Revue de littérature : la rupture du ligament croisé antérieur : particularités féminines

We know that female athletes practicing pivoting sports have a higher risk of anterior cruciate ligament (ACL) injury compared to male. Many series confirm that the risk is four to seven times higher among female athletes at the same sporting level. Furthermore, most ACL injuries in female athletes occur during a noncontact episode, typically during deceleration, lateral pivoting or landing. A literature review confirms the higher incidence of ACL injuries among women in the pivot sports with or without contact. This sex difference can be explained by external and internal risk factors. The external risk factors are competition in games versus training, footwear and playing surfaces, protective equipment and physical preparation. The internal risk factors are anatomical risk factors: anatomy of the notch, posterior tibial slope, hyperlaxity, biomechanical factors: kinematics and kinetics of the knee, neuromuscular risk factors and hormonal risk factors. Indeed, the hormonal factors (estrogen, relaxin, progesterone and testosterone) seem to be responsible, especially during the ovulatory phase of the menstrual cycle. This study confirms that female athletes have a higher risk of ACL injuries compared to male athletes. A better knowledge of the external and internal risk factors, such as the injury mechanism and the hormonal factors may help in the future prevent these injuries.     

麻醉护理的探索与发展

本篇文章主要通过对美国麻醉护理历史、发展和现状的详细介绍和比较我国麻醉护理的现状,为开展我国麻醉护理工作提供参考。     

La hanche du danseur : partie 1 : une hanche tournée vers l’extérieur

For a better approach of the dancers pathologies, practitioners should take account a fundamental notion: the functional turnout. Notion, which has been developed in international dance medicine literature for 10 years. Understanding tendinomuscular unbalance, the abilities but also the limits of a dancer, enables to make an accurate diagnosis and to give the adequate treatment.     

经腹部妇科超声检查前饮水量和憋尿时间对膀胱充盈度的影响研究

目的:探讨饮水量和憋尿时间对膀胱充盈度的影响,为经腹部妇科超声(TAS)检查前的准备提供正确的指导。方法:共选取270人,根据饮水量随机分为两组,饮水500ml组135人,饮水800ml 组135人,分别在憋尿时间为1h、1.5h、2h对憋尿的不适症状和是否适合检查进行观察,采用 χ₂检验,P＜0.05为差异有显著意义。结果：饮水量500ml憋尿1.5h及饮水量800ml憋尿1h检查顺利度最高。结论：经腹部妇科超声检查指导患者饮水量500ml憋尿1.5h或饮水量800ml憋尿1h更容易得到超声标准图像。     

肠道准备在临床中的应用与评价

肠道准备是广大临床医务人员共同关注的问题。肠道清洁的好坏直接影响肠道疾病诊疗的成功与否。由于多种因素的影响,临床中患者的肠道准备常常难以达到理想的清洁度。为改善肠道清洁效果,提高肠道疾病确诊率,降低术后并发症,减少费用,临床上越来越强调对肠道准备清洁度的评价。本文将对临床中常用的肠道准备方法及肠道准备清洁效果的评价方法做一综述,以期为指导临床实践提供依据。     

静脉输液后拔针方法的研究进展

全面概述国内静脉输液后拔针方法的研究和改进,论述拔针的角度﹑按压血管的时间﹑拔针方法的改进﹑拔针后按压方式的改进(输液贴三指横压法﹑创可贴拇指按压法),对传统的拔针法进行补充和修改,选择最佳方法,从而减少皮下淤血的出现,保护静脉血管,减轻病人痛苦,同时有利于指导临床护理工作,提高护理质量。     

Infiltrations articulaires et para-articulaires chez le sportif : intérêts et limites

Few studies have validated the use of corticosteroid joint injections in sports medicine, and many recent studies have questioned their usefulness. The beneficial effect is essentially short lived, enabling the athlete to complete a specific performance. Local complications have been well described but the systemic effects are underestimated, especially during the first week. Corticosteroid joint injections are not on the regulatory list of products requiring an Authorization for Use for Therapeutic Applications (AUTa) for sportive events. Several studies have demonstrated that the corticotrop axis can be inhibited after a single injection, reflected by decreased production of endogenous cortisol for as long as two weeks. This biological adrenal insufficiency can lead to acute renal insufficiency if the athlete resumes competition too early under stressful conditions. Since there is no known way to identify predisposed individuals, the risk appears to be disproportionate compared with the expected benefit. Rest from sports must therefore be prescribed for any individual given a joint injection.     

Épicondylites : « les nouveautés en 2007 »

What news for 2007 concerning sportsmen lateral epicondylitis? Concerning biomechanics, we will evaluate the role of the supinatus at the same time we will talk about the complex characteristics of the functionnel unit. An anatomic work has showed in some cases, the involvment of ligment structure that could explain the atypical side of the pain and sometime the failure of the treatment. As for rehabilitation, we will insist on the importance of excentric work. The braces conserve a certain importance. We insist on new therapeutics and mostly on the interest of trinitrine patches. Botulinium toxic is still discussed and the recent study of Hayton does not show any significant difference with placebo injection. An original autologue blood injection in the epicondylitis tendon demonstrates good results and specially in the cases that resist to the corticoid therapeutics. We will talk about our experience. Considering corticoide injections a Crowther publication reveals a significant result compared to choc waves therapy. At last, we will criticize the Smidt study because we believe that the use of fluorite corticoid induce iatrogenic effects. We will conclude this article by our 2007 propositions about the local corticoid indication.     

