Tracking the information about your manuscript
Communicate with the editorial office
Query manuscript payment status Editorial officeCollecting, editing, reviewing and other affairs offices
Managing manuscripts
Managing author information and external review Expert Information Peer ReviewOnline Review
Online Communication with the Editorial Department
cover
Journal information
Sponsored by: Chinese Academy of Medical Sciences
Published by: Editorial Office of Chinese Journal of Bone and Joint Surgery
ISSN: 2095-9958
CN: 10-1316/R
Address：No.9 Dong Dan San Tiao, Beijing PRC
Post Code：100730
Tel：0086-10-65281306
E-mail：guguanjie@126.com
http: //www.cjbjs.com
Slideshow
Analysis of the efficacy of preoperative personalized safe zone planning and accuracy of prosthesis implantation in total hip arthroplasty using the HURWA surgical robot
ZHAO Xiaolong;MI Qindong;ZHANG Miaomiao;LIN Jin;WANG Wei;Objective: To investigate the efficacy of preoperative planning for personalized safe zone in total hip arthroplasty(THA) using the HURWA surgical robot based on pelvic tilt, as well as the accuracy of prosthesis implantation, and clinical outcomes. Methods: Twenty-three patients with hip osteoarthritis scheduled for robot-assisted THA at Peking Union Medical College Hospital were prospectively enrolled between April and October 2023. The cohort included 14 men and 9 women, aged 26 to 79 years with a mean age of 56.1±14.8 years, and had a body mass index of 24.53±3.39 kg/m2; all patients underwent unilateral THA assisted by the HURWA robot. Preoperative planning for the personalized safe zone was performed based on three-dimensional CT reconstruction. The plan was adjusted intraoperatively, and effectiveness was defined as an intraoperative adjustment of the acetabular cup anteversion of ≤5°. The acetabular cup prosthesis was implanted according to the adjusted intraoperative data, and the actual intraoperative anteversion and abduction angles of acetabular cup were obtained; procedural accuracy was defined as a difference of <2.0° between the achieved and the planned angles for both anteversion and abduction.. Postoperative radiographs were reviewed to obtain postoperative measurement data, which were compared with the intraoperative target values; implantation accuracy was defined as a deviation of ≤5° for each angle. At 1-year follow-up, visual analog scale(VAS) score, Harris Hip Score(HHS), and patient satisfaction were assessed. Results: Intraoperatively, the preoperative personalized safe zone plan was not adjusted in 13 patients, adjusted by ≤5° in 7, and adjusted by >5° in 3, resulting in an effectiveness rate of 86.96%(20/23). Procedural accuracy was 82.61%(19/23) for both acetabular cup anteversion and abduction angles. Implantation accuracy was 86.96%(20/23) for acetabular cup anteversion and 95.65%(22/23) for acetabular cup abduction. At the 1-year follow-up,both the HHS and VAS scores showed significant improvement from preoperative baselines(both P < 0.05), and patient satisfaction was 9.26 ± 0.73 points. Conclusions: The HURWA surgical robot facilitates preoperative planning of a personalized safe zone for THA based on pelvic tilt, assists in accurate acetabular cup implantation, and yields satisfactory clinical outcomes.
