Computational analysis of the safe zone for the antegrade lag screw in posterior column fixation with the anterior approach in acetabular fracture: A cadaveric study

ObjectiveThe fluoroscopically-guided procedure of antegrade posterior lag screw in posterior column fixation through anterior approach is technique-dependent and requires an experienced surgeon. The purpose of this study was to establish the safe zone for the antegrade posterior lag screw by using computational analysis.MethodThe virtual three-dimensional model of 178 hemi-pelvises was created from the CT data (DICOM format) by using Mimics^® program, and were used to measure the safe zone of antegrade lag screw fixation on the inner table of the iliac wing, and the largest diameter of cylindrical implant inside safe zone. The central point (point A) of the cylinder was assessed and was compared with the intersection point (point B) between the linea terminalis and the anterior border of the sacroiliac articulation.ResultsThe safe zone was triangular with an average area of 670.4 mm² (range, 374.8–1084.5 mm²). The largest diameter of the cylinder was a mean 7.4 mm (range, 5.0–10.0 mm). When height was under 156.3 cm, the diameter of the cylindrical implant was smaller than 7.0 mm (p < 0.001, regression coefficient = 0.09). The linear distance between points A and B was 32.5 mm (range, 19.2–49.3 mm). Point A was far enough away from the well-positioned anterior column plate to prevent collision between the two.ConclusionThe safe zone was shaped like a triangle, and was large enough for multiple screws. Considering the straight-line distance between points A and B, the central screw can be fixed without overlapping with the well-positioned anterior column plate at the point between holes 2 and 3.     

Pain on injection of propofol: a comparison of methylene blue and lidocaine

Study Objective

To investigate whether methylene blue, given before injection of propofol, was effective in reducing the frequency and severity of pain associated with propofol injection.

Design

Prospective, randomized, double-blinded clinical study.

Setting

Operating room of a university hospital.

Patients

90 adult, ASA physical status 1 and 2 patients undergoing elective surgery.

Interventions

Patients were randomly allocated to one of three groups of 30 patients each. Group I received 50 mg of methylene blue, Group II received 40 mg of lidocaine, and Group III, the control group, was given normal saline. All drugs were given as a 2.0 mL bolus 45 seconds before propofol administration.

Measurements

Injection pain using vocal responses, facial grimacing, arm withdrawal, tears, and questioning of the patient were noted. A 4-point scale was used for documenting pain.

Main Results

Pain frequency was 90% in the saline group, whereas the frequencies were significantly lower in the lidocaine and methylene blue groups (26.7% and 40%, respectively).

Conclusions

Intravenous pretreatment with methylene blue appears to be effective in reducing the pain during propofol injection.     

上胸段脊柱病变的前路与后路手术治疗

目的观察比较前、后手术入路治疗上胸段脊柱病变的疗效。方法选择上胸段脊柱病变56例,其中肿瘤27例,结核23例,陈旧性外伤6例,分别经前、后路病灶切除减压、植骨,大部分(48例)辅以内固定。随访6～48个月。结果本组均安全度过围手术期,3例术后发生乳糜漏,4例出现喉返神经牵拉伤所致一过性声音嘶哑,4例出现一过性膈神经刺激引起的呃逆症状。48例术后神经功能有不同程度改善,8例无明显改善。随访期间1例于1个月后双侧肺炎死亡,2例局部肿瘤复发,2例局部结核复发,1例肿瘤细胞全身转移死亡。均无断钉及内固定脱落。结论对上胸段脊柱病变正确选择应用前、后入路手术可暴露病变部位,彻底清除病灶。     

