Abstract Complex tibial plateau fractures are a challenge in trauma surgery. In these fractures it is necessary to anatomically reduce
the articular part of the fracture and to obtain stable fixation. The aim of this study is to review the results of a surgical
technique consisting of fluoroscopic closed reduction and combined percutaneous internal and external fixation. Thirty-two
complex tibial plateau fractures in 32 patients were included. Twenty-one fractures were closed, 4 were open Gustilo grade
I, 3 were Gustilo grade II and 4 were Gustilo grade III. The mean age was 37.8 years (range 21–64 years). Surgery was performed
with patients in transcalcaneal traction and the knee flexed at 30° was used. Through a 1-cm incision centred over the tibial
metaphysis of the tibia, a 3.2-mm hole was drilled in the antero-medial tibial aspect. The tibial plateau fracture fragments
were elevated using either 1 or 2 curved Kirschner wires under fluoroscopy to control the reduction. Then the fragments were
fixed with 2 cannulated AO screws inserted through small incisions into the medial aspect of the tibial plateau. Knee rehabilitation
started postoperatively. Weight bearing started after 8–12 weeks depending upon the radiographic appearance. All external
fixators were removed in outpatient facilities. All patients were clinically and radiographically evaluated at a mean follow-up
of 48 months (range 38–57 months). Clinical results were evaluated according to the Knee Society clinical score. Average healing
time was 24 weeks (range 18–29 weeks). In 1 patient a non-union occurred. This patient was treated with open reduction and
plate fixation. In 2 patients a varus knee deformity occurred and a surgical correction was performed. There were no surgical
complications. Mean knee range of motion was 105° (range 75–125°) and mean Knee Society clinical score was 89. Twenty-five
results were scored as excellent, 4 good, 2 fair and 1 poor. Using this technique there is limited soft tissue damage and
virtually no periosteum damage to the fracture fragments. However anatomical reconstruction of the joint can be obtained.
Furthermore knee rehabilitation can be started immediately after surgery. We think that these factors were responsible for
the optimal clinical long-term results. 相似文献
Four patients, who received epidural blood patch to treat postdural puncture headache, were examined with computed tomography in order to demonstrate the distribution of the injected blood. Blood alone could not be identified, but adding 2 ml contrast agent Iohexol 180 mg J/ ml (Omnipaque®, Nycomed Imaging) to 18 ml blood gave an excellent demonstration of the distribution of the blood in the epidural space, both cranio-caudally (7–14 segments) and spatially in relation to the epidural septae. The blood-contrast media had a strong affinity to the dural sac. There was no support of the spacefilling effect of blood patch. 相似文献
Study Objective: To test the hypothesis that slow administration of local anesthetic into the epidural space by gravity flow reduces the incidence of signs and symptoms of unintended injection.
Design: Prospective, randomized study.
Setting: Teaching hospital.
Patients: 600 ASA physical status I and II parturients scheduled for labor and delivery or elective cesarean section.
Interventions: After identification of the epidural space with pulsations of an air-fluid column, parturients for vaginal delivery (n = 380) were randomized to receive a test dose of 3 ml 3% 2-chloroprocaine with epinephrine 20 μg, two doses of 7 ml bupivacaine 0.03 % with sufentanil 1 μg/ml and epinephrine 2 μg/ml by either gravity flow (Group 1) given over 30 seconds or by bolus injection (Group 2) given over 5 seconds through the epidural needle; parturients for Cesarean delivery (n = 220) were randomized to receive a test dose and two doses of 6 ml lidocaine 2 % with sufentanil 1 μg/ml and epinephrine 2 μg/ml by either gravity flow or by bolus injection through the epidural needle. Changes in maternal heart rate (HR) and blood pressure, signs of intravascular injection, and adverse effects of epidural bupivacaine-sufentanil were recorded after each dose.
Measurements and Main Results: Gravity flow administration (Group 1) was associated with a smaller increase in mean maternal HR (p < 0.001), less hypotension (p < 0.01), sedation (p < 0.01), nausea (p = 0.01), and segmental spread (p < 0.0001) than were corresponding doses given by traditional bolus injection (Group 1) for vaginal or Cesarean deliveries. The incidence of systemic toxicity was zero of 300 (0%) with gravity flow and 4 of 300 (1.3%) by bolus injection, p = 0.12, Fisher's exact test. No patient in either group had an accidental intrathecal injection.
Conclusion: Gravity flow administration of local anesthetic-opioid solution during epidural block for obstetrics was associated with fewer signs of systemic drug absorption and cardiovascular perturbations than was the traditional bolus injection. This study supports the current opinion that slow administration of local anesthetic during epidural black contributes to fewer adverse events. 相似文献
This study attempts to demonstrate the existence of allergic contact dermatitis from grass, and to develop a patch test series to screen patients with grass intolerance. 6 common grass species from lawns and military training areas were collected. Solvent extracts of polar. non-polar and volatile fractions were prepared and used for patch testing in 20 control subjects and 46 patients with a history of grass intolerance. The 20 control had negative responses to patch testing. 5 out of 46 patients had positive patch tests to Axonopus compressus (carpet grass). Ischaenmum muticum (sea-shore centipede grass). Imperata evlindrica (lalang). Panicum maximum (Guinea grass) and Pennisetum purpureum (elephant grass). Reactions to the non-polar fraction for all 5 species were noted. This study demonstrates the existence of allergic contact dermatitis from various common species of grass. In our series, this is seen in 11% of those with a history of grass intolerance. 相似文献