Evaluation of short-term clinical effect of minimally invasive total hip arthroplasty with direct anterior approach in lateral position / 中国骨伤

OBJECTIVE@#To investigate the short-term clinical effect of direct anterior approach (DAA) in total hip arthroplasty(THA).@*METHODS@#From January 2018 to September 2018, the data of 30 patients(33 hips) who underwent the first THA using the side lying DAA completed by the same operation team were followed up and evaluated. There were 19 males and 11 females;the age was 58 to 80 (69.0±5.4) years old;the visual analogue scale (VAS) of pain was used, Harris scoring system, operation time, intraoperative blood loss, related complications and hip radiographs were evaluated in clinical and imaging aspects.@*RESULTS@#Thirty patients (33 hips) were followed up for 12 to 20(14.3±3.7) months, operation time (66.0±7.2) min and intraoperativehemorrhage (156±32) ml. The position of acetabulum prosthesis was examined by imaging:anteversion angle (18.6±3.6)° and abduction angle (41.2±4.8)° respectively. The VAS score was improved from 7 to 9(8.1±1.4) before operation to 1 to 3(1.9±0.7) at 1 month after operation. Harris score of hip joint improved significantly, from 28 to 46(35.4±5.2) before operation to 76 to 92 (88.6±4.5) at 1 month after operation, 74 to 93 (85.6±6.9) at 6 months after operation, and 79 to 95 (90.7±8.1) at 12 months after operation, the difference was statistically significant(<0.05). Complications occurred in 3 cases of fracture of the proximal femur, including 1 case of hip sprain fracture due to careless walking one month after operation. Considering that incomplete fracture may have occurred during the operation, 1 case of avulsion fracture of anterior inferior iliac spine, no deep infection, no dislocation. There were 1 case of injury of lateral femoral cutaneous nerve and 2 cases of injury of tensor fascia lata, among which 1 case was complete incision of the edge of the hook.@*CONCLUSION@#The primary THA with DAA in lateral position has a good short;term clinical effect, can meet the needs of patients' rapid recovery, and is a safe and effective surgical approach.

Outcomes of Internal Fixation with Compression Hip Screws in Lateral Decubitus Position for Treatment of Femoral Intertrochanteric Fractures / 대한고관절학회지

PURPOSE: Internal fixation using compression hip screws (CHS) and traction tables placing patients in the supine position is a gold standard option for treating intertrochanteric fractures; however, at our institution, we approach this treatment with patients in a lateral decubitus position. Here, the results of 100 consecutive elderly (i.e., ≥45 years of age) patients who underwent internal fixation with CHS in lateral decubitus position are analyzed. MATERIALS AND METHODS: Between March 2009 and May 2011, 100 consecutive elderly patients who underwent internal fixation with CHS for femoral intertrochanteric fracture were retrospectively reviewed. Clinical outcomes (i.e., Koval score, Harris hip score [HHS]) and radiographic outcomes (i.e., bone union time, amount of sliding of lag screw, tip-apex distance [TAD]) were evaluated. RESULTS: Clinical assessments revealed that the average postoperative Koval score decreased from 1.4 to 2.6 (range, 0–5; P < 0.05); HHS was 85 (range, 72–90); and mean bone union time was 5.0 (range, 2.0–8.2) months. Radiographic assessments revealed that anteroposterior average TAD was 6.95 (range, 1.27–14.63) mm; lateral average TAD was 7.26 (range, 1.20–18.43) mm; total average TAD was 14.21 (range, 2.47–28.66) mm; average lag screw sliding was 4.63 (range, 0–44.81) mm; and average angulation was varus 0.72°(range, −7.6°−12.7°). There were no cases of screw tip migration or nonunion, however, there were four cases of excessive screw sliding and six cases of varus angulation at more than 5° CONCLUSION: CHS fixation in lateral decubitus position provides favorable clinical and radiological outcomes. This technique is advisable for regular CHS fixation of intertrochanteric fractures.

