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Re-Contouring Interpositional Gap Arthroplasty with Ramus Height Preservation for Treatment of Temporomandibular Joint Ankylosis: Case Report (New Technique) 保留关节支高度的再轮廓间隙置换术治疗颞下颌关节强直1例(新技术)
IF 0.5 Q4 EMERGENCY MEDICINE Pub Date : 2020-01-01 DOI: 10.30491/TM.2020.214021.1040
F. Akhlaghi, M. Majd
Background: Ankylosis of the temporomandibular joint (TMJ) is an intracapsular union between the mandibular condylar disc and the temporal articular surface that restricts mandibular functions. The management of TMJ ankylosis requires minimally invasive methods. Objectives: This study aims to present a new surgical method for restoring ramus height as much as possible after condylectomy of the TMJ due to ankylosis. Case Prsentation: Two patients with TMJ ankylosis participated in this investigation. Patients’ preoperative maximal mouth openings were 3 mm and 9 mm. A new method was used to separate the bony fusion between the condyle and the glenoid fossa. Then, the condylar head on the mandibular ramus was recontoured, and finally the temporalis musculofascial flap was employed as an interpositional graft. Patients were followed for six months. Both surgeries were performed at the Department of Oral and Maxillofacial Surgery of Taleghani Hospital, Shahid Beheshti University of Medical Science, Tehran, Iran. Results: Both patients had an average maximal mouth opening of 35-40 mm postoperatively. Conclusion: In patients who have TMJ ankylosis   the excessive bone between the condyle and the zygomatic arch can be removed by releasing the ankylotic site followed by routine gap arthroplasty so that the ramus becomes shorter than the other side. With this method, however, the condylar head is also recontoured, thus preserving more ramus length than with other techniques; future orthognatic surgery or distraction osteogenesis (DO), if necessary, will also be easier.
背景:颞下颌关节强直(TMJ)是下颌髁突椎间盘与颞关节面之间的囊内愈合,限制了下颌功能。TMJ强直的治疗需要微创方法。目的:本研究旨在提出一种新的手术方法,以尽可能地恢复关节强直后的关节支高度。病例介绍:2例颞下颌关节强直患者参与了本研究。患者术前最大开口分别为3mm和9mm。采用一种新的方法分离髁突与关节盂窝之间的骨融合。然后对下颌支的髁突头进行整形,最后采用颞肌筋膜瓣作为间位移植物。患者随访6个月。两例手术均在伊朗德黑兰Shahid Beheshti医科大学Taleghani医院口腔颌面外科进行。结果:两例患者术后平均最大开口35 ~ 40mm。结论:对于颞下颌关节强直患者,可通过解除强直部位后常规间隙关节置换术去除髁突与颧弓之间过多的骨,使支比另一侧短。然而,使用这种方法,髁头也被重塑,因此比其他技术保留了更多的分支长度;如果有必要,将来的正颌手术或牵张成骨术(DO)也会更容易。
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引用次数: 0
Pain Management in a Case of Severe Electrocution Injury and Resultant Quadruple Amputation 1例严重触电伤致四肢截肢的疼痛处理
IF 0.5 Q4 EMERGENCY MEDICINE Pub Date : 2019-11-01 DOI: 10.30491/TM.2019.104266
Shigong Guo, M. Moiz, D. H. Slater
Background: A 33-year-old patient presented to the Oxford Centre for Enablement for rehabilitation following severe electrical burn injuries requiring bilateral below elbow amputations, right below knee amputation and a left midfoot amputation. Specific issues: Chronic pain at the amputation sites as well as phantom limb initially proved challenging to manage medically however were eventually controlled with careful consideration of analgesic regimens. Pain was measured using the Numeric Pain Rating Scale. A likely attributing cause for the pain was peripheral neuropathy. Management: A combination of neuropathic agents and opioids helped to control pain. These analgesic included amitriptyline, gabapentin, pregabalin, tramadol and morphine in various regimens. Paracetamol and ibuprofen were also used. Implications: Rigorous search strategies were created which interrogated the MEDLINE, EMBASE, CINAHL, PsycINFO databases for studies reporting limb pain management in electrocution injuries. A total of 841 studies were found with 583 screened after removal of duplicates. No RCTs could be identified investigating limb pain management in electrical injuries. Case reports and case series have described various treatment options including nerve blocks, neuropathic analgesia, physiotherapy, botulinum toxin, fracture fixation and even the use of Virtual Reality headsets.  We discuss this available evidence. No consensus exists as to the optimum management approach of pain in such patients. From our experience with this patient we suggest that a multi- modal analgesic approach is likely to be needed in such patients and should therefore be considered. Level 1 research into pain management in electrocution injuries is required.
