Résumé
Objective:To explore the effect of home-based rehabilitation training on a patient with posterior shoulder dislocation with reverse Hill-Sacks lesion. Methods:According to the preoperative and postoperative evaluation and the operation way, a four-phase home-based rehabilitation training plan was developed for the patient, which included the training of muscle strength and range of motion, and proprioceptive sensation training and so on. The patient was followed up in rehabilitation department regularly. The range of motion was measured, and were also evaluated with Manual Muscle Test, Visual Analogue Score (VAS) and modified Rowe Score. Results:Six months after operation, the active range of motion of flexion, extension, adduction, abduction and external rotation of his shoulder reached to the normal range, the active internal rotation reached to level L3, the muscle strength recovered to the normal level, the VAS decreased from six preoperative to 0 postoperative, and the modified Rowe Score improved from 16 preoperative to 91. Ten months after operation, his active internal rotation reached to level L1, and the modified Rowe Score was 93. Conclusion:Individualized remote guidance and reasonable home-based rehabilitation training might be effective on posterior shoulder dislocation with reverse Hill-Sacks lesion.
Résumé
<p><b>OBJECTIVE</b>To investigate the effect of a continuous infusion of low-dose dexmedetomidine on patient-controlled analgesia (PCA) with fentanyl in elderly patients after total hip replacement.</p><p><b>METHODS</b>Forty patients (ASA I-II) aged 66-81 years after total hip replacement were randomized equally into the control and test groups. The patients in the test group received continuous infusion of dexmedetomidine at the rate of 0.2 µg·kg(-1)·h(-1) from the beginning to the end of PCA with fentanyl after the surgery, while those in the control group received normal saline. The cumulative fentanyl dose, VAS pain scores and Ramsay sedation score were recorded at 0, 4, 8, 12 and 24 h after the surgery.</p><p><b>RESULTS</b>All the patients in the two groups reported good pain relief and none needed additional fentanyl. The VAS pain score was significantly lower (P<0.05 or 0.01), while the Ramsay sedation scores higher (P<0.05) in the test group than in the control group. The cumulative fentanyl dose was significantly lower in the test group (P<0.05 or 0.01). The incidence of such adverse effects as nausea and vomiting was significantly lower in the test group (P<0.05).</p><p><b>CONCLUSION</b>PCA with fentanyl combined with low-dose dexmedetomidine infusion is safe for elderly patients, and can decrease fentanyl consumption and improve the effect of PCA with fentanyl.</p>