Regional Anaesthesia Techniques for Orthopaedic Surgery

Background

In recent years, there has been a significant resurgence of interest in regional anaesthesia techniques. Despite various advantages, regional anaesthesia is not used to its full potential in orthopaedic surgeries.

Methods

This study was conducted to evaluate the efficacy and safety of regional anaesthesia techniques in 400 consecutive patients, posted for orthopaedic surgeries in a tertiary care centre. Data was analysed for patient profile, type of surgery, nature of anaesthetic technique used, success rate, complications and satisfaction level of patients.

Result

Age of patients ranged from three months to 92 years with male preponderance (84.5 %). Regional anaesthesia was used in 85% cases. Most frequently used technique for upper limbs was supraclavicular brachial plexus block (12.05 %) followed by interscalene block (5.58 %) and intravenous regional anaesthesia or Bier''s block (2.64 %). For lower limbs, subarachnoid block was used in 50 % cases followed by combined spinal-epidural technique (21.47 %) and paravertebral block (4.70 %). Less commonly used techniques like lumbar plexus block, popliteal fossa block, sciatic + femoral nerve blocks were found to be useful but incidence of partial blocks was high. Overall success rate was 96.17 %. In 22.05 % cases supplementation with analgesic / sedative was needed, whereas in 3.82 % cases, technique was converted into general anaesthesia. There was no major complication. Six patients had reversible sensory neuropathy. In 91.64 % cases, satisfaction level was good to excellent.

Conclusion

Skilfully performed techniques in regional anaesthesia can facilitate excellent surgical anaesthesia and postoperative pain management.Key Words: Regional anaesthesia, Orthopaedic surgery, Central neuraxial block, Peripheral nerve block     

区域卫生信息化人才需求与培养途径

介绍国内外区域卫生信息化发展现状,分析研究我国区域卫生信息化人才需求现状,并对区域卫生信息化人才培养途径提出建议,包括政府引导、医疗卫生部门信息化人才队伍建设、医学高等院校信息化人才培养等方面。     

食管胃颈部吻合两种术式疗效比较

目的探讨机械吻合法与手工吻合法2种术式对食管癌患者行食管胃颈部吻合的优劣。方法将78例食管中上段癌患者随机分成2组,其中机械吻合组42例,手工吻合组36例。对2组均行食管胃颈部吻合,比较2组的手术效果。结果2组在吻合时间,术后吻合口漏、吻合口出血方面,机械吻合组明显优于手工吻合组（P〈0．05）;而在术后吻合口狭窄及病死率方面,2组无显著性差异（P〉0．05）。结论采用机械吻合法行食管胃颈部吻合,与手工吻合法相比,能有效减少术后并发症的发生,是较为理想的重建方法。     

两种术式治疗老年不稳定型股骨粗隆间骨折的效果比较

目的比较半髋关节置换和防旋型股骨近端髓内钉(PFNA)治疗高龄不稳定型股骨粗隆间骨折患者的临床疗效。方法选取2008年1月至2012年12月新疆维吾尔自治区人民医院北院收治的高龄不稳定型股骨粗隆间骨折患者368例,采用随机数字表法将其分为Ⅰ组(184例)和Ⅱ组(184例)。Ⅰ组患者实施半髋关节置换术,Ⅱ组患者实施PFNA进行治疗,观察对比两组患者手术疗效。结果Ⅰ组手术时间、出血量、术后引流量显著高于Ⅱ组[(52±7)min比(64±7)min,(139±19)m L比(121±18)m L,(81±17)m L比(70±15)m L],患肢开始负重时间显著短于Ⅱ组[(16.5±2.6)min比(26.8±3.7)min],差异有统计学意义(P<0.01)。1年后Ⅰ组髋关节功能优良率显著高于Ⅱ组(78.8%比63.0%),Ⅰ组早期并发症发生率高于Ⅱ组(14.1%比4.9%),晚期并发症发生率低于Ⅱ组(5.4%比19.0%),差异有统计学意义(P<0.05)。结论半髋关节置换术适用于身体情况好的患者,但早期并发症较多;对于身体状况较差合并有慢性内科疾病的患者,可选择PFNA治疗,但晚期并发症多。     

组织弹性测量之新型印压技术简介

印压是一种常用的测量软组织弹性特征的测试方法,除了2011年第7期介绍的传统印压测试方法外,近来,还出现了一些新型的印压技术,如超声印压、光学印压、流体印压和纳米印压等.这些新型印压技术具有某些自己独特的优点,如超声印压系统便携性高,能够同时获得组织的初始厚度和形变,可以应用于多种组织的弹性测量;纳米印压能够非常小范围(微米或纳米级)地测量组织的弹性,可以分析组织的弹性分布,研究局部组织结构和弹性之间的关系.本文对这些技术及应用作一些介绍,最后讨论该领域的发展方向.     

