ObjectiveTo assess the effect of polyurethane gelatum grommet positioning and Mayfield head holder positioning under suboccipital retrosigmoid approach in acoustic neuroma resection on patients' facial crushing. MethodsRetrospective analysis of the clinical and nursing data of 90 patients treated by microsurgical surgery under the lateral prone position in our hospital from January 2013 to January 2014 was carried out. Patients in group A (n=28) were given grommet positioning, while those in group B (n=62) were given Mayfield head holder positioning, and then we compared the situation of facial crushing between the two groups. ResultsIn group A, 5 patients showed abnormality including 2 cases of skin injury in lower frontozygomatic and mandibular area, 2 cases of lower conjunctival edema and 1 of co-existing skin injury in lower zygomatic area and lower conjunctival edema, and the crushing rate was 17.86% in group A. In group B, the crushing rate was 1.61% with one case of mandibular skin injury. There was a significant difference between the two groups (χ2=5.778, P=0.016). ConclusionUnder suboccipital retrosigmoid approach for acoustic neuroma resection, Mayfield head holder positioning is better to avoid facial crushing.
目的 探讨体位指导对产程的影响。 方法 选择2007年1月-2008年1月产科住院的经特殊体位管理分娩的260例产妇，作为观察组；同期未予以体位指导的经阴道分娩的260例产妇作为对照组，产程中未作体位指导，一般以平卧为主。观察两组产程进展情况、胎儿宫内窘迫、剖宫产率等。 结果 观察组与对照组相比，第1产程及第2产程明显缩短，胎儿宫内窘迫、剖宫产率明显降低，有统计学意义（P＜0.05）。 结论 对孕妇实行体位管理能加快产程，避免各种产科并发症的发生，增加了阴道分娩率，减少了剖宫产率。
至2002年4月,分娩期会阴保护的证据如下: ①合成的可吸收材料在分娩期外阴1、2度撕伤修补和外阴切开中的应用(可以减少疼痛时间):1个系统评价发现,使用合成的可吸收缝合线相对于普通肠线明显减少了分娩后10天内镇痛药的使用剂量.对于分娩期的疼痛和分娩3个月后的性交痛,合成的可吸收材料与普通肠线无显著差别.系统评价中的一个大规模RCT发现,合成的可吸收材料在分娩后12个月显著降低性交痛. ②皮下连续缝合材料在外阴1、2度撕伤修补和外阴切开中的应用(减少疼痛时间):1个系统评价发现,皮下连续缝合相对间断缝合明显减轻了分娩后10天以内的疼痛.③分娩期对病人持续的支持(减少助产器械的使用):1个系统评价发现,分娩期对产妇持续的支持(注释:分娩过程中有护士、助产士等专业人士陪伴,并提供咨询)明显减少了助产器械的使用及会阴切开,但不能防止分娩期损伤的发生.④各种方法和材料在3、4度撕伤修补中的应用: 我们没有找到评论外阴3、4度撕伤修补最好的材料和方法的RCT.⑤硬膜外麻醉(增加了助产的机率,从而增加了会阴损伤的机率):1个系统评价没有找到直接的证据来比较硬膜外麻醉和其他麻醉对会阴损伤的影响.但是,一些RCT发现,仅在第一产程使用硬膜外麻醉和在第一产程及二、三产程都使用硬膜外麻醉相比,后者的器械助产及会阴损伤风险显著升高.⑥不协助孕妇分娩和协助分娩的比较( 增加了孕妇疼痛,无证据显示会阴损伤风险及会阴切开机率减少):1个RCT发现,不协助孕妇分娩(不接触胎儿头部或者保护产妇会阴)与协助产妇分娩(分娩期在胎头上施压及保护产妇会阴)相比,显著增加了产后10天的疼痛但却减少了会阴切开的机率.但无证据显示前者增加了会阴损伤风险或3、4度外阴撕伤风险.⑦会阴正中切开(相比会阴侧切增加了3、4度会阴撕伤机率):无证据显示会阴正中切开能比会阴侧切减少会阴疼痛或者伤口裂开的机率.一项来自半随机试验的有限证据表明,会阴正中切开可能增加3、4度会阴撕伤的机率.⑧会阴2度撕伤及会阴切开后不缝合会阴肌肉: 1个小样本RCT发现,在皮肤烧灼感和痛觉上,缝合与不缝合肌肉在产后2～3天,愈合后2～3天或产后8周没有差别.⑨会阴1、2度撕伤和切开后不缝合会阴皮肤(减少了性交痛): 1个大样本RCT发现,不缝合皮肤与常规缝合相比,产后10天疼痛没有显著差异,但却显著减少了分娩3个月后的性交痛.