关节镜下治疗髌骨骨折42例

目的探讨关节镜治疗髌骨骨折的疗效.方法应用关节镜技术治疗单纯新鲜髌骨骨折42例,在关节镜下清理关节内血凝块,对骨折进行复位、固定,经皮平行打入2枚克氏针固定骨折块,皮下导入钢丝行改良张力带固定.结果手术时间1.2～3 h,平均2.2 h.骨折愈合时间7～10周,平均7.5周.术后住院时间7～14 d,平均8.5 d.37例随访6个月～4年,平均19.2月,骨折全部愈合,无关节不稳和创伤性关节炎.疗效优34例,良2例,可1例,优良率97.3%(36/37).结论关节镜下内固定术治疗髌骨骨折,具有关节面复位好,固定牢固,创伤小可早期功能锻炼,术后功能恢复好等优点.     

经关节镜复位钢丝固定治疗Ⅱ型髌骨骨折

目的探讨关节镜下应用腰穿针引导钢丝固定治疗髌骨骨折的手术方法和效果。方法 2017年12月-2019年1月,在关节镜辅助下应用腰穿针引导钢丝固定治疗髌骨骨折32例。手术在关节镜辅助下进行,复位骨折块,髌骨钳固定后,两枚2.0 mm克氏针临时固定,采用腰穿针紧贴髌骨周围边缘引导钢丝"环形"加"8"字形固定,通过腰穿针引导钢丝,皮下打结固定骨折块。结果所有患者术后恢复良好,无膝关节屈曲功能障碍,均随访1年以上,Lysholm评分平均98分。结论关节镜下复位应用钢丝固定髌骨骨折,操作简单,手术创伤小,术后切口美观,功能恢复良好,可早日恢复活动或劳动。     

关节镜监视下经皮空心钉内固定治疗髌骨骨折

目的探讨膝关节镜监视下经皮空心钉内固定治疗髌骨骨折的疗效。方法2005年9月至2008年7月共22例在膝关节镜监视下行髌骨骨折经皮骨折复位空心钉内固定手术治疗。手法挤压髌骨,复位后用大松质骨复位钳抓持。膝关节镜观察髌骨软骨关节面复位情况,并做适当调整,关节面复位满意后,垂直骨折线平行用电钻钻入2枚直径2.0 mm克氏针,C型臂透视见克氏针位置满意后拧入2枚空心钉。结果随访6-14个月,平均10个月。术后膝关节功能恢复良好,根据胥少汀评分法,优18例（81.8%）,良3例（13.7%.）,中1例（4.5%）。结论关节镜下经皮螺丝钉内固定治疗髌骨骨折创伤小,复位确切,固定可靠,关节功能恢复好。     

关节镜辅助下经皮中空螺丝钉加张力带法治疗髌骨横骨折

目的:探讨髌骨横骨折在关节镜下复位、中空螺丝钉加张力带法固定的治疗效果。方法:12例新鲜髌骨横骨折患者通过关节镜清理关节腔内的血凝块、碎骨块和骨折块之间嵌顿的软组织,直视下观察骨折复位情况以指导骨折复位固定,在C形臂X线透视下帮助骨折复位,关节镜观察关节面解剖复位后,经皮从近折端向远折端平行打入2枚克氏针固定骨折块,顺克氏针拧入2枚中空螺钉,拔除克氏针,顺螺钉空心导入钢丝,行张力带“8”字固定。结果:平均随访12.4个月,骨折愈合时间最短6周,最长10周,平均7.6周。根据Lysholm膝关节评分标准,优10例,良1例,尚可1例,优良率达91.67%。结论:关节镜辅助下经皮中空螺丝钉加张力带法治疗髌骨横骨折具有手术创伤小、关节面复位好、固定坚强、能早期功能锻炼、住院时间短、功能恢复快和合并症少等优点,为治疗新鲜髌骨横骨折提供了一种新的治疗方法。     

关节镜下经皮空心螺钉内固定治疗髌骨骨折

目的：探索微创关节镜下经皮空心螺钉治疗髌骨骨折的方法和疗效。方法：本组14例，纵裂骨折3例，横行骨折11例，手术通过关节镜冲洗清除关节内的血肿及碎屑，在关节镜监视下闭合复位，观察髌骨关节软骨面平整后，经皮平行打入2支克氏针做为导针，再经导针拧入两枚中空钉带固定，术后不做外固定，48小时后开始股四头肌等长收缩，1周后可采用CPM机关节被动活动和主动屈曲锻炼相结合进行术后功能康复。结果：14例全部获得7个月以上随访，随访时间7-14个月，平均10个月。骨折全部愈合。采用Lysholm膝关节功能评分法评估手术后膝关节功能，终末随访平均95分。全部患膝屈曲活动130°以上，无伸直受限。结论：微创关节镜下经皮中空钉内同定髌骨骨折，手术创伤少，术后康复快，能较满意地恢复膝关节运动功能，是治疗髌骨骨折另一有效方法。     

关节镜监视下经皮复位内固定治疗髌骨骨折

目的:研究探讨采用膝关节镜监视下经皮复位松质骨螺钉或张力带内固定治疗髌骨骨折的新方法及疗效.方法:本组35例,横行骨折18例,纵裂骨折4例,粉碎性骨折13例.手术通过关节镜清除关节腔内血凝块和碎屑,在关节镜监视下将髌骨复位,恢复关节面平整,经皮拧入松质骨螺钉,对有移位者并以钢丝经皮下导入,绕螺钉两端行张力带固定.术后早期CPM功能锻炼.结果:术后随诊8个月～4.5年,骨折全部愈合,平均愈合时间9周.按胥氏疗效标准:优27例,良6例,中2例.结论:关节镜监视下经皮复位内固定治疗髌骨骨折,创伤小,对膝关节结构破坏少,关节面复位确切,术后恢复快,为治疗髌骨骨折提供了一种新的治疗方法.     

