial infarction, pulmonary-heart-renal failure”.

DIAGNOSTICS OF THE DEGREE OF BLOOD LOSS BY THE METHOD OF STATISTICAL ANALYSIS OF MAPS OF OPTICAL ACTIVITY OF THE POLYCRYSTALLINE COMPONENT OF BIOLOGICAL TISSUES AND FLUIDS

The research was conducted to create a reliable and accurate approach to determining the volume of blood loss, which will allow forensic experts to increase objectivity and accuracy in establishing the causes and circumstances of death, as well as assessing the degree of traumatic injuries, and will help ensure more reliable examination results in forensic practice. The aim of the work is to develop and evaluate the effectiveness of a method for differential diagnosis of the degree of blood loss in corpses using statistical analysis of optical activity maps of the polycrystalline component of biological tissues and fluids. Material and methods. The study material was brain, kidney and blood samples (n=124) from corpses aged 18 to 60 years with a previously known blood loss volume from 0mm3 to 2500mm3. The study was conducted using the method of multiparametric differential Muller matrix tomography, which allows detecting changes in the structure of polycrystalline elements of biological tissues at different degrees of blood loss. Calculation of digital values was performed using a laser polarimeter of a standard scheme, further statistical processing was performed using MS® Excel® 2010™ and Statistica® 7.0 software. Results. For all studied biological samples, the method demonstrates high sensitivity in the range of blood loss volume from 0 мм³ to 1500 мм³ with an accuracy level of 86%-92%. Within the range of blood loss volume from 2000 мм³ to 2500 мм³ the accuracy of the method decreases to 56%-68%. The maximum level of accuracy is achieved for statistical parameters of kidney samples (SM4↔86%-92%), brain (SM4↔86%-90%) and blood films (SM2↔90%-92%), which characterize the Muller matrix maps of circular birefringence. Conclusions. Based on the conducted study, the high efficiency of the multiparametric Muller matrix differential tomography method in determining the degree of blood loss within the volume of lost blood ∆V=0mm3÷1500mm3 was established. The obtained results demonstrate that this method allows for an objective assessment of structural changes in biological tissues and fluids caused by blood loss. This makes it a unique tool for objectively determining the volume of blood loss.

Laparoscopic anatomical SVIII resection via middle hepatic fissure approach: Caudal or cranio side.

Laparoscopic hepatectomy is a proven safe and technically feasible approach for liver tumor resection, but laparoscopic anatomical SVIII resection (LASVIIIR) remains rarely reported due to poor accessibility, difficult exposure, and the deep-lying Glissonean pedicle. This study examined the safety, feasibility, and perioperative outcomes of LASVIIIR via a middle hepatic fissure approach at our institution. To investigate the safety, feasibility, and perioperative outcomes of LASVIIIR via a middle hepatic fissure approach at our institution. From November 2017 to December 2022, all patients with a liver tumor who underwent LASVIIIR were enrolled. The perioperative outcomes and postoperative complications were evaluated. Thirty-four patients underwent LASVIIIR via a middle hepatic fissure approach from the side or cranio side and were included. The mean operation time was 164 ± 54 minutes, and the intra-operative blood loss was 100 mL (range: 20-1000 mL). The mean operative times were, respectively, 152 ± 50 minutes and 222 ± 29 minutes (P = 0.001) for the caudal side and cranial side approaches. In addition, the median blood loss volumes were 100 mL (range: 20-300 mL) and 250 mL (range: 20-1000 mL), respectively, for the caudal and cranial sides (P = 0.064). Three patients treated using the cranial side approach experienced bile leakage, while 1 patient treated using the caudal side approach had subphrenic collection and underwent percutaneous drainage to successfully recover. There were no differences regarding postoperative hospital stays for the caudal and cranial side approaches [9 (7-26) days vs 8 (8-19) days] (P = 0.226). LASVIIIR resection remains a challenging operation, but the middle hepatic fissure approach is a reasonable and easy-to-implement technique.

Redefining Clinically Significant Blood Loss in Complex Adult Spine Deformity Surgery.