⑩第二产程胎头被动下降: 1个RCT比较了胎头被动下降和主动推动胎头快速下降,结果发现二者对会阴损伤没有差别.(11)限制性的会阴切开 (减少了后壁的损伤): 1个系统评价发现,对有胎儿或母亲指征的产妇限制性使用会阴切开能显著减少会阴后壁的撕伤,但却增加了阴道前壁及阴唇的损伤风险.(12)持续性的屏气向下用力:1篇来自2个质量不高的临床对照试验的系统评价发现,第二产程向下用力时,屏气与不屏气对会阴撕伤的发生率及程度没有影响.1篇RCT比较胎头被动下降与屏气用力推动胎头下降,二者对会阴撕伤率也没有影响.(13)分娩期体位:1个系统评价比较了直立位、仰卧位和侧卧位,结果发现分娩期直立位显著降低了会阴切开机率,却明显增加了会阴2度撕伤的风险.(14)胎头吸引(相比产钳减少了会阴损伤,但增加了新生儿脑出血风险):1个系统评价发现,胎头吸引器与产钳相比,显著降低了会阴损伤机率,但增加了新生儿脑出血和视网膜出血的风险.
Objective To evaluate the feasibil ity and effectiveness of percutaneous kyphoplasty in hyperextension position for treatment of stage II or III Kümmell disease. Methods Between May 2003 and February 2009, 17 patients with Kümmell disease (6 at stage II, 11 at stage III) were treated with percutaneous kyphoplasty in hyperextension position. There were 5 males and 12 females with an average age of 71 years (range, 55-85 years). The involved vertebral bodies were T10 in 1 case, T11 in 3 cases, T12 in 7 cases, L1 in 4 cases, L2 in 1 case, and T12, L1 in 1 case by X-ray, CT, and MRI examinations. The effectiveness was determined by the visual analogue scale (VAS) and the Oswestry Disabil ity Index (ODI). The height and the kyphotic Cobb angle of the involved vertebral body were measured pre- and postoperatively. Results The operation was successfully completed in all the patients, and the incisions healed by first intention. Pain was alleviated or eliminated within 48 hours after operation; no spinal nerves injury or pulmonary embolism occurred. One patient had cement leakage to the adjacent disc, who did not manifest any cl inical symptoms. Thirteen patients were followed up 24 to 56 months (mean, 32 months). The VAS score, ODI, anterior and medial vertebral height, kyphotic Cobb angle of involved vertebral body were improved significantly at 1 week after operation and at last follow-up (P lt; 0.05), there was no significant difference between at 1 week after operation and at last follow-up (P gt; 0.05). Adjacent vertebral fracture occurred in 1 patient at 6 months after operation and was cured after percutaneous kyphoplasty. Conclusion Percutaneous kyphoplasty in hyperextension position for treatment of stage II or III Kümmell disease can rel ieve back pain, improve viabil ity, decrease Cobb angle, and retain the vertebral body height and spinal alignment. The general condition of the patient is needed to be evaluated and the operation indication should be controlled strictly.
