Operation In Observation Group Research Articles

Effects of tramadol hydrochloride preemptive analgesia in kyphoplasty of thoracolumbar osteoporotic fractures under local anesthesia

To explore preemptive analgesic effect of preoperative intramural tramadol injection in percutaneous kyphoplasty (PKP) of vertebrae following local anesthesia. From August 2019 to June 2021, 118 patients with thoraco lumbar osteoporotic fractures were treated and divided into observation group and control group, with 59 patients in each gruop. In observation group, there were 26 males and 33 females, aged from 57 to 80 years old with an average of (67.69±4.75)years old;14 patients on T11, 12 patients on T12, 18 patients on L1, 15 patients on L2;tramadol with 100 mg was injected intramuscularly half an hour before surgery in observation group. In control group, there were 24 males and 35 females, aged from 55 to 77 years old with an average of (68.00±4.43) years old;19 patients on T11, 11 patients on T12, 17patients on L1, 12 patients on L2;the same amount of normal saline was injected intramuscularly in control group. Observation indicators included operation time, intraoperative bleeding, visual analogue scale (VAS) evaluation and recording of preoperative (T0), intraoperative puncture(T1), and working cannula placement (T2) between two groups of patients, at the time of balloon dilation (T3), when the bone cement was injected into the vertebral body (T4), 2 hours after the operation (T5), and the pain degree at the time of discharge(T6);adverse reactions such as dizziness, nausea and vomiting were observed and recorded;the record the patient's acceptance of repeat PKP surgery. All patients were successfully completed PKP via bilateral pedicle approach, and no intravenous sedative and analgesic drugs were used during the operation. There was no significant difference in preoperative general data and VAS(T0) between two groups (P>0.05). There was no significant difference in operation time and intraoperative blood loss between the two groups (P>0.05). VAS of T1, T2, T3, T4 and T5 in observation group were all lower than those in control group(P<0.05), and there was no significant difference in T6 VAS (P>0.05). T6 VAS between two groups were significantly lower than those of T0, and the difference was statistically significant (P<0.05). There was no significant difference in incidence of total adverse reactions between two groups (P>0.05). There was a statistically significant difference in the acceptance of repeat PKP surgery (P<0.05). Half an hour before operation, intramuscular injection of tramadol has a clear preemptive analgesic effect for PKP of single-segment thoracolumbar osteoporotic fracture vertebral body under local anesthesia, which could increase the comfort of patients during operation and 2 hours after operation, and improve patients satisfaction with surgery.

Efficacy and safety analysis of bupivacaine liposome for pericapsular nerve group block for postoperative analgesia in elderly patients with hip replacement

Objective: To investigate the efficacy and safety of bupivacaine liposome for pericapsular nerve group block (PENGB) for postoperative analgesia in elderly patients with total hip replacement. Methods: A total of 42 elderly patients underwent total hip replacement were selected in the Second Affiliated Hospital of Wenzhou Medical University from May to July in 2023, including 19 males and 23 females, aged (68.8±6.3) years, the American Society of Anesthesiologists (ASA) grade Ⅰ to Ⅲ. They were divided into bupivacaine liposome group (observation group) and levobupivacaine hydrochloride group (control group) according to random number table, with 21 cases in each group. All the patients were anesthetized by lumbar anesthesia combined with PENGB. During PENGB, the observation group was injected with 10 ml (133 mg) bupivacaine liposome+5 ml normal saline, and the control group was injected with 10 ml (75 mg) levobupivacaine hydrochloride+5 ml normal saline. The primary outcome measures included the rest and movement visual analogue scale (VAS) scores at 6, 12, 24, 36, 48, 60, and 72 h after operation, the sufentanil consumption in analgesic pump, the numbers of analgesic pump compressions, and the rates of additional parexib sodium use in ward. The secondary outcome measures were the changes in lower limb muscle strength, the length of hospital stay and the occurrence of adverse reactions. Results: There was no significant difference in the rest and movement VAS scores between the two groups at pre-operation and at 6 h after operation (P>0.05);but the rest and movement VAS scores at 12, 24, 36, 48, 60 and 72 h after operation in observation group were significantly lower than those in control group (P<0.05); the rest and movement VAS scores at 6, 12, 24, 36, 48, 60 and 72 h after operation were lower than those at pre-operation in two group (P<0.05). The consumption of sufentanil in analgesic pump and parexib sodium usage in observation group were lower than those in control group at 12, 24, 36 and 48 h after operation (P<0.05). The total number of analgesic pump compressions, the number of effective compressions and the number of ineffective compressions in 48 h in observation group were lower than those in control group (P<0.05). The muscle strength of the lower limbs of all patients were able to move against gravity at 12 h after operation. The incidence of nausea in 48 h after operation in observation group was 9.5% (2/21), which was lower than 42.9% (9/21) in control group (P=0.014). No postoperative vomiting occurred in all patients. The length of the hospital stay was (9.3±2.2) d in observation group and (8.9±1.9) d in control group, and there was no significant difference between the two groups (P=0.500). Conclusion: Compared with levobupivacaine hydrochloride, liposomal bupivacaine in PENGB provides analgesic effects for up to 72 h after total hip replacement in elderly patients, reduces postoperative opioid and other analgesics usage, decreases the incidence of postoperative nausea, and has a minor effect on lower limb movement without prolonging hospitalization.

