Postoperative Lower Extremity Research Articles

Postoperative femoral anteroposterior position while standing correlates with the posterior tibial slope and posterior femoral condylar offset in medial pivot total knee arthroplasty.

After total knee arthroplasty (TKA), the femur tends to be located posteriorly under weight-bearing (WB) conditions, and a paradoxical femoral anterior motion occurs, leading to joint instability. We aimed to clarify factors which affect the postoperative femoral anteroposterior position relative to the tibia under WB conditions (A-P position) in medial pivot (MP) TKA. Among 126 knees (81 women) with primary TKA using MP prosthesis for varus osteoarthritic knees, 70 knees had cruciate-retaining inserts (CR) with the reduced conformity and 56 knees had cruciate-substituting inserts (CS) with the full conformity. Using the three-dimensional (3D) assessment system, the associations between the A-P position and the factors including pre- and postoperative lower extremity alignment, component positions, and posterior femoral condylar offset (PCO), were assessed regarding the type of inserts. Significant correlations were seen between the A-P position and posterior tibial slope (PTS), medial PCO, and lateral PCO. Regarding the difference between the two inserts, the PTS, medial PCO, and lateral PCO significantly correlated with the A-P position in the CR, but only the PTS correlated in the CS. The increased PTS and decreased PCO were the dominant factors for the A-P position in MP TKA.

Influence of Catheter–Incision Congruency in Epidural Analgesia on Postcesarean Pain Management: A Single-Blinded Randomized Controlled Trial

Patient-controlled epidural analgesia (PCEA) or epidural morphine may alleviate postcesarean pain; however, conventional lumbar epidural insertion is catheter–incision incongruent for cesarean delivery. Methods: In total, 189 women who underwent cesarean delivery were randomly divided into four groups (low thoracic PCEA, lumbar PCEA, low thoracic morphine, and lumbar morphine groups) for postcesarean pain management. Pain intensities, including static pain, dynamic pain, and uterine cramp, were measured using a 100 mm visual analog scale (VAS). The proportion of participants who experienced dynamic wound pain with a VAS score of >33 mm was evaluated as the primary outcome. Adverse effects, including lower extremity blockade, pruritus, postoperative nausea and vomiting, sedation, and time of first passage of flatulence, were evaluated. Results: The low thoracic PCEA group had the lowest proportion of participants reporting dynamic pain at 6 h after spinal anesthesia (low thoracic PCEA, 28.8%; lumbar PCEA, 69.4%; low thoracic morphine, 67.3%; lumbar morphine group, 73.9%; p < 0.001). The aforementioned group also reported the most favorable VAS scores for static, dynamic, and uterine cramp pain during the first 24 h after surgery. Adverse effect profiles were similar among the four groups, but a higher proportion of participants in the lumbar PCEA group (approximately 20% more than in the other three groups) reported prolonged postoperative lower extremity motor blockade (p = 0.005). In addition, the first passage of flatulence after surgery reported by the low thoracic PCEA group was approximately 8 h earlier than that of the two morphine groups (p < 0.001). Conclusions: Epidural congruency is essential to PCEA for postcesarean pain. Low thoracic PCEA achieves favorable analgesic effects and may promote postoperative gastrointestinal recovery without additional adverse effects.

Optimal “Low” Pedicle Screw Stimulation Threshold to Predict New Postoperative Lower-Extremity Neurologic Deficits During Lumbar Spinal Fusions