Application of proximal femoral bionic nails in femoral intertrochanteric fractures: a finite element analysis
ZHANG Xiaomeng;ZHANG Lijia;WANG Yanhua;WU Xingguo;YANG Jian;ZHANG Yichong;XIONG Chen;FU Huijuan;WANG Yujie;ZHANG Dianying;Objective: To compare the biomechanical characteristics of proximal femoral bionic nail(PFBN) with those of dynamic hip screw(DHS) and proximal femoral nail antirotation(PFNA) in intertrochanteric fractures with varying degrees of integrity of the proximal femoral lateral wall, and to explore the indications for PFBN in different types of intertrochanteric fractures of the femur.Methods: The femoral intertrochanteric fracture models classified as Arbeitsgemeinschaft Für Osteosynthesefragen/Orthopaedic Trauma Association(AO/OTA) 31-A1, A2, and A3 were created. Each fracture type was fixed with DHS, PFNA, or PFBN, respectively, resulting in nine bone-implant assembly models. A load of 2 100 N was applied along the mechanical axis of the femur. The following parameters were recorded: the maximal bone stress on the proximal femoral lateral wall, the maximal bone stress on the proximal femoral medial cortex, the maximal implant stress in the proximal femur, the maximal bone displacement in the proximal femur, the maximal implant displacement in the proximal femur, and the maximal relative displacement between bone and implant. Results: Across A1 to A3 fracture types, the maximal bone stress on the proximal femoral lateral wall followed the order PFBN>PFNA>DHS, the maximal implant stress in the proximal femur followed DHS>PFNA>PFBN, and the maximal bone displacement in the proximal femur followed DHS>PFNA>PFBN. In A1 and A3 fracture types, the maximal bone stress on the proximal femoral medial cortex followed the order DHS>PFNA>PFBN, however, in A2 fracture type, the order was PFNA>DHS>PFBN. In A1 and A2 fracture types, the maximal implant displacement in the proximal femur followed the order DHS>PFNA>PFBN, however, in A3 fracture type, the order was DHS>PFBN>PFNA. For the maximal relative displacement between bone and implant, the order was DHS>PFNA>PFBN across all A1 to A3 fracture types. In intertrochanteric fracture models with an intact or partially compromised lateral wall(A1 and A2 types), PFBN demonstrated superior biomechanical performance compared to PFNA. However, in models with a completely deficient lateral wall(A3 type), PFBN showed no significant biomechanical advantage over PFNA. Conclusions: PFBN demonstrates biomechanical suitability for AO/OTA 31-A1 and A2 femoral intertrochanteric fractures, but offers no significant advantage over PFNA for A3 fractures.
Construction and internal validation of a prediction model for the nature of pulmonary nodules in osteosarcoma based on clinical and serological indicators
ZHANG Jiayu;HUANG Qingshan;LIANG Fude;LIN Jianhua;WU Zhaoyang;Objective: To construct a prediction model for determining the nature of pulmonary nodules in osteosarcoma patients based on clinical and serological indicators, with the aim of assisting clinical decision-making. Methods: This retrospective study included 98 osteosarcoma patients with solitary pulmonary nodules who were admitted to the First Affiliated Hospital of Fujian Medical University between December 2012 and December 2024. Patient age, sex, tumor location and volume, as well as levels of C-reactive protein(CRP), erythrocyte sedimentation rate(ESR), lactate dehydrogenase(LDH), and alkaline phosphatase(ALP) were collected. Variables for the model were screened using LASSO regression, and the prediction model was subsequently constructed via multivariable logistic regression. The model was presented as a nomogram and its performance was comprehensively evaluated via the receiver operating characteristic(ROC) curve analysis, calibration curve, concordance index(C-index), and decision curve analysis(DCA). Internal validation was performed using the Bootstrap resampling method with 1, 000 repetitions. Results: Five predictive variables were ultimately identified: patient age, CRP, ESR, LDH, and ALP. The constructed nomogram-based prediction model demonstrated excellent predictive performance, with an area under the ROC curve(AUC) of 0.815 and a C-index of 0.815 [95% confidence interval(95%CI): 0.720-0.910]. The calibration curve indicated that the predicted results of the model were highly consistent with the actual outcomes. DCA confirmed that the model's clinical utility within a threshold probability range of 0.06 to 0.64, indicating a net benefit for patients. Internal validation using the Bootstrap resampling further supported the reliability of the model(C-index=0.833). Conclusions: The prediction model for the nature of pulmonary nodules based on patient age, CRP, ESR, LDH, and ALP can intuitively estimate the probability that a pulmonary nodule in osteosarcoma patients represents lung metastasis, and demonstrates good clinical decision-making value.
