Herbert钉内固定联合植骨并肌腱团填塞治疗Lichtman Ⅲb期月骨缺血性坏死

目的探讨Herbert钉内固定联合植骨局限性融合腕舟头关节并掌长肌腱团填塞治疗Lichtman Ⅲb期月骨缺血性坏死的临床疗效。方法回顾性分析自2011-10—2015-10诊治的10例Lichtman Ⅲb期月骨缺血性坏死,采用腕背侧入路摘除坏死的月骨,切除桡骨茎突植骨于舟头关节间隙,用Herbert钉固定舟头关节,取掌长肌腱团填塞月骨空隙。结果术后10例均获得随访,随访时间平均13.5(10~18)个月。所有患者腕部疼痛症状完全消失,术后腕骨高度与术前比较无明显差异,未发现腕关节炎。X线片显示腕部舟头关节局部融合满意,融合时间平均9.2周。末次随访时患侧手握力35.6 kg,较术前明显改善。末次随访时腕关节活动范围:背伸平均47.0°,掌屈平均55.0°,尺偏平均28.0°,桡偏平均9.0°。末次随访时腕关节功能根据中华医学会手外科学会上肢部分功能标准评定:优4例,良4例,可2例。结论采用Herbert钉内固定联合植骨局限性融合腕舟头关节并掌长肌腱团填塞治疗Lichtman Ⅲb期月骨缺血性坏死可有效缓解腕部疼痛,提高腕部握力,改善腕关节的活动范围。     

自体骨肌腱腱膜团填塞治疗月骨缺血性坏死

目的探讨月骨缺血性坏死的治疗方法。方法采用摘除坏死月骨,用保留止点的桡侧腕短伸肌肌腱包裹带骨膜的桡骨块,制成带有一定血供的骨肌腱腱膜团填塞治疗月骨缺血性坏死12例。结果12例均获随访,腕部疼痛均消失或明显减轻,握力增强,腕关节背伸功能较术前明显改善,X线片显示骨块显影逐渐增大,明显有新骨生成,并逐渐占据月骨切除后的间隙。腕高比值(腕骨高度/第三掌骨全长)较术前未见明显下降。结论自体骨肌腱腱膜团填塞治疗月骨缺血性坏死疗效满意,值得推广。     

掌长肌腱填塞和STTC融合治疗月骨无菌性坏死的疗效

目的　报道月骨摘除后用掌长肌腱球填塞和腕舟骨 ,大、小多角骨 ,头状骨融合固定术(STTC) ,治疗月骨缺血性坏死的结果。方法　对 17例患者行坏死月骨摘除术后填塞掌长肌腱球 ,同时行舟骨 -大、小多角骨 ,舟 -头关节融合术。结果　术后随访 14～ 5 8个月 ,平均 2 3.6个月。 9例腕痛完全缓解 ,7例仍有轻度疼痛 ,1例腕痛严重。腕背伸平均度数为术前的 95 %、正常侧的 46 .4% ;掌屈平均度数为术前的 6 5 .4%、正常侧的 5 6 %。握力平均达正常侧的 75 %。 17例中 16例的舟、大、小多角骨、头状骨均已完全融合 ,腕高指数平均为 0 .49。结论　应用该法治疗 、 期的月骨缺血性坏死 ,能有效地缓解疼痛、改善握力及腕关节活动度和保持腕高     

腕关节部分融合治疗退行性腕关节炎的疗效

目的评价头骨、月骨、三角骨及钩骨四关节融合治疗退行性腕关节炎的效果。方法1997年7月～2002年12月应用腕关节部分融合术创伤性腕关节炎治疗20例,术后随访15个月,随访检查包括术后腕关节疼痛程度、腕关节活动度、握力以及患侧X线检查。视觉模拟评分法评价疼痛程度。腕关节总体功能评价采用Krimmer腕关节评分表。结果腕疼痛值静息时为2.1,用力后为5.3;屈伸活动度为64°(对侧126°);尺桡偏为30°(对侧57°);平均握力为24kg(对侧40kg)。Krimmer腕关节评分值为67。X线检查头、月、三角及钩骨均融合。结论腕关节部分融合后能保存腕关节部分功能,是治疗退行性腕关节炎有效的方法。     

近排腕骨切除加骨间掌、背侧神经切断治疗退行性腕关节炎

目的评价近排腕骨切除加骨间掌、背侧神经切断术治疗退行性腕关节炎的疗效。方法1996年3月-2002年12月,对30例退行性腕关节炎行近排腕骨切除和腕部骨间掌、背侧神经切断术。术后测量腕关节的活动度、握力和疼痛程度,腕关节功能评定采用Krimmer评分法。术后拍摄腕关节X线正侧位片,了解腕关节骨性改变情况。结果术后随访8~66个月。腕关节屈伸活动度平均为70°(健侧为126°),尺桡偏平均为36°(健侧为66°);握力为25kg(健侧为46kg);疼痛值为32(术前为73);腕关节功能评分为70。腕关节X线片示,术后3例腕关节形成关节炎。结论近排腕骨切除加骨间掌侧及背侧神经切断可保留腕关节部分功能,减轻腕关节疼痛,是治疗退行性腕关节炎的有效手段。     