The relationship between pillow height and cervical intervertebral disc stress in lateral decubitus position by three-dimensional finite element analysis / 国际生物医学工程杂志

Objective To analyze the relationship between pillow height and cervical intervertebral disc stress in lateral decubitus position of the human body using three-dimensional finite element method,and to provide the basis for appropriate pillow selection.Methods A cervical spine CT scan was performed on a normal male volunteer.The medical 3D image reconstruction software (Mimics),reverse engineering software (Geomagic Studio) and finite element software (MSC.Patran) were collectively used to establish three-dimensional finite element models of the whole cervical spine under three lateral decubitus conditions,includes pillow height of 10 cm (cervical spine leftward flexion),17 cm (cervical spine neutral),and 25 cm (cervical spine rightward flexion).Moreover,the finite element analysis and calculation of the three models were conducted.Results The Von-Mises stress,maximal principal stress and maximum shear stress of the model in cervical spine neutral (pillow height=17 cm) were all significantly lower than those of the cervical spine lateral model.Conclusions When the cervical coronal plane is in neutral position,the cervical discs can achieve the best stress distribution state.In lateral decubitus position of the human body,a appropriate pillow height should make the cervical vertebrae in neutral position.

Effect of cataract surgery on intraocular pressure in supine and lateral decubitus body postures.

Purpose: To investigate the effect of phacoemulsification on intraocular pressure (IOP) in different recumbent body postures including supine and lateral decubitus (LD) positions. Materials and Methods: This prospective, observational study included patients who had no glaucoma and who had planned to undergo phacoemulsification and intraocular lens implantation in one eye. Before and 1 month after cataract surgery, IOP was measured in both eyes using the Tono‑Pen AVIA. We measured IOP in the sitting, supine, and LD (with the operated eye placed on the lower side) positions. IOP was measured 10 min after assuming each position in a randomized sequence. The Wilcoxon signed‑rank test was used to compare the IOP changes before and 1 month after phacoemulsification in all postures. Results: Twenty‑nine patients participated in this study. Postoperative IOP was lower than the preoperative IOP when measured by Goldmann applanation tonometry in the sitting position (13.8 ± 1.9 mmHg vs. 12.6 ± 2.1 mmHg, P = 0.007). The postoperative IOP was lower than the preoperative IOP for the supine and LD positions. The average IOP reduction of the operated eye was 0.6 mmHg, 1.7 mmHg, and 3.0 mmHg in the sitting, supine, and LD positions, respectively (sitting vs. supine, P = 0.048; sitting vs. LD, P = 0.001; supine vs. LD, P = 0.028). In the nonoperated eye, IOP did not change significantly after surgery (all P > 0.05). Conclusions: Cataract surgery lowered IOP in the sitting position as well as in the supine and LD positions. Such postoperative IOP reductions were greater in the recumbent positions than in the sitting position.

Stereotactic vacuum-assisted breast biopsy under lateral decubitus position

PURPOSE: Stereotactic vacuum-assisted breast biopsy (VAB) has been established as a standard method for histological diagnosis of microcalcification or nonpalpable breast lesions on mammography. Generally, the procedure has been done under the prone position or upright sitting position. We herein attempt to evaluate clinical utility of Stereotactic VAB under lateral decubitus position. METHODS: One hundred six women (mean age, 51.2 years) with mammographically detected microcalcification underwent lateral decubitus positioning VAB using the 8G probe. In all cases, we obtained mammography specimens for identification of microcalcification and postprocedure mammography. We reviewed mean procedure time, pieces of specimen, pathology and follow-up mammography. RESULTS: The procedure took approximately 20 minutes (range, 15-24 minutes). Average number of obtained specimens was 8.5 pieces (range, 6-12 pieces). Microcalcifications were confirmed in both specimen mammography and microscopic slides. Of 106 cases, 10 cases were diagnosed as ductal carcinoma in situ. Additional surgical management was performed. Atypical ductal hyperplasias were found in 8 cases, and fibrocystic changes in 88 cases. CONCLUSION: Stereotactic VAB using the 8G probe under lateral decubitus position does not need a dedicated table, and is easier to maintain the position. Also, this procedure is accurate and safe. Thus, stereotactic VAB using the 8G probe under lateral decubitus position will be a useful method for diagnosis of microcalcification or nonpalpable breast lesions on mammography.

