三种方法治疗跗跖关节骨折脱位的比较

目的　比较 3种不同方法治疗跗跖关节骨折脱位的疗效。方法　对 10 4例跗跖关节骨折脱位患者分别应用闭合复位石膏外固定 (2 7例 )、闭合复位克氏针内固定 +石膏外固定 (44例 )、开放复位AO螺钉内固定 (33例 ) 3种方法进行治疗。术后平均随访 5年 ,对其自觉症状、跗跖关节功能及X线片显示的关节间隙等改善程度进行比较 ,同时对关节面的受损程度、复位效果与疗效的相关性进行统计学分析。结果　 90例获得良好的功能恢复 ;14例出现创伤性关节炎 ,其中石膏外固定组 4例 ,克氏针内固定 +石膏外固定组 6例 ,AO螺钉内固定组 4例 ,3组间差异无显著性 (P >0 0 5 )。 84例解剖复位者 6例发生创伤性关节炎 ,2 0例复位欠佳者出现 8例 ,两者间差异有显著性 (P <0 0 1)。 30例关节面受损者 14例出现创伤性关节炎 ,74例关节面未受损者疗效均达优良 ,两者间差异有显著性(P <0 0 1)。结论　跗跖关节骨折脱位后创伤性关节炎的发生与关节面的受损及复位的效果直接相关 ,闭合复位石膏外固定、闭合复位克氏针内固定 +石膏外固定和开放复位AO螺钉内固定疗效无明显差异     

不同方法治疗跗跖关节骨折脱位的疗效分析

目的：比较分析不同方法治疗跗跖关节骨折脱位的疗效。方法：对82例跗跖关节骨折脱位患者分别应用闭合石膏外固定（21例）;闭合复位克氏针内固定的同时石膏外固定（35例）;开放复位AO螺钉内固定（26例）三种方法进行治疗。术后平均随访5年,对其自觉症状、足部肌力、跗跖关节功能及X线片显示的关节间隙等改善程度进行比较的同时对关节面的受损程度及复位效果与疗效的相关性进行统计学分析。结果：72例获得良好的功能效果。10例出现创伤后关节炎,其中石膏外固定组3例;克氏针内固定的同时石膏外固定组4例;AP螺钉内固定组3例,三组差异无显著性意义（P＞0．05）。67例解剖复位4例发生创伤性关节炎,15例复位欠佳者出现6例,两者间差异有显著的统计学意义（P＜0．05）。23例关节面受损者10例出现创伤性关节炎,59例关节面未受损者疗效均达优良,两者间存在显著性差异（P＜0．01）。结论：跗跖关节骨折脱位后创伤性关节炎的发生与关节面的受损及得复位的效果直接相关,闭合复位石膏外固定、闭合复位克氏针内固定同时石膏外固定和开放复位AO螺钉内固定疗效无明显差异。     

空心加压螺钉联合克氏针治疗跖跗关节骨折脱位

目的探讨切开复位空心加压螺钉联合克氏针内固定治疗跖跗关节骨折脱位的疗效。方法 35例跖跗关节骨折脱位的患者采用切开复位空心加压螺钉联合克氏针内固定治疗,术后复查X线片评估复位情况,应用美国矫形足踝协会（AOFAS）中足评分标准对患足术后功能进行评定。结果骨折脱位均解剖复位。术后伤口感染3例。35例均获随访,时间6～34个月。功能评定：优14例,良15例,可4例,差2例。发生创伤性关节炎6例,3例药物治疗后症状缓解,3例行跖楔关节融合术。结论切开复位空心加压螺钉联合克氏针内固定治疗跖跗关节骨折脱位能够达到解剖复位及坚强固定,效果满意。     