针对性护理干预在小儿肺炎护理中的应用价值及效果

目的 探析针对性护理用于在小儿肺炎护理中的价值与效果。方法 选取本院 2021 年 1 月至 2022 年 12 月收治的 100 例 肺炎患儿作为研究对象。随机分配法将患儿分为对照组和观察组,每组各 50 例。对照组采用常规护理;观察组采用针对性护 理。分析对比两组的症状缓解时间与住院时间、依从性、不良反应以及护理满意度。结果 观察组咳嗽、发热、X 线片阴影、肺 部啰音等症状缓解时间与住院时间均比对照组显著缩短（P<0.05）。观察组的依从性显著高于对照组（P<0.05）。观察组的不良 反应发生率显著低于对照组（P<0.05）。观察组患儿家属的护理满意度显著高于对照组（P<0.05）。结论 在小儿肺炎患者护理中, 针对性护理能促进患儿的康复,提高患儿配合度,减少不良反应发生,提升护理满意度。     

儿童腺样体切除术后在麻醉恢复室的护理

目的 探讨小儿腺样体全麻术后在恢复室的护理要点,减少术后并发症的发生。方法 对70例腺样体切除术后患儿进行严密监护, 在麻醉恢复室(PACU)平均监护时间64.29min,动态记录患儿的生命体征、血氧饱和度,严格掌握好拔管的指征,离PACU的标准,针对护理隐患预见性护理。结果 麻醉恢复期发生各种并发症41例（58.57%）,其中舌后坠12例（17.14%）,轻度喉痉挛2例（2.86%）,躁动26例（37.14%）,寒战1例（1.43%）。腺样体切除术后患儿护理效果满意,均安全度过麻醉恢复期。结论 儿童腺样体切除术后易发生躁动、气道梗阻, 应加强安全防护以及呼吸道的管理,以利于减少患儿麻醉后的并发症,提高手术安全性。     

Rupture du LCA : cas de l’athlète féminine

Female athletes have 2–3 times more risks of ACL injury than male. Hormonal, anatomical and neuromuscular factors would explain this female predisposition. Prevention training, aimed to avoid “dynamic” valgus, leads to a reduction of ACL injury risks. These programs, including a neuromuscular training, improve knee dynamic control in female athletes and decrease the loadings on the ACL. The aim of this review is to make an inventory of the knowledge on this subject by analyzing theses predispositions and most specially the influence of the neuromuscular factors. Therefore, the purpose is to make a comparative assessment of the various prevention programs to determine the essential elements for an effective intervention of the physiotherapist.     

Les kystes du ligament croisé antérieur : à propos de 24 cas

The purpose of this study is to present clinical and magnetic resonance imaging (MRI) features of ganglion cysts of the anterior cruciate ligament (ACL). Such cysts are rare and often unsuspected. We reviewed a series of 24 ganglion cysts of the ACL (7 females, 17 males) between 1998 and 2004. The mean age was 45 years old (25–74). All patients presented with knee pain. The mean follow-up was 25 months (6–48). All patients had a preoperative MRI, which confirmed the diagnosis. Seventeen patients had an arthroscopic treatment and 7 were treated with percutaneous aspiration and steroid injection under. Fourteen patients were evaluated with the International knee Documentation Committee (IKDC) subjective score. Computed tomography or ultrasound guidance. MRI demonstrated 16 mucoid degenerative cysts of the ACL and 8 well circumscribed ganglion cysts with a fluid collection. The surgical pathology confirmed 13 mucoid cysts and 4 ganglion cysts; 2 recurrences were observed after surgical treatment. After percutaneous aspiration, we observed 3 recurrences, 2 failures and one vascular complication. We observed two types of ACL cysts, which could be differentiated on the MRI. Percutaneous treatment was less reliable than surgical treatment. The percutaneous aspiration should be reserved to the ganglion cysts with fluid collection, while arthroscopy is indicated for the failure cases. We recommend resection for the mucoid cysts. An aggressive resection of the ACL may compromise the knee stability so that the patient must be informed preoperatively. In theses cases, aspiration was often inefficient.     

L'histoire de la ventilation mécanique : des machines et des hommes

From the mid-1500s until the early 1900s attempts to resuscitate apparently dead humans by applying artificial ventilation with a bellows trough a tracheal tube were time to time recorded. In 1876 E Woillez presented the Spirophore that was the first negative pressure tank ventilator. The Pulmotor designed in 1906 by H Dräger was the first preset pressure ventilator. The first ventilator to be used successfully for long term mechanical ventilation was the Drinker-Shaw iron lung (1928) that saved many lives during the poliomyelitis epidemics. All the senior critical care physicians keep in mind the Engtröm 150 (1954) as the first electrically powered ventilator which contributed to the development of critical care. In 1959 Frumin demonstrated that the immersion of the exhalation limb under few centimetres of water was an efficient method to improve gas exchange. This simple method to improve gas exchange was promoted by Asbaugh and Petty and termed continuous positive airway pressure then positive end expiratory pressure (PEEP). Produced by Siemens the “Servo 900 A” (1970) was the first electronically device equipped with a PEEP valve and offering the possibility to monitor gas flow and airway pressure. Since 1980 the introduction of servo controlled valves have made possible the synchronisation between the patient inspiratory effort and the delivered gas flow. Assisted Spontaneous Breathing, a mode that will be termed later Pressure Support Ventilation, was the first pressure preset mode. Recent advances mainly focused on ergonomic and undesirable secondary effects of mechanical ventilation.