The effect of test position on lumbar spine position sense

STUDY DESIGN: Repeated-measures experimental design. OBJECTIVES: The purpose of this study was to compare lumbar spine position sense in 3 test positions (standing, sitting, and 4-point kneeling [FPK]) to determine if position sense is affected by test position. BACKGROUND: Several recent studies have tested position sense in the spine. There has, however, been no consistency in the testing methods or test positions used in these studies. METHODS AND MEASURES: Seventy asymptomatic males (range, 20-51 years) volunteered for testing. Active lumbar spine repositioning accuracy and precision was tested 3-dimensionally in 3 test positions (standing, sitting, and FPK) and under 2 conditions (eyes open and blindfolded), using the neutral spine posture as the initial reference position. RESULTS: Both the accuracy and precision of lumbar spine repositioning was found to be significantly affected by test position. Repositioning errors (reflective of accuracy) were significantly larger in FPK than in both sitting and standing, and significantly larger in sitting than in standing, under both eyes-open and blindfolded conditions. Precision of repositioning was significantly less in the FPK position as compared to the standing position. CONCLUSION: The results of this study suggest that test position has a significant effect on the acuity of lumbar spine position sense and should be considered when examining the current literature on spine proprioception.     

Theoretical stress analysis in wrist joint--neutral position and functional position

A three-dimensional rigid body spring model (3D-RBSM) was used to analyse force distribution through the wrist joint. In the neutral position, 48% of the force was transmitted through the radioscaphoid fossa, 40% through the radiolunate fossa, and 12% through the triangular fibrocartilage complex. In the functional position, the wrist joint was slightly extended, resulting in significantly increased force through the lunate (53%). The lunate appears to bear more load than has been reported previously.     

不同体位胸腔镜食管切除术的临床比较

目的比较采取侧卧位和俯卧位两种不同体位进行胸腔镜食管切除术的安全性和有效性。方法回顾性分析2008年1月至2009年12月间复旦大学附属中山医院胸外科收治的88例胸腔镜食管切除术患者的临床资料,其中侧卧位下胸腔镜食管切除术52例（侧卧位组）,俯卧位下食管切除术36例（俯卧位组）。结果两组均无中转开胸病例。与侧卧位组相比...     

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The prone position

Obtaining a clear view during laparoscopic surgery in the posterior abdominal cavity, on the abdominal backwall, or during colon surgery is time consuming and therefore one of the major objections to these procedures. In an experimental setting we positioned the animals in the prone position using the abdominal flanks to introduce the trocars. Our experience with this position is that a clear and unobstructed view of the abdominal back wall and the large intestines is obtained, facilitating laparoscopic procedures in these areas.     

Society position statement

Purpose

There are more than 200,000 Canadians living with permanent pacemakers or implantable defibrillators, many of whom will require surgery or invasive procedures each year. They face potential hazards when undergoing surgery; however, with appropriate planning and education of operating room personnel, adverse device-related outcomes should be rare. This joint position statement from the Canadian Cardiovascular Society (CCS) and the Canadian Anesthesiologists?? Society (CAS) has been developed as an accessible reference for physicians and surgeons, providing an overview of the key issues for the preoperative, intraoperative, and postoperative care of these patients.

Principal findings

The document summarizes the limited published literature in this field, but for most issues, relies heavily on the experience of the cardiologists and anesthesiologists who contributed to this work. This position statement outlines how to obtain information about an individual??s type of pacemaker or implantable defibrillator and its programming. It also stresses the importance of determining if a patient is highly pacemaker-dependent and proposes a simple approach for nonelective evaluation of dependency. Although the document provides a comprehensive list of the intraoperative issues facing these patients, there is a focus on electromagnetic interference resulting from electrocautery and practical guidance is given regarding the characteristics of surgery, electrocautery, pacemakers, and defibrillators which are most likely to lead to interference.

Conclusions

The document stresses the importance of preoperative consultation and planning to minimize complications. It reviews the relative merits of intraoperative magnet use vs reprogramming of devices and gives examples of situations where one or the other approach is preferable.     