关于跗跖关节骨折脱位治疗的再认识（附61例报告）

目的：探讨跗跖关节骨折脱位的治疗、疗效。方法：对61例跗跖关节骨折脱位患者26例采取开放复位AO螺钉固定,35例行闭复位克氏针内固定,53例解剖复位,8例复位欠佳。结果：61例随访2-4年（平均3.1年）。54例获得良好的功能效果。7例出现创伤后关节炎,均伴有关节面的损伤,其中螺钉固定组3例,克氏针固定组4例。结论：跗跖关节骨折脱位后创伤性关节炎的发生与关节面的受损及复位的效果直接相关,开放复位AO螺钉固定与闭合复位克氏针内固定疗效无明显差异。     

跖跗关节骨折脱位手术治疗21例报告

我院自 1993年 5月 - 2 0 0 1年 5月采用闭合复位或切开复位克氏针内固定治疗跖跗关节骨折脱位2 1例 ,取得满意疗效 ,现报告如下。1　临床资料　　本组 2 1例 ;男 14例 ,女 7例 ;左侧 12例 ,右侧 8例 ,双侧 1例 ;年龄 2 1～ 6 8岁 ,平均 4 0 5岁 ;闭合性骨折脱位 16例 ,开放性骨折脱位 5例 ;按照Kuss分类法 :同向性脱位 15例 ,分离性脱位 6例 ;伤因 :车祸伤 12例 ,高处坠落伤 5例 ,重物压伤 3例 ,扭伤 1例。同时伴肢体骨折 6例 ,胸腹伤 3例。2　治疗方法本组 16例闭合性损伤均采用闭合复位克氏针内固定。一般在硬麻下进行 ,取平卧位 ,膝关…     

可吸收钉经皮克氏针固定治疗跖跗关节骨折脱位

目的探讨跖跗关节骨折脱位的手术治疗方案。方法对23例跖跗关节骨折脱位的患者用开放复位可吸收螺钉结合经皮克氏针固定治疗,对其临床疗效进行评价。结果本组平均手术时间43 min（30-65 min）,术后平均随访11.6个月（6-18个月）,按照美国足踝外科协会（AOFAS）中足评分标准,术后平均得分84.7分,其中50-60分1例,60-70分2例,70-80分5例,80-90分12例,90-100分3例,优良率为87%。结论可吸收螺钉结合经皮克氏针固定治疗跖跗关节骨折脱位手术创伤小,软组织剥离少,是治疗跖跗关节损伤的理想方法,中柱复位并沿Lisfrance韧带方向用可吸收螺钉固定是手术治疗成功的关键。     

T型接骨板治疗桡骨远端不稳定骨折45例早期疗效分析

目前治疗桡骨远端骨折的方法很多，包括手法复位外固定、闭合复位外固定架固定、切开复位克氏针内固定、切开复位板钉内固定等。大多数桡骨远端关节外的简单骨折手法复位石膏外固定可获得满意疗效，对不稳定的桡骨远端粉碎骨折，尤其关节内骨折，单纯关节固定很难做到关节面良好的对位和稳定的固定，从而造成桡腕及桡尺关节骨性关节炎、握力下降、顽固性腕关节疼痛等并发症。因此对桡骨远端不稳定骨折诊断及治疗的研究日益受到各国学者重视。     

跖跗关节复合体损伤的手术治疗

目的 评价跖跗关节复合体损伤的手术治疗效果.方法 2003年1月至2008年12月,共收治167例闭合性跖跗关节损伤患者,其中跖跗关节复合体损伤35例.通过X线及CT检查明确诊断,闭合或切开复位螺钉或钢板内固定,术后定期放射学检查随访,以美国足踝外科协会(AOFAS)中足评分系统进行功能评估.结果 本组有135例获得12～78个月随访,平均随访时间48个月.其中跖跗关节复合体损伤26例,术后AOFAS评分48～75分,平均67分;其中16例继发创伤性关节炎,12例因疼痛明显、行走受限二期行关节融合术;单纯跖跗关节损伤109例,术后AOFAS评分70～95分,平均82分,继发创伤性关节炎的17例中5例二期行关节融合术.单纯跖跗关节损伤闭合复位经皮螺钉内固定者术后AOFAS中足评分82～95分,平均87分,与跖跗关节复合体损伤者比较差异具有统计学意义(t=2.651,P<0.05).结论 跖跗关节复合体损伤的预后比单纯跖跗关节损伤的差,而准确诊断、实现复合体各个部分的解剖复位和可靠固定是取得良好治疗效果的关键.     

