克氏针治疗舟骨骨折

2005年1月～2007年12月,我们应用切开复位克氏针内固定治疗新鲜舟骨骨折9例,效果满意. 1 材料与方法 1.1 病例资料本组9例,男7例,女2例,年龄19～38岁.右侧6例,左侧3例.按改良Herbert舟骨骨折分型[1]:B1型1例,B2型5例,B3型1例,B4型2例.受伤至手术时间3～11 d.     

微型钢板治疗掌指骨骨折的疗效

<正>2016年6月～2017年6月,我院对30例掌指骨折患者分别采用微型钢板和克氏针固定,比较两种术式的疗效,报道如下。1材料与方法1. 1病例资料本组30例(42指),男22例,女8例,年龄19～67岁。按照随机数字表法将其分为克氏针组(15例,22指)和微型钢板组(15例,20指)。1. 2治疗方法两组患者均在臂丛神经阻滞麻醉下手术。(1)克氏针组:采用克氏针内固定。术后Edinburgh位夹板     

两种克氏针固定方法治疗儿童肱骨髁上骨折疗效比较

目的：探讨两种克氏针固定方法治疗儿童肱骨髁上骨折的疗效。方法：自2004年1月至2006年12月应用克氏针内固定治疗儿童肱骨髁上骨折117例,按克氏针固定方式分组：两针组45例,男31例,女14例;年龄1～11岁,平均5.6岁;Garland Ⅱ型19例,Ⅲ型26例。三针组72例,男47例,女25例;年龄2～12岁,平均6.8岁;Garland Ⅱ型22例,Ⅲ型50例。术后测量肘关节屈伸范围及提携角,参照Flynn肱骨髁上骨折疗效评定标准及术后并发症情况,分析两种克氏针内固定方式的疗效。结果：所有患儿均获随访,时间2～24个月,平均15.4个月。两针组45例：优27例,良12例,可4例,差2例,41例术后6周均获得骨性愈合,4例术后1周骨折端移位,固定失败,肘内翻畸形2例。三针组72例：优60例,良11例,差1例,所有患儿术后6周均获得骨性愈合,屈伸活动度经功能锻炼后基本恢复正常,肘内翻畸形1例。结论：克氏针固定是一种稳定而可靠的治疗儿童肱骨髁上骨折方法,内外髁三针交叉固定较单纯外髁两针固定有更大的优点。     

空心螺钉内固定治疗Lisfranc损伤的安全性探讨

[目的]探讨4.0 mm空心螺钉内固定治疗Lisfranc损伤的疗效及安全性。[方法]2010年2月²012年8月收治Lisfranc损伤患者29例,男19例,女10例,年龄232012年8月收治Lisfranc损伤患者29例,男19例,女10例,年龄23⁶2岁,平均34.3岁。依据Meryson分型:A型2例,B1型6例,B2型11例,C1型9例,C2型1例。切开复位后采用4.0 mm空心螺钉固定内侧柱及中间柱,2 mm克氏针经皮固定外侧柱,术后8周拔除克氏针,术后462岁,平均34.3岁。依据Meryson分型:A型2例,B1型6例,B2型11例,C1型9例,C2型1例。切开复位后采用4.0 mm空心螺钉固定内侧柱及中间柱,2 mm克氏针经皮固定外侧柱,术后8周拔除克氏针,术后4⁶个月取出空心螺钉。[结果]本组27例获得随访,2例失访,平均随访18个月(126个月取出空心螺钉。[结果]本组27例获得随访,2例失访,平均随访18个月(12³6个月),未观察到内固定断裂及复位丢失等并发症(其中6例患者未按要求于术后436个月),未观察到内固定断裂及复位丢失等并发症(其中6例患者未按要求于术后4⁶个月内取出内固定螺钉)。依据美国骨科矫形足踝协会(AOFAS)评分标准评价术后患足的功能,平均得分为84分,其中优5例,良16例,一般5例,差1例。[结论]采用4.0 mm空心螺钉内固定治疗Lisfranc损伤,操作简单,安全可靠,术后足弓垫保护下行走,可以获得较好的临床疗效。     