关节镜下应用EndoPearl与Intrafix固定双侧腘绳肌肌腱一期重建膝关节前后交叉韧带

目的 探讨关节镜下应用EndoPearl与Intrafix固定双侧腘绳肌肌腱同时重建膝关节前后交叉韧带的近期临床效果.方法 对2004年6月～2005年3月收治的10例膝关节前后交叉韧带同时断裂的患者,切取双侧腘绳肌腱,2条半腱肌腱和2条股薄肌腱分别对折成四束,折端固定同直径EndoPearl.关节镜下利用两组移植物同时分别重建膝前后交叉韧带.股骨端应用可吸收界面螺钉顶压固定EndoPearl与移植肌腱,胫骨端应用Intrafix固定四束肌腱.结果 10例均获得随访,平均7.5个月(6～15个月),切口Ⅰ期愈合,无感染.其中新鲜损伤4例,陈旧性损伤6例,合并后外侧复合体损伤3例,均予同期修复,合并内侧副韧损伤6例,未予特殊处理,5例曾急诊修复腘动静脉.术后3个月膝关节活动范围均超过120°,无伸膝受限,后抽屉试验Ⅰ度阳性2例,其余为阴性;Lyshlom评分(92.6±3.2)分.结论 关节镜下应用EndoPearl与Intrafix固定双侧腘绳肌肌腱同时重建膝关节前后交叉韧带方法确切,可有效恢复膝关节功能.     

关节镜下LARS人工韧带重建后交叉韧带及有限切开重建外侧副韧带

目的探讨后交叉韧带、外侧副韧带同时损伤后,应用LARS人工韧带关节镜下重建后交叉韧带并同时有限切开重建外侧副韧带的手术方法。方法8例关节镜下LARS人工韧带重建后交叉韧带同时有限切开LARS人工韧带重建外侧副韧带。术后随访6~29个月,采用国际膝关节委员会韧带标准评价表(IKDC)和Lysholm膝关节功能评分表评估患膝功能。结果术后无膝关节感染发生,无伸膝受限,屈膝活动度115~125°,术后随访时IKDC评分:8例均为A类,患者术前Lysholm膝关节功能评分平均为60分以下,终末随访时为平均91·5分。结论膝关节后交叉韧带、外侧副韧带同时损伤,较为少见,采用自体或异体移植物等方法重建创伤大,移植物来源有限,术后并发症多,膝关节术后不能达到即时稳定,易导致术后再次发生膝关节不稳。而应用LARS人工韧带关节镜下重建后交叉韧带,同时重建外侧副韧带,术后膝关节可获得即时稳定,利于膝关节早期活动,避免相关并发症的发生,临床疗效满意。     

吻合血管的骨间背皮瓣移植修复手指皮肤缺损

目的游离长蒂骨间背侧穿支感觉皮瓣修复手指皮肤缺损。方法急诊或择期行同侧骨问背侧穿支感觉皮瓣修复手指皮肤缺损8例；其中单纯皮肤缺损4例，各关节主及被动活动正常；合并肌腱伤或骨折者4例，关节主动活动有不同程度影响。皮瓣大小：3、5cm×2cm～5cm×3cm；端端吻合骨间背侧动脉-指固有动脉，伴行静脉-指掌侧浅静脉，前臂后侧皮神经-指固有神经。术后定期测量两点辨别觉、外观满意度及关节活动度，评估手术效果。结果本组皮瓣全部存活，无1例发生血管危象，两点辨别觉8～18mm。外观满意度评估优5例，良3例。结论长蒂骨间背侧穿支感觉皮瓣是修复手指尤其是指端及指腹皮肤软组织缺损的一种较好方法。     

Effects of using the posterior or anterior approaches to the lumbar plexus on the minimum effective anesthetic concentration (MEAC) of mepivacaine required to block the femoral nerve: a prospective, randomized, up-and-down study

