后交叉韧带断裂并胫腓骨骨折12例报告

膝关节后交叉韧带断裂并胶胖骨骨折是下肢一种严重的复合伤，如未及时有效的治疗，常造成膝关节失稳而影响活动与劳动。我院自1992年～1995年间收治12例，疗效满意，现报告如下。临床资料12例中男10例，女2例；年龄20～45岁；均为同侧肢体，右侧5例，左侧7例；均为新鲜损伤（1例漏诊变为陈旧性后交叉韧带断裂）；致伤原因：摩托车车手车祸伤9例，车祸伤2例，坠落伤1例；后交叉韧带在胶骨止点处撕脱骨折8例，胜骨止点处撕裂3例，中央部断裂1例；胫腓骨开放性骨折9例，闭合性骨折3例；合并同侧髌骨骨折3例，脑震荡2例，对侧股骨干骨折2例。治…     

重建钉治疗股骨干合并同侧髋部骨折

自 2 0 0 1年至今应用股骨重建钉治疗股骨干合并股骨颈骨折及转子间骨折或转子下粉碎性骨折共 7例 ,取得良好的效果 ,现报告如下。1　临床资料1 1　一般资料　本组 7例均为男性 ,年龄 17～ 5 9岁 ,平均34岁。左侧 3例 ,右侧 4例。骨折部位 :按ＡＯ/ＡＳＩＦ分类 ,股骨干Ａ型 2例 ,Ｂ型 4例 ,Ｃ型 1例。髋部 2例Ａ2 型 ,3例Ａ3 型 ,2例Ｂ2 型。其中 2例股骨干为开放性骨折 ,余均为闭合性骨折。致伤原因 :6例车祸伤 ,1例高处坠伤。合并伤 :休克 2例 ,颅脑损伤 1例 ,上肢骨折 2例 ,同侧胫腓骨开放骨折 2例。1 2　治疗方法　病人入院后即予建立…     

重建交锁髓内钉治疗同侧股骨干和股骨颈骨折11例

我科自 1997年 8月～ 2 0 0 0年 11月应用重建型股骨交锁髓内钉治疗股骨干骨折伴同侧股骨颈骨折 11例 ,疗效满意。1　临床资料1 1　一般资料　应用由Ｓｍｉｔｈ＆Ｎｅｐｈｅｗ和Ａｕｓｔｏｆｉｘ提供的重建型股骨交锁髓内钉治疗 11例股骨干合并同侧股骨颈骨折 ,男 9例 ,女 2例 ;年龄 18～ 5 6岁 ,平均 34岁。患者均为高能量损伤包括车祸和高处坠落伤 ,其中 8例为多发伤 (合并脑外伤 3例 ,其余肢体骨折 3例 ,肋骨骨折 2例 ,下颌骨骨折 1例 )。1 2　手术方法　应用全身麻醉 ,8例患者闭合复位、穿钉 ,仰卧于骨折牵引床 ,健侧下肢外展 ,患肢尽量…     

外固定架治疗胫骨平台C型骨折

胫骨平台Ｃ型骨折指胫骨双髁骨折合并胫骨干骺端骨折的严重骨折类型 ,治疗复杂 ,预后差[1] 。我院自 1993年 3月～ 1999年 12月 ,用超长单侧外固定架与Ｔ型单侧外固定架交替治疗胫骨平台Ｃ型骨折 16例 ,效果满意 ,报告如下 :1　临床资料1 1　一般资料　本组 16例 ,男 12例 ,女 4例 ,年龄 2 2～74岁 ,平均 33 7岁。车祸伤 13例 ,高空坠落伤 3例。开放性骨折 7例 ,闭合性骨折 9例。合并同侧侧副韧带断裂 5例 ,交叉韧带断裂 3例 ,半月板损伤 7例。合并软组织挫裂伤 6例 ,四肢多发骨折 9例。手术时间于伤后 1 5ｈ至 12ｄ ,平均 38ｈ。1 2　治疗…     

尺骨鹰嘴骨折内固定失败原因分析

自1 995年1月～2 0 0 2年8月,共收治尺骨鹰嘴骨折76例。临床资料完整者4 3例。现报告如下。1　临床资料1 1　一般资料　本组男2 8例,女1 5例,年龄1 2～5 1岁,平均37岁。左侧2 4例,右侧1 9例。致伤原因:车祸伤2 5例。高处坠落伤1 8例。开放性损伤1 2例(按Custilo和An derson分型,属Ⅱ型5例) ;闭合性损伤31例。尺骨鹰嘴粉碎性骨折37例,斜形骨折6例。其中38例合并冠状突骨折,5例合并肱骨外髁骨折。36例合并其它损伤,包括同侧股骨干骨折8例,肋骨骨折1 4例,同侧桡骨远端骨折7例,同侧肩胛盂骨折3例。开放性损伤均急诊清创内固定术,闭合性损伤患…     

31例髋关节中心性脱位诊治体会

髋关节中心性脱位为一种严重的关节损伤，多伴有其它部位创伤，在抢救及治疗其它部位伤时，也应及早治疗济关节损伤，否则将导致患肢残疾。我院10年间共收治31例欧关节中心性脱位，治疗效果良好，优良率占80．6％，现报告如下。1临床资料1．1一般资料男24例，女7例，年龄14～61岁，平均35．6岁。1．2致伤原因车祸伤22例，坠落伤7例，挤压伤2例。1．3分型及合并伤左20例，右11例。按Ei-chenholtz分型“‘：I。9例，I。7例，I。5例，刀。6例，血型4例。伴有肢体骨折22例，其中9例为同侧下肢骨折（股骨干骨折4例，腔肿骨骨折3例，转子及股骨…     

