膨胀式椎弓根钉系统治疗椎体骨质疏松性骨折

[目的]探讨膨胀式椎弓根钉系统内固定治疗伴有神经损伤表现的胸腰段椎体骨质疏松性骨折的疗效。[方法]本组共有患者31例,平均年龄68.3岁(61～84岁)。术前诊断为胸腰段椎体骨质疏松性骨折并马尾神经或腰神经根损害。全部病例接受了骨折复位、椎管减压、膨胀式椎弓根钉系统内固手术治疗。采用VAS和Oswestry功能障碍指数(ODI),以及影像学观测脊柱Cobb角和受伤椎体高度回复率评估临床疗效。[结果]全部患者得到随访,平均随访20.7个月(6～36个月),腰背部疼痛基本消失。术后VAS为2.8分、ODI为32.2%。术后压缩性骨折基本复位,观察期间内固定物无松脱、折断。[结论]膨胀式椎弓根钉系统有利于骨质疏松性椎体骨折的复位和维持,进而减轻疼痛症状和提高生存质量,用于伴有神经损伤的老年骨质疏松性椎体骨折是安全和有效的。     

微创球囊扩张椎体成型术的临床应用

目的:探讨经皮穿刺球囊扩张椎体成形术治疗中老年胸腰椎椎体压缩性骨折,椎体肿瘤的疗效.方法:局麻下采用经皮穿刺球囊扩张椎体后凸成形术,治疗中老年胸腰椎椎体压缩性骨折,63例75个椎体,椎体转移肿瘤4例5个椎体,血管瘤2例2个椎体.采用后路椎弓根入路.双侧18椎,余均为单侧.结果:随访5～24个月,患者胸腰背疼痛缓解明显,脊柱后凸畸形及椎体高度恢复明显.结论:该手术治疗中老年中老年胸腰椎椎体压缩性骨折、椎体肿瘤效果满意.     

经皮椎体后凸成形术治疗老年人骨质疏松性椎体压缩性骨折24例

目的探讨经皮椎体后凸成形术治疗老年人骨质疏松性椎体压缩性骨折的临床疗效。方法分析24例老年人骨质疏松性椎体压缩性骨折患者应用椎体后凸成形术治疗,在伤椎椎弓根建立工作通道,应用球囊扩张后注入骨水泥,骨水泥固化后拔除工作套筒,完成手术。结果本组24例全部获得随访,术后随访6～18个月,平均12个月,患者伤椎恢复原有高度,腰背部疼痛消失,无复发,手术成功。结论经皮椎体后凸成形术在治疗骨质疏松性椎体压缩性骨折中可以迅速缓解疼痛,恢复椎体高度和形态,是一种理想的治疗方法,具有较好的临床应用前景。     

经皮椎体强化术辅助技术研究进展

经皮椎体强化术具有微创、安全等优点,但对于骨质疏松性椎体压缩性骨折(OVCF),其重建伤椎椎体高度和纠正局部后凸成角方面仍有不足,并存在术后伤椎椎体高度和后凸角度再丢失现象,加重患者疼痛和脊柱后凸畸形。椎弓根体外恢复术、改良经皮椎体后凸成形术、椎体支架植入术、Spine Jack系统、Osseofix系统等经皮椎体强化术辅助技术,在重建OVCF患者伤椎椎体高度和矫正后凸成角方面的优势相当明显。该文对经皮椎体强化术辅助技术在OVCF治疗中的研究进展作一综述。     

经皮椎体后凸成形术治疗骨质疏松性椎体压缩性骨折

目的评价球囊扩张椎体后凸成形术治疗老年骨质疏松椎体压缩性骨折的疗效和安全性。方法自2008年8月至2011年7月采用椎体后凸成形术治疗老年骨质疏松脊柱压缩骨折30例42椎,患者均有腰背部疼痛。取俯卧位调节手术床使椎体骨折部位过伸,达到满意的闭合复位后,经皮双侧或单侧椎弓根穿刺球囊扩张,填充骨水泥。随访观察患者的疼痛、日常功能以及影像学改变情况。根据术前和术后侧位X线片测量椎体高度、后凸畸形角度,进行统计学分析。利用Oswestry评分、视觉模拟评分（visualanaloguescale,VAS）评定临床疗效。观察有无骨水泥渗漏等并发症。结果术后随访6～24个月,平均10个月。术后伤椎处疼痛均明显缓解,VAS评分从术前平均（8．45±0．48）分降至术后平均（2．45±0．52）分,椎体高度明显恢复,后凸畸形得到矫正。随访期间疗效满意,伤椎高度无明显丢失。未出现严重的骨水泥渗漏并发症。术后椎体高度及伤椎后凸角度与术前比较有统计学差异（P〈0．05）,术后VAS及Oswestry评分与术前比较有统计学差异（P〈0．01）。结论球囊扩张椎体后凸成形术治疗骨质疏松脊柱压缩性骨折,能有效恢复椎体高度和矫正后凸畸形,能迅速缓解疼痛,减少骨折并发症,提高患者生活质量。     