Retrospective analysis of prospectively-collected data. This study aims to define clinically relevant blood loss in adult spinal deformity (ASD) surgery. Current definitions of excessive blood loss following spine surgery are highly variable and may be suboptimal in predicting adverse events (AE). Adults undergoing complex ASD surgery were included. Estimated blood loss (EBL) was extracted for investigation, and estimated blood volume loss (EBVL) was calculated by dividing EBL by the preoperative blood volume utilizing Nadler's formula. LASSO regression was performed to identify five variables from demographic and peri-operative parameters. Logistic regression was subsequently performed to generate a receiver operating characteristics (ROC) curve and estimate an optimal threshold for EBL and EBVL. Finally, the proportion of patients with AE plotted against EBL and EBVL to confirm the identified thresholds. In total 552 patients were included with a mean age of 60.7±15.1 years, 68% females, mean CCI was 1.0±1.6, and 22% experienced AEs. LASSO regression identified ASA score, baseline hypertension, preoperative albumin, and use of intra-operative crystalloids as the top predictors of an AE, in addition to EBL/EBVL. Logistic regression resulted in ROC curve which was used to identify a cut-off of 2.3 liters of EBL and 42% for EBVL. Patients exceeding these thresholds had AE rates of 36% (odds-ratio: 2.1, 95% CI [1.2-3.6]) and 31% (odds-ratio: 1.7, 95% CI [1.1-2.8]), compared to 21% for those below the thresholds of EBL and EBVL, respectively. In complex ASD surgery, intraoperative EBL of 2.3 liters and an EBVL of 42% are associated with clinically-significant AEs. These thresholds may be useful in guiding preoperative-patient-counseling, healthcare system quality initiatives, and clinical perioperative bloodloss management strategies in patients undergoing complex spine surgery. Additionally, similar methodology could be performed in other specialties to establish procedure-specific clinically-relevant bloodloss thresholds.

The safety and feasibility of robotic pancreaticoduodenectomy: A multicenter retrospective assessment of 425 patients in Japan.

The Japanese public health insurance system has recently covered robotic pancreaticoduodenectomy (RPD). This study aimed to review the results of RPD during the introductory period and elucidate its safety and feasibility in Japan. Consecutive data of 425 patients who underwent RPD were retrospectively collected from 10 high-volume centers in Japan between April 2020 and September 2022. The primary endpoints were the rates of conversion to open surgery and completion of minimally invasive surgery (MIS), defined as the use of a totally robotic operation or combined robotic and laparoscopic procedures. Secondary endpoints were operative time, blood loss, complication rate, and 30- and 90-day mortality rates. Study comprised 222 males and 203 females, with a median age of 70 (p10-p90; 50-81) years. The conversion to open surgery and completion rates of MIS were 3.8% (16 patients) and 91.1% (387 patients), respectively. The median operative time was 617 min (p10-p90; 456-834 min), and the median volume of blood loss was 160 g (p10-p90; 30-558 g). The complication rate (Clavien-Dindo classification grade ≥ IIIa) was 20.5%. The 30- and 90-day mortality rates were 0.2% and 0.5%, respectively. Our results indicate that RPD can be introduced successfully and is a promising approach for pancreaticoduodenectomy.

Treatment of lumbar spondylolysis in young adults using modified intravertebral screw-rod fixation system for single vertebral body combined with autologous cancellous bone graft: a technical note and preliminary report

BackgroundThere is currently no consensus on the surgical treatment of lumbar spondylolysis in young adults, and the nonunion rate remains relatively high even after surgery. Therefore, in this study, we proposed a modified intravertebral screw-rod fixation technique within a single vertebral segment and investigated the clinical efficacy of this modified fixation system combined with autologous cancellous bone grafting in the treatment of lumbar spondylolysis in young adults.MethodsThis study included 28 young adults with lumbar spondylolysis who were treated at our center between 2021 and 2023. All patients underwent modified intravertebral screw-rod fixation within a single vertebral segment combined with autologous cancellous bone grafting. We performed postoperative follow-ups regularly to assess the patient’s pain status using the visual analog scale (VAS), Oswestry Disability Index (ODI), and radiological findings.ResultsAll 28 patients successfully underwent the surgery with an average operation time and blood loss volume of 96.01 ± 21.3 min and 186.78 ± 63.43 mL, respectively. Postoperatively, patients experienced significant symptom relief, with notable decreases in VAS scores and ODI indices at 1, 3, 6, and 12 months compared with preoperative conditions. These differences were statistically significant (P < 0.05). Radiological findings revealed a healing rate of 92.86% for the 56 fractured pars interarticularis among the 28 patients. No implant-related complications, such as fracture, loosening, or pseudarthrosis, were observed.ConclusionsThe modified intravertebral screw-rod fixation system within a single vertebral segment combined with autologous cancellous bone grafting is a safe and effective treatment for lumbar spondylolysis in young adults. It significantly improves pain and functional disability as it promotes bone healing.