Previous studies have shown that pedicle screw stimulation thresholds ≤6-8 mA yield a high diagnostic accuracy of detecting misplaced screws. Our objective was to determine the optimal "low" stimulation threshold to predict new postoperative neurologic deficits and identify additional risk factors associated with deficits. We included patients with complete pedicle screw stimulation testing who underwent posterior lumbar spinal fusion surgeries from 2010-2012. We calculated the diagnostic accuracy of pedicle screw responses of ≤4 mA,≤6 mA, ≤8 mA, ≤10 mA, ≤12 mA, and ≤20 mA to predict new postoperative lower-extremity (LE) neurologic deficits. We used multivariate modeling to determine the best logistic regression model to predict LE deficits and identify additional risk factors. Statistics software packages used were Python3.8.5, NumPy 1.19.1, Pandas 1.1.1, and SPSS26. We studied 1179 patients who underwent 8584 pedicle screw stimulations with somatosensory evoked potential and free-run electromyographic monitoring for posterior lumbar spinal fusion. Twenty-five (2.1%) patients had new LE neurologic deficits. A stimulation threshold of≤8 mA had a sensitivity/specificity of 32%/90% and a diagnostic odds ratio/area under the curve of 4.34 [95% confidence interval: 1.83, 10.27]/0.61 [0.49, 0.74] in predicting postoperative deficit. Multivariate analysis showed that patients who had pedicle screws with stimulation thresholds ≤8 mA are 3.15 [1.26, 7.83]× more likely to have postoperative LE deficits while patients who have undergone a revision lumbar spinal fusion surgery are 3.64 [1.38, 9.61]× more likely. Our results show that low thresholds are indicative of not only screw proximity to the nerve but also an increased likelihood of postoperative neurologic deficit. Thresholds ≤8 mA prove to be the optimal "low" threshold to help guide a correctly positioned pedicle screw placement and detect postoperative deficits.

Predictive value of thromboelastography for postoperative lower extremity deep venous thrombosis in gastric cancer complicated with portal hypertension patients

ABSTRACT Background To explore the predictive value of thromboelastography (TEG) for the occurrence of lower extremity deep venous thrombosis (LDVT) in gastric cancer combined with portal hypertension patients after operation. Methods 172 gastric cancer patients combined with portal hypertension were randomly divided into laparoscopic surgery or laparotomy groups. All patients were taken venous blood on an empty stomach 1 day before operation, 1 day, 3 days, and 5 days after operation. Results There was no significant difference in R value, K value, α angle, and MA before and after operation (P > .05). Compared with the same group before operation, the R value and K value were decreased at 1, 3, and 5 days after operation, while the α angle and MA were increased (P < .05). Compared with the non-LDVT group, the postoperative R value and K value in the LDVT group were significantly lower, while the α angle and MA were significantly higher (P < .05). The AUC of R value, K value, α angle, and MA levels at 3 days after surgery to identify patients with LDVT was 0.778, 0.718, 0.881, and 0.781, respectively. The estimated probability of the final model for LDVT was 0.622. Compared with the estimated probability ≥0.622 group, the LDVT rate in the estimated probability <0.622 group was significantly increased (χ2 = 60.128, P < .001). Conclusions The combination of R value, K value, α angle, and MA at 3 days after surgery has a moderately effective predictive effect for the occurrence of LDVT in gastric cancer patients combined with portal hypertension.

Application of chimerical ALT perforator flap with vastus lateralis muscle mass for the reconstruction of oral and submandibular defects after radical resection of tongue carcinoma: a retrospective cohort study

BackgroundPatients with tongue carcinoma who undergo combined tongue and neck radical resection often have simultaneous oral and submandibular defects. Due to its high flexibility, the anterolateral thigh (ALT) perforator flap is gradually being adopted by surgeons for oral reconstruction. However, the tissue volume of perforator flaps is insufficient for the reconstruction of both the oral and submandibular regions. In this retrospective cohort study, we compared the postoperative outcomes and complications between patients reconstructed with using the classical ALT perforator flap and patients reconstructed using the chimeric ALT perforator flap with vastus lateralis muscle mass.MethodsFrom August 2017 to August 2019, 25 patients underwent reconstructive therapy using a classical ALT perforator flap (classical group), while 26 patients were reconstructed with the chimeric ALT perforator flap (chimeric group) after radical resection of tongue cancer in Xiangya Hospital, Central South University. The flap survival rate, incidence of submandibular infection, lateral appearance, lower extremity function, and quality of life were compared between the two groups.ResultsThere were no differences in flap survival rate and postoperative lower extremity function between the two groups. The incidence of submandibular infection was 15.4 and 40% in the chimeric and classical group, respectively. The duration of recovery was 12.20 ± 2.69 and 15.67 ± 4.09 days in the chimeric and classical group, respectively. The submandibular region fullness was satisfactory in the chimeric group. The postoperative quality of life in the chimeric group was better than that in the classical group (P < 0.05).ConclusionsThe chimerical ALT perforator flap with muscle mass reconstructs both the oral and submandibular defects accurately. It maintains the profile and fullness of the submandibular region and may reduce the incidence of submandibular infection.

