人工流产术前宫颈及子宫内膜麻醉的镇痛效果探讨

目的　探讨宫颈与子宫内膜两部位联合麻醉、普鲁卡因与利多卡因两药物配合应用在人工流产术中的镇痛效果。方法　人工流产术前对麻醉组 10 6例行普鲁卡因宫颈浸润麻醉和利多卡因子宫内膜表面麻醉。术中记录受术者腹痛程度、无阻力插入宫颈内口的扩张器号、出血量、人流综合征例数等指标。按照世界卫生组织规定疼痛标准及人工流产综合征反应进行评价 ,同期选择按传统机械扩宫法 10 4例做对照。结果　麻醉组镇痛有效率95 3% ,宫口松驰有效率 95 3% ,人流综合征无 1例发生。两组比较P均 <0 0 0 1。两组出血量比较无差异 ,无利多卡因毒性反应发生。结论　人工流产术前普鲁卡因宫颈浸润麻醉和利多卡因子宫内膜表面麻醉镇痛效果显著 ,可大大降低人流综合征的发生 ,避免利多卡因的毒性反应     

二维超声诊断胎儿脐带绕颈136例分析

目的 了解胎儿脐带绕颈时对胎儿安危及窘迫和缺氧的影响程度。方法 采用日本Aloka-630型超声诊断仪,孕妇孕周为28-42周。结果 二维超声诊断胎儿脐带绕颈136例,经分娩证实129例。符合率94.85%。结论 二维超声诊断与分娩后证实比较,超声是诊断脐带绕颈的可靠方法之一。为分娩方式提供依据。     

Investigation and management of the neck lump

A neck lump is a common presenting sign in both the paediatric and adult population and may represent a broad range of benign or malignant diagnoses. The appropriate initial assessment, investigation and management is key to delivering appropriate treatments and to avoid missing potentially serious diagnoses. There is a range of imaging modalities available to the treating clinician and huge variability in the appropriate surgical or non-surgical management of disease. In this article we discuss the approach to the assessment of patients with a neck lump, including the history and examinations which should take place. We discuss the imaging modalities which are most appropriate for each condition and the range of management options available. Both common and rarer diagnoses are discussed through the course of the review.     

Perioperative Mortality and Periprosthetic Fracture: A Single-Center Experience of 857 Uncemented Hemiarthroplasties for Displaced Femoral Neck Fractures

BackgroundUncemented hemiarthroplasty (UHA) for displaced femoral neck fracture (FNF) is favored by some surgeons because of the reduced rate of perioperative mortality and operative time. However higher rates of intraoperative and postoperative periprosthetic fractures (PPFs) have been reported. The aim of the study was to review day-0, day-1, day-2, day-30, and one-year mortality as well as intraoperative and postoperative PPF after UHA for displaced FNF and compare this with cemented hemiarthroplasties (CHAs) performed. Secondary objectives were to assess whether femoral stem geometry and alignment were associated with PPF in UHA.MethodsA retrospective observational study was conducted of patients treated with a hemiarthroplasty for a displaced FNF over an eleven-year period. Radiographic analysis was conducted of femoral geometry and stem alignment.ResultsOver the 11-year study period, 857 UHAs and 247 CHAs were performed. There were no on-table, day-0, day-1, or day-2 deaths in UHA. Intraoperative PPF occurred in 3.6% UHA and 2% CHA and postoperative PPF in 2.4% UHA and 4.8% CHA. Intraoperative PPF was not associated with increased mortality (P = .15), postoperative PPF, or all-cause revision in UHA. Valgus stem alignment was a risk factor for a postoperative PPF and additional surgery in UHA (P = .004).ConclusionUHA was associated with no perioperative deaths and a 30-day mortality rate of 5% in this series. It can be considered in patients with multiple medical comorbidities. Careful surgical planning and technique is important to optimize stem alignment particularly in Dorr C type femurs.     

Conventional computed tomography software can be used for accurate pre-operative templating in bipolar hip arthroplasty: A preliminary report

BackgroundThe aim of this study was to investigate the use of pre-operative templating for bipolar hip arthroplasty (BHA) for displaced femoral neck fracture using multiplanar reconstruction (MPR) of computed tomography (CT) images.MethodsNineteen patients who underwent BHA were enrolled in this study. For pre- and post-operative evaluation, a CT scan was performed from the pelvis to the knee joints. MPR of the CT image was done using software to measure the femoral head cup diameter, offset, stem size, length of the modular neck, distance from the neck osteotomy, and femoral anteversion. We compared these parameters pre- and post-operatively.ResultsBoth the femoral head cup diameter and length of the modular neck were found to be significantly different between pre- and post-operative measurements, although the differences were minor. Other parameters, including the femoral offset, were not significantly different between the pre- and post-operative measurements. The size of the femoral stem, cup diameter, and length of the modular neck were consistent with the planned size and accurate (within ±1 size) in more than 84% cases.ConclusionOur pre-operative templating approach for BHA using MPR of CT has potential clinical utility as a complementary tool for pre-operative planning using three-dimensional templating software. Moreover, this technique could be feasible in most hospitals without additional expenditure.     

Closed Transverse Pinning for Reduction and Fixation of Metatarsal Neck Fractures: Surgical Technique

Most metatarsal neck fractures can be successfully treated non-operatively in a cast boot. Displaced metatarsal neck fractures tend to be less stable and have a propensity for the distal fragment to angulate, secondary to the strong flexor tendons, which often forces the distal fracture fragment in a plantar direction and leads to relative metatarsal shortening. Most literature is focussed on antegrade fixation of metatarsal neck fractures using pre-bent K wires or thin elastic nails. Apart from the technical challenges, this technique is limited when bones are osteoporotic as the pre-bent distal end of the K-wire may penetrate the plantar cortex of the proximal metatarsal and prevent the wire from entering the medullary canal of the metatarsal and advancing to the fracture site. Furthermore, when the medullary canal is narrow especially in Asian patients, it may be difficult to pass a bent K-wire through the isthmus of the metatarsal shaft. We describe an innovative technique of closed transverse wiring of the metatarsal head necks that has a distinct advantage in Asian population with osteoporotic bones. With percutaneous manipulation using digital pressure, closed reduction of fracture fragments of the most displaced fracture is done under fluoroscopic guidance to achieve a satisfactory alignment followed by closed transverse wiring of the metatarsal heads. With this procedure, adjacent fractures remain stable within an acceptable range because of intermetatarsal ligaments connected to the adjacent intact head. Our technique has a relatively short operating time and allows for early motion of the metatarso-phalangeal joint. This is especially useful for those with osteoporosis, narrow canal, soft tissue compromise, intra-operative failure of ante-grade pinning and in scenarios of limited surgical equipment/expertise.