The Intersection of Trauma and Immunity: Immune Dysfunction Following Hemorrhage.

Hemorrhagic shock is caused by rapid loss of a significant blood volume, which leads to insufficient blood flow and oxygen delivery to organs and tissues, resulting in severe physiological derangements, organ failure, and death. Physiologic derangements after hemorrhage are due in a large part to the body's strong inflammatory response, which leads to severe immune dysfunction, and secondary complications such as chronic immunosuppression, increased susceptibility to infection, coagulopathy, multiple organ failure, and unregulated inflammation. Immediate management of hemorrhagic shock includes timely control of the source of bleeding, restoring intravascular volume, preferably with whole blood, and prevention of ischemia and organ failure by optimizing tissue oxygenation. However, currently, there are no clinically effective treatments available that can stabilize the immune response to hemorrhage and reinstate homeostatic conditions. In this review, we will discuss what is known about immunologic dysfunction following hemorrhage and potential therapeutic strategies.

Comparison of the effects of high tibial osteotomy with and without a tourniquet

BackgroundTourniquets are routinely employed to achieve hemostasis in modern limb surgeries. Nevertheless, the precise role and benefits of tourniquets in high tibial osteotomy (HTO) surgeries remain understudied. The aim of this study was to assess the application of tourniquets in high-tibial osteotomy procedures.MethodsThis was a prospective study of patients who underwent HTO surgery at an identical hospital. The participants were randomly assigned into two groups: Group A, with a tourniquet (n = 43); and Group B, without a tourniquet (n = 43). The same surgical technique and postoperative care were employed for both groups of patients. Knee range of motion (ROM) and pain were assessed by utilizing a visual analogue scale (VAS) after exercise and maximum calf circumference, and postoperative Hospital for Special Surgery (HSS) score, as well as inflammatory markers including CRP and IL-6, were adopted to compare and analyse the recovery of knee function in the two groups of patients following surgery.ResultsAll participants were followed up for a period exceeding three months. No cases of vascular or nerve injuries were observed during surgery in either group. Moreover, there was no statistically significant difference in total blood loss volume throughout treatment or haemoglobin or haematocrit levels (P > 0.05). furthermore, Group A underwent a shorter operation than Group B did (P < 0.05). Group B demonstrated decreased postoperative visual analog scale (VAS) pain levels, calf swelling (P < 0.05), increased early knee range of motion (P < 0.05), and diminished release of blood inflammation markers(IL-6 and CRP) (P < 0.05).ConclusionThe application of tourniquets in HTO surgery reduces intraoperative blood loss and shortens the operative time yet does not substantially affect total bleeding. Nonetheless, the absence of a tourniquet resulted in reduced postoperative pain and facilitated early rehabilitation of knee function.

Preliminary experience in using the lateral single-incision laparoscopic totally extraperitoneal approach for inguinal hernia repair.

To evaluate the feasibility, safety, and efficacy of the lateral single-incision laparoscopic totally extraperitoneal (L-SILTEP) approach in patients with inguinal hernia who had contraindications to the midline approach. This study included 58 patients who underwent L-SILTEP. Data on their baseline characteristics and perioperative details were collected. Quality of life and cosmetic satisfaction assessments were performed. Of the evaluated patients, 25.9% had a history of middle and lower abdominal surgery and 10.3% had skin diseases around the umbilicus. The mean surgical duration, blood loss volume, and incision length were 53.5 (± 22.3) min, 7.2 (± 9.7) mL, and 2.0 (± 0.13) cm, respectively. Additionally, 29.3% of patients experienced intraoperative peritoneal rupture, and one patient had epigastric vessel bleeding. The 6-, 24-, and 48-h postoperative pain scores were 3.0 (± 0.6), 1.6 (± 0.6), and 1.1 (± 0.4), respectively. Postoperative complications included seroma (n = 3), hematoma (n = 1), and scrotal edema (n = 1). The surgical incision in the L-SILTEP approach was more aesthetically pleasing than that in previous surgeries. Approximately 17.2%, 8.6%, and 10.3% of patients reported pain, mesh sensation, and movement limitation, respectively. Severe or disabling symptoms were not reported, and there were no cases of 30-day readmissions. Hernia recurrence or incisional hernia was not observed over a mean follow-up duration of 14.6 (± 6.1) months. L-SILTEP can be used for patients with contraindications to the midline approach. Furthermore, it is a safe and effective procedure.