BACKGROUND AND OBJECTIVES: To evaluate if psoas compartment block requires a larger concentration of mepivacaine to block the femoral nerve than does an anterior 3-in-1 femoral nerve block. METHODS: Forty eight patients undergoing anterior cruciate ligament repair were randomly allocated to receive an anterior 3-in-1 femoral block (femoral group, n = 24) or a posterior psoas compartment block (psoas group, n = 24) with 30 mL of mepivacaine. The concentration of the injected solution was varied for consecutive patients using an up-and-down staircase method (initial concentration: 1%; up-and-down steps: 0.1%). RESULTS: The minimum effective anesthetic concentration of mepivacaine blocking the femoral nerve in 50% of cases (ED(50)) was 1.06% +/- 0.31% (95% confidence interval [CI], 0.45%-1.68%) in the femoral group and 1.03% +/- 0.21% (95% CI, 0.6%-1.45%) in the psoas group (P = .83). The lateral femoral cutaneous and obturator nerves were blocked in 4 (16%) and 5 (20%) femoral group patients as compared with 20 (83%) and 19 (80%) psoas group patients (P = .005 and P = .0005, respectively). Intraoperative analgesic supplementation was required by 15 (60%) and 5 (20%) patients in the femoral and psoas groups, respectively (P = .01). CONCLUSIONS: Using a posterior psoas compartment approach to the lumbar plexus does not increase the minimum effective anesthetic concentration of mepivacaine required to block the femoral nerve as compared with the anterior 3-in-1 approach, and provides better quality of intraoperative anesthesia due to the more reliable block of the lateral femoral cutaneous and obturator nerves.     

多种细胞内第二信使在人垂体生长激素腺瘤生长激素分泌的调控作用

目的 探讨多种第二信使在人垂体生长激素（GH）腺瘤GH分泌的调控作用。方法 采用18例体外人垂体GH腺瘤细胞培养方法观察第二信使cAMP、三 磷酸肌醇（IP3）和Ca^2 在GH释放中的调节效应,肿瘤组织同时采用聚合酶链式反应和直接序列分析法评价gsp癌基因的表达。结果 6／18（33％）为gsp癌基因阳性,其中11例肿瘤观察了人工合成GH释放剂（GHPR－6）和GH释放激素（GHRH）对cAMP水平的相互影响,GHRP－6在9例gsp阴性对cMAP产生差异无显著性（P＞0．05）,而在2例gsp阳性组中却表现出有显著性的cAMP产生刺激效应。且GHRP－6可增加gsp癌基因阴性组GHRH所致cAMP产生效应。钙调蛋白抑制W7和蛋白激酶C抑制 剂均可减低GHRP－6所致的GH分泌。结论 在GH的分泌调节过程中有多种第二信使的介入。     

The posterolateral portal: A new approach for shoulder arthroscopy

Since the beginning of shoulder arthroscopy, many different approaches were described for Bankart repair to allow visualization and treatment. The anterior portals do not allow access to the posterior and inferior part of the glenoid. We present a new instrumental portal for shoulder arthroscopy. This approach is perfectly safe, without any anatomic risk. It is particularly helpful in the correct treatment of an anterior Bankart lesion, in repairing posterior and inferior extensions of a Bankart lesion, and in performing a plication in multidirectional hyperlaxity.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 17, No 9 (November-December), 2001: pp 1000–1002     

骨间后血管及其返支为蒂串连皮瓣的临床应用

目的为手部皮肤软组织缺损探寻一种新的修复方法.方法在40侧人体上肢标本上,对骨间后血管及其返支的来源、走行、分支、分布及吻合情况进行解剖观察的基础上,设计以前臂骨间后血管及其返支为蒂的串连皮瓣.1998年8月～2000年7月间临床应用此皮瓣逆行移位修复手背远侧及手指背侧皮肤缺损17例.皮瓣范围最大15cm×10cm,最小7cm×5cm.结果术后随访3周～6个月,除1例皮瓣远端有2cm×3cm坏死外,其余皮瓣全部成活,外观及功能满意.结论此皮瓣不损伤肢体主要血管,血管蒂较长,皮瓣切取面积较宽,厚薄适中,可用于修复拇指、手背至手指近节背侧的皮肤软组织缺损.手术简便,效果良好.