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"ABSTRACTCross-leg sitting is locus posture performed well in Asian area, and a lifestyle and culture are thought to affect it. It is usually essential to cross-leg sitting carried out in the case of Zen meditation to maintain cross-leg sitting locus in a relaxed state to perform locus posture in floor, and to perform it in hip joint flexion of bilateral feet, abduction, and lateral rotation position in the meditation for a long time. The spinal column of cross-leg sitting was intended that aligning it confirmed backbone in lumbar vertebrae being displaced than rest standing position in the kyphosis direction or raising a bearing surface whether aligning it changed into lordotic projection from the lumbar vertebrae kyphosis direction. The thoracic vertebra angle and the lumbar vertebrae angle measured it using SpinalMouse®. We decided to measure a thoracic vertebra angle, a lumbar vertebrae angle when we changed the height of the target rest standing position and the bearing surface of cross-leg sitting. The thoracic vertebra angle did not change by raising the bearing surface of cross-leg sitting, however the lumbar vertebrae angle changed. It showed a significant correlation between hip joint flexion, abduction, an external rotation angles and the change of the lumbar vertebrae angle. Results of this study suggested that lumbar, aligning it changed to lordosis in the high cross-leg sitting thing that we changed. The quantity that aligning it biases into lordosis of the lumbar part is related to the flexion of the hip joint, abduction, external rotation flexibility."

"Latar belakang: Anestesia obstetrik termasuk anestesia yang memiliki risiko tinggi dalam praktik anestesia. Perubahan fisiologi ibu selama kehamilan dan keberadaan janin merupakan tantangan yang unik untuk anestesia obstetrik. Baik kehamilan normal maupun obesitas, sama-sama mengalami perubahan anatomi dan fisiologi yang signifikan dan pengaruh anestesi yang hampir sama. Belum ada penelitian sebelumnya yang membandingkan tingkat keberhasilan insersi jarum spinal dalam posisi duduk bersila antara ibu hamil obes maupun ibu hamil bukan obes yang menjalani seksio sesarea. Penelitian ini dilakukan di RSCM dan RSU Tangerang antara bulan Juli sampai Agustus 2016. Tujuan: Penelitian ini bertujuan untuk membandingkan tingkat keberhasilan insersi jarum spinal pada posisi duduk bersila antara ibu hamil obes dan ibu hamil bukan obes yang menjalani seksio sesarea. Metode: Penelitian ini merupakan open label study yaitu uji klinis terbuka dimana perlakuan sama-sama diketahui oleh subjek maupun pelaku anestesia. Ibu hamil yang menjalani seksio sesarea dibagi menjadi dua kelompok yaitu obes O dan bukan obes NO . Pada keduanya dilakukan insersi jarum spinal dalam posisi duduk bersila. Pada penelitian ini dilakukan penilaian tingkat keberhasilan insersi jarum spinal, persentase keberhasilan insersi jarum spinal, banyaknya kontak jarum spinal dengan tulang, dan kekerapan tusukan pembuluh darah. Hasil: Dari136 subjek penelitian, tidak ada yang termasuk kriteria penolakan dan pengeluaran. Keberhasilan insersi jarum spinal pada kelompok NO adalah 47 subjek 69,12 dan pada kelompok O 45 subjek 66,18. Secara statistik tidak berbeda bermakna antara kelompok NO dan kelompok O pada tingkat keberhasilan insersi jarum spinal p=0,714, jumlah kontak jarum spinal dengan tulang p=0,591, dan kekerapan tertusuknya pembuluh darah pada waktu insersi jarum spinal p=0,282. Simpulan: Tingkat keberhasilan insersi jarum spinal yang dilakukan dalam posisi duduk bersila pada ibu hamil bukan obes tidak lebih baik jika dibandingkan pada ibu hamil obes.

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Background: Obstetric anesthesia is high risk in practice. The physiological changes during pregnancy and fetal wellbeing are unique challenges posed for obstetric anesthesia. Significant changes in anatomy and physiology along with anesthesia considerations are similar in normal and obese pregnancy. Up to this day, there are no studies comparing successful spinal needle insertion rate in cross legged sitting position between obese and non obese parturient undergoing caesarean section. This study was done in RSCM and RSU Tangerang between July August 2016.

Aim: This study aims to compare successful rate of spinal needle insertion in cross legged sitting position between obese and non obese parturient undergoing caesarean section.

