基于Y-shaped路网的早高峰拼车定价策略

针对交通资源配置有限导致的早高峰通勤拥堵问题,借鉴共享经济理论,引入拼车出行概念,充分考虑通勤者出行方式和Y-shaped路网特点,建立了基于通勤者出行效益的拼车定价模型.模型结合费用补偿机制,讨论了以平台利润最大化和系统负效用最小化为目标的拼车定价策略,并给出了定价策略有效的阈值条件.研究结果表明,当通勤者都参与到拼车服务中时,拼车平台利润和交通系统负效用在其相应拼车定价策略下均能达到最优值,并且以交通系统负效用最小化为目标的拼车定价策略能消除Y-shaped路网中瓶颈处的交通拥堵.

Knee Osteoarthritis Progression after Distal Femur Closing Wedge Osteotomy

Background: Despite the conservative treatment of tibio-femoral osteoarthritis through realignment osteotomies, the rate of total knee replacements following an osteotomy is increasing. The aim of this study was to identify the factors associated with the progression of knee osteoarthritis after a medial closing-wedge distal femoral osteotomy. Methods: Hospital-based observational study on 20 patients who underwent a medial closing-wedge distal femoral osteotomy evaluating the progression of osteoarthritis using the Kellgren and Laurence classification. The Wilcoxon test was used to compare the variation in the progressive stage of the Kellgren and Laurence classification of knee osteoarthritis preoperatively and at the final follow up. Univariate analysis made it possible to determine the factors associated with progression. The final significance threshold for statistical tests was set at 5% (p Results: Overall, the mean follow-up of 46 months ± 6.6 months, with a mean age of 43 years (range: 27 - 69 years) and a female predominance (M: F = 3/7). The progression of tibiofemoral osteoarthritis following a medial closing-wedge distal femoral osteotomy is associated with valgus or varum malalignment been a moderate valgus (OR 6.2 [1.5 - 42.7] at 95% CI;p-value = 0.02), a correction of the mechanical deviation angle with a valgus alignment (OR 2.7 [0.9 - 8.3] at 95% CI), and loss of correction (OR 3.8 [1.3 - 11.6] at 95% CI;p -value) for the lateral compartment while varus alignment (OR 1.7 [0.9 - 8.3] 95% CI, p-value = 0.05) and with rupture of the lateral cortex (OR 2.8 [1.7 - 11.5] 95% CI, p-value = 0.02) were those of the medial compartment. Conclusion: Distal femur closing wedge osteotomy does not definitively interrupt the progression of valgus knee osteoarthritis. The factors associated with the progression of this pathology are modifiable. Taking them into account when performing this surgical technique could improve the osteotomy survival curve.

Osteotomy Protocol for Implant Insertion of One Day Biotech: One Drill, One Implant

Background: Four factors determine the quality of an implantology kit: 1) Heat generated by the drills;2) Morphology of the osteotomy according to the diameter of the implant;3) Efficiency of collecting autologous bone;and 4) Osteotomy execution time. Materials and Methods: This article examines the heat produced by drills during osteotomy, focusing on the effect of the following factors: drilling technique;volume of autologous bone harvested;drilling time;implant primary stability;and the percentage of osseointegrated implants after primary healing. Discussion: The four factors mentioned above are analyzed based on the data obtained for sequential, biological, and One Drill milling techniques. Conclusions: 1) One Drill is the fastest technique for performing the osteotomy;2) All techniques stay within the biological temperature range of living bone, with the lowest increase in temperature achieved using One Drill with irrigation;3) The bone harvested showed no statistically significant differences between biological milling and the One Drill technique, both far superior to the sequential technique;and 4) There is no statistically significant difference in the number of osseointegrated implants among the three techniques analyzed.

