Liposomal Bupivacaine vs Ropivacaine for Adductor Canal Blocks in Total Knee Arthroplasty: A Prospective Randomized Trial

BackgroundThe purpose of this study is to determine the benefit of the analgesic liposomal bupivacaine compared to ropivacaine, by assessing pain and joint stiffness, and total oral opioid consumption by milligram morphine equivalent (MME) after total knee arthroplasty.MethodsPatients were randomized to receive either the study drug (liposomal bupivacaine admixed with bupivacaine) or the control drug (ropivacaine) in an adductor canal block. Only the anesthesiologist performing the block was aware of which arm of the study the patient was randomized to. MME, pain, Knee injury and Osteoarthritis Outcome Score Joint Replacement, and overall benefit of analgesia scores were recorded 24, 48, and 72 hours post-surgery either face-to-face or via telephone depending on patient discharge status.ResultsOne hundred patients were enrolled into the study and analyzed: 54 in the control group and 46 in the experimental group. Primary outcomes measured were pain as a numerical rating scale, MME, and length of stay in hours. Secondary outcomes were joint pain and stiffness recorded as Knee injury and Osteoarthritis Outcome Score Joint Replacement outcome and overall benefit of analgesia score. No statistically significant between-group differences were observed for any measured outcome.ConclusionWe did not find any supporting evidence that liposomal bupivacaine yields increased pain relief following total knee arthroplasty compared to the control drug, ropivacaine.     

A mini-incision carpal tunnel release technique to prevent pillar pain: A technical note

Pillar pain represents one of the most common complications of classic open carpal tunnel release (CTR). This complication causes a sense of discomfort worse than the compression syndrome itself. We, herein, introduce a new treatment method for CTR through a mini-incision, which allows subcutaneously cutting the transverse carpal ligament (TCL) and releasing the median nerve without neurovascular complications. This mini-incision approach can allow the direct visualization and preservation of the thenar motor branch in those rare cases where it has an aberrant origin. For the past 10 years, we have consecutively performed this technique in the surgical treatment of 318 patients with the diagnosis of primary CTS, without developing any neurovascular and tendon injuries as well as pillar pain.     

临床护理路径在椎管占位切除术及稳定性重建术后患者护理中的应用效果

目的探讨临床护理路径在椎管占位切除术及稳定性重建术后患者护理中的应用效果。方法选取2017年6月至2019年12月医院收治的116例行椎管占位切除术及稳定性重建术的患者作为研究对象,将2017年6月至2018年8月收治的58例患者设为对照组,2018年9月至2019年12月收治的58例患者设为观察组。对照组采用常规护理,观察组采用临床护理路径干预,比较两组住院天数、护理满意度、并发症发生情况。结果观察组住院天数短于对照组,护理满意度评分高于对照组,差异有统计学意义(P<0.05);观察组并发症发生率低于对照组,差异有统计学意义(P<0.05)。结论临床护理路径应用于椎管占位切除术及稳定性重建术后患者,可有效缩短患者的住院天数,提高护理满意度,降低并发症发生率。     

国人男性椎管的测量与观察

本文对广西出土的113例男性干燥椎骨的椎孔,进行了矢径、横径的测量和形态观察。椎孔的矢、横径在壮族(30例),汉族(57例)间无显著差异(P>0.05)。在C_(3～6)椎骨水平,推管的矢径和形态与脊髓的外形不一致,矢径于该处形成生理性狭窄,以C_4处为最小(12.92mm)。除C_1外,椎管的形态可分为4型:Ⅰ型圆型;Ⅱ型三角型;Ⅲ型过渡型;Ⅳ型不整型。 C_(1,2)椎管的形状为圆型,向下至C_6,通过半圆形逐步过渡到三角形(C_6占81.31％);再向下至T_6,三角形通过蛤形和多边形又逐渐过渡为圆形(T_6占84.76％);再向下至L_5,又通过蛤形逐渐过渡为三角型(L_5占99％)。从L_3至L_5,三角形椎孔有逐步通过钟形向三叶形过渡的趋势。三叶形腰椎管占5.02％。本文结果支持Eisenstein的观点,认为三叶形结构是一种普通的、非病理性的现象,与年龄增长、骨赘或椎孔狭窄无关,这或许是一种正常的发育性变异。     

Behavior of horizontal semicircular canal afferents in alert monkey during vestibular and optokinetic stimulation

