Search

Anterior section of the hip joint capsule is innervated by femoral nerve and obturator nerve, and posterior section is innervated by the nerve to quadratus femoris muscle and occasionally by the superior gluteal (posterolateral region) and sciatic nerve (posterosuperior region). One of the regional anesthesia options for hip surgery is the fascia iliaca compartment block (FICB) that affects nerves important for hip innervation and sensory innervation of the thigh - femoral, obturator and lateral femoral cutaneous nerve. FICB can be easily performed and is often a good solution for management of hip fractures in emergency departments. Its use reduces morphine pre-operative requirement for patients with femoral neck fractures and can also be indicated for hip arthroplasty, hip arthroscopy and burn management of the region. Quadratus lumborum block (QLB ) is a block of the posterior abdominal wall performed exclusively under ultrasound guidance, with still unclarified mechanism of action. When considering hip surgery and postoperative management, the anterior QLB has shown to reduce lengthy hospital stay and opioid use, it improves perioperative analgesia in patients undergoing hip and proximal femoral surgery compared to standard intravenous analgesia regimen, provides early and rapid pain relief and allows early ambulation, thus preventing deep vein thrombosis and thromboembolic complications etc. However, some nerve branches responsible for innervation of the hip joint are not affected by QLB , which has to be taken into consideration. QLB has shown potential for use in hip surgery and perioperative pain management, but still needs to be validated as a reliable treatment approach., Prednji dio čahure zgloba kuka nerviraju n. femoralis i n. obturatorius, dok stražnji dio čahure inervira n. musculi quadratus femoris i povremeno n. glutealis superior (posterolateralni dio) i n. ischiadicus (posterosuperiorni dio). Jedna od mogućnosti za primjenu regionalne anestezije u kirurgiji zgloba kuka je blok odjeljka fascije iliace (FICB), koji zahvaća živce bitne za inervaciju kuka te senzornu inervaciju bedra – n. femoralis, n.obturatorius i n. cutaneus femoris lateralis. FICB se može izvesti relativno jednostavno i predstavlja dobru opciju za zbrinjavanje fraktura kuka u hitnim situacijama. Dokazano je kako smanjuje upotrebu morfija preoperativno u pacijenata s frakturom vrata femura, a može biti indicirani za artroplastiku kuka, artroskopije kuka te sanaciju opeklina u regiji bedra. Quadratus Lumborum blok (QLB ) spada u blokove stražnjeg abdominalnog zida te se provodi isključivo pod kontrolom ultrazvuka. Još uvijek nije razjašnjen točan mehanizam njegovog djelovanja. Dokazano je kako prednji QLB dovodi do smanjenja trajanja boravka u bolnici i smanjenja upotrebe opioida nakon operacija kuka. Također, pokazao se kao uspješnija metoda perioperativne analgezije u bolesnika u kojih se provodi zahvat na kuku ili proksimalnom femuru u usporedbi sa standardnom intravenskom analgezijom, te omogućuje ranu mobilizaciju pacijenata, što smanjuje pojavnost duboke venske tromboze i tromboembolijskih komplikacija. S druge strane, neki živčani ogranci koji sudjeluju u inervaciji zgloba kuka nisu zahvaćeni s QLB , što također treba uzeti u obzir. QLB se pokazao kao potencijalna opcija za anesteziju u kirurgiji kuka, no tek se treba dokazati njegova pouzdanost.

Osteoid osteoma (OO) is the most common benign osteogenic bone tumor that predominantly affects young adults. OO is commonly localized in long bones, and therefore, it is rarely considered in differential diagnosis of chronic shoulder pain. We report a case of a 22-year-old male athlete, without history of previous trauma, who presented to our Department with chronic shoulder pain, which escalated during the night and responded to nonsteroidal anti-inflammatory drug treatment. Considering these typical symptoms, diagnostic pathway was immediately directed towards OO, with magnetic resonance and computed tomography confirming the diagnosis of OO of the coracoid process (CP). Since neurovascular structures are in the proximity of CP, and this very delicate area does not support radiofrequency ablation, we decided to perform an open procedure with drilling of the lesion and excochleation. The pain withdrew immediately after the procedure, and on six-month follow up the patient remained pain free. In the treatment of OO of the CP, we recommend open surgical procedure with tumor ablation by drilling instead of CP resection, presenting a safe, simple and low-cost method that simultaneously completely destroys the lesion and preserves the anatomical and functional role of CP., Osteoid osteom (OO) je dobroćudni osteoblastični tumor kostiju koji se najčešće javlja u adolescenata i mlađih odraslih osoba. Uobičajena lokalizacija OO su duge kosti pa se rijetko razmatra u diferencijalnoj dijagnostici kronične boli u području ramena. Prikazujemo slučaj mladog sportaša u dobi od 22 godine koji se žalio na bolove u lijevom ramenu, i to bez prethodne ozljede. Intenzitet boli značajno se pojačavao tijekom noći, a bol se smirivala nakon primjene nesteroidnih protuupalnih lijekova. Ovi tipični simptomi odmah su usmjerili dijagnozu k OO, a magnetska rezonancija i kompjutorizirana tomografija pokazale su da je riječ o OO korakoidnog nastavka skapule. Budući da se žilnoživčani snop nalazi u blizini korakoidnog nastavka radiofrekventna ablacija nije prikladna metoda za liječenje OO te lokalizacije pa smo se odlučili za kirurško liječenje. Načinili smo ablaciju tumora svrdlanjem te ekskohleacijom. Od operacijskog zahvata bolesnik se više nije žalio ni na kakvu bol u području lijevog ramena. S obzirom na današnje spoznaje savjetujemo da se OO korakoidnog nastavka svakako liječi kirurškim zahvatom tijekom kojeg valja tumor uništiti svrdlanjem. Za razliku od resekcije korakoidnog nastavka, svrdlanjem se u potpunosti uništava leziju i istodobno čuva integritet korakoidnog nastavka, što je od velikog anatomskog i funkcionalnog značenja.