Bundles of care prevents postoperative delirium in elderly patients with hip fractures / 中华创伤杂志

Objective To evaluate the effect of bundles of care on the prevention of postoperative delirium among elderly patients with hip fractures.Methods A prospective randomized case control study was conducted on 80 patients (≥65 years old) with hip fractures from March 2017 to June 2017.The patients were divided into experimental group (n =43) and control group (n =37) according to the random number table method.The experimental group received bundles of care,while the control group received routine nursing.The patients in both groups were all surgically treated,and the confusion assessment method (CAM) was applied to diagnose delirium after surgery.Gender,age,fracture type,duration from injury to operation,internal fixation type,operation time,total amount of bleeding,visual analogue scale (VAS),incidence of delirium,complications,and adverse events were compared between the two groups.Results Among the 80 patients,there were 11 males and 69 females,aged averagely 79.3 years (range,65-95 years).No significant differences were found between experiment group and control group in terms of gender (male:6 cases vs.5 cases,females:37 cases vs.32 cases),age [(79.8 ± 7.8) years vs.(78.7 ± 8.9) years],cause of injury (traffic injuries:7 cases vs.4 cases;falling injuries:36 cases vs.33 cases),duration from injury to operation [(66.1 ±14.3)hours vs.(63.4 ±14.9) hours],fracture type (femoral neck:13 cases vs.10 cases;intertrochanteric:26 cases vs.24 cases;subtrochanteric:4 cases vs.3 cases),internal fixation type (artificial total hip:5 cases vs.5 cases;artificial femoral head:8 cases vs.5 cases;PFNA:29 cases vs.27 cases),operation time [(55.5 ± 16.8) minutes vs.(51.6 ± 17.0) minutes],total blood loss [(114.4 ± 73.9) ml vs.(108.1 ±72.0) ml] (P ＞ 0.05).After bundles of care intervention,the postoperative VAS [(2.2 ± 0.8) points vs.(4.3 ± 1.2) points],postoperative delirium incidence (9％ vs.32％),incidence of complications and adverse events (2％ vs.19％) in experimental group were significantly lower than those in control group (P ＜ 0.05).Conclusion Bundles of care can relieve the pain and effectively reduce the incidences of postoperative delirium,complications,and adverse events in elderly patients with hip fracture.

Management and Outcomes of Cerebrospinal Fluid Leak Associated With Anterior Decompression for Cervical Ossification of the Posterior Longitudinal Ligament With or Without Dural Ossification.

STUDY DESIGN: A retrospective clinical study. OBJECTIVE: To analyze and evaluate the clinical outcomes of cerebrospinal fluid (CSF) leak after anterior decompression for cervical ossification of the posterior longitudinal ligament (OPLL) with or without dural ossification (DO). SUMMARY OF BACKGROUND DATA: Anterior decompression can be highly efficacious in the treatment of OPLL. However, in some cases of OPLL, there often exists DO and fusion with the posterior longitudinal ligament, which may increase the chance for CSF leak during an anterior decompression surgery. MATERIALS AND METHODS: A retrospective analysis was performed on 126 OPLL patients (89 men and 37 women) treated with anterior decompression surgery between January 2008 and January 2012. The mean age at operation was 61 years (ranging from 46 to 72 y) and the average duration of diagnosis was 4.2 years (ranging from 3 d to 7 y). DO was present in 11 patients, of whom 7 developed dural tear or defect. Among the 115 patients without DO, only 4 developed dural tear. Intraoperative dural repair was performed with gelatin foam onlay and fibrin glue seal. Postoperative care for CSF leak involved bed rest, CSF drainage, nutritional support, and antibiotics. RESULTS: A total of 11 cases associated with dural tear or defect developed postoperative CSF leak (an overall incidence of 8.7%). There was a statistically significant difference (P<0.001) in the incidence of CSF leak between the DO group (63.6%) and the non-DO group (3.5%). While leakage in 3 patients resolved spontaneously within 5 days of surgery, intermittent CSF cysts developed in 8 patients. These were treated with circular pressure bandages, repeated aspiration, and lumbar drainage. All 8 cases resolved 14-30 days after surgery. These 11 patients were followed up for an average of 12.8 months (range of 1 to 36 mo) with an average Japanese Orthopedic Association score of 51.2% and no significant neurological deficit or persistent headaches were recorded. CONCLUSIONS: Patients with DO are at increased risk for dural injury while undergoing anterior decompression for the treatment of OPLL. This is associated with a high incidence of CSF leak. However, the majority of patients with CSF leak could be managed conservatively.

Evaluation of a new type of titanium mesh cage versus the traditional titanium mesh cage for single-level, anterior cervical corpectomy and fusion.

