Single shot spinal anesthesia with very low hyperbaric bupivacaine dose (3.75 mg) for hip fracture repair surgery in the elderly. A randomized,double blinded study

PurposeSingle shot spinal anesthesia is used worldwide for hip fracture repair surgery in the elderly. Arterial hypotension is a frequent adverse effect. We hypothesized that lowering local anesthetics dose could decrease the incidence of arterial hypotension, while maintaining quality of surgical anesthesia.MethodsIn a randomized double blinded study, 66 patients over the age of 65 years, with hip fracture needing surgical repair, were assigned to B0.5 group 7.5 mg hyperbaric bupivacaine 5 mg/ml (control group), and B0.25 group 3.75 mg hyperbaric bupivacaine 2.5 mg/ml (study group). Sensory and motor block level, and hemodynamic parameters including blood presure, heart rate and vasopressor dose administration were registered, along with rescue anesthesia needs, the feasibility of surgery, its duration, and regression time of sensory anesthesia to T12.ResultsAfter exclusions, 61 patients were included in the final analysis. Arterial hypotension incidence was lower in the B0.25 group (at the 5, 10, and 15 min determinations), and a lower amount of vasopressor drugs was needed (mean accumulated ephedrine dose 1.6 mg vs. 8.7 mg in the B0.5 group, p < 0.002). Sensory block regression time to T12 was shorter in the B0.25 group, mean 78.6 ± 23.6 (95% CI 51.7–110.2) min vs. 125.5 ± 37.9 (95% CI 101.7–169.4) min in the B0.5 group, p = 0.033. All but one patient in the B0.25 group were operated on under the anesthetic procedure first intended. No rescue anesthesia was needed.ConclusionLowering bupivacaine dose for single shot spinal anesthesia for hip fracture repair surgery in elderly patients was effective in decreasing the occurrence of arterial hypotension and vasopressor use, while intraoperative quality remained.     

Comparison of two closed surgical techniques at isolated pediatric radial neck fractures

IntroductionThis paper aims to compare the clinical and radiological results of children operated using elastic stable intramedullary nailing as described by Métaizeau to those with the closed reduction and percutaneous pinning (CRPP).MethodsResults of 21 pediatric patients with radial neck fracture who were treated by two pediatric surgeons between January 2011 and December 2013 were reviewed retrospectively. 10 were treated with the Métaizeau method versus 11 with the CRPP. Operation time, fluoroscopic exposure time, Mayo elbow performance score (MEPS) and radiological assessment at final follow-up 1 year or greater and complications were main outcome measures.ResultsThe MEPS were excellent in all the patients of both groups. Reduction quality was excellent in 8 patients and good in 2 of the Métaizeau, and excellent in 9 and good in 2 of the CRPP. The fluoroscopy and operating times were statistically significantly greater, 3-fold and 2-fold respectively, in the Métaizeau method compared to the CRPP with comparable functional and radiological results.ConclusionSurgeon should adhere to a closed surgical method of his/her experience for excellent result.Level of evidenceTherapeutic Level III.     

Herbert螺钉治疗肱骨小头骨折应用分析

目的 评价Herbert 螺钉治疗有移位的肱骨小头骨折的优越性.方法 自2005年3月以来应用Herbert螺钉治疗有移位的肱骨小头骨折11例,按Bryan-Morrey肱骨小头骨折分型:Ⅰ型7例,Ⅱ型1例,Ⅲ型3例.结果 经平均随访3年 8个月,术后功能按Mayo评分优7例,良4例,大多数患者完全恢复正常,无并发症.结论 Herbert 螺钉治疗肱骨小头骨折能提供牢固的内固定,大多数患者肘关节功能恢复良好,稳定无疼痛.在处理这类骨折中,本治疗方法 较常规方法 具有明显的优越性.     

侧卧位单侧椎弓根外入路无痛椎体强化术治疗合并内科重症骨质疏松性椎体压缩骨折(OVCFs)患者的临床疗效研究

目的:探讨侧卧位单侧椎弓根外入路无痛椎体强化术治疗合并内科重症骨质疏松性椎体压缩骨折(OVCFs)患者的临床疗效。方法:回顾性分析65例合并内科重症OVCFs患者的临床资料,全部患者均接受侧卧位单侧椎弓根外入路无痛椎体强化术治疗,比较本组患者术前、术中生命体征指标与术后康复情况。结果:本组患者手术治疗过程中的呼吸频率、收缩压、心率与血氧饱和度与术前差异无统计学意义(P>0.05);本组患者术后伤椎Cobb角、术后VAS评分与ODI低于术前,椎体压缩部位高度高于术前,差异具有统计学意义(P<0.05)。结论:合并内科重症OVCFs患者接受侧卧位单侧椎弓根外入路无痛椎体强化术治疗的疗效确切,术后疼痛低,可促进肢体功能恢复,临床应用价值高。     

股骨干骨折合并胸部损伤患者326例观察

目的探讨股骨干骨折合并胸部损伤患者的疗效方式。方法回顾分析1998年5月至2010年10月该院收治的326例股骨骨折合并胸部损伤患者的临床资料。结果术中、术后患者均未出现脂肪栓塞综合征(FES),2例病情不稳定患者外固定架固定后出现急性呼吸窘迫综合征(ARDS)。结论股骨干骨折合并胸部损伤患者应根据实际情况选择不同的术式和手术时机。     

螺旋CT在腰椎间盘突出症的临床应用价值分析

目的:探讨螺旋CT应用在腰椎间盘突出症中的临床价值。方法:筛选经临床手术证实为腰椎间盘突出患者120例,作为研究对象。采用螺旋CT扫描及X线平片对所有患者腰椎间盘进行检查,比较两种检查手段诊断的正确率及病情评价情况。结果:螺旋CT诊断正确率为113例(94.17%),X线平片诊断正确率为93例(77.50%),二者比较,差异有统计学意义(P<0.05);螺旋CT对软组织病变、神经根及硬膜囊损伤评价结果较X线平片具有显著优势(P>0.05)。结论:应用螺旋CT检查腰椎间盘突出症具有诊断准确,可对腰椎神经根等病理性损伤做出准确评价,可指导临床治疗方案的选择。     

星状钢板固定治疗合并内侧副韧带损伤的股骨内髁撕脱骨折

<正>2012年3月~2013年12月,我科采用星状钢板内固定治疗11例股骨内髁内侧副韧带止点处的撕脱骨折患者,疗效满意,报道如下。1材料与方法1.1病例资料本组11例,男9例,女2例,年龄27~53岁。左侧4例,右侧7例。均为新鲜损伤。1.2治疗方法取股骨下端内侧弧形切口,长5~6 cm,将侧副韧带连带撕脱骨片向上牵拉复位。采用星状钢板及1枚空心松质骨拉力螺钉固定。检查外翻应力试验阴性后,冲洗、缝合切口。术后