关节镜下经皮螺丝钉内固定治疗髌骨骨折14例

目的探讨膝关节镜下螺丝钉内固定治疗髌骨骨折的疗效.方法 2001年11月～2004年6月我院在膝关节镜下对14例髌骨骨折经皮行髌骨骨折复位螺丝钉内固定术治疗14例髌骨骨折.先用手法挤压髌骨或经皮钻入克氏针撬拔协助复位, 大布巾钳抓持或克氏针临时固定, 膝关节镜观察或C形臂X机透视髌骨复位情况,并做适当调整,在进钉处做小切口,钻孔、测深、攻丝,平行打入2枚钛螺丝钉或可吸收螺丝钉.结果 13例随访6～18个月,平均10个月.术后膝关节功能恢复良好,根据胥少汀评分法,优11例(84.6%),良2例(15.4%).结论关节镜下经皮螺丝钉内固定治疗髌骨骨折创伤小,复位确切,固定可靠, 关节功能恢复好.     

W形克氏针结合张力带钢丝内固定治疗髌骨骨折

目的探讨W形克氏针结合张力带钢丝内固定治疗髌骨骨折的临床疗效。方法对38例髌骨骨折患者采用髌前纵行切口,骨折复位后均行W形克氏针结合张力带钢丝内固定。结果 38例均获随访,时间8-24个月。骨折均达骨性愈合,髌骨关节面光整,无克氏针旋转、内固定物松动、断裂等并发症发生。关节功能根据Lysholm膝关节评分标准：优36例,良2例。结论 W形克氏针结合张力带钢丝内固定治疗髌骨骨折预防了改良张力带由于克氏针的旋转刺破皮肤而影响功能恢复等并发症发生。该方法操作方便,创伤小,固定牢靠,能早期活动,符合生物力学原理,临床疗效满意。     

关节镜监视下经皮复位内固定治疗髌骨骨折

目的：研究探讨采用膝关节镜监视下经皮复位松质骨螺钉或张力带内固定治疗髌骨骨折的新方法及疗效。方法：本组35例，横行骨折18例，纵裂骨折4例，粉碎性骨折13例。手术通过关节镜清除关节腔内血凝块和碎屑，在关节镜监视下将髌骨复位，恢复关节面平整，经皮拧入松质骨螺钉，对有移位者并以钢丝经皮下导入，绕螺钉两端行张力带固定。术后早期CPM功能锻炼。结果：术后随诊8个月～4．5年，骨折全部愈合，平均愈合时间9周。按胥氏疗效标准：优27例，良6例，中2例。结论：关节镜监视下经皮复位内固定治疗髌骨骨折，创伤小，对膝关节结构破坏少，关节面复位确切，术后恢复快，为治疗髌骨骨折提供了一种新的治疗方法。     

微创克氏针张力带钢丝内固定治疗髌骨横断骨折

目的探讨微创克氏针张力带钢丝内固定治疗髌骨横断骨折的疗效。方法2001年3月～2005年5月,选择性对35例髌骨横断骨折采取闭合复位微创克氏针张力带钢丝内固定术,先在C形臂X线机透视下复位,大布巾钳维持复位,在进出针处做小切口,钻入克氏针,皮下经硬膜外穿刺针引导钢丝,“8”字环扎形成张力带。结果手术时间1～1.5h,平均1.2h。术后住院时间5～12d,平均6.5d。骨折愈合时间7～11周,平均8.5周。35例随访6～36个月,平均13个月,术后膝关节功能恢复良好。疗效优27例,良5例,可2例,差1例。结论微创克氏针张力带钢丝内固定治疗髌骨横断骨折创伤小,复位确切,固定可靠,关节功能恢复好。     

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.     

Synergistic interaction between the effects of propofol and midazolam with fentanyl on phrenic nerve activity in rabbits

Background: It has been shown that the depressive effects of both propofol and midazolam on consciousness are synergistic with opioids, but the nature of their interactions on other physiological systems, e. g. respiration, has not been fully investigated. The present study examined the effect of propofol and midazolam alone and in combination with fentanyl on phrenic nerve activity (PNA) and whether such interactions are additive or synergistic. Methods: PNA was recorded in 27 anaesthetised and artificially ventilated rabbits. In three groups, propofol, fentanyl and midazolam were administered intravenously in incremental doses to construct dose-response curves for the depressant effects of each one on PNA. In another two groups, the effect of pretreatment with either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. on the effects of propofol and fentanyl respectively on PNA were studied. Results: Propofol and fentanyl caused a dose-dependent depression of PNA with complete abolition at the highest total doses of 16 mg · kg^?1 i. v. and 32 μg · kg^?1 i. v., respectively. In contrast, midazolam in incremental doses to a total of 0.8 mg · kg^?1 reduced mean PNA by 63%, but approximately 12% of PNA remained at a total dose as high as 6.4 mg · kg^?1. The mean ED₅₀s, calculated from dose-response curves, were 5.4 mg · kg^?1, 3.9 μg · kg^?1 and 0.4 mg · kg^?1 for propofol, fentanyl and midazolam, respectively. Initial doses of either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. acted synergistically with subsequent doses of either propofol or fentanyl to abolish PNA at total doses of 8 mg · kg^?1 and 8 μg · kg^?1, respectively. Conclusion: Fentanyl has a synergistic interaction with both propofol and midazolam on PNA and hence potentially on respiration.