两种不同手术方式治疗高恤压脑出血的临床分析

目的探讨微创钻孔引流与开颅血肿清除两种手术方法治疗高血压脑出血疗效的差异。方法对我院2008年3月～2010年5月收治的82例高血压脑出血手术病例进行回顾分析,比较微创钻孔引流和开颅两组患者的预后情况。结果微创钻孔引流组各创伤指标和残留血肿量较开颅组均显著降低（P〈0．05）;并发症较开颅组低（P〈0．05）,ADL疗效评价与开颅组比较无明显差异（P〉0．05）。结论微创钻孔引流手术清除脑内血肿具有微创、省时、并发症少等优点,与开颅手术具有相近的疗效,为治疗高血压脑出血提供了一种新方法。     

支架置入术与内膜切除术治疗颈动脉狭窄的系统评价

目的:评价颈动脉血管成形术和颈动脉内膜切除术治疗颈动脉狭窄的近期临床疗效和安全性。方法:电子检索中国学术期刊网全文数据库(1996～2006年)、Medline(1996～2006年)和Cochrane图书馆(2006年12月前已发表的文献和已注册但未发表的临床试验),并与研究者取得联系获得更多的相关研究资料。纳入比较颈动脉血管成形术和内膜切除术治疗颈动脉狭窄的随机对照试验,比较两种治疗方法术后30d内卒中发生率和卒中与死亡的联合发生率。以卒中发生率作为疗效评价指标,以卒中和死亡的联合发生率作为安全性评价指标。2名评价员独立检索和提取资料,对纳入试验的方法学质量进行评价。结果:在术后30d内的卒中发生率方面,共纳入4项临床试验的2541例患者,其中颈动脉血管成形术组1278例,颈动脉内膜切除术组1263例,在术后30d的卒中和死亡的联合发生率方面,纳入5项临床试验,共2760例患者,其中颈动脉血管成形术组1385例,颈动脉内膜切除术组1375例。分析结果显示,在术后30d内的卒中发生率方面,颈动脉血管成形术与颈动脉内膜切除间差异无统计学意义(OR:1144;95%CI:1105～1197,Z=2128,P=0...     

生物组织弹性测量:技术、仪器和应用

在临床上,可以通过用手触诊去感知某些组织的硬块来作出一些初步的诊断,例如乳腺癌的早期诊断.但是这种手触诊技术只能给出定性的结果,该结果依赖于操作者的经验,所以带有很大的主观性,于是能让诊断结果更加客观化的弹性成像和测量技术应运而生.弹性成像和弹性测量技术各有不同特点:弹性成像往往给出成像区域里面的弹性对比度而不必给出组织的本征参数;不同于弹性成像,弹性测量技术能给出组织弹性的本征参数例如杨氏模量等,有利于诊断某些弥漫性的组织疾病,例如肝硬化,并且跟踪组织的弹性随时间的变化情况,而且结果的比较不会受制于所使用的测量仪器.因此,伴随着各种医学成像技术,例如超声、核磁共振成像(MRI)和光学成像的广泛普及,针对活体组织的弹性测量学在最近的二三十年里得到了长足的发展,诞生了很多新的测量技术和仪器,并且部分已经开始用于临床测试.可以预见,随着这些测量技术的发展和进步还将有源源不断的新的测量技术诞生,将会有越来越多的临床领域开始尝试或者大力普及通过弹性测量的方法来补充现有的一些不太完善的诊断方法,或者用来评估治疗方法的有效性.本文尝试给读者介绍一些传统和近来出现的弹性测量的技术和系统,然后简要介绍它们在诊断特定组织病变和评估治疗方法疗效方面的应用,最后我们对此领域的未来研究方向和前景作一些展望.对于其中比较成熟的几种方法,我们会在这一期刊的随后几期作详细的介绍.     