Vacuum sealing drainage combined with eggshell-like debridement antibiotic-loaded calcium sulphate for calcaneal osteomyelitis

BackgroundTo compare the clinical efficacy of vacuum sealing drainage, eggshell-like debridement combined with antibiotic calcium sulphate implantation and conventional debridement combined with antibiotic calcium sulphate implantation in the treatment of calcaneal osteomyelitis.MethodsSixty-six patients with calcaneal osteomyelitis who were treated in our department between January 2017 and August 2021 were included in this study. Thirty-one patients underwent VSD and eggshell-like debridement combined with antibiotic calcium sulphate implantation. Thirty-five patients underwent conventional debridement combined with antibiotic calcium sulphate implantation. The inflammatory markers, operation time, wound healing time, hospital stay, full weight bearing time after operation, recurrence rate of infection, complications, and American Orthopedic Foot and Ankle Society (AOFAS) scores were compared between the two groups.ResultsThe operation time and full weight bearing time after operation of observation group were longer than that of control group. Compared with preoperative results, WBC, ESR, CRP and PCT in both groups were significantly decreased at 14 days after operation, and there was no statistical significance between the two groups. The wound healing time and hospital stay in the observation group were shorter than those in the control group (P < 0.05). There were four patients with aseptic exudation in the observation group and ten patients with aseptic exudation in the control group, and the wounds healed well after multiple dressing changes. Seven patients in the observation group underwent secondary bone grafting due to bone defects, and four patients in the control group received secondary bone grafting due to bone defects. In the observation group, three patients received debridement combined with antibiotic calcium sulphate implantation again due to recurrent infection, compared with seven patients in the control group. One year after operation, the observation group had a better AOFAS scores than the control group, especially in terms of foot function (P < 0.05).ConclusionCompared with conventional debridement and antibiotic calcium sulphate implantation, VSD and eggshell-like debridement combined with antibiotic calcium sulphate implantation in the treatment of calcaneal osteomyelitis can shorten the wound healing and hospital stay of patients, reduce postoperative aseptic exudation complications and infection recurrence rate, and better preserve the foot function, which is a simple and effective method.

Comparative analysis of clinical efficacy between posterior percutaneous endoscopic discectomy and anterior cervical discectomy and fusion in the treatment of cervical spondylotic radiculopathy

To explore the clinical efficacy of posterior percutaneous endoscopic discectomy(PPECD) in the treatment of cervical spondylotic radiculopathy. A total of 56 patiens with single segment cervical spondylotic radiculopathy from December 2017 to October 2020, were randomly divided into observation group and control group. In observation group, there were 16 males and 11 females, including 8 cases of C4,5, 13 cases of C5,6 and 6 cases of C6,7 performed posterior percutaneous endoscopic discectomy, aged from 34 to 61 years old with an average of (51.15±6.29) years old. In control group, there were 19 males and 10 females with single segment cervical spondylotic radiculopathy including 10 cases of C4,5, 14 cases of C5,6 and 5 cases of C6,7 performed anterior cervical discectomy and fusion, aged from 40 to 65 years old with an average of (53.24±5.31) years old. The operative time, intraoperative blood loss, postoperative time of lying in bed and length of postoperative hospital stay were recorded. Visual analogue scale(VAS) and neck disability index(NDI) were used to evaluate the clinical efficacy. Cervical plain films or MRIs, CTs were taken for re-visiting patients. All patients were followed up more than 2 years. The observation group patients were followed up, the duration ranged from 24 to 42 months with an average of (30.48±4.91) months. The control group patients were followed up, the duration ranged from 25 to 47 months, with an average of (32.76±4.53) months. Compared with control group, operative time, intraoperative blood loss, postoperative time of lying in bed and length of postoperative hospital stay were decreased(P<0.05). Compared with pre-operation, VAS of neck and upper limb and NDI at the latest follow-up between two groups were significantly improved(P<0.05). Compared with control group, VAS of neck and upper limb at 1 day after operation in observation group were significantly reduced(P<0.05). There was no significant difference in VAS of neck and upper limb and NID at 1, 3 months and the latest follow-up after operation between two groups(P>0.05). In the observation group, one patient's deltoid muscle strength was weakened to grade 4 after operation, and returned to normal after 12 weeks of conservative treatment. In control group, there was 1 case of postoperative adjacent spondylosis with symptoms of spinal compression after 2 years operation, then underwent cervical artificial intervertebral disc replacement. And there was 1 case of dysphagia after operation in control group and improved after 1 year. There was no significant difference in incidence of complications between two groups. PPECD has advantages of shortening operative time, decreasing intraoperative blood loss, reducing postoperative time of lying in bed and length of postoperative hospital stay. However, applicable age range of patients and long-term clinical efficacy needs further study.

