钢丝张力带配合韧带修复治疗肩锁关节脱位

目的 观察张力带配合韧带修复治疗肩锁关节脱位的疗效。方法 17例肩锁关节脱位,新鲜的肩锁关节脱位14例(<2W),陈旧性肩锁关节脱位3例(>2W)。Allman分类法,Ⅱ度脱位5例,Ⅲ度脱位12例。根据张力带原理应用单根克氏针钢丝张力带法固定肩锁关节,修复肩锁韧带、喙锁韧带及肩锁关节囊。术后早期功能锻炼并作定期随访,平均48月。结果 17例肩锁关节脱位均复位良好,无一复发,术后肩锁关节功能良好。结论 张力带法治疗肩锁关节脱位是一种简便、有效的手术方法,疗效确切。但术中必须配合韧带及关节囊的修复,才能保证肩锁关节的长期稳定。     

锁骨钩钢板治疗肩锁关节脱位36 例疗效观察

目的观察锁骨钩钢板治疗Ⅲ度肩锁关节脱位的疗效。方法2002年2月至2005年3月采用锁骨钩钢板内固定治疗新鲜Ⅲ度肩锁关节脱位36例，全部修复肩锁韧带，直接修复断裂的喙锁韧带21例，其余15例未予修复重建。回顾性对比分析以往使用克氏针、螺钉、克氏针张力带治疗同型新鲜肩锁关节脱位80例，进行疗效评定。结果按照Lazzcano标准评定患者术后功能，锁骨钩钢板固定组优良率远高于其他三组，所有患者均未发生感染，无钢板螺钉松动断裂，仅1例并发肩峰下撞击征。结论应用锁骨钩钢板治疗肩锁关节脱位较克氏针、螺钉、张力带治疗具有操作简单、复位好、动态固定、牢固可靠、喙锁韧带等长愈合、肩关节功能恢复快、优良率高、并发症少等特点，内固定取出后不复发，是目前治疗新鲜Ⅲ度肩锁关节脱位疗效确切而理想的方法，可推为首选。     

锁骨钩钢板加可吸收线治疗肩锁关节脱位

肩锁关节脱位在肩部损伤中较为常见约占所有关节脱位2%～16%[1].传统手术治疗多采用克氏针、螺钉内固定,治疗疗效不甚满意,使肩部功能的恢复受损.本院自2001年5月至2003年8月,采用AO锁骨钩钢板内固定加可吸收线修复肩锁、喙锁韧带治疗Ⅲ度肩锁关节脱位28例,无1例复发,疗效满意.     

肩锁钩板联合动力修复肩锁关节脱位的随访研究

目的 探讨采用肩锁钩板联合动力修复肩锁关节脱位的临床疗效.方法 对63例TossyⅢ型肩锁关节脱位行肩锬钩板内固定联合动力修复治疗.结果 63例获随访4～34个月,取出内固定后2例发生半脱位,无全脱位及肩锁关节炎发生.内固定取出前肩关节评分为(84.82±2.28)分,内固定取出后肩关节评分为(95.17±1.73)分,差异有统计学意义(P＜0.05).结论 肩锁钩板联合动力修复肩锁关节脱位,固定牢固、远期效果确切,但肩锁钩板长期存留影响肩关节功能,取出后功能明显改善.     

锁骨钩钢板治疗Ⅲ度肩锁关节脱位42例

目的探讨应用锁骨钩钢板内固定治疗Ⅲ度肩锁关节脱位的临床疗效。方法2000年3月至2007年4月应用上述方法治疗Ⅲ度肩锁关节脱位42例（均为新鲜脱位）全部修复肩锁韧带及喙锁韧带。结果随访13～18个月，平均16个月，无一例出现脱钩、断板、螺钉松动及伤口感染。结论锁骨钩钢板治疗Ⅲ度肩锁关节脱位是一种具有操作简单、复位良好、固定可靠、肩关节功能恢复良好、并发症少等特点的有效方法，且内固定物取出后不复发，是目前治疗Ⅲ度新鲜肩锁关节脱位的首选方法，值得推广。     

锁骨钩钢板治疗肩锁关节脱位及锁骨外侧端骨折

目的寻找一种治疗肩锁关节脱位以及锁骨外侧端骨折的新方法.方法在2001～2002年应用AO锁骨钩系统治疗6例肩锁关节脱位和1例锁骨外侧端骨折的病人.结果获得随访的6例肩锁关节脱位病人,均无肩部疼痛、不适感,无畸形复发;无内固定松动;肩关节外展上举满意,功能恢复良好.结论利用锁骨钩系统治疗肩锁关节脱位以及锁骨外侧端骨折,固定可靠,畸形纠正满意,并发症少,功能恢复良好,是治疗肩锁关节脱位以及锁骨外侧端骨折的良好方法.     