A cadaveric study of total hip arthroplasty assisted by the domestic ROPA artificial intelligence-powered robotic system for hip replacement
XU Hongjun;LIU Xingyu;LI Songlin;ZHANG Yiling;LIU Sen;DING Ran;CHEN Jing;YIN Zhaojing;WANG Weiguo;CHAI Wei;QIAN Wenwei;Objective: To evaluate the accuracy and safety of total hip arthroplasty(THA) assisted by a domestically developed, artificial intelligence(AI)-enabled robotic system(ROPA) in a cadaveric model. Methods: Four adult cadaveric specimens with intact lower limbs underwent THA performed with the ROPA robotic system. Preoperative planning targeted the following parameters: femoral neck resection distance, acetabular component anteversion and abduction, acetabular floor bone stock, implant sizes, combined offset, and limb length discrepancy. Postoperatively, measured values were compared with the preoperative plans to calculate the deviation for each parameter. Results: Three cadavers underwent bilateral THA, and one cadaver underwent unilateral THA. No intraoperative complications such as periprosthetic fracture or dislocation occurred. The robotic system operated stably throughout all procedures. Postoperative deviations from preoperative plans were as follows: femoral neck resection distance, 0 to 0.4 mm; acetabular component anteversion, 0° to 4°; acetabular component abduction, 0.3° to 3.9°; acetabular floor bone stock, 0.1 to 0.8 mm. The sizes of both acetabular and femoral stem implants used intraoperatively matched the preoperative plans exactly, yielding an accuracy rate of 100%(7/7). The deviation in combined offset was 0 to 0.8 mm. The postoperative limb length discrepancy was <5 mm in all specimens, with deviations from preoperative planning ranging from 0.2 to 1.6 mm. Conclusions: In this cadaveric study, THA assisted by the domestically developed ROPA AI-enabled robotic system demonstrated excellent accuracy and safety.
Efficacy of robot-assisted double-threaded pedicle screw implantation in the treatment of osteoporotic lumbar spondylolisthesis
QING Peidong;XIE Bin;XU Hongda;DENG Haitao;LI Mingfan;ZHAO Shengxing;GUO Yuankun;ZHANG Lei;WANG Tieheng;HU Yupeng;ZHAO Yiwei;Objective: To investigate the feasibility of achieving adequate fixation in patients with osteoporotic lumbar spondylolisthesis by using robot-assisted implantation of longer, larger-diameter double-threaded pedicle screws. Methods: A total of 80 patients with degenerative lumbar spondylolisthesis admitted to Mianyang Orthopaedic Hospital from August 2022 to June 2024 were enrolled. All patients were diagnosed with osteoporosis and underwent posterior decompression, instrumented spinal fusion with bone grafting, and reduction of spondylolisthesis using pedicle screw fixation. They were randomly assigned to a robot-assisted group(40 patients) and a cement augmentation group(40 patients). The operation time, intraoperative blood loss, and intraoperative radiation dose were recorded. Postoperative X-rays and CT scans were routinely performed. The ratio of screw diameter to pedicle width(SD/PW) was calculated; the position of the pedicle screws was graded using the Gertzbein-Robbins scale; and facet joint violation was assessed on CT images. The visual analogue scale(VAS) was recorded preoperatively and on postoperative day 3. The Oswestry disability index(ODI) and short form-36(SF-36) survey were assessed preoperatively and at 6 months postoperatively to evaluate functional recovery and quality of life, respectively. Complications were observed through X-ray and CT examinations at 6 months postoperatively. Results: The robot-assisted group had shorter operative time and lower intraoperative radiation dose than the cement augmentation group(both P<0.001). Pedicle screws in the robot-assisted group were longer in length, larger in diameter, and had a higher SD/PW ratio compared to the cement augmentation group(all P<0.001). There was no statistically significant difference in the acceptable rate of screw implantation between the two groups(χ2=2.513, P=0.113). The facet joint violation rate was 10.2%(19/186) in the robot-assisted group, significantly lower than the 19.1%(39/204) in the cement augmentation group(χ2=5.408, P=0.020). On the postoperative day 3, the VAS score in the robot-assisted group was significantly lower than that in the cement augmentation group(P=0.027). Both ODI and SF-36 at 6 months postoperatively were significantly improved compared with those preoperative values in both groups(all P<0.001). No patient required revision surgery due to fixation failure caused by pedicle screw loosening, pullout, or breakage. Conclusions: For patients with osteoporotic lumbar spondylolisthesis, the use of robot-assisted implantation of longer and larger-diameter double-threaded screws can achieve a similar fixation effect to bone cement-augmented screws, with shorter operation time, less radiation exposure, and reduced difficulty in revision surgery.
