BACKGROUND Fat embolism syndrome(FES)is a rare disease characterized by pulmonary distress,neurologic symptoms,and petechial rash and seriously threatens human life and health.It is still neglected clinically because ...BACKGROUND Fat embolism syndrome(FES)is a rare disease characterized by pulmonary distress,neurologic symptoms,and petechial rash and seriously threatens human life and health.It is still neglected clinically because of the lack of verifiable diagnostic criteria and atypical clinical symptoms.No studies on FES with pulmonary embolism(PE)and tympanic membrane perforation have been reported to date.Here,we report a rare case of concomitant FES,PE and tympanic membrane perforation after surgery in a patient with a tibiofibular fracture.CASE SUMMARY A 39-year-old man presented with right lower extremity pain due to a car accident while driving a motorbike on the road.X-ray and computed tomography scans revealed a fracture of the right mid-shaft tibia and proximal fibula categorized as a type A2 fracture according to the AO classification.A successful minimally invasive operation was performed 3 d after the injury.Postoperatively,the patient developed sudden symptoms of respiratory distress and hearing loss.Early diagnosis was made,and supportive treatments were used at the early stage of FES.Seven days after surgery,he presented a clear recovery from respiratory symptoms.The outcome of fracture healing was excellent,and his hearing of the left ear was mildly impaired at the last follow-up of 4 mo.CONCLUSION Concomitant FES,PE and tympanic membrane perforation are very rare but represent potentially fatal complications of trauma or orthopedic surgery and present with predominantly pulmonary symptoms.Early diagnosis and treatment can reduce the mortality of FES,and prevention is better than a cure.展开更多
A stable and precise articulation of the distal tibiofibular syndesmosis maintains the tibiofibular relationship,and it is essential for normal motion of the ankle joint.The disruption of this joint is frequently acco...A stable and precise articulation of the distal tibiofibular syndesmosis maintains the tibiofibular relationship,and it is essential for normal motion of the ankle joint.The disruption of this joint is frequently accompanied by rotational ankle fracture,such as pronation-external rotation,and rarely occurs without ankle fracture.The diagnosis is not simple,and ideal management of the various presentations of syndesmotic injury remains controversial to this day.Anatomical restoration and stabilization of the disrupted tibiofibular syndesmosis is essential to improve functional outcomes.In such an injury,including inadequately treated,misdiagnosed and correctly diagnosed cases,a chronic pattern characterized by persistent ankle pain,function disability and early osteoarthritis can result.This paper reviews anatomical and biomechanical characteristics of this syndesmosis,the mechanism of its acute injury associated to fractures,radiological and arthroscopic diagnosis and surgical treatment.展开更多
BACKGROUND Acute injuries to the tibiofibular syndesmosis,often associated with high ankle sprains or malleolar fractures,require precise diagnosis and treatment to prevent long-term complications.This case report exp...BACKGROUND Acute injuries to the tibiofibular syndesmosis,often associated with high ankle sprains or malleolar fractures,require precise diagnosis and treatment to prevent long-term complications.This case report explores the use of needle arthroscopy as a minimally invasive technique for the repair of tibiofibular syndesmosis injuries.CASE SUMMARY We report on a 40-year-old male patient who presented with a trimalleolar fracture and ankle subluxation following a high ankle sprain.Due to significant swelling and poor soft tissue quality,initial management involved external stabilization.Subsequently,needle arthroscopy was employed to assess and treat the tibiofibular syndesmosis injury.The procedure,performed under spinal anesthesia and fluoroscopic control,included nanoscopic evaluation of the ankle joint and reduction of the syndesmosis using a suture button.Follow-up assessments showed significant improvement in pain levels,range of motion,and functional scores.At 26 weeks post-procedure,the patient achieved full range of motion and pain-free status.Needle arthroscopy offers a promising alternative for the management of acute tibiofibular syndesmosis injuries,combining diagnostic and therapeutic capabilities with minimal invasiveness.CONCLUSION This technique may enhance clinical outcomes and reduce recovery times,warranting further investigation and integration into clinical practice.展开更多
