ObjectiveTo explore the application of clinical pathway in patients undergoing orthopedic day surgery.MethodsPatients who were scheduled for orthopedic treatment at Day Surgery Department of the Second Hospital of Shanxi Medical University from May to October 2020 were selected as the clinical pathway group, and all of them were managed by clinical pathway. Patients who were scheduled for orthopedic treatment at Day Surgery Department of the Second Hospital of Shanxi Medical University from May to October 2019 were selected as the routine group, and all of them were managed by conventional clinical methods. The general conditions of patients, physicians’ work efficiency, medical costs and medical quality were compared between the two groups.ResultsThe clinical pathway group included 246 patients, and the routine group included 391 patients. There was no significant difference in gender, age or disease distribution between the two groups (P>0.05). Compared with the routine group, the clinical pathway group had obvious advantages in terms of average time spent by a physician in issuing a medical order each time [(5.64±3.29) vs. (2.12±1.05) min], average number of revisions per physician’s order (1.40±0.24 vs. 0.38±0.19), rate of filing medical records within 3 days (90.28% vs. 97.97%), hospital costs [(7462.10±1035.01) vs. (6252.52±1189.05) yuan], drug costs [(652.21±88.53) vs. (437.17±108.20) yuan], length of stay [(1.23±1.04) vs. (1.02±0.18) d] and delayed discharge rate (7.93% vs. 2.03%), with statistically significant differences (P<0.05). There was no significant difference between the two groups in terms of unplanned reoperation rate, unplanned rehospitalization rate, or patient satisfaction (P>0.05).ConclusionCompared with routine clinical management, clinical pathway management can improve work efficiency, reduce medical cost and improve medical quality more effectively in the implementation of orthopedic day surgery, which has very positive effects and is worthy of promotion and application.
Objective To develope a modified surgical lavage tube to improve the efficacy of the treatment of orthopaedic postoperative infection. Methods A retrospective analysis was performed on 126 patients who received the pulsed lavage therapy with side-hole double valve lavage tube between March 2005 and March 2010. There were 98 males and28 females, aged 19-63 years (mean, 35 years). The infected sites included femur in 61 cases, tibiofibula in 46 cases, humerus in 12 cases, and patella in 7 cases. The lavage tube obstruction and defluvium, secondary infection of drainage opening, and wound heal ing were observed during treatment. Results No lavage tube defluvium occured during the lavage in all cases. Lavage tube obstruction occurred in 68 cases, edema at the peri pheral tissue was caused by obstruction in 9 cases; secondary infection at the lavage and drainage opening in 10 cases, which were cured after corresponding treatment. All cases achieved wound healing by first intention within 2 weeks. Lavage tube and drainage opening were closed within 1 month. All patients were followed up 1-5 years (mean, 18 months) with no recurrence. Conclusion Pulsed lavage therapy with side-hole double valve lavage tube can obviously improve the efficacy of the treatment of orthopaedic postoperative infection, so it is an effective modification to convention lavage.
ObjectiveTo understand the current national status of the rating of published orthopedic guidelines and consensus in China, to help users select the appropriate use of these clinical guidelines, to guide clinical practice, and to promote the targeted improvement of the quality of Chinese orthopedic guidelines and consensus. MethodsChinese biomedical databases, including CNKI, WanFang Data, and SinoMed were searched electronically from January 2016 to October 2023, and relevant Chinese orthopedic clinical practice guidelines and consensus documents were collected. Two evaluators independently screened the retrieved literature and extracted data. The scientificity, transparency, and applicability rankings (STAR) tool was used to comprehensively rate Chinese orthopedic guidelines and consensus documents published in medical journals since 2016. Any dispute between the two evaluators was resolved by consulting a third evaluator. Kappa values were used to evaluate the consistency of the results between the two evaluators. ResultsA total of 191 orthopedic-related guidelines and consensus documents were obtained, including 74 guidelines and 117 consensus documents. The average score of the guidelines included in the evaluation was 34.4 points, while the average score of consensus documents included in the evaluation was 21.7 points. Guidelines scored higher than consensus documents in areas such as registration, planning, workgroups, clinical issues, evidence, consensus methods, recommendations, accessibility, and other fields. The Kappa value test result was 0.684. ConclusionThere has been a progressive increase in methodological scores of Chinese orthopedic clinical practice guidelines and consensus documents published in recent years, but the overall quality is not high. Future guidelines development needs to improve methodology further, especially in terms of transparent funding, formation of recommendations, guidelines release, and dissemination.