Expert consensus in enhanced recovery after total hip and knee arthroplasty in China: perioperative management
ZHOU Zongke;WENG Xisheng;QU Tiebing;ZHANG Xianlong;YAN Shigui;CAO Li;ZHU Zhen'an;LIAO Weiming;QIAN Qirong;YANG Liu;ZHU Qingsheng;WU Haishan;SHI Zhanjun;HUANG Wei;ZHAO Jianning;QIAN Wenwei;LIAO Ren;LIU Bin;SUN Xueli;WANG Kunzheng;QIU Guixing;PEI Fuxing;Project group for the National Health and Family Planning Commission's public-benefit project: the safety and effect assessment of joint arthroplasty;Joint Surgery Society of Chinese Orthopaedic Association;Joint Surgery Committee of Orthopedics Branch of China International Exchange and Promotive Association for Medical and Health Care;Orthopedics Department, West China Hospital, Sichuan University;Orthopedics Department, Peking Union Medical College Hospital, CAMS & PUMC;Orthopedics Department, Beijing Chaoyang Hospital;Orthopedics Department, Shanghai Sixth People's Hospital;Orthopedics Department, Second Affiliated Hospital, Zhejiang University;Orthopedics Department, First Affiliated Hospital, Xinjiang Medical University;Orthopedics Department, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine;Orthopedics Department, First Affiliated Hospital, Sun YatSen University;Orthopedics Department, Shanghai Changzheng Hospital;Orthopedics Department, Southwest Hospital, Third Military Medical University;Orthopedics Department, Xijing Hospital, Fourth Military Medical University;Orthopedics Department, Nanfang Hospital,Southern Medical University;Orthopedics Department, First Affiliated Hospital, Chongqing Medical University;Orthopedics Department, General Hospital of Nanjing Military Region;Department of Anesthesiology, West China Hospital, Sichuan University;Department of Psychiatric, West China Hospital, Sichuan University;Orthopedics Department, Second Affiliated Hospital,Xi'an Jiao Tong University School of Medicine;Enhanced recovery after surgery(ERAS) is defined that effective perioperative management therapies proved by evidence-based medicine is applied to reduce the stress reaction and complications caused by surgery and improve the operation safety and patients' satisfaction. Enhanced recovery after total hip/knee arthroplasty(THA/TKA) focus on the improvement of surgical techniques and optimization of perioperative management, including reducing surgical trauma and blood loss, managing pain, preventing infection and venous thromboembolism(VTE), optimizing the use of drainage tube, catheter and tourniquet. By means of reading literatures and expert group discussion, based on the database of the project group for the "National Health and Family Planning Commission's public-benefit project: the safety and effect assessment of joint arthroplasty" and evidence-based medicine, we compile this consensus which mainly contains patients' education, nutritional support, anesthetic management, concept of minimally invasive operation, perioperative blood management, prevetion of infection, VTE and postoperative nausea and vomiting(PONV), optimization of analgesia, sleep management, wound management, functional exercise and postoperative follow-up management. We hope that this consensus wound give some help to orthopedic surgeon.
[Downloads: 11,717 ] [Citations: 996 ] [Reads: 107 ] HTML PDF Cite this article
Expert consensus in enhanced recovery after total hip and knee arthroplasty in China:pain and sleep management
SHEN Bin;WENG Xisheng;LIAO Ren;QU Tiebing;ZHANG Xianlong;CAO Li;YAN Shigui;LIAO Weiming;QIAN Qirong;ZHU Zhen'an;TIAN Hua;QIAN Wenwei;YUAN Hongbin;LIU Bin;HUANG Yuguang;WANG Kunzhen;SUN Xueli;QIU Guixing;PEI Fuxing;Project group for the National Health and Family Planning Commission's public-benefit project:the safety and effect assessment of joint arthroplasty;Joint Surgery Society of Chinese Orthopaedic Association;Joint Surgery Committee of Orthopedics Branch of China International Exchange and Promotive Association for Medical and Health Care;Orthopedics Department, West China Hospital, Sichuan University;Orthopedics Department, Peking Union Medical College Hospital, CAMS & PUMC;Department of Anesthesiology, West China Hospital,Sichuan University;Orthopedics Department, Beijing Chaoyang Hospital;Orthopedics Department, Shanghai Sixth People's Hospital;Orthopedics Department, First Affiliated Hospital,Xinjiang Medical University;Orthopedics Department, Second Affiliated Hospital, Zhejiang University;Orthopedics Department, First Affiliated Hospital, Sun Yat-sen University;Orthopedics Department, Shanghai Changzheng Hospital;Orthopedics Department, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine;Orthopedics Department, Peking University Third Hospital;Department of Anesthesiology, Shanghai Changzheng Hospital;Department of Anesthesiology, Peking Union Medical College Hospital, CAMS & PUMC;Orthopedics Department, Second Affiliated Hospital, Xi'an Jiao Tong University Scholl of Medicine;Psychiatric Department, West China Hospital, Sichuan University;The enhanced recovery after surgery(ERAS) aims to reduce surgical stress and incidences of pain and complications, enhance functional rehabilitation, and improve patients' satisfaction by using approved efficient methods in perioperative period. Pain and insomnia are obstacles for enhanced recovery. Based on the database of the project group for the"National Health and Family Planning Commission's public-benefit project: the safety and effect assessment of joint arthroplasty"and evidence-based medicine, we compile this consensus and hope it can give some help to orthopedists. This consensus contains two parts. The first part is about pain management during perioperative period of TKA and THA, which mainly discuss pain evaluation, goal, principle, common method and procedure of pain management. The second part introduces perioperative insomnia classification, reason, clinical manifestation and the diagnosis and treatment for conditioned insomnia,chronic insomnia and anxiety insomnia.