The efficacy of somatosensory evoked potentials in evaluating new neurological deficits after spinal thoracic fusion and decompression.

Posterior thoracic fusion (PTF) is used as a surgical treatment for a wide range of pathologies. The monitoring of somatosensory evoked potentials (SSEPs) is used to detect and prevent injury during many neurological surgeries. The authors conducted a study to evaluate the efficacy of SSEPs in predicting perioperative lower-extremity (LE) neurological deficits during spinal thoracic fusion surgery. The authors included patients who underwent PTF with SSEP monitoring performed throughout the entire surgery from 2010 to 2015 at the University of Pittsburgh Medical Center (UPMC). The sensitivity, specificity, odds ratio, and receiver operating characteristic curve were calculated to evaluate the diagnostic accuracy of SSEP changes in predicting postoperative deficits. Univariate analysis was completed to determine the impact of age exceeding 65 years, sex, obesity, abnormal baseline testing, surgery type, and neurological deficits on the development of intraoperative changes. From 2010 to 2015, 771 eligible patients underwent SSEP monitoring during PTF at UPMC. Univariate and linear regression analyses showed that LE SSEP changes significantly predicted LE neurological deficits. Significant changes in LE SSEPs had a sensitivity and specificity of 19% and 96%, respectively, in predicting LE neurological deficits. The diagnostic odds ratio for patients with new LE neurological deficits who had significant changes in LE SSEPs was 5.86 (95% CI 2.74-12.5). However, the results showed that a loss of LE waveforms had a poor predictive value for perioperative LE deficits (diagnostic OR 1.58 [95% CI 0.19-12.83]). Patients with new postoperative LE neurological deficits are 5.9 times more likely to have significant changes in LE SSEPs during PTF. Surgeon awareness of an LE SSEP loss may alter surgical strategy and positively impact rates of postoperative LE neurological deficit status. The relatively poor sensitivity of LE SSEP monitoring may indicate a need for multimodal neurophysiological monitoring, including motor evoked potentials, in thoracic fusion surgery.

Effect of different doses of low molecular weight heparin on coagulation mechanism in thoracic cancer surgery

Objective To study the effect of different doses of low molecular weight heparin on coagulation mechanism after thoracic surgery. Methods A prospective randomized controlled study was conducted to select patients who underwent thoracic cancer surgery (lung cancer, esophageal cancer, cardiac cancer) from February 2015 to October 2018. According to the Caprini risk assessment model, 101 patients with high risk of deep venous thrombosis were randomly assigned to groups A, B and C. Control group A (34 cases) did not use low molecular weight heparin; group B (34 cases) used prophylactic low molecular weight heparin calcium after operation; group C (33 cases) used therapeutic low molecular weight heparin calcium after operation. The platelet count (PLT), fibrinogen (FIB), prothrombin time (PT), D-dimer (D-D), postoperative thoracic drainage and lower extremity deep vein ultrasound were observed before and after operation. Results The incidence of deep venous thrombosis (DVT) was 11.76% in group A, 2.94% in group B and 3.03% in group C, with significant difference between group B and C and group A (P 0.05). The levels of FIB and D-D after operation were significantly higher than those before operation (P<0.05), but the levels of indexes in group B and C were significantly lower than those in group A (P<0.05). Conclusions Low molecular weight heparin calcium does not increase bleeding and thoracic drainage, which is beneficial to improve the hypercoagulable state of patients and has good safety. However, the use of low molecular weight heparin calcium in different doses (prevention amount and treatment amount) has no significant effect on the occurrence of lower extremity deep vein thrombosis and coagulation index. Key words: Thoracic neoplasms; Thoracic surgical procedures; Heparin, low-molecular-weight; Blood coagulation tests

Study of risk factors for lower extremity deep venous thrombosis in elderly patients with degenerative diseases of the spine