Method: This was an open label study, which was an open clinical trial where treatment was known by subjects and anesthesiologist. Parturient undergoing caesarean section were categorized into two groups, which were obese O and non obese NO. Both of the groups had spinal needle insertion in cross legged sitting position. In this study, the variables assessed were the rate of successful spinal needle insertion, the percentage of successful spinal needle insertion, the frequency of spinal needle contact with bone, and the frequency of vein puncture.

Result: All 136 subjects were included in the analysis. The rate of successful spinal needle insertion in the NO group was 47 subjects 69.12 and 45 subjects in the O group 66.18. This result was not statistically significant p 0.714, along with the frequency of spinal needle contact with bone p 0.591 , and the frequency of vein puncture during spinal needle insertion p 0.282.

Conclusion: The rate of successful spinal needle insertion in cross legged sitting position on non obese parturient was not better than on obese parturient.Key Words Spinal needle insertion, cross legged sitting position, obese and non obese parturient, bone contact, vein puncture."

"[Latar Belakang: Posisi pasien selama tindakan anestesia spinal menentukan keberhasilan penempatan jarum spinal. Traditional sitting position (TSP) merupakan posisi standar untuk anestesia spinal, namun angka keberhasilannya masih cukup rendah. Crossed leg sitting position (CLSP) merupakan salah satu posisi alternatif dalam anestesia spinal yang memiliki kelebihan berupa derajat fleksi lumbal yang lebih besar. Penelitian ini bertujuan untuk membandingkan CLSP dan TSP terhadap keberhasilan penempatan jarum spinal pada pasien bedah urologi. Metode: Penelitian ini adalah uji klinik acak tidak tersamar terhadap pasien yang menjalani anestesia spinal untuk prosedur urologi pada bulan Maret-April 2015 di RSUPN dr. Cipto Mangunkusumo. Setelah mendapatkan persetujuan izin etik dari Komite Etik Penelitian Kesehatan FKUI-RSCM, sebanyak 138 subjek dialokasikan ke dalam dua kelompok posisi penusukan jarum spinal yaitu kelompok CLSP dan TSP. Proporsi keberhasilan penempatan jarum spinal di rongga subarakhnoid, kemudahan perabaan landmark, dan jumlah needle-bone contact pada kedua kelompok kemudian dinilai.Hasil: Enam subjek masuk kriteria pengeluaran berupa kegagalan penempatan jarum spinal setelah lebih dari sembilan kali percobaan. Tersisa 132 subjek, 67 subjek pada kelompok CLSP dan 65 subjek pada kelompok TSP, yang berhasil menyelesaikan penelitian. Keberhasilan penempatan jarum spinal secara one shot pada kelompok CLSP dan TSP tidak berbeda bermakna (64.2% vs 53.8%, p=0.227). Kemudahan perabaan landmark pada kelompok CLSP berbeda bermakna dengan TSP (94% vs 75%, p=0.003). Jumlah needle-bone contact pada kedua kelompok tidak berbeda bermakna (p=0.337). Simpulan: Keberhasilan penempatan jarum spinal pada kelompok CLSP tidak berbeda bermakna dibandingkan dengan keberhasilan penempatan jarum spinal pada kelompok TSP pada pasien bedah urologi.;Background: Patient position during spinal anesthesia plays a major role in determining the success of spinal needle insertion to subarachnoid space. Traditional sitting position (TSP) is a standard position for spinal anesthesia, but the success rate for spinal anesthesia in TSP is still quite low. Crossed leg sitting position (CLSP) is one of the alternative positions in spinal anesthesia, which can increase the degree of lumbar flexion. This study aimed to compare CLSP and TSP to the successful insertion of spinal needle in urologic surgery patients.Methods: This study was a non-blinded randomized controlled trial in patients undergoing spinal anesthesia for urologic procedures between March-April 2015 in RSUPN dr. Cipto Mangunkusumo. After obtaining approval from FKUI-RSCM Ethical Committee, 138 subjects were allocated into two groups, CLSP group and TSP group. The proportion of successful spinal needle insertion to the subarachnoid space, ease of landmark palpation, and the number of needle-bone contact in both groups were then analyzed and assessed.Result: Six subjects met dropout criteria, which was failure of obtaining successful spinal needle insertion after nine consecutive redirections. The remaining 132 subjects, 67 subjects in the CLSP group and 65 subjects in TSP group, successfully completed the study. The proportion of successful spinal needle insertion in a one-time shot, was not significantly different between CLSP and TSP group (64.2% vs. 53.8%, p = 0227). Ease of landmark palpation in CLSP group was significantly different with TSP group (94% vs. 75%, p = 0.003). The number of needle-bone contact in both groups was not significantly different (p = 0337).Conclusion: The proportion of successful spinal needle insertion in CLSP group was not significantly different compared to TSP group for urologic surgery patients.;Background: Patient position during spinal anesthesia plays a major role in determining the success of spinal needle insertion to subarachnoid space. Traditional sitting position (TSP) is a standard position for spinal anesthesia, but the success rate for spinal anesthesia in TSP is still quite low. Crossed leg sitting position (CLSP) is one of the alternative positions in spinal anesthesia, which can increase the degree of lumbar flexion. This study aimed to compare CLSP and TSP to the successful insertion of spinal needle in urologic surgery patients.Methods: This study was a non-blinded randomized controlled trial in patients undergoing spinal anesthesia for urologic procedures between March-April 2015 in RSUPN dr. Cipto Mangunkusumo. After obtaining approval from FKUI-RSCM Ethical Committee, 138 subjects were allocated into two groups, CLSP group and TSP group. The proportion of successful spinal needle insertion to the subarachnoid space, ease of landmark palpation, and the number of needle-bone contact in both groups were then analyzed and assessed.Result: Six subjects met dropout criteria, which was failure of obtaining successful spinal needle insertion after nine consecutive redirections. The remaining 132 subjects, 67 subjects in the CLSP group and 65 subjects in TSP group, successfully completed the study. The proportion of successful spinal needle insertion in a one-time shot, was not significantly different between CLSP and TSP group (64.2% vs. 53.8%, p = 0227). Ease of landmark palpation in CLSP group was significantly different with TSP group (94% vs. 75%, p = 0.003). The number of needle-bone contact in both groups was not significantly different (p = 0337).Conclusion: The proportion of successful spinal needle insertion in CLSP group was not significantly different compared to TSP group for urologic surgery patients., Background: Patient position during spinal anesthesia plays a major role in determining the success of spinal needle insertion to subarachnoid space. Traditional sitting position (TSP) is a standard position for spinal anesthesia, but the success rate for spinal anesthesia in TSP is still quite low. Crossed leg sitting position (CLSP) is one of the alternative positions in spinal anesthesia, which can increase the degree of lumbar flexion. This study aimed to compare CLSP and TSP to the successful insertion of spinal needle in urologic surgery patients.Methods: This study was a non-blinded randomized controlled trial in patients undergoing spinal anesthesia for urologic procedures between March-April 2015 in RSUPN dr. Cipto Mangunkusumo. After obtaining approval from FKUI-RSCM Ethical Committee, 138 subjects were allocated into two groups, CLSP group and TSP group. The proportion of successful spinal needle insertion to the subarachnoid space, ease of landmark palpation, and the number of needle-bone contact in both groups were then analyzed and assessed.Result: Six subjects met dropout criteria, which was failure of obtaining successful spinal needle insertion after nine consecutive redirections. The remaining 132 subjects, 67 subjects in the CLSP group and 65 subjects in TSP group, successfully completed the study. The proportion of successful spinal needle insertion in a one-time shot, was not significantly different between CLSP and TSP group (64.2% vs. 53.8%, p = 0227). Ease of landmark palpation in CLSP group was significantly different with TSP group (94% vs. 75%, p = 0.003). The number of needle-bone contact in both groups was not significantly different (p = 0337).Conclusion: The proportion of successful spinal needle insertion in CLSP group was not significantly different compared to TSP group for urologic surgery patients.]"