China guideline for diagnosis and treatment of senile osteoporosis(2023)
Workgroup of Chinese Guideline for the Diagnosis and Treatment of Senile Osteoporosis（2023） ;Osteoporosis Society of China Association of Gerontology and Geriatrics ;Osteporosis Society of China International Exchange and Promotive Association for Medical and Health Care ;Osteoporosis Prevention and Rehabilitation Committee of Chinese Association of Rehabilitation Medicine ;Research Group on Prevention and Control Technology of Common Clinical Problems in the Elderly ;WANG Liang ;TAO Tianzun ;YANG Huilin ;LI Chunlin ;YANG Nailong ;CHENG Xiaoguang ;CHEN Bohua ;DENG Lianfu ;ZHU Ping ;TANG Peifu ;QIN Ling ;QIU Guixing;The Osteoporosis Society of China Association of Gerontology and Geriatrics, in collaboration with the Osteoporosis Society of China International Exchange and Promotive Association for Medical and Health Care, the Osteoporosis Prevention and Rehabilitation Committee of Chinese Association of Rehabilitation Medicine, and Research Group on Prevention and Control Technology of Common Clinical Problems in the Elderly, developed standardized methods and procedures for formulating guidelines based on domestic and international evidence-based medicine guidelines. Following the procedures for the development of evidencebased medicine guidelines, a multidisciplinary guideline development working group was established to review clinical issues outlined in the original guidelines and new issues identified by reviewing literature published over the past five years. The grading of recommendations assessment, development and evaluation(GRADE) system was used to assess the quality of evidence and the strength of recommendations from systematic reviews. The updated "China Guideline for Diagnosis and Treatment of Senile Osteoporosis(2018)" aims to better standardize and guide the clinical diagnosis and treatment of senile osteoporosis, providing patients with safe and efficient medical services in China.
[Downloads: 15,105 ] [Citations: 335 ] [Reads: 110 ] HTML PDF Cite this article
Expert consensus in enhanced recovery after spinal surgery in China:perioperative management
SUN Tiansheng;SHEN Jianxiong;LIU Zhongjun;LI Chunde;HONG Yi;SUN Changtai;LI Fang;ZHU Yue;YANG Huilin;DONG Jian;CHEN Qixin;JIN Dadi;LUO Zhuojing;MA Xun;YANG Bo;MENG Hao;WANG Fei;DU Pei;QIU Guixing;Orthopedics Department,Army General Hospital;Orthopedics Department,Peking Union Medical College Hospital,CAMS & PUMC;Orthopedics Department,Peking University Third Hospital;Orthopedics Department,Peking University First Hospital;Orthopedics Department,Beijing Boai Hospital,China Rehabilitation Research Center;Orthopedics Department,Beijing Hospital;Orthopedics Department,First Affiliated Hospital,China Medical University;Orthopedics Department,First Affiliated Hospital,Soochow University;Orthopedics Department,Zhongshan Hospital,Fudan University;Orthopedics Department,Second Affiliated Hospital,Zhejiang University;Orthopedics Department,Third Affiliated Hospital,Southern Medical University;Orthopedics Department,Xijing Hospital,Fourth Military Medical University;Orthopedics Department,Shanxi Dayi Hospital;Enhanced recovery after surgery(ERAS) is a series of perioperative optimization measures based on evidencebased medicine, in order to reduce perioperative physiological and psychological trauma stress and complications, and achieve accelerated rehabilitation. However, there is not a complete set of ERAS system for spinal surgery in China, which can help patients recover quickly. A thorough literature search was undertaken to examine the use of ERAS pathways in spinal surgery, and the results presented in this paper. This expert consensus mainly contains patients' education, pre-operative evaluation and management, antibiotics usage and skin preparation, analgesia, surgical techniques, steroids, perioperative blood and infusion management, venous thromboembolism(VTE) prophylaxis, pain management, post-operative management of the digestive system, drainage tube and ureter management, functional exercise and postoperative follow-up management.