Objective To explore the risk factors of lower extremity deep venous thrombosis (DVT) after orthopedic surgery in orthopedic patients. Methods We retrospectively analyzed 500 patients who underwent surgery in orthopedics due to degenerative diseases of the spine from September 2016 to May 2019. All patients underwent ultrasound examination of the lower extremities before surgery to confirm the absence of thrombosis Double lower extremity ultrasound on the 3th, 6th, 9th and 12th postoperative day. According to the results of ultrasound, the patients were divided into DVT group and non-DVT group. A total of 65 cases of DVT were diagnosed and the DVT formation rate was 13%. The age, D-dimer, body mass index (BMI), comorbidity, preoperative and postoperative coagulation, operation time, Logistic multivariate regression analysis of hospitalization time, intraoperative blood loss, etc. to explore risk factors associated with DVT. Results A total of 500 patients were included for analysis, According to the final results, 65 patients were included in the DVT group, and 435 were included in the non-DVT group. The incidence of DVT was 13%. Univariate analysis showed statistically significant differences in age, BMI, and hypertension between the two groups (P<0.05). Logistic regression analysis showed D-dimer [odds ratio (OR)=7.059, 95% confidence interval (CI)=2.864-17.401], OR=1.836, 95%CI=1.022-3.301) and operative time (OR=1.513, 95%CI= 1.039-2.203) is a risk factor for postoperative lower extremity DVT. Conclusion Obesity, D-dimer and long operation time are independent risk factors for lower extremity DVT. Key words: Spinal degenerative disease; Lower extremity deep venous thrombosis; Risk factor

Incidence and risk factors of deep venous thrombosis in lower extremity in patients with tibial plateau fracture

Objective To investigate the incidence and risk factors of deep venous thrombosis (DVT) in lower extremity in patients with tibial plateau fracture. Methods The data from 148 patients with tibial plateau fracture were retrospectively analyzed who had been admitted to the Department of Orthopaedic Trauma, Honghui Hospital between September 2014 and December 2017. They were 90 males and 58 females, aged from 19 to 83 years (average, 47.2±13.1 years). According to the Schatzker classification of tibial plateau fractures, 24 cases belonged to type Ⅰ, 17 to type Ⅱ, 25 to type Ⅲ, 29 to type Ⅳ, 34 to type Ⅴ, and 19 to type Ⅵ. The incidence of DVT was detected by venous ultrasound of bilateral lower extremities before and after surgery. The factors related to the occurrence of DVT were statistically analyzed. Univariate analysis was used to determine risk factors, and multivariate logistic regression analysis was used to identify the primary independent risk factors. Results The preoperative DVT incidence was 43.92% (65/148) and the postoperative DVT incidence 52.70% (78/148). Distal thrombus predominated both preoperatively and postoperatively. Age (OR=1.043, 95%CI 1.015~1.072, P=0.002) and D-dimer level upon admission(OR=1.219, 95%CI 1.009~1.473, P=0.040) were independent risk factors for preoperative DVT formation; age (OR=1.075, 95%CI 1.042~1.110, P=0.000), operative time (OR=0.994, 95%CI 0.989~0.999, P=0.016), D-dimer level at 1 day postoperatively (OR=1.135, 95%CI 1.025~1.258, P=0.015) and at 3 days postoperatively (OR=1.366, 95%CI 1.008~1.853, P=0.044) were independent risk factors for postoperative DVT. Conclusions The incidence of DVT in the lower ex-tremity may be high in patients with tibial plateau fracture. Distal thrombus is the main manifestation. In fracture patients, especially the middle-aged and elderly ones, dynamic monitoring of D-dimer level should be combined with lower extremity venous ultrasound for early diagnosis of DVT. In patients with lower extremity DVT, surgical progress should be accelerated on the basis of good surgical quality to reduce the incidence of postoperative lower extremity DVT. Key words: Venous thrombosis; Risk factors; Age factors; D-dimer; Tibial plateau fracture

Foam padding in postoperative lower extremity casting: an inexpensive way to protect patients

Foam padding in postoperative lower extremity casting: an inexpensive way to protect patients