ObjectiveTo systematically review the efficacy of different positions on the clinical outcomes of percutaneous nephrolithotomy (PCNL). MethodsThe PubMed, Web of Science, EBSCO, Cochrane Library, Embase, CNKI, WanFang Data, VIP, and CBM databases were electronically searched to collect randomized controlled trials (RCTs) related to the objectives from January 2014 to April 2024. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies, a network meta-analysis was conducted using Stata 18.0 software. ResultsA total of 54 RCTs involving 5 092 patients and 7 different positions were included. The results of the best probability ranking showed that for positioning time, the split-leg prone position required the shortest time, while the traditional prone position required the longest. For access establishment time, the recumbent lithotomy position had the shortest duration, and the traditional prone position the longest. Intraoperative blood loss was lowest in the supine position and highest in the traditional prone position. Surgical duration was shortest for the recumbent lithotomy position and longest for the traditional prone position. Postoperative hospital stay was shortest for the supine position and longest for the traditional prone position. Complication rates were lowest for the oblique supine position and highest for the traditional prone position. Stone clearance rates were highest for the modified curved prone position and lowest for the traditional prone position. Conclusion Current evidence shows that different body positions have different clinical effects on percutaneous nephrolithotomy. The recumbent lithotomy position may optimize access establishment and surgical duration, while the supine position offers advantages in reducing intraoperative blood loss and shortening postoperative hospitalization. The split-leg prone position minimizes positioning time, the oblique supine position lowers complication rates, and the modified curved prone position maximizes stone clearance. Due to the limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.
Pars plana vitrectomy (PPV) combined with intraocular tamponade surgery is one of the main surgical methods for treating retinal detachment. Due to the use of filling substances, patients need to maintain specific postures after the operation to promote retinal reattachment and reduce the occurrence of complications. Currently, during the process of performing postural management for such surgical patients, there are problems such as low compliance and insufficient monitoring and management. Clinical medical staff have actively explored ways to improve the quality of positioning management, but no corresponding norms and consensus have been formed. The standards implemented by different places are closely related to the degree of medical experience. The evaluation of the performance of the patient's position by the medical care mainly relies on the patient's self-report or the nurse's inspection record, which lacks continuity and accuracy. In the future, it is necessary to further promote the development and transformation of auxiliary tools, implement scientific monitoring and management of patients with the help of artificial intelligence, formulate individualized plans and dynamically adjust them according to the patient's condition, and ensure the effect and improve patient satisfaction.
ObjectiveTo conclude the effectiveness of arthroscopy combined with Burks and SchaVer's approach in the treatment of posterior cruciate ligament (PCL) avulsion fractures in a floppy lateral position. MethodsBetween May 2010 and March 2014, 21 patients with PCL avulsion fractures were treated. There were 13 males and 8 females, aged 21 to 62 years (mean, 39.1 years). The causes included traffic accident injury in 10 cases, sports injury in 5 cases, and falling injury from height in 6 cases. The time from injury to hospital was 1-6 days (mean, 2.5 days). The results of posterior drawer test were all positive, and the results of anterior drawer test and lateral stress test were all negative. The Lysholm score was 28.0±5.5 before operation. And the American Orthopaedic Foot and Ankle Society (IKDC) score was 46.2±7.6 before operation. According to Meyer standards for fractures classification, 11 cases were rated as type II and 10 cases as type III. Arthroscopy was used to inspect and treat the intra-articular lesions, then avulsion fracture was fixed by Burks and SchaVer's approach in lateral position. Postoperative functional exercises were performed. ResultsPrimary healing of incision was obtained, without nerve and vascular injury or joint infection. All patients were followed up 18-36 months (mean, 27.2 months). The X-ray films of the knee joint showed good fractures reduction and healing at 3 months after operation. The results of posterior drawer test and reverse Lachman test were negative. The knee range of motion was recovered to normal level. At last follow-up, the Lysholm score of the knee joint was significantly improved to 90.9±1.4 from preoperative one (t=54.584, P=0.000), and the IKDC score was significantly increased to 90.5±5.3 from preoperative one (t=15.638, P=0.000), including 19 cases of grade A and 2 cases of grade B. ConclusionA combination of arthroscopy and Burks and SchaVer's approach for the treatment of PCL avulsion fractures in a floppy lateral position has the advantages of minimal invasion and safe approach, short operative time, and early postoperative rehabilitation exercises, so it can provide satisfactory function recovery of the knee joint.