计算机导航下闭合复位空心钉内固定治疗股骨颈骨折

目的 探讨计算机导航技术在股骨颈骨折空心钉内固定治疗中的应用.方法 对12例股骨颈骨折首先牵引床牵引,用C型臂X线机透视复位良好后,摄正侧位图像保存于计算机中,然后利用计算机导航系统在指引器引导下完成内固定.结果 所有病例全部在计算机导航下完成空心钉内固定,内固定位置理想.手术平均时间为22min,平均透视时间为13s.经6～18个月随访,平均骨折愈合时间为4个月.结论 计算机导航技术用于空心钉内固定手术,使手术过程更简便、直观,提高了手术的精度和成功率,同时显著减少了术中射线的辐射.     

计算机导航辅助空心钉内固定治疗无移位股骨颈骨折

目的探讨计算机导航辅助空心钉内固定在无移位股骨颈骨折治疗中的应用。方法自2013-09—2014-09对22例无移位股骨颈骨折行经皮3枚空心钉内固定术,其中12例在计算机导航辅助下完成(导航组),10例采用传统经皮内固定技术(传统组),比较分析2组术中透视次数、术中钻孔次数、手术时间、颈干角偏离角度、前倾角偏离角度。结果所有患者手术均顺利完成,无神经、血管并发症。导航组在术中透视次数、术中钻孔次数、手术时间、颈干角偏离角度、前倾角偏离角度方面均优于传统组,差异均有统计学意义(P0.05)。结论计算机导航辅助置入空心钉内固定治疗无移位股骨颈骨折能够减少术中透视次数、钻孔次数,缩短手术时间,提高内固定置入的准确性。     

计算机导航在骨科手术中的应用

目的将计算机导航技术应用于骨科手术,并对其进行初步分析。方法2004年2～12月,计算机导航系统辅助下共行134枚椎弓根螺钉固定,51枚股骨颈骨折空心钉内固定,58枚交锁髓内钉远端交锁螺钉固定。结果所有病例全部在导航下完成手术,术中明显减少C型臂X线机透视次数,未发生血管和神经损伤并发症。结论计算机导航手术安全有效,更有利于微创手术的开展。     

骨科机器人辅助下闭合复位空心钉内固定治疗股骨颈骨折

目的:探讨机器人导航定位系统辅助下闭合复位空心钉内固定治疗股骨颈骨折的临床初步疗效。方法:回顾分析2019年7月至2020年1月36例闭合性股骨颈骨折患者,根据是否采用机器人系统辅助股骨颈骨折内固定手术分为两组。采用机器人系统导航下闭合复位内固定治疗股骨颈骨折16例(导航组),男7例,女9例,年龄25～72(53.61±5.45)岁;骨折Garden分型,Ⅰ型3例,Ⅱ型3例,Ⅲ型8例,Ⅳ型2例。非导航组(对照组):采用闭合复位空心钉内固定治疗股骨颈骨折20例,男8例,女12例,年龄46～70 (55.23±4.64)岁;GardenⅠ型2例,Ⅱ型4例,Ⅲ型11例,Ⅳ型3例。对两组患者手术时间、透视次数、导针钻孔次数、螺钉调整次数、术中出血量等指标进行评价。结果:两组术后均获随访,时间12～18(15.6±2.8)个月。两组骨折均愈合,无骨折延迟愈合及骨不连发生。两组愈合时间比较,差异无统计学意义(P=0.782)。末次随访时两组Harris评分比较,差异无统计学意义(P=0.813>0.05)。两组间手术时间比较,差异无统计学意义(P>0.05)。两组透视次数、导针钻孔次数...     