Rhabdomyolysis after prolonged laparoscopic radical nephrectomy: A case report

Rhabdomyolysis is characterized by the breakdown of skeletal muscle and the subsequent release of intracellular contents into the circulatory system. It is potentially life-threatening because it is sometimes associated with very high creatine kinase levels, myoglobinuria, and acute renal failure. We experienced a case of postoperative rhabdomyolysis after prolonged laparoscopic radical nephrectomy in the semi-lateral decubitus position. It was associated with suspicious gluteal compartment syndrome. Fortunately, the patient's renal function was normal through his hospital course. Rhabdomyolysis is well worth considering at the point of intraoperative positioning and postoperative care after prolonged surgery.

A sistematização do retalho do músculo latíssimo do dorso em decúbito dorsal / The formation of the latissimus dorsi muscle flap in the dorsal decubitus position

Introdução: O músculo latíssimo do dorso localiza-se na parede latero-posterior do tórax. O retalho do músculo latíssimo do dorso (RMLD) tem uma extensa aplicabilidade devido a sua anatomia pouco variável contribuindo, assim, para sua utilização em Cirurgia Plástica. A possibilidade de dissecar este músculo em decúbito dorsal (DD) dispensa a mudança de posição do paciente e cria uma opção para reconstruções microcirúrgicas. Este estudo objetiva sistematizar a técnica utilizada para dissecção do RMLD em DD. Método: Foram avaliados 10 casos de RMLD realizados no Hospital Universitário da Universidade Federal de Alagoas, os procedimentos cirúrgicos de individualização dos retalhos e seu posicionamento na região receptora foram semelhantes nos dez casos. É realizada a avaliação do músculo e a demarcação do retalho com o paciente em pé. Depois, com o paciente em DD, faz-se a indução anestésica e a preparação do campo a ser operado. Faz a abordagem do pedículo vásculo-nervoso por incisão na margem superior da elipse que delimita o RMLD, secciona o tendão de inserção do músculo e retira-se o retalho necessário à área receptora a ser reconstruída. Resultados: A posição do paciente no intraoperatório foi o DD, inclusive durante a dissecação dos retalhos musculares, e a técnica utilizada não proporcionou desvantagens do ato cirúrgico. Conclusão: É possível realizar a dissecção e individualização do RMLD estando o paciente em DD.

Introduction: The latissimus dorsi muscle is located on the lateral-posterior chest wall. The latissimus dorsi muscle flap (LDMF) has extensive applications due to its consistent anatomy, which contributes to its use in plastic surgery. This muscle can be dissected in the dorsal decubitus (DD) position; this removes the need for a change in patient position and enables microsurgical reconstruction to be performed. This study aimed to describe the technique used for the dissection and transfer of the LDMF in the DD position. Method: We evaluated 10 cases of LDMF formation performed in the University Hospital of the Federal University of Alagoas. The surgical procedures of individualization of the flaps and their positioning in the receiver region were similar in all ten cases. The evaluation of the muscle and the demarcation of the flap were performed with the patient in the standing position. Then, with the patient in the DD position, anesthetic induction was initiated and the operating field prepared. The neurovascular pedicle was formed by incising the top edge of the ellipse that delimits the LDMF, dissecting the insertion tendon of the muscle, and removing the flap necessary for the reconstruction of the receiver area. Results: The patient was in the DD position during the intraoperative period, even during the dissection of muscle flaps, and the technique used had no surgical disadvantages. Conclusion: It is possible to perform the dissection and individualization of the LDMF with the patient in the DD position.

