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Yi J.,Jishuitan Hospital
Beijing da xue xue bao. Yi xue ban = Journal of Peking University. Health sciences | Year: 2010

To determine the most suitable concentration of ropivacaine on sciatic nerve blocks with stimulating catheters. Sixty adult patients undergoing surgeries involving the foot and ankle were randomly divided into 3 groups (n=20): The patients in group A were given 0.1% ropivacaine, the patients in groups B and C received 0.125% and 0.15% ropivacaine respectively. We combined ultrasound and nerve stimulators for popliteal sciatic nerve blocks, and then placed stimulating catheters for postoperative analgesia. VAS and adverse effects were monitored 6 h, 12 h, 24 h and 48 h after surgery. The difference of VAS was of significance in statistics 6 h and 12 h postoperation. VAS in Group A at postoperative 6 h and 12 h was significantly higher than that in Groups B and C(P<0.05). The incidence of motor disturbance and limbs numbness in Group C was significantly higher than that in Groups A and B (P<0.05). There was no significant difference in the satisfaction of the three groups (P>0.05). The most suitable concentration of ropivacaine on sciatic nerve blocks with stimulating catheters is 0.125%.


To observe the efficacy and safety of fascia iliaca compartment block (FICB) with 0.2% ropivacaine in the early analgesia of children with development dislocation of the hip (DDH) undergoing Salter arthroplasty. Approved by the hospital ethics committee, a total of 64 DDH children were divided randomly into 2 groups: group F (FICB with ropivacaine 0.2%, 1 ml/kg, max. 30 ml) and group C (FICB with 0.9% normal saline 1 ml/kg, max. 30 ml). The intra-operative doses of fentanyl, PACU (post-anesthesia care unit), CRIES pain score at 1, 4 and 24 h postoperatively, patient satisfaction score and side effects were recorded. The intra-operative doses of fentanyl and PACU were lower. Pain scores at 1, 4 and 24 h postoperatively were lower. And the patient satisfaction score was significantly higher in the FICB group. The administration of ropivacaine (0.2%) for FICB in the early analgesia of DDH children has the advantages of safety, precision, long-lasting and convenience.


To evaluate the combined tenodesis for long head of bicep tendon lesion with massive rotator cuff tear. From January 2004 to June 2009, 41 patients of long head of bicep tendon lesion with massive rotator cuff tear were treated by arthroscopy. The follow-up period was over 12 months. There were 19 males and 22 females with an average age of 57 ± 11 year old. All patients were treated by arthroscopy with double row technique for rotator cuff tear repair and tenodesis for lesions of long head of bicep tendon. It combined the long head of bicep tendon with anterior edge of rotator cuff. The mean visual analogue scale (VAS) was 5.1 ± 23, the range of forward flexion (100 ± 55)°, external rotation (27 ± 24)° and internal rotation up to T(12) (T(5)-S(1)) level pre-operation on average. The Constant-Merly score was 50 ± 23, the University of California at Los Angeles (UCLA) score 14 ± 6 and the simple shoulder test (SST) score 4.0 ± 2.7 pre-operation on average. The strength of flexed elevation was (17 ± 20)% and strength of elbow flexion (101 ± 16)% versus the other side. All patients healed without any complication. Their outcomes improved significantly (P < 0.01). The mean VAS score improved to 1.5 ± 1.8, forward flexion (155 ± 21)°, external rotation (37 ± 24)° and post-operative internal rotation up to T(10) (T(4)-L(3)) on average. The mean Constant improved to 87 ± 13, mean UCLA 29 ± 5 and mean SST 9.3 ± 2.4. The strength of flexed elevation recovered to (68 ± 21)% post-operation. Significant differences were found in range of motion, VAS, strength and functional score (P < 0.01). No difference was observed for Mayo elbow performance score (MEPS) and elbow flexion strength at pre-operation versus post-operation. The combined tenodesis with double row rotator cuff repair is an effective approach for treating lesion of long head of bicep tendon with massive rotator cuff tear.


Zhang J.,Jishuitan Hospital
Zhongguo gu shang = China journal of orthopaedics and traumatology | Year: 2013

To evaluate the effect and complication of surgical treatment for Pilon fracture using the posterolateral approach. From August 2009 to March 2011, 15 patients with Pilon fractures (2 in B3,13 in C) and with a separate displaced posterior malleolar fragment was treated in two-stage: the first stage management was on stabiliztion of the soft tissue envelope with temporary external fixator of spanning arthritis, and the second stage management was open reduction and internal fixation with posterolateral approach and anteromedial or anteralateral approach. All patients were followed-up for 12 to 17 months (14.2 months in average). Thirteen of the 15 fractures healed, but 2 fractures needed autologous bone graft procedure duo to nonuion. There was no wound complication related to poterolateral incion. Fourteen fractures had less than 2 mm of incongruity of distal tibia joint. According to Baired-Jackson criteria, the results were excellent in 2 cases, good in 7, fair in 4, and poor in 2. The posterolateral approach offers direct visualization for the reduction and fixation of the fibula and posterior distal fragment of the tibia Pilon fractures, faciliate the management of this difficult fracture pattern.


Zhang Y.J.,Jishuitan Hospital
Beijing da xue xue bao. Yi xue ban = Journal of Peking University. Health sciences | Year: 2010

To investigate the changes of serum enzymes and their prognostic value in patients with pulmonary thromboembolism after orthopaedic surgery. Clinical data of 134 cases of confirmed pulmonary thromboembolism after orthopaedic surgery from 1997 to 2010 were reviewed.The 134 cases were divided into dead group (n=28) and survival group (n=106). The clinical presentation, electrocardiogram, arterial oxygen pressure (PaO2), chest X-ray, echocardiography,and serum enzymes including alanine transaminase (ALT), aspartate aminotransferase (AST), gamma-glutamyl transpeptidase (γ-GT), lactate dehydrogenase (LDH), creatine kinase (CK) and creatine kinase isoenzyme (CK-MB) were analyzed. And multivariable Logistic regression was conducted to identify the risk factors of in-hospital death. The average age of dead patients was higher than that of survival patients (P=0.043), while the P(O2) of dead patients was much lower than that of survival patients (P=0.035). The percentage of syncope, hypotension, right bundle-branch block and SIQIIITIII, pulmonary hypertension and right ventricular dysfunction in dead patients were higher than those in survival patients (P=0.009, P=0.041, P=0.018, P=0.030, P=0.042 and P=0.038), respectively. There were significant differences of elevated serum ALT, LDH and CK-MB levels between dead patients and survival patients (P=0.042, P=0.035 and P=0.017). Logistic regression indicated that the risk factors for death of patients with PTE after orthopaedic surgery were age (OR, 1.182; 95% CI, 1.010-1.383; P=0.036), hypoxemia (OR, 1.128; 95% CI, 1.018-1.249; P=0.022), hypotension (OR, 3.346; 95% CI, 1.116-10.031; P=0.031), right ventricular dysfunction (OR, 4.083; 95% CI, 1.040- 16.035; P=0.044) and elevated serum CK-MB levels (OR, 3.466; 95% CI, 1.054-11.400; P=0.041). The incidence rate of elevated serum ALT, LDH and CK-MB levels in patients who died of pulmonary thromboembolism after orthopaedic surgery was higher than that of survival patients; Age, hypoxemia, hypotension and right ventricular dysfunction were independent risk factors of in-hospital death; The CK-MB might be a useful biomarker for risk stratification of acute PTE.

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