背景:一名33岁的患者在严重电烧伤后,需要双侧肘部以下截肢,右膝以下截肢和左足中部截肢,随后来到牛津康复中心接受康复治疗。具体问题:截肢部位的慢性疼痛以及幻肢最初证明具有挑战性,但最终通过仔细考虑镇痛方案得到控制。疼痛采用数字疼痛评定量表进行测量。疼痛的可能原因是周围神经病变。治疗方法:神经病变药物和阿片类药物联合使用有助于控制疼痛。这些镇痛药包括阿米替林、加巴喷丁、普瑞巴林、曲马多和吗啡。还使用了扑热息痛和布洛芬。意义:建立了严格的搜索策略,查询MEDLINE, EMBASE, CINAHL, PsycINFO数据库,以报告触电损伤中肢体疼痛管理的研究。共发现841项研究,剔除重复项后筛选出583项。未发现调查电损伤肢体疼痛管理的随机对照试验。病例报告和病例系列描述了各种治疗方案,包括神经阻滞、神经性镇痛、物理治疗、肉毒杆菌毒素、骨折固定,甚至使用虚拟现实耳机。我们讨论这些现有的证据。对于此类患者疼痛的最佳治疗方法尚无共识。根据我们对这名患者的经验,我们建议在这类患者中可能需要多模式镇痛方法,因此应予以考虑。一级研究的疼痛管理在触电伤害是必需的。
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引用次数: 0
Cubital Tunnel Syndrome: An Entrapment Neuropathy Which May Arise from Vascular Malformation 肘管综合征:一种可能由血管畸形引起的压迫性神经病
IF 0.5 Q4 EMERGENCY MEDICINE Pub Date : 2019-11-01 DOI: 10.30491/TM.2019.104267
M. Emamhadi, S. Yousefzadeh-Chabok, Alireza Mehrvarz, S. Andalib
Vascular malformation as a cause of cubital tunnel syndrome has not yet been reported. Cubital tunnel syndrome (CuTS), the most common entrapment neuropathy of the ulnar nerve at elbow level, is also the second most common entrapment neuropathy in the upper extremity, regardless of carpal tunnel syndrome. Here, we report CuTS due to vascular malformation in a 63-year-old woman. The ulnar nerve at the distal part of tunnel was markedly compressed. There was no connection between the lesion and the ulnar nerve. The diagnosis was made by using histopathology, and thereafter the lesion was fully resected. Pain in her ring and little fingers disappeared one month after resection of the malformation.