Achieving Standardized Medication Data in Clinical Research Studies: Two Approaches and Applications for Implementing RxNorm

The National Institutes of Health has proposed a roadmap for clinical research. Test projects of this roadmap include centralized data management for distributed research, the harmonization of clinical and research data, and the use of data standards throughout the research process. In 2003, RxNorm was named as a standard for codifying clinical drugs. Clinical researchers looking to implement RxNorm have few template implementation plans. Epidemiological studies and clinical trials (types of clinical research) have different requirements for model standards and best implementation tools. This paper highlights two different (epidemiological and intervention) clinical research projects, their unique requirements for a medication standard, the suitability of RxNorm as a standard for each, and application and process requirements for implementation. It is hoped that our experience of selecting and implementing the RxNorm standard to address varying study requirements in both domestic and international settings will be of value to other efforts.     

子宫切除术后两种舒芬太尼镇痛方法的疗效观察

目的 观察子宫切除术后,舒芬太尼经硬膜外复合罗哌卡因或经静脉行患者自控镇痛的临床效果及安全性.方法 选择美国麻醉师协会(American Society of Anesthesiologists,ASA)分级Ⅰ～Ⅱ级、择期在腰麻-硬膜外联合麻醉下行经腹子宫切除术患者60例,随机分为硬膜外自控镇痛(patient con...     

下腔静脉彩超测定在血透者干体重确定中的应用

目的:探讨维持性血液透析患者干体重确定的安全、准确的方法.方法:对 68例维持性血液透析患者应用彩色多普勒超声仪,在透析前后测定下腔静脉直径(IVCD) , 计算IVCD与体表面积之比(VCD)同时结合临床及检查等.并分组观察血压、超滤量等相关影响因素,进行对照分析.结果:整体透析超滤之后,VCD均值为(9.45±2.29),较透析前显著减小,与正常对照组无显著性差异,结合胸片血压及临床症状,确定达到干体重.高血压、超滤率≥2.5时 IVCD、VCD值大于整体均值.结论:彩色多普勒测定 IVCD及VCD是确定维持性血透患者干体重的好方法.     

Aneurysms of the Internal Carotid Artery Simulating Pituitary Tumours: Report of Two Cases

Two patients suffering from aneurysms of the internal carotid artery simulating pituitary tumours are reported. One of these was a 17-year-old boy with a mycotic aneurysm of the right internal carotid artery causing failure of growth and pubertal maturation. The second was a 53-year-old woman with a left internal carotid artery aneurysm, probably of atherosclerotic origin, who had evidence of anterior pituitary insufficiency.

In both cases there was paresis of extraocular muscles and one patient had bitemporal hemianopsia. While lateral radiographs of the skull suggested intrasellar calcification in each case, further roentgenological investigation established that this calcification was actually extrasellar, and carotid arteriograms demonstrated the presence of an internal carotid aneurysm in each case. Investigations of the endocrine system confirmed the presence of anterior pituitary insufficiency in both patients, and diabetes insipidus became evident in one patient after cortisone therapy was commenced.

This lesion, while rare, may be difficult to differentiate from a pituitary tumour. It is likely that this syndrome depends on aneurysmal expansion to the region of the sella turcica with compression of the pituitary gland itself, as well as the optic fibres.

     

Automated model versus treating physician for predicting survival time of patients with metastatic cancer

ObjectiveBeing able to predict a patient’s life expectancy can help doctors and patients prioritize treatments and supportive care. For predicting life expectancy, physicians have been shown to outperform traditional models that use only a few predictor variables. It is possible that a machine learning model that uses many predictor variables and diverse data sources from the electronic medical record can improve on physicians’ performance. For patients with metastatic cancer, we compared accuracy of life expectancy predictions by the treating physician, a machine learning model, and a traditional model.Materials and MethodsA machine learning model was trained using 14 600 metastatic cancer patients’ data to predict each patient’s distribution of survival time. Data sources included note text, laboratory values, and vital signs. From 2015–2016, 899 patients receiving radiotherapy for metastatic cancer were enrolled in a study in which their radiation oncologist estimated life expectancy. Survival predictions were also made by the machine learning model and a traditional model using only performance status. Performance was assessed with area under the curve for 1-year survival and calibration plots.ResultsThe radiotherapy study included 1190 treatment courses in 899 patients. A total of 879 treatment courses in 685 patients were included in this analysis. Median overall survival was 11.7 months. Physicians, machine learning model, and traditional model had area under the curve for 1-year survival of 0.72 (95% CI 0.63–0.81), 0.77 (0.73–0.81), and 0.68 (0.65–0.71), respectively.ConclusionsThe machine learning model’s predictions were more accurate than those of the treating physician or a traditional model.     

