Effect of Dexmedetomidine infusion during hip fracture surgery on hemodynamic parameters and blood loss: A triple-blinded Randomized Clinical Trial

Introduction In this study, we aim to assess the intra-operative effect of dexmedetomidine administration on the hemodynamic parameters and bleeding volume during hip fracture surgery.Patients and methods we designed and implemented a triple-blinded randomized clinical trial to objectively compare the effects of 0.5 µg/kg/h infusion of dexmedetomidine with placebo (equal amount of normal saline) during hip fracture surgery. All included cases were between 30 and 70 years old and underwent surgery for fixation of a proximal femur fracture from September 26, 2020 until February 15, 2021. They were all ASA class I or II with preoperative hemoglobin levels of 10 mg/dL or higher. Surgical blood loss and hemodynamic parameters were documented.Results 76 patients were enrolled. There were no significant differences in baseline patient characteristics. The bleeding rate was 620 ± 190.0 mL for the normal saline group and 476 ± 177.98 mL in the dexmedetomidine group (P = 0.04). No significant effect on hemodynamic parameters was observed.Conclusion Based on the current study, intravenous infusion of dexmedetomidine during hip fracture surgery under general anesthesia reduced the amount of intraoperative bleeding without causing any significant hemodynamic disturbances.Registration number IRCT20191222045857N1 (Iranian Registry of Clinical Trials)     

系统康复治疗对年轻肩关节脱位患者肩关节稳定性的作用

目的对年轻患者肩关节脱位进行系统的康复治疗,以检验系统康复疗法疗效优于单纯固定的假设。方法根据所采用的治疗方法,将43例40岁以下的急性肩关节脱位患者分成实验组23例,对照组20例。实验组患者进行包括关节活动范围锻炼、发展肩胛骨周围肌的肌力训练、发展肩袖肌的肌力、适度的外展、外旋锻炼及耐力训练在内的系统康复治疗。对照组只进行单纯固定后未经系统康复治疗。对两组患者的临床效果进行比较。结果实验组复发率为17%(4/23),对照组复发率为45%(9/20),两组复发率比较差异有显著性意义(χ2=3.866,P<0.05);随访结果显示肩关节ASES评分实验组为90.9±4.87,对照组为75.4±4.94,两组差异有非常显著性意义(t=9.94,P=2.99×10-12<0.01)。结论肩关节脱位年轻患者进行系统的康复锻炼,可以提高患肩的稳定性。     

原发性骨质疏松骨折治疗探讨

目的　探讨原发性骨质疏松骨折的治疗方法。方法　对 138例原发性骨质疏松骨折 ,在治疗骨折的同时采用联合用药 ,中西医结合用药及脉冲电磁场进行病因学治疗。结果　 138例中 134例获得 8～ 36个月 ,平均 13.5个月的随访 ,按优、良、可、差疗效评定标准 ,优 4 8例 ,良 6 2例 ,可 14例 ,差 6例 ,优良率 85.1% ,另 4例半年后死于其它疾病。结论　原性骨质疏松性骨折必须在进行骨折治疗的同时 ,进行骨质疏松病因学的治疗 ,二者结合才能收到较好的疗效     

逆行交锁髓内钉治疗股骨远段骨折24例体会

目的 总结股骨逆行交锁髓内钉应用的适应症、优点及其疗效.方法 2001年6月～2006年3月,采用切开复位交锁髓内钉内固定,治疗股骨远段骨折24例,早期行膝关节功能锻炼.结果 22例获随访,全部骨性愈合,功能恢复良好,无膝痛、跛行、膝关节僵直等.结论 股骨逆行交锁髓内钉治疗股骨远段骨折具有明显优势,固定牢固、坚强,功能恢复快,并发症少等优点,手术不需要C臂X线机和骨科手术牵引床,适合基层医院临床应用.     

An unusual presentation of a recurrent neurofibroma in the hand

Neurofibromas in the hand are uncommon and constitute less than 5% of all hand tumours. Accurate diagnosis and appropriate management are important because malignant transformation has been reported, especially in Von Recklinghausen’s neurofibromatosis. We report a case of a large neurofibroma in the right hand of an 18-year-old girl of Afro-Caribbean origin. She was symptomatic with complaints of pain and weakness of grip. General examination revealed multiple café-au-lait spots on the trunk and one nodular swelling in the forearm. The swelling was excised through a palmar approach and histology proved it to be a neurofibroma. The case is being reported for its rarity and it emphasizes the importance of general examination. Histopathological examination is vital in excluding malignant transformation.     

Effects of restriction of forefoot rocker functions by immobilisation of metatarsophalangeal joints on kinematics and kinetics during walking

ObjectiveThis study was conducted to investigate the effects of restriction of forefoot rocker (FFR) functions by immobilisation of unilateral metatarsophalangeal joints (MPJs) on kinematic and kinetic factors during walking.MethodsEighteen healthy young adults participated in this study. To immobilise the MPJs of the right leg, an aluminium sole plate (AS) was fixed on the sole of the foot. Kinematic and kinetic data were collected while each subject walked at a comfortable speed with the AS and without.ResultsIn the AS condition, the walking speed and contralateral step length were significantly decreased, and an asymmetrical centre of mass (COM) movement was observed. The range of plantarflexion motion and positive work by the ankle joint were decreased markedly during the late stance of the AS limb. In contrast, maximum hip and knee flexion angles in the swing phase of the AS limb and positive work by the bilateral hip joints over the gait cycle were increased.ConclusionsThe results suggested that MPJ immobilisation may result in marked motion limitation of ankle plantarflexion and inhibition of push-off by the ankle joint despite no restrictions on the ankle joint. These changes may interfere with gait speed and a smooth and symmetrical COM shift during walking.     