Clinical outcomes of triceps reflecting anconeus pedicle and olecranon osteotomy approach for distal humerus intercondylar fractures

BACKGROUND The preferred treatment for distal humeral intercondylar fractures is open reduction and internal fixation.While there is consensus about the posterior approach,several posterior approaches have been developed.It is debatable as to which approach is best.AIM To compare triceps reflecting anconeus pedicle(TRAP)and olecranon osteotomy approaches for internal fixation of distal humeral intercondylar fracture.METHODS In total,40 cases of Arbeitsgemeinschaft für Osteosynthesefragen/Association of the Study of Internal Fixation type C,closed,and Gustilo type I intercondylar humeral fractures were included.Patients ranged in age from 18 years to 70 years.The patients were randomized into two groups:TRAP group and olecranon osteotomy group,with 20 cases in each.All were followed up at 6 wk,3 months,6 months,and 12 months.Functional outcomes were measured in terms of flexion-extension arc,Disabilities of Arm,Shoulder and Hand score,and Mayo Elbow Performance Score.RESULTS The mean age was 43.2 years in the TRAP group and 37.5 years in the olecranon osteotomy group.The mean operative time and mean duration of hospital stay in the TRAP group were significantly higher than in the olecranon osteotomy group(119.5 vs 111.5 min and 9.85 vs 5.45 d,respectively).The mean arc of flexion-extension,Disabilities of Arm,Shoulder and Hand score,and Mayo Elbow Performance Score were comparable without any significant difference in the groups at the 12-month follow-up(107.0 vs 106.2,18.3 vs 15.7,and 84.2 vs 86.2,respectively).Ulnar paresthesia and superficial infections were comparable in both groups(2 cases vs 3 cases and 3 cases vs 2 cases,respectively).Hardware prominence was significantly higher in the olecranon osteotomy group,mostly due to tension band wiring.CONCLUSION Both approaches were equivalent,but there is a need for further study including higher numbers of subjects and longer study duration to prove the benefits of one approach over the other.

Unicompartmental knee arthroplasty vs high tibial osteotomy for knee osteoarthritis:A comparison of clinical and radiological outcomes

BACKGROUND Unicompartmental knee arthroplasty(UKA)and high tibial osteotomy(HTO)are well-established operative interventions in the treatment of knee osteoarthritis.However,which intervention is more beneficial to patients with knee osteoarthritis remains unknown and a topic of much debate.Simultaneously,there is a paucity of research assessing the relationship between radiographic parameters of knee joint alignment and patient-reported clinical outcomes,preoperatively and following HTO or UKA.AIM To compare UKAs and HTOs as interventions for medial-compartment knee osteoarthritis:Examining differences in clinical outcome and investigating the relationship of joint alignment with respect to this.METHODS This longitudinal observational study assessed a total of 42 patients that had undergone UKA(n=23)and HTO(n=19)to treat medial compartment knee osteoarthritis.Patient-reported outcome measures(PROMs)were collected to evaluate clinical outcome.These included two disease-specific(Knee Injury and Osteoarthritis Outcome Score,Oxford Knee Score)and two generic(EQ-5D-5L,Short Form-12)PROMs.The radiographic parameters of knee alignment assessed were the:Hip-knee-ankle angle,mechanical axis deviation and angle of Mikulicz line.RESULTS Statistical analyses demonstrated significant(P<0.001),preoperative to postoperative,improvements in the PROM scores of both groups.There were,however,no significant inter-group differences in the postoperative PROM scores of the UKA and HTO group.Several significant correlations associated a more distolaterally angled Mikulicz line with worse knee function and overall health preoperatively(P<0.05).Postoperatively,two clusters of significant correlations were observed between the disease-specific PROM scores and knee joint alignment parameters(hip-knee-ankle angle,mechanical axis deviation)within the HTO group;yet no such associations were observed within the UKA group.CONCLUSION UKAs and HTOs are both efficacious operations that provide a comparable degree of clinical benefit to patients with medial compartment knee osteoarthritis.Clinical outcome has a limited association with radiographic parameters of knee joint alignment postoperatively;however,a more distolaterally angled Mikulicz line appears associated with worse knee function/health-related quality of life preoperatively.