3D打印导航模板辅助股骨颈骨折空心钉置入的应用价值

目的探讨3D打印导航模板辅助置钉在股骨颈骨折空心钉内固定术中的应用价值。方法回顾性分析自2015-10—2016-10采用空心钉内固定治疗的50例股骨颈骨折,25例术中应用3D打印导航模板辅助置钉(导板组),25例术中在C型臂X线机透视下徒手置钉(徒手组)。比较2组手术时间、术中出血量、术中X线透视次数,以及末次随访时髋关节功能Harris评分。结果导板组解剖复位22例,功能复位3例;徒手组解剖复位21例,功能复位4例。50例均获得随访,随访时间平均5.8(5~7)个月。导板组手术时间、术中X线透视次数少于徒手组,差异有统计学意义(P0.05)。导板组与徒手组术中出血量、末次随访时髋关节功能Harris评分差异无统计学意义(P0.05)。结论股骨颈骨折空心钉内固定术中采用3D打印导航模板辅助置钉可减少手术时间及术中X线透视次数,可取得良好治疗效果。     

手法复位透视下经皮空心钉固定治疗股骨颈骨折86例疗效分析

目的总结并评价空心钉治疗股骨颈骨折的疗效,探讨手术方法。方法采用手法复位透视下经皮空心钉固定的方法治疗不同类型、不同年龄的股骨颈骨折86例,按Garden分型:Ⅰ型2例,Ⅱ型46例,Ⅲ型26例,Ⅳ型12例,时间3～36个月,平均18个月。结果69例获骨性愈合,8例出现不愈合,6例出现股骨头坏死,3例于术后死于其他内科疾病,患者年龄均超过85岁。骨折愈合者术后髋关节功能Harris评分60～100分。结论闭合复位,符合生物力学的空心钉内固定治疗股骨颈骨折创伤小、操作简便、疗效可靠。     

透视导航下微创手术治疗骨盆前环骨折

目的探讨导航技术在手术治疗骨盆前环骨折中的初步临床应用结果。方法2005年1-10月，采用C型臂透视导航设备行导航下骨盆前环骨折内固定术18例，包括27处骨折。对导航下行骨盆前环骨折手术患者的相关资料进行统计。结果术中共置人27枚空心钉，其中每枚空心钉的平均置人时间为23．1min，X线透视时间平均为18．9s。将导航下图像与真实C型臂机摄片进行对照，放置空心钉后验证位置平均偏差距离为（3．38±1．04）mm，平均偏差角度为2．86。±1．78。。术中出血量极少（〈22．1mL／枚），术中1枚（3．7％）螺钉出现偏移。术后无感染及内固定失败等并发症发生。术后平均随访时间为16．6个月（12—18个月）。术后1年对所有患者进行短期骨骼肌肉功能调查问卷：功能评分平均为64．26分，烦恼指数评分平均为65．83分。结论使用透视导航技术手术治疗骨盆前环骨折，手术更精确、安全，可以减少手术时间和X线暴露时间；但若要在创伤骨科手术中更好地应用透视导航技术，则需制定标准化操作程序，完善术前培训。     

天玑骨科手术机器人辅助导航空心钉内固定治疗儿童Delbet Ⅱ、Ⅲ型股骨颈骨折

目的 探讨天玑骨科手术机器人辅助导航空心钉内固定治疗儿童DelbetⅡ、Ⅲ型股骨颈骨折的临床疗效。方法回顾性分析自2019-09—2022-10应用天玑骨科手术机器人辅助导航空心钉内固定治疗的5例儿童DelbetⅡ、Ⅲ型股骨颈骨折。术后每个月复查X线片直至骨折愈合,根据股骨颈X线片骨折线判断骨折愈合情况,同时观察有无并发症（股骨头缺血性坏死、内固定物滑脱、髋内翻等）发生,采用Ratliff评分标准评价术后髋关节功能。结果 5例均获得随访,随访时间0.5～3年,平均1.1年。术中透视次数10～17次,平均12.2次。导针钻孔次数3～5次,平均3.7次。空心钉调整次数为0～2次,平均0.5次。置钉时间23～41 min,平均29.6 min。切口均一期愈合,骨折均顺利愈合,骨折愈合时间9～13周,平均10.8周。1例于术后3个月下床时向患侧歪倒,导致患侧股骨髁上青枝骨折,继续卧床1个月后再次下床活动,股骨颈骨折完全愈合,其余4例均无髋内翻畸形、骨折不愈合、下肢短缩等并发症发生。末次随访时,采用Ratliff评分标准评价术后髋关节功能：优4例,良1例。结论 应用天玑骨科手术机器人辅助导航空心...     

