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1.
微创股骨近端防旋髓内钉治疗老年股骨转子间骨折   总被引:1,自引:0,他引:1  
黄俊  纪方  章浩 《实用骨科杂志》2009,15(6):413-416
目的探讨微创股骨近端防旋髓内钉(proximal femoral nailanti-rotation,PFNA)内固定术治疗老年股骨转子间骨折的方法和疗效。方法2005年12月至2007年3月,在术中C臂X线机透视下,采用闭合复位,股骨近端防旋髓内钉内固定术治疗股骨转子间骨折58例,其中顺转子间型30例,反转子间型12例,转子下型16例。按AO分型,A1型5例,A2型34例,A3型19例,均为闭合性骨折。男26例,女32例;年龄65~91岁,平均79.2岁。其中8例合并一种内科疾病,25例合并两种以上内科疾病。所有患者均经牵引、闭合复位,术中不显露骨折区域,小切口置入PFNA。术后每月进行一次随访,根据随访时髋关节疼痛、功能及关节活动度进行Harris评分,作出疗效评定。结果平均手术时间是57min。术中平均出血量是168mL。平均手术切口长度是5cm。术后无感染、脂肪栓塞、深静脉血栓形成、骨折不愈合、髋内翻及旋转畸形等并发症发生,无死亡病例。58例患者全部获得12~15个月(平均13个月)的随访,骨折全部愈合,愈合时间8~12周,平均10周。Harris评分,优46例,良12例,优良率100%。结论微创PFNA内固定术治疗老年股骨转子间骨折具有手术创伤小、疗效较好、内固定可靠、允许早期功能锻炼、并发症少、促进患肢功能恢复的优点,更适合于治疗老年人股骨转子间骨折。  相似文献   

2.
PFNA治疗老年不稳定性股骨转子间骨折   总被引:5,自引:4,他引:1  
目的通过回顾性分析PFNA治疗老年不稳定性股骨转子间骨折的手术效果,评价PFNA的临床疗效。方法对21例老年不稳定性股骨转子间骨折应用PFNA固定。结果术后随访8~58周(平均26周),骨折全部愈合,所有患者髋关节功能良好。结论PFNA具有操作简单、创伤小、骨折固定稳定、符合生物学固定原则等优点,对老年不稳定性股骨转子间骨折是一种良好的内固定方法。  相似文献   

3.
目的总结PFNA治疗老年不稳定股骨转子间骨折的临床效果。方法采用PFNA治疗老年不稳定股骨转子间骨折17例。结果所有患者均获随访,平均24(6~54)周,骨折均愈合,愈合平均时间14(8—22)周。未见患肢短缩内翻、旋转畸形或内固定螺旋刀片切割,无感染等并发症。髋关节功能按Sanders评分标准评价:优15例,良2例。结论PFNA治疗老年不稳定股骨转子间骨折具有操作简单、创伤小、稳定性好、并发症少等优点。  相似文献   

4.
目的探讨防旋型股骨近端髓内钉(PFNA)治疗老年股骨转子间骨折的临床疗效。方法2010年3月至2011年6月采用PFNA治疗42例老年股骨转子间骨折。手术采用牵引床闭合复位,c形臂x线透视机透视下小切口置入PFNA内固定。结果42例患者手术时间为40-85min,平均59min;术中失血量为40-150ml,平均86.4ml。所有患者经9~16个月,平均12.4个月随访,x线片显示骨折均愈合,愈合时间为9~15周,平均12周。术后未发生感染、髋内翻畸形、螺旋刀片切出股骨头等并发症。根据髋关节Harris髋关节功能评分,优17例,良22例,可3例,差0例,优良率为92.9%。结论PFNA治疗老年股骨转子间骨折具有操作简便、手术时间短、创伤小、固定牢靠等优势,是目前治疗老年股骨转子间骨折的理想选择。  相似文献   

5.
股骨近端防旋髓内钉治疗老年股骨转子间骨折的复位技巧   总被引:1,自引:0,他引:1  
目的 探讨股骨近端防旋髓内钉(PFNA)治疗老年股骨转子间骨折的闭合复位技巧,并总结经验. 方法 2006年3月至2010年12月采用闭合复位PFNA治疗73例股骨转子间骨折患者,男26例,女47例;年龄63~97岁,平均80.6岁.骨折按AO分型:31A2型64例,31A3型9例;按改良Evans分型:ⅡA型15例,ⅡB型16例,Ⅲ型42例.术前仔细阅读患者影像资料,通过牵引、内旋、后侧支撑及撬拨等方法进行闭合复位,选择合适长度的PFNA进行内固定.应用Fogagnolo复位标准评定骨折复位质量,采用髋关节Harris评分评估患髋功能. 结果 55例(75.3%)患者术后获12 ~48个月(平均27 4个月)随访,18例患者失访(包括9例死亡患者).应用Fogagnolo复位标准评价骨折复位质量:优43例,可12例.骨折愈合时间为8~16周,平均10周.患者术后平均8周(6~16周)可完全负重行走.无感染、深静脉血栓形成、髋内翻畸形、股骨头切割及断钉发生,其中2例因术后摔倒致主钉远端股骨干骨折,二期行加长PFNA内固定治疗.按髋关节Harris评分标准评定患髋功能:优34例,良16例,中5例,优良率为90.9%.结论 对于老年股骨转子间骨折,闭合复位时可以通过一定的复位技巧来纠正内翻移位、向后成角移位及旋转移位等情况,从而提高骨折复位质量,顺利地应用PFNA进行徽创治疗.  相似文献   