锁骨钩钢板加喙肩韧带转位治疗肩锁关节Ⅲ度脱位

目的介绍锁骨钩钢板加喙肩韧带转位治疗Ⅲ度肩锁关节脱位的方法和经验。方法2003年4月至2008年4月采用锁骨钩钢板内固定加喙肩韧带转位治疗Ⅲ度肩锁关节脱位18例,术中清理肩锁关节,喙肩韧带转位重建喙锁韧带,肩锁关节复位,锁骨钩钢板固定。结果术后均接受随访,按照Lazzcano标准评定患者术后功能,均未发生感染及钢板螺钉松动断裂现象,钢板取出后脱位无复发,效果良好。结论该术式治疗肩锁关节脱位具有操作简单、牢固可靠、动态固定、复位良好、重建韧带效果可靠、肩关节功能恢复快、优良率高、并发症少及内固定取出后不复发等特点,是目前治疗新鲜Ⅲ度肩锁关节脱位理想的方法,可推广应用。     

肩锁关节脱位手术复位中肩锁韧带的标志性作用

目的探讨肩锁关节脱位手术复位中修复肩锁韧带的作用。方法对我科2009年04月～2011年07月收治21例肩锁关节脱位采用切开复位锁骨解剖钩状钢板内固定＋肩锁韧带修补术的资料进行回顾性分析。结果本组21例手术中,19例达到肩锁韧带无张力修复,2例未能修复,可修复率达95.2%。术后21例均获得随访,根据Karlsson标准评定疗效,其中优17例,可2例,差2例。结论在肩锁关节脱位治疗中,用锁骨解剖钩状钢板内固定,同时修补喙锁韧带、肩锁韧带是治疗肩锁关节脱位的可靠方法。其中,肩锁韧带的无张力修复对肩锁关节解剖复位有很高的临床使用价值。     

肩锁钩板治疗锁骨外端骨折和肩锁关节脱位

目的探讨不稳定的锁骨外端骨折及度肩锁关节脱位的治疗方法。方法临床治疗13例不稳定型的锁骨外端骨折和9例度肩锁关节脱位病人,其中肩锁关节脱位病人中有7例直接修复断裂的喙锁韧带,2例无法修复,用喙肩韧带代替喙锁韧带,所有病例根据肩关节功能评价标准进行了9个月以上的随访。结果按karlsson标准进行评价,优良19例,满意3例,优良满意率为100%。13例锁骨外端骨折病人均达到骨性愈合,无畸形愈合和骨不连情况。9例肩锁关节脱位术后X线提示,复位满意,拆除内固定后无再脱位情况。结论肩锁钩板治疗不稳定的锁骨外端骨折和结合重建喙锁韧带、肩锁韧带治疗度肩锁关节脱位,具有固定牢固、可早期活动肩关节及关节功能恢复满意的优点。     

锁骨钩钢板治疗肩锁关节脱位及锁骨外侧端骨折

目的：寻找一种治疗肩锁关节脱位以及锁骨外侧端骨折的新方法。方法：在2001-2002年应用AO锁骨钩系统治疗6例肩锁关节股位和1例锁骨外侧端骨折的病人。结果：获得随访的6例肩锁关节脱位病人，均无肩部疼痛，不适感，无畸形复发；无内固定松动；肩关节外展上举满意，功能恢复良好，结论：利用锁骨钩系统治疗肩锁关节脱位以及锁骨外侧端骨折，固定可靠。畸形纠正满意。并发症少，功能恢复良好，是治疗肩锁关节脱位以及锁骨外侧端骨折的良好方法。     

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.     

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.     

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.     

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.