STUDY DESIGN: A retrospective review of prospectively collected data in an academic institution. OBJECTIVE: To evaluate the safety and efficacy of a new type of titanium mesh cage (TMC) in single-level, anterior cervical corpectomy and fusion (ACCF). METHODS: Fifty-eight patients consecutive with cervical spondylotic myelopathy (CSM) from cervical degenerative spondylosis and isolated ossification of the posterior longitudinal ligament were treated with a single-level ACCF using either a new type of TMC (28 patients, group A) or the traditional TMC (30 patients, group B). We evaluated the patients for TMC subsidence, cervical lordosis (C2-C7 Cobb and Cobb of fused segments) and fusion status for a minimum of 30 months postoperatively based on spine radiographs. In addition, neurologic outcomes were evaluated using the Japanese Orthopedic Association (JOA) scores. Neck pain was evaluated using a 10-point visual analog scale (VAS). RESULTS: The loss of height of the fused segments was less for group A than for group B (0.8 ± 0.3 vs. 2.8 ± 0.4 mm) (p < 0.01); also, there was a lower rate of severe subsidence (≥3 mm) in group A (4 %, 1/28) than in group B (17 %, 5/30) (p < 0.01). There were no differences in the C2-C7 Cobb and Cobb of fused segments between the groups preoperatively or at final follow-up (p > 0.05), but the Cobb of fused segments immediately postoperative were significantly less for group B than for group A (p < 0.01). All patients, however, had successful fusion (100 %, each). Both groups had marked improvement in the JOA score after operation (p < 0.01), with no significant differences in the JOA recovery ratio (p > 0.05). The postoperative VAS neck pain scores for group A were significantly less than that for group B (p < 0.05); severe subsidence was correlated with neck pain. CONCLUSIONS: The new type of TMC provides comparable clinical results and fusion rates with the traditional TMC for patients undergoing single-level corpectomy. The new design TMC decreases postoperative subsidence (compared to the traditional TMC); the unique design of the new type of TMC matches the vertebral endplate morphology which appears to decrease the severity of subsidence-related neck pain in follow-up.

Dysphagia after anterior cervical discectomy and fusion: a prospective study comparing two anterior surgical approaches.

BACKGROUND: The Smith-Robinson approach is commonly used to expose the vertebrae in anterior cervical discectomy and fusion (ACDF). Postoperative dysphagia has been frequently reported following this procedure. In this approach, surgical dissection can be carried out either lateral (LEO) or medial (MEO) to the omohyoid muscle. The purpose of this study was to compare the degree of dysphagia between the LEO and MEO groups. METHODS: In this randomized, prospective study, 80 patients were enrolled and evenly divided into the MEO and LEO groups. Patients underwent two-level ACDF using a right-sided Smith-Robinson approach. Follow-up was obtained 1, 3, 6, 12 week and 6 months after surgery. The degree of dysphagia was assessed using a 14-item questionnaire from the SWAL-QOL survey. RESULTS: There were no differences between the MEO and LEO groups with respect to age, gender, body mass index, or length of surgery. Overall, the SWAL-QOL scores were not different between the two groups at any of the follow-up time points. However, when the level of surgery was taken into consideration, the early postoperative SWAL-QOL scores were significantly lower in the C3-C4 subgroup when the MEO approach was used. Conversely, the SWAL-QOL scores were significantly lower in the C6-C7 subgroup when the LEO approach was used. Two patients with C6-C7 surgery in the MEO group also developed dysphonia that resolved spontaneously within 3 months. CONCLUSION: The findings from this study suggest that the LEO approach should be selected if the level of surgery involves C3-C4. For C6-C7 surgery, however, a left-sided MEO approach should be used. Depending on surgeon's preference, either approach can be used if both cervical levels are involved.

Trauma-induced spinal cord injury in cervical spondylotic myelopathy with or without lower cervical instability.

Dynamic factors are important contributors to neurologic deficits in cervical spondylotic myelopathy (CSM) patients. Between 2005 and 2009, we retrospectively investigated 72 patients with CSM with or without lower cervical instability for their neurologic status after low-energy trauma and surgery. Patients were divided into two groups: the instability group and the stability group. The neurologic status was evaluated using the Japanese Orthopaedic Association (JOA) scoring system. The incidence of neurologic deterioration after trauma was higher in patients with lower cervical instability than in those without (p<0.05). Patients in the instability group had a lower preoperative JOA score (p<0.05) and experienced less post-surgery improvement in neurologic function than those in the stability group (p<0.01). Even a minor trauma to the neck can lead to irreversible spinal cord injury for patients with CSM with cervical instability. Eliminating local instability through surgical and non-surgical methods is necessary for such patients before decompression and fusion surgery.

The Problem Designment in PBL Approach under the Constructivism Theory / 中华医学教育探索杂志

Problem-based Learning(PBL)is a teaching approach focusing on students under the constructivism theory.In such a teaching approach,problems are essential.The thesis discusses the theoretical basis of the problem designment in PBL,namely the forms of problems,their functions,and principles in the problem designment under the constructivism theory.

A comparison of defecation function between coloplasty pouch and colonic J-pouch in patients after resection for rectal carcinoma / 中国普通外科杂志

0.05). Conclusion The defecation function was similar between CPP group and CJP group. Therefore, the coloplasty pouch seems to be superior because of feasibility, simplicity, and effectiveness.

Clinical application of patella arthroplasty in total knee arthroplasty / 第二军医大学学报

Objective:To analyze and compare the clinical outcomes of total knee arthroplasty with patella arthroplasty and patella replacement. Methods: From May 1999 to January 2004, 251 knees in 203 patients (45 males and 158 females; age range: 25 to 91 years, average 62.8 years) with osteoarthritis (206 knees) and rheumatoid arthritis (45 knees) were evaluated using a questionnaire during physical examination. Totally 137 knees underwent patella arthroplasty and 114 underwent patella replacement, with a mean follow-up of 28.1 months. The patients were scored using KSS Score, Feller Score and British Orthopedics Association Patient-satisfaction Score. Results: Patella arthroplasty and replacement showed no obvious difference in post-operative improvement of the knee score, knee function score, patella function score and range of flexion and extent of knee. Compared with patella replacement group, patella arthroplasty group had a higher patient satisfaction rate (P