Should aspirin be stopped before carpal tunnel surgery? A prospective study

AIM: To determine whether patients taking aspirin during carpal tunnel release had an increase of complications.METHODS: Between January 2008 and January 2010, 150 patients underwent standard open carpal tunnel release(CTR) under intravenous regional anaesthesia. They were divided into three groups: groups 1 and 2 were made of 50 patients each, on aspirin 100 mg/d for at least a year. In group 1 the aspirin was never stopped. In group 2 it was stopped at least 5 d before surgery and resumed 3 d after. Group 3 acted as a control, with 50 patients who did not take aspirin. The incidence of clinically significant peror post-operative complications was recorded and divided into local and cardio-cerebro-vascular complications. Local complications were then divided into minor and major according to Page and Stern. Local haematomas were assessed at 2 d(before resuming aspirin in group 2) and 14 d(after resuming aspirin in group 2) postoperatively. Patients were reviewed at 2, 14 and 90 d after surgery.RESULTS: There was no significant difference in the incidence of complications in the three groups. A total of 3 complications(2 major and 1 minor) and 27 visible haematomas were recorded. Two major complications were observed respectively in group 1(non stop aspirin) and in group 3(never antiaggregated). The minor complication, observed in one patient of group 2(stop aspirin), consisted of a wound dehiscence, which only led to delayed healing. All haematomas were observed in the first 48 h, no haematoma lasted for more than 2 wk and all resolved spontaneously. A major haematoma(score > 20 cm2) was observed in 8 patients. A minor haematoma(score < 20 cm2) was recorded in 19 patients. All patients at 90 d after surgery were satisfied with the result in terms of relief of their preoperative symptoms. Major and minor haematomas did not impair hand function or require any specific therapy.CONCLUSION: Our study demonstrates that continuation of aspirin did not increase the risk of complications. It is unnecessary to stop aspirin before CTR with good surgical techniques.

肥胖对全髋置换术后假体周围骨溶解影响的5年和10年随访观察

背景：全髋关节置换术后最主要的远期并发症是假体周围的骨溶解。相当多的接受关节置换术的患者为体型肥胖者。目前认为，导致骨溶解的危险因素包括患者的活动、植入物的类型以及固定质量等。但关于肥胖因素对骨溶解的影响鲜见相关文献报道，而且颇受争议。本文的目的是评估肥胖对全髋关节骨水泥型假体柄置换术后5年和10年骨溶解的危险因素；其次是对临床结果及患者的满意度作出评价。方法：我们对1996至2003午期间行第三代骨水泥型假体柄全髋关节置换术的患者进行前瞻性研究。所有患者均于术后5年或10年进行随访观察，获取X线、体重指数（BMI：〈25kg／m^2=正常，25～29．9kg／m^2=超重，≥30kg／m^2=肥胖）资料以及髋关节活动度情况。对活动度的评估采用洛杉矶加利福尼亚大学（UCLA）评分方法予以评定。临床结果采用Harris髋关节评分系统和Merled’Aubign6和Postel评分系统进行分析。结果：本文对433例患者中503髋关节置换术进行研究，其中241髋（47．9％）于术后5年，262髋（52．1％）于术后10年进行评估。181髋正常体重患者中的24髋（13.3％）、205髋超重患者中的11髋（5．4％）以及117髋肥胖患者中的9髋（7．7％）发生了骨溶解，共44髋。正常体重患者髋关节活动度最高【平均UCLA活动评分（±标准差）为（5．5＋2．0）分]；肥胖患者评分最低[平均UCLA活动评分为（5．0±1．7）分]。当调整了活动度、骨水泥质量、患者年龄和性别因素后，肥胖患者发生骨溶解的概率并不比超重患者高（调整比值比为1．4，95％置信区间为0．6-3．7），而发现正常体重患者发生股骨骨溶解的风险明显高于超重患者（调整比值比为2．6，95％置信区间为1．2-5．7）。各组之间临床结果没有显著性差异。结论：我们发现肥胖患者在行骨水泥型股骨柄全髋置换术后5年和10年后，假体周围骨溶解的风险并未增加；而正常体重患者骨溶解的发生率反而最高。