低位直肠癌低位前切除保肛术的可行性

目的 探讨低位直肠癌行保肛术的可行性。方法 对26例低位直肠癌行低位、超低位Dixon术。结果 全组手术进程顺利。术后肛门功能优良率92．3％。肿瘤术后局部复发率为11％，3年存活率为88．2％，5年存活率为69．5％。结论 低位直肠癌行低位、超低位Dixon术是可行的。     

Laryngoscopy force in the sniffing position compared to the extension-extension position

Laryngoscopy is sometimes easier with the patient's head and neck in the extension-extension position (head extension with the neck extended by the head section of the table bent down at 30 degrees) rather than the classical 'sniffing the morning air' position. We therefore tested the hypothesis that the axial force required for laryngoscopy is less in the extension-extension than the sniffing position. We measured the force axial to the handle of a Macintosh 3 laryngoscope in 20 subjects under general anaesthesia who had been given neuromuscular blocking drugs. Measurement of force was made in the sniffing position and the extension-extension position. The mean (SD) axial force required in the extension-extension position was lower than in the sniffing position (19.6 (7.8) N versus 23.6 (8.6) N, p = 0.04). In the setting of routine tracheal intubation, less force is required when the patient is in the extension-extension position than in the sniffing position.     

Influence of prosthetic joint line position on knee kinematics and patellar position

Prosthetic joint line position after total knee arthroplasty (TKA) was investigated using sagittal roentgenograms obtained from six fresh frozen cadaver knees. A specially designed knee testing device was developed that allowed for a controlled flexion angle while maintaining a constant quadriceps force. Pre- and postoperative roentgenograms were obtained from 30 degrees to 120 degrees in 15 degrees intervals. Steinman pins inserted into the medial femoral condyle and patella were used as reference points in the roentgenograms. A displacement vector between the medial femoral condyle and tibial plateau was used to analyze the tibiofemoral joint relationship. The functional patellar length (Insall-Salvati ratio), was used to determine correct patellar height. Another displacement vector was used to measure the patellofemoral joint relationship, and the angle between the patellar cut surface and femoral long axis was also calculated. Bone resection thickness from the femoral, tibial, and patellar surfaces was equal to the prosthetic thickness. This reconstructive scheme produced correct ligament balance and flexibility of the knee without the aid of tensioning devices or special measurements. Patellar tracking appeared to be identical before and after surgery. This accurate but simple surgical technique also reproduced normal knee extensor mechanisms that may influence longevity and long-term results of TKA.     

俯卧位与侧卧位胸腔镜食管癌根治术的对照研究

目的对比俯卧位与侧卧位微创食管切除术(minimally invasive esophagectomy,MIE)的近期疗效,探讨俯卧位MIE的可行性、安全性。 方法回顾性分析2019年1月至2021年6月期间204例接受MIE治疗的食管癌患者资料,按手术体位分组并比较。 结果107例俯卧位MIE(A组)与97例侧卧位MIE(B组)相比,总手术时间与胸部操作时间更短[总手术时间210 min(190,240 min)比295 min(260,325 min)、胸部操作时间(91.7±22.0)min比(119.4±24.8)min(P<0.05)],术中出血量更少[(82.1±46.3)ml比(170.9±98.1)ml(P<0.05)],术后住院时间[(12.8±4.4)d比(16.0±9.6)d]、术后经口进食时间[(8.7±2.1)d比(13.8±9.2)d]、术后拔除胸腔引流管时间[(8.7±3.3)d比(12.5±8.7)d]均更短(P<0.05);并发症发生率更低[15.0%(16/107)比34.0%(33/97)(P<0.05)],淋巴结清扫数[(23.2±7.2)枚比(22.6±5.1)枚]和术后氧饱和度(97.9%±1.6%比97.4%±3.3%)差异无统计学意义(P>0.05)。 结论相较侧卧位,俯卧位MIE手术视野显露更好、手术时间更短、术中出血量更少、术后并发症发生率更低、住院时间更短,安全、可靠,短期疗效满意。