Comparison of Intraocular Pressures According to Position Using Icare Rebound Tonometer

PURPOSE: To evaluate changes in intraocular pressure (IOP) according to position using a portable rebound tonometer. METHODS: We measured the IOP values of 20 healthy volunteers (40 eyes) in the sitting, supine, right lateral decubitus and left decubitus positions with a portable rebound tonometer, and then analyzed using the Wilcoxon signed rank test. IOP in sitting position was also measured with a non-contact tonometer and a Goldmann applanation tonometer, and analyzed with Kruskal-Wallis test and Spearman correlation analysis. Agreement among the 3 tonometers was calculated using the Bland-Altman method. RESULTS: The IOP measured with rebound tonometer in the supine position was significantly higher than in the sitting position (p = 0.002). However, there was no significant difference in IOP between the supine and decubitus positions. In the decubitus position, there was no significant difference in IOP between the dependent and non-dependent eyes. IOP measurement using the rebound tonometer showed positive correlation with that of the noncontact and Goldmann applanation tonometers. CONCLUSIONS: In normal subjects, IOP measurement obtained with a rebound tonometer in the supine position was significantly higher than in the sitting position, but there was no significant difference in IOP between the supine and decubitus positions. A rebound tonometer may be useful for patients whose intraocular pressure measurement with Goldmann applanation tonometer or non-contact tonometer is impossible. When using a portable rebound tonometer in bed-ridden or pediatric patients, we should pay attention to the interpretation of IOP in the supine position.

Lumbar plexopathy after radical nephrectomy: A case report / 대한마취과학회지

Lumbar plexopathy is characterized by an abrupt onset of sensory disturbances, weakness, and loss of deep tendon reflexes of lower extremities. The various causes of lumbar plexopathy include trauma, infections, space-occupying lesion, vascular diseases, metabolic diseases, and the use of drugs such as heroin. Postoperative rhabdomyolysis occurs secondary to prolonged muscle compression due to surgical positioning. Herein, we report a case of lumbar plexopathy, complicating an injury to the paraspinal muscle and iliopsoas muscle that occurred in the flexed lateral decubitus position following radical nephrectomy.

Development of complex regional pain syndrome at independent arm associated with lateral decubitus position: A case report

A 27-year-old man underwent excision of a mediastinal mass using video-assisted thoracoscopic surgery (VATS) performed in the right lateral position. Postoperatively, he complained of pain in the left upper arm and chest wall, limitation of the left shoulder joint, allodynia, hyperalgesia, spontaneous pain in left finger, edema, hypohidrosis, and change of skin color of the left hand. We diagnosed the patient with complex regional pain syndrome (CRPS) by using the proposed modified International Association of the Study of Pain (IASP) research diagnostic criteria, and initiated treatment through medication and interventional management. After 3 months of treatment, the pain intensity reduced to below 2 cm on the VAS. In this study, we describe a case of postoperative CRPS, which is believed to have been caused by excessive stretching of the brachial plexus. Careful positioning of patients on the operating table with proper padding will reduce injuries to the peripheral nerves.

Rhabdomyolysis recognized after elevation of liver enzymes following prolonged urologic surgery with lateral decubitus position: A case report / 대한마취과학회지

The classic signs and symptoms of rhabdomyolysis are non-specific and not present in all cases, and mild cases might go unrecognized. We present a case of rhabdomyolysis recognized in a 68-year-old man after elevation of liver enzymes following prolonged urologic surgery. The patient's postoperative course was concerned with elevated serum aspartate aminotransferase and alanine aminotransferase without any clinical manifestations on the first postoperative day. After examining the serum creatine kinase and myoglobin levels, the patient was diagnosed with rhabdomyolysis. After 16 days, he was discharged with fully recovered liver enzymes and creatine kinase. We suggest that sufficient perioperative attentions should be given to patients at a higher risk of rhabdomyolysis.