浮膝损伤的治疗方法选择

由于浮膝损伤发生时暴力大 ,造成的损伤相对较严重 ,并发症的发生相对较多 ,其治疗有着特殊性。我院自 1990年～ 1999年共收治浮膝损伤患者 47例 ,得随访 42例 ,现报告如下 :1　临床资料1 1　一般资料　本组男 31例 ,女 11例。年龄 2 3岁～ 5 6岁 ,平均 38岁 ;车祸伤 2 9例 ,高处坠落伤 9例 ,机器伤 4例。其中开放性骨折 7例 ,均为胫骨开放性骨折 ,Ⅰ度 2例 ,Ⅱ度 5例 ;合并脾破裂 3例 ,合并肠破裂 1例 ,合并骨盆骨折 2例 ,合并脑震荡 1例。骨折类型 :Ⅰ型 :股骨髁部合并胫骨髁部骨折 3例 ;Ⅱ型 :股骨干中下 1/3合并胫 (腓 )骨中 1/3以上部…     

股骨颈骨折漏诊9例原因分析

2003年12月～2008年12月,我院共收治股骨颈骨折漏诊患者9例,笔者对资料进行分析,探讨预防措施。 1材料与方法 1．1病例资料本组9例,男5例,女4例,年龄25—80岁。受伤原因：跌伤3例,坠落伤2例,机动车祸伤2例,自行车撞伤1例,外伤史不详1例;漏诊病例合并症：颅脑损伤昏迷1例,同侧股骨干中下段骨折1例,L1骨折1例。6例为单纯股骨颈骨折。发现漏诊时间7d一3个月。     

股骨干合并同侧股骨颈及转子部骨折三种内固定方法的临床比较

股骨干及转子部骨折合并同侧股骨颈骨折系高能量创伤所致 ,且常伴有多个系统的骨折损伤 ,临床上称为复杂股骨骨折[1] 。自 1995年 7月以来共收治此类病人 2 3例 ,分别用三种内固定方法治疗 ,分析各自术中及术后情况 ,报告如下。1　临床资料1 1　一般资料　本组 2 3例 ,男 15例 ,女 8例。年龄 19～6 7岁 ,平均 36 5岁。右侧 14例 ,左侧 9例。受伤原因 :车祸伤 16例 ,高处坠落伤 5例 ,重物砸伤 2例。1 2　骨折类型及术式　股骨干骨折部位 :股骨干上 1/3骨折 11例 ,中 1/3骨折 7例 ,下 1/3骨折 5例。股骨颈骨折 10例 ,Ｇａｒｄｅｎ分型分别为…     

股骨干骨折合并同侧股骨颈骨折的治疗(附8例报告)

股骨干骨折是较常见的创伤,但股骨干骨折合并同侧股骨颈骨折较少见,自1986年7月～1997年8月,我们收治284例股骨干骨折病人,合并同侧股骨颈骨折的有8例,分析报告如下:1　临床资料11　一般资料　8例中男6例,女2例。年龄30～46岁,平均385岁。车祸伤5例,高空坠落伤3例。漏诊4...     

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 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.     

Influence of dopexamine hydrochloride on haemodynamics and regulators of circulation in patients undergoing major abdominal surgery

Background: Catecholaminergic support is often used to improve haemodynamics in patients undergoing major abdominal surgery. Dopexamine is a synthetic vasoactive catecholamine with beneficial microcirculatory properties. Methods: The influence of perioperative administration of dopexamine on cardiorespiratory data and important regulators of macro- and microcirculation were studied in 30 patients undergoing Whipple pancreaticduodenectomy. The patients received randomized and blinded either 2 μg · kg^?1 · min^?1 of dopexamine (n=15) or placebo (n=15, control group). The infusion was started after induction of anaesthesia and continued until the morning of the first postoperative day. Endothelin-1 (ET-1), vasopressin, atrial natriuretic peptide (ANP), and catecholamine plasma levels were measured from arterial blood samples. Measurements were carried out after induction of anaesthesia, 2 h after onset of surgery, at the end of surgery, 2 h after surgery, and on the morning of the first postoperative day. Results: Cardiac index (CI) increased significantly in the dopexamine group (from 2.61±0.41 to 4.57±0.78 1 · min^?1 · m^?2) and remained elevated until the morning of the first postoperative day. Oxygen delivery index (DO₂I) and oxygen consumption index (VO₂I) were also significantly increased in the dopexamine group (DO₂I: from 416±91 to 717±110 ml/m² · m²; VO₂I: from 98±25 to 157±22 ml/m² · m²), being significantly higher than in the control group. pHi remained stable only in the dopexamine patients, indicating adequate splanchnic perfusion. Vasopressive regulators of circulation increased significantly only in the untreated control patients (vasopressin: from 4.37±1.1 to 35.9±12.1 pg/ml; ET-1: from 2.88±0.91 to 6.91±1.20 pg/ml). Conclusion: Patients undergoing major abdominal surgery may profit from prophylactic perioperative administration of dopexamine hydrochloride in the form of improved haemodynamics and oxygenation as well as beneficial influence on important regulators of organ blood flow.