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Objective To observe and compare the analgesic efficacy of femoral nerve block (FNB)and sufentanil for positioning patients with fractured hip.Methods Sixty patients scheduled for hip fracture surgery were randomized into three groups.Fifteen minutes before positioning for subarachnoid block,the FNB group received nerve ultrasound guided FNB using 20 ml ropivacaine 0.5% .Five minutes before positioning,the S group received a dose of IV sufentanil 0.15μg/kg,the C group didn't accept any intervention.The visual analog scale(VAS)following positioning (T2 ),OAA /S scale before positioning (T1 ),MAP,HR,SpO2 entering operating room (T0 )and T1 ,T2 ,adverse reactions were recorded.The plasma concentration of noradrenaline(NA)and cortisol(Cor)by T0 and T2 were measured.Results MAP,HR,the level of NA,Cor by T2 in group C increased significantly by comparing with T0 (P 0.05).There were no significant differences in MAP,HR,the level of NA,Cor in all instances among the three groups(P >0.05).The OAA /S of S group was higher than the other groups(P <0.05).Compared with group C,group F and S showed markedly lower VAS at T2 (P <0.05),there were no significant differences between the two group.Side effects of group S included respiratory depression in 3 patients,nausea vomiting in 1 and dizzy in 1,no adverse reaction were found in other groups.Conclusions Both FNB and intravenous sufentanil can reduce the pain of positioning patients with fractured hip,showing almost the same analgesic efficacy,FNB can more inhibit stress reaction caused by pain.
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BACKGROUND: Nitric oxide plays an important role in bone metabolism. However, the effects of different doses of L-arginine, nitric oxide substrate, on the healing of osteoporotic fractures remain unclear. OBJECTIVE: To investigate the influence of different doses of L-arginine on the healing of osteoporotic fractures and blood biochemistry in rats. METHODS: A total of 50 female Wistar rats, aged 6-month-old, were randomly divided into sham-surgery (n=10) and osteoporosis (bilateral ovariectomy, n=40). After osteoporosis model was established, left middle femoral fractures were made in al 50 rats, and the osteoporosis group was further divided into four groups, low, middle and high dose of L-arginine, and control groups. The L-arginine groups were intraperitoneal y injected with 1, 3, and 5 mg/kg L-arginine at the second day fol owing surgery, while the control and sham-surgery groups were injected with the same volume of normal saline. At 8 weeks, the lumbar and cal us bone mineral density, serum nitric oxide, and nitric oxide synthase were detected. Meanwhile, the bone cal us histological examination was conducted. RESULTS AND CONCLUSION: During fracture healing, osteoporosis rats showed a low level of serum nitric oxide and nitric oxide synthase compared with normal fractured rats (P < 0.05). L-arginine can improve the concentration of serum nitric oxide and nitric oxide synthase in osteoporosis rats. Moreover, middle dose of L-arginine can increase the cal us and lumbar spine bone mineral density of osteoporosis rats, so the number and continuity of bone trabecula were enhanced. These findings suggest that middle dose of L-arginine (3 mg/kg) can promote healing process of osteoporotic fractures and improve osteoporosis.
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ObjectiveTo evaluate the effects of double plates in the treatment of humeral intercondylar fractures.MethodsFrom January 2004 to March 2011,31 patients with humeral intercondylarfractures were reviewed.According to AO/Müller classification,there were three patients with type C1 fractures,16 with type C2 and 12 with type C3.Trans-olecranon osteotomy or trans-triceps-side approach and internal fixation by standard method of AO double plates were performed in all patients.ResultsAll 31patients were followed up for 12 -18 months,which showed fracture healing 6-12 months after surgery.According to the Cassebaum scoring system,the effects were evaluated as excellent in seven patients,good in 19,fair in four and poor in one,with excellence rate of 87％. ConclusionDouble plates is proved to be a good choice for humeral intercondylar fractures,since it can obtain satisfactory outcome with solid fixation,stable mechanical properties,few complications and facilitation for early rehabilitation.
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[Objective]To improve the diagnosis and treatment of acute fatal pulmonary thromboembolism(PTE)in orthopedic perioperation.[Method]Clinical manifestations,radiological features,laboratory examination data,treatment and prognosis of 12 patients diagnosed as acute fatal PTE in orthopedic perioperation from February,2002 to July,2005 were retrospectively analyzed.[Result]Nine patients received emergent thrombolytic and anticoagulant therapy,7 were alleviated and 2 died;3 patients with sudden cardiac arrest died after failed cardiopulmonary resuscitation.[Conclusion]Acute fatal PTE is a severe disease of orthopaedics.The realization and alert of the existence of acute fatal PTE must be increased.Early diagnosis and efficient treatment is the key to preventing from death.