[Downloads: 4,850 ] [Citations: 243 ] [Reads: 125 ] HTML PDF Cite this article
China guideline for diagnosis and treatment of senile osteoporosis(2023)
Workgroup of Chinese Guideline for the Diagnosis and Treatment of Senile Osteoporosis（2023） ;Osteoporosis Society of China Association of Gerontology and Geriatrics ;Osteporosis Society of China International Exchange and Promotive Association for Medical and Health Care ;Osteoporosis Prevention and Rehabilitation Committee of Chinese Association of Rehabilitation Medicine ;Research Group on Prevention and Control Technology of Common Clinical Problems in the Elderly ;WANG Liang ;TAO Tianzun ;YANG Huilin ;LI Chunlin ;YANG Nailong ;CHENG Xiaoguang ;CHEN Bohua ;DENG Lianfu ;ZHU Ping ;TANG Peifu ;QIN Ling ;QIU Guixing;The Osteoporosis Society of China Association of Gerontology and Geriatrics, in collaboration with the Osteoporosis Society of China International Exchange and Promotive Association for Medical and Health Care, the Osteoporosis Prevention and Rehabilitation Committee of Chinese Association of Rehabilitation Medicine, and Research Group on Prevention and Control Technology of Common Clinical Problems in the Elderly, developed standardized methods and procedures for formulating guidelines based on domestic and international evidence-based medicine guidelines. Following the procedures for the development of evidencebased medicine guidelines, a multidisciplinary guideline development working group was established to review clinical issues outlined in the original guidelines and new issues identified by reviewing literature published over the past five years. The grading of recommendations assessment, development and evaluation(GRADE) system was used to assess the quality of evidence and the strength of recommendations from systematic reviews. The updated "China Guideline for Diagnosis and Treatment of Senile Osteoporosis(2018)" aims to better standardize and guide the clinical diagnosis and treatment of senile osteoporosis, providing patients with safe and efficient medical services in China.
[Downloads: 15,105 ] [Citations: 335 ] [Reads: 110 ] HTML PDF Cite this article
Expert consensus in enhanced recovery after total hip and knee arthroplasty in China: perioperative management
ZHOU Zongke;WENG Xisheng;QU Tiebing;ZHANG Xianlong;YAN Shigui;CAO Li;ZHU Zhen'an;LIAO Weiming;QIAN Qirong;YANG Liu;ZHU Qingsheng;WU Haishan;SHI Zhanjun;HUANG Wei;ZHAO Jianning;QIAN Wenwei;LIAO Ren;LIU Bin;SUN Xueli;WANG Kunzheng;QIU Guixing;PEI Fuxing;Project group for the National Health and Family Planning Commission's public-benefit project: the safety and effect assessment of joint arthroplasty;Joint Surgery Society of Chinese Orthopaedic Association;Joint Surgery Committee of Orthopedics Branch of China International Exchange and Promotive Association for Medical and Health Care;Orthopedics Department, West China Hospital, Sichuan University;Orthopedics Department, Peking Union Medical College Hospital, CAMS & PUMC;Orthopedics Department, Beijing Chaoyang Hospital;Orthopedics Department, Shanghai Sixth People's Hospital;Orthopedics Department, Second Affiliated Hospital, Zhejiang University;Orthopedics Department, First Affiliated Hospital, Xinjiang Medical University;Orthopedics Department, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine;Orthopedics Department, First Affiliated Hospital, Sun YatSen University;Orthopedics Department, Shanghai Changzheng Hospital;Orthopedics Department, Southwest Hospital, Third Military Medical University;Orthopedics Department, Xijing Hospital, Fourth Military Medical University;Orthopedics Department, Nanfang Hospital,Southern Medical University;Orthopedics Department, First Affiliated Hospital, Chongqing Medical University;Orthopedics Department, General Hospital of Nanjing Military Region;Department of Anesthesiology, West China Hospital, Sichuan University;Department of Psychiatric, West China Hospital, Sichuan University;Orthopedics Department, Second Affiliated Hospital,Xi'an Jiao Tong University School of Medicine;Enhanced recovery after surgery(ERAS) is defined that effective perioperative management therapies proved by evidence-based medicine is applied to reduce the stress reaction and complications caused by surgery and improve the operation safety and patients' satisfaction. Enhanced recovery after total hip/knee arthroplasty(THA/TKA) focus on the improvement of surgical techniques and optimization of perioperative management, including reducing surgical trauma and blood loss, managing pain, preventing infection and venous thromboembolism(VTE), optimizing the use of drainage tube, catheter and tourniquet. By means of reading literatures and expert group discussion, based on the database of the project group for the "National Health and Family Planning Commission's public-benefit project: the safety and effect assessment of joint arthroplasty" and evidence-based medicine, we compile this consensus which mainly contains patients' education, nutritional support, anesthetic management, concept of minimally invasive operation, perioperative blood management, prevetion of infection, VTE and postoperative nausea and vomiting(PONV), optimization of analgesia, sleep management, wound management, functional exercise and postoperative follow-up management. We hope that this consensus wound give some help to orthopedic surgeon.