"Latar Belakang: Anestesia spinal pada wanita hamil sangat dipengaruhi oleh posisi pasien. Pendant position merupakan posisi yang baru diperkenalkan pada laporan kasus. Penelitian ini bertujuan untuk membandingkan keberhasilan penempatan jarum spinal pada usaha pertama antara pendant position dengan traditional sitting position untuk pasien yang menjalani pembedahan Sesar. Metode: Penelitian ini adalah uji klinik Randomized Controlled Trial (RCT), dilakukan secara terbuka (tidak tersamar). Subjek dilakukan randomisasi untuk menentukan perlakuan pendant position atau traditional sitting position. Keberhasilan penempatan jarum spinal dinilai dari jumlah usaha, jumlah kontak tulang dan lama waktu penempatan jarum spinal. Hasil: Sebanyak 308 subjek penelitian, tidak ada yang termasuk kriteria penolakan dan pengeluaran. Keberhasilan penempatan jarum spinal pada usaha pertama untuk pendant position lebih baik (142 subjek (92%) vs 121 subjek (78%), p 0,001), total jumlah kontak tulang lebih sedikit (185 vs 421, p<0,001) dan median lama waktu yang dibutuhkan untuk penempatan jarum spinal lebih cepat ( 9 (4-350) vs 12 (5-486) detik, p<0,001) jika dibandingkan dengan traditional sitting position. Simpulan: Pendant position lebih baik dalam hal keberhasilan penempatan jarum spinal pada usaha pertama untuk pasien yang menjalani pembedahan Sesar jika dibandingkan traditional sitting position.

