俯卧位手术病人髋垫与术后股外侧皮神经损伤的相关性研究

[目的]研究手术病人俯卧位致股外侧皮神经损伤的相关因素。[方法]选择使用OSI-5803i多功能手术床的Jackson脊柱床面进行脊柱外科手术病人58例,通过记录手术时间、髂前上棘脂肪厚度、身体与髋垫接触的压迹面积、接触部位中心距髂前上棘距离及术后大腿前外侧有无异常感觉、何时出现症状、随访期间症状变化,共随访7d,对引起术后股外侧皮神经损伤的相关因素进行分析。[结果]手术时间、髋垫压迹横径、接触部位中心距髂前上棘距离与股外侧皮神经损伤相关。[结论]与俯卧位术后股外侧皮神经损伤相关的主要因素为手术时间、髋垫压迹横径及髋垫与髂前上棘的相对位置。     

1例患者取俯卧位致股外侧皮神经损伤的报道

俯卧位是脊柱外科最常采用的手术体位，具有手术视野暴露充分、便于手术医生操作等优点，但此体位可造成患者生理学的改变，易导致循环、呼吸障碍，神经损伤和皮肤压疮等并发症，但少见俯卧位致股外侧皮神经损伤的报道。我院收治1例腰椎后路切开减压植骨内固定术患者因术中取俯卧位导致股外侧皮神经损伤。现报道如下。     

俯卧位腰椎手术致股外侧皮神经损伤的预防与护理

目的探讨俯卧位腰椎手术致股外侧皮神经损伤的原因、预防与护理措施。方法对我院收治并行俯卧位腰椎手术并发股外侧皮神经损伤的12例的临床资料进行回顾性分析。结果我院2006年10月～2009年6月行腰椎后路切开减压植骨固定术193例,其中12例出现股外侧皮神经损伤。经积极治疗和热敷、屈髋及足踝、足趾、膝关节的屈伸活动等康复护理后均治愈。结论合理的手术体位是手术成功和患者安全的基本保证。俯卧位腰椎手术股外侧神经损伤后积极的治疗和做好康复护理有助于患者恢复。     

股外侧皮神经超声探测方法学

目的提供高效、准确的股外侧皮神经超声探测的方法,并评估其解剖变异。方法以阔筋膜张肌和缝匠肌之间的间隙作为股外侧皮神经声像图定位标志,18 MHz超声探测150例志愿者的股外侧皮神经。测量神经与髂前上棘之间的距离,观察腹股沟韧带水平的神经分支数目和神经与腹股沟韧带之间的关系,并记录探查时间。结果所有受检者的股外侧皮神经在阔筋膜张肌和缝匠肌之间的肌间隙均清晰显示。股外侧皮神经与髂前上棘之间的平均距离为(15.4±4.1)mm。其中252条神经走行于腹股沟韧带的深面,此水平的神经由1~4根分支组成。鉴别一条神经的平均时间为7s。结论以阔筋膜张肌和缝匠肌的间隙作为声像图定位标志,有助于超声高效,准确地显示股外侧皮神经,超声可观察其解剖学变异。     

微创双切口全髋置换术应用解剖与临床效果回顾分析

目的 研究微创双切口全髋关节置换术手术安全区和评价手术对软组织的损伤.方法 对20具成年尸体(40髋)解剖,记录股外侧皮神经(LFCN)的走向及与周围解剖标志的距离,臀中肌和梨状肌间隙与水平面的夹角.对3具新鲜灌注尸体标本行模拟手术,现察切口周围软组织的损伤情况. 27例患者(27髋)施行微创双切口全髋关节置换术.结果 LFCN手术风险区为出骨盆处沿腹股沟韧带方向距髂前上棘(ASIS)距离6～71 mm,沿缝匠肌方向穿出缝匠肌外缘处距ASIS 21～112 mm;出缝匠肌外侧缘处水平垂直于ASIS垂线的距离1～35 mm;屈髋、极度内收和放置于另一下肢上,髌骨平行于地面时梨状肌和臀中肌间隙与水平面的夹角为(60±5)°(范围55-68°).模拟手术显示臀中肌、梨状肌和臀小肌均有损伤.前侧手术切口5.0 cm(4.6～6.5 cm)和后侧手术切口3.7 cm(3.0～4.2 cm),所有患者术后第1天站立行走;输血4例.1例术中股骨近端骨折.平均随访18个月无其他并发症,Harris评分94.5(92～96).结论 双切口全髋置换术前侧切口选择髂前上棘下3 cm外1 cm垂直切口,后侧切口选择从梨状肌和臀中肌间隙最下点和水平方向60°;术中会造成臀中肌、梨状肌和臀小肌损伤.双切口全髋置换术具有肌肉间隙操作的特点.出血少、康复快,但手术费时,技术要求高,术中需要透视.     