[Downloads: 11,717 ] [Citations: 996 ] [Reads: 107 ] HTML PDF Cite this article
Expert consensus on the prevention and treatment of perioperative venous thromboembolism in major orthopaedic surgery in enhanced recovery after surgery program
ZHAO Jichun ;QIU Guixing ;PEI Fuxing;Orthopaedic ERAS profession Committee of Chinese Research Hospital Association;Orthopaedic ERAS profession Committee of China Association of Rehabilitation Technology Transformation and Promotion;Venous thromboembolism(VTE) is a common complication in the perioperative period of major orthopaedic surgery and also one of the important factors for perioperative death and unexpected deaths in hospital. It is a crucial clinical task for enhanced recovery after surgery(ERAS) to detect the symptoms of VTE as early as possible, and carry out scientific preliminary examination,evaluation and treatment. In order to guide orthopaedic surgeons to better prevent and treat perioperative VTE, Orthopaedic Expert Group of ERAS profession Committee of National Health Commission, Orthopaedic ERAS profession Committee of Chinese Research Hospital Association, Orthopaedic ERAS profession Committee of China Association of Rehabilitation Technology Transformation and Promotion, together with experts from related disciplines, established a collaborative expert committee for this consensus writing.Focusing on the clinical problems and following evidence-based medicine principles, the experts summarized the following eight aspects:(1)modes of prevention and treatment of perioperative VTE;(2)assessment and prevention of potential VTE;(3)screening and treatment of preoperative potential deep vein thrombosis(DVT);(4)timing of surgery for patients diagnosed DVT or calf venous thrombosis;(5)treatment of DVT diagnosed after surgery;(6)treatment of patients diagnosed as calf venous thrombosis after surgery;(7)diagnosis and treatment of patients with pulmonary embolism(PE) or high risk of PE before surgery;(8) risk assessment of bleeding during VTE prevention and treatment with medicine. Around these eight aspects, literature was searched and induced, and the latest researches of recent five years were referenced as well as the 2016 edition of Prevention of venous thromboembolism after major orthopaedic surgery and 2019 edition of Expert consensus on the application of tranexamic acid and anticoagulant for the enhanced recovery after orthopaedic surgery in China. Through repeated discussions and revisions, this consensus was developed hoping to promote the multidisciplinary cooperation and realize rapid recovery for patients.