Effect of total arthroscopic rotator cuff repair on pain degree and complications of elderly patients with rotator cuff injury within 72 hours after operation

To analyze the clinical effect of rotator cuff repair and small incision rotator cuff repair under the total arthroscopy in elderly patients with rotator cuff injury. A total of 60 elderly patients with rotator cuff injury from January 2017 to November 2018 were selected as the research objects, including 37 males and 23 females;aged from 61 to 77 years old with an average of (63.45±12.34) years old;disease duration ranged from 6 to 12 months, with an average of (5.32±1.02 ) months;29 cases on the left side and 31 cases on the right side. Among them, 30 patients underwent total arthroscopic rotator cuff repair (observation group), 30 patients underwent small-incision rotator cuff repair(control group). The scores of University of California, Los Angeles(UCLA) shoulder rating scale, before and after surgery in the two groups were observed and recorded. The American Shoulder and Elbow Surgeons(ASES) score, Constant-Murley score, shoulder flexion range of motion, external rotation range of motion, abduction range of motion, visual analogue scale(VAS) within 72 hours after surgery, as well as the complcations were compared. The postoperative UCLA score, ASES score and Constant-Murley score between two groups were significantly higher than those before operation (P<0.05). There was no significant difference in postoperative UCLA, ASES and Constant-Murley score between two groups (P>0.05). The shoulder flexion range of motion, external rotation range of motion and abduction range of motion between two groups were significantly higher than those before operation (P<0.05). There was no significant difference between the two groups after operation (P>0.05). The VAS at 24, 48 and 72 h after operation in observation group were significantly lower than those in control group (P<0.05). The total incidence of complications in observation group(13.33%, 4/30) was sinificantly lower(P<0.05)than that in control group(33.33%, 10/30). Total arthroscopic rotator cuff repair and small incision rotator cuff repair can improve the shoulder function after rotator cuff injury in elderly, but the degree of pain and complications within 72 hours after total arthroscopic rotator cuff repair are significantly better than small incision rotator cuff repair, which can be selected according to the clinical situation and needs of patients.

A contrastive study on the clinical efficacy and safety oflaparoscopic myomectomy and high intensity focused ultrasound in the treatment of uterine fibroids.

This study intended to compare the safety and clinical efficacy between two treatments of uterine fibroids: laparoscopic myomectomy (LM) and high intensity focused ultrasound (HIFU). Clinical data were collected from 587 uterine fibroid patients who were treated in The People's Hospital of Nanchuan, Chongqing from January 1, 2018 to December 31, 2019. Among the patients, 287 cases were treated with HIFU (observation group), and 300 cases were treated with LM (control group). The progression-free survival (PFS) was taken as the primary endpoint. The secondary endpoints included operation results (including operative time, intraoperative blood loss, and intraoperative fluid replacement), complications, hemoglobin level one month after surgery and clinical efficacy. In addition, the fibroid volume of the observation group before treatment and 3, 6, and 12 months after treatment were also analyzed. The operative time of observation group was evidently shortened compared to the control group, and the intraoperative blood loss and intraoperative fluid replacement of observation group were also considerably reduced (all p < 0.05), but there was no significant difference in the hemoglobin level between the two groups one month after surgery (p > 0.05). In terms of curative effect, the total effective rate of HIFU group and LM group was 98.6% (283/287) and 95.3% (286/300) respectively, with statistically significant difference (p < 0.05). In terms of complications, the incidence of bleeding and infection in HIFU group was obviously lower than that in LM group (both p < 0.05), while no significant differences were observed in the remaining complications (all p > 0.05). Fibroid volume comparisons before treatment and 3, 6 and 12 months after operation in observation group showed that fibroid volume decreased significantly (all p < 0.05). The median follow-up time was 30.6 months. The mean PFS of patients in the observation group and control group was 29.71 months (95% CI 28.24-29.75) and 26.74 months (95% CI 26.49-28.33), respectively (HR 0.47; 95% CI, 0.29 to 0.76; Log-rank p = 0.0019). HIFU could improve the intraoperative efficacy and reduce the complications of patients with uterine fibroids and has excellent performance in improving clinical efficacy and prolonging PFS. HIFU can be used as an alternative to surgical treatment.

