Objective To illustrate the situation of delayed discharge of patients after total knee arthroplasty (TKA) under fast-track (FT) recovery model, and analyze the reasons. Methods We retrospectively analyzed the clinical data of 152 patients who accepted perioperative management under fast-track model from January to December 2014. The reasons for discharging over 72 hours after hospitalization were analyzed. Results Among the 152 patients, 119 were discharged over 72 hours after surgery, and the rate was 78.2%. The main reasons for delayed discharge were pain (32.8%), limited range of motion (31.9%) and unwillingness to be discharged (27.7%), respectively. Conclusion For patients who have undergone TKA, FT model can shorten hospital stay, save expenses, and accelerate postoperative rehabilitation, but there is still much room for improvement.
Objective To explore the efficacy of multidisciplinary nutritional support model in the perioperative management of elderly patients with nutritional risks undergoing joint replacement. Methods Between March 1, 2014 and May 31, 2015, 342 elderly patients who underwent joint replacement due to osteoarthritis were screened with nutritional risk screening 2002 (NRS2002). For patients who got a NRS2002 score of equal to 3 points or higher, nutritional treatment and intervention was carried out by doctor-nurse-rehabilitation therapist-dietitian collaboration and hospital departments related to patients’ complications. Results Among all the 342 patients, 225 (65.79%) had a NRS2002 score of equal to 3 points or higher on the admission day, in which 117 (52.00%) were male and 108 (48.00%) were female, 168 (74.67%) were at the age between 60 and 70 years old and 57 (25.33%) were at the age between 71 and 87. One day before surgery, the number of patients with a NRS2002 score equal to 3 points or higher decreased to 10 (2.92%), and the number became 68 (19.88%) after surgery. The difference was statistically significant (P<0.05). In those 68 elderly patients, 10 had a preoperative NRS2002 score equal to 3 points or higher, and 58 had newly developed nutritional risks after surgery; there were 23 patients with an age over 75, and 7 over 80. The NRS2002 score of all the 342 patients was below 3 points before discharge. For patients with nutritional risks at different periods before and after surgery, their serum albumin and hemoglobin levels were both improved after the treatment of nutritional support (P<0.05). Conclusion Multidis- ciplinary nutritional support for elderly perioperative patients undergoing joint replacement can reduce the incidence of postoperative complications, providing favorable conditions for the patients to undergo joint replacement surgery.
Objective To evaluate the applied value of group psychotherapy intervention in patients with malignant bone tumor. Methods From May 2015 to February 2016, 66 patients with malignant bone tumor were divided into the intervention group (n=30) and the control group (n=36) according to their preference. Patients in the intervention group were treated with psychological intervention and the ones in the control group were only received regular telephone follow-up guidance. The quality of life, mood, social support and other changes were collected and compared between the two groups. Results The patients’ overall health and quality of life scores, emotional function scores and Social Support Revalued Scale scores in the intervention group (75.2±21.4, 59.2±10.5, 39.20±5.60) were higher than those in the control group (68.3±14.7, 51.4±11.4, 35.30±5.30), while the patients’ Self-rating Anxiety Scale scores, Self-rating Depression Scale scores, self-blame, and retreat scores in the intervention group (39.2±8.3, 35.1±6.7, 0.29±0.22, 0.41±0.22) were lower than those in the control group (44.2±7.5, 40.9±7.7, 0.34±0.24, 0.50±0.41), and the differences were all statistically significant (P<0.05). Conclusion The implementation of group psychotherapy intervention in patients with malignant bone tumor can effectively ameliorate the patients’ negative emotions, and improve social support and coping styles status of the patients.