血管畸形作为肘管综合征的病因尚未见报道。肘管综合征(CuTS)是最常见的肘部水平尺神经卡压神经病,也是上肢第二常见的卡压神经病,与腕管综合征无关。在此,我们报告一位63岁女性因血管畸形导致的切口。隧道远端尺神经明显受压。病变和尺神经之间没有联系。通过组织病理学进行诊断,然后完全切除病变。术后1个月无名指和小指疼痛消失。
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引用次数: 0
Correlation between Post-Operation Center-Trochanteric Distance (CTD) and Tip Apex Distance (TAD) changes in Intertrochanteric Fractures Treated by Dynamic Hip Screw 动力髋螺钉治疗股骨粗隆间骨折术后中心-粗隆距离(CTD)和尖端距离(TAD)变化的相关性
IF 0.5 Q4 EMERGENCY MEDICINE Pub Date : 2019-11-01 DOI: 10.30491/TM.2019.104271
A. Ebrahimpour, A. Karimi, M. Sadighi, M. Sajjadi, M. Okhovatpour, A. Irani, R. Zandi
Background: One of the most common injuries and an important cause of mortality and morbidity in the elderly is intertrochanteric fracture. The dynamic hip screw (DHS) is one of the best procedures for fixation of these fractures; however, using DHS is accompanied by failure risk. Objectives: Therefore, with the purpose of reducing failure risk, this study aimed to evaluate the correlation between post-operation CTD and TAD, NSA changes in patients with intertrochanteric fractures. Methods: In this case series study, patients with intertrochanteric fracture treated with DHS between September 2015 and January 2016 were included. The exclusion criteria were pathologic fracture, multiple fractures, greater trochanter fracture, soft-tissue issues, A3OTA type, patients who missed the follow-up period, history of previous hip fracture or dislocation, and TAD>25mm. Ultimately, 24 patients were included in this study. Two surgeons reviewed the anteroposterior (AP) and lateral (Lat) radiographs. The measures of TAD, CTD, and NSA after six-months of follow-up were assessed. In addition, variables such as demographic data, fracture side, duration of operation, blood loss volume, weight bearing day, and Harris hip score (HHS) were analyzed. The relationship between post-operation CTD and TAD, NSA changes after six months of follow-up was analyzed. All data was analyzed using SPSS 20 software (SPSS, IBM Inc., USA). The significance level for all tests was considered to be 0.05. Results: This study evaluated 24 patients. The mean age of the patients was 69.9 ± 12.00 years, and 15 (62.5%) of them were male. No significant correlations were seen in the collected data, especially CTD and NSA changes after six-months of follow-up (p>0.05). Maximum and minimum TAD values after surgery were 25.6 and 11.0, respectively. Maximum and minimum TAD values at the six-month follow-up were 34.9 and 11.0, respectively. Mean TAD was constant at 19.8±5.3 in postoperative and follow-up measurements. This shows that patients experienced increases in TAD and others experienced decreases in TAD within the six months of follow-up. Conclusion: The results showed that despite the abnormal CTD after surgery, the risk of TAD changes increased. Generally, TAD is a well-established radiographic measurement for predicting the risk of cut-out. CTD and TAD can be used together or separately to predict the risk of DHS screw cut-out in patients with intertrochanteric fractures in future studies.
背景:股骨粗隆间骨折是老年人最常见的损伤之一,也是死亡率和发病率的重要原因。动态髋螺钉(DHS)是固定这些骨折的最佳方法之一;然而,使用DHS伴随着故障风险。目的:为了降低手术失败的风险,本研究旨在评价粗隆间骨折患者术后CTD与TAD、NSA变化的相关性。方法:本病例系列研究纳入2015年9月至2016年1月期间接受DHS治疗的股骨粗隆间骨折患者。排除标准为病理性骨折、多发骨折、大转子骨折、软组织问题、A3OTA型、错过随访期、既往髋部骨折或脱位史、TAD>25mm。最终,24名患者被纳入本研究。两位外科医生检查了正位(AP)和侧位(Lat) x线片。随访6个月后评估TAD、CTD、NSA指标。此外,还分析了人口统计学数据、骨折侧面、手术时间、出血量、负重日、Harris髋关节评分(HHS)等变量。术后随访6个月,分析CTD与TAD、NSA变化的关系。所有数据采用SPSS 20软件(SPSS, IBM Inc., USA)进行分析。所有检验的显著性水平被认为是0.05。结果:本研究评估了24例患者。患者平均年龄69.9±12.00岁,男性15例(62.5%)。随访6个月后CTD、NSA变化差异无统计学意义(p>0.05)。术后TAD最大值为25.6,最小值为11.0。6个月随访时最大TAD值为34.9,最小TAD值为11.0。术后和随访的平均TAD恒定在19.8±5.3。这表明,在六个月的随访中,患者的TAD增加,而其他人的TAD减少。结论:尽管术后CTD异常,但TAD改变的风险增加。一般来说,TAD是一种公认的用于预测切割风险的放射学测量方法。在未来的研究中,CTD和TAD可联合或单独用于预测股骨粗隆间骨折患者DHS螺钉切开的风险。