Percutaneous endoscopic lumbar discectomy in the treatment of adjacent segment lumbar disc herniation after lumbar fusion

To explore the clinical effect of percutaneous endoscopic lumbar discectomy in the treatment of adjacent segment lumbar disc herniation after lumbar fusion. From February 2010 to June 2018, 64 patients with adjacent segment lumbar disc herniation after lumbar fusion were retrospectively analyzed and divided into observation group and control group. In observation group, there were 23 males and 10 females performed with percutaneous endoscopic lumbar discectomy, including 27 cases of single segment fusion and 6 cases of double segment fusion, aged from 55 to 83 years old with an average of (65.7±7.4) years old. In control group, there were 22 males and 9 females performed with traditional open fusion revision, including 25 cases of single-segment fusion and 6 cases of double segment fusion, aged from 51 to 78 years old with an average of(64.8±7.8) years old. The operative time, intraoperative blood loss, fluoroscopy times, postoperative ambulation time and length of postoperative hospital stay were recorded. The clinical efficacy was evaluated by visual analogue scale(VAS) and Oswestry Disability Index(ODI). The complications between two groups were observed. All patients were followed up for at least 2 years. The observation group patients were followed up with an average of (2.4±0.5) years. The control group patients were followed up with an average of(2.6±0.7) years. Compared with control group, operation time, intraoperative blood loss, postoperative ambulation time and length of postoperative hospital stay of the observation group were significantly reduced (P<0.05), and the fluoroscopy times of observation group were significantly increased compared with control group(P<0.05). The VAS of low back and lower limb, and ODI at the latest follow-up between two groups were all significantly improved compared to those of pre-operation (P<0.05). The VAS of low back at each point and ODI at 1, 3 months after operation in observation group was significantly reduced compared with control group(P<0.05), however there was no significant difference in VAS for lower limb between two groups (P>0.05). The difference of complications between two groups was statistically significant (P<0.05). Compared with traditional open fusion revision surgery, percutaneous endoscopic lumbar discectomy for the treatment of adjacent segment lumbar disc herniation after lumbar fusion has the advantages of reducing operation time and intra-operative blood loss, shortening ambulation time and the length of postoperative hospital stay, and promoting pain and functional improvement, and decrease incidence of complications. However, long-term clinical efficacy needs further study.

The Effect of Different Surgical Approaches of Ultrasound-Guided Quadratus Lumborum Block on the Analgesic Effect in Cesarean Section

Objective To study the effect of different surgical approaches of ultrasound-guided quadratus lumborum block on the analgesic effect in cesarean section. Methods 150 parturients underwent elective caesarean section in our hospital from February 2017 to February 2020 were enrolled in this study. They were divided into observation group and control group according to the method of random number table, with 75 cases in each group. In control group, anterior QLB was used, while in observation group, posterior QLB was used. The operation process was performed by the same anesthesiologist. If the injection situation was not ideal, the position of needle tip was timely adjusted. Both groups were given sufentanil 100 HQ/kg (diluted with 100 mL normal saline) and a single addition of morphine 50 mg (diluted with 100 mL normal saline) for self-controlled analgesia after operation. The postoperative time to first water intake, the time to first discharge from bed, hospital stay and satisfaction degree of labor pain were compared between the two groups. The numerical pain score (NRS) and visual analogue scale (VAS) scores of rest and movement at different time after operation were compared. The dosage of sufentanil and morphine in perioperative period and the occurrence of postoperative adverse reactions were compared between the two groups. Results The time to first water intake, the time to first discharge from bed and hospital stay in the observation group were significantly shorter than those in the control group (P &lt; 0.05), and the satisfaction score of analgesia in the observation group was significantly higher than that in the control group (P &lt; 0.05). The NRS score of observation group at TO, 1, 2, 3 and 4 after operation was significantly lower than that of control group (P &lt; 0.05). There was no significant difference in VAS score of rest and movement at 4 and 8 h after operation between the two groups (P &gt; 0.05); the VAS score of rest and movement at 12 and 24 h after operation in observation group was significantly lower than that in control group (P &lt; 0.05). The amount of sufentanil and morphine used in the perioperative period in the observation group was significantly less than that in the control group (P &lt; 0.05). The total incidence rate of adverse reactions in observation group was not significantly different from that in control group (P &gt; 0.05). Conclusion Both anterior and posterior QLB can provide analgesia after cesarean section, but posterior QLB can better relieve the postoperative pain of parturients, which is worth popularizing in clinic.

