C型骨盆骨折的手术内固定治疗

目的 探讨开放复位内固定治疗严重不稳定骨盆骨折的疗效。方法 对28例严重不稳定骨盆骨折病人采用切开复位重建钢板内固定和C型臂X线机或CT引导下经皮拉力螺钉内固定和TSRH系统固定。结果 2例浅表感染，1例神经损伤，随访3～36个月，无骨折不愈合，复位按照Matta标准：优23例，良3例，可2例。优良率92．86％。结论 对严重不稳定骨盆骨折病人采用切开复位重建钢板内固定和C型臂X线机或CT引导下经皮拉力螺钉内固定是较好的选择，可以使病人早期康复。     

地震伤骨盆骨折后环不稳的微创治疗

目的 探讨地震伤骨盆骨折后环不稳微创治疗的技术要点及疗效.方法对9例地震伤骨盆骨折后环不稳,采用前环钢板内固定后环在C型臂X线机引导下经皮微创置入骶髂空心拉力螺钉内固定.结果 骨盆骨折后环不稳患者在C型臂X线机引导下经皮微创置入骶髂空心拉力螺钉内固定,疗效满意.结论 掌握经皮骶髂关节置钉技术要点,采用骶髂拉力螺钉微创固...     

地震伤C1型骨盆骨折的微创治疗

[目的]探讨地震伤C1型骨盆骨折经皮微创技术治疗的可行性.[方法]13例Tile分类C1型骨盆骨折患者采取前环骨盆外固定架结合在C型臂X线机引导下经皮微创技术置入拉力螺钉复位固定骶髂关节.[结果]C型臂X线机引导下经皮置入空心拉力螺钉成功,外固定架固定骨盆前环复位良好,术后复查X线片复位满意.[结论]外固定架结合C型臂X线机引导下经皮置入空心拉力螺钉是治疗骨盆C1型骨折的最好方法之一.     

复杂骨盆骨折的微创治疗

目的探讨经皮微创技术治疗 C1 型骨盆骨折的可行性。方法对 13 例 Tile C1 型骨盆骨折患者采取前环骨盆外固定架结合在 C 型臂 X 线机引导下经皮微创技术置入拉力螺钉复位固定骶髂关节治疗。结果经皮置入空心拉力螺钉成功, 术后复查 X 线片复位满意。结论外固定架结合 C 型臂 X 线机引导下经皮置入空心拉力螺钉是治疗骨盆 C1 型骨折的较好方法之一。     

复杂骨盆骨折的微创治疗

目的探讨经皮微创技术治疗C1型骨盆骨折的可行性。方法对13例Tile C1型骨盆骨折患者采取前环骨盆外固定架结合C型臂X线机引导下经皮微创技术置入拉力螺钉复位固定骶髂关节治疗。结果经皮置入空心拉力螺钉成功，术后复查X线复位满意。结论外固定架结合C型臂X线机引导下经皮置入空心拉力螺钉是治疗骨盆C1型骨折的较好方法之一。     

CT引导下空心拉力螺钉内固定治疗骶髂复合体损伤

目的　探讨在CT引导下经皮微创技术置入松质骨拉力螺钉内固定治疗骶髂关节复合体损伤的可行性。方法　选择 36例Tile -Mueller分类B型和C型骨盆骨折患者 (同时存在旋转和垂直不稳定 )前环复位用重建钢板固定后 ,在CT引导下经皮微创技术置入拉力螺钉复位固定骶髂关节。结果　 36例在CT引导下经皮置入骶髂关节螺钉成功 ,经近 2年随访该方法固定牢靠 ,无并发症 ,功能恢复满意。结论　CT引导下经皮置入空心拉力螺钉是治疗骶髂关节复合体损伤的最好方法之一     

CT引导下空心拉力螺钉内固定治疗骶髂复合体损伤

目的 探讨在CT引导下经皮微创技术置人松质骨拉力螺钉内固定治疗骶髂关节复合体损伤的可行性。方法 选择36例Tile—Mueller分类B型和C型骨盆骨折患者(同时存在旋转和垂直不稳定)前环复位用重建钢板固定后，在CT引导下经皮微创技术置人拉力螺钉复位固定骶髂关节。结果 36例在CT引导下经皮置人骶髂关节螺钉成功，经近2年随访该方法固定牢靠，无并发症，功能恢复满意。结论CT引导下经皮置人空心拉力螺钉是治疗骶髂关节复合体损伤的最好方法之一。     