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引用次数: 0
Lessons Learned; Hospital Emergency Evacuation in Ilam, Iran 经验教训;伊朗伊拉姆的医院紧急疏散
IF 0.5 Q4 EMERGENCY MEDICINE Pub Date : 2019-11-01 DOI: 10.30491/TM.2019.104265
E. Shafiei, Kosar Yousefi, Ali Sahebi
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引用次数: 3
Motorcycling adolescents as child neglect: A health emergency in Iran 骑摩托车的青少年被视为儿童忽视:伊朗的卫生紧急情况
IF 0.5 Q4 EMERGENCY MEDICINE Pub Date : 2019-11-01 DOI: 10.30491/TM.2019.104264
H. Seddighi, I. Salmani, H. Sajjadi
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引用次数: 0
Post-traumatic Intradiploic Leptomeningeal Cyst in Adult: A Case Report and Mini-Review of Literature 成人外伤性网膜内轻脑膜囊肿1例报告及文献复习
IF 0.5 Q4 EMERGENCY MEDICINE Pub Date : 2019-11-01 DOI: 10.30491/TM.2019.104268
Hossein Ghalaenovi, N. Eshraghi, A. Fattahi, M. Benam
Post-traumatic intradiploic leptomeningeal cyst (IDPTLC) manifests as an internal table disruption of the skull concomitant with a dural defect and intact external table after a previous skull fracture. It is very rare, especially in adults. We present a 30-year-old male with right occipital IDPTLC treated with duraplasty with allograft and cranioplasty with autograft ribs. Seventeen cases of IDPTLC in adulthood since 1978 were found in the literature; to the best of our knowledge, ours is the eighteenth case. Considering the possible etiology at the time of the first trauma, torn dura matter was not healed and retracted overtime. Also due to intracranial CSF pulsation, the disrupted inner table was widened and continuous force on the diploe caused a thinned swollen external table. We recommended performing overlying cranioplasty with autologous bone (rib or normal external table) with the edge of the duraplasty and the cranioplasty placed at different sites.
外伤性脑脊膜内轻脑膜囊肿(IDPTLC)表现为颅骨内壁破裂,伴硬脑膜缺损和颅骨外壁完整。这是非常罕见的,尤其是在成人中。我们报告一例30岁男性右枕部IDPTLC,采用同种异体硬脑膜成形术和自体肋骨颅骨成形术治疗。自1978年以来,文献中发现17例成人IDPTLC;据我们所知,我们的案例是第十八起。考虑到第一次创伤时可能的病因,撕裂的硬脑膜没有愈合,并随着时间的推移而缩回。同样由于颅内脑脊液的脉动,破裂的内表被加宽,持续的力作用于偶板造成外表变薄肿胀。我们建议使用自体骨(肋骨或正常外表)进行复盖颅骨成形术,硬脑膜成形术的边缘和颅骨成形术放置在不同的位置。
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引用次数: 0
Job Stress and Job Burnout Based on Personality Traits among Emergency Medical Technicians 基于人格特质的急救医务人员工作压力与职业倦怠
IF 0.5 Q4 EMERGENCY MEDICINE Pub Date : 2019-11-01 DOI: 10.30491/TM.2019.104270
M. Bahadori, R. Ravangard, M. Raadabadi, S. Hosseini-Shokouh, M. Behzadnia
Background: Emergency medical services employees, the first people providing pre-hospital services for critically ill or injured patients, are constantly exposed to many stressful factors that can lead to job burnout in the long run. The level of job burnout varies according to employees' personality traits. Objectives: The present study aimed to investigate job stress and job burnout based on the personality traits of emergency medical service technicians of the Tehran Disaster and Emergency Medical Management Center. Methods: This cross-sectional, descriptive study was conducted in 2018 on all operational staff of the Tehran Disaster and Emergency Medical Management Center (N = 1551). A sample of 308 