首页 | 本学科首页   官方微博 | 高级检索  
相似文献
 共查询到20条相似文献,搜索用时 62 毫秒
1.
全锁髓内钉的设计及其临床应用   总被引:30,自引:0,他引:30  
锁式髓内钉是近十余年来国际上有关髓内钉骨折内固定技术的三大进展之一。我院骨科在参考Huckstep钉的基础上,设计了改进型Huckstep钉(即全锁髓内钉,简称全锁钉,下同)及其手术器械和手术方法,不需要X线辅助设备,用于治疗复杂股骨骨折。自1987年4月~1992年12月用全锁钉治疗复杂股骨骨折48例,其中男33例、女15例;年龄最大55岁,最小20岁,平均34.6岁。致伤原因:车祸21例、高处坠落伤14例、工业伤10例、其他3例。骨折部位:股骨干上1/3骨折17例、中1/3骨折4例、下1/3骨折5例、全股骨多处骨折5例(其中股骨骨折合并股骨颈骨折3例、合并转子间骨折和转子下骨折各1例)、股骨转子间骨折12例,股骨转子下骨折5例。48例中39例获得随访,最长107个月,最短42个月,平均66.4个月。优30例(76.9%),良7例(18.0%),失败2例(5.1%)。  相似文献   

2.
目的 应用没髓内钉治疗股骨干骨折合并同侧股骨颈骨折及转子间骨折或转子下粉碎骨折。方法 在1996年7月 ̄1998年11月收治的16例复杂股骨骨折中,股骨干骨折合并同侧股骨颈骨折3例,合并转子间骨折4例,转子下粉碎骨折9例。其中10例应用国产加长型Gamma钉,6例使用Russell-Taylor股骨重建钉固定。结果 所有病例随访6 ̄22个月,平均11个月。除1例股骨干骨折合并同侧股骨颈骨折患术后  相似文献   

3.
目的:综合评估改良型Gamma钉治疗股骨转子间骨折的远期疗效,并分析并发症发生原因。方法:对术后平均2.7年的39例患者进行随访,采用主观症状、客观体征和双下肢功能评分,按得分评定疗效。统计本组57例患者发生的并发症。结果:患者远期疗效优良率达到81.6%。并发症中伤口问题(脂肪液化1例,血肿2例,感染1例)占7.0%;大转子继发骨折3例,占5.3%;加压螺钉穿出股骨头和髋内翻畸形各有2例(各占3.5%);异位骨化3例(5.3%);内固定断裂1例(1.8%);术后股骨继发性骨折1例(1.8%)。结论:(1)改良型Gamma钉手术损伤小,可减少患者住院和卧床时间,患者下地早、恢复快,是治疗此种骨折的有效方法。(2)大转子继发骨折和异位骨化对手术疗效影响不大。(3)加压螺钉穿出股骨头、严重髋内翻畸形、内固定断裂和继发股骨骨折是较严重的并发症,需二次手术。(4)术后继发股骨骨折与钉体设计、手术方法和患者再损伤有关,作者建议骨折愈合后应尽早拔钉。  相似文献   

4.
L—梯形加压钢板治疗股骨转子间骨折   总被引:12,自引:0,他引:12  
目的:采用内固定治疗不稳定性股骨转子间骨折(ITFF)仍存在一些问题,为此作者设计了系列L-梯形加压钢板(L-TCP)。方法:从1986年6月~1996年6月,72例股骨转子间骨折患者采用作者设计的L-梯形加压钢板治疗,平均年龄为68.5岁(29~91岁),其中65例为不稳定性骨折。58例采用切开复位,L-TCP固定,14例采用X线监视下闭合复位,有限切开L-TCP固定。结果:60例随访6~69个月。其中3例并发伤口感染,1例骨不连,3例髋内翻,2例钢板断裂,共6例9个并发症,均发生在切开复位组。结论:采用闭合复位,有限切开内固定损伤小,稳定性好,术后并发症少  相似文献   

5.
本院自1998年8月至2001年5月间,共收治70岁以上高龄的股骨转子间骨折31例,均施行了手术治疗,随访疗效满意。现报道如下。资料与方法1.性别与年龄:31例中男12例,女19例;平均年龄75.98岁,65~74岁16例,75~84岁9例,≥85岁6例。2.骨折分类:按胥少汀分类犤1犦:I类一型2例,二型4例,三型15例,四型10例。3.并存疾病:25.8%(8/31)病例为单纯一种合并症,其余均为多系统疾病并存,慢性支气管炎、肺部感染、肺气肿6例;心律失常7例,高血压6例,心包炎1例;糖尿病…  相似文献   