ObjectiveTo assess the effect of prolonged oxygen inhalation after total hip arthroplasty (THA) on early postoperative rehabilitation in elderly patients.MethodsPatients who underwent primary unilateral THA from June to December 2018 were divided into a conventional oxygen inhalation group (control group) and a prolonged oxygen inhalation group (trial group) according to a random number table. The control group received oxygen inhalation via a single nasal catheter from their return to the ward after surgery until 08:00 a.m. on the first day postoperatively. In addition to routine oxygen inhalation, the trial group received oxygen inhalation during the rehabilitation exercise in bed and before half an hour of floor activities on the first and second day after operation. Oxygen saturation, heart rate, respiratory rate, blood pressure, pain, fatigue score, hip mobility and Pittsburgh Sleep Quality Index (PSQI) scores were recorded and analyzed at 24 and 48 hours after surgery.ResultsA total of 60 patients were included finally, 30 patients in each group. At 24 and 48 h after surgery, the differences were statistically significant in the respiratory rate [(20.30±1.20) vs. (21.40±1.04) breaths per minute, (18.87±1.14) vs. (22.03±0.85) breaths per minute], oxygen saturation [(94.70±2.34)% vs. (90.60±0.73)%, (96.40±1.81)% vs. (91.20±0.85)%］, abduction angles of hip joint [(33.50±5.44) vs. (29.31±5.30)°, (38.67±2.60) vs. (33.00±4.84)°], pain scores (3.03±1.27 vs. 5.07±1.14, 1.43±0.97 vs. 3.60±1.13) and fatigue scores (4.17±1.34 vs. 8.20±0.61, 3.23±1.38 vs. 7.43±1.19) between the trial group and control group (P<0.05). PSQI scores (2.20±0.76 vs. 3.97±0.76) on the first day after surgery, and hip flexion [(105.17±4.82) vs. (99.50±2.40)°] , heart rate [(72.86± 6.38) vs. (79.40±3.97) beats per minute], diastolic blood pressure [(71.43±10.24）vs. (77.57±4.59) mm Hg (1 mm Hg=0.133 kPa)] at 48 h after surgery in the trial group were better than the those in control group (P<0.05).ConclusionCompared with conventional oxygen inhalation, prolonged oxygen inhalation after THA in elderly patients can improve postoperative pain, fatigue, sleep and hip function.
ObjectiveTo investigate the effect of different use time of intermittent pneumatic compression (IPC) on the incidence of deep vein thrombosis (DVT) of lower extremities after arthroplasty.MethodsBetween October 2018 and February 2019, 94 patients who planned to undergo unilateral total hip or knee arthroplsty and met the selection criteria were randomly divided into a control group (47 cases) and a trial group (47 cases). There was no significant difference in gender, age, surgical site, and surgical reason between the two groups (P>0.05). After returning to the ward, all patients were treated with IPC. And the IPC was used until 9:00 pm on the day after operation in the trial group and until 8:00 am the next day after operation in the control group. The levels of hemoglobin, platelet count, D-dimer, hospital stay, treatment costs, patients’ satisfaction with IPC, the parameters of thromboelastrography [kinetics (K value), freezing angle (α angle), reaction time (R value), maximum amplitude (MA value)], visual analogue scale (VAS) score, circumference difference of calf before and after operation, Pittsburgh sleep assessment score, and the incidence of DVT of lower limbs were recorded and compared between the two groups.ResultsThe K value and D-dimer before operation were significant different between the two groups (P<0.05). There was no significant difference in pre- and post-operative hemoglobin, platelet count, and the other parameters of thromboelastography between the two groups (P>0.05). There was no significant difference in pre- and post-operative VAS scores and post-operative circumference difference of calf between the two groups (P>0.05). The sleep assessment score of the trial group at 1 day after operation was significant lower than that of the control group (t=2.107, P=0.038). There was no significant difference in the hospital stay and treatment costs between the two groups (P>0.05). There was 1 case (2.1%) of DVT, 3 cases (6.4%) of intermuscular venous thrombosis, and 1 case (2.1%) of infection in the trial group, and 2 cases (4.3%), 4 cases (8.5%), and 0 (0) in the control group. The differences were not significant (P>0.05). After the completion of postoperative IPC treatment, the satisfaction rates of using IPC were 89.4%(42/47) in the trial group and 70.2% (33/47) in the control group, and the difference was not significant (χ2=0.097, P=0.104).ConclusionIPC using for a short period of time after arthroplasty do not increase the degrees of the pain and the swelling of calf; it can effectively prevent DVT of the lower extremity, improve the quality of sleep in patients, and is good for the limbs rehabilitation.