陈旧性经舟骨月骨周围脱位22例治疗观察

[目的]分析陈旧性经舟骨月骨周围脱位采取近排腕骨切除加骨间掌、背侧神经终末支切断术的临床疗效。[方法]从1999年6月～2007年12月收治的22例陈旧性经舟状骨骨折月骨周围腕骨脱位患者,术前病程28d～1.2年,术后测量腕关节的活动度、握力和腕部疼痛程度,腕关节功能评定采用Krimmer评分法。[结果]术后随访24～72个月,腕关节腕掌屈、背伸活动度平均72°,尺桡偏平均35°,健侧为68°±8°;侧握力为(26±8)kg,健侧握力为(45±10)kg;疼痛值为28;腕关节功能评分为72,腕关节X线片显示:未见骨关节炎表现;满意率90%。[结论]本术式是用于治疗陈旧性经舟骨月骨周围脱位引起腕部功能障碍和腕部疼痛的有效手段。     

腕关节融合钢板内固定术的临床疗效

目的评价腕关节融合钢板内固定术的临床疗效。方法2000年7月-2004年12月，采用腕关节融合钢板内固定术治疗创伤性腕关节炎21例。随访内容包括腕关节疼痛程度、手指关节活动度、握力和x线片。根据Buck—Gramcko／Lohrnanrm评分表评价腕关节总体功能，DASH调查表评价腕关节融合术对患者日常活动及生活质量的影响。结果术后21例获得随访，平均随访时间为20个月。术后患侧腕部疼痛值平均为1．5（术前4．5），12例掌指关节和lO例拇指指间关节出现轻微背伸功能障碍，腕部握力为30kg（健侧为38kg）。x线片示腕关节全部骨性融合。Buck—Gramcko／Lohmanrm评分值为8．7，其中优5例、良10例，中6例。DASH值为32，DASH调查表结果表明腕关节融合术后部分日常活动受限。结论腕关节融合钢板内固定成功率高，腕关节疼痛明显减轻，但术后腕关节部分功能丧失。     

桡骨远端骨瓣转移治疗晚期月骨无菌性坏死

目的 报告以桡动脉腕背分支为蒂的桡骨远端骨瓣转移治疗晚期月骨无菌性坏死的手术方法及初步疗效.方法 对2例晚期(Ⅳ期)月骨无菌性坏死患者,采用桡动脉腕背分支为蒂的桡骨远端骨瓣转移治疗.术后随访患者症状、腕关节活动度和腕关节影像学的改变,并用Krimmer 评分表和DASH评分表进行功能评定.结果 2例患者随访时间分别为3年和6个月,静息时疼痛均已消失,活动时疼痛程度减低.影像学表现:例1患者X线片月骨可见高密度坏死骨质已吸收,有新骨质形成;例2患者MRI显示坏死骨和腕骨塌陷无进一步进展.2例腕关节功能按Krimmer评分、DASH评分均较术前有明显的改善.结论 桡动脉腕背分支为蒂的桡骨远端骨瓣转移术治疗晚期月骨无菌性坏死.初步疗效良好.     

带血管蒂头状骨瓣移位治疗终末期月骨缺血性坏死的远期疗效

目的总结带血管蒂头状骨瓣移位治疗终末期月骨缺血性坏死的远期疗效。方法 2004年6月-2008年1月,采用带血管蒂头状骨瓣移位治疗16例LichtmanⅢB或Ⅳ期月骨缺血性坏死患者。男10例,女6例;年龄27~59岁,平均38.8岁。发病原因:创伤10例,原因不明6例。主要临床症状为腕关节疼痛伴活动受限;症状持续时间5~32个月,平均26.5个月。患侧腕高度指数为0.88±0.05,桡舟角为(63.8±9.1)°。结果术后切口均Ⅰ期愈合,无感染及神经、血管损伤等并发症发生。16例均获随访,随访时间5年4个月~9年,平均5.8年。末次随访时,腕关节VAS评分为(2.0±1.5)分。腕关节掌屈、背伸活动度均显著小于健侧(P0.05);握力及腕关节功能Evans评分与健侧比较,差异均无统计学意义(t=—0.997,P=0.327;t=—1.852,P=0.077)。X线片测量示,患侧腕高度指数为0.94±0.03,桡舟角为(48.4±4.8)°,与术前比较差异均有统计学意义(t=—3.927,P=0.000;t=5.987,P=0.000)。6例出现桡骨背侧与头状骨背侧硬化带,2例出现舟骨旋转。结论采用带血管蒂头状骨瓣移位治疗终末期月骨缺血性坏死,尽管存在不同程度腕关节功能受限,但因腕关节疼痛消失及握力显著改善,远期疗效满意。     

带血管蒂桡骨瓣移植联合舟头固定治疗Lichtman Ⅱ、ⅢA期月骨无菌性坏死的早期疗效

目的探讨第4、5间室内动脉蒂桡骨瓣移植联合舟头固定治疗Lichtman Ⅱ、ⅢA期月骨无菌性坏死的临床疗效。方法自2018年2月至2020年3月, 我们对9例Lichtman Ⅱ、ⅢA期月骨无菌性坏死患者, 采用第4、5间室内动脉蒂桡骨瓣移植联合舟头固定的方法治疗。分别于术前、术后3个月、术后6个月时随访患者腕关节运动范围(range of motion, ROM)和患侧健侧握力比值, 以及疼痛视觉模拟评分(visual analogue scale, VAS)、腕关节PRWE评分。根据腕部X线片测量腕高比, 根据腕关节MRI观察月骨高信号与月骨面积比值。结果术后9例患者均获得随访。术前VAS平均(6.22±1.39)分, 术后3个月为(1.44±0.88)分, 差异有统计学意义(P<0.05)。术前患侧健侧手握力比值为0.47±0.09, 术后3个月为0.81±0.06, 差异有统计学意义(P<0.05)。术前腕关节ROM为(84.55±4.24)°, 术后6个月为(89.88±3.75)°, 差异无统计学意义(P>0.05)。腕关节PRWE评分术前为73.22±7...     

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.     

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.     

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.     

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.