股骨颈动力交叉钉系统与空心钉内固定治疗股骨颈骨折的疗效比较

目的 比较股骨颈动力交叉钉系统（Femoral neck system,FNS）与空心钉内固定治疗股骨颈骨折的临床疗效。方法回顾性分析自2020-06—2021-06采用FNS与空心钉内固定治疗的31例股骨颈骨折,根据内固定方式不同分为试验组（FNS内固定）和对照组（空心钉内固定）。比较两组手术时间、术中出血量、术中透视次数、骨折愈合时间以及术后6个月时的Harris髋关节功能评分,术后第2天复查患侧X线片观察骨折断端对位及内固定物在位情况。结果 试验组和对照组的手术时间、骨折愈合时间、术后6个月时的Harris髋关节功能评分差异无统计学意义（P>0.05）,对照组术中出血量少于试验组,差异有统计学意义（P<0.05）,但是试验组术中透视次数少于对照组,差异有统计学意义（P<0.05）。对照组有1例于术后第6个月时出现退钉情况,试验组随访期间无退钉情况发生。结论 FNS系统与空心钉内固定治疗股骨颈骨折在手术时长、术后髋关节功能恢复及骨折愈合时间等方面无明显差异,空心钉内固定术中出血量较少,而FNS系统内固定术中透视次数较少并且具有更好的抗剪切、防旋转、防滑作用。     

两种方法治疗青壮年股骨颈骨折的疗效比较

目的 比较切开复位与闭合复位空心钉内固定治疗青壮年股骨颈骨折的疗效。方法 将66例青壮年股骨颈骨折患者按照随机数字表法分为切开复位组(采用切开复位空心钉内固定治疗)和闭合复位组(采用闭合复位空心钉内固定治疗),各33例。记录两组手术情况、骨折复位情况、骨折愈合情况、髋关节功能Harris评分及并发症发生情况。结果 患者均获得随访，时间34～36个月。手术时间切开复位组长于闭合复位组(P<0.05)。术中透视次数、骨折解剖复位率、骨折愈合时间、末次随访时髋关节功能Harris评分切开复位组均优于闭合复位组(P<0.05)。两组术后切口愈合良好，无皮缘坏死、皮肤及关节感染、双下肢深静脉血栓形成等并发症发生；随访期间未出现空心钉断钉、退钉等情况。结论 与闭合复位空心钉内固定相比，采用切开复位空心钉内固定治疗青壮年股骨颈骨折具有术中透视次数少、骨折复位效果好、骨折愈合快、髋关节功能恢复好、并发症少等优点，但手术时间较长。     

Vasopressor hormone response following mesenteric traction during major abdominal surgery

Background : We investigated the vasopressor hormone response following mesenteric traction (MT) with hypotension due to prostacyclin (PGI₂) release in patients undergoing abdominal surgery with a combined general and epidural anesthesia. Methods : In a prospective, randomized, placebo-controlled study we administered 400 mg ibuprofen (i.v.) in 42 patients scheduled for abdominal surgery. General anesthesia was combined with epidural anesthesia (T4-L1). Before as well as 5, 15, 30, 45, and 90 min after MT we recorded plasma osmolality, hemodynamics and measured 6-keto-PGFlα (stabile metabolite of PGI₂), TXB₂ (stabile metabolite of thromboxane A₂) active renin, and arginine vasopressin (AVP) plasma concentrations by radioimmunoassay. Catecholamine levels were assessed by high-pressure liquid chromatography (HPLC) with electrochemical detection. Results : Following MT, arterial hypotension occurred along with a substantial PGI₂ release. This was completely abolished by ibuprofen administration. Although plasma levels of 6-keto-PGF_1α (1133 (708) vs. 60 (3) ng/L, median (median absolute deviation), P=0.0001, placebo vs. ibuprofen) remained significantly elevated, blood pressure was restored within 30 min after MT in the placebo group. At the same point in time plasma concentrations of TXB² (164 (87) vs. 58 (1) ng/L, P=0.0001), epinephrine (46 (33) vs. 14 (6) ng/L, P=0.001), AVP (41 ± (18) vs. 12 (7) ng/L, P=0.0004), and active renin (27 (12) vs. 12 (4) ng/L, P = 0.001) were significantly higher in placebo-treated patients. Conclusion : Under combined general and epidural anesthesia arterial hypotension following MT due to endogenous PGI₂ release is associated with enhanced release of AVP, active renin, epinephrine and thromboxane A₂, presumably contributing to hemodynamic stability within 30 min after MT.     

