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1.
颈前路加压螺钉固定治疗齿状突骨折 总被引:3,自引:0,他引:3
目的:分析颈前路加压螺钉内固定治疗齿状突骨折的临床疗效。方法:对8例新鲜齿状突Ⅱ型骨折在C型臂X线机监视下行前路加压螺钉内固定治疗,分析其结果及并发症。结果:随访4个月-3年1个月,平均10个月,X线片示骨折均获骨性愈合,无明显颈部运动受限,无螺钉断裂、移位及神经损伤等并发症,临床症状完全消失7例,1例合并颅脑损伤者残留部分头痛、头晕。结论:颈前路加压螺钉内固定技术是治疗Ⅱ型齿状突骨折可供选择的方法,具有损伤小、并发症少、固定牢靠及愈合率高等优点,能最大限度地保留寰枢椎的生理活动功能。 相似文献
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颈前路空心加压螺钉治疗Ⅱ型齿状突骨折 总被引:1,自引:0,他引:1
目的探讨前路单枚空心加压螺钉内固定治疗Ⅱ型齿状突骨折的临床疗效。方法 C臂X线机透视下采用前路单枚空心加压螺钉内固定治疗AndersonⅡ型齿状突骨折24例。结果 24例均获随访,时间12-48(24±12)个月。患者全部骨性愈合。无术中及术后并发症。末次随访时无内固定螺钉松动、移位或断裂,颈椎活动无明显受限。结论前路空心加压螺钉固定治疗齿突骨折既可提供良好的稳定性,又能保留寰枢关节活动性,骨折愈合率较高,并发症低,是治疗Ⅱ型齿突骨折有效的方法。 相似文献
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齿状突骨折的手术治疗 总被引:3,自引:0,他引:3
目的:报告齿状突骨折的内固定及融合方法。方法:对8例齿状突骨折患者行内固定治疗,其中5例新鲜骨折行前路空心螺钉内固定,3例齿状突陈旧性骨折行后路经关节突螺钉(Magerl法)加钛缆线Gallie法内固定并取髂骨植骨融合术。结果:经过2-16个月,平均6.1个月的随访,5例齿状突新鲜骨折均愈合,临床症状完全消失4例,明显改善1例。颈部旋转活动良好5例。3例陈旧性骨折环枢椎融合良好,临床症状消失2例,明显改善1例,颈部旋转活动部分障碍2例,障碍1例。结论:前路空心螺钉内固定技术的主要优越性在于保留了环枢椎的生理活动功能,后路经关节突螺钉(Magerl法)与钛缆线Gallie法联合固定保证了上颈椎的稳定性。 相似文献
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目的 总结前路螺钉内固定治疗齿状突骨折的经验。方法 采用前路螺钉内固定治疗成人齿状突骨折 15例 ,其中男 11例 ,女 4例 ,Anderson -D′AlonzoⅡ型骨折 10例 ,Ⅲ型骨折 5例。结果 随访 1~ 5年 ,骨折均获骨性愈合。临床症状完全消失 12例 ,明显减轻者 3例 ,均无明显颈部活动受限。结论 前路螺钉内固定技术的主要优越性在于保存了寰枢椎的生理活动 ,而术前骨折解剖复位是保证手术成功的关键所在。 相似文献
6.
前路单枚螺钉治疗齿状突骨折的临床观察 总被引:3,自引:1,他引:3
目的 评价颈前路单枚螺钉内固定治疗齿状突骨折的临床疗效.方法 对23例齿状突骨折行颈前路单枚螺钉内固定术.结果 患者均获得随访,平均随访11个月,骨折愈合良好,颈椎活动基本恢复正常,无螺钉松动、断裂.21例临床症状完全消失,2例有颈部僵硬感.结论 颈前路单枚螺钉内固定是治疗齿状突骨折的一种有效方法,可最大限度的保留寰枢椎的生理活动功能. 相似文献
7.
颈前路双空心螺钉内固定治疗成人游离粉碎型齿状突骨折 总被引:7,自引:1,他引:7
目的:探讨颈前路双空心螺钉内固定治疗成人游离粉碎型齿状突骨折的疗效。方法:应用颈前路双空心螺钉内固定治疗8例成人游离粉碎型齿状突骨折。按Anderson-D'Alonzo分型,Ⅱ型5例,Ⅲ型3例。结果:7例获得平均13个月随访,骨折复位满意,均获骨性愈合,未出现术中、术后并发症,1例遗留颈部僵硬感,但临床检查无活动受限。结论:颈前路双空心螺钉内固定治疗成人游离粉碎型齿状突骨折效果良好。 相似文献
8.
AOSF技术治疗Ⅱ型和浅Ⅲ型齿状突骨折疗效分析 总被引:3,自引:1,他引:2
目的 探讨前路齿状突螺钉内固定技术治疗Ⅱ型和浅Ⅲ型齿状突骨折安全性和临床疗效.方法 应用前路齿状突螺钉内固定技术治疗齿状突骨折32例,男23例,女9例.年龄19~78 岁,平均(52.6±3.2) 岁.按Anderson-D′Alonzo分型,Ⅱ型20例,浅Ⅲ型12例.均采用1枚空心加压螺钉固定.通过上颈椎正侧位及张口位X线片和CT进行评价.结果 32例均获得随访,随访时间6~28月,平均18个月.除2例Ⅱ型骨折未愈合外,其余平均愈合时间6个月.无螺钉断裂、移位及神经损伤等并发症.临床症状完全消失26例,3例遗留颈部僵硬感,但临床检查无活动受限,2例合并颅脑损伤者残留部分头痛、头晕.结论 前路齿状突螺钉内固定技术是治疗Ⅱ型和浅Ⅲ型齿状突骨折有效和安全的方法,能最大限度地保留寰枢椎的生理活动功能. 相似文献
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Vasopressor hormone response following mesenteric traction during major abdominal surgery 总被引:1,自引:0,他引:1
A. Brinkmann W. Seeling C. F. Wolf E. Kneitinger C. Schonberger N. Vogt K. H. Orend M. Buchler P. Radermacher M. Georgieff 《Acta anaesthesiologica Scandinavica》1998,42(8):948-956
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-PGF1α (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.
Kai von Appen Christoph Weber Udo Losert† Heinrich Schima† Hans-Jürgen Gurland Dieter Falkenhagen 《Artificial organs》1996,20(6):420-425
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
14.
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 H2 O 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
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 H
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
15.
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
16.
Volatile anaesthetics reduce adhesion of blood platelets under low-flow conditions in the coronary system of isolated guinea pig hearts 总被引:3,自引:0,他引:3
B. Heindl B. F. Becker S. Zahler P. F. Conzen 《Acta anaesthesiologica Scandinavica》1998,42(8):995-1003
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
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
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D. Ma S. M. Sapsed-Byrne M. K. Chakrabarti J. G. Whitwam 《Acta anaesthesiologica Scandinavica》1998,42(6):670-677
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. 相似文献
18.
Influence of dopexamine hydrochloride on haemodynamics and regulators of circulation in patients undergoing major abdominal surgery 总被引:1,自引:0,他引:1
J. Boldt M. Papsdorf S. Piper W. Padberg G. Hempelmann 《Acta anaesthesiologica Scandinavica》1998,42(8):941-947
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
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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. 相似文献
20.
T. Tateishi M. Watanabe H. Nakura M. Tanaka T. Kumai T. Aoki S. Kobayashi 《Acta anaesthesiologica Scandinavica》1998,42(9):1028-1032
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
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