Clinical effect modified Chevron osteotomy combined with lateral tissue loosening in treating mild-moderate hallux valgus through internal signal approach / 中国骨伤

<p><b>OBJECTIVE</b>To explore clinical effect of modified Chevron osteotomy combined with lateral tissue loosening for the treatment of mild-moderate hallux valgus through internal signal approach.</p><p><b>METHODS</b>From July 2015 to June 2016, 26 patients with mild-moderate hallux valgus treated with modified Chevron osteotomy combined with lateral tissue loosening through internal signal approach, including 2 males and 24 females aged from 45 to 65 years old with an average of(54.6±4.8) years old;the courses of diseases ranged from 1 to 5 months with an average of (7.5±3.3) months. Hallux valgus angle(HVA), inter metatarsal angle(IMA) were measured at 12 months after operation, and AOFAS score was applied to evaluate clinical effect before and after operation.</p><p><b>RESULTS</b>All incisions were healed at stage I. No incision occurred infection, metatarsal necrosis and recurrence of hallux valgus deformity. Two patients occurred skin numbness caused by musculocutaneous nerve injury. Twenty-six patients were followed up from 6 to 12 months with an average of(9.12±2.06) months. HVA, IMA were(30.01±3.71)°, (14.00±1.50)° before operation and(9.41±4.16)°, (7.00±0.60)° after operation, which had significant difference. There was statistical significance in AOFAS score before operation 54.77±9.59 and after operation 92.73±5.47, and 19 cases obtained excellent results and 7 moderate.</p><p><b>CONCLUSIONS</b>Modified Chevron osteotomy combined with full thread headless pressure screw fixation and lateral tissue loosening for the treatment of mild-moderate hallux valgus has advantages of excellent exposure, simple operation, stable fixation, rapid recovery. Akin osteotomy with internal capsulorrhaphy were used with lateral loosening and could recover soft tissue balance between lateral and internal, and could receive satisfied clinical effects.</p>

The Effect of PCSA with Parecoxib Sodium and Sufentanil on the Postoperative Delirium in Patients after the Spinal Surgery / 昆明医科大学学报

Objective To investigate the effect of patient controlled subcutaneous analgesia (PCSA) of Sufentamil and Parecoxib sodium on the postoperative delirium in patients after the spinal surgery. Methods 240 patients with ASA Ⅱ- Ⅲ age 18-64 yrs after the spinal surgery were divided into two groups: group NO-PCSA (analgesic management: patients were accepted pethidine 25-50 mg intramuscular injection n = 120 );group PCSA (analgesic management: patient controlled subcutaneous analgesia was started since skin suture with the following composition:Sufentanil 0.9 ug/(kg.d)+Parecoxib sodium 120 mg+Tropisetron 10 mg+normal saline 150 mL. The PCSA setting was as follows:background infusion at 2 mL/h, a bolus dose of 0.5 mL, lockout interval 15 min. If the VAS was greater than 5, patient was accepted pethidine 25-50 mg intramuscular injection n=120) . The effect of analgesia was assessed by visual analogue scale (VAS) . The delirium was assessed by the confusion assessment, VAS and delirium were recorded with in 2, 24, 48, 72 hours postoperatively. Results During the analgesia period, the VAS and the incidence of postoperative delirium were significantly lower in group PCSA than those in group NO-PCSA ( <0.05) . Conclusion PCSA of Sufentamil and Parecoxib sodium have a good postoperative analgesic effect in patients after the spinal surgery. It is an effective measure and the incidence of postoperative delirium can be decreased by reliefing postoperative pain.