Osteotomy combined with anterior cruciate ligament reconstruction for anterior cruciate ligament injury and biplanar deformity

BACKGROUND It has been confirmed that the increased posterior tibial slope over 12 degrees is a risk factor for anterior cruciate ligament injury,and varus deformity can aggravate the progression of medial osteoarthritis.AIM To evaluate the efficacy of modified high tibial osteotomy(HTO)and anterior cruciate ligament reconstruction(ACLR)in the treatment of anterior cruciate ligament(ACL)injuries with varus deformities and increased posterior tibial slope(PTS)based on clinical and imaging data.METHODS The patient data in this retrospective study were collected from 2019 to 2021.A total of 6 patients were diagnosed with ACL injury combined with varus deformities and increased PTS.All patients underwent modified open wedge HTO and ACLR.The degree of correction of varus deformity and the PTS was evaluated by radiography and magnetic resonance imaging.RESULTS All 6 patients(6 knee joints)were followed up for an average of 20.8±3.7 months.The average age at surgery was 29.5±3.8 years.At the last follow-up,all patients resumed competitive sports.The International Knee Documentation Committee score increased from 50.3±3.1 to 87.0±2.8,the Lysholm score increased from 43.8±4.9 to 86±3.1,and the Tegner activity level increased from 2.2±0.7 to 7.0±0.6.The average movement distance of the tibia anterior translation was 4.8±1.1 mm,medial proximal tibial angle(MPTA)was 88.9±1.3°at the last follow-up,and the PTS was 8.4±1.4°,both of which were significantly higher than those before surgery(P<0.05).CONCLUSION Modified open wedge HTO combined with ACLR can effectively treat patients with ACL ruptures with an associated increased PTS and varus deformity.The short-term effect is significant,but the long-term effect requires further follow-up.

Gastrotracheal fistula:Treatment with a covered self-expanding Y-shaped metallic stent

A 67-year-old man had a sev-ere cough and pulmonary infection for 1 wk before seeking evaluation at our hospital.He had undergone esophagectomy with gastric pull-up and radiotherapy for esophageal cancer 3 years previously.After admission to our hospital,gastroscopy and bronchoscopy revealed a fistulous communication between the posterior tracheal wallnear the carina and the upper residual stomach.We measured the diameter of the trachea and bronchus and determined the site and size of the fistula using multislice computed tomography and gastroscopy.A covered self-expanding Y-shaped metallic stent was implanted into the trachea and bronchus.Subsequently,the fistula was closed completely.The patient tolerated the stent well and had good palliation of his symptoms.

Y-shaped block copolymers of poly(ethylene glycol) and poly(N-isopropylacrylamide) synthesized by ATRP

Novel Y-shaped block copolymers of poly（ethylene glycol） and poly（N-isopropylacrylamide）, PEG-b-（PNIPAM）2, were successfully synthesized through atom transfer radical polymerization （ATRP）. A difunctional macroinitiator was prepared by esterification of 2,2-dichloroacetyl chloride with poly（ethylene glycol） monomethyl ether （PEG）. The copolymers were obtained via the ATRP ofN-isopropylacrylamide （NIPAM） at 30℃ with CuCl/Me6TREN as a catalyst system and DMF/H2O （v/v = 3：1） mixture as solvent. The resulting copolymers were characterized by gel permeation chromatography （GPC） and ^1H NMR. These block copolymers show controllable molecular weights and narrow molecular weight distributions （PDI 〈 1.15）. Their phase transition temperatures and the corresponding enthalpy changes in aqueous solution were measured by differential scanning calorimetry （DSC）. As a result, the phase transition temperature of PEG45-b-（PNIPAM55）2 is higher than that of PNIPAM, however, the corresponding enthalpy change is much lower, indicating the significant influence of the macromolecular composition and architecture on the phase transition.

