The Modified Concorde Position with an Intraoperative Skew Head Rotation: Technical Note

The Concorde position was developed to approach pineal and cerebellar lesions with a midline suboccipital craniotomy. The neutral head position is needed to divide the occipital muscles symmetrically. The patient’s head is tilted to the right and the face is turned to the right for the microscopic procedure to keep the midline of the patient’s head axis straight in the surgical field for comfortable and accurate surgical manipulation. However, intraoperative repositioning of the patient’s head is somewhat difficult to release the holding arm of the Sugita head holder in the original method. We found that a skew head rotation by fixing the head asymmetrically in the Sugita head holder is very quick and convenient to obtain the optimal head position both for a craniotomy and a microscopic procedure.     

基于护士岗位管理建立优质护理服务长效机制

目的探讨实施护士岗位管理,建立优质护理服务长效机制的措施。方法通过对本院护士岗位设置和岗位测算,确定职数和晋级标准,做到多劳多得、同工同酬。结果自2012年9月实施护士岗位管理以来,住院患者和责任护士满意度均提高,与实施前比较,差异有统计学意义(P0.05)。结论由身份管理转变为岗位管理,有效地调动了护士工作积极性,从而提高了患者的满意度。     

术前眼位注视训练应用于铁质角膜异物剔除术患者的效果观察

目的探讨术前眼位注视训练在铁质角膜异物剔除术患者中的应用效果。方法选取我院行铁质角膜异物剔除术患者182例,按随机数字表随机分为对照组和观察组各91例,对照组给予常规治疗和护理;观察组在术前常规治疗和护理基础上给予术前眼位注视训练。观察比较两组患者术中眼球旋转偏移发生率、头面部偏移发生率、手术时间、一次手术成功率及角膜损伤发生率。结果观察组术中眼球旋转偏移、头面部偏移发生率及角膜损伤发生率均低于对照组(P0.01);观察组手术时间短于对照组,一次手术成功率高于对照组,差异均有统计学意义(P0.01)。结论术前眼位注视训练可降低患者术中眼球旋转偏移和头面部偏移发生率,缩短手术时间,提高一次手术成功率,减少角膜损伤发生率,并且其操作方法简单,值得临床推广应用。     

改良式俯卧位通气对ARDS患者压力性损伤的影响

目的：观察改良式俯卧位通气（PPV）对急性呼吸窘迫综合征（ARDS）患者压力性损伤（PI）的效果。方法：选取2015年1月至2019年1月在温州医科大学附属第二医院重症医学科需PPV的ARDS患者68例，按随机数字表法分为常规组和改良组。常规组33例，采取0°持续PPV 16 h；改良组35例，采用头高脚低30°俯卧，左、右30°侧俯卧交替进行，每个体位维持2 h，16 h后改为仰卧位。比较2组俯卧位后PI发生率、数量、部位和分期。结果：常规组14例患者发生了47处PI，其中1期26处，2期21处；改良组6例发生15处PI，1期10处，2期5处；常规组PI发生率为42.42%（14/33），改良组为17.14%（6/35）。2组PI的发生率和分期比较差异均有统计学意义（P＜0.05）。结论：应用改良式PPV可以减少ARDS患者PI的发生率。     

Preoperative tibiofemoral rotational alignment is a risk factor for component rotational mismatch in total knee arthroplasty

BackgroundRotational mismatch between the femoral and tibial components is reported to be a risk factor for unsuccessful total knee arthroplasty (TKA). However, the rotational mismatch can still occur even when each component is aligned within the desired angle. Therefore, there may be other unknown factors. This study aims to investigate a risk factor for component rotational mismatch in TKA. The authors hypothesized a significant correlation between the rotational mismatch angle and not only the rotational alignments of components, but also the preoperative tibiofemoral rotation angle.MethodThis retrospective cohort study included 79 knees who underwent TKA. Computed tomography images were obtained preoperatively and 2 weeks after surgery for the component positional measurement. The postoperative component rotational mismatch angle between the tibial and femoral components and the rotational alignment of each tibial and femoral component to anatomical axes was evaluated. In addition, the preoperative rotational angle between the tibia and femur bones and patients’ demographics were also investigated. The correlation between the postoperative component rotational mismatch angle and perioperative variables was analyzed to identify risk factors for component rotational mismatch.ResultsThe mean component rotational mismatch angle was 1.8° of internal rotation of the tibial component relative to the femoral component, and the angle ranged from 11.3° of internal rotation to 7.3° of external rotation of the tibial component. Multivariate regression analysis showed that the preoperative rotational alignment between the tibia and femur and the rotational alignment of each component were influential factors in the postoperative component rotational mismatch angle.ConclusionThe preoperative tibiofemoral rotational alignment and the rotational alignment of each tibial and femoral component and are risk factors for the postoperative component rotational mismatch in TKA.     

