手术治疗移位的跟骨关节内骨折

目的评价手术治疗移位的跟骨关节内骨折的临床疗效。方法对28例(32足)移位的跟骨关节内骨折行跟骨外侧入路切开复位内固定，其中26例予以植骨。结果26例获得随访，随访时间8～20个门，平均13个月，骨折均完全愈合，参照跟骨关节内骨折评分标准：优15例，良9例，可2例。术后创口局部渗液5例，皮缘局限性坏死1例，经换药后治愈。结论跟骨外侧入路切开复位内固定并植骨术是治疗移位的跟骨关节内骨折的有效方法。     

跟骨骨折的切开复位内固定与微创复位内固定治疗

目的探讨切开复位内固定及微创复位内固定治疗跟骨骨折的疗效。方法103例（103足）跟骨骨折患者分别以切开复位内固定及微创复位内固定进行治疗，根据术前、术后及随访的X线及CT影像，对手术效果进行比较。结果103足术后总体疗效优良率为79．61％。L型切口钢板内固定71足中，优9足，良47足，可13足，差2足，优良率为78．87％。外侧小切口空心钉内固定32足中，优5足，良21足，可6足，优良率为81．25％。结论外侧小切口入路治疗跟骨骨折，手术切口小，软组织损伤小，术后并发症较少。L形切口钢板内固定较牢靠，适用于关节面较为粉碎的跟骨骨折。     

后关节面移位的跟骨骨折的手术治疗

目的探讨后关节面移位的跟骨骨折手术治疗的相关问题。方法2003年1月～2006年1月，26例33足后关节面移位的跟骨骨折，经可延长的外侧“L”形入路行切开复位异形钢板内固定治疗。Essex—Lopresti分类：舌形骨折18足，关节压缩骨折15足；Sanders分类：Ⅱ型骨折21足，Ⅲ型骨折12足。13例合并身体其他部位骨折。骨折后平均8．3d（4～15d）接受手术。结果所有患者获得8～44个月（平均24．3个月）随访，切口均愈合良好，无皮瓣坏死及局部感染，骨折复位满意。按Maryland足部评分标准评价手术效果：优18足，良10足，中4足，差1足，优良率84．8％。结论经跟骨外侧“L”形入路的切开复位内固定技术是一种值得信赖的治疗移位跟骨骨折的方法。     

跟骨骨折手术并发症的临床分析

目的探讨手术治疗跟骨骨折手术并发症的形成和预防。方法回顾了2001年3月至2005年12月共165例173足的跟骨骨折手术病例，其中男性135例142足，女性30例31足。年龄21岁～80岁，平均37．5岁。伤后至手术时间3～18d。手术取跟骨外侧入路，复位后用可塑形钛板置外侧壁固定，术中有43例行人工骨充填植骨。术后常规负压引流48～72h并加压包扎。结果共发生手术并发症20例，占11．6％，其中7例切口缘浅表坏死，2例深部感染至慢性骨髓炎，1例腓骨长短肌腱断裂，5例腓肠神经损伤，5例复位丢失。结论正确把握手术时机、选择手术入路，规范操作、引流、植骨是减少跟骨骨折手术并发症的关键。     

外侧低位切口手术治疗跟骨关节内骨折

目的探讨跟骨外侧低位手术切口对涉及跟距关节跟骨骨折手术的治疗效果。方法自2011年2月至2012年12月在广东省东莞市黄江医院手术治疗38例40足距下关节塌陷性跟骨骨折患者,按照Sander分型,Ⅱ型20例22足,Ⅲ型15例15足,Ⅳ型3例3足。骨折手术切口采用跟骨外侧低位切口,骨折内固定材料选用跟骨"Y"型钛板。结果术后随访12~18个月,平均14个月。跟骨外侧切口术后全部愈合,跟骨骨折全部愈合,骨折愈合时间为10~20周。按美国足踝外科协会的Maryland足部评分标准评定,优28足,良9足,中3足,优良率为92.5%。结论涉及跟距关节面跟骨骨折采取手术治疗可以尽可能恢复跟骨形态和关节面平整,而采用跟骨外侧低位手术切口可减少术后并发症发生。     