Effects of different pelvic osteotomies on acetabular morphology in developmental dysplasia of hip in children

Developmental dysplasia of hip seriously affects the health of children,and pelvic osteotomy is an important part of surgical treatment.Improving the shape of the acetabulum,preventing or delaying the progression of osteoarthritis is the ultimate goal of pelvic osteotomies.Re-directional osteotomies,reshaping osteotomies and salvage osteotomies are the three most common types of pelvic osteotomy.The influence of different pelvic osteotomy on acetabular morphology is different,and the acetabular morphology after osteotomy is closely related to the prognosis of the patients.But there lacks comparison of acetabular morphology between different pelvic osteotomies,on the basis of retrospective analysis and measurable imaging indicators,this study predicted the acetabular shape after developmental dysplasia of the hip pelvic osteotomy in order to help clinicians make reasonable and correct decisions and improve the planning and performance of pelvic osteotomy.

Binary collision approximation for solitary waves in a Y-shaped granular chain

We implement a binary collision approximation to study solitary wave propagation in a two-dimensional double Y- shaped granular chain. The solitary wave was transmitted and reflected when it met the interface of the bifurcated branches of the Y-shaped granular chains. We obtain the analytic results of the ratios of the transmitted and reflected speeds to the incident speed of the solitary wave, the maximum force between the two neighbor beads in a solitary wave, and the total time taken by the pulse to pass through each branch. All of the analytic results are in good agreement with the experimental observations from Daraio et al. [Phys. Rev. E 82 036603 （2010）]. Moreover, we also discuss the delay effects on the arrival of split pulses, and predict the recombination of the split waves traveling in branches in the final stem of asymmetric systems. The prediction of pulse recombination is verified by our numerical results.

Evaluation of ultimate bearing capacity of Y-shaped vibro-pile

Based on Mindlin stress solution, a numerical computational method was proposed to calculate the stresses in the ground induced by side friction and the resistance of Y-shaped vibro-pile. The improved Terzaghi's and ЪерезанцевВГ's methods for ultimate bearing capacity evaluation were proposed by considering the stress strength induced by friction resistance at pile head level of Y-pile. A new method to calculate the ultimate bearing capacity of Y-pile was also proposed based on the assumptions of soil failure mode at the tip of Y-pile and the use of Mohr-Coulomb soil yield criterion and Vesic compressive correction coefficient with the induced stresses in the ground. Based on the comparisons with the field static load test results, it is found that the improved Terzaghi's method gives higher ultimate capacity, while the other two methods shows good agreement with the field results.

Transfer characteristics of dynamic biochemical signals in non-reversing pulsatile flows in a shallow Y-shaped microfluidic channel: signal filtering and nonlinear amplitude-frequency modulation

The transports of the dynamic biochemical signals in the non-reversing pulsatile flows in the mixing microchannel of a Y-shaped microfluidic device are ana- lyzed. The results show that the mixing micro-channel acts as a low-pass filter, and the biochemical signals are nonlinearly modulated by the pulsatile flows, which depend on the biochemical signal frequency, the flow signal frequency, and the biochemical signal transporting distance. It is concluded that, the transfer characteristics of the dynamic biochemical signals, which are transported in the time-varying flows, should be carefully considered for better loading biochemical signals on the cells cultured on the bottom of the microfluidic channel.

Y-Shaped Intra-Scleral Fixated Lens versus Retro-Pupillary Iris Claw Lens in the Treatment of Aphakia