The Impact of Epidural Analgesia on the Rate of Thromboembolism without Chemical Thromboprophylaxis in Major Oncologic Surgery

Patients with abdominopelvic cancers are at increased risk of venous thromboembolism (VTE) due to their malignancy. We evaluated outcomes and the rate of VTE in patients undergoing abdominopelvic surgery for malignancy with preoperative epidural analgesia without postoperative chemical VTE prophylaxis. A retrospective review between 2009 and 2015 identified 285 patients with malignancy who underwent abdominopelvic surgery by a single surgeon (AWS). Lower extremity venous duplex scans (VDS) were performed preoperatively and before discharge. Demographics, procedures, and VTE outcomes were reviewed. The median age was 66 years. The average operative time was 315 minutes. All patients ambulated on postoperative day (POD) one or two. Epidural catheters (ECs) were removed on postoperative day four or five. No patient received VTE prophylaxis while an epidural catheter was in place. Preoperative lower extremity VDS revealed above-knee deep vein thrombosis (DVT) in seven patients (2.5%). Postoperative lower extremity VDS revealed acute DVT in 24 patients (8.4%): nine (3.2%) above-knee and 15 (5.2%) below-knee. The nine patients with above-knee DVT were anticoagulated after epidural removal. No patient developed a pulmonary embolism. Our data suggest that patients undergoing major open operations with epidural analgesia have low rates of DVT and may obviate the need for chemical prophylaxis. However, larger studies are required to determine the overall effects of epidural analgesia on the development of DVTs postoperatively.

Effects of antithrombotic pressure pump combined with graduated compression stocking on the incidence of lower extremity deep venous thrombosis in the postoperative breast cancer patients

Objective To investigate the prevention effects of antithrombotic pressure pump combined with graduated compression stockings (GCS) on incidence of postoperative lower extremity deep venous thrombosis (LEDVT) in breast cancer patients. Methods A total of 363 cases of breast cancer patients after operation were divided into routine care group (124 cases) according to the method of random number table, pressure group (127 cases) and combined treatment group (112 cases). The routine care group received conventional LEDVT ankle pump exercises. The pressure group used GCS besides the routine intervention. The combined group received GCS and antithrombotic pressure pump besides the routine intervention. Then the levels of thrombosis markers, D-dimers, platelets, and incidences of LEDVT were examined in the three groups. Results Before operation, no significant differences between the levels of prothrombin time (PT), activated partial prothrombin time (APTT), thrombin time (TT), fibrinogen, plasma D-dimer and platelets (P>0.05). After operation, the levels of PT, APTT, TT, fibrinogen, plasma D-dimer and platelets in three groups were (10.22±0.76) s, (27.24±3.68) s, (14.60± 0.88) s, (2.94±0.59) mg/L, (0.31±0.21) mg/L, (288.48±71.29)×109/L, (10.73±0.79) s, (27.35±2.54) s, (14.71± 1.76) s, (4.12±1.09) mg/L, (0.46±0.38) mg/L, (284.26±70.98) ×109/L and (11.11±0.64) s、(28.52±2.74) s, (14.33± 1.02) s, (4.42±1.20) mg/L, (0.35±0.33) mg/L, (258.79±62.35) ×109/L, respectively. There was significant difference among these groups (F=5.71-87.31, P<0.01). The differences on PT, APTT, fibrinogen and D-dimers between combined treatment group and routine care group were statistically significant (P<0.05). The differences on PT, fibrinogen and platelets between combined treatment group and pressure group were statistically significant (P<0.05). The differences on PT, APTT, fibrinogen and D-dimers between routine care group and pressure group were statistically significant (P<0.05). Through one months of follow-up, the incidence of LEDVT in routine care group, pressure group and combined treatment group were 12.10%(15/124),3.15% (4/127),0.89% (1/112), respectively. There was significant difference among these groups (χ2=16.279, P<0.01). Conclusions The application of antithrombotic pressure pump combined with GCS significantly improves the postoperative hypercoagulable states in breast cancer patients. The combined treatment reduces the incidence of LEDVT without bleeding risk. Therefore, antithrombotic pressure pump combined with GCS is recommended for clinical use in the postoperative breast cancer patients. Key words: Breast neoplasms; Nursing care; Lower extremity deep vein thrombosis; Antithrombotic pressure pump; Graduated compression stockings