弧刃针刀治疗股外侧皮神经卡压综合征37例临床观察

<正>股外侧皮神经卡压综合征(Lateral Femoral Cutaneous Nerve LFCN)又称股外侧皮神经炎、Bemhardt-Both综合征。是指股外侧皮神经在其行走过程中穿过髂腹股沟部位受到周围组织病变的卡压而引起的大腿前外侧皮肤感觉异常及疼痛等神经功能障碍为特征的一种疾病[1~3]。其症状和体征易与腰椎间盘突出症、坐骨神经痛及局部软组织损伤等     

改良俯卧位摆放在脊柱外科手术中的应用256例分析

目的：探讨脊柱外科手术俯卧位的摆放方法。方法：采用自行设计制作的俯卧位垫,通过调节床面与肢体角度,避免压力集中分布及身体与支撑面呈点状接触,并恰当固定。结果：本组256例俯卧位安置,手术野显露充分、便于操作,维护了正常的呼吸、循环功能,体位稳定,患者舒适度高。254例无软组织及神经损伤等并发症发生;2例脊柱畸形矫正患者面部压红,术后2h恢复。结论：恰当的体位安置,是手术成功的基本保证,是预防术后并发症的重要措施。     

带血管游离髂骨移植的临床应用

作者近年来进行了 9例带血管髂骨移植 ,均获成功 ,现介绍如下。1　临床资料本组共 9例 ,男 5例 ,女 4例 ,年龄 2 6～ 52岁 ,平均 33岁。其中用于治疗肱骨骨囊肿 3例 ,胫骨巨细胞瘤 2例 ,肱骨骨髓炎 2例 ,外伤性胫骨及皮肤大块缺损 2例。术后随访 5年以上 ,治愈率 1 0 0 %。手术方法 :于腹股沟韧带上方 2ｃｍ处作横切口 ,其切口纵轴应位于从肩胛骨下角与腹股沟韧带中点的连线上 ,先从皮瓣内侧缘即股动脉搏动处开始 ,外侧至髂前上棘 ,并沿髂嵴稍延伸。从髂前上棘内侧稍下方约 2 0ｃｍ处[1 ] 找到股外侧皮神经 ,并沿神经走向纵行切开腹壁肌。…     

四黄膏在俯卧位脊柱手术中预防压疮的应用观察

[目的]探讨四黄膏在俯卧位脊柱手术中预防压疮的效果观察。[方法]将俯卧位脊柱手术病人120例,按住院先后顺序分为对照组60例和观察组60例,两组病人在摆放手术体位前,对照组病人受压部位给予涂抹凡士林;观察组病人受压部位给予涂抹四黄膏,两组病人术后改变为平卧位30min后,观察受压皮肤压疮发生程度(Ⅰ期、Ⅱ期)及发生率情况。[结果]观察组病人术中皮肤压疮发生程度(Ⅰ期、Ⅱ期)及发生率均明显低于对照组(P0.05)。[结论]俯卧位脊柱手术病人,术前使用四黄膏涂抹受压部位皮肤,可有效预防和减少皮肤压疮的发生。     

老年骨质疏松性椎体骨折患者经皮椎体成形术治疗的体位护理

总结27例老年骨质疏松性椎体骨折患者经皮椎体成形术治疗的体位护理.术前3 d开始行俯卧位练习,2～3次/d,每次0.5～1 h,俯卧时胸部垫软枕;术中协助患者取过伸位俯卧于手术台上,并使脊柱保持纵轴位,两侧肩部及髂前上棘处用10 cm厚软枕垫高,恢复脊柱的生理前凸;术后患者平卧4～6 h,腰部垫高5 cm、宽20 cm的腰枕.本组患者均能配合体位训练与摆放,未发生并发症.     