Background: Many reasons can lead to an aphakia without adequate capsular support for implantation of a posterior chamber intraocular lens (IOL), such as intraoperative unintentional rupture of posterior capsule during phacoemulsification, planned intracapsular cataract extraction, ocular trauma and lens dislocation due to congenital and acquired causes. Purpose: To compare Y-shaped intra-scleral fixation of a posterior chamber IOL with retro pupillary fixation of an iris-claw intraocular lens (IOL) for Aphakic eyes without sufficient capsular support as respects safety, visual recovery and complications of both methods. Patients and Methods: One hundred Aphakic eyes were arbitrarily distributed between two groups. Group A included 50 eyes treated with retropupillary fixation of iris claw lens and group B included 50 eyes treated with Y-shaped intra-scleral fixation technique. Preoperative, intraoperative and postoperative data were analysed including best corrected visual acuity (BCVA), intraocular pressure (IOP), surgical time, intraoperative problems, IOL malposition and postoperative complications. Following up on patients was carried out for at least six months. Results: The mean duration of surgery was 21 ± 5.3 min in group A and was 53.4 ± 6.9 min in group B (p-value 0.05). IOL tilt was found in 0 (0%) eyes in group A and in 5 (10%) eyes in group B (p 0.05). Conclusion: The results of our study indicated that both methods are satisfactory in correcting aphakia without sufficient capsular support as regards postoperative best corrected visual acuity (BCVA);however the surgical technique of retropupillary iris claw lens is easier, shorter, with low intra- and postoperative complications and safer than those used for intra-scleral fixation of IOL. But for eyes which lack both iris and capsular support, a scleral fixation of a posterior chamber IOL remains the only option.

Comparison of lag screws and double Y-shaped miniplates in the fixation of anterior mandibular fractures

BACKGROUNDMandibular fractures constitute about 80.79% of maxillofacial injuries inAlexandria University, either as isolated mandibular fractures or as a part ofpanfacial fractures. The combination of symphyseal and parasymphyseal fracturesrepresent 47.09% of the total mandibular fractures.AIMTo compare the effectiveness of lag screws vs double Y-shaped miniplates in thefixation of anterior mandibular fractures.METHODSThis study is a prospective randomized controlled clinical trial, performed onsixteen patients with anterior mandibular fractures. Patients were divided equallyinto two groups, each consisting of eight patients. Group 1: Underwent openreduction and internal fixation using two lag screws. Group 2: Underwent openreduction and internal fixation using double Y-shaped plates. The followingparameters were assessed: operating time in minutes, pain using a visual analogscale, edema, surgical wound healing for signs and symptoms of infection,occlusion status and stability, maximal mouth opening, and sensory nervefunction. Cone beam computed tomography was performed at 3 and 6 mo tomeasure bone density and assess the progression of fracture healing.RESULTSThe study included 13 males (81.3%) and 3 females (18.8%) aged 26 to 45 years(mean age was 35.69 ± 6.01 years). The cause of trauma was road traffic accidentsin 10 patients (62.5%), interpersonal violence in 3 patients (18.8%) and othercauses in 3 patients (18.8%). The fractures comprised 10 parasymphyseal fractures(62.5%) and 6 symphyseal fractures (37.5%). The values of all parameters were comparable in both groups with no statistically significant difference except forthe mean bone density at 3 mo postoperatively which was 946.38 ± 66.29 in group 1 and 830.36 ± 95.53 in group 2 (P = 0.015).CONCLUSIONBoth lag screws and double Y-shaped miniplates provide favorable means offixation for mandibular fractures in the anterior region. Fractures fixed with lagscrews show greater mean bone density at 3 mo post-operation, indicative ofhigher primary stability and faster early bone healing. Further studies with largersample sizes are required to verify these conclusions.

The Radiological Outcome of Surgical Correction of Hallux Valgus with Combined Scarf and Akin Osteotomies

Background: Hallux valgus deformity is one of the most common chronic and progressive foot deformities. Surgical correction of the deformity plays a central role in the treatment of symptomatic hallux valgus. However, more than one hundred different surgical techniques have been described. Objective: To assess the radiological outcome of hallux valgus surgical correction using a scarf and akin osteotomies. Materials and methods: A cross-sectional hospital-based study was conducted on 25 adult patients (36 feet). Twenty-two females and two males with hallux valgus were treated with surgical correction using a scarf and akin osteotomies. All candidates were kept on regular postoperative, scheduled clinical follow-up programs for one year and assessed radiologically. Results: Twenty-five patients (36 feet) were included in this study. The hallux valgus angle significantly shifted to the normal range (less than 15°) after surgery, and the inter-metatarsal angle also improved to the normal range (less than 9°). Conclusion: Using scarf and akin osteotomies in treating moderate and severe hallux valgus deformity provides the satisfactory radiological outcomes in form of decreasing hallux valgus angle and inter-metatarsal angle.