Risk assessment of venous thromboembolism based on Caprini model in lung cancer patients after thoracoscopic surgery

Objective To explore the risk assessment of venous thromboembolism (VTE) based on Caprini model in patients after thoracoscopic lobectomy and to analyze the related risk factors of VTE. Methods From January 2016 to January 2018, this study selected 42 early lung cancer patients with thoracoscopic lobectomy of Shandong Provincial Chest Hospital in control group, and selected 28 early lung cancer patients with VTE after surgery in observation group. This study also collected and compared the general information and the score of the Caprini risk assessment of patients between two groups, and analyzed the risk factors in the Caprini risk assessment model. Results The ages, preoperative fibrinogen, preoperative D-Dimer, the ratio of histories of malignant tumor, body mass index (BMI) ≥25 kg/m2, hypertension, hyperglycemia, lobectomy and smoking history of observation group were higher than those of control group with statistical differences (P<0.05) . The score of the Caprini risk assessment of observation group was higher than that of control group with statistical difference (P<0.01) . Multivariate analysis showed that risk factors of VTE of lung cancer patients after thoracoscopic surgery included the D-Dimer higher than critical value, smoking history and BMI≥25 kg/m2 with statistical differences (P<0.05) . Conclusions Caprini risk assessment model can effectively calculate the patients with VTE after thoracoscopic lobectomy, classify and quantize the incidence risk of deep vein thrombosis (DVT) . The high risk factors of patients with VTE after thoracoscopic lobectomy include the increased D-Dimer, overweight and heavy smoking. Key words: Venous thromboembolism; Thoracoscopes; Postoperative complications; Lobectomy; Caprini model; Risk assessment; Risk factors

Application value of transurethral ureteroscopic minimally invasive urethra in closed urethral injury

Objective To explore the application value of transurethral ureteroscopic minimally invasive urethra in closed urethral injury. Methods From October 2016 to October 2018, 76 patients with closed urethral injury admitted to our hospital were selected as the research object. According to the different surgical methods, the patients were divided into control group and observation group, 38 cases in each group. The control group was treated with open urethral reunion. Ureteroscopy and transurethral resection of the suprapubic urethra were performed in the observation group. Results ①The total effective rate of operation in observation group was significantly higher than that in control group (97.37% vs.84.21%, P<0.05). ②the blood volume (36.25±9.23) mL and operation time (22.97±3.56) h in observation group were significantly shorter than those in control group [(92.56±8.64)mL, (45.23±3.68) h], and the hospitalization time (4.62±2.13)d was significantly shorter than that in control group (8.14±2.21)d. The maximum urinary flow rate (22.16±1.63)mL/s was higher than that of the control group (17.36±1.84)mL/s(P<0.05). ③The total incidence of postoperative complications in the observation group was significantly lower than that in the control group (15.79% vs.49.99%, P<0.05). Conclusions Transurethral ureteroscopic urethral minimally invasive technique for closed urethral injury has the advantages of less trauma, lower incidence of complications, shorter hospitalization time and higher maximum urinary flow rate, which is worthy of clinical promotion. Key words: Urethral Diseases; Ureteroscopy; Minimally Invasive Surgical Procedures

Compositional analysis of naive and recurrent urinary calculus by infrared spectroscopy

Objective To explore rate of recurrent urinary calculus in patients received infrared spectroscopy and diet intervention. Methods A total of 1136 patients with urolithiasis diagnosed in our hospital from January 2017 to June 2017 were selected as the research subjects. Infrared spectroscopy analysis system was performed to analyze the stone components of all the patients. All of them were divided into two group(observation group and control group). Observation group contained 703 patients who underwent diet intervention based on the analysis results of the stone main components. Other patients were not altered their dietary habit. The probability of disease recurrence, re-operation and main components changing of two groups 12 months after discharge was compared. Results The objective of the present study was to retrospective review 1136 patients with calculus who were divided into two groups. Observation group included 703 patients and control group got the rest. There were 85 patients formed calculus after surgery in observation group, 42 of that needed re-operation. Ninety-six patients recurred urinary calculus in control group, 68 of that came back to hospital for urinary after the first time. The rate of recurrence and re-operation in observation group were lower(12.09 % vs.22.17 %, χ2=9.595, P=0.002; 5.97 % vs.15.07 %, χ2=9.595, P=0.002 ). Changing of main calculus components occurred 14 patients of 42 in observation group. The same variation appeared 7 patients of 68 in control group. The rate of main components changing in observation group was lower(χ2=8.922, P=0.005). Conclusions After the surgery of urolithiasis, appropriate diet plan according to stone composition analysis by infrared spectroscopy will reduce the formation of urinary stones by controlling the intake of calcium-containing foods, so that the recurrence and re-operation rate will drop significantly after discharge. Key words: Urinary Calculi; Infrared Rays; Feeding Behavior