Comparative study of open elbow arthrolysis with and without hinge external fixation for the treatment of post-traumatic elbow stiffness

BackgroundThe present study aimed to compare the functional outcomes of hinged external fixators and non-external fixation in open elbow arthrolysis (OEA) for post-traumatic elbow stiffness (PTES) and to evaluate their applicability and limitations in patients with posttraumatic elbow stiffness.MethodsThe clinical data of patients with PTES treated with OEA at our hospital between March 2015 and June 2022 were retrospectively analyzed. The assessed variables were the operation time, intraoperative blood loss volume, duration of hospitalization, and treatment costs. The elbow range of motion (ROM), Mayo Elbow Performance Score (MEPS), shortened disabilities of the arm, shoulder and hand questionnaire (Q-DASH) score, Oxford Elbow score (OES), Broberg and Morrey score (BMS), visual analog scale (VAS) for pain, and complications such as pin tract infection and heterotopic ossification were compared between patients with and without hinge external fixation. We also compared the baseline characteristics and functional outcomes of patients with and without hinge external fixation.ResultsA total of 156 patients (48 patients with hinged external fixators and 108 patients without external fixators) diagnosed with PTES were included in this study. The mean follow-up was 15.8 ± 3.6 months. Compared with patients without external fixators, those with external fixators showed significantly greater improvements in elbow flexion and extension ROM (59.6° ± 26.1° vs. 46.2° ± 26.2°, p = 0.004) but had a significantly longer duration of hospitalization (p < 0.001), significantly longer operation time (p < 0.001), significantly higher treatment costs (p < 0.001), and significantly greater intraoperative blood loss volume (p < 0.001). There were no significant differences between the two groups in terms of improvement in elbow rotation ROM, MEPS score, VAS score for pain, OES score, Q-DASH score, BMS score, or incidence of complications.ConclusionThe use of a hinged external fixator in open arthrolysis for posttraumatic elbow stiffness may result in short-term improvements in flexion-extension range of motion but is accompanied by increased blood loss, longer operative time, extended hospitalization, and higher costs. Further studies are needed to confirm these findings.Clinical trial numberNot applicable.

Optimizing Surgery for Idiopathic Scoliosis: Does a Dual Approach Help Young Surgeons?

Introduction Inidiopathic scoliosissurgery, studies have shown two attending surgeons have better curve correction, pain, and recovery time. There is conflicting evidence on operative time, blood loss, infection rate, and hospital length of stay. Limited literature examines the impact of surgeon experience on the dual approach. The purpose of this study was to evaluate the performance of two young orthopedic attendings compared to a senior-level attending in idiopathic scoliosis surgery. Methods We examined adolescent idiopathic scoliosis (AIS) patients undergoing posterior spinal fusion by a single or dual-attending approach. We performed a 1:1 propensity score match with the variables of age at surgery, sex, body mass index, Cobb angle, and number of levels fused. Peri- and postoperative outcomes were analyzed. Results There were 24 patients in each cohort. Patients having surgery by dual attendings had a shorter mean operative time overall (232 vs. 327 minutes, p<0.001) and per levels fused (19 vs. 26 minutes per level, p<0.001). Dual attendings had better percent curve correction (70% vs. 56%, p=0.001) and smaller overall final postoperative curve magnitude (17° vs. 25°, p<0.001). Estimated blood loss (421 vs. 989 mL, p=0.023) and cell saver volume transfused (59 vs. 178 mL, p<0.001) were lower in dual attending cases. Dual attending patients had a shorter length of stay (3 vs. 4 days, p<0.001). There were no differences in Hemovac blood loss, transfusion requirements, need for intensive care, or complications. Over time, the young dual attendings improved in hospital length of stay (R: -0.617, p=0.001) and hemovac blood loss (R: -0.474, p=0.019). Conclusion A dual attending approach in idiopathic scoliosis surgery may result in shorter operative time, greater curve correction, reduced operative blood loss, and shortened hospital length of stay. No differences were identified in postoperative blood loss or transfusion requirement, need for intensive care, or overall complication rate. Within the limitations of this study, we conclude that dual attending surgery in idiopathic scoliosis is safe and effective when conducted by two young orthopedic surgeons, with results that are similar to that of a more experienced senior surgeon.