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Background: Spinal anesthesia in pregnant women is strongly influenced by the position of the patient. Pendant position is a new position introduced in the case report. This study aimed to compare the successful placement of spinal needle on the first attempt between pendant position and traditional sitting position for patients who underwent sectio Caesarean.

Methods: The study was a randomized controlled trial (RCT), conducted openly (not blind). Subject randomization to determine treatment pendant position or traditional sitting position. The successful placement of spinal needle judged from the number of first attempt, the amount of bone contact and the duration of the placement of spinal needle.

Results: A total of 308 subjects, none of which include criteria for exclusion and drop out. The successful placement of spinal needle on the first attempt of pendant position is better (142 subjects (92%) vs. 121 subjects (78%), p 0.001), the total amount of bone contact is less (185 vs. 421, p <0.001) and the median length of time required for placement of spinal needle is faster (9 (4-350) vs. 12 (5-486) seconds, p <0.001) when compared to the traditional sitting position.

Conclusion: Pendant position is better in terms of the successful placement of spinal needle on the first attempt for a patient who underwent sectio Caesarean compared to traditional sitting position."

"Pendahuluan: Laparoskopi memiliki risiko intraoperatif dan pascaoperasi, termasuk instabilitas hemodinamik dan nyeri pascaoperasi. Anestesi umum sering digunakan untuk operasi ini, namun teknik ini tidak menekan peningkatan resistensi vaskular sistemik selama laparoskopi sehingga fluktuasi hemodinamik tetap terjadi. Sayatan dinding abdomen dan regangan peritoneum selama operasi juga menyebabkan nyeri somatis dan viseral yang dirasakan pascaoperasi. Penambahan blok TAP pada operasi laparoskopi belum memuaskan disamping memerlukan instrumen tambahan serta bergantung pada kemampuan operator. Anestesi spinal dapat menguntungkan karena dapat menetralkan peningkatan SVR dan menghambat nyeri selama operasi, namun penggunaannya dikaitkan dengan mobilisasi yang tertunda. Penelitian ini bertujuan untuk mengetahui apakah kombinasi anestesi umum dan anestesi spinal lebih baik dalam menjaga perubahan hemodinamik intraoperatif, nyeri pascaoperasi, dan waktu pulih dibandingkan anestesi umum dan blok TAP.Metode: Penelitian ini merupakan uji klinis acak tersamar tunggal pada 40 pasien yang dibagi menjadi 2 kelompok. Kelompok S (spinal) dilakukan anestesi spinal menggunakan bupivacaine 10 mg + morfin 50 mcg intratekal disusul anestesi umum. Kelompok T (blok TAP) dilakukan anestesi anestesi umum disusul blok TAP dengan bupivacaine 0.25% 20 ml pada kedua sisi abdomen. Perubahan tekanan darah dan nadi, NRS pascaoperasi 3 jam dan 6 jam, waktu untuk mencapai Bromage 0, serta kejadian nyeri bahu dan mual muntah pascaoperasi dicatat. Hasil: Pada kelompok S terdapat perubahan tekanan darah sistolik yang signifikan dibandingkan dengan kelompok T setelah 15 menit insuflasi (-9,35(±19,69) vs 7,65(±16,34), p<0,05). Tidak ada perbedaan nyeri pascaoperasi dan waktu pulih pada kedua kelompok.Kesimpulan: Kombinasi anestesi umum dan anestesi spinal lebih baik dalam menurunkan tekanan darah sistolik, namun tidak berbeda dalam nyeri pascaoperasi, dan waktu pulih dibandingkan kombinasi anestesi umum dan blok TAP.

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Introduction: Laparoscopy is associated with intraoperative and postoperative risks, including hemodynamic instability and postoperative pain. Although general anesthesia is often used for this procedure, hemodynamic fluctuations still occur because this technique does not suppress the increase in systemic vascular resistance during laparoscopy. Incisions in the abdominal wall and stretching of the peritoneum during surgery can also cause somatic and visceral pain after surgery. Adding TAP block to laparoscopic surgery is not satisfactory, apart from requiring additional instruments and depending on the operator’s abilities. Spinal anesthesia may be beneficial as it can counteract the increase in SVR and suppress pain during surgery, but its use is associated with delayed mobilization. The purpose of this study is to determine whether the combination of general and spinal anesthesia is superior in maintaining intraoperative hemodynamic changes, postoperative pain, and recovery time compared to general anesthesia and TAP blockade.