机器人辅助全髋关节置换术的护理

总结14例机器人辅助全髋关节置换术的护理配合要点。①参加术前讨论,熟悉手术计划,根据术前建模结果准备手术器械、假体;②手术室仪器合理布局,方便术中患者骨性标记点与机器人摄像立架的信息反馈,减少术中设备反复移动;③器械护士提前洗手上台检查机械臂性能,参与完成参考架和动力设备的安装以及机械臂配准、验证;④严格执行手术清点制度,包括粘贴于髌骨中心的心电图电极片、术中置于髂前上棘的骨针和分别固定在股骨大粗隆、髋臼外上缘的标记钉;⑤加强术中机械臂的无菌管理,保证术中操作时的有效活动范围;⑥根据手术入路,安放体位,保持肢体处于功能位,充分暴露手术野;⑦术后定期维护保养仪器设备,机械臂基座处于蓄电状态。14例均顺利完成手术,术后随访未发现脱位、感染、血管神经损伤等并发症。     

Ultrasound‐Guided Suprainguinal Fascia Iliaca Technique Provides Benefit as an Analgesic Adjunct for Patients Undergoing Total Hip Arthroplasty

Analgesia after total hip arthroplasty is often accomplished by the fascia iliaca compartment block, traditionally performed below the inguinal ligament, to anesthetize both femoral and lateral femoral cutaneous nerves. The course of the lateral femoral cutaneous nerve below the inguinal ligament is variable as opposed to consistent above the inguinal ligament in the pelvis. In this case series including 5 patients, we demonstrate that an ultrasound‐guided suprainguinal fascia iliaca approach would consistently anesthetize the lateral femoral cutaneous nerve along with anterior cutaneous femoral nerve branches and provide cutaneous analgesia after total hip arthroplasty, as shown by decreased opioid consumption.     

人工全髋关节置换术后下肢深静脉血栓形成原因的实验观察

背景深静脉血栓由于可继发致命性的肺栓塞和远期下肢深静脉功能不全,已被公认为是一种严重的术后并发症.随着人工关节外科的不断发展和手术日益普及,人工关节置换术后深静脉血栓形成已倍受关注.目的观察髋臼周围动静脉的解剖位置及全髋关节置换手术中损伤情况,探讨人工全髋关节置换术后下肢深静脉血栓的原因.设计单一样本观察,自身前后对照.单位大体解剖在湖州师范学院医学院解剖实验室完成,全髋关节置换术在浙江中医学院附属新华医院骨科完成.对象正常成年人体骨盆标本60具(男30具,女30具),选择浙江中医学院附属新华医院骨科2002-03/2003-08收治的全髋关节置换患者30例,男18例,女12例.方法大体实验于2003-03/05在湖州师范学院医学院人体解剖实验室进行.观察60具骨盆标本双侧髂外动静脉的解剖位置及股动静脉分支与髋臼的关系.为了观察方便,制作髋臼的12点划分模式图,从髂前上棘到髂前下棘作一条连线,该线的延长线与髋臼缘相交处即确定为12点,其他点按顺时针排列.对30例患者采用髋关节后外侧入路行人工全髋关节置换术,1周行双侧下肢深静脉造影检查下肢深静脉血栓形成情况.主要观察指标①髂外动、静脉及股动、静脉分支与髋臼的解剖关系.②全髋关节置换术后患者下肢深静脉血栓形成率.③不良事件及副反应.结果正常成年骨盆标本60具,人工髋关节置换患者30例,均进入结果分析.①髂外动静脉及股动静脉的解剖观察结果发现股动静脉分支旋股内外动静脉绕髋臼走行,且进入髋臼内;拉钩的安全位置在点12～3和5～9点为安全区,反之9～12点及3～5点为易损伤区.②人工髋关节置换术后深静脉血栓发生率术后进行双侧下肢深静脉造影检查,发现有11例并发深静脉血栓,发生率为37%.③不良事件及副反应3例出血达1 000 mL.为充分暴露手术视野,用拉钩阻挡肌肉等组织,即造成血管的长期积压,血流迟缓.结论人工全髋置换术易损伤髋臼血管内壁,从而导致血流减慢和血小板聚集,最终促使血栓形成.同时术中失血多,使血液黏稠导致血栓形成.根据易损伤区及安全区模式图可知,下肢深静脉血栓是可以减少的.     