ObjectiveTo review and evaluate the basic principles and advantages of orthopedic robot-assisted technology, research progress, clinical applications, and limitations in the field of traumatic orthopedics, especially in fracture reduction robots. Methods An extensive review of research literature on the principles of robot-assisted technology and fracture reduction robots was conducted to analyze the technical advantages and clinical efficacy and shortcomings, and to discuss the future development trends in this field. Results Orthopedic surgical robots can assist orthopedists in intuitive preoperative planning, precise intraoperative control, and minimally invasive operations. It greatly expands the ability of doctors to evaluate and treat orthopedic trauma. Trauma orthopedic surgery robot has achieved a breakthrough from basic research to clinical application, and the preliminary results show that the technology can significantly improve surgical precision and reduce surgical trauma. However, there are still problems such as insufficient evaluation of effectiveness, limited means of technology realization, and narrow clinical indications that need to be solved. ConclusionRobot-assisted technology has a broad application prospect in traumatic orthopedics, but the current development is still in the initial stage. It is necessary to strengthen the cooperative medical-industrial research, the construction of doctors’ communication platform, standardized training and data sharing in order to continuously promote the development of robot-assisted technology in traumatic orthopedics and better play its clinical application value.
Objective To analyze current research status of enhanced recovery after surgery of orthopedics in China, and to provide reference for further development of enhanced recovery after surgery in orthopedics department. Methods We searched Wanfang database and China National Knowledge Infrastructure (CNKI) database for articles about enhanced recovery after surgery of orthopedics department which were included by the Chinese Science and Technology Core Journal (2018 version) or Chinese Core Journal criterion of Peking University (2017 version), and bibliometric analysis was performed. Results A total of 135 articles were included in this study, 49 of which were collected in Chinese Core Journal criterion of Peking University. The amount of articles showed a rising trend in general over last decade. The main research topic was joint diseases (69 articles, 51.11%), followed by traumatic diseases (23 articles, 17.04%) and spinal diseases (21 articles, 15.56%); 35.56% (48 articles) of the articles were supported by different funds; Sichuan Province had the largest number of publications (36 articles) and the largest number of funds so far (8 items); clinical studies accounted for 37.78% (51 articles) with 78.43% (40 articles) randomized controlled trials, in which evaluation indicators focused on function scores, pain, length of hospital stay, complications or adverse reactions, patient satisfaction, and hospitalization costs. Conclusions The research on enhanced recovery after surgery of orthopedics in China was in a rising stage, and joint replacement was one of the hotspots. The funds are insufficient, and a series of guidelines should be developed according to the evidence-based study to accelerate the enhanced recovery after surgery of orthopedics.
Objective To explore the timing of indwelling urinary catheter removal in male patients undergoing orthopedic surgery under general anesthesia by a prospective randomized controlled study. Methods Male patients who underwent orthopedic surgery under general anesthesia in the First People’s Hospital of Shuangliu District between September 2019 and January 2021 were selected prospectively. The patients were randomly assigned to group A (pull out the catheter before anesthesia) and group B (pull out the catheter within 24 hours after anesthesia) at a ratio of 1∶1 by sortition. The age, operation duration, operation site, heart rate when pulling out the catheter, first urination, urinary tract infection, patient comfort score, nursing satisfaction score and patient satisfaction related indicators of the two groups were recorded and analyzed. Results A total of 120 patients were included in the study. All patients successfully completed the trial without dropping out or quitting. There was no significant difference between the two groups in terms of age, operation duration and operation site (P>0.05). No urinary tract infection occurred in both groups. There was no significant difference in the first urination between the two groups (P>0.05). The heart rate of patients in group A when pulling out the catheter was slower than that of group B [(74.62 ± 11.38) vs. (84.52 ± 8.98) times/min], and the satisfaction of patients in group A (group A: 46 cases were satisfied, 11 cases were relatively satisfied, 3 cases were dissatisfied; group B: 17 cases were satisfied, 25 cases were relatively satisfied, 18 cases were dissatisfied), comfort score (17.82±2.73 vs. 16.68±2.13), and nursing satisfaction score (19.62±1.59 vs. 16.32±2.05) were better than those in group B (P<0.05). Conclusions For male patients who need catheterization before orthopedic surgery under general anesthesia, pulling out the catheter before waking up after anesthesia can effectively reduce the physiological stress reaction of patients, reduce discomfort, improve patient satisfaction, and reduce the workload of nurses after surgery, which is conducive to early rehabilitation exercise of patients.