Summary The behavior of single vestibular nerve fibers from the lateral semicircular canal was recorded during sinusoidal oscillations of the head, during optokinetic stimulation with the head stationary, and during spontaneous oculomotor behavior in the alert monkey. The response of similar fibers to adequate vestibular stimulation was also studied in some of the animals under deeply anesthetized conditions. In the alert animals all units were spontaneously active and their discharge was modulated only by adequate vestibular stimulation. Ipsilateral horizontal rotations of the head were excitatory for all units. No modification of this basic vestibular response by visual stimulation including full-field striped drum rotation was observed. Furthermore no correlation of unit activity with oculomotor function including voluntary saccadic and pursuit eye movements was found in any of the units. The regularity of spontaneous discharge was the most consistent characteristic that differentiated the unit response into types. Most units were very regular in discharge, but a few were very irregular. The averaging of unit discharge over several cycles of oscillatory head rotation showed that the irregular type units were also consistently modulated by adequate vestibular stimulation. Both regular and irregular type units were found in the anesthetized animals. Unimodal distributions of the quantitative values for unit resting discharge rate, sensitivity, and phase relationship were found. The distributions for these three parameters were similar in the units recorded in the anesthetized animals. Thus at least these characteristics of semicircular canal response seem not to be affected by the vestibular efferent system which should be altered or eliminated in the case of the anesthetized animals.Research supported by NIH Grant EY0995-04.     

下颌第三磨牙根尖与下颌管的位置关系

本文对50侧96例成人下颌骨第三磨牙根尖与下颌管的位置关系等进行了观测,下颌管在根尖下方者占86.5%,在根尖外侧者占8.3%,在根尖内侧者占5.2%。第三磨牙根尖至下颌管间的距离在2mm以内占35.4%.根尖与下颌管之间的位置关系及距离可供临床应用参考。     

近端联合远端收肌管阻滞在全膝关节置换术患者术后镇痛和早期功能康复中的应用

目的 探讨近端联合远端收肌管阻滞在全膝关节置换术患者术后镇痛和早期功能康复中的应用。方法 选取2019年1月至2020年12月在解放军总医院第六医学中心择期行单侧全膝关节置换术患者90例,按随机数字表法分为3组,每组30例。A组为对照组,于超声引导下行股神经联合腘窝上坐骨神经阻滞;B组为近端联合远端收肌管阻滞组,于超声引导下分别行收肌管近端和远端阻滞;C组为右美托咪定联合收肌管阻滞组,于超声引导下将罗哌卡因与右美托咪定混合液分别注射至收肌管近端和远端。比较3组患者术后6 h(T₁)、12 h(T₂)、24 h(T₃)和48 h(T₄)时静息VAS评分,术后T₃和T₄时运动VAS评分,48 h内羟考酮和氟比洛芬酯使用情况;以及术后24 h(T₃)、48 h(T₄)和72 h(T₅)膝关节活动范围(ROM)和股四头肌肌力;记录3组患者术后首次直腿抬高≥10 cm时间,术后首次下床活动时间,术后7...     

经迷路下开放内耳道的应用解剖研究

目的 :为经迷路下开放内耳道提供解剖资料。方法 :解剖测量 1 0 0块颞骨、2 5具成人头颅。结果 :经迷路下后方开放耳道的后下部分 ,该处血管、神经分界清楚 ,易完整切断前庭神经。乙状窦前缘中点 ,前庭导水管外口为该手术进路的外部解剖标志 ,沿后半规管下支向内磨除可将 76%标本的内耳道开放 2 /3。后半规管曲部骨质厚度为 3.1 3± 1 .59mm,后半规管下支末端骨质厚度为 5.83± 1 .59mm,后半规管下支至颈静脉球顶点的距离为 5.47± 3.2 6mm,单孔至后半规管曲部的距离为 1 0 .2 1 1 .2 1 mm,单孔前庭的距离为2 .99± 0 .79mm。结论 :经迷路下开放内耳道是另一种非破坏迷路开放内耳道的手术方法。     

哑铃形椎管肿瘤29例临床分析

回顾性分析我院从 1 990年 3月～ 1 998年 1 1月 2 9例哑铃形椎管肿瘤的诊治。所有病例经CT ,MRI确诊。MRI能提供多时向、多空间图像 ,故可视为诊断哑铃形椎管肿瘤最有价值的方法。除 2例拒绝手术治疗外 ,2 7例采用后正中或后外侧入路作Ⅰ期显微手术切除 ,疗效较满意。本文重点讨论了该肿瘤的临床表现特征 ,CT ,MRI检查和手术治疗的特点     

后半规管阻塞前后豚鼠前庭及耳蜗功能的动态变化

目的 探讨机械性后半规管阻塞前后豚鼠前庭和耳蜗功能的动态变化。方法 采用２０只豚鼠建立单侧后半规管阻塞的动物模型,观察手术前后眼震电图,听性脑干反应,耳声发射等变化。结果 术后第１天,第３天豚鼠正弦摆动刺激术侧眼震反应,明显减术,术后第５天起双侧眼震恢复正常。术后早期ＡＢＲ阈值一度升高,第５天达高峰,ＡＢＲ阈值平均升高４．５ｄＢ。ＤＰＯＡＥ反应幅度无明显改变。结论 后半规管阻塞能选择性地消除后半规