Objective To study the anesthetic effects of cervical plexus C4 transverse process block one-point method under ultrasound guidance in internal fixation of clavicle fracture.Methods Eighty patients with clavicle fracture admitted to Suqian Traditional Chinese Medicine Hospital from October 2019 to October 2021 were randomly assigned(1∶1)to control group,or experimental group according to radom number table.The control group was anesthetized by cervical plexus C4 transverse process block one-point method with blind exploration,while the experimental group was anesthetized by cervical plexus C4 transverse process block one-point method under ultrasound guidance.The completion time of nerve block and surgical time were compared between the 2 groups.The hemodynamics(heart rate[HR],mean artery pressure[MVP]),and analgesic effects(visual analogue scale[VAS])before anesthesia(T0),during surgical skin incision(T1),fracture reduction(T2),and during surgical skin suture(T3)were also compared between the 2 groups.The anesthetic efficacy and anesthesia-related adverse reactions were statistically analyzed.Results There were no significant differences in surgical time between the 2 groups(P>0.05).The completion time of nerve block in the experimental group was significantly shorter than that in the control group(P<0.05).There were significant differences in the levels of HR and MAP at different time points of the 2 groups,when comparisons were made between the 2 groups(P<0.05).There were no significant differences in the levels of HR or MAP,when comparisons were made between the 2 groups at T0(P>0.05).The levels of HR and MAP in the experimental group at T1,T2,and T3 were significantly lower than those in the control group(P<0.05).The levels of HR and MAP at T1,T2,and T3 in the control group were significantly higher than those at T0(P<0.05).However,there were no significant differences in the levels of HR or MAP,when comparisons were made at different time points in the experience group(P>0.05).There were significant differences in VAS scores,when comparisons were made between different groups,at different time points,at different time points between groups(P<0.05).There were no significant differences in VAS scores,when comparisons were made between the 2 groups at T0(P>0.05).The VAS scores of the experimental group at T1,T2,and T3 were significantly lower than those of the control group(P<0.05),and the VAS scores of the 2 groups at T1,T2,and T3 were significant differences lower than those at T0(P<0.05).The effective anesthetic rate of the experimental group was 95.00%and that of the control group was 82.50%,with statistical significance,when comparisons were made between the 2 groups(P<0.05).There were no singificant differences in the incidences of phrenic nerve block,recurrent laryngeal nerve block,or Horner syndrome,when comparisons were made between the 2 groups(P>0.05).The incidence of vascular injury in the experience group was significantly lower than that in the control group(P<0.05).Conclusion The application of cervical plexus C4 transverse process block one-point method under ultrasound guidance in clavicular fracture internal fixation can shorten the completion time of nerve block,maintain hemodynamic stability,improve analgesic effect,with good anesthetic effects.Furthermore,it can reduce the incidence of adverse reactions of vascular injury.

OBJECTIVE To explore the characteristics,the therapeutic methods and effects of external auditory canal cholesteatoma(EACC).METHODS The clinical records of 66 cases diagnosed with EACC between January 2014 and January 2016 were retrospectively reviewed.Their ages ranged from 3 to 75 years (average 32.5± 1.68 years).There were 32 men and 34 women.According to Holt's grading criteria for EACC,there were 10 ears of phase Ⅰ,26 ears of phase Ⅱ,and 30 ears of phase Ⅲ.The phase Ⅰ ears were treated by removing cholesteatoma from the external auditory canal.Canaloplasty and/or tympanoplasty were performed in phase Ⅱ ears.The phase Ⅲ ears were managed by canaloplasty and tympanoplasty or radical mastoidectomy.The duration of follow-up ranged from 6 months to 2 years.RESULTS In the present study,hearing impairment was the most common symptoms(61 ears,92.42％),other symptoms include ear fullness(49 cases,74.24％),otalgia(45 cases,68.18％),otorrhea(44 cases,66.67％),peripheral facial paralysis(lcase,1.52％).There were 2 recurrences at 11 and 14 months postoperatively.All the other ears remained patent and dry with good skin coverage.Apart from 5 patients who underwent radical mastoidectomy,the rest of patients obtained intact tympanic membranes and impoved hearing.Facial nerve function of 1 patient with peripheral facial paralysis returned to normal6 months after operation.CONCLUSION The EACC can easily damage the bony meatus of external auditory canal and the adjacent structure.The clinical stages can help identify the primary lesions and determine the choice of the best treatment approach.