Rhabdomyolysis after laparoscopic radical nephrectomy: A case report / 대한마취과학회지

Rhabdomyolysis is a rare but potentially lethal clinical syndrome that results from acute muscle fiber necrosis with leakage of muscle constituents into blood. This devastating disease could be due to muscle compression caused by urologic positioning for a lengthy nephrectomy. In this regard, laparoscopic renal surgery may be a risk for the development of rhabdomyolysis. This phenomenon of massive muscle necrosis can produce secondary acute renal failure. The risk factors have to be managed carefully during anesthetic management. Here, we report a case of a patient with rhabdomyolysis that developed in the flexed lateral decubitus position during laparoscopic nephrectomy.

Radiographic Examination at Lateral Decubitus Position for Reducing the Variability of Cup Inclination / 대한정형외과학회잡지

PURPOSE: This study analyzed the factors related to a variable inclination angle in patients who have undergone total hip arthroplasty by taking pelvis AP X-rays in the lateral decubitus position with a 45degrees targeted goniometer. MATERIALS AND METHODS: We recruited 100 adults (50 men and 50 women) who were without a history of hip joint disease. The mean age was 30.1 years for the men and 33.7 years for the women. The circumferences of the shoulder and pelvis, the shoulder to pelvis ratio, and the body mass index were checked. We examined the radiographs with using a goniometer, which was targeted to 45degrees for allowing a rod to be across the center of the acetabulum. The cross angle between the rod and the interteardrop line was checked. RESULTS: On the comparison of the gender groups, the shoulder to pelvis ratio was on average 1.18 in men and it was 1.08 in women. The mean cross angle was 45.3degrees in men and 48.1degrees in women. As the ratio was increased, the cross angle decreased. CONCLUSION: For men, there was little pelvic tilt in the lateral decubitus position. But for women, if inserting the acetabular cup with the acetabular orientation at 45degrees is done without considering the pelvic tilt inclination at the lateral decubitus position, then the inclination angle could be lower than expected.

Acute pulmonary edema progressing from unilateral to bilateral after brief laparoscopic surgery under lateral position in elderly patient: A case report / 대한마취과학회지

Although pulmonary vascular permeability and gravity changes have been known to be the mechanism of pulmonary edema, yet the etiology of pulmonary edema remains speculative. The multiple conditions such as congestive heart failure, fluid overload, hypoalbuminemia, upper air way obstruction, increased pulmonary artery pressure and laparoscopic surgery cause poor pulmonary circulatory condition. Pulmonary edema usually occurs bilaterally, but unilateral pulmonay edema is uncommon entity. Unilateral pulmonary edema was reported to occur in special circumstances such as one lung ventilation, lateral decubitus position and unilateral pulmonary damage. We experienced abruptly onset and rapid healing pulmonary edema from unilateral to bilateral after brief laparoscopic operation under lateral decubitus position. Thus, we report this case as complicated condition of acute pulmonary edema in elderly patient without fluid overload, long operation time.

Severe Hypoxemia Following Lateral Positioning after Induction of Anesthesia in a Patient with a Diaphragmatic Hernia: A case report / 대한마취과학회지

A case of acute intraoperative hypoxemia following placement in the lateral decubitus position in a chronic diaphragmatic hernia patient undergoing general anesthesia for hip arthroplasty is presented. The patient had previously received a series of transurethral cystectomies under general anesthesia without any pulmonary complications, even though the patienthad a diaphragmatic hernia. Hypoxemia occurred after the induction of anesthesia and reposition, and surgery was subsequently postponed. The mechanisms proposed for the hypoxemia were a progressive compression atelectasis of the dependant lung caused by placement in the lateral decubitus position and the presence of the diaphragmatic hernia during anesthesia, and further reduction of the FRC of the dependent lung caused by mechanical ventilation. The patient was intubated with a left-sided endobronchial tube. After placing the patient in the lateral decubitus position, intermittent passive hyperinflation to the dependent lung and then positive pressure ventilation of both lungs was maintained to provide adequate oxygenation throughout the surgery. Therefore, differential ventilation using a double lumen tube is effective at improving hypoxemia of a patient in altered pulmonary compliance, such as in the lateral decubitus position with adiaphragmatic hernia.