双头空心加压螺钉经皮固定治疗股骨颈骨折

目的：探索双头加压螺钉经皮固定治疗股骨颈骨折的临床效果。方法：C形臂X线机透视下,手法复位股骨颈骨折后,经皮穿置直径2mm骨圆针4－6根预固定,选用股骨颈轴线上的三枚骨针作为导针,引导旋入直径为5mm双头加压螺纹钉3枚,治疗股骨颈骨折57例,术后随访2－5年,对其临床功能、X线片、CT等作总结分析。结果：功能正常或度受限者47例,占86．2％,骨折愈合53例,占92．7％,肌骨头坏死6例,占10．5％。骨折不愈合并股骨头坏死者1例,术后3年2个月,仍有良好的功能。结论：空心双头加压螺纹钉经皮固定股骨颈骨折,方法简单,固定可靠,治疗效果好,适合治疗各型股骨颈骨折。     

三根中空双头螺纹加压钉经皮固定治疗股骨颈骨折

目的：总结三根中空双头螺纹加压钉经皮固定治疗股骨颈骨折的效果，并分析其特点。方法：自1993年～2000年，在“C”形臂X线机监视下，以Mc-Elvenny法行骨折复位，应用三枚中空双头螺纹加压钉经皮固定治疗股骨颈骨折42例。结果：股骨颈骨折愈合率达90％(38／42)。35例获得优良的功能，7例发展为股骨头坏死。无其他严重并发症。结论：中空双头螺纹加压钉经皮固定治疗股骨颈骨折疗效可靠，操作简单，有很高的骨折愈合率，创伤小、螺钉不易松动、退出，感染机会少。     

中空双头螺纹加压钉治疗儿童股骨颈骨折

目的探讨中空双头螺纹加压钉治疗儿童股骨颈骨折的疗效。方法采用中空双头螺纹加压钉治疗儿童股骨颈骨折18例,与采用多根骨圆针治疗该骨折的20例进行疗效对比。结果随访2～5年,平均3.2年,螺纹加压钉组3个月骨折愈合率明显高于骨圆针组(P<0.01),关节疼痛及跛行螺纹加压钉组低于骨圆针组(P<0.05),股骨头缺血坏死例数螺纹加压钉组明显少于骨圆针组(P<0.01)。结论中空双头螺纹加压钉是治疗儿童股骨颈骨折的有效方法,优于多根骨圆针内固定。     

双头中空加压螺纹钉治疗股骨颈骨折

目的:观察双头加压螺纹钉治疗股骨颈骨折的临床疗效。方法:股骨颈骨折202例,男97例,女105例;年龄15~83岁,平均63.8岁。在闭合复位后,行2枚双头中空加压螺纹钉内固定手术,观察其疗效并对结果进行分析。结果:术后192例获得随访,平均38.2个月。按照梁雨田等制定的疗效标准:优76例,良99例,可9例,差8例,优良率为91.1%。股骨头坏死9例,占4.68%;骨折不愈合10例,占5.2%。骨折平均愈合时间为(6.8±0.5)个月。结论:使用2枚双头加压螺纹钉固定牢固,能明显促进股骨颈骨折的愈合,降低股骨头坏死及骨折不愈合等并发症。     

股骨颈骨折内固定物的选择与比较(附165例随访分析)

目的 :运用几种不同内固定物治疗股骨颈骨折 ,观察并比较其临床效果。方法 :选择 1988年 1月～ 1999年12月在我院治疗并随访一年半以上的 165例股骨颈骨折病人 ,其中三翼钉内固定 3 0例 ,三根骨圆针内固定 17例 ,单一空心加压螺纹钉内固定 3 9例 ,三枚空心加压螺纹钉内固定 61例 ,人工股骨头 7例 ,全髋关节置换 11例。结果 :优 60例 ,占 3 6.3 % ,良 2 9例 ,占 17.6% ,可 2 8例 ,占 17% ,差 48例 ,占 2 9%。结论 :作者认为 5 5岁以上的头下型骨折中Garden ～ 型骨折 ,经颈型中 Garden 骨折 ,而且 Pauwels角 >70°的可采用人工关节置换术为好 ,5 5岁以下的首选三枚空心加压螺纹钉内固定治疗 ,其次为单一空心加压螺纹钉 ,三翼钉及三根骨圆针较差     