Objective To evaluate the safety and efficacy of intermittent pneumatic compression in prevention of deep venous thrombosis after major orthopedic operation. Methods We searched MEDLINE (1966 to January 2008), The Cochrane Library (Issue 2, 2008), CBM (1996 to January 2008), CNKI (1998 to January 2008), VIP (1998 to January 2008), and retrieved clinical controlled trials (CCTs) or randomized controlled trials (RCTs) in which IPC was used as an intervention to prevent DVT, and all the trials were published in English or Chinese. The methodological quality of the included studies was assessed according to the standard of Cochrane systematic review. RevMan 4.2 software was used for meta-analysis. Results Seven RCTs and 1 CCT were included. Their methodological quality was poor. The results of Meta–analyses showed: (1) The incidence of DVT in the IPC group was lower than that in the control group (RR=0.20, 95%CI 0.11 to 0.35, Plt;0.000 01); (2) There was no difference in the incidence of DVT between the IPC group and the LMWH group (RR=0.70, 95%CI 0.28 to 1.74, P=0.44); (3) The incidence of DVT in the IPC plus LMWH group was lower than that in the LMWH-alone group (RR=0.23, 95%CI 0.10 to 0.52, P=0.000 4). Furthermore, the incidence of DVT in the IPC plus LMWH group was lower than that in the GCS plus LMWH group (Plt;0.000 1). No severe adverse reaction of IPC in DVT prevention was reported. Conclusion IPC shows an effective tendency in DVT prevention, but because of the low quality and the small sample of the included studies, this conclusion needs to be verified by protocols of more samples and high quality.
Objective To investigate the short-term effectiveness of TiRobot combined with O-arm navigation system in the minimally invasive treatment of hindfoot fracture. Methods Between March 2019 and March 2021, 25 patients with hindfoot fractures were admitted. There were 14 males and 11 females, with an average age of 51.7 years (range, 19-76 years). The causes of injuries included falling from height in 17 cases and traffic accident in 8 cases. The interval between injury and operation was 1-3 days (mean, 2.1 days). There were 16 cases of calcaneus fracture, 7 cases of talus fracture, and 2 cases of calcaneus and talus fractures. According to Sanders classification criteria, the calcaneus fractures were classified as type Ⅱ in 10 cases and type Ⅲ in 8 cases; according to the Hawkins classification criteria, the talus fractures were classified as type Ⅱ in 4 cases and type Ⅲ in 5 cases. Preoperative American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score was 48.1±9.1. During operation, the fractures were fixed with the percutaneous cannulated screws with the assistance of the TiRobot combined with the O-arm navigation system. The operation time, hospital stay, and the occurrence of related complications were recorded. X-ray films were reviewed to evaluate the fracture healing and the occurrence of talus osteonecrosis, and the width, length, height, Böhler’s angle, and Gissane’s angle of the calcaneus were measured; AOFAS ankle-hindfoot score was used to evaluated the foot function. Results The operation time ranged from 47 to 71 minutes (mean, 60.5 minutes). The length of hospital stay ranged from 2 to 5 days (mean, 3.4 days). All incisions healed by first intention. All patients were followed up 12-24 months (mean, 17.3 months). One patient demonstrated hypoesthesia on the lateral side of foot after operation and recovered after symptomatic treatment. All fractures healed confirmed by X-ray films and the healing time ranged from 10 to 16 weeks (mean, 11.8 weeks). No talus osteonecrosis occurred during follow-up. There were significant differences in the width, length, height, Böhler’s angle, and Gissane’s angle of the calcaneus between pre-operation and at last follow-up (P<0.05). At last follow-up, AOFAS ankle-hindfoot score was 91.2±5.0, the difference was significant when compared with preoperative score (t=22.169, P<0.001). The results were excellent in 16 cases and good in 9 cases, with an excellent and good rate of 100%. Conclusion TiRobot combined with O-arm navigation system for minimally invasive treatment of hindfoot fractures can obtain the satisfactory short-term effectiveness, with the advantages of less surgical trauma, precise fixation, and fewer complications.
Objectives To explore the application effect of orthopedic psychological sleep management mode based on enhanced recovery after surgery (ERAS) in orthopedic patients. Methods A non-synchronous clinical controlled study was conducted. The intervention group enrolled 118 orthopedic patients who admitted to our hospital between April and June 2017, and the control group enrolled 111 orthopedic patients who admitted to our hospital between January and March 2017. The control group used routine nursing measures during hospitalization, while the intervention group implemented an ERAS-based orthopedic psychological sleep management mode based on routine nursing measures, which included carrying out a new mode of multidisciplinary collaborative management, implementing the normative path of orthopedic psychological sleep management, and implementing the comprehensive psychological sleep management. The mood, sleep quality and satisfaction of the two groups within 24 hours after admission and before discharge were compared. Results Before the intervention, there was no statistically significant difference in general data, mood or sleep quality between the two groups (P>0.05). After the intervention, the median score (the lower and upper quartiles) of the Huaxi Emotional Index of the intervention group was 1 (0, 5), while the score of the control group was 2 (0, 6); the median score (the lower and upper quartiles) of the Pittsburgh Sleep Quality Index was 4 (3, 7) in the intervention group and 6 (4, 9) in the control group; the satisfaction score in the intervention group was better than that in the control group (96.47±2.72vs. 95.52±2.79); the differences between the two groups were statistically significant (P<0.05). Conclusions The ERAS-based orthopedic psychological sleep management mode is beneficial to improve the patients’ emotional disorder, sleep quality and satisfaction. It facilitates the patients’ accelerated recovery.