Methods: This study is a single-blind, randomized clinical trial with 41 patients divided into two groups. Group S (spinal) received spinal anesthesia with 10 mg bupivacaine + 50 μg morphine administered intrathecally, followed by general anesthesia. Group T (TAP block) received general anesthesia followed by TAP block with 20 ml of 0.25% bupivacaine on each side of the abdomen. Intraoperative blood pressure and heart rate changes, NRS at 3 and 6 hours postoperatively, time to reach bromage 0, and occurrence of postoperative shoulder pain and nausea and vomiting were recorded.

Results: In group S there was a significant change in systolic blood pressure compared to group T after 15 minutes of insufflation (-9,35(±19,69) vs 7,65(±16,34), p<0,05). There was no difference in postoperative pain and recovery time in the two groups.

Conclusion: The combination of general anesthesia and spinal anesthesia is better in reducing systolic blood pressure, but does not differ in postoperative pain and recovery time compared to the combination of general anesthesia and TAP block."

"Pendahuluan: Kelengkungan spinal dapat menjadi tolak ukur untuk menilai postur tubuh, fungsi tulang belakang dalam melindungi struktur saraf di dalamnya, dan dapat mempengaruhi kualitas hidup seseorang. Tumor spinal primer merupakan salah satu penyebab kelainan kelengkungan atau deformitas spinal. Penyakit ini memerlukan tindakan pembedahan sebagai tatalaksana utama. Sayangnya, tindakan operasi berpotensi untuk mendisrupsi komponen pembentuk kelengkungan spinal. Tulisan ini bertujuan untuk melihat perubahan kelengkungan pascaoperasi, faktor yang mempengaruhi, dan melihat hubungannya dengan luaran klinis pasca operasi.Metode: Penelitian ini menggunakan pendekatan kohort retrospektif, menggunakan data pasien dengan tumor spinal primer yang dilakukan operasi dari Januari 2017 hingga Desember 2022 di Rumah Sakit Cipto Mangunkusumo. Subjek penelitian ini adalah pasien dengan usia lebih dari 18 tahun, memiliki pemeriksaan penunjang berupa MRI spinal dan rekam medis lengkap, dilakukan operasi tanpa fusi. Sebanyak 32 pasien masuk dalam kriteria ini. Penilaian kelengkungan spinal menggunakan metode Cobb pada MRI sebelum dan setelah operasi di bulan ke-6, dan luaran klinis dinilai menggunakan data dari rekam medisHasil: Sebanyak 81,3% termasuk tumor intradural-ekstramedula dengan schwannoma adalah jenis terbanyak. Terdapat perubahan sudut C2-C7 sebesar -3,81 ± 2,97 derajat menuju kifotik (p=0,003) pada regio cervical. Pada regio thorakal, kami dapatkan perubahan sudut pada thorakal atas (Th1-Th5) sebesar 1,28 ± 0,51 derajat mengarah ke kifotik (p=0,000). Tidak didapatkan perubahan sudut Cobb pada tumor spinal regio lumbosacral. Secara klinis, VAS preoperasi berpengaruh terhadap kelengkungan pada regio lumbosacral (p=0,036). Analisis multivariat menunjukkan terdapat pengaruh yang bermakna antara teknik operasi (hemilaminektomi vs laminektomi), dan nilai cobb’s angle preoperasi pada regio cervical (C2-C7).  Pada penelitian ini, semua kasus tumor spinal yang dilakukan operasi mengalami perbaikan klinis yang signifikan. Tidak terdapat perbedaan bermakna antara perubahan cobb’s angle, teknik operasi, cobb’s angle preoperasi, onset, jenis kelamin, level laminektomi, dan resektabilitas dengan luaran klinis pascaoperasi.Kesimpulan: Teknik operasi dan cobb’s angle preoperasi merupakan faktor prediktor yang berpengaruh terhadap besarnya kemungkinan perubahan cobb’s angle pascaoperasi tumor spinal primer regio cervical. 