股骨颈多针内固定钢针折断2例

例1，××，女，60岁，因左股骨颈骨折，于伤后3天，闭合性手法复位后，打入3枚直径4mm螺纹钉c术后9个月X光片见1枚螺纹钉折断。19个月取针时，仅取出1枚完整螺纹钉，X光片显示股骨头内有2枚螺纹钉尖部残留。例2，XX，男，52岁，因左股骨颈骨折，于伤后70天，闭合性手法复位后，打入直径4mm骨圆针2枚及直径2．smm克氏针正枚。术后5个月X光片见粗针已脱出1枚，另1枚粗针退出约Icm，细针折弯约15’～20”。8个月X光片见另1枚粗针亦脱出，细针已折断。经验教训用多针固定股骨颈骨折，钢针游走已有较多报告，钢针折断尚不多见，究此2例原因，…     

加压螺纹钉加斯氏针治疗股骨颈骨折89例报告

目的 :报告加压螺纹钉加斯氏针治疗股骨颈骨折手术方法的治疗效果。方法 :对 87年以来本术式治疗的 89例股骨颈骨折疗效分析。功能评价按Harris评分标准 ,优良率 85 .3 % ,骨不愈合和股骨头坏死二者合并发生率 3 .7% ,效果满意。从力学原理方面比较了常用三刃钉和加压螺纹钉之不足 ,在应用加压螺纹钉之后 ,加用 1～ 2枚斯氏针 ,以加强该钉在纵轴方向的防旋力 ,使固定牢固。结论 :本手术方法简单 ,内固定牢固 ,尤适用于老年股骨颈骨折     

经皮自动加压螺纹钉治疗股骨颈骨折的生物力学研究

目的探讨自动加压螺纹钉治疗股骨颈骨折的生物力学性能。方法采用36具新鲜成人离体股骨作为标本，随机分为4组。分别用以下4种方法进行内固定：A组用3枚3．5mm斯氏针做类衍架固定；B组用三翼钉固定；C组用单根双头加压螺纹钉（直径20mm）固定；D组用3枚经皮自动加压螺纹钉做类衍架固定。通过生物力学测试，对四种内固定器械的生物力学性能进行比较。结果经皮自动加压螺纹钉最大抗压强度和同扭距扭转20。，强度明显大于其他3种内固定。结论经皮自动加压螺纹钉不但具有良好的生物力学特性，在固定中更加符合股骨近端本身的力学特点，亦可同时有效地重建股骨近端抗压力系统和抗张力系统。     

中空双头螺纹加压钉治疗股骨颈骨折的生物力学测试与临床应用

探讨中空双头螺纹加压钉固定股骨颈骨折的生物力学性能与临床效果。利用9具成年新鲜股骨尸体标本,分别采用中空双头螺纹加压钉、实心螺纹钉、三翼钉进行股骨颈骨折内固定,并进行生物力学实验。三枚中空双头螺纹加压钉比三枚实心螺纹钉、三翼钉在抗压、抗弯、抗扭强度和刚度上占有一定的优势。统计结果显示,具有显著性差异(P<0.01)。临床22例实践证明,这种内固定方法能加速骨折愈合,功能恢复较快。中空双头螺纹加压钉是治疗股骨颈骨折理想的内固定器械,符合生物力学特性。     

闭合复位加压螺纹钉治疗股骨颈骨折

目的 :介绍作者对 5 6例股骨颈骨折施行闭合复位 ,加压螺纹钉内固定治疗的一点体会。方法 :硬膜外麻醉下 ,患者仰卧位于牵引床上 ,采用C形臂X线机监控下闭合复位 ,然后沿导引针安置加压螺纹钉 ,术后无需牵引 ,伤髋可不负重活动。结果 :5 3例伤髋无功能障碍 ,占总数的 94.6 % ;2例因年龄大而出现行走不便 ;1例因股骨颈陈旧性骨折而出现股骨头无菌性坏死。结论 :闭合复位加压螺纹钉内固定治疗股骨颈骨折 ,手术创伤小 ,手术时间短 ,伤髋能早期不负重活动 ,从而能减少肺部感染、尿路感染及褥疮等并发症的发生。     

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.     

A comparison of the inhibitory effects of four volatile anaesthetics on the metabolism of chlorzoxazone, a substrate for CYP2E1, in rabbits

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.     

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.     

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.     

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.     

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.