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Background Anemia is one of severe complications in the perioperative period of total hip arthroplasty (THA). Erythropoietin (EPO) has been considered to improve patients’ anemia state, but its efficiency and safety remains controversial. Methods A total of 152 patients who underwent total hip arthroplasty from January 2017 to March 2019 were randomized to 2 groups. Recombinant human erythropoietin (rHu-EPO) group was treated with rHu-EPO subcutaneous injection 10000 IU after operation and once daily in the next week, while control group was treated with none extra treatment. Routine hematologic examination and thrombelastography (TEG) performed at different time point respectively. Doppler ultrasound for bilateral lower limbs was performed 1 day before surgery and 7 days after surgery. Auxiliary examination outcomes, blood transfusions outcomes, and postoperative complications were recorded as assessment indicators. Results The difference in the relevant indexes of traditional coagulation and TEG values between two groups were not significantly. No significant difference was observed in the incidence of thromboembolism events and other complications between two groups during postoperative period. The amount of intraoperative blood loss was similar between the two groups. However, the postoperative use and dosage of allogeneic blood in the rHu-EPO group were lower than those in the control group. The hemoglobin and hematocrit level in the rHu-EPO group were higher than that in the control group after surgery. Conclusion Postoperative subcutaneous injection of rHu-EPO can improve hematological anemia-related parameters, reduce the use and dosage of allogeneic blood transfusions (ABTs), and has no significant influence on the formation of thrombosis and other complications in patients undergoing total hip arthroplasty in short term.

Objective: Despite the wide use of tranexamic acid (TXA) in the perioperative period of total hip arthroplasty (THA), whether the hemostatic state changes after the application of intravenous (IV)-TXA are still unknown. The aim of this study was to investigate whether IV administration of TXA changes the blood coagulation following primary THA via thrombelastography (TEG) analysis and conventional laboratory tests. Methods: A total of 174 patients who underwent primary THA from September 2016 to July 2018 were selected. They were randomly divided into two groups, 86 patients with IV administration of 15 mg/kg TXA and 88 controls without TXA usage. Demographic data, TEG paremeters, d-dimer levels, fibrin degradation products, hemoglobin, hematocrit concentration, platelet, transfusion rates, perioperative blood loss, and the occurrence of deep vein thrombosis were collected. TEG and conventional laboratory tests were performed the day before operation, the first day after operation, and seventh day after operation. Results: There were no differences with regard to TEG or conventional laboratory tests between the two groups ( p > 0.05). The total blood loss and drain blood loss in the TXA group were significantly lower than those in the control group ( p < 0.05). The transfusion rates and the volume of blood transfusion of the control group were higher than those of the TXA group ( p < 0.05). Conclusion: The administration of IV-TXA resulted in a significant reduction in total blood loss, transfusion volumes, and transfusion rates without the increase of thromboembolic complications. Moreover, it was confirmed that TXA would not change the coagulation via the TEG analysis.

Objective :To explore the safety and accuracy of the novel C2 laminar staple guide through in vitro experiments. Methods 40 cases of cervical spine 3D CT data were selected to produce the same two sets of 3D printed specimens (groups a and b), and the self-made guide was used to assist nail placement on group a specimens (group A: guide nail placement group), and group b Laminate nails were placed free-hand on the specimens (group B: free-hand nailing group), and a three-dimensional modeled simulated nailing was reconstructed on the computer (group C: 3D simulated nailing group). Simultaneously measure the danger level, the position of the needle exit point and the inclination angle of the screw placement position of each group. Results :In group A, 75 screws were acceptable and 5 were dangerous. The acceptable rate was 93%, and the double cortical rate was 92%. There were 62 position-acceptable screws in group B, and 18 positions were dangerous, with an acceptable rate of 77% and a double cortical rate of 32%. There was a statistically significant difference between the two groups (P Conclusion: The guide is universal, with stable structure, accurate guidance, and easy operation. It can be placed with bilateral lamina screws at the same time, shortening the time of nail placement, avoiding the collision of two-way cross screws, increase the rate of double cortex. Ultimately, efficiency and security can be improved.