A comparison of the inhibitory effects of four volatile anaesthetics on the metabolism of chlorzoxazone, a substrate for CYP2E1, in rabbits

Background: Halothane inhibits in vitro and in vivo activity of cytochrome P-450 (CYP) 2E1. There are several fluorinated volatile anaesthetics besides halothane, and most of them are defluorinated by CYP2E1. It is unclear whether other fluorinated anaesthetics inhibit the in vivo activity of CYP2E1.
Methods: We compared the inhibitory effects of therapeutic concentrations of four inhalational anaesthetics, halothane, enflurane, isoflurane, and sevoflurane, on chlorzoxazone metabolism in rabbits receiving artificial ventilation.
Results: All four inhalational anaesthetics decreased arterial blood pressure and increased plasma chlorzoxazone concentration. However, no significant differences in the plasma chlorzoxazone concentration were found between the four anaesthetics. The estimated chlorzoxazone clearance increased after beginning inhalation with all four agents, but no significant difference in clearance was noted between agents.
Conclusions: At therapeutic concentrations, the in vivo inhibitory effect on chlorzoxazone metabolism was similar for all four inhalational anaesthetics examined, even though their chemical characteristics and extent of hepatic metabolism differ considerably.     

A Teaspoon Pump for Pumping Blood with High Hydraulic Efficiency and Low Hemolysis Potential

Abstract: Virtually all blood pumps contain some kind of rubbing, sliding, closely moving machinery surfaces that are exposed to the blood being pumped. These valves, internal bearings, magnetic bearing position sensors, and shaft seals cause most of the problems with blood pumps. The original teaspoon pump design prevented the rubbing, sliding machinery surfaces from contacting the blood. However, the hydraulic efficiency was low because the blood was able to "slip around" the rotating impeller so that the blood itself never rotated fast enough to develop adequate pressure. An improved teaspoon blood pump has been designed and tested and has shown acceptable hydraulic performance and low hemolysis potential. The new pump uses a nonrotating "swinging" hose as the pump impeller. The fluid enters the pump through the center of the swinging hose; therefore, there can be no fluid slip between the revolving blood and the revolving impeller. The new pump uses an impeller that is comparable to a flexible garden hose. If the free end of the hose were swung around in a circle like half of a jump rope, the fluid inside the hose would rotate and develop pressure even though the hose impeller itself did not "rotate"; therefore, no rotating shaft seal or internal bearings are required.     

Microspheres Based Detoxification System: A New Method in Convective Blood Purification

Abstract: A variety of protein-bound or hydrophobic substances, accumulating as a result of pathologic conditions such as exogenous or endogenous intoxications, are removed poorly by conventional detoxification methods because of low accessibility (hemodialysis), insufficient adsorption capabilities (hemosorption), low efficiency (peritoneal dialysis), or economic limitations (high-volume plasmapheresis). Combining advantages of existing methods with microspheric technology, a module-based system was designed. Major operating parameters of the latter can be modified to allow for adjustment to individual clinical situations. An extracorporeal blood circuit including a plasmafilter is combined with a secondary high-velocity plasma circuit driven by a centrifugal pump. Different microspheric adsorbers can be combined in one circuit or applied in sequence. Thus, a prolonged treatment can be tailored using specially designed selective adsorber materials. Comparing this system with existing methods (high-flux hemodialysis, molecular adsorbent recycling system), results from our in vitro studies and animal experiments demonstrate the superior efficiency of substance removal.     