Is metaphyseal ulnar shortening osteotomy superior to diaphyseal ulnar shortening osteotomy in the treatment of ulnar impaction syndrome?A meta-analysis

BACKGROUND Although metaphyseal ulnar shortening osteotomy(MUSO)is safer for the treatment of ulnar impaction syndrome(UIS)than diaphyseal ulnar shortening osteotomy(DUSO),DUSO is widely used for UIS treatment.AIM To evaluate the effectiveness of DUSO and MUSO for UIS treatment and determine the factors that should be considered when choosing surgical treatment for UIS.METHODS Articles comparing the effectiveness of DUSO and MUSO for UIS treatment were systematically retrieved from MEDLINE(Ovid),PubMed,EMBASE,and Cochrane Library.The demography,incidence of complications,secondary operation rate,postoperative DASH score,wrist pain on the visual analogue scale,and grip strength improvement were also evaluated.In addition,the correlation between the improvement of grip strength and the shortening of osteotomy length of ulna was analyzed.The outcome of the patient was discontinuous,and the odds ratio,risk ratio(RR),and 95%CI were calculated and analyzed via RevMan5.3 software.RESULTS Six studies,including 83 patients receiving MUSO(experimental group)and 112 patients receiving DUSO(control group),were included in the meta-analysis.The second operation rate was significantly higher after DUSO than after MUSO.The DASH scores were slightly lower in the MUSO group than in the DUSO group.The patients receiving MUSO had slightly better pain relief effect than patients receiving DUSO.However,the incidence of complications and improvement of grip strength were not significantly different between the two groups.CONCLUSION Although DUSO and MUSO provide similar effects for UIS,MUSO is associated with a lower secondary operation rate,slightly lower postoperative DASH scores and slightly better pain relief effect than DUSO,indicating that MUSO can effectively be used for UIS treatment.

Mid-term results of sub-trochanteric valgus osteotomy for symptomatic late stages Legg-Calvé-Perthes disease

BACKGROUND The treatment of late stages of Legg-Calvé-Perthes disease(LCPD)is controversial.Although the concept of femoral head containment is a well-established technique of treatment,its use remains debatable in the late stages of the disease,as it does not improve symptoms in terms of limb length discrepancy and gait.AIM To assess the results of subtrochanteric valgus osteotomy in symptomatic patients with late-stage Perthes disease.METHODS From 2000 to 2007,36 symptomatic patients with late stage of Perthes disease were surgically treated with subtrochanteric valgus osteotomy and followed-up for 8 to 11 years using the IOWA score and range of motion(ROM)variables.The Mose classification was also assessed at the last follow-up to reflect possible remodeling.The patients were 8 years old or older at the time of surgery,in the post-fragmentation stage,and complaining of pain,limited ROM,Trendelenburg gait,and/or abductor weakness.RESULTS The preoperative IOWA score(average:53.3)markedly improved at the 1-year post follow-up period(average:85.41)and then slightly improved at the last follow-up(average:89.4)(P value<0.05).ROM improved,with internal rotation increased on average by 22°(from 10°preoperatively to 32°postoperatively)and abduction increased on average by 15.9°(from 25°preoperatively to 41°postoperatively).The mean Mose deviation of femoral heads was 4.1 mm at the end of the follow-up period.The tests used were the paired t-test and Pearson correlation test,where the level of significance was a P value less than 0.05.CONCLUSION Subtrochanteric valgus osteotomy can be a good option for symptomatic relief in patients with late-stage of LCPD.