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Introduction: Spinal curvature can be a benchmark for assessing body posture, the function of the spine in protecting the nerve structures within it, and can affect a person's quality of life. Primary spinal tumors are one of the causes of spinal curvature abnormalities or deformities. This disease requires surgery as the main treatment. Unfortunately, surgery has the potential to disrupt the components that form spinal curvature. This paper aims to examine changes in postoperative curvature, influencing factors, and see their relationship with postoperative clinical outcomes.

Methods: This study used a retrospective cohort approach, using data on patients with primary spinal tumors who underwent surgery from January 2017 to December 2022 at Cipto Mangunkusumo Hospital. The subjects of this study were patients over 18 years of age, who had supporting examinations in the form of spinal MRI and complete medical records, who underwent surgery without fusion. Spinal curvature was assessed using the Cobb method on MRI before and after surgery at 6 months, and clinical outcomes were assessed using data from medical records

Results: A total of 32 patients met these criteria, and 81.3% included intradural-extramedullary tumors with schwannoma being the most common type. There was a change in the C2-C7 angle of -3.81 ± 2.97 degrees towards kyphotic (p=0.003) in the cervical region. In the thoracic region, we found a change in the upper thoracic angle (Th1-Th5) of 1.28 ± 0.51 degrees towards khypotic (p=0.000). There was no change in the Cobb angle in spinal tumors in the lumbosacral region. Clinically, preoperative VAS affected curvature in the lumbosacral region (p=0.036). Multivariate analysis showed that there was a significant influence between surgical technique (hemilaminectomy vs laminectomy), and preoperative Cobb's angle values in the cervical region (C2-C7). In this study, all cases of spinal tumors that underwent surgery experienced significant clinical improvement. There were no significant differences between changes in Cobb's angle, surgical technique, preoperative Cobb's angle, onset, gender, laminectomy level, and resectability and postoperative clinical outcomes.

Conclusion: Surgical technique and preoperative Cobb's angle are predictor factors that influence the likelihood of changes in Cobb's angle after surgery for primary spinal tumors in the cervical region."

"Dokter bedah dan PPDS bedah merupakan kelompok profesi yang berisiko tinggi mengalami nyeri muskuloskeletal akibat berbagai pajanan saat melakukan pekerjaan. Nyeri muskuloskeletal dapat memengaruhi kualitas kerja dan kualitas hidup. Tujuan penelitian ini adalah mengetahui keselarasan postur berdiri serta adanya nyeri muskuloskeletal pada PPDS Bedah di RSCM. Penelitian ini menggunakan desain studi potong lintang pada tiga puluh tujuh subjek yang berpartisipasi sesuai dengan kriteria inklusi. Luaran dari penelitian ini adalah abnormalitas postur berdiri bidang sagital yang dinilai dari foto postur berdiri dan ada tidaknya nyeri muskuloskeletal yang dinilai dengan kuesioner Nordic terstandar. Dari penilaian postur didapatkan sebanyak 72,97% subjek mengalami abnormalitas postur berdiri pada bidang sagital. Sebanyak 46% subjek mengeluhkan adanya nyeri muskuloskeletal terkait pekerjaan. Tidak terdapat hubungan bermakna antara abnormalitas postur berdiri bidang sagital dengan nyeri muskuloskeletal (p=0,46). Dari analisis multivariat didapatkan bahwa faktor berupa status nutrisi (p=0,22), rerata durasi operasi (p=0,21), dan rerata durasi operasi per minggu (p=0,17) turut memengaruhi terjadinya abnormalitas postur berdiri bidang sagital. Faktor kebiasaan berolahraga (p=0,059), kebiasaan merokok (p=0,092), dan lama bekerja di kamar operasi (p=0,081) memengaruhi terjadinya nyeri muskuloskeletal pada subjek. Diperlukan penelitian lebih lanjut dengan menambah cakupan subjek. Sebagai tambahan, sebaiknya juga dilanjutkan dengan analisis kamar operasi dan pemeriksaan postur selama melakukan berbagai tindakan operasi.Surgeons and surgery residents are professional groups that are high risk of experiencing musculoskeletal pain due to various exposures while doing work. The study determined the alignment of sagittal standing posture and the presence of musculoskeletal pain in surgery resident at RSCM. This study was a cross-sectional study in thirty-seven subjects according to inclusion criteria. The outcome was the abnormality of sagittal standing posture by photographs and the presence of musculoskeletal pain as assessed by Nordic standardized questionnaire. It was found that 72.97% of the subjects experienced abnormalities in sagittal plane of standing posture. Approximately 46% of the subjects complained of work-related musculoskeletal pain. There was no relationship between abnormal standing posture in the sagittal plane and musculoskeletal pain (p=0.46). From multivariate analysis, it was found that nutritional status (p=0.22), mean duration of surgery (p=0.21), and average duration of surgery per week (p=0.17) influenced the occurrence of abnormal standing posture in the sagittal plane. The factors of exercise habits (p=0.059), smoking habits (p=0.092), and length of work in the operating room (p=0.081) influenced the occurrence of musculoskeletal pain. Further research is needed by increasing scope of the subject. In addition, it is advisable to continue with operating room analysis and posture checks during various operations.  "