坐位分娩在第二产程应用的研究进展

对产妇在第二产程应用坐位分娩的相关研究进行综述,包括坐位分娩的具体方法及对母婴分娩结局的影响。与其他体位相比,坐位分娩有其特有的优势,助产士和产科医生可根据产妇的偏好和产程进展等因素综合决定是否在第二产程采用坐位分娩。     

Static balance performance differs depending on the test,age and specific role played in acrobatic gymnastics

BackgroundStatic balance performance appears to detect differences between roles played in team sports. Static balance can also be influenced by the subject's height and age, and the type of test used.Research questionCould the static balance profile show differences among the role played depending on the specific test evaluated and the gymnasts’ age?MethodsA cross-sectional design was applied. 46 acrobatic gymnasts (37 females and 9 males) were divided in four groups according to role (base or top gymnast) and stage of adolescence (early adolescent or mid-adolescent) during two different static tests: (1) unipedal with open and closed eyes (generic), and (2) headstand (specific). To test the effect of the role and the age group, a two-way analysis of variance (ANOVA) between groups was performed. Centre of pressure (COP) measurements were obtained and normalised relative to participants height, including length travelled on the anteroposterior and mediolateral axis (AP_CoP and ML_CoP) and the mean speed (SP_CoP).ResultsBase gymnasts obtained lower values in the CoP excursion than Top gymnasts but only in unipedal tests for all the variables analysed (5.536 ≥ F_1,42 ≤ 10.589, 0.002 ≥ p ≤ 0.023), except for the AP_CoP in unipedal-closed. Mid-adolescent gymnasts obtained lower values in the CoP excursion regardless of the task than early adolescent (5.324 ≥ F_1,42 ≤ 14.805, 0.000 ≥ p ≤ 0.026).SignificanceIt has been observed a clear effect of age on the static balance manifested in acrobatic gymnastics, regardless of the subject's height, the role played, and the test performed. The effect of the role played in this team sport has been different depending on the type of test performed.     

患者坐位超声引导下经皮肾穿刺造瘘术的临床应用

目的 对患者坐位超声引导下行经皮肾穿刺造瘘术(Percutaneous nephrostomy,PCN)的临床资料进行总结,探讨患者坐位超声引导下PCN的可行性。方法 回顾性分析2017年1月～2018年12月对上尿路积水患者16例(27侧)进行PCN治疗,对比PCN前、后肾功能的变化。结果 对梗阻性肾积水(Hydronephrosis),嘱患者取坐位,超声引导下PCN,满意放置UrovisionR造瘘管,成功率96.3%(26/27)。局麻下操作,对患者的呼吸、血流动力学影响小,未出现严重并发症,患者容易耐受,PCN前、后肾功能变化差异有统计学意义(P0.05)。结论 坐位实时超声引导PCN成功率高、安全、可靠,手术操作者更舒适,患者也更容易耐受,合理选择PCN通道是操作成功的关键。     

支撑喉镜下喉显微手术患者的体位改进

目的 探讨嗅物位对支撑喉镜下喉显微手术术野暴露的优势。 方法 选择拟行支撑喉镜下喉显微手术的嗓音疾病患者60例,随机分为嗅物位组(A组)及去枕仰卧位组(B组)2组,每组30例。A组患者予以枕下垫自制头枕,肩背部紧贴于手术台面,再将其头部伸展于寰枕关节;B组患者摆放去枕仰卧位。评价声门暴露情况,根据声带病变范围及性质行喉显微手术。 结果 (1)暴露声门耗时:A组(2.42±1.04)min明显短于B组(3.20±0.95)min,两组比较差异具有统计学意义(P<0.05);(2)手术并发症:A组术后喉部疼痛VAS评分低于B组,两组比较差异具有统计学意义(P<0.05);A组术后咽喉部黏膜损伤发生率(6.7%)明显低于B组(30.0%),术后舌部麻木及术中术后牙齿损伤情况基本无发生,与B组比较,术后恢复良好、手术并发症少。 结论 嗅物位较去枕仰卧位更有利于支撑喉镜下的声门暴露,耗时更短、手术并发症更少。