目的对比不同入路下微创经皮内固定(Minimally invasive percutaneous plate osteosynthesis,MIPPO)治疗远端胫腓骨骨折(Fracture of tibia and fibula,OTFF)患者的效果。方法选取2020年1月-2022年10月收治的78例远端OTFF患者,按随机数...目的对比不同入路下微创经皮内固定(Minimally invasive percutaneous plate osteosynthesis,MIPPO)治疗远端胫腓骨骨折(Fracture of tibia and fibula,OTFF)患者的效果。方法选取2020年1月-2022年10月收治的78例远端OTFF患者,按随机数字表法分成A组(n=39)、B组(n=39)。两组均行MIPPO治疗,A组接受前外侧入路,B组接受常规入路。对比两组手术效果、手术指标、手术前后美国矫形足踝协会评分系统(AOFAS)踝-足评分量表评分、应激指标[P物质(SP)、白细胞介素-6(IL-6)、前列腺素E2(PGE2)、降钙素原(PCT)]水平、并发症发生率。结果A组手术优良率97.44%(38/39),较B组79.49%(31/39)高(P<0.05);术后1个月、3个月A组AOFAS评分较B组高(P<0.05);A组骨折愈合耗时较B组短,术中失血量较B组少(P<0.05);术后1 d、3 d A组血清SP、IL-6、PGE2、PCT水平较B组低(P<0.05);A组并发症发生率2.56%(1/39),较B组20.51%(8/39)低(P<0.05)。结论与常规入路MIPPO治疗远端OTFF患者相比,应用前外侧入路MIPPO治疗于优化手术指标、减少并发症、提升手术效果、改善踝关节功能方面更具优势,且对机体产生应激影响更小。展开更多
目的:探讨右美托咪定超前镇痛对老年胫腓骨骨折患者镇痛效果的影响。方法:选择2021年1月—2023年1月盘州市第二人民医院收治的82例老年胫腓骨骨折患者作为研究对象,按随机数表法将其分为对照组和观察组,各41例。观察组于切皮前15 min开...目的:探讨右美托咪定超前镇痛对老年胫腓骨骨折患者镇痛效果的影响。方法:选择2021年1月—2023年1月盘州市第二人民医院收治的82例老年胫腓骨骨折患者作为研究对象,按随机数表法将其分为对照组和观察组,各41例。观察组于切皮前15 min开始给予右美托咪定超前镇痛直至手术结束,对照组给予相同剂量的生理盐水,两组术后均采用自控静脉镇痛(PCIA)。比较两组镇静效果[Ramsay镇静评分法(RSS)]、镇痛效果[视觉模拟评分法(VAS)]、血清疼痛介质[前列腺素E2(PGE2)、P物质(SP)、缓激肽(BK)]水平、术后48 h PCIA用药量、PCIA按压次数及不良反应。结果:用药前(T1)、用药30 min(T4),两组RSS评分比较,差异无统计学意义(P>0.05);用药10 min(T2)、用药20 min(T3)、用药30 min(T4),两组RSS评分高于T1,但观察组仅T2、T3 RSS评分高于对照组,差异有统计学意义(P<0.05)。术前,两组VAS评分比较,差异无统计学意义(P>0.05);观察组术后12 h、24 h VAS评分高于术前,但观察组低于对照组,观察组术后48 h VAS评分低于术前与对照组,但对照组术后12 h、24 h、48 h VAS评分高于术前,差异有统计学意义(P<0.05)。术前,两组血清疼痛介质水平比较,差异无统计学意义(P>0.05);术后12 h、24 h、48 h,观察组血清PGE2、SP及BK水平低于对照组,差异有统计学意义(P<0.05)。观察组术后48 h PCIA用药量及PCIA按压次数少于对照组,差异有统计学意义(P<0.05)。观察组不良反应发生率低于对照组,差异有统计学意义(P<0.05)。结论:老年胫腓骨骨折患者使用右美托咪定超前镇痛效果良好,可有效镇痛、镇静,减少术后PCIA用药量、PCIA按压次数及不良反应发生情况。展开更多
基金The Subject Leadership Project of Shanghai Pudong New Area,No.PWRd2016-06the Featured Clinical Discipline Project of Shanghai Pudong,No.PWYts2018-03.
文摘BACKGROUND Fat embolism syndrome(FES)is a rare disease characterized by pulmonary distress,neurologic symptoms,and petechial rash and seriously threatens human life and health.It is still neglected clinically because of the lack of verifiable diagnostic criteria and atypical clinical symptoms.No studies on FES with pulmonary embolism(PE)and tympanic membrane perforation have been reported to date.Here,we report a rare case of concomitant FES,PE and tympanic membrane perforation after surgery in a patient with a tibiofibular fracture.CASE SUMMARY A 39-year-old man presented with right lower extremity pain due to a car accident while driving a motorbike on the road.X-ray and computed tomography scans revealed a fracture of the right mid-shaft tibia and proximal fibula categorized as a type A2 fracture according to the AO classification.A successful minimally invasive operation was performed 3 d after the injury.Postoperatively,the patient developed sudden symptoms of respiratory distress and hearing loss.Early diagnosis was made,and supportive treatments were used at the early stage of FES.Seven days after surgery,he presented a clear recovery from respiratory symptoms.The outcome of fracture healing was excellent,and his hearing of the left ear was mildly impaired at the last follow-up of 4 mo.CONCLUSION Concomitant FES,PE and tympanic membrane perforation are very rare but represent potentially fatal complications of trauma or orthopedic surgery and present with predominantly pulmonary symptoms.Early diagnosis and treatment can reduce the mortality of FES,and prevention is better than a cure.
