Zhonghua yi xue za zhi
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Zhonghua yi xue za zhi · Mar 2018
[Biomechanical behaviors of cervical spinal cord injury related to various bone fragment impact velocities: a finite element study].
Objective: To establish a three-dimensional (3D) finite element (FE) model of the whole cervical spinal cord (WSCS) and explore the biomechanical behaviors of cervical spinal cord injury related to different bone fragment impact velocities by FE analysis. Methods: A 3D FE model of WCSC was established based on the morphologic data of each segment of the human cervical cord. The reconstruction structures, which included the dura mater, the cerebrospinal fluid, the gray and white matter in the C(2) to C(7) cervical vertebrae, were validated. ⋯ The von Mises stress of the spinal cord ranged between 240 and 320 kPa at a velocity of 6.0 m/s, and CSA decreased by more than 50%. Conclusion: The 3D FE model of WSCS could provide more insights on the biomechanical mechanisms of spinal cord injury through various bone fragment impacts in burst fracture. When the impact velocity of the bone fragment exceeds 3.5 m/s, the maximum stress significantly increases and the reduction of CSA of the spinal cord is over 30%, and this could possibly lead to the contusion injury of the spinal cord.
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Zhonghua yi xue za zhi · Mar 2018
[Continuous fascia iliaca compartment block combined with oral analgesics for pre-operative pain control in elderly hip fracture patients].
Objective: The purpose of this study was to assess the efficacy of ultrasound-guided continuous fascia iliaca compartment block combined with oral analgesics for pre-operative pain control in elderly patients with hip fracture. Methods: One hundred and sixteen patients with hip fractures in Xuan Wu Hospital of Capital Medical University during Dec. 2015 to Dec. 2016 were included. These patients were randomized into 2 groups: control group (group C) (receiving the traditional analgesia: tramadol 50 mg and paracetamol 500 mg tid, po from admission to surgery), study group (group S) (receiving ultrasound-guided continuous fascia iliaca compartment block combined with oral analgesics for pre-operative pain control from admission to surgery). ⋯ The occurrence of nausea and vomiting was 6.9% and 1.7% in group S, which were lower than that in group C (22.4%, 12.1%) (χ2=6.779, 2.416, all P<0.05). There were no obvious complications of continuous fascia iliaca compartment block in group S. Conclusion: Ultrasound guided continuous fascia iliaca compartment block combined with oral analgesics preoperatively is an effective way of providing analgesia for elderly with hip fracture, which can improve the patient's comfort and satisfaction.
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Zhonghua yi xue za zhi · Mar 2018
Randomized Controlled Trial[Dexmedetomidine combined with ropivacaine for continuous femoral nerve block improved postoperative sleep quality in elderly patients after total knee arthroplasty].
Objective: To investigate the effect of dexmedetomidine adding to ropivacaine for continuous femoral nerve block on the improvement of postoperative sleep quality in elderly patients after total knee arthroplasty. Methods: One hundred and sixty patients aged 60 years or older in Jishuitan Hospital scheduled for single total knee arthroplasty between Nov. 2016 and Jun. 2017 were recruited. All patients received spinal anesthesia and were randomized to receive either combined ropivacaine and dexmedetomidine (0.2% ropivacaine 250 ml and 5 μg/kg dexmedetomidine, at a rate of 5 ml/h or 0.1 μg·kg-1·h-1 dexmedetomidine, dexmedetomidine group) or only ropivacaine (0.2% ropivacaine, at a rate of 5 ml/h, controlled group) for continuous femoral nerve block as postoperative analgesia after surgery. ⋯ The difference was statistically significant. There were no significant differences between groups regarding the incidences of adverse events. Conclusion: Dexmedetomidine combined with ropivacaine for continuous femoral nerve block may improve subjective sleep quality, postoperative analgesia, and reduce delirium in the elderly after total knee arthroplasty.
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Zhonghua yi xue za zhi · Mar 2018
[The efficacy of ultrasound-guided spinal nerve posterior ramus pulsed radiofrequency treatment for aged lower back post-herpetic neuralgia].
Objective: To evaluate the efficacy of ultrasound-guided spinal nerve posterior ramus pulsed radiofrequency treatment of lower back post-herpetic neuralgia. Methods: One hundred and twenty-eight cases of lower back or anterior abdominal wall acute post-herpetic neuralgia patients were enrolled. They were randomly divided into two groups. ⋯ Comparison between the two groups after treatment, morphine consumption of the radio frequency group decreased significantly than the control group, and the difference was statistically significant (t=22.341, 16.758, 17.827, 15.541, all P<0.05). During the operation , no error occurred with needle penetrating the abdominal cavity, chest, offal or blood vessels. Conclusion: Ultrasound-guided spinal nerve posterior ramus pulsed radio frequency treatment of lower back or anterior abdominal wall post-herpetic neuralgia proves effective and can reduce patient morphine usage and lead to fewer adverse reactions.
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Zhonghua yi xue za zhi · Mar 2018
[Clinical experience in diagnosis and treatment of primary retroperitoneal liposarcoma].
Objective: To summarize the experience in diagnosis and treatment of primary retroperitoneal liposarcoma. Methods: The clinic data of 73 cases of primary retroperitoneal liposarcoma were reviewed. The age of patients was 23 to 75 years old, with a median age of 53 years. ⋯ The main treatment of retroperitoneal liposarcoma was surgical resection. Complete resection was the objective of the operation, and the combined viscera resection was performed for those with invasion of other organs. Retroperitoneal liposarcoma had the characteristics of local recurrence after operation and insensitivity to radiotherapy and chemotherapy, but the recurrent tumor can still be resected.