Deep vein thrombosis of the upper extremity: intra- and interobserver study of digital subtraction venography

Our objective was to assess the inter-observer and intra-observer agreement in the interpretation of digital subtraction venography (DSV) in patients with suspected deep vein thrombosis of the upper extremity (DVTUE). Prospectively, 62 consecutive DSV studies in 54 patients with clinically suspected DVTUE were included. Hard copies were presented without demographic data or original report. All venograms were read twice, at 3-month intervals, by an interventional vascular radiologist (observer 1) and an experienced general radiologist (observer 2). Consensus reading took place in the presence of a third experienced interventional radiologist. Inter-observer and intra-observer agreement were assessed using kappa statistics. Initial reading in 62 venograms showed an inter-observer agreement of 71% (kappa 0.48). The inter-observer agreement of the second reading was 83% (kappa 0.71). The agreement with the consensus report ranged from 76 to 94%. The intra-observer agreement for the first and second observer was 94% (kappa 0.89) and 76% (kappa 0.56), respectively (p<0.01). Digital subtraction venography has moderate to excellent intra- and inter-observer agreement, suggesting that digital subtraction venography is reliable for the diagnosis of DVTUE. Electronic Publication     

A new kinematic model of the upper extremity based on functional joint parameter determination for shoulder and elbow

A new upper extremity model is introduced for clinical application. It combines the advantages of functional methods to determine the joint parameters for the shoulder joint centre and the elbow axis location with the ease of a minimal skin mounted marker set. Soft tissue artefacts at the shoulder and upper arm are reduced via a coordinate transfer between dynamic calibration and the actual motion analyzed. A unique technical frame linked to markers on the forearm is defined for the humerus. The protocol has been applied to 50 subjects over a wide age range (5–85 years) and with varying physical status, proving clinical feasibility. Variability in joint centre localization in repeated measures was typically below 1 cm. Based on these estimated joint centre locations for shoulder and elbow, three shoulder joint angles together with elbow flexion and forearm pro-/supination were determined in a large set of static arm postures in 5 subjects. These were compared to synchronous universal goniometer measurements to analyse intra-tester, inter-tester, and inter-subject repeatability. Differences between the computed angles and the angles obtained directly with the goniometer remained below ±5° for joint angles up to 120° and ±10° above 120°.     

严重多发伤合并下肢深静脉血栓33例的诊断及治疗

目的探讨严重多发伤患者合并下肢深静脉血栓的发病率、诊断和治疗情况。方法收集2013年3月~2014年3月我院创伤外科收治的30例严重多发伤合并下肢深静脉血栓形成患者的病例资料进行统计分析,其中男性28例,女性5例;平均年龄(41.2±11.1)岁。分析静脉血栓的发病率、危险因素、辅助诊断、预防及治疗现状等。结果多发伤下肢深静脉血栓的发生率为4.2%(33/785);33例经术前血管超声筛查确诊为下肢深静脉血栓;血浆D-二聚体浓度在下肢静脉血栓为阳性和阴性的严重多发伤患者中没有统计学差异;所有择期手术的下肢深静脉血栓患者术前均行下腔静脉滤网置入术。结论严重多发伤患者下肢深静脉血栓的发病率高于普通住院患者,血管超声是筛查和诊断下肢深静脉血栓的重要手段,D-二聚体对多发伤患者血栓形成诊断价值有限。     

Upper extremity peripheral neuropathies: role and impact of MR imaging on patient management

To investigate the role of MR imaging (MRI) in the evaluation of peripheral nerve lesions of the upper extremities and to assess its impact on the patient management. Fifty-one patients with clinical evidence of radial, median, and/or ulnar nerve lesions and unclear or ambiguous clinical findings had MRI of the upper extremity at 1.5 T. MR images and clinical data were reviewed by two blinded radiologists and a group of three clinical experts, respectively, with regard to radial, median, and/or ulnar nerve, as well as muscle abnormalities. MRI and clinical findings were correlated using Spearman's (p) rank correlation test. The impact of MRI on patient management was assessed by the group of experts and ranked as "major," "moderate," or "no" impact. The correlation of MRI and clinical findings was moderate for the assessment of the median/radial nerve and muscles (p = 0.51/0.51/0.63, respectively) and weak for the ulnar nerve (p = 0.40). The impact of MRI on patient management was assessed as "major" in 24/51 (47%), "moderate" in 19/51 (37%), and "no" in 8/51 (16%) patients. MRI in patients with upper extremity peripheral neuropathies and unclear or ambiguous clinical findings substantially influences the patient management.     