Objective Deep vein thrombosis (DVT) is one of the severe complications after total knee arthroplasty (TKA). Gender has been considered to influence the incidence of the thrombosis formation in TKA patients. However, it remains controversial which gender would be more prone to form thrombosis. The aim of this study was to assess the effects of gender differences on coagulation status after TKA via the thromboelastography (TEG). Methods A total of 57 male patients who underwent primary TKA from September 2015 to January 2021 were included in this study. According to the matching principle of age, body mass index (BMI), and anticoagulation treatment, 60 female patients were selected. The conventional coagulation tests, routine blood tests, and thromboelastography were conducted before the operation, 1 day and 7 days after the operation. In addition, Doppler ultrasound was also performed 1 day before the operation and at the 7 days after the operation. The parameters of conventional coagulation tests, routine blood tests, and thromboelastography were compared between the two groups. Results There were no significant differences in the blood transfusion rate, the incidence of DVT during the perioperative period, D-dimer (D-D), fibrin degradation products (FDP), hemoglobin (HB), hematocrit (HCT), prothrombin time (PT), activated partial thromboplastin time (APTT), and C-reactive protein (CRP) at any corresponding time point between the male group and the female group ( P > .05). There were no significant differences in neutrophil-to-lymphocyte ratio (NLR) preoperatively; however, there were significant differences in NLR 1 day after the surgery and 7 days after the surgery between the two groups ( P .05). Binary logistic regression analysis demonstrated that gender, age, BMI, tourniquet application time were not independent predictors ( P > .05). Conclusion Gender differences have no significant influence in TKA patients with regard to conventional coagulation tests and thromboelastography.

To observe the effect of admission blood urea and creatinine levels on mortality in elderly patients with hip fracture.Form January 2013 to December 2014, 767 elder patients with hip fracture were treated in our hospital including 253 males and 514 females, aged from 65 to 96 years old with an average of(75.67±6.81) years old. According blood urea and creatinine levels, the 767 hip fracture patients were divided into four groups as follow: group A(blood urea=5 mmol/L, creatinine=70 μmol/L); group B (blood urea=5 mmol/L, creatinine70 μmol/L); group C (blood urea5 mmol/L, creatinine=70 μmol/L); group D(blood urea5 mmol/L, creatinine70 μmol/L). In group A, there were 211 patients including 70 males and 141 females, aged from 65 to 95 years old with an average of(80.24±6.51) years old; in group B, there were 355 patients including 125 males and 230 females, aged from 65 to 93 years old with an average of(78.46±7.09) years old; in group C, there were 36 patients including 11 males and 25 females, aged from 65 to 95 years old with an average of (77.83±6.78) years old; in group D, there were 165 patients including 47 males and 118 females, aged from 65 to 96 years old with an average of (76.71±8.35) years old. The survivals and dead patients in four groups were collected and in-hospital mortality rate, 3-month, 12-month and 18-month mortality rate of patients were calculated. COX regression analysis was performed on these data, and clinical significance of serum urea and creatinine at admission in the elderly patients was researched.All 767 hip fracture patients were followed up from 18 to 24 months with an average of (21.33±1.25) months, 159 patients were died in follow up period. The in-hospital mortality rate in 3-month, 12-month and 18-month mortality rate of the patients with high blood urea and high blood creatinine (urea=5 mmol/L, creatinine=70 μmol/L) were 2.37%, 9.95%, 16.11% and 26.07%, and were higher than other three groups respectively. COX regression analysis revealed that the independent predictors effecting the mortality rate included age [Elderly hip fracture patients with high serum urea and high serum creatinine at admission indicate higher fatality rate. Age, serum urea and serum creatinine at admission were independent predictors of fatality rate of elderly hip fracture patients.