"Pendahuluan: Rekonstruksi anatomi dan biomekanik panggul yang akurat sangat penting untuk mendapatkan luaran klinis yang optimal pasca THR. Kesejajaran stem femur yang sesuai berperan dalam mendapatkan luaran yang diharapkan, terutama mencegah terjadinya impingement dan loosening. Meski demikian, tilting stem femur pada bidang sagital belum banyak diteliti dan pengaruhnya pada luaran klinis dan radiologis masih belum jelas. Pada studiini, peneliti ingin mengevaluasi posisi stem femur pada bidang sagital pasca THR cementless dan menganalisis hubungannya dengan luaran klinis dan parameter radiologis pascaoperasi. Metode: Studi analitik observasional dengan desain potong lintang dilakukan pada total 71 panggul (67 pasien, usia 18-85 tahun) yang telah dilakukan prosedur THR cementless di dua pusat orthopedi di Jakarta, Indonesia. Semua panggul dioperasi dengan teknik anterolateral atau posterior dan menggunakan implan dengan desain extended/full- coating wedge tapered stem (Corail, Depuy) atau proximal-coated wedge tapered stem (EcoFit, Implantcast; M/L Taper, Zimmer). Evaluasi dilakukan pada satu waktu dengan median 1,1 tahun (13,7 bulan). Luaran klinis dievaluasi menggunakan penilaian dengan kusioner mHHS, nilai VAS pada nyeripaha depan, dan penilaian derajat lingkup gerak sendi panggul. Kesejajaran sagital stem femurdan variabel radiologis lainnya diukur dari foto polos pelvis dan femur. Subjek dibagi ke dalam3 grup (anterior tilt, netral, dan posterior tilt) dan dilakukan analisis luaran pada ketiga grup tersebut. Pada studi ini, peneliti juga melakukan studi bivariat antara kesejajaran sagital stem femur dengan morfologi femur, approach, dan desain implan untuk melihat efeknya terhadapposisi stem.Hasil: Nilai median kesejajaran sagital stem adalah 2o (-4,3o – 7.2o) dengan posisi stem netralditemukan lebih banyak dibandingkan stem yang mengalami tilting (54,9% vs. 45,1%). Tidakditemukan perbedaan bermakna antara skor mHHS, nilai VAS nyeri paha, dan derajat ROM diantara ketiga grup stem alignment. Nilai anteversi dan offset implan pasca prosedur juga tidakdipengaruhi oleh posisi stem femur. Studi ini menemukan beberapa faktor yang mempengaruhi kesejajaran sagital stem yang bermakna secara statistik. Uji regresi linier pada morfologi femurmendapatkan bahwa setiap penambahan sudut kelengkungan anterior femur (femoral tilt) 1o berpotensi meningkatkan tilting stem femur sebesar 0,69o ke posterior (Coeff. = 0,502). Posisistem netral lebih banyak ditemukan pada approach anterolateral dibandingkan posterior(56,9% berbanding 50%; p=0,000). Anterior tilt ditemukan hanya pada approach posterior dansebaliknya posterior tilt ditemukan lebih banyak pada approach anterolateral approach (43,1%berbanding 20%). Deviasi stem juga ditemukan lebih besar secara proporsi pada proximal- coated stem dibandingkan dengan fully-coated stem (66,6% berbanding 37,7%; p=0,000).Kesimpulan: Perbedaan kesejajaran stem femur di bidang sagital tidak mempengaruhi luaran klinis maupun radiologis pasien pasca operasi. Meskipun demikian, dalam memposisikan stem, approach ̧anterolateral merupakan teknik terbaik untuk mendapatkan posisi stem netral. Sebaliknya, deviasi stem banyak ditemukan pada approach posterior maupun tipe implant proximal-coated. Terkait morfologi femur, setiap penambahan 1o anterior bowing, posterior tilting dapat bertambah 0,69o. Temuan ini akan sangat berguna bagi klinisi dalam melakukan perencanaan preoperasi THR cementless untuk medapatkan posisi stem femur yang ideal.