Application of perioperative meticulous nursing in patients with video-assisted thoracoscope surgery

Objective To explore the effects of perioperative meticulous nursing in patients with video-assisted thoracoscope surgery. Methods From January to December 2017, we selected 196 patients with video-assisted thoracoscope surgery at Chengdu Fifth People's Hospital as subjects by convenience sampling. All of the patients were divided into observation group and control group with the method of random number table, 98 cases in each group. Control group received perioperative routine nursing. On the bases of routine nursing, observation group carried out perioperative meticulous nursing. We counted the related indexes of postoperative recovery and incidence of complications, evaluate the Visual Analogy Score (VAS) as well as quality of life among patients between two groups at different time points after surgery. Results The times of out-of-bed activity, extubation of catheter, indwell time of chest tube, time of anal exhaust and hospital stay of observation group were shorter than those of control group with statistical differences (t=25.492, 10.205, 7.132, 23.087, 11.063; P<0.01) . The incidence of postoperative complications of observation group was 8.16% lower than that of control group with a statistical difference (χ2=10.531, P<0.01) . The scores of VAS at 2 and 48 hours after surgery of observation group were statistically lower than those of control group (t=15.717, 21.229; P<0.01) . The scores of physical functioning, role-physical, mental health and social functioning of observation group one week after surgery were higher than those of control group (t=8.321, 8.232, 9.761, 9.507; P<0.01) . Conclusions Perioperative meticulous nursing can effectively reduce the postoperative complications of patients with video-assisted thoracoscope surgery and relieve patients' postoperative pain which makes for patients' postoperative recovery and improving quality of life. Key words: Perioperative nursing; Thoracoscopes; Postoperative complications; Quality of life; Pain, postoperative period; Meticulous nursing

Effects of enhanced recovery nursing after surgery on knee function among patients with anterior cruciate ligament reconstruction under arthroscope

Objective To explore the effects of enhanced recovery after surgery (ERAS) intervention on functional rehabilitation among patients with anterior cruciate ligament (ACL) reconstruction under arthroscope. Methods From January 2013 to April 2016, we selected 120 patients with ACL reconstruction under arthroscope in Department of Orthopedics in West China Hospital of Sichuan University by convenience sampling. All of the patients were divided into two groups according to the admission time including control group (n=60, traditional rehabilitation) and observation group (n=60, ERAS intervention) . We compared the ankle swelling, effusion and the knee flexion as well as knee rehabilitation effect of patients in two groups with the Judet score and the Lysholn score after surgery. Results The early ankle swelling of patients in observation group was more obvious than that in control group, and there were 12 cases with joint puncture drainage after surgery in observation group and 5 cases in control group with no statistical difference (χ2=3.358, P=0.067) . There were 6 cases with knee functional disorder after surgery in control group reaching the excellent knee function after manual release. The excellent rates of knee function activity in observation group were respectively 83.33% and 96.67% three and six months after surgery superior than those (58.33% and 83.33%) in control group with statistical differences (χ2=9.076, 5.926; P<0.05) . The excellent rates of scores of knee function in observation group were respectively 80.00%, 91.67% three and six months after surgery higher than those (56.67% and 78.33%) in control group with statistical differences (χ2=7.548, 4.183; P<0.05) . Conclusions The application of ERAS intervention in ACL reconstruction under arthroscope can effectively improve early function and scope of activity of knee, however the complications may occur, such as ankle swelling and effusion. Key words: Anterior cruciate ligament; Arthroscopes; Rehabilitation; Knee joint; Enhanced recovery after surgery

The clinical effect and influence to renal function of microwave ablation assisted laparoscopic renal tumor extirpation in diameter less than 4 cm

Objective To observe the clinical effect of microwave ablation assisted laparoscopic renal tumor extirpation in diameter less than 4 cm, and analyze the influence to renal function. Methods From January 2015 to December 2017, 80 patients with diameter were selected as the research object.They were divided into control group and observation group, each 40 cases.They all were treated with laparoscopic renal tumor extirpation.The control group was subjected to radiofrequency ablation, while the observation group was microwave ablation.The surgical indicators, complications arise, tumor ablation and renal function related index before and after the operation of two groups were compared. Results The intraoperative blood loss, postoperative hospitalization days and postoperative complication rate of observation group were all less than control group, with statistical significance(P<0.05). The BUN, Scr and KIM-1 were all significantly more than before, and those indicators after operation in observation group were all better than control group, with statistical significance(P<0.05). Conclusions Buttress plata used in posterior malleolar fracture has less postoperative complication, even though it has more operation time and intraoperative blood loss.And it has better operation result and ankle range motion, worth promoting in clinic.Microwave ablation assisted laparoscopic renal tumor extirpation has less traumatic to patient, and less blood loss, and mild effect on renal function, and less postoperative complications.It helps patients recover faster and it is worth popularizing and applying in clinical practice. Key words: Kidney Neoplasms; Microwaves; Laparoscopy

