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OBJECTIVE: To explore the effect of collaborative nursing based on Roy Adaptive Mode (RAM) on postoperative functional reconstruction, soft tissue pain and quality of life in patients with femoral intertrochanteric fracture. METHODS: A retrospective matched control method was used in this study. A total of 96 patients with femoral intertrochanteric fracture admitted to our hospital from July 2018 to September 2021 were selected. According to different nursing methods, the patients were divided into a collaborative group and a routine group, with 48 cases in each group. Patients in both groups were treated with intramedullary nail surgery. The routine group was given routine perioperative nursing intervention, and the collaborative group was given collaborative nursing intervention on this basis. The hip function recovery and quality of life before and after the intervention were compared between the two groups. The preoperative and postoperative pain degree, and the perioperative complications of the two groups were recorded. Logistic multivariate regression analysis was used to analyze the risk factors affecting the recovery of hip joint function in patients with femoral intertrochanteric fracture after operation, thereby constructing a risk prediction model. ROC curve was used to analyze the clinical value of influencing factors in predicting postoperative hip function recovery in patients with femoral intertrochanteric fracture. RESULTS: Harris score each dimension after intervention in the collaborative group was obviously higher than that of before intervention and the conventional group (P < 0.05). After intervention, the excellent and good rate of hip joint function the collaborative group was 83.33%, which was significantly higher than 60.42% in the routine group (P < 0.05). Postoperative VAS scores each time point in the collaborative group was obviously lower than that in the routine group (P < 0.05). After intervention, the scores of physiological function, physiological role, body pain and general health in the collaborative group were significantly higher than those in the routine group (P < 0.05). The incidence of complications in the collaborative group was 6.25%, which was significantly lower than 22.92% in the routine group (P < 0.05). There were statistically significant differences in age, preoperative ASA grade, internal fixation method, osteoporosis grade and perioperative nursing methods between the excellent hip recovery group and the poor hip recovery group (P < 0.05). Logistic multivariate regression analysis showed that age, preoperative ASA grade, internal fixation method and osteoporosis grade were the risk factors affecting the recovery of hip joint function after operation, and perioperative nursing method was the protective factor (P < 0.05). Among the influencing factors, the internal fixation method and the grade of osteoporosis had certain clinical value in predicting the recovery of hip joint function in patients with femoral intertrochanteric fracture after operation. CONCLUSION: The RAM model-based collaborative nursing method may effectively restore the hip joint function of patients with femoral intertrochanteric fracture after operation, and may reduce the perioperative pain degree of patients, improve the quality of life of patients and reduce the incidence of complications, which can be popularized and applied in clinical practice. In addition, there are many factors influencing the recovery of hip joint function in patients with femoral intertrochanteric fracture after operation, and targeted measures should be taken according to the influencing factors to improve the effect of intramedullary nail treatment.

Asunto(s)

Fijación Intramedular de Fracturas , Fracturas de Cadera , Dolor Postoperatorio , Calidad de Vida , Recuperación de la Función , Humanos , Femenino , Masculino , Fracturas de Cadera/cirugía , Estudios Retrospectivos , Anciano , Dolor Postoperatorio/etiología , Dolor Postoperatorio/diagnóstico , Dolor Postoperatorio/prevención & control , Persona de Mediana Edad , Fijación Intramedular de Fracturas/métodos , Fijación Intramedular de Fracturas/efectos adversos , Anciano de 80 o más Años , Resultado del Tratamiento , Articulación de la Cadera/cirugía , Articulación de la Cadera/fisiopatología

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Soft tissue musculoskeletal pain disorders are common in the primary care setting. Early recognition and diagnosis of these syndromes minimizes patient pain and disability. This article gives a brief overview of the most common soft tissue musculoskeletal pain syndromes. The authors used a regional approach to organize the material, as providers will encounter these syndromes with complaints of pain referring to an anatomic location. The covered disorders include myofascial pain syndrome, rotator cuff tendinopathy, bicipital tendinopathy, subacromial bursitis, olecranon bursitis, epicondylitis, De Quervain disease, trigger finger, trochanteric bursitis, knee bursitis, pes anserine bursitis, Baker cyst, plantar fasciitis, and Achilles tendinopathy.