personnel was selected using the stratified random sampling method proportional to size and simple random sampling method. The required data was collected using a four-part questionnaire which measured demographic characteristics and included the Health and Safety Executive Job Stress Questionnaire, the Maslach Burnout Questionnaire, and the revised Costa and McCrae NEO Five-Factor Inventory (NEO-FFI). The collected data was analyzed using SPSS 22.0. Results: Reducing exhaustion, job stress, and neuroticism and strengthening conscientiousness and agreeableness among emergency medical services employees are very important issues. Reducing working hours, examining factors of dissatisfaction and stressors in the workplace, and improving welfare facilities can decrease job burnout among employees. Moreover, the heads and managers of pre-hospital emergency services should plan to provide continuous training in stress management skills at emergency bases in order to reduce job stress among employees.
背景:紧急医疗服务人员是为危重病人或受伤病人提供院前服务的第一批人,他们经常面临许多压力因素,从长远来看,这些因素可能导致工作倦怠。工作倦怠的程度因员工的人格特征而异。目的:本研究旨在探讨德黑兰灾害与急救医疗管理中心急救医疗技术人员的工作压力与工作倦怠。方法:本横断面描述性研究于2018年对德黑兰灾难和紧急医疗管理中心的所有业务人员(N = 1551)进行。采用按人数比例分层随机抽样和简单随机抽样相结合的方法,抽取308人。所需要的数据是通过四部分问卷收集的,该问卷测量了人口统计学特征,包括健康与安全行政人员工作压力问卷、Maslach职业倦怠问卷和修订的Costa和mcrae NEO五因素量表(NEO- ffi)。收集的数据采用SPSS 22.0进行分析。结果:减少急救医务人员的疲劳、工作压力和神经质,增强责任心和亲和力是急救医务人员必须解决的重要问题。减少工作时间,检查工作场所的不满和压力因素,改善福利设施可以减少员工的工作倦怠。此外,院前急救服务的主管和管理人员应计划在急救基地持续提供压力管理技能培训,以减少雇员的工作压力。
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引用次数: 7
Psychometric Evaluation of the Safe Road-crossing Behaviors Scale: A Study among Iranian University Students 伊朗大学生安全过马路行为量表的心理测量评价
IF 0.5 Q4 EMERGENCY MEDICINE Pub Date : 2019-11-01 DOI: 10.30491/TM.2019.104269
M. M. Alavijeh, B. Hamzeh, Raziyeh Piroozeh, F. Jalilian
Background: Millions of pedestrians are seriously injured, disabled, or lose their lives in road traffic accidents annually. The availability of a standard scale specifically for predicting road-crossing behaviors would be beneficial in research applications and in tailoring interventions. Objectives: The purpose of the current research was to psychometrically evaluate the safe road-crossing behaviors scale based on the Prototype Willingness Model (PWM) among college students. Methods: In this cross-sectional study, a purposive and multi-stage sampling method was used to select 315 students from Kermanshah University of Medical Sciences (KUMS) during 2018. The studied social-cognitive determinants from the PWM included attitude, subjective norms, prototype, intention, and willingness. Participants completed a written self-report questionnaire. Data was analyzed using SPSS (ver. 20.0). Exploratory factor analysis (EFA) with VARIMAX rotation was applied to determine the number and composition of constructs. Results: Five factors were extracted. The calculated Kaiser–Meyer–Olkin (KMO) value was 0.806. Overall, the PWM constructs explained 64.39% of the variance in the hypothesized model. Cronbach’s alpha for the measured constructs of attitude, subjective norms, prototype, intention, and willingness were 0.87, 0.81, 0.68, 0.71, and 0.61, respectively. Conclusion: The present study provides some support from among students at an Iranian university for the internal validity and reliability of the safe road-crossing behaviors scale. This scale could be used in planning interventions for the promotion of safe road-crossing behaviors among pedestrians.