旋转和垂直不稳定型骨盆骨折患者的诊断和治疗

目的探讨旋转和垂直不稳定型骨盆骨折的临床特点及其急诊处理、诊断和治疗方法选择。方法回顾性分析18例存在旋转和垂直不稳定的骨盆骨折患者，10例保守治疗，8例手术治疗。8例手术患者骨盆前环骨折均行切开复位内固定，2例耻骨上支骨折采用重建钢板固定，2例采用拉力螺钉固定，4例耻骨联合分离患者均采用双钢板固定；6例骨盆后环骨折患者采用切开复位双钢板固定，2例在CT引导下经皮置入骶髂关节松质骨拉力螺钉固定。结果18例患者全部恢复行走功能，所有保守治疗患者骨盆骨折均畸形愈合，遗留骶髂关节部位酸痛6例，遗留双小腿、双足麻木3例，行走跛行2例。8例手术治疗患者骨盆外形均恢复好，仅1例患者诉沿髂嵴切口有不适，2例CT引导下经皮置入骶髂关节螺钉患者骨盆外形接近完全恢复，功能恢复快而满意。结论旋转和垂直不稳定型骨盆骨折患者保守治疗效果差，宜首选内固定手术治疗，宜同时固定骨盆前、后环或先行前环切开复位内固定，2～3d后再次在CT引导下经皮置入骶髂关节螺钉内固定。CT引导下经皮置入骶髂关节螺钉手术操作简单、时间短、出血少、固定牢靠，是固定骶髂关节骨折脱位的首选方法。     

经皮骶髂螺钉与骶髂关节前方钢板固定治疗不稳定性骨盆骨折的对比研究

 目的 比较骨盆骨折合并骶髂关节脱位经皮空心螺钉内固定与切开复位重建钢板内固定治疗的临床疗效, 并评价其安全性和实用性。方法 2004年 3月至 2010年 10月, 收治 37例不稳定 性骨盆骨折。在野C冶型臂 X线机引导下, 20例患者接受经皮骶髂关节螺钉内固定, 17例患者接受切开复 位重建钢板内固定, 比较和分析两组的围手术期参数和术后影像学指标。结果 对全部病例随访 6~26 个月, 平均 15个月。经皮螺钉组与切开钢板组在手术时间、术中出血量、术后疼痛程度、术后平均发热 时间和住: 时间等方面比较差异均有统计学意义, 两组根据术后 X线评价的复位效果差异无统计学意 义。骨折平均愈合时间: 经皮螺钉组为 32个月, 切开钢板组为 36个月, 两组差异无统计学意义。经皮 螺钉组无感染、弯钉及断钉等并发症发生。结论 经皮骶髂空心螺钉内固定术治疗骨盆骨折具有定位 准确、损伤小、出血少、疼痛轻、恢复快等优点, 是一种理想的微创手术方法, 前后环固定适用于骨折及 脱位不明显者;该术式对术者操作技术要求较高, 充分的术前准备及患者术后配合能减少并发症发生。 重建钢板或桡骨远端野T冶形钢板可用于固定垂直不稳定性骨盆骨折。     

不稳定性骨盆环骨折的手术治疗

目的 探讨开放复位内固定治疗不稳定性骨盆环骨折的方法和效果.方法 2001年10月至2006年10月,对78例不稳定骨盆环骨折患者采用切开复位重建钢板内固定和"C"型臂X线机或CT引导下经皮空心螺钉内固定及TSRH系统固定.按照AO分型:B2型3例,B3型4例,C1型12例,C2型34例,C3型25例.患者入院后均在抗休克、输血等治疗的同时急诊用骨盆外固定架暂时固定复位,以稳定病情、减少出血.伤后7～10 d手术,20例前路手术后1周行后路手术,58例为一期前后路同时手术内固定.后路经皮"C"型臂X线机引导下骶髂复合体空心螺钉固定10例,CT引导下经皮空心螺钉固定20例,切开复位TSRH系统固定48例.手术时间2～5 h,平均3 h.结果 术后浅表感染5例,经换药愈合;深部感染2例,经清创引流愈合.3例术中损伤膀胱行及时修补,2例术后发现膀胱损伤行膀胱造瘘后愈合.发生下肢深静脉血栓6例,经溶栓等保守治疗治愈.术前合并骶丛损伤的患者术后3～6个月功能大部分恢复.术后随访6～60个月,平均30个月,无骨折不愈合.下肢长度差异在10 mm内72例,10～20 mm 6例.复位根据Tornetta和Matta评定标准,优58例,良16例,可4例,优良率94.9%.术后功能按照Majeed评分系统,优45例,良20例,可13例,优良率83.3%.结论 对不稳定性骨盆环骨折患者采用前后环切开复位内固定,稳定性好、并发症少,可使患者早期康复.     

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.     

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.     

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.