Effect of fast-track surgery on perioperative nursing care for patients with abdominal surgery: a Meta analysis

Objective To evaluate the effect of fast-track surgery on perioperative nursing care for patients with abdominal surgery. Methods Using FTS and perioperative nursing as keywords, relevant literature was retrieved from the CNKI, Wanfang Med, Cochrane Library and PubMed databases. Articles including patients who underwent abdominal surgery as the research subjects were screened and analyzed with RevMan 5.3. Results Seven articles were included, covering 288 experimental cases and 290 control cases. Patients with FTS nursing had a higher satisfaction with nursing (P<0.05) , shorter postoperative hospital stay (Z=6.71, P<0.05), shorter postoperative anal exhaust time (Z=9.08, P<0.05), and lower incidence of postoperative incision infection (Z=2.65, P=0.05),Hospitalization costs were also reduced (Z=11.75, P<0.05). The incidence of complications, including postoperative abdominal infection, anastomotic fistula, intestinal obstruction, and lower extremity deep vein thrombosis, did not increase. Conclusions FTS nursing can improve the satisfaction of patients with abdominal surgery and reduce their hospitalization expenses and recovery time these results indicate that FTS is a safe and feasible nursing measure. Key words: Abdominal; Fast-track surgery; Perioperative nursing

Effect of intra-articular injection of tranexamic acid on the effectiveness and safety after blood loss and functional recovery of knee joint arthroplasty

Objective To analyze the impact of blood loss and postoperative functional rehabilitation of primary unilateral total knee arthroplasty (TKA) with application of intra-articular traneamic acid (TXA) injection and clamping the drainage tube for 3 h. Methods From February 2014 to Augest 2015, 110 patients with knee osteoarthritis undergoing primary unilateral TKA were randomly divided into TXA group, first control group and second control group. There were 30 patients in the TXA group, 39 patients in the first control group and 41 patients in the second control group. TXA (2.0 g dissolved in 100 ml normal saline) or placebo (100 ml normal saline) was prepared. Patients in TXA group were injected with TXA (2.0 g dissolved in 100 ml normal saline) into intra-articular by drainage tube before deflation of the tourniquet. Patients in first control group and second control group were injected with normal saline (100 ml) into intra-articular by drainage tube before deflation of the tourniquet. In the TXA group and first control group, the drainage tube was clamped for 3 h immediately after injection. In the second control group, the drainage tube was not clamped. Gender, age, and body mass index (BMI) showed no significant differences among the three groups. Results There was statistically significant difference among the three groups in postoperative drainage volume, hidden blood loss, total blood loss, transfusion volume and rate, degree of knee joint swelling, the incidence of postoperative lower extremity ecchymosis area >1%, ROM and knee association score (KSS) function scores on the fifth day and first month after operation, but postoperative venous thrombus embolism showed no statistically significant difference (P=0.971). Conclusion Injection of TXA (2.0 g dissolved in 100 ml normal saline) into intra-articular by drainage tube before deflation of the tourniquet significantly reduced hidden blood loss and transfusion volume and rate in primary TKA and did not increase the risk of venous thromboembolisms or other adverse events, and it is beneficial to the early functional recovery of knee joint after operation. Key words: Tranexamic acid; Arthroplasty; Knee joint; Blood loss; Functional rehabilitation

Effect of the focus intervention on the rehabilitation of patients with total hip replacement and the nursing experience

Objective To investigate the effect of the focus intervention on the rehabilitation of patients with total hip replacement. Methods From March 2014 to March 2016, selected 166 cases of elderly patients with total hip replacement, the patients were divided into observation group (89 cases) and control group (77 cases) according to admission orders, 77 cases from March 1 2014 to February 28 2015 are classified as the control group, whereas 89 cases from March 1 2015 to February 29 2016 are classified as the experimental group. The observation group was treated with focus intervention, and the control group received routine nursing care, observed two groups postoperative rehabilitation effect, the incidence of postoperative lower extremity venous thrombosis and infection, and patient satisfaction with care, etc. Results The postoperative recovery of hip function in the observation group was better than that in the control group (Z=-2.787, P 0.05) . The nursing satisfaction in observation group was 92.13% (82/89) , significantly higher than that in the control group72.73% (56/77) , the difference was statistically significant (χ2=11.089, P < 0.05). Conclusion The focus intervention on the functional recovery of patients with total hip replacement may have some help, reduce complications and improve patient satisfaction. Key words: Focal intervention; Total hip replacement; Rehabilitation effect

Applicability of a modified angular correction measurement method for open-wedge high tibial osteotomy.