Asunto(s)

Enfermedades Reumáticas/diagnóstico , Enfermedades Reumáticas/terapia , Bursitis/diagnóstico , Bursitis/terapia , Diagnóstico Diferencial , Fibromialgia/diagnóstico , Fibromialgia/terapia , Articulación de la Cadera , Humanos , Articulación de la Rodilla , Osteonecrosis/diagnóstico , Osteonecrosis/terapia , Distrofia Simpática Refleja/diagnóstico , Distrofia Simpática Refleja/terapia , Tendinopatía/diagnóstico , Tendinopatía/terapia

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BACKGROUND: Despite the broad differential diagnosis in any patient referring with symptoms involving the chest or abdomen, a small number of conditions overshadow the rest by their probability. Chest and abdominal wall pain continues to constitute a common and expensive overlooked source of pain of unknown cause. In particular, cutaneous nerve entrapment syndrome is commonly encountered but not easily diagnosed unless its specific symptoms are sought and the precise physical examination undertaken. CASE REPORT: A primigravida woman with unbearable abdominal pain was referred repeatedly seeking a solution for her suffering. Numerous laboratory and imaging studies were employed in order to elucidate the cause of her condition. After numerous visits and unnecessary delay, the diagnosis was finally made by a physician fully versed in the field of torso wall pain. The focused physical examination disclosed abdominal cutaneous nerve entrapment syndrome as the diagnosis, and anesthetic infiltration led to immediate alleviation of her pain. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Cutaneous nerve entrapment is a common cause of abdominal pain that is reached on the basis of thorough history and physical examination alone. Knowledge dissemination of the various torso wall syndromes is imperative for prompt delivery of suitable care. All emergency physicians should be fully aware of this entity because the diagnosis is based solely on physical examination, and immediate relief can be provided in the framework of the first visit. Wider recognition of this syndrome will promise that such mishaps are not repeated in the future.

Asunto(s)

Dolor Abdominal/etiología , Síndromes de Compresión Nerviosa/diagnóstico , Pared Abdominal/inervación , Pared Abdominal/fisiopatología , Femenino , Número de Embarazos , Humanos , Síndromes de Compresión Nerviosa/complicaciones , Embarazo , Adulto Joven

RESUMEN

OBJECTIVE: To demonstrate the importance of recognizing and separating nonmedian nerve-related symptoms from those related to median nerve compression at the carpal tunnel. METHODS: The records of 80 patients, aged 31-82 years (39 males and 41 females), who had undergone median nerve decompression using open and endoscopic release surgery, were reviewed. Peripheral electrodiagnostic studies were performed in all patients prior to surgery. Those whose nonmedian nerve-related symptoms, also known as musculoskeletal and soft tissue pain and tenderness, persisted postoperatively, were referred to another electrodiagnostic study to reassess the median nerve function at the carpal tunnel. Peripheral electrodiagnostic studies were deemed unnecessary for patients with exclusively median nerve-related symptoms who improved dramatically following surgery. Included from the study were cases whose presenting symptoms were primarily referrable to median nerve dysfunction with or without associated musculoskeletal pain. Cases that were excluded were those whose symptoms were related to various primary conditions. Outcome of surgery was reviewed and correlated with symptoms related to median nerve compression and musculoskeletal irritation, and with electrodiagnostic abnormalities. RESULTS: Complete resolution of symptoms, following surgery, occurred in patients with clinical and electrophysiologic signs of median nerve compression but without significant symptoms of musculoskeletal irritation. Those with concurrent and prominent musculoskeletal and soft tissue pain had variable results, both favorable and unfavorable, including three who developed signs and symptoms of complex regional pain syndrome. CONCLUSION: The symptoms related to median nerve compression at the carpal tunnel and the symptoms related to musculoskeletal and soft tissue irritation are two different symptom complexes that have important diagnostic and therapeutic considerations. We would like to propose that "true carpal tunnel syndrome" symptoms, those that are exclusively median nerve related, should be considered a distinct entity. When musculoskeletal and soft tissue pain is more prominent and dominates the overall clinical presentation, the term "mechanical stress syndrome" is more appropriate.

RESUMEN

Objective To explore the reliability and validity of the Chinese version of the 36-item Short Form Health Survey (SF-36) for evaluating the health-related quality of life of patients with chronic soft tissue pain, (CSTP). Methods Two hundred and ten CSTP patients were rated with the SF-36 and the Medical Outcomes Study Pain Measurement (MOSPM) instrument and retested 2 weeks later. The internal consistency, test-retest relia-bility and parallel validity of the SF-36 were analyzed. Results The SF-36 showed good internal consistency and test-retest reliability. Most repeated reliability internal correlation coefficients were between 0.44 and O. 66 (P≤0.01) except that of the SF sub-scale of the SF-36, which was O. 336 (P≤0.05). All the internal consistency Cronbach's a coefficients were >0.70. In the assessment of validity, there was significant correlation among all eight sub-scales of the SF-36, and between items 4-11 and total MOSPM scores. The correlation coefficients were between -0.145 and 0. 635 (P≤0.05 or P≤0.01), except between GH of the SF-36 and item 4 of the M OSPM (pain in-fluence on walking) and between MH and item 10 (pain influence days). Conclusion The Chinese version of the SF-36 has good reliability and validity in assessing the health related quality of life of CSTP patients.