有限切开复位顺行与逆行克氏针内固定治疗青少年锁骨中段骨折

<正>2008年2月～2016年10月,我们采用有限切开复位顺行与逆行克氏针髓内固定治疗41例青少年锁骨中段骨折患者,疗效满意,报道如下。1材料与方法1. 1病例资料本组41例,男32例,女9例,年龄10～16岁。采用有限切开复位顺行克氏针固定20例和逆行克氏针固定21例。伤后至手术时间2～4 d。1. 2治疗方法全身麻醉或臂丛+颈丛神经阻滞麻醉下手术。(1)顺行固定:选用1. 5～2 mm的克氏针,在骨折端内侧3～4 cm处做1 cm横切口,在骨折内端开口、顺行进针。另切开骨折部位,显     

跟骨牵引闭合复位克氏针内固定治疗跟骨骨折

<正>2014年2月～2018年5月,我科采用跟骨牵引闭合复位克氏针内固定治疗21例跟骨骨折患者,疗效良好,报道如下。1材料与方法1.1病例资料本组21例,男16例,女5例,年龄19～62岁。左侧8例,右侧13例。均为闭合骨折。骨折Sanders分型:Ⅱ型15例,Ⅲ型6例。受伤至手术时间4～8 d。     

两种方法治疗儿童GartlandⅡ、Ⅲ型肱骨髁上骨折的疗效比较

目的比较两种不同方法治疗儿童GartlandⅡ、Ⅲ型肱骨髁上骨折的临床疗效。方法回顾性分析我院2010年1月至2016年1月102例GartlandⅡ、Ⅲ型肱骨髁上骨折患者,分别采用闭合复位经皮克氏针内固定与切开复位克氏针内固定治疗。采用闭合复位经皮克氏针内固定(A组)53例,其中男32例,女21例;年龄3~13岁,平均(7.65±1.89)岁;采用切开复位克氏针内固定(B组)49例,其中男30例,女19例;年龄2~12岁,平均(7.48±2.03)岁。比较两组病例一般资料、围手术期指标、肘内翻及并发症(钉道感染、关节僵硬等)。按照Flynn肘关节疗效评定标准对疗效进行比较。结果随访6~45个月,平均23.7个月。两组病例一般资料、骨折愈合时间、疗效优良率、肘内翻及术后并发症发生率比较差异无统计学意义(P0.05),但闭合复位经皮克氏针内固定组的手术时间及住院时间均优于切开复位克氏针内固定组(P0.05)。结论两种方法治疗的临床疗效均好,但闭合复位经皮克氏针内固定具有创伤小、功能恢复快、并发症少等优势,值得临床进一步推广。     

克氏针治疗儿童胫腓骨远端骨折

2011年2月～2012年2月,我科采用有限切开复位、克氏针固定治疗16例胫腓骨远端骨折患儿,效果满意,报道如下. 1 材料与方法 1.1 病例资料本组16例,男10例,女6例,年龄5～14岁.左侧7例,右侧9例.均为闭合骨折.骨折按AO分类:A1型6例,A2型3例,A3型4例,B1型2例,C1型1例.无合并伤.     

记忆接骨板治疗锁骨中段粉碎性骨折

自 2 0 0 1年 3月～ 2 0 0 2年 4月对锁骨粉碎性骨折采取切开复位、记忆接骨板内固定 ,收到了满意的效果。结合以前行克氏针内固定 6 8例中随机抽取 14例治疗情况进行比较分析 ,现报告如下。1　临床资料1 1　一般资料　所有病人骨折部位均位于锁韧带以近至胸锁关节以远中段粉碎性骨折 ,骨碎块有 3～ 6块不等。记忆钉组 14例 ,男 8例 ,女 6例 ,年龄 2 1～ 6 1岁 ,平均 39 6岁 ,右侧 9例 ,左侧 5例。受伤时间最短 4h ,最长 5d。克氏针内固定组 14例 ,男 9例 ,女 5例 ,平均年龄 4 1岁。两组患者性别、年龄、病程等临床资料经X2 检验 ,无显著性…     

不同内固定治疗锁骨骨折的体会

我院自2003年3月至2007年1月分别用钢丝螺丝钉、克氏针、1/3管型钢板、钩钢板、重建钢板内固定治疗锁骨骨折患者59例,现总结如下. 1 临床资料 1.1 一般资料:四种内固定共59例,男46例,女13例.年龄6～75岁,平均39岁.     

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.