The purpose of this study was to evaluate the clinical potential of a new measurement technique for open-wedge high tibial osteotomy (HTO) based on the medial cortex opening (MCO) associated with the Miniaci preoperative planning technique. A retrospective review of 97 cases of valgus-producing HTO that were performed between 2008 and 2013, using the intra-operative fluoroscopic mechanical axis technique, was carried out. The Miniaci-based measurement technique was then used as a theoretical point of comparison with the intent to compare the disparity between postoperative and ideal lower extremity (LE) mechanical axis with the measured disparity between postoperative and Miniaci-based planned MCO. A significant correlation was observed for the comparison of the disparity between postoperative and Miniaci-based planned MCO and the disparity between postoperative and ideal LE mechanical axis (0.53, P=0.001). This would suggest that the MCO associated with the Miniaci preoperative planning technique would have resulted in a better alignment had it been the chosen method to guide the amount of osteotomy opening. No significant correlation was observed between perioperative and postoperative LE mechanical axis (n.s.), the variable on which the current technique is based, confirming the poor reliability of the fluoroscopic mechanical axis technique. This study suggests a more accurate and precise technique of realizing the appropriate angular correction when performing a HTO, which could lead to better clinical outcomes. III.

保存的に管理した術後下腿コンパートメント症候群の1例

52歳肥満患者の直腸癌に対し頭低位砕石位にて腹腔鏡下低位前方切除術が施行された．術直後から左下腿背側の疼痛および腫脹が出現し，翌朝には血清CPKが14,028 IU/Lと上昇した．急性下腿コンパートメント症候群を疑い，筋内圧を測定すると43mmHgと高値ではあったが，症状と組織灌流圧から判断し筋膜切開は施行せず保存的に管理した．術後10日目に症状改善し，歩行リハビリテーションを開始すると疼痛および腫脹に加え，一過性の知覚障害が出現したが，術後45日目には改善し，退院となった．下腿コンパートメント症候群の保存的管理では，急性期だけでなく回復期まで，筋膜切開を考慮した注意深い経過観察が重要である．

Effect of the modified lithotomy position on prevention of lower extremity deep venous thrombosis in patients with laparoscopic panhysterectomy

Objective To explore the effects of modified lithotomy position on prevention of lower extremity deep venous thrombosis(DVT) in patients with laparoscopic panhysterectomy. Methods A total of 168 patients with laparoscopic panhysterectomy undergoing lithotomy position were randomly divided into observation group (n=84) and control group (n=84). Patients in the observation group were placed with modified lithitomy position: the tail end of the leg-holding plates were adjusted higher and the upper portions of the calf muscle of the patients were placed on the plates so that their ankles were made 6~8 cm higher above knees.The range from 1/2 of feet to 6 cm upper knees were bound with the elastic bandage.The control group was adopt traditional lithotomy position with their lower legs placed on the leg-holding plate and the knees flexed naturally.The degrees of blood oxygen saturation(SpO2), plasma thrombus precursor protein(TpP) and the variations of postoperative lower extremity were observed in the two groups during the implementation of lithotomy position. Results The degrees of plasma TpP were all increased in the two groups after the implementation of lithotomy position.The TpP of control group was significantly higher than that of observation group at different time (P<0.01). The abnormal rate of the SpO2 in toes of observation group(15.48%) was significantly higher than that of control group (2.38%) (P<0.01). The incidence of DVT in control group(9.52%) was significantly higher than that in observation group (1.19%) (P<0.05). Conclusion Modified lithotomy position can alleviate the venous blood stasis of lower extremity and reduce the incidence of DVT in patients with laparoscopic panhysterectomy. Key words: Laparoscopic surgery; Panhysterectomy; Lithotomy position; Deep venous thrombosis; Nursing