Is the recovery profile of mivacurium independent of the rate of decay of its plasma concentration in patients with normal plasma cholinesterase activity?

Background: The duration of action of muscle relaxants is poorly correlated to the rate of decay of their plasma concentration. The plasma concentration of mivacurium may rapidly decrease below its active concentration because of the extensive hydrolysis of mivacurium. By inflating a tourniquet on one upper limb for 3 min after the administration of atracurium, mivacurium or vecuronium, we studied the influence of the initial decline of their plasma concentration on their effect. Methods: In 50 patients anaesthetised with thiopental, isoflurane and fentanyl, the effect of bolus doses of 0.15 or 0.25 mg . kg^?1 mivacurium (MIV 15, MIV 25), 0.3 or 0.5 mg . kg^?1 atracurium (ATR 30, ATR 50) and 0.06 or 0.1 mg . kg^?1 vecuronium (VEC 06, VEC 10) were measured on both arms (evoked response of the adductor pollicis to train-of-four stimulation every 12 s), a tourniquet being applied on one arm just before and during 3 min after the muscle relaxant bolus. Results: Tourniquet inflation of 3 min almost abolished the neuromuscular effect of mivacurium. In the vecuronium groups and in the ATR 50 group, tourniquet inflation did not modify the maximum degree of depression of the twitch response. Also, the duration of action of vecuronium was unaffected by the tourniquet. In the ATR 30 group, times to return of the twitch response to 25% (duration 25%) and 75% (duration 75%) of control response were significantly shorter in the cuffed arm, 23 min vs 27 min, and 41 min vs 45 min, respectively. In the ATR 50 group, only duration 25% was significantly shorter in the cuffed arm (41 min vs 45 min). Conclusion: The results suggest that the rate of decline of the plasma concentration of mivacurium is so rapid, that a very low and almost clinically ineffective concentration is present as soon as 3 min after its administration. The results also indicate that the recovery from a mivacurium-induced neuromuscular blockade is not influenced by the rate of decay of its plasma concentration in patients with genotypically normal plasma cholinesterase.     

Membranes in Artificial Organs

Abstract: Membrane processes play a pivotal and enabling role in modern replacement therapy for acute and chronic organ failure and in the management of immunologic diseases. In fact, virtually all contemporary extracorporeal blood purification methods employ membrane devices, and the next generation of artificial organs and tissue engineering therapies are almost certain to be similarly grounded in membrane technology. In this short essay, we comment on the similarities and differences among synthetic membranes and their natural counterparts and also provide a critical overview of the demographics and technology of hemodialysis, hemofiltration, apheresis, oxygenation, and emerging membrane technologies and applications.     

Tissue perfusion in relation to cardiac output during continuous positive-pressure ventilation and administration of propranolol or verapamil

Background : Our objective was to determine whether administration of propranolol or verapamil modifies the hemodynamic adaptation to continuous positive-pressure ventilation (CPPV), in particular the regional distribution of cardiac output (CO).
Methods : General hemodynamics and regional blood flows assessed by microsphere technique (15 (μm) were recorded in 16 anesthetized pigs during spontaneous breathing (SB) and CPPV with 8 cm H₂O end-expiratory pressure (CPPV8) before and after intravenous administration of propranolol (0.3 mg · kg⁻¹ followed by 0.15 mg · kg⁻¹ · h⁻¹, n=8) or verapamil (0.1 mg · kg⁻¹ followed by 0.3 mg · kg⁻¹ · h⁻¹, n=8).
Results : CPPV8 depressed CO by 25% without shifts in its relative distribution with the exception of a noteworthy increase in adrenal perfusion. Propranolol increased arterial blood pressure, and due to a fall in heart rate, CO dropped by 25%. The kidneys and, to a lesser extent, the splanchic region and central nervous system received increased fractions of the remaining CO at the expense of skeletal muscle flow. Similar patterns were seen during SB and CPPV8 such that the combination of propranolol and CPPV8 depressed CO by 50%. The circulatory effects of verapamil were less evident but myocardial perfusion tended to increase.
Conclusions : The combination of propranolol or verapamil with CPPV does not result in any specific hemodynamic interaction in anesthetized pigs, except that the combined effect of propranolol and CPPV may severely reduce CO.     