球囊扩张椎体后凸成形术治疗老年骨质疏松性椎体骨折

目的：探讨球囊扩张椎体后凸成形注入骨水泥治疗老年骨质疏松性椎体骨折的疗效。方法：对52例老年骨质疏松性单椎体骨折患者采用球囊扩张椎体后凸成形术治疗。在DSA透视引导下行单侧或双侧椎弓根穿刺,注入骨水泥。结果：发生骨水泥渗漏6例,术后1周腰背疼痛、后凸角度、伤椎高度、活动能力较术前明显改善（P〈0.05）,术后6个月、末次随访与术后1周,上述指标比较差异均无显著性（P〉0.05）。结论：球囊扩张椎体后凸成形注入骨水泥,不仅能够明显缓解骨质疏松性脊柱骨折导致的疼痛,而且可以部分恢复椎体高度和改善脊柱后凸畸形,有利于脊柱功能的恢复。     

双侧穿刺单球囊扩张椎体成形术治疗胸腰椎骨折疗效观察

目的探讨经皮双侧椎弓根穿刺单球囊扩张椎体后凸成形术治疗老年骨质疏松性骨折的临床疗效。方法回顾性分析2011年1月至2013年6月,采用经皮双侧椎弓根穿刺单球囊扩张椎体后凸成形术治疗老年骨质疏松性胸腰椎骨折28例临床疗效,观察患者手术前后疼痛视觉模拟评分(visual analogue scale,VAS)、椎体前柱高度、Cobb角及活动能力评分。结果全部病例均顺利完成手术,无并发症发生,28例均获得随访至少1年。术后2 d及末次随访结果提示所有患者术后疼痛明显减轻,椎体高度、Cobb角及行动能力均取得明显改善(P0.01)。结论经皮双侧椎弓根穿刺单球囊扩张椎体后凸成形术治疗老年骨质疏松骨折可有效缓解疼痛,恢复椎体高度,纠正脊柱后凸畸形,改善生活质量,取得满意的临床疗效,同时手术中只使用一个球囊,可以有效减轻患者的经济负担。     

椎体成形术治疗骨质疏松性椎体压缩骨折

目的探讨经皮椎体成形术治疗老年骨质疏松性椎体压缩骨折的临床效果。方法 26例骨质疏松性椎体压缩骨折患者中20例采用单侧椎弓根穿刺注射,6例采用双侧椎弓根穿刺注射。术后比较VAS及ODI变化评价疗效。结果所有患者均穿刺成功,单个椎体注射骨水泥量为3.0～4.5 mL(平均3.2 mL),全部病例获随访6～24个月,平均13.5个月。椎体高度和后凸畸形无明显恢复。术后VAS评分和ODI明显改善。结论 PVP是治疗骨质疏松性椎体压缩性骨折安全、有效的方法,其缓解疼痛效果明显。     

骨水泥强化椎弓根钉固定联合椎体成形术治疗重度骨质疏松性脊柱骨折

目的 探讨骨水泥强化椎弓根钉固定联合椎体成形术治疗严重骨质疏松性椎体压缩骨折的围术期处理和临床疗效.方法 回顾分析2005年8月～ 2009年4月收治的15例严重骨质疏松性椎体压缩骨折患者的临床资料,平均63.1岁,无重大基础病存在,经脊柱后入路椎弓根钉撑开复位,钉道采用骨水泥灌注加强并行经伤椎椎体成形术.术后随访10～ 38个月,平均21月.结果 均耐受手术,平均手术时间为106.7±5.3min;平均失血量为370±6.1ml,术后腰背痛明显改善,椎体高度恢复至90％左右,随访椎体高度角度丢失不明显.结论 应用骨水泥强化椎弓根钉固定联合椎体成形术治疗严重骨质疏松性椎体压缩骨折,矫正及维持椎体复位效果好,手术适应证的选择和骨质疏松药物治疗是关键.     

Sky膨胀式椎体成形器治疗老年骨质疏松脊柱压缩骨折

目的探讨Sky膨胀式椎体成形器治疗疼痛性老年骨质疏松脊柱压缩骨折的疗效和安全性.方法2004年8月～2005年2月,我院采用Sky膨胀式椎体成形器行经皮椎体后凸成形术治疗疼痛性老年骨质疏松脊柱压缩骨折10例15椎.椎体后壁完整,术前均无脊髓和神经根受损的症状和体征.采用经皮穿刺单侧椎弓根置入Sky膨胀式椎体成形器使骨折塌陷椎体复位,用骨水泥进行充填.结果10例术后24 h内疼痛症状明显缓解或消失,术后1 d可下地行走,3 d出院.术后第2天常规行X线复查,1例2个椎体出现骨水泥少许渗漏,未见神经压迫症状.术前骨折椎体前缘的高度为(18.34±3.25)mm,术后椎体前缘的高度为(20.61±1.34)mm(t=2.1475,P=0.00);术前骨折椎体中线的高度为(14.40±2.56)mm,术后椎体中线的高度为(19.56±1.28)mm(t=3.1866,P=0.00);术前骨折椎体后缘的高度为(23.88±1.89)mm,术后椎体后缘的高度为(24.47±2.03)mm(=1.2956,P=0.15),均提示伤椎前中部高度恢复明显.后凸畸形纠正范围13°～26°,平均19°.10例随访3～6个月,平均5.2月,未诉明显疼痛,X线示椎体高度未见明显丢失.未出现严重并发症.结论Sky膨胀式椎体成形器治疗疼痛性骨质疏松脊柱压缩骨折,能迅速缓解疼痛,恢复椎体高度.     

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.