The Effects of Limb Elevation on Muscle Oxygen Saturation: A Near-Infrared Spectroscopy Study in Humans

BackgroundOrthopaedic and rehabilitation physicians often instruct patients to elevate a traumatized or postoperative lower extremity. Elevation is thought to improve patient comfort, as well as decrease swelling, wound complications, and the risk of compartment syndrome. Elevating a limb with increased compartment pressures, however, has been shown to reduce perfusion pressure and contribute to tissue ischemia. This investigation aims to advance our understanding of the tissue effects of limb elevation using a healthy patient model. ObjectiveTo quantify the effects of elevation, experimentally induced ischemia, and immobilization on muscle oxygen saturation in the human leg using near-infrared spectroscopy (NIRS). DesignExperimental crossover study. SettingOrthopaedic Surgery research laboratory, Stanford Hospitals & Clinics. Patients for ParticipationTwenty-six healthy volunteers. MethodsUsing transcutaneous sensors, we measured muscle oxygen saturation of the anterior compartment of the left (control) leg at 0, 15, and 30 cm of elevation relative to the heart using NIRS. A standardized short leg splint and a thigh tourniquet inflated to 50 mmHg were then applied to the right (experimental) leg to simulate a traumatized state. NIRS measurements were then repeated, again at 0, 15, and 30 cm of elevation. Muscle oxygen saturation values at various degrees of elevation of the control and experimental limb were then compared and analyzed by the use of a crossover study design and mixed-effects regression. Main Outcome MeasurementsMuscle oxygen saturation at varying levels of elevation in both the (1) control leg and (2) experimental leg in a simulated traumatic state. ResultsMale (18) males and female (8) patients between 22 and 62 years of age (mean 29.8 years) were enrolled. Mean regional muscle oxygen saturation (rSO2) of the control limbs at 0, 15 and, 30 cm of elevation were 74.2%, 72.5%, and 70.6%, respectively, whereas mean rSO2 of the experimental limbs were 66.3%, 65.0%, and 63.3%. A statistically significant decrease of rSO2 was observed (mean 7.65%) in the experimental limbs compared with the control limbs. As elevation increased, there was a statistically significant decrease in rSO2 of 0.12% per centimeter of elevation. Elevation did not decrease the rSO2 in the experimental limb to a greater degree than in the control limb. ConclusionIncreasing levels of elevation in a human limb results in progressively compromised muscle oxygen saturation as measured by NIR.

PD35-07 EVALUATION AND MANAGEMENT OF RENAL FOSSA RECURRENCE FOLLOWING NEPHRECTOMY FOR RENAL CELL CARCINOMA

after surgical resection a flexible cystoscope is inserted into the vena cava for direct visual inspection of the caval lumen with high flow heparinized saline irrigation. Perioperative outcomes including estimated blood loss, transfusion requirements, residual tumor, changes in management due to findings at cavoscopy, and postoperative complications were analyzed. RESULTS: All patients underwent endoscopy of the vena caval lumen without complications. 8 of 32 patients were found to have residual tumor thrombus upon visualization of the lumen. Of these, six patients were noted to have tumor invasion of the intraluminal wall resulting in cavectomy. Residual intraluminal tumor was noted in 2 patients which was bluntly resected with no residual tumor visible on repeat endoscopy. Median estimated blood loss was 3L (0.5-16) with a median intraoperative transfusion requirement of 14 units (0-63 units). Median Pringle Maneuver time was 15 minutes (3-30 minutes). Median length of stay was 10 days (4-73 days). Postoperative lower extremity edema was noted in 5 patients (3 following cavectomy) with resolution in all patients and a median resolution time of 52 days (30-322 days). There were no complications associated with vena cavoscopy. CONCLUSIONS: Vena Cavoscopy using a flexible cystoscope is an expedient and feasible technique that may be utilized intra-operatively in order to ensure clearance of residual thrombus burden within the inferior vena cava or hepatic veins and to assess for caval wall invasion.