儿童孟氏骨折的治疗

目的 对儿童孟氏骨折的非手术与手术治疗效果进行分析。方法 1991年1月～2001年12月．对128例孟氏骨折患儿采用非手术和手术方法进行治疗．男91例，女37例；年龄2～14岁．平均7．4岁。按Bado法分型：Ⅰ型(伸展型173例．占570％；Ⅱ型(屈曲型)20例，占15．6％；Ⅲ型(内收型)33例，占25．8％；Ⅳ型(尺桡骨双骨折合并桡骨头脱位)2例，占1．6%。非手术治疗50例，均为1周内的新鲜骨折；手术治疗78例．包括闭合复位失败的新鲜骨折30例及陈旧性骨折48例。非手术组患儿均行手法复位，石膏固定；手术组患儿中，45例采用单针固定(新鲜骨折16例，陈旧性骨折29例)．即肱桡关节复位后，单枚克氏针固定，尺骨骨折复位后不做内固定；33例采用双针固定(新鲜骨折14例．陈旧性骨折19例)，即复位肱桡关节及尺骨骨折后，分别用克氏针固定，手术组中．新鲜骨折环状韧带可行简单修补．但不需重建；陈旧性骨折不行环状韧带修复或重建，手术组术后均行石膏固定4～6周。结果 128例患儿均获得随访．随访时间1～10年，平均5．6年．根据李没民等制定的标准刘患儿肢体功能进行评定。非手术组：优42例，良4例，一般2例．差2例．优良率92.0％；单针固定组：优37例．良5例，一般2例．差1例．优良率93．3％；双针固定组：优22例，良7例．一般2例，差2例．优良率87．9％。结论 儿童新鲜盂氏骨折治疗应首选闭合复位，手术治疗仅限于不能获得解剖复位和不能维持复位的新鲜孟氏骨折及陈旧性骨折。手术切开复位．整复肱桡关节后给予克氏针加石膏外固定，可获得较好疗效。     

指骨骨折闭合穿针部位及穿刺技术的探讨

手部骨折常用手法复位、石膏等外固定或切开复位克氏针、AO微型钢板等内固定，综合各术式，疗效各异。我院于2001年8月-2004年12月，对12例手指闭合新鲜骨折患者，行闭合复位，克氏针内固定治疗，取得满意临床疗效，现将其穿针部位及穿刺技术的技巧报道如下。     

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.     

Reduction of Plasma Fibrinogen, Immunoglobulin G, and Immunoglobulin M Concentrations by Immunoadsorption Therapy with Tryptophan and Phenylalanine Adsorbents

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.     

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.     

The multiply injured child

Blunt trauma is the principal cause of childhood death in many developed countries. This review outlines the differences between adults and children with respect to resuscitation and treatment of orthopaedic injuries in a child with polytrauma. Recent advances in techniques of fracture stabilization are reported.     

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.     

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.     

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.     

Systemic analgesia adapted to the children's condition

A concept of balanced analgesia using nonsteroidal anti-inflammatory drugs (NSAIDs), paracetamol (acetaminophen), opioids, and corticosteroids can also be used in patients with pre-existing illnesses. NSAIDs are the most effective treatment for acute pain of moderate intensity in children; however, these drugs should be avoided in patients at increased risk for serious side effects, e.g. patients with renal impairment, bleeding tendency, or extreme prematurity. NSAIDs can be given with minimal risks to the younger child with mild to moderate asthma, and, in these patients, the use of steroids can be encouraged; in addition to their antiemetic and analgesic action, a beneficial effect on asthma symptoms can be expected. In the non-intubated child with cerebral trauma, exaggerated sedation caused by opioids and increased bleeding tendency caused by NSAIDs must be avoided. In neonates and small infants, the oral administration of sucrose or glucose is helpful to minimize pain reaction during short uncomfortable interventions.