Utility of computed tomography angiography in traumatic lower limb injury: Review of clinical impact in level 1 trauma centre

IntroductionCT angiography (CTA) is efficient and accurate in detecting lower limb vascular injury in the setting of trauma (1-6). Less clear is the in-practice correlation between appropriate indications for these examinations and subsequent clinical impacts.Materials and MethodsAll CT leg angiography acquired from January 2016 through April 2019 were reviewed via retrospective search. Studies not acquired for trauma were excluded. Imaging and reports were reviewed to assess for vascular injury. Electronic medical records were reviewed to assess the presence or absence of classical ‘hard’ or ‘soft’ signs of vascular injury and whether vascular intervention was undertaken.ResultsA total of 347 lower limb injuries were identified in 273 men and 74 women. Mean age was 41.5 years ranging from 15-95 years. 268 cases were fractures with 177 open injuries. 301 of injuries were secondary to blunt trauma, 31 penetrating injury occurred and 15 cases were ascribed to blast/gunshot injury.74 (21.3%) studies were deemed to have a positive finding of vascular injury, 249 (71.8%) were reported as negative and 24 (6.9%) were indeterminate. Of the cases with positive findings, 26 underwent intervention (7.4% of all patients undergoing CTA). No patients with negative CTA required intervention, while three (3, 0.8% of total) with indeterminate findings required intervention.Where there were no clinical signs (absence of any hard or soft signs) 249 CTA's were performed and none required any form of intervention.ConclusionIn the absence of clinical signs of vessel injury, CT angiography is unlikely to demonstrate vascular injury requiring intervention in the setting of lower limb trauma.     

Pedobarographic outcome after subtalar screw arthroereisis in flexible juvenile flatfoot

BackgroundFlatfoot is a frequent skeletal deformity in childhood that can be minimally invasively treated by arthroereisis. Question: Does the motion of juvenile flexible flatfoot normalize after arthroereisis?MethodPedographic measurements were obtained from 39 patients preoperatively, six months postoperatively and compared to a healthy group. The footprints were divided into 8 areas. The selected parameters were: contact area and force-time-integral.ResultsAfter surgery, a load shift from the medial to the lateral areas was detected under the midfoot and forefoot. The force-time-integral under the hallux normalized. However, under the lateral midfoot, the postoperative force-time-integral was significantly higher than in the control group.SignificanceThe study shows that arthroereisis is able to correct the medially displaced load distribution of juvenile flexible flatfoot. However, further investigations are required to find out if the higher punctual loading under the lateral midfoot may cause problems in the long term.     

骨圈对椎弓根钉系统负载影响的三维有限元分析

目的：探讨单枚人体皮质骨圈(allograft fusion cage，AFC)斜植融合术中椎弓根钉系统受力分布，并对临床常见断钉原理进行分析，为临床应用提供理论依据。方法：采用二三维有限元方法(finite element method，FEM)，对放置及不放置AFC的脊柱Steffee钢板固定效果进行评估。结果：未放置AFC时Steffee钢板所受最大应力约为放置AFC状态下的4．8倍；椎弓根钉与螺帽交界处所受应力为最大，尤其上位螺钉与靠近椎体侧螺帽交界处是应力值最大点，未放置AFC时椎弓根钉最大应力点约为放置AFC状态下的5．0倍。结论：螺钉与钢板交界区是容易发生断钉的区域，尤其上位螺钉与靠近椎体侧螺帽交界处是最易断钉的部位；椎弓根钉系统放置AFC会明显增强融合节段稳定性，减少断钉等并发症。     

螺纹异体骨椎间融合支架治疗腰椎不稳的临床疗效

目的报告作者自行设计制作的螺纹异体皮质骨椎间融合支架(aliograft interbody fusion cage,AIFC)椎间融合治疗腰椎不稳的临床疗效.方法本组27例,其中男12例,女15例,年龄20～72岁,平均48.5岁.Ⅰ～Ⅱ°滑脱17例,Ⅱ～Ⅲ°滑脱7例,退行性腰椎不稳3例.前路手术3例,后路手术24例,其中15例同时行内固定,手术共植入AIFC 39个,其中一个间隙植入2个9例,植入1个15例,同时2个间隙各植入1个3例.结果平均随访13个月,临床疗效评价优21例,良5例,可1例.X线动态观察术后3～4月手术撑开的椎间隙有1～2mm的回落丢失,1例AIFC破裂,全部获骨性愈合.结论AIFC具有足够支撑、维持椎间隙高度功能,抗滑稳定性好,椎间融合率高,可避免取髂骨和金属椎间融合器永久植入的一些并发症,是一种治疗腰椎失稳症的理想材料和方法.