侧卧位无牵引床髓内钉固定在股骨粗隆下骨折治疗中的应用

目的 探讨侧卧位无牵引床髓内钉固定在股骨粗隆下骨折治疗中应用的效果。方法 回顾性研究。纳入2015年11月-2018年7月五河县人民医院骨科收治的34例股骨粗隆下骨折患者的临床资料。其中男20例、女14例,年龄23~83(61.7±12.7)岁;SeinsheimerⅡA型5例、ⅡB型4例、ⅡC型7例、ⅢA型3例、ⅢB型5例、Ⅳ型6例、Ⅴ型4例;受伤至手术时间1~12(7.0±1.9)d。患者均在C臂X线机透视下,采用侧卧位无牵引床闭合复位髓内钉固定治疗。记录患者术前体位摆放时间、手术操作时间、术中失血量、术中X线透视次数、骨折复位质量、术后并发症及骨折愈合时间;术后定期随访,记录并比较术后1、6个月及末次随访时髋关节疼痛视觉模拟评分(VAS)、髋关节功能Harris评分,末次随访根据Harris评分评价关节功能。结果 患者体位摆放时间5~11(7.7±1.6)min,手术时间为29~82(60.3±10.9)min,术中失血量为45~350(212.3±57.8)mL,术中透视次数为18~53(33.8±7.3)次。术后即刻摄片,骨折复位质量获解剖复位13例,可接受的复位21例。术后患者切口均一期愈合,未发生感染、深静脉血栓形成、内固定失败。34例患者均获随访,随访时间12~48(22.4±7.7)个月。骨折愈合时间为4~12(5.8±1.7)个月。1例Seinsheimer Ⅳ型患者术后7个月仍未骨愈合,取自体髂骨植骨处理,二次术后3个月愈合。术后1、6个月及末次随访时患者髋关节疼痛VAS评分依次为(4.76±0.96)、(1.91±0.79)和(0.97±0.63)分,Harris评分依次为(74.35±5.83)、(78.79±6.31)和(85.76±6.53)分,差异均有统计学意义(P值均＜0.05)。末次随访髋关节功能优11例、良20例、可2例、差1例,优良率达91.2%。结论 侧卧位无牵引床髓内钉固定治疗股骨粗隆下骨折,方法简便、微创,能够取得满意的手术效果,适合在基层医院应用推广。     

Predictive value of intraoperative blink reflex monitoring for surgical outcome during microvascular decompression for hemifacial spasm

ObjectiveTo investigate the prognostic and predictive value of intraoperative blink reflex (BR) monitoring during microvascular decompression (MVD) for hemifacial spasm (HFS).MethodsWe retrospectively reviewed 41 patients with HFS undergoing MVD with intraoperative BR and lateral spread response (LSR) monitoring. Facial spasm was evaluated for six months postoperatively.ResultsThe BR resolved in 38 patients and persisted in three after MVD. For patients who exhibited BR resolution, 1-day, 1-month, and 6-month follow-ups revealed that 35 (92.1%), 35 (92.1%), and 38 (100%) patients had spasm resolution, respectively. However, of the three patients with persistent BR, one (33.3%), one (33.3%), and zero (0%) patients exhibited spasm resolution at the three corresponding follow-ups. We found a statistically significant difference in spasm resolution between the persistent and resolved BR groups at six months postoperatively. A comparison between intraoperative BR and LSR monitoring revealed that BR was a better predictor of clinical outcomes.ConclusionsIntraoperative BR monitoring is a potentially useful tool to help facilitate an adequate decompression and is a reliable prognostic predictor of surgical outcome.SignificanceThis study is the first to document the relationship between intraoperative BR monitoring and surgical outcome in patients with HFS.     

Cephalometric Norms for Kuwaiti Adults: A preliminary study

PurposeTo establish for the first time cephalometric norms for adult Kuwaitis with normal class I occlusion according to ethnic group and gender, and to compare the findings to the previously published norms of the Caucasoid.Materials and methodsEight hundred adult Kuwaiti subjects were screened at two locations. The inclusion criteria were: Kuwaiti adults born to parents, and grandparents of pure Arab or Persian heritage; esthetically pleasing faces; angle class I molar and canine relationships; all permanent teeth present; irregularity index of less than 4 mm; and no history of orthodontic treatment or plastic surgery. Lateral cephalometric radiographs were taken by one investigator then traced and analyzed using twenty-nine angular, and linear measurements. Independent sample t-test was used to assess the inter-ethnic and the inter-gender differences. The results were then statistically compared to the norms of the Caucasoid.ResultsA total of 56 adult subjects were included. Several significant differences were noted between the Kuwaiti Arab and the Kuwaiti Persian ethnic groups. The most noteworthy differences were observed for the angles SNA and SNB and for the mean total lengths of the maxilla and mandible. When compared to the Caucasoid, statistically significant differences were noted in all mean dental and soft tissue measurements between the pooled Kuwaiti population and the Caucasoid.ConclusionThere are some fundamental variations in the craniofacial structure of Arabs, and Persians of the adult Kuwaiti population. These differences should be considered in larger future studies to establish clinical norms for orthodontic patients in Kuwait.     