两种手术方法治疗良性前列腺增生合并膀胱结石的比较

目的:探讨良性前列腺增生(BPH)合并膀胱结石的治疗方法。方法:回顾性分析我院自2008年1月-2010年3月收治的47例高龄BPH合并膀胱结石患者的临床资料。结果:25例采用经尿道前列腺等离子体双极电切术(PK-PR)联合经Trocar膀胱取石术,22例行经尿道前列腺等离子体双极电切术联合气压弹道碎石。结论:经尿道前列腺等离子体双极电切术联合经Trocar膀胱取石术治疗BPH合并膀胱结石具有手术时间短、操作简单、损伤小等优点,有一定的应用价值。     

高龄患者两种不同测血压方式的效果比较

目的:通过水银血压计和上臂式电子血压计两种不同测量方法的效果比较,找到方便快捷准确的测量血压方法。方法:将高龄高血压患者80例,进行自身对照,先用水银血压计测量,5分钟后再用电子血压计测量,比较前后所测的血压数值,及护士测血压耗时。结果:两种测血压方式所获得的结果无明显差异,电子血压计耗时明显低于水银血压计,P<0.05。结论:采用电子血压计测量血压准确又节时。     

Inter-Greedy Technique for Fusion of Different Segmentation Strategies Leading to High-Performance Carotid IMT Measurement in Ultrasound Images

User-based estimation of intima-media thickness (IMT) of carotid arteries leads to subjectivity in its decision support systems, while being used as a cardiovascular risk marker. During automated computer-based decision support, we had developed segmentation strategies that follow three main courses of our contributions: (a) signal processing approach combined with snakes and fuzzy K-means (CULEXsa), (b) integrated approach based on seed and line detection followed by probability based connectivity and classification (CALEXsa), and (c) morphological approach with watershed transform and fitting (WS). These grayscale segmentation algorithms yielding carotid wall boundaries has certain bias along with their own merits. We recently developed a fusion technique that was helpful in removing bias which combines two carotid wall boundaries using ground truth as an ideal marker. Here we have extended this fusion concept by taking merits of these multiple boundaries, so called, Inter-Greedy (IG) approach. Further we estimate IMT from these fused boundaries from multiple sources. Starting from the technique with the overall least system error (the snake-based one), we iteratively swapped the vertices of the profiles until we minimized its overall distance with respect to ground truth. The fusion boundary was the Inter-Greedy boundary. We used the polyline distance metric for performance evaluation and error minimization. We ran the segmentation protocol over the database of 200 carotid longitudinal B-mode ultrasound images and compared the performance of all the four techniques (CALEXia, CULEXsa, WS, IG). The mean error of Inter-Greedy technique yielded 0.32 ± 0.44 pixel (20.0 ± 27.5 μm) for the LI boundary (a 33.3% ± 5.6% improvement over initial best performing technique) and 0.21 ± 0.34 pixel (13.1 ± 21.3 μm) for MA boundary (a 32.3% ± 6.7% improvement). IMT measurement error for Greedy method was 0.74 ± 0.75 pixel (46.3 ± 46.9 μm), a 43.5% ± 2.4% improvement.     

两种不同方法测定复方甲亢片中甲巯咪唑的含量

目的 比较复方甲亢片中甲巯咪唑含量测定的两种不同方法.方法 分别采用紫外分光光度(uv)法及高效液相色谱(HPLC)法测定.UV法采用甲醇为溶剂,检测波长为259nm;HPLC法采用Agilent HC-C<,18>(4.6mm×25mm,5.0μm)柱,以甲醇-水(7:93)为流动相,流速为1.0mL/min,检测波...