Expert consensus in enhanced recovery after total hip and knee arthroplasty in China:pain and sleep management
SHEN Bin;WENG Xisheng;LIAO Ren;QU Tiebing;ZHANG Xianlong;CAO Li;YAN Shigui;LIAO Weiming;QIAN Qirong;ZHU Zhen'an;TIAN Hua;QIAN Wenwei;YUAN Hongbin;LIU Bin;HUANG Yuguang;WANG Kunzhen;SUN Xueli;QIU Guixing;PEI Fuxing;Project group for the National Health and Family Planning Commission's public-benefit project:the safety and effect assessment of joint arthroplasty;Joint Surgery Society of Chinese Orthopaedic Association;Joint Surgery Committee of Orthopedics Branch of China International Exchange and Promotive Association for Medical and Health Care;Orthopedics Department, West China Hospital, Sichuan University;Orthopedics Department, Peking Union Medical College Hospital, CAMS & PUMC;Department of Anesthesiology, West China Hospital,Sichuan University;Orthopedics Department, Beijing Chaoyang Hospital;Orthopedics Department, Shanghai Sixth People's Hospital;Orthopedics Department, First Affiliated Hospital,Xinjiang Medical University;Orthopedics Department, Second Affiliated Hospital, Zhejiang University;Orthopedics Department, First Affiliated Hospital, Sun Yat-sen University;Orthopedics Department, Shanghai Changzheng Hospital;Orthopedics Department, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine;Orthopedics Department, Peking University Third Hospital;Department of Anesthesiology, Shanghai Changzheng Hospital;Department of Anesthesiology, Peking Union Medical College Hospital, CAMS & PUMC;Orthopedics Department, Second Affiliated Hospital, Xi'an Jiao Tong University Scholl of Medicine;Psychiatric Department, West China Hospital, Sichuan University;The enhanced recovery after surgery(ERAS) aims to reduce surgical stress and incidences of pain and complications, enhance functional rehabilitation, and improve patients' satisfaction by using approved efficient methods in perioperative period. Pain and insomnia are obstacles for enhanced recovery. Based on the database of the project group for the"National Health and Family Planning Commission's public-benefit project: the safety and effect assessment of joint arthroplasty"and evidence-based medicine, we compile this consensus and hope it can give some help to orthopedists. This consensus contains two parts. The first part is about pain management during perioperative period of TKA and THA, which mainly discuss pain evaluation, goal, principle, common method and procedure of pain management. The second part introduces perioperative insomnia classification, reason, clinical manifestation and the diagnosis and treatment for conditioned insomnia,chronic insomnia and anxiety insomnia.
Guideline on perioperative pain management for the enhanced recovery after orthopedic surgery in China
ZHOU Zongke;LIAO Ren;TANG Peifu;CAO Li;TU Zhongqi;WU Xinbao;WANG Haoyang;LI Ting;WANG Guanglin;SHEN Huiyong;SUN Tiansheng;WANG Fei;LIU Hao;ZHAO Jinmin;WENG Xisheng;YANG Huilin;JIANG Baoguo;QIU Guixing;PEI Fuxing;China Association of Rehabilitation Technology Transformation and Promotion;Chinese Research Hospital Association;China International Exchange and Promotion Association for Medical and Healthcare;Bethune Charitable Foundation;Department of Orthopedics,West China Hospital, Sichuan University;Department of Anesthesiology,West China Hospital, Sichuan University;Department of Orthopedics, Chinese PLA General Hospital;Department of Orthopedics, First Affiliated Hospital, Xinjiang Medical University;Department of Orthopedics, Beijing Jishuitan Hospital;Department of Orthopedics, the Eighth Affiliated Hospital, Sun Yat-Sen University;Department of Orthopedics, the Seventh Medical Center of PLA General Hospital;Department of Ortho-pedics, Third Hospital of Hebei Medical University;Department of Orthopedics, the First AffiliatedHospital of Guangxi Medical University;Department of Orthopedics, Peking Union Medical CollegeHospital,CAMS & PUMC;Department of Orthopedics, the First Affiliated Hospital of Soochow Univer-sity;Department of Orthopedics, Peking University People's Hospital;The perioperative pain control directly affects the postoperative rehabilitation and medical quality of orthopedic surgery. Application of approved efficient pain management in perioperative period can reduce analgesic related complications, enhance functional rehabilitation, and improve patients' satisfaction. By reviewing the literatures, based on the database of the project group for the"National Health Commission's public-benefit project: the safety and effect assessment of joint arthroplasty", the China Association of Rehabilitation Technology Transformation and Promotion, Chinese Research Hospital Association,China International Exchange and Promotion Association for Medical and Healthcare and Bethune Charitable Foundation organized experts to make the guideline following the principles of evidence-based medicine. After repeated discussions and communications as well as revisions, we reached the consensus on the perioperative pain management in patients undergoing orthopedic surgery so as to guide the daily clinical practice for a wide range of orthopedic surgeons. This guideline contained the objectives, principles, classification and evaluation method of perioperative pain and a series of analgesic programs based on the characteristics of pain in different patients before, during and after surgery and emphasized the role of tranexamic acid and glucocorticoids in suppressing inflammatory response and relieving pain during the perioperative period.
[Downloads: 6,415 ] [Citations: 160 ] [Reads: 183 ] HTML PDF Cite this article