Fronto-orbital feminization technique. A surgical strategy using fronto-orbital burring with or without eggshell technique to optimize the risk/benefit ratio

The demand for facial feminization is increasing in transsexual patients. Masculine foreheads present extensive supraorbital bossing with a more acute glabellar angle, whereas female foreheads show softer features. The aim of this article is to describe our surgical technique for fronto-orbital feminization. The mask-lift technique is an upper face-lift. It provides rejuvenation by correcting collapsed features, and fronto-orbital feminization through burring of orbital rims and lateral canthopexies. Depending on the size of the frontal sinus and the thickness of its anterior wall, frontal remodeling is achieved using simple burring or by means of the eggshell technique. Orbital remodeling comprises a superolateral orbital opening, a reduction of ridges and a trough at the lateral orbital rim to support the lateral canthopexy. Frontal, corrugator and procerus myectomies, plus minimal scalp excision, complete the surgery. Our technique results in significant, natural-looking feminization. No complications were observed in our series of patients. The eggshell technique is an alternative to bone flap on over-pneumatized sinus. Fronto-orbital feminization fits into a wider surgical strategy. It can be associated to rhinoplasty, genioplasty, mandibular angle remodeling, face lift and laryngoplasty. Achieving facial feminization in 2 or 3 stages improves psychological and physiological tolerance.     

Sodium and water intake are not affected by GABAC receptor activation in the lateral parabrachial nucleus of sodium-depleted rats

The activation of GABAergic receptors, GABA_A and GABA_B, in the lateral parabrachial nucleus (LPBN) increases water and sodium intake in satiated and fluid-depleted rats. The present study investigated the presence of the GABA_C receptor in the LPBN, its involvement in water and sodium intake, and its effects on cardiovascular parameters during the acute fluid depletion induced by furosemide combined with captopril (Furo/Cap). One group of male Wistar rats (290–300 g) with bilateral stainless steel LPBN cannulas was used to test the effects of a GABA_C receptor agonist and antagonist on the fluid intake and cardiovascular parameters. We investigated the effects of bilateral LPBN injections of trans-4-aminocrotonic acid (TACA) on the intake of water and 0.3 M NaCl induced by acute fluid depletion (subcutaneous injection of Furo/Cap). c-Fos expression increased (P<0.05), suggesting LPBN neuronal activation. The injection of different doses of TACA (0.5, 2.0 and 160 nmol) in the LPBN did not change the sodium or water intake in Furo/Cap-treated rats (P > 0.05). Treatment with the GABA_C receptor antagonist (Z)-3-[(aminoiminomethyl)thio]prop-2-enoic acid sulfate (ZAPA, 10 nmol) or with ZAPA (10 nmol) plus TACA (160 nmol) did not change the sodium or water intake compared with that for vehicle (saline) (P > 0.05). Bilateral injections of the GABA_C agonist in the LPBN of Furo/Cap-treated rats did not affect the mean arterial pressure (MAP) or heart rate (HR). The GABA_C receptor expression in the LPBN was confirmed by the presence of a 50 kDa band. Although LPBN neurons might express GABA_C receptors, their activation produced no change in water and sodium intake or in the cardiovascular parameters in the acute fluid depletion rats. Therefore, the GABA_C receptors in the LPBN might not interfere with fluid and blood pressure regulation.     

Intraoperative lateral rectus electromyographic recordings optimized by deep intraorbital needle electrodes

ObjectiveWe demonstrate the advantages and safety of long, intraorbitally-placed needle electrodes, compared to standard-length subdermal electrodes, when recording lateral rectus electromyography (EMG) during intracranial surgeries.MethodsInsulated 25 mm and uninsulated 13 mm needle electrodes, aimed at the lateral rectus muscle, were placed in parallel during 10 intracranial surgeries, examining spontaneous and stimulation-induced EMG activities. Postoperative complications in these patients were reviewed, alongside additional patients who underwent long electrode placement in the lateral rectus.ResultsIn 40 stimulation-induced recordings from 10 patients, the 25 mm electrodes recorded 6- to 26-fold greater amplitude EMG waveforms than the 13 mm electrodes. The 13 mm electrodes detected greater unwanted volume conduction upon facial nerve stimulation, typically exceeding the amplitude of abducens nerve stimulation. Except for one case with lateral canthus ecchymosis, no clinical or radiographic complications occurred in 36 patients (41 lateral rectus muscles) following needle placement.ConclusionsIntramuscular recordings from long electrode in the lateral rectus offers more reliable EMG monitoring than 13 mm needles, with excellent discrimination between abducens and facial nerve stimulations, and without significant complications from needle placement.SignificanceLong intramuscular electrode within the orbit for lateral rectus EMG recording is practical and reliable for abducens nerve monitoring.