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Introduction: Optimal stem alignment is essential after THR. However, stem sagittal tilting has not been sufficiently investigated and outcome is still unclear. We aimed to evaluate sagittal stem position following cementless THR and its relationship with functional and radiological outcomes.

Method: Seventy-one hips underwent primary cementless THR. Median follow up was 1,1 years. Postoperative clinical and radiological outcomes were evaluated. Subjects divided based on tilting degree and outcomes were compared between groups. Bivariate analysis was performed between sagittal alignment and several influencing factors for stem position.

Results: Median sagittal alignment was 2º (-4,3º – 7.2º) with neutral stem more frequent. There were no significant differences on clinical or radiological outcomes. Test result showed 0,69º increase of posterior tilt for every 1º anterior bowing. Anterior tilting found only in posterior approach. Conversely, more posterior tilting after anterolateral approach. Larger stem deviation were found on proximal-coated stem.

Conclusion: Stem tilting in sagittal plane did not affect patient’s functional or radiological outcome postoperatively. Although, in term of stem positioning, anterolateral is the best approach to obtain neutral stem. In addition, for every degree of increased anterior femoral bowing, 0,69º increase in posterior stem tilting can be expected."

"[ABSTRAKPencahayaan yang baik sangat diperlukan untuk melakukan suatu pekerjaan. Salah satunya adalah dalam dunia penerbangan. PT. Dirgantara Indonesia membutuhkan rancangan kokpit yang ergonomis dan salah satunya mencakup bidang pencahayaan, yaitu untuk mengetahui jenis dan titik pemasangan domelight terbaik pada rancangan pesawat perintis XYZ. Domelight sejatinya digunakan untuk membantu pilot maupun kopilot dalam menyiapkan prosedur penerbangan dalam kondisi gelap terutama di malam hari. Kemudian dari hasil perhitungan, lampu 6500K memiliki hasil yang paling baik pada segi performa maupun dari segi kenyamanan. Untuk itu berdasarkan pada penelitian ini diusulkan domelight yang digunakan adalah dengan lampu 6500K yang diletakkan di posisi 2 karena memiliki waktu performa yang terbaik dan nilai kenyamanan tertinggi dibandingkan dengan kombinasi yang lainnya. Dengan didapatkannya hasil tersebut diharapkan kombinasi tersebut nantinya akan bisa membantu pilot dan kopilot dalam melakukan prosedur penerbangan terutama di malam hari.

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ABSTRACTGood lighting is very necessary to do a job especially in aviation. PT. Dirgantara Indonesia requires the design of an ergonomic cockpit and one of them includes the fields of lighting to know the type and the mounting point of the best aircraft design domelight in pioneer plane type XYZ. Domelight are essentially used to help pilot or co-pilot doing flight procedures in dark conditions especially in the evening. Then from the results of the calculation, the light 6500K have the best results on in terms of performance as well as in terms of convenience. For it is based on this research proposed domelight used is 6500K with lights placed at position 2 because it has the best performance time and highest comfort values compared with other combinations. With the expected results he obtained such combinations will be able to help the pilot and co-pilot of flight procedures in performing mainly at night.;Good lighting is very necessary to do a job especially in aviation. PT. Dirgantara Indonesia requires the design of an ergonomic cockpit and one of them includes the fields of lighting to know the type and the mounting point of the best aircraft design domelight in pioneer plane type XYZ. Domelight are essentially used to help pilot or co-pilot doing flight procedures in dark conditions especially in the evening. Then from the results of the calculation, the light 6500K have the best results on in terms of performance as well as in terms of convenience. For it is based on this research proposed domelight used is 6500K with lights placed at position 2 because it has the best performance time and highest comfort values compared with other combinations. With the expected results he obtained such combinations will be able to help the pilot and co-pilot of flight procedures in performing mainly at night., Good lighting is very necessary to do a job especially in aviation. PT. Dirgantara Indonesia requires the design of an ergonomic cockpit and one of them includes the fields of lighting to know the type and the mounting point of the best aircraft design domelight in pioneer plane type XYZ. Domelight are essentially used to help pilot or co-pilot doing flight procedures in dark conditions especially in the evening. Then from the results of the calculation, the light 6500K have the best results on in terms of performance as well as in terms of convenience. For it is based on this research proposed domelight used is 6500K with lights placed at position 2 because it has the best performance time and highest comfort values compared with other combinations. With the expected results he obtained such combinations will be able to help the pilot and co-pilot of flight procedures in performing mainly at night.]"