Observation on the efficacy of binocular vision training for stereopsis establishment on concomitant strabismus children after surgery

Objective To evaluate the clinical efficacy of binocular vision training for stereopsis establishment on concomitant strabismus children after surgery. Methods The clinical data of 76 children who underwent common strabismus surgery from Jan. 2016 to Jan. 2018 were analyzed retrospectively. They were divided into two groups randomly. The control group were given routine care and the observation group were given binocular vision training. The binocular vision function of the two groups were examined and analyzed after surgery. Results The proportion of simultaneous visual, visual fusion and stereopsis in two groups at 6 months after surgery were significantly higher than those before surgery (P<0.05). The proportion of simultaneous visual, visual fusion and stereoscopic vision of observation group were significantly higher than those of the control group at 3 months after surgery (P<0.05). The stereoscopic sharpness of the two groups 3 and 6 months after surgery was significantly higher than that before surgery, and the stereoscopic sharpness of 6 months after surgery was significantly higher than that of 3 months after surgery (P<0.001). The stereoscopic sharpness at 3 and 6 months after surgery of observation group were significantly higher than those of the control group (P<0.001). Conclusion Binocular vision training is helpful on stereopsis establishment in concomitant strabismus children after surgery. Key words: Strabismus, concomitant; Children; Function, stereoscopic; Training, binocular-vision

Local injection of dexamethasone helping to prevent lower back pain after epidural delivery analgesia.

This report aims to retrospectively analyze the clinical effect of local pretreatment with dexamethasone (DXMS) on lower back pain after epidural labor analgesia. Patients with epidural labor analgesia treated in People's Hospital of Rizhao from January 2014 to December 2016 were studied. All 368 cases involved were pregnant primipara with full-term single birth. Parturient received injection of DXMS and lidocaine mixture around the epidural puncture point was the observation group (n=188), and parturient received injection of 0.9% sodium chloride and lidocaine mixture around the epidural puncture point was the control group (n=180). The incidence and degree of lower back pain postoperatively in the two groups were evaluated by pain visual analogue scale method. The incidence of lower back pain at 48 h, 72 h after operation in observation group was significantly lower than that in control group (p<0.05). Among patients undergoing one puncture and more than one puncture, the incidence of postoperative lower back pain in the observation group was significantly lower than that in the control group (59.26%) (p<0.05). Among the parturient with spontaneous delivery, the incidence of postoperative lower back pain in the observation group was significantly lower than that in the control group (p=0.028). Among the cesarean section patients, the incidence of pain in observation group was significantly lower than that in control group (p=0.019). At 48 and 72 h after operation, severe pain in the observation group was significantly less than that in the control group (p<0.05). DXMS local pretreatment can significantly reduce the incidence of postoperative lower back pain and the degree of pain after epidural delivery analgesia. DXMS pretreatment in epidural analgesia deserved to be widely used clinically.

Evidence based practice for the application of feeding management after spinal operation

Objective To analyze the effect of evidence based practice on feeding after spinal operation. Methods To formulate an answerable question, find the best available evidence, appraise the evidence and formulate the recommendations by using the method of evidence-based medicine. A total of 60 postoperative patients who received spinal operation were divided into observation group and control group (30 cases in each group). Those patients in control group received the routine diet guidance and the guidelines for the standardization of intake and consumption after spinal cord surgery were used for patients in observation group. The outcomes were evaluated by postoperative recovery and complications of patients after spinal operation. Results There were no significant difference in the incidence of nausea, vomiting, bloating and celialgia in the 5 hours after surgery and 2 hours after feeding between the two groups (P>0.05). The incidence of thirst and hunger in the 5 hours after surgery in observation group were 3.33%(1/30) and 13.33%(4/30).The incidence of thirst and hunger in the 5 hours after surgery in control group were 80.00%(24/30) and 83.33%(25/30). There were statistically significant in the incidence of thirst and hunger in the 5 hours after surgery between the two groups (χ2=36.27, 24.09, P 0.05). Conclusions Evidence-based practice in the use of guidelines for the standardization of intake and consumption after spinal cord surgery can guide clinical practice. Key words: Post spinal operation; Postoperation feeding; Evidence-based medicine

Clinical effects of self-expandable metallic stent insertion plus laparoscopy surgery for malignant colorectal obstruction in aged patients