背景:每年有数百万行人在道路交通事故中严重受伤、致残或丧生。提供一个专门用于预测过马路行为的标准量表,将有利于研究应用和定制干预措施。目的:利用原型意愿模型(PWM)对大学生安全过马路行为量表进行心理测量学评价。方法:采用横断面研究方法,采用有目的的多阶段抽样方法,对2018年克尔曼沙阿医科大学315名学生进行抽样调查。研究的社会认知决定因素包括态度、主观规范、原型、意图和意愿。参与者完成了一份书面自我报告问卷。数据采用SPSS (ver.)进行分析。20.0)。应用VARIMAX旋转探索性因子分析(EFA)确定构建体的数量和组成。结果:提取出5个因素。计算的KMO值为0.806。总体而言,PWM结构解释了假设模型中64.39%的方差。被测态度、主观规范、原型、意图和意愿构式的Cronbach’s alpha分别为0.87、0.81、0.68、0.71和0.61。结论:本研究对伊朗某高校学生安全过马路行为量表的内部效度和信度提供了一定的支持。该量表可用于规划促进行人安全过马路行为的干预措施。
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引用次数: 1
Comparison of Periodontium Reaction to Fixation of Mandibular Fractures with and Without Erich Arch Bars 下颌骨折用与不用Erich弓棒固定时牙周组织反应的比较
IF 0.5 Q4 EMERGENCY MEDICINE Pub Date : 2019-09-01 DOI: 10.5812/TRAUMAMON.87872
Erich Arch Bars, M. Ghavimi, Milad Ghanizadeh, M. Alipour
Background: There are two general types of fixation methods used in mandibular fractures and osteotomy: closed fixation method with Erich arch bars and the open fixation method (without Erich arch bars). Periodontium inflammation, following mandibular fixation methods, is a complication of the healing period.Objectives: The current study aimed at evaluating and comparing periodontium reaction to fixation of mandibular fractures with and without Erich arch bars.Methods: This cross-sectional study was carried out on 48 patients with mandibular fractures. Twenty-four patients were treated with close method and Erich arch bars and 24 patients with open method and without Erich arch bars. Periodontium clinical indices, including plaque index (PI), gingival index (GI), bleeding on probing (BOP), and probing pocket depth (PPD), were measured immediately before the surgery and four, six, and eight weeks later.Results: After four, six, and eight weeks, subjects with arch bars had significantly greater PI, GI, and PPD (P value 0.001).Conclusions: According to the results, the use of Erich arch barsmore decreased periodontium status compared to the other group.
背景:下颌骨骨折截骨常用的固定方法有两种:带Erich弓棒的封闭式固定方法和不带Erich弓棒的开放式固定方法。牙周炎,继下颌固定方法,是一个并发症的愈合期。目的:本研究旨在评估和比较使用和不使用Erich弓棒固定下颌骨骨折时牙周组织的反应。方法:对48例下颌骨骨折患者进行横断面研究。24例采用闭式法加Erich弓棒治疗,24例采用开式法不加Erich弓棒治疗。牙周组织临床指标,包括牙菌斑指数(PI)、牙龈指数(GI)、探诊出血(BOP)和探诊袋深度(PPD),分别在手术前和术后4、6、8周进行测量。结果:在4周、6周和8周后,弓形棒组受试者的PI、GI和PPD显著增加(P值0.001)。结论:与对照组相比,使用Erich牙周弓能明显降低牙周组织状况。
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引用次数: 0
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Trauma monthly
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