Volatile anaesthetics reduce adhesion of blood platelets under low-flow conditions in the coronary system of isolated guinea pig hearts

Background : Inhibitory effects of volatile anaesthetics on platelet aggregation have been demonstrated in several studies. However, the influence of volatile anaesthetics on intracoronary platelet adhesion has not been elucidated so far.
Methods : Isolated hearts of guinea pigs were perfused with buffer in the absence or presence of volatile anaesthetics (0.5 and 1 MAC) at constant coronary flow rates of 5 ml/min for 25 min, then 1 ml/min for 30 min and again 5 ml/min for 10 min. Before, during and after low-flow perfusion, a bolus of human platelets was applied into the coronary system. To simulate thrombogenic conditions, 0.3 U/ml human thrombin was infused during low-flow perfusion and reperfusion. The number of platelets sequestered to the endothelium was calculated from the difference between coronary in- and output of platelets. The myocardial production of lactate and consumption of pyruvate and coronary perfusion pressure were also determined.
Results : At a flow rate of 5 ml/min only about 3% of the applied platelets did not emerge from the coronary system, in any group. In contrast, 13.1±1.2% (mean±SEM) of infused platelets became adherent in low-flow perfusion in the control group without anaesthetic. The adherence was reduced with each 1 MAC isoflurane (to 6.2±1.2%), sevoflurane (to 4.4±0.9%) or halothane (to 3.2±1.5%) (each P <0.05 vs. control). Volatile anaesthetic, 0.5 MAC, did not inhibit platelet adhesion to a statistically significant extent in any case. Perfusion pressure and metabolic parameters were not statistically different between the control and the hearts exposed to anaesthetics.
Conclusion : Volatile anaesthetics in a concentration of 1 MAC can reduce the adhesion of platelets in the coronary system under reduced flow conditions. This action does not arise from vasodilation or inhibition of ischaemic stress.     

Bariatric Surgery in Some "Central and East-European (former Eastern bloc)"Countries - Current Status and Prediction for the Next Millennium

Background: Obesity is increasing globallly, including in the formerly "Eastern Bloc" countries. Methods: A survey was made of obesity and bariatric surgery. Results: In the 8 East and Central European countries studied, with total population 300 million, roughly 43% of the population was overweight (BMI 25-30), 23% obese (BMI > 30), with about 15 million people morbidly obese (BMI > 40). From 0-10 morbidly obese individuals/100,000/year undergo bariatric surgery. Conclusion: Most countries were found to provide inadequate treatment for obesity.The majority of the morbidly obese are not treated effectively. However, health-care awareness of obesity and bariatric surgeons are slowly increasing.     

Dilemma of Membrane Biocompatibility and Reuse

Abstract: Numerous articles have been published on the multiple use of dialyzers and on the effect of different reprocessing chemicals and techniques on the dialyzer biocompatibility and performance. The results often appear contradictory, especially those comparing standard biocompatibility parameters. Despite this confusion, a discerning review of the published works allows certain limited conclusions to be drawn. Reprocessing of used hemodialyzers changes the biocompatibility profile of a dialyzer as defined by the parameters complement activation. leukopenia, and cytokine release. The effect of reprocessing depends on the chemicals and reprocessing technique applied and also on the type of membrane polymer being subjected to the reprocessing procedure. Reports of pyrogenic reactions indicate that the flux of the membrane also influences how suitable it is for safe reuse. An increased risk of allergic and pyrogenic reactions appears to be associated with dialyzer reuse. Furthermore, there has been a lack of investigations into the immunologic effect of the layer of adsorbed and chemically altered proteins that remains on the inner surface of reprocessed dialyzers. We conclude that the clinical benefit of dialyzer reuse cannot be generally accepted from a biocompatibility point of view.