Ultrasound-guided blockade of the lateral femoral cutaneous nerve: technical description and review of 10 cases

Blockade of the lateral femoral cutaneous nerve (LFCN) is performed for therapeutic management of meralgia paresthetica and as a regional anesthetic technique. The conventional technique is associated with high failure rates secondary to variable LFCN anatomy. We describe a technique for blockade of the LFCN using ultrasound guidance. A cross-sectional view of the LFCN was obtained by identifying the anterior superior iliac spine, then moving a 14-to-7MHz linear array ultrasound probe in a medial caudal direction until the nerve was encountered. The needle was advanced to the LFCN under ultrasound guidance via a lateral to medial approach. Injection using dynamic ultrasound demonstrated excellent perineural spread. Ten subjects underwent successful blockade of the LFCN with this technique. Five subjects were obese. Use of ultrasound for precise needle placement allowed low injection volumes to be utilized. Theref were no complications. Ultrasound guidance can facilitate blockade of the LFCN for diagnostic and therapeutic purposes and may be particularly beneficial with patients with challenging surface anatomic landmarks, or when low volume injections are desired.     

人工全髋关节置换术中肢体长度的平衡

Totalhipjointreplacementisusedwidelyasanimportantmethodtotreathipjointdisease．Leg－lengthequalizationisveryimportantaftertotalhipjointreplacement；otherwise，itwillleadtoaseriesofclinicalsymptomsandshortenusefultimeofartificialjoint．Accordingtoreports，incidenceofleg－lengthunequalizationreachesto５０％～８０％aftertotalhipjointreplacement犤１，２犦．Correctjudgmentofprosthesisimplantingpositionandlimblengthinpe－riodofoperationisveryimportant．Nowadays，thereisnofixedmethodandcriteriatocont…     

Meralgia paresthetica in differential diagnosis of low-back pain

OBJECTIVE: Meralgia paresthetica is a syndrome of pain or dysesthesia or both in the anterolateral thigh, caused by entrapment of the lateral femoral cutaneous nerve at the anterior superior iliac spine. The aim of this report is to emphasize that meralgia paresthetica can be confused with low-back pain. PATIENT: A 21-year-old man was admitted to hospital because of low-back and thigh pain. He had a history of low-back pain. Physical examination and radiologic studies for low-back pain and radiculopathy showed no pathologic findings. It was suspected that the most likely cause was lateral femoral cutaneous neuropathy, caused by the wide military belt he continuously wore tightly around his waist. INTERVENTIONS: The nerve was blocked with 10 ml of bupivacaine 0.25%, which provided immediate pain relief. A nonsteroidal anti-inflammatory drug was administered orally. RESULTS: After 15 days of bed rest and 45 days without the belt, he was completely symptom-free. CONCLUSIONS: It is important to be rigorous in investigating the etiology of low-back pain. Meralgia paresthetica can mimic low-back pain because of the similarity of the symptoms. It can be treated by conservative or ablative therapeutic interventions; however, conservative methods should be considered primarily.     

Leg-length equalization for total hip joint replacement patients

Objective To investigate the methods to maintain leg-equalization for patients undergoing primary total hip joint replacement .Methods 40 patients,45 hipswith various diseases were treated by total hip joint replacement from Jan 2000 to Sep 2001,Before operation,the perpendicular length from center of femoral head to the summit of great tuberosity and the tip of less tuberosity to the line of bilateral ischial tuberosity were measured;the length from anterior superior iliac spine to medial malleolus were measured at same time.Leg-length was decided and corrected according to these lines ,Results Before operation,shortening of limbs were presented in 39 hips,I to 4cm,average 2,4 cm.After operation,discrepancy of both legs was 0-0.8cm,Apparent limps were not observed in all patients,Conclusion This measurement is a useful method to maintain and recover leg-length in total hip joint replacement.     

肌内注射时臀中肌定位方法探讨

目的 探讨肌内注射中臀中肌的准确定位.方法 对285例臀中肌肌内注射病人分别采用不同定位方法后注射,一组采用改进定位即以小指末端骨隆突置于髂前上棘,小指紧沿髂棘外侧三横指为肌注面,另一组采用髂前上棘外侧三横指避开改进定位区域为肌注面,采用mecil疼痛问答法,患者评估注射过程疼痛程度.结果 2种定位法的疼痛评分有显著性差异,改进定位法注射时疼痛程度明显减轻.结论 改进定位较传统定位能更准确定位臀中肌.