跟骨丘部重建距下关节融合治疗跟骨骨折严重畸形愈合

目的介绍自体植骨丘部重建距下关节融台术治疗严重跟骨骨折畸形愈台的方法，探讨手术适应证及优、缺点。方法1998年11月～2002年8月．对17例21足跟骨骨折严重畸形愈台患者采用自体植骨丘部重建距下关节融台的方法进行治疗．男13例17足．女4例4足；年龄25～45岁，平均35.4岁；单侧跟骨骨折13侧13足，双侧4例8足．选择跟骨外侧改良“L”形切口行自体植骨丘部重建距下关节融合术，其中15例17足取髂骨植骨，1例2足分别取髂骨植骨和跟骨外膨的外侧壁植骨．1例2足取跟骨外膨的外侧壁植骨。所有跟骨外嘭的外删壁均做切除．结果15例18足获得随访。随访时间9～22个月，平均14．5个月。按Maryland方法评价术后功能：优7足，良9足，可2足；优良率为88．9%，X线片示Bohler角、Gissane角、距骨倾斜角、跟骨宽度及丘部高度基本恢复正常，结论自体植骨丘部重建距下关节融台术是治疗严重跟骨骨折畸形愈合的一种有技方法。可明显矫正跟骨畸形．恢复后足外形及功能。     

跟骨骨折手术、康复一体化治疗的临床观察简

目的探讨采用开放复位内固定结合康复锻炼治疗跟骨骨折的方法和临床疗效。方法自2009年3月至2011年4月，我科采用跟骨外侧改良“L”形入路，对跟骨骨折行切开复位钢板内固定手术67例（68足），同时在围手术期进行康复干预，形成一个康复一手术一康复的治疗顺序，进行术前术后放射学比较，术后1年对患足功能进行评价。结果67例患者随访10～22个月，平均随访13．3个月。骨折全部愈合，愈合时间平均11．9周。手术切口并发症发生率为5．97％，取钢板时间平均11．6个月。术后跟骨Boehler’s角和Gissane’S角恢复到正常范围。根据MarylandFootScore系统评价术后1年的足功能情况，优32足，良28足，可7足，差1足，优良率为89．55％。结论跟骨骨折手术、康复一体化治疗，可以更好的恢复跟骨的生理功能，减少骨折并发症，是治疗跟骨骨折的一种良好的治疗模式。     

跟骨关节内骨折的手术治疗

目的 总结应用跟骨解剖型钢板治疗跟骨关节内骨折的临床效果。方法 回顾分析1999年1月～2003年9月治疗的82例跟骨骨折的病例，所有患者手术前后均行常规的X线检查和CT半冠状位扫描，根据骨折粉碎情况和移位程度决定治疗的方法。其中Sanders分型Ⅲ型36例和Ⅳ型9例，共有45例采用外侧L型切口跟骨解剖型钢板内固定手术治疗。结果 45例患者应用跟骨解剖型钢板内固定手术基本恢复跟骨的高度、长度和宽度，术后切口感染3例，经治疗切口愈合。4例患者术后明显的距下关节炎，行二期跟距关节融合术。平均随访38个月，根据美国足踝外科协会跟骨骨折的评分标准，优6例、良26例、可7例、差6例。优良率达71.1％。结论 应用跟骨解剖型钢板治疗Sanders Ⅲ型、Ⅳ型跟骨关节内骨折，可以恢复跟骨的大体形态，能够获得较好的临床治疗效果。     

人工骨植骨治疗跟骨粉碎性骨折

目的 介绍应用人工骨植骨治疗跟骨粉碎性骨折的手术方法和临床疗效。方法 采用足外侧入路，骨折及关节面复位后人工骨植骨，可塑形跟骨钛钢板内固定治疗患者32例，比较不同骨折类型的骨折愈合后的复位丢失率和治疗效果，评价手术治疗病例并发症情况。结果 参照Maryland提出的评分系统临床治疗效果优良率为81．2％，Ⅱ型优良率93．3％，Ⅲ型优良率75％，Ⅳ型优良率60％。骨折复位丢失率Ⅱ型3．3％，Ⅲ型5．4％，Ⅳ型10％。手术并发症发生率3．1％。结论 切开复位人工骨植骨钢板内固定治疗跟骨粉碎性骨折获得满意的临床效果，能减轻患者自身植骨造成的损伤及痛苦。     

开放复位可塑形钛板内固定治疗跟骨骨折33例

目的 评价开放复位可塑形钛板内固定治疗跟骨骨折的疗效。方法 对33例(37足)以后关节突移位为主的跟骨骨折，行跟骨外侧入路、开放性复位可塑形钛板螺钉内固定，必要时行植骨术(18例)。结果 平均随访11．5个月，参照Mary1and food score评分，对患足是否疼痛、步态、距下关节及踝关节活动度、是否支架辅助、术后X线摄片等加以评估，19足疗效为优，17足为良，l足可。其中钛板断裂l例，手术切口皮缘坏死l例，换药后自愈。结论 跟骨外侧入路开放复位可塑形钛板螺钉内固定，必要时植骨术是治疗跟骨骨折的有效方法。     

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.