Successful hip revision surgery following refracture of a modern femoral stem using a cortical window osteotomy technique:A case report and review of literature

BACKGROUND The ExeterTM Universal cemented femoral component is widely used for total hip replacement surgery.Although there have been few reports of femoral component fracture,removal of a broken femoral stem can be a challenging procedure.CASE SUMMARY A 54-year-old man with a Dorr A femur sustained a refracture of a primary ExeterTM stem,two years after receiving a revision using a cement-within-cement technique(CWC)through an extended trochanteric osteotomy(ETO).The technical problems related to the CWC technique and the ETO played a major role in the stem fatigue refracture.We performed revision surgery and removed the distal cement using a cortical femoral window technique,followed by reimplantation with an uncemented,modular,distally-fixed uncemented stem.The patient experienced an uneventful postoperative recovery.CONCLUSION Re-fracture of a modern femoral ExeterTM stem is a rare event,but technical complications related to revision surgery can lead to this outcome.The cortical window osteotomy technique can facilitate the removal of a broken stem and cement,allowing for prosthetic reimplantation under direct vision and avoiding ETO-related complications.

改良后路经椎弓根截骨术治疗陈旧性胸腰椎骨折伴后凸畸形

创伤性脊柱骨折是临床较为常见的骨折类型,多为高处坠落、交通事故等外力冲击所致,胸腰段(T_(11)~L_2)是脊柱骨折最常见的区域^([1])。由于骨折椎体终板及椎间隙损伤、骨质严重缺损、骨质疏松、治疗不及时、承重过早、固定不充分等原因,一部分胸腰椎骨折可发展为陈旧性胸腰椎骨折伴后凸畸形^([2-3])。后凸矫形手术治疗的主要目的是通过截骨矫形及内固定技术,纠正局部后凸畸形,获得理想的胸腰段曲度,重塑脊柱的平衡及稳定性,同时减压受到压迫的脊髓或神经根^([4-5])。后路经椎弓根截骨术(PSO)经椎弓根进入椎体进行截骨,截骨面大,融合率及融合质量高,单节段可矫正30°~40°的后凸畸形^([6])。然而,PSO截骨过程中后柱切除范围较大,远期对脊柱节段稳定性有一定的影响^([7])。

氨甲环酸不同使用方法在胫骨高位截骨过程中的安全及有效性

背景:胫骨高位截骨围术期会产生大量失血现象,应用氨甲环酸可有效降低围术期失血量,但关于氨甲环酸的应用方式尚未达成共识。目的:探讨在胫骨高位截骨过程中应用不同方法给予氨甲环酸对围术期止血效果及安全性的影响。方法:选择2019年1月至2021年12月就诊于滨州医学院附属医院行初次单侧胫骨高位截骨术患者共160例,其中男69例,女91例,采用随机数字表法分为4组,其中40例患者松止血带之前10 min予以静滴氨甲环酸2 g(静脉组),40例予以静滴氨甲环酸1 g,关闭切口后引流管内灌注氨甲环酸1 g(联合组),40例予以关闭切口后引流管内灌注氨甲环酸2 g(灌注组),另40例予以静滴等量生理盐水(空白组)。比较4组患者围术期的一般资料,记录4组患者术后第1,3,5天血红蛋白及红细胞压积、术中出血量、引流量、输血情况、切口并发症及静脉血栓形成情况,计算总失血量、隐性出血量。结果与结论:①4组患者术前一般资料比较差异均无显著性意义;②术中出血量组间比较差异无显著性意义;③术后第1,3,5天血红蛋白及红细胞压积最大下降值均为联合组<静脉组<灌注组<空白组;引流量、总失血量、隐性出血量均为联合组<静脉组<灌注组<空白组;④空白组术后输血率均高于其他3组,差异有显著性意义;联合组、静脉组与灌注组术后输血率组间比较差异无显著性意义;⑤4组患者术后静脉血栓形成情况、术后切口并发症比较差异无显著性意义;⑥提示:在胫骨高位截骨术中应用氨甲环酸对减少围术期出血和降低术后输血率有显著作用,不增加下肢静脉血栓和切口并发症发生率,静脉输液联合引流管灌注效果更佳。