The purpose of this study was to quantify the peri-operative blood loss of elderly patients with intertrochanteric fractures treated by unreamed proximal femoral nail anti-rotation (PFNA) and analyze whether the substantial hidden blood loss was induced by initial trauma or the operation. The clinical data of 123 patients with intertrochanteric fracture treated with unreamed PFNA from Jan 2013 to Apr 2017 were analyzed retrospectively. Blood routine on admission day (ADM), pre-operative day one (PRE), post-operative days one and three (POD1 and POD3) and the visible blood loss (VBL) were obtained. The total blood loss (TBL) from ADM to POD1 and POD3 were 693.5 ± 359.6 ml and 863.8 ± 429.9 ml, of which the corresponding hidden blood loss (HBL) was 86.8% and 89.4% respectively. The mean TBL and HBL from ADM to PRE (375.5 ± 242.0 ml, 375.5 ± 242.0 ml) were higher than that from PRE to POD1 (318.0 ± 183.4 ml, 226.5 ± 163.2 ml), p < 0.001 respectively. There was no significant difference between HBL from ADM to PRE and HBL from PRE to POD3 (375.5 ± 242.0 ml, 396.7 ± 254.0 ml, p = 0.361). The majority of peri-operative HBL occurred before surgery, it was mainly associated with the initial trauma rather than the operation.
Laminectomy is commonly performed to treat degenerative spinal diseases by reducing compression on the spinal cord and nerve roots. The postoperative epidural fibrosis and epidural adhesions may result in failed back surgery syndrome, which is characterized by the symptoms of lower back pain or leg pain. There is currently no satisfactory treatment for this complication. The pathological processes of epidural fibrosis and epidural adhesions are relevant to the proliferation of fibroblasts, transdifferentiation of fibroblasts into myofibroblasts, and the excessive deposition of extracellular matrix (ECM) protein. According to reports, transforming growth factor-β1 (TGF-β1) played a vital role in the development of fibrosis by promoting aforementioned processes. Decorin, an endogenous proteoglycan and natural inhibitor of TGF-β1, has exhibited prominent anti-fibrosis activity in various scar formation and fibrosis models of many organs. However, the preventive effect of decorin on epidural fibrosis and epidural adhesions requires further investigation. Here, we investigated the therapeutic effects and potential mechanisms of decorin on epidural fibrosis and epidural adhesions. Our results indicated that decorin could significantly suppress the TGF-β1-induced proliferation, transdifferentiation, and extracellular matrix production in primary fibroblasts. Furthermore, Smad2/3 signaling pathway had been demonstrated to be involved in the preventive effect of decorin. Moreover, administration of decorin in vivo could notably inhibit epidural fibrosis and epidural adhesions after laminectomy. To date, there is no approved therapy to target TGF-β1 for the treatment of epidural fibrosis and epidural adhesions after laminectomy. Our research proved the anti-fibrosis effect of decorin, which may provide an effective and promising treatment for epidural fibrosis and epidural adhesions.
The purpose of this study was to evaluate the effect of Ilizarov external fixation (IEF) and plate internal fixation (PIF) in the treatment of end-stage ankle arthritis on pain relieving and function improvement. The study cohort consisted of 59 patients with end-stage ankle arthritis underwent ankle arthrodesis with IEF or PIF between June 2011 and June 2015. Standard radiographs and computed tomography (CT) scans were obtained before surgery and during the follow-up. Functional assessments were performed using Foot and Ankle pain score of American Orthopedics Foot and Ankle Society (AOFAS) and Visual Analogue Scale (VAS). The average AOFAS scores in both IEF group and PIF groups increased significantly after operation, from 45.5 ± 6.3 to 84.8 ± 4.9 and from 45.9 ± 6.6 to 86.6 ± 5.4, respectively. The average VAS scores in both groups decreased significantly after operation, from 8.4 ± 1.9 to 2.5 ± 0.6 and from 8.2 ± 1.5 to 2.3 ± 0.7, respectively. Nevertheless, there was no significant difference for preoperative or postoperative AOFAS and VAS scores between the two groups. The IEF would result in comparable postoperative functional recovery and pain relieving to PIF and may be an effective substitute to PIF in the treatment of end-stage ankle arthritis.
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