股骨近端锁定接骨板治疗股骨转子间骨折疗效分析

目的探讨应用股骨近端锁定接骨板内固定治疗高龄股骨转子间骨折的方法及临床效果。方法回顾性分析2006年8月至2009年1月应用股骨近端锁定接骨板固定治疗48例高龄股骨转子间骨折患者,其中男30例,女18例;年龄63—91岁,平均77岁。切开显露大转子及前侧关节囊,直视下牵引复位,保持正常颈干角,选择合适长度的股骨近端锁定接骨板置于大转子下,远端钳夹固定。通过钢板近端孔向股骨头颈方向钻入三枚导针,术中C形臂X线机透视下监视复位及导针位置。测深、钻入自攻锁定螺钉3枚,然后钻孔、测深、攻丝、拧入远端螺钉,远端螺钉全部使用普通螺钉。结果骨折处均顺利愈合,无切口感染、退钉、髋内翻畸形发生。黄公怡疗效评定标准：优良率91．7％。结论股骨近端锁定接骨板内固定通过3枚近端锁定松质骨拉力螺钉,将股骨头颈与股骨上端采用多点固定,可有效控制近端旋转,建立股骨上端支架结构,术中无需预弯钢板,直视下复位较容易,安放方便。尤其对于高龄老年骨质疏松患者,锁定螺钉固定有效降低了术后退钉、髋关节内翻、颈干角丢失等的发生率。     

加压空心螺纹钉治疗52例股骨颈骨折

1　材料与方法1.1　病例资料　本组 5 2例 ,男 2 2例 ,女 30例 ,年龄 30～ 92岁。骨折按解剖部位分型〔1〕:头下型 11例 ,经颈型 2 8例 ,基底型 13例 ;Ｇａｒｄａｎ分型 :Ⅱ型 4例 ,Ⅲ型 14例 ,Ⅳ型 34例。伤后至手术时间 1～ 6天。1.2　治疗方法　 2枚螺钉固定 46例 ,3枚螺钉固定 6例。术前行胫骨结节牵引或股骨髁上牵引 3～ 6天 ,术中去除牵引。采用腰麻或连硬外麻醉 ,将患者置于骨科手术台上 ,在Ｃ臂Ｘ线机透视下 ,闭合复位 ,满意后 ,固定患肢。取 1枚 3ｍｍ克氏针穿过皮肤 ,从股骨大转子下 2 5ｃｍ处打入 ,该针在股骨颈中央上方与股骨…     

解剖型锁定钢板治疗骨质疏松Singh Ⅰ、Ⅱ度股骨粗隆间骨折疗效分析

目的 探讨分析解剖型锁定钢板内固定治疗骨质疏松Singh Ⅰ、Ⅱ度股骨粗隆间骨折的临床疗效.方法 对47例老年骨质疏松性股骨粗隆间骨折均在C型臂X线机透视下闭合复位后采用解剖型锁定钢板内固定治疗,统计手术时间、术中出血量以及骨折愈合时间,并对术后髋关节进行Harris评分.结果 45例得到随访,2例失访,随访时间6～2...     

锁定解剖钢板内固定治疗老年股骨转子间骨折

目的 探讨锁定解剖钢板内固定治疗老年股骨转子间骨折的疗效.方法 2009年1月至2011年3月采用锁定解剖钢板内固定治疗22例老年股骨转子间骨折患者,男9例,女13例；年龄56 ～ 87岁,平均76.4岁.骨折按改良Evans分型:IA型6例,IB型6例,Ⅱ型7例,Ⅲ型l例,逆转子间骨折2例.闭合牵引复位满意后纵向切开股外侧肌起点肌膜1 cm,紧贴股骨外侧皮质向远端插入钢板,近端3孔置入3枚空心锁定螺钉.远端经皮锁定至少3枚双层皮质螺钉.结果 本组患者手术时间为45～60 min,平均52 min；术中出血量约50～80 mL,平均62 mL.22例患者术后获5～18个月(平均10.1个月)随访.骨折均获愈合,临床愈合时间为8～13周,平均10.2周.髋关节功能按Harris评分评定:优11例,良7例,可4例,优良率为81.8％.无骨折端移位、螺钉松动、拔出及断钉、髋内翻等并发症发生.2例患者大腿中上部疼痛持续半年余.结论 锁定解剖钢板内固定治疗老年股骨转子间骨折具有创伤小、愈合快、并发症少、操作简单及疗效佳等优点.     