Objective To investigate the clinical effects of the stent-laparoscopy approach in treatment of elderly patients with malignant colorectal obstruction. Methods Clinical data of 55 elderly hospitalized patients with colorectal cancer-induced bowel obstruction in Wenzhou Central Hospital from January 2009 to January 2014 were evaluated retrospectively.All patients were treated with expandable metallic stents for remission of bowel obstruction.Patients were divided to laparoscopy surgery-observation group (n=14) receiving laparoscopic surgery after decompression and the laparotomy surgery-control group (n=41) receiving conventional open colorectal cancer operation.The intraoperative information, postoperative complications and long-term curative effect were compared between the laparoscopy surgery-observation vs laparotomy surgery-control group. Results During laparoscopy surgery period, two patients operated by laparoscopy surgery were converted to laparotomy surgery.Surgical time was significantly longer in the laparoscopy surgery-observation group than in laparotomy surgery-control group[(178±33) min vs.(145±31) min, t=3.384, P=0.001], and bowel function recovery and postoperative hospital stay were significantly shorter in the laparoscopy surgery-observation group than in laparotomy surgery-control group[3.1±0.9) d vs.(4.3±1.3) d and (7.1±1.3) d vs.(12.6±5.7) d, t=3.193 and t=2.911, P=0.002 and P=0.005]. Intraoperative blood loss was less in the laparoscopy surgery-observation group than in the laparotomy surgery-control group[(63±29) ml vs (86±37) ml, t=2.11, P=0.04], with no significant differences in postoperative complications between the two groups (0.0 vs 9.76%, χ2=1.47, P=0.225). Fifty-five patients were followed up for 2 years.All patients survived in the laparoscopy surgery-observation group, but one patient died from the cerebrovascular accident in the laparotomy surgery-control group. Conclusions The stent-laparoscopy approach to treat colorectal cancer (CRC) patients with acute colorectal obstruction is a safe, effective, recovery quick and minimally invasive option for elderly patients.Emergency surgery may be converted to a limited operation by this method.Laparoscopic radical surgery with one-stage anastomosis is feasible. Key words: Colorectal neoplasms; Intestinal obstruction; Stents; Laparoscopy

Expression of transferrin in hematoma brain tissue at different stages after intra cerebral hemorrhage in rats.

To explore the expression of transferrin (Tf) and transferrin receptor (TfR) in hematoma brain tissue at different stage after intracerebral hemorrhage (ICH) in rats. ICH rats model were established by collagenase method, and rats were sacrificed at 24h, 72h, 7d and 14d after operation. The levels of Tf and TfR in different periods of rats were detected by immunohistochemical method, and correlation between two groups was analyzed. Tf, TfR-positive cells at each time after operation in observation group were significantly higher than that in control group (P<0.05). Tf, TfR-positive cells began to increase from 24h after the operation and reached the peak 72h-7d after surgery, but then gradually decreased. Tf was mainly expressed in nucleus and cytoplasm of neurons and glial cells around the hematoma, but TfR was mainly expressed in nucleus and cytoplasm of neurons and choroid plexus endothelial cells. Correlation analysis showed that the Tf-positive cell was significantly positively correlated with TfR-positive cell expression (r=0.447, P=0.022). Tf and TfR were important transporters in brain tissue excessive load iron transport after ICH, and detecting the expression levels of the two indicators can provide a reference for prognosis treatment in ICH.

Application of early enteral nutrition for postoperative patients with severe acute pancreatitis

Objective To improve the nutritional status and prognosis of postoperative patients with severe acute pancreatitis. Methods A total of 56 patients with severe acute pancreatitis were randomly divided into the observation group(n=28) and control group(n=28) from April 2012 to April 2014. On the basis of the conventional parenteral vien nutrition, enteral nutrition was applied respectively on the third day after surgery in observation group and on the seventh day after surgery in control group, respectively. The levels of prealbumin, albumin, the percentage of Nitrogen balance and infection rate of the two groups were compared. Results All the 56 patients recovered well postoperatively, with no death or infection. Three days after the surgery, patients′ nutritional indicators had no statistically significant difference (P>0.05). Ten days after the surgery, prealbumin, albumin and Nitrogen balance values in the observation group were (320.41±12.3)mg/L, (39.26±6.25)g/L and (0.65±0.31)%, respectively, which were significantly better than those in the control group (t=5.739 4, 5.901 7, 1.907 9, respectively; P 0.05). Conclusions Concerning the tolerance and prognosis, the best time for applying enteral nutrition is about five days after surgery. If patients can be tolerated, the early enteral nutrition can effectively reduce the infection rate and complications. Key words: Severe acute pancreatitis; Postoperative complications; Enteral nutrition