6.
目的总结应用PFNA微创闭合复位内固定治疗老年股骨转子间骨折的临床体会。方法对144例股骨转子间骨折行闭合复位微创PFNA内固定治疗,观察患者手术效果及Harris髋关节功能评分。结果本组平均手术时间25.80 min。患者切口均Ⅰ期愈合。术后X片检查显示,骨折处对线良好。均获随访10~12个月,骨折愈合时间9~17周。按髋关节功能Haeeis评分标准,本组优良率97.92%(141/144),随访期间未发生骨不连、内固定松动、断裂、切割等并发症。结论 PFNA微创复位内固定治疗老年转子间骨折,创伤小、内固定牢靠、术后并发症少、功能恢复好。  相似文献   

7.
目的 比较闭合复位与切开复位防旋型股骨近端髓内钉(PFNA )固定治疗老年股骨转子间骨折的疗效.方法 对87例老年股骨转子间骨折患者行PFNA固定治疗,切开复位32例,闭合复位55例.比较两组的切口长度、手术时间、术中失血量、骨折复位、内固定满意率、患肢部分负重时间、骨折愈合时间、并发症及髋关节功能情况.结果 切口长度、手术时间及术中失血量闭合复位组均明显短(少)于切开复位组(P〈0.01),骨折复位满意率闭合复位组高于切开复位组(P〈0.05).87例均获随访,随访时间:闭合复位组12~42个月,切开复位组12~48个月.部分负重时间闭合复位组明显早于切开复位组(P〈0.01).并发症:切开复位组发生率为22%,闭合复位组无严重并发症(P〈0.01).两组骨折全部愈合,愈合时间差异无统计学意义(P〉0.05).末次随访时髋关节Harris评分闭合复位组高于切开复位组(P〈0.01).结论 与切开复位PFNA固定比较,闭合复位PFNA固定治疗老年股骨转子间骨折手术操作简便,患者功能恢复更好.  相似文献   

8.
防旋股骨近端髓内钉治疗老年不稳定型股骨转子间骨折   总被引:1,自引:0,他引:1  
目的 探讨应用防旋股骨近端髓内钉(PFNA)治疗老年股骨转子间骨折的方法及疗效.方法 2006年6月至2008年8月,收治41例老年股骨转子间骨折患者,Evans-Jensen分型:ⅡA型11例,ⅡB型24例,Ⅲ型6例;其中男12例,女29例;平均年龄74.3岁(67~92岁).均在C型臂X线机透视下闭合复位后采用PFNA内固定治疗,术后髋关节功能采用Harris评分. 结果所有患者均获得随访,时间6~31个月,平均17.2个月.骨折均愈合,时间 10~17周,平均12.5周.术后髋关节Harris评分:优26例,良13例,可2例,优良率为95.1%.均未出现感染、髋内翻畸形、下肢外旋及短缩畸形、螺旋刀片切割股骨头、股骨干骨折、内同定失效及延迟骨愈合等并发症. 结论 PFNA治疗老年不稳定型股骨转子间骨折符合生物学固定原则,对骨折端的血运影响和骨质破坏较小,具有操作简单、创伤小、内固定牢靠、可早期功能锻炼及术后并发症少等优点,疗效满意.  相似文献   

9.
目的探讨防旋股骨近端髓内钉(proximal femoral nail antirotation,PFNA)微创治疗老年患者股骨转子间骨折的临床疗效。方法2007年2月-2008年6月,采用PFNA治疗老年股骨转子间骨折25例,按照Tronzo-Evans分型:Ⅰ型2例,Ⅱ型2例,Ⅲ型16例,Ⅳ型5例,闭合复位,小切口置入PFNA。结果手术时间30-70 min,平均50.3 min。术中出血量70-200 ml,平均100.2 ml。25例随访3-12个月,平均7.1月,骨折全部愈合,愈合时间10-14周,平均11周,未出现髋内翻,内固定物松动及切割现象;按Harris髋关节功能评分标准:优20例,良4例,中1例。结论PFNA具有微创,操作简单,手术时间短,出血量少,固定牢靠,愈合率高等特点,尤其适用于老年骨质疏松患者,是治疗老年股骨转子间骨折较为理想的内固定材料。  相似文献   

10.
目的分析老年骨质疏松股骨粗隆间骨折患者在内固定选择方面,防旋型股骨近端髓内钉 (PFNA)和新型股骨近端髓内钉(丨NTERTAN)临床治疗效果。方法自2010年11月~ 2012年04 月,在我院手术治疗的61例患者中37例使用PFNA固定,24例使用Intertan固定,比较两组平均手术 时间、术中出血量、骨折愈合时间、部分负重时间、完全负重时间、术后内固定失败例数、髋关节Harris 功能评分。结果全部患者均获6-24个月随访,平均13.3个月,髋关节功能评分以末次随访的情 况计人资料。PFNA组手术操作时间、术中出血量较Intertan组少(P < 0. 05 ),两组骨折愈合时间、术 后内固定失败例数、髋关节Harrisa能评分均无明显差异(P>0.05)。结论 PFN A和Intertan均设 计合理,在老年骨质疏松股骨粗隆间骨折患者中均能起到很好的固定效果,达到临床愈合。  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.
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   

15.
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   

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.
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   

18.
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   

19.
20.
Abstract: Photopheresis is a technique in which peripheral blood mononuclear cells, in the presence of a photoacti-vatable compound, are exposed extracorporeally to ultraviolet A light and reinfused, inducing a host autoregula-tory immune response. Experimental work and ongoing clinical studies are helping to define the role of this novel, safe, and non-toxic immunomodulating technology in the field of transplantation.  相似文献   

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