文摘A stable and precise articulation of the distal tibiofibular syndesmosis maintains the tibiofibular relationship,and it is essential for normal motion of the ankle joint.The disruption of this joint is frequently accompanied by rotational ankle fracture,such as pronation-external rotation,and rarely occurs without ankle fracture.The diagnosis is not simple,and ideal management of the various presentations of syndesmotic injury remains controversial to this day.Anatomical restoration and stabilization of the disrupted tibiofibular syndesmosis is essential to improve functional outcomes.In such an injury,including inadequately treated,misdiagnosed and correctly diagnosed cases,a chronic pattern characterized by persistent ankle pain,function disability and early osteoarthritis can result.This paper reviews anatomical and biomechanical characteristics of this syndesmosis,the mechanism of its acute injury associated to fractures,radiological and arthroscopic diagnosis and surgical treatment.
文摘BACKGROUND Acute injuries to the tibiofibular syndesmosis,often associated with high ankle sprains or malleolar fractures,require precise diagnosis and treatment to prevent long-term complications.This case report explores the use of needle arthroscopy as a minimally invasive technique for the repair of tibiofibular syndesmosis injuries.CASE SUMMARY We report on a 40-year-old male patient who presented with a trimalleolar fracture and ankle subluxation following a high ankle sprain.Due to significant swelling and poor soft tissue quality,initial management involved external stabilization.Subsequently,needle arthroscopy was employed to assess and treat the tibiofibular syndesmosis injury.The procedure,performed under spinal anesthesia and fluoroscopic control,included nanoscopic evaluation of the ankle joint and reduction of the syndesmosis using a suture button.Follow-up assessments showed significant improvement in pain levels,range of motion,and functional scores.At 26 weeks post-procedure,the patient achieved full range of motion and pain-free status.Needle arthroscopy offers a promising alternative for the management of acute tibiofibular syndesmosis injuries,combining diagnostic and therapeutic capabilities with minimal invasiveness.CONCLUSION This technique may enhance clinical outcomes and reduce recovery times,warranting further investigation and integration into clinical practice.
文摘目的对比不同入路下微创经皮内固定(Minimally invasive percutaneous plate osteosynthesis,MIPPO)治疗远端胫腓骨骨折(Fracture of tibia and fibula,OTFF)患者的效果。方法选取2020年1月-2022年10月收治的78例远端OTFF患者,按随机数字表法分成A组(n=39)、B组(n=39)。两组均行MIPPO治疗,A组接受前外侧入路,B组接受常规入路。对比两组手术效果、手术指标、手术前后美国矫形足踝协会评分系统(AOFAS)踝-足评分量表评分、应激指标[P物质(SP)、白细胞介素-6(IL-6)、前列腺素E2(PGE2)、降钙素原(PCT)]水平、并发症发生率。结果A组手术优良率97.44%(38/39),较B组79.49%(31/39)高(P<0.05);术后1个月、3个月A组AOFAS评分较B组高(P<0.05);A组骨折愈合耗时较B组短,术中失血量较B组少(P<0.05);术后1 d、3 d A组血清SP、IL-6、PGE2、PCT水平较B组低(P<0.05);A组并发症发生率2.56%(1/39),较B组20.51%(8/39)低(P<0.05)。结论与常规入路MIPPO治疗远端OTFF患者相比,应用前外侧入路MIPPO治疗于优化手术指标、减少并发症、提升手术效果、改善踝关节功能方面更具优势,且对机体产生应激影响更小。
文摘目的:探讨右美托咪定超前镇痛对老年胫腓骨骨折患者镇痛效果的影响。方法:选择2021年1月—2023年1月盘州市第二人民医院收治的82例老年胫腓骨骨折患者作为研究对象,按随机数表法将其分为对照组和观察组,各41例。观察组于切皮前15 min开始给予右美托咪定超前镇痛直至手术结束,对照组给予相同剂量的生理盐水,两组术后均采用自控静脉镇痛(PCIA)。比较两组镇静效果[Ramsay镇静评分法(RSS)]、镇痛效果[视觉模拟评分法(VAS)]、血清疼痛介质[前列腺素E2(PGE2)、P物质(SP)、缓激肽(BK)]水平、术后48 h PCIA用药量、PCIA按压次数及不良反应。结果:用药前(T1)、用药30 min(T4),两组RSS评分比较,差异无统计学意义(P>0.05);用药10 min(T2)、用药20 min(T3)、用药30 min(T4),两组RSS评分高于T1,但观察组仅T2、T3 RSS评分高于对照组,差异有统计学意义(P<0.05)。术前,两组VAS评分比较,差异无统计学意义(P>0.05);观察组术后12 h、24 h VAS评分高于术前,但观察组低于对照组,观察组术后48 h VAS评分低于术前与对照组,但对照组术后12 h、24 h、48 h VAS评分高于术前,差异有统计学意义(P<0.05)。术前,两组血清疼痛介质水平比较,差异无统计学意义(P>0.05);术后12 h、24 h、48 h,观察组血清PGE2、SP及BK水平低于对照组,差异有统计学意义(P<0.05)。观察组术后48 h PCIA用药量及PCIA按压次数少于对照组,差异有统计学意义(P<0.05)。观察组不良反应发生率低于对照组,差异有统计学意义(P<0.05)。结论:老年胫腓骨骨折患者使用右美托咪定超前镇痛效果良好,可有效镇痛、镇静,减少术后PCIA用药量、PCIA按压次数及不良反应发生情况。