6.
髋部骨折426例分布调查   总被引:3,自引:0,他引:3  
通过对426例髋部骨折的流行病学调查发现:(1)髋部骨折多分布于老年人,男性分布高峰在70 ̄80岁,女性在60 ̄80岁,儿童少见。(2)50岁以上年龄组男女髋部骨折分布比为1:1.33;50岁以下为1:0.36,(3)粗隆间骨折与颈骨折分布比为1:1.51。(4)摔、跌、扭等轻度损伤是髋部骨折的常见致伤原因,占68.5%。(5)四季发病分布比为1:0.65:0.70:1.35。(6)左,右侧别分布  相似文献   

7.
股骨髁间严重粉碎骨折属AO分类的C2、C3型,非手术治疗效果不佳,手术治疗如无可靠内固定往往难以取得满意疗效犤1犦。本院自1997年10月至2000年10月,采用股骨长髁支持钢板治疗股骨髁间严重粉碎骨折24例,效果满意。现报道如下。1资料与方法1.1一般资料:本组24例,其中男性18例,女性6例;年龄16~62岁(平均36.8岁)。致伤原因:车祸20例,坠落伤4例;按AO分型犤2犦:C217例,C37例。闭合性骨折21例,开放性骨折3例。合并伤:股动脉损伤1例,创伤性休克5例,半月板损伤5例,交叉韧…  相似文献   

8.
手术治疗老年股骨转子间骨折   总被引:11,自引:4,他引:7  
目的探讨手术治疗老年股骨转子间骨折的效果。方法用国产Richards钉、130°角钢板(新型氮化钛自动加压梯形钢板)及加压螺钉3种内固定技术治疗不同类型老年股骨转子间骨折82例。结果稳定型骨折术后优良率100%,不稳定型骨折术后优良率92%;3种术式优良率:Richards钉45/48,130°角钢板19/20,加压螺钉3/3。结论老年股骨转子间骨折以手术治疗为宜,手术方式应根据患者情况和骨折稳定程度决定。  相似文献   

9.
梯形加压钢板治疗成人股骨干骨折并发症的预防及治疗   总被引:8,自引:2,他引:6  
作者对梯形自身加压钢板治疗成人股骨干骨折351例并发症的防治进行研究。1986年3月 ̄1998年1月采用梯形钢板治疗成人股骨干骨折351例,随访6个月至11年2月297例305处骨折。并发感染的6例(1.9%),骨不连8例(2.6%),畸形愈合5例(1.6%),再骨折3例(1%),钢板弯曲断裂7例(2.3%),螺钉断裂3例(1%)。9例(3%)经再次手术,最终除1例外,骨折均愈合。关节功能优的18  相似文献   

10.
加压滑动鹅头钉治疗髋部骨折35例分析   总被引:10,自引:1,他引:9  
我院自1990年采用加压滑动鹅头钉治疗髋部骨折35例,效果满意。1临床资料11一般资料本组病例男21例,女14例,年龄42~78岁,平均年龄655岁,60岁以上31例。骨折部位:股骨颈骨折基底型5例,转子间骨折27例,转子下骨折3例。左侧20例,...  相似文献   

11.
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 (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.  相似文献   

12.
Don Dame 《Artificial organs》1996,20(5):613-617
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.  相似文献   

13.
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.  相似文献   

14.
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.  相似文献   

15.
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.  相似文献   

16.
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.  相似文献   

17.
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.  相似文献   

18.
Abstract Immunoadsorption (1A) therapy with tryptophan (TR-350) or phenylalanine (PH-350) adsorbents has been used to reduce the concentration of serum antibodies in human lymphocyte antigen (HLA)-immunized patients. Other forms of plasma purification have been reported to reduce the level of fibrinogen, which affects the blood properties. In this study we investigated the effects of IA therapy using both adsorbents on plasma fibrinogen and immunoglobulins G and M in 13 patients (8 patients were treated with TR-350, and 5 patients were treated with PH-350). During each session 1 plasma volume (2.8 ± 0.4 L of plasma) was processed through the immunocolumn and then returned to the patient together with the blood cells. Compared with the pretreatment values, the plasma fibrinogen, IgG, and IgM concentrations were significantly reduced after IA therapy (p < 0.01 for TR-350; p < 0.04 for PH-350). There was a positive correlation between the degree of reduction of plasma proteins and the number of IA treatments given. A nonpara-metric test (Wilcoxon's signed-rank test or the Mann-Whitney test) was used for statistical analysis. We conclude from our study that IA therapy effectively lowers the plasma levels of fibrinogen, IgG, and IgM and thus can be considered a valuable alternative to other blood purification methods.  相似文献   

19.
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.  相似文献   

20.
设为首页 | 免责声明 | 关于勤云 | 加入收藏

Copyright©北京勤云科技发展有限公司  京ICP备09084417号