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991.
《Anaesthesia and Intensive Care Medicine》2022,23(3):160-165
Brachial plexus blockade is used for a variety of upper limb surgical procedures. Ultrasound guidance is generally considered to be the gold-standard technique, although large-scale studies examining efficacy and complications of ultrasound-guided techniques compared with nerve stimulation are still needed. Interscalene block remains the approach of choice for shoulder surgery, although phrenic nerve blockade is common even using low volumes of local anaesthetic. Of the currently available studies comparing the other approaches, there seems to be little difference in efficacy between axillary, supraclavicular and infraclavicular approaches for elbow, forearm and hand surgery when equivalent levels of expertise are used. The major features influencing block choice and performance are discussed. 相似文献
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《International journal of oral and maxillofacial surgery》2020,49(11):1421-1429
The purpose of this study was to assess the pre- and postoperative position and dimensions of the inferior alveolar canal (IAC) following sagittal split osteotomy (SSO) and identify any association with postoperative neurosensory deficit (NSD) at 1 year. This retrospective cohort study enrolled consecutive patients who had SSO performed to correct skeletal malocclusion. The pre- and postoperative cone beam computed tomography data were superimposed to visualize differences in IAC position and dimensions. Subjective and objective neurosensory tests were used to determine NSD in the inferior alveolar nerve distribution. A total of 20 subjects were included. The preoperative distance from the lateral cortex of the IAC to the inner aspect of the lateral cortex of the mandible was significantly greater in sides with NSD when compared to sides without NSD (P = 0.01). A significantly greater reduction in the postoperative distance measurement was seen in sides with NSD when compared to sides without NSD (P = 0.01). The magnitude of mandibular movement was significantly increased in sides with NSD (P = 0.02). The preoperative location of the IAC, as well as certain changes in the mediolateral and vertical positions as a result of SSO, are risk factors for postoperative NSD. 相似文献
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C. Jiamton N. Ratreprasatsuk R. Jarayabhand A. Kritsaneephaiboon T. Apivatthakakul 《Clinical anatomy (New York, N.Y.)》2019,32(2):176-182
The aim of this study was to determine the feasibility of applying MIPO of the humerus via the posterior approach and to observe the tension of the radial nerve in different elbow positions. Two separate incisions were made on the posterior aspect of the humerus in ten fresh cadavers (20 humeri). The radial nerve was identified at the proximal incision and the distances through which the nerve could be elevated from the bone with the elbow in flexion and extension were measured. A 10‐hole extra‐articular distal humeral locking compression plate was inserted and fixed through the submuscular tunnel. The tunnel was then explored to identify any entrapment of the radial nerve and to observe the anatomical relationship of the radial nerve to the plate and bone. There was no entrapment of the radial nerve or its branches. The distances through which the radial nerve could be elevated were greater with the elbow in extension than in flexion (P < 0.01). The radial nerve crossed the medial and lateral borders of the posterior surface of the humerus at 80.1–132 mm (average 104.7 mm) and 116.6–175.5 mm (average 142.7 mm) of its total length, respectively. The axillary nerve was located at 38.7–61.7 mm (average 47.9 mm) of total humeral length. MIPO of the humerus using the posterior approach is an alternative option for treating distal humeral shaft fracture. The risk of radial nerve injury can be minimized by careful dissection in the proximal incision. Clin. Anat. 32:176–182, 2019. © 2018 Wiley Periodicals, Inc. 相似文献
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James Bowness Katie Turnbull Alasdair Taylor Jayne Halcrow Fraser Chisholm Calum Grant Ourania Varsou 《Clinical anatomy (New York, N.Y.)》2019,32(3):390-395
Regional anesthesia relies on a sound understanding of anatomy and the utility of ultrasound in identifying relevant structures. We assessed the ability to identify the point at which the superficial peroneal nerve (SPN) emerges through the deep fascia by ultrasound on 26 volunteers (mean age 27.85 years ± 13.186; equal male: female). This point was identified, characterized in relation to surrounding bony landmarks (lateral malleolus and head of the fibula), and compared to data from 16 formalin‐fixed human cadavers (mean age 82.88 years ± 6.964; equal male: female). The SPN was identified bilaterally in all subjects. On ultrasound it was found to pierce the deep fascia of the leg at a point 0.31 (±0.066) of the way along a straight line from the lateral malleolus to the head of the fibula (LM‐HF line). This occurred on or anterior to the line in all cases. Dissection of cadavers found this point to be 0.30 (±0.062) along the LM‐HF line, with no statistically significant difference between the two groups (U = 764.000; exact two‐tailed P = 0.534). It was always on or anterior to the LM‐HF line, anterior by 0.74 cm (±0.624) on ultrasound and by 1.51 cm (±0.509) during dissection. This point was significantly further anterior to the LM‐HF line in cadavers (U = 257.700, exact two‐tailed P < 0.001). Dissection revealed the nerve to divide prior to emergence in 46.88% (n = 15) limbs, which was not identified on ultrasound (although not specifically assessed). Such information can guide clinicians when patient factors (e.g., obesity and peripheral edema) make ultrasound‐guided nerve localization more technically challenging. Clin. Anat. 32:390–395, 2019. © 2019 Wiley Periodicals, Inc. 相似文献
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