外固定支架辅助牵引复位内固定治疗股骨远端骨折

2015年3月~2018年10月,我科采用外固定支架辅助牵引复位内固定治疗23例股骨远端骨折患者,疗效满意,报道如下。1材料与方法1.1病例资料本组23例,男18例,女5例,年龄37~68岁。骨折AO分型:A型12例,B型7例,C型4例。伤后均先行胫骨结节骨牵引。受伤至手术时间3~10 d。1.2治疗方法硬膜外麻醉下手术。在同侧髂前下棘和胫骨结节处分别打入1枚4.0 mm斯氏针,安装复位外架牵开器。转动调整螺丝牵开复位,C臂机透视确认骨折复位后,在股骨髁外侧、股骨近端外侧分别取3 cm切口,采用微创经皮钢板固定(MIPPO)技术,用股骨外侧长钢板固定骨折端,两侧分别上4~5枚螺钉,透视无误后关闭切口。放置引流24~48 h,石膏外固定3~4周。     

中老年人股骨转子间骨折动力髋螺钉内固定术疗效分析

目的探讨中老年人股骨转子间骨折经动力髋螺钉内固定的方法及临床疗效。方法在C型臂X线机透视下闭合复位，应用动力髋螺钉（DHS）内固定治疗中老年人股骨转子间骨折31例，其中男23例，女8例；年龄49～65岁，平均57.3岁。结果术后随访9～17个月，平均13．1个月。骨折均达到满意复位并愈合，无髋内翻，髋螺钉切割、拔出或穿透股骨头现象。结论中老年人多存在不同程度的骨质疏松，应用DHS内固定治疗股骨转子间骨折，固定牢，创伤小，术后并发症少，疗效满意。     

股骨重建钉治疗股骨粗隆周围骨折

目的 探讨股骨重建钉在股骨粗隆周围骨折治疗中的临床疗效.方法 对23例股骨粗隆周围骨折,采用直切口,暴露粗隆间窝,开口、扩髓,C型臂X线机透视下复位骨折后打人股骨主钉,确定好前倾角打人股骨颈拉力螺钉2枚,安装远端锁钉固定.结果 本组随访1个月～5年.无一例发生骨折不愈合和股骨头坏死,未出现髋内翻、畸形愈合,功能恢复良好...     

多轴锁定钢板治疗老年Jensen-Evans Ⅴ型股骨转子间骨折

目的探讨多轴锁定钢板治疗老年Jensen-EvansⅤ型股骨转子间骨折的临床疗效。方法应用股骨远端多轴锁定钢板倒置治疗31例老年Jensen-EvansⅤ型股骨转子间骨折患者。结果患者均获得随访,时间16~36(27.4±6.5)个月。手术时间为38~72(50±8.2)min,C臂机透视次数为3~8(5.3±2.5)次,术中失血量为100~220(108±10.5)ml,骨折愈合时间为13~18(12.2±5.5)周。1例出现骨折内固定失效,二期给予髋关节置换;2例出现股骨头坏死,二期给予髋关节置换;3例出现转子部位屈髋痛,钢板取出后疼痛消失。根据Harris髋关节功能评分:优16例,良9例,差6例。结论多轴锁定钢板治疗老年Jensen-EvansⅤ型股骨转子间骨折手术时间短,C臂机透视次数少,失血量少,固定可靠。     

股骨转子间骨折不同固定方式的临床疗效

手术治疗固定股骨转子间骨折的方法[1],根据骨折类型可行动力髋螺钉(dynamic hip screws,DHS)内固定(A组)、股骨近端髓内钉(proximal femoral nail,PFN)内固定(B组)和带空心钉锁定型股骨近端解剖钢板内固定(C组).我院从2009年1月～2011年2月采用上述方法治疗股骨转子间骨折患者,报告如下.     

三枚空心拉力螺钉经皮治疗股骨颈骨折

目的通过研究三枚空心拉力螺钉经皮治疗股骨颈骨折临床操作方法,手术前后注意事项,达到提高临床疗效,减少股骨颈骨折的并发症.方法本组41例均为新鲜股骨颈骨折,经术前牵引复位,在牵引状态及C型臂机透视下,从患肢大腿外侧穿刺,与股骨成20°～30°角的方向交叉钻入导引针,定位正确后,再分别拧入3枚空心拉力螺钉.结果随访2年2个月～13年2个月,采用北京积水潭医院疗效评定标准,41例中愈合39例,愈合率95.12%,发生股骨头缺血性坏死6例,占14.63%.结论术前良好的复位,术中选择合适的螺钉,正规的操作,是手术成功的关键,骨折愈合的基础.术后早期不负重,正确的康复锻炼是降低股骨头缺血性坏死发生率的必备条件.     

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.     

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.     

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.     

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.