Effects of upper body strength,hand placement and foot placement on ladder fall severity

BackgroundA plurality of fatal falls to lower levels involve ladders. After a slip/misstep on a ladder, climbers use their upper and lower limbs to reestablish contact with the ladder.Research questionThis study investigates the impact of upper body strength, hand placement and foot placement on fall severity after a ladder climbing perturbation.MethodsParticipants performed upper body strength tests (breakaway and grip strength) and climbed a vertical, fixed ladder while a misstep perturbation was applied under the foot. After the perturbation, three hand placement and two foot placement responses were generally observed. Common hand placement responses included the hand moving two rungs, one rung, or did not move to a different rung. Foot placement responses included at least one foot or no feet reestablished contact with the ladder rung(s). Fall severity was quantified by the peak harness force observed after the perturbation.ResultsIncreased strength, reestablishing at least one foot on the ladder, and ascending (compared with descending) the ladder was associated with a reduction in fall severity. An interaction effect indicated that the impact of hand placement was altered by climbing direction. Moving the hand one rung during ascent and moving the hand two rungs during descent was associated with an increased fall severity. Cases where the hand decoupled from the ladder was associated with higher fall severity. Upper body strength assessed using a portable grip dynamometer was sufficient to predict fall severity.DiscussionThis study confirms the multifactor role of upper body strength, hand placement and foot placement in preventing falls from ladders. Furthermore, a portable dynamometer shows potential to screen for high-risk individuals. Results of this investigation may guide targeted interventions to prevent falls from ladders.     

全景拼接软件在脊柱及下肢畸形患者矫形手术中的应用研究

目的：采用全景拼接软件对脊柱和下肢畸形患者数字化X线摄影（DR）进行拼接,对其临床应用价值进行探讨。方法回顾性分析我院自2013年5月至2013年10间收治的14例脊柱以及下肢畸形患者的病例。对患者进行常规的DR摄影,采用北京新网科技拼图软件工作站对图像进行拼接,获得患者的全景图像。结果经软件处理后,采用2~3张DR图就可以拼接出完整、清晰和连续的图像。结论全景拼接软件得到的全景图能有效满足脊柱和下肢畸形患者临床诊断需要,值得临床推广。     

创伤骨科患者围术期下肢静脉血栓形成诊断及防治专家共识(2022年)

下肢深静脉血栓形成(DVT)是创伤骨科患者的主要并发症之一,严重DVT甚至会影响动脉供血,出现相应肢体供血不足。若发生血栓脱落可并发肺栓塞,病死率较高。临床上下肢骨折患者DVT的治疗和康复策略均有其特殊性。创伤骨科患者并发DVT已经引起广泛的关注与研究,预防和治疗DVT的最佳措施也在不断发展。近年来国内外陆续更新了一系列血栓防治指南,但临床上对于不同创伤骨折患者DVT的防治方式仍有不少疑惑。因此,笔者在总结国内外最新的循证医学证据和广大专家的临床经验基础上,针对创伤骨科患者DVT的临床诊疗和预防方案进行总结,就下肢DVT的诊断、评估、治疗及预防措施等方面制订本共识,为创伤骨科患者下肢DVT的处理提供一套适合我国国情且简便易行的方案,以期改善患者预后,提高其生活质量。     

急诊室连续竖脊肌平面阻滞对胸部创伤患者疼痛控制及不良反应的影响

目的评价在急诊室实施超声引导下连续竖脊肌平面阻滞对胸部创伤患者围术期疼痛控制及不良反应的影响。方法前瞻性分析2017年12月-2018年11月联勤保障部队第九O九医院心胸外科收治的68例胸创伤急诊患者,男性44例,女性24例;年龄19~73岁,平均45. 8岁;ASA分级Ⅱ~Ⅲ级,AIS评分3~4分;致伤机制:冲击伤49例,挤压伤14例,爆震伤5例。按照随机数字法分为连续竖脊肌平面阻滞复合静脉自控镇痛组(E组,n=34)和静脉自控镇痛组(P组,n=34),记录两组患者注药前(T0)、注药后30min(T1)、麻醉前(T2)、术后12h(T3)、术后24h(T4)、术后48h(T5) VAS评分及围术期不良反应、阿片类药物追加率和使用总量、住院天数、术后慢性疼痛(CPSP)的发生率。结果 E组T1~T5时间点VAS评分显著低于P组(P <0. 05),E组住院期间肺部感染(8. 8%)、肺不张(8. 8%)、恶心呕吐(5. 8%)、术后CPSP发生率分别为20. 5%,显著低于P组(17. 6%、26. 4%、35. 2%、38. 2%,P <0. 05)。E组哌替啶使用率(17. 6%)、使用总量(550mg)与平均住院天数(6. 8±2. 4) d显著低于P组[76. 4%、2350mg、(10. 5±1. 1) d,P <0. 05]。结论急诊室超声引导下连续竖脊肌平面阻滞可以明显缓解胸部创伤患者的疼痛,缩短患者住院时间,降低不良反应发生率。