儿童陈旧性孟氏骨折的外科治疗

目的研究和探讨儿童陈旧性孟氏骨折的手术治疗方法。方法本组16例患儿,2~16岁,采用Boyd切口显露桡骨小头肱桡关节及尺骨上段,在骨折成角顶部行斜形或楔形型截骨,桡骨小头解剖复位,行尺骨内固定,从肱三头肌腱的外侧游离长8cm、宽1cm的腱性部分重建环状韧带,石膏固定4~6周。结果术后随访0.5~1.5年,优75%,良18.7%,可9.1%,优良率93.7%。结论尺骨截骨延长,同时用肱三头肌腱重建环状韧带治疗儿童陈旧性孟氏骨折疗效满意。     

尺骨截骨矫形环状韧带重建治疗儿童陈旧孟氏骨折

目的探讨通过尺骨截骨结合环状韧带重建术治疗陈旧性儿童孟氏骨折的临床效果。方法本文回顾分析了自2010—2015年收治的儿童陈旧性孟氏骨折11例,其中男9例,女2例;年龄9~16岁,平均12.5岁。采用Boyd切口,显露肱桡关节、上尺桡关节及尺骨近端,对成角或短缩畸形的尺骨行截骨矫形,1/3管形钢板固定,切除嵌在肱桡关节或近端尺桡关节中残存的环状韧带和瘢痕组织,复位桡骨头后用克氏针固定,取前臂深筋膜绕桡骨颈重建环状韧带。如残存的环状韧带足够长可将其与纤维瘢痕视为一体合拢缠绕桡骨颈重建环状韧带。术后石膏外固定4~6周,拆除石膏,拔除克氏针后行功能锻练。结果随访10例,随访时间6~48个月。疗效评价:优8例,良1例,差l例,优良率达90%。肘关节由术前的屈25°~50°、伸5°~10°、旋前旋后5°~20°,改善为术后的屈90°~120°、伸0°~5°、旋前旋后75°~90°,功能改善明显。结论尺骨截骨矫正成角或短缩畸形,结合环状韧带重建治疗儿童陈旧孟氏骨折疗效满意。     

尺骨截骨治疗儿童陈旧性孟氏骨折

目的探讨尺骨截骨手术治疗陈旧性儿童孟氏骨折的疗效。方法对28例患儿采取尺骨截骨固定桡骨小头复位,同时行环状韧带重建,其中3例行桡骨中段缩短截骨固定。结果28例均得到随访,时间6个月～8年。肘关节功能：优20例,良8例。4例合并桡神经损伤患儿完全得到恢复。结论尺骨截骨手术是治疗儿童陈旧性孟氏骨折良好术式。     

阔筋膜重建环状韧带治疗陈旧性桡骨小头脱位的疗效评价

[目的] 评价阔筋膜重建环状韧带治疗陈旧性桡骨小头脱位的疗效.[方法] 回顾性研究了采用阔筋膜重建环状韧带治疗陈旧性桡骨小头脱位的24例患者,手术时年龄5-14岁,从受伤到接受手术治疗的时间间隔为6个月～5年,所有病例的治疗方法均应用阔筋膜替代环状韧带重建肱桡关节,术时并未行尺骨截骨,术后应用钢针固定肱桡关节.[结果] 获随访11例,随访时间5～7年,平均随访5年9个月.其中6例有不同程度的旋转功能受限.平均旋转受限69°,旋前平均受限33°,旋后平均受限36°.屈伸受限4例,其中伸直平均受限21°,屈曲受限不明显.半脱位2例,桡骨颈明显变细2例,肱桡关节钢针断裂4例.暂时性桡神经损伤1例.[结论] 大龄儿童13岁以上的桡骨小头脱位,脱位时间2年以上,应慎行阔筋膜重建环状韧带手术;取阔筋膜重建环状韧带,效果可靠,但增加了创伤.可考虑应用肱三头肌腱膜或前臂深筋膜替代环状韧带.     

小儿孟氏骨折的修复与重建

报道１９８０年～１９９２年手术治疗６２例小儿孟氏骨折。其中新鲜孟氏骨折１８例，陈旧性孟氏骨折４４例。行桡骨小头及尺骨解剖复位或截骨延长内固定手术，环状韧带重建，桡神经深支修复术。经随访１年～１２年，疗效优良率为９３％。简要介绍了手术方去，讨论了小儿孟氏骨折的早期诊断与及时有效治疗的重要性。尺骨牢固固定和环状韧带修复或重建是防止桡骨小头再脱位的关键。术后缩短外固定时间，积极进行功能练习是提高疗效的重要措施。     

儿童陈旧性孟氏骨折遗留关节功能障碍的早期手术治疗体会

目的探讨儿童陈旧性孟氏骨折遗留关节功能障碍早期手术方法及近期疗效。方法回顾性分析2009-01—2014-06诊治的16例儿童陈旧性孟氏骨折。7例行尺骨截骨矫形,9例行尺骨截骨延长;然后均行桡骨头切开复位、环状韧带修补及关节囊紧缩缝合术。10例肱桡关节克氏针贯穿固定,7例尺骨截骨端克氏针髓内固定,9例接骨板固定。结果16例均获得随访12~28个月,平均15.6个月。末次随访时,1例前臂旋前受限于50°。肘关节伸直0°~10°,平均4°;屈曲120°~145°,平均133°;旋前70°~90°,平均75°;旋后80°~90°,平均87°。疗效采用Mackay临床功能标准评定,优8例,良7例,差1例。结论儿童陈旧性孟氏骨折早期手术,尺骨截骨矫形(或延长)、桡骨头切开复位是恢复肱桡关节及上尺桡关节正常结构的关键,视桡骨头稳定情况行肱桡关节克氏针短期固定,为关节功能早期恢复创造条件。     

改良手术治疗儿童陈旧性孟氏骨折

目的探讨改良手术治疗儿童陈旧性孟氏骨折的疗效。方法23例儿童陈旧性孟氏骨折在传统手术尺骨延长、桡骨头复位、环状韧带重建的基础上,根据桡骨畸形情况,增加桡骨旋转截骨术。结果23例随访6～36个月（平均20个月）,根据临床与X线检查,优17例,良5例,可1例。结论通过桡骨旋转截骨改良儿童陈旧性孟氏骨折的手术治疗,操作方法简单实用,临床疗效确切,可在临床推广应用。     

儿童陈旧性孟氏骨折的手术改良

[目的]探讨手术解决儿童陈旧性孟氏骨折更佳方法。[方法]对23例儿童陈旧性孟氏骨折，在传统手术治疗三原则即尺骨延长、桡骨头复位、环状韧带重建的基础上增加桡骨旋转截骨术，随访治疗效果。[结果]本组23例，随访6～36个月，平均23个月，优良率为95．7％，效果满意。[结论]通过桡骨旋转截骨改良儿童陈旧性孟氏骨折的手术治疗，操作方法简单实用，临床疗效确切，可在临床推广应用。     

2种截骨方式治疗儿童陈旧性孟氏骨折的疗效比较

目的比较尺骨截骨延长与桡骨短缩截骨术治疗儿童陈旧性孟氏骨折的临床疗效。方法自2005-06—2013-05共诊治儿童陈旧性孟氏骨折28例,采用尺骨截骨延长13例,采用桡骨短缩截骨15例。结果术后切口均一期愈合,28例均获得随访,尺骨截骨组随访6~32个月,平均17个月,截骨处均一期愈合,平均愈合时间3.8周;采用Mackay进行效果评定:优11例,良1例,差1例。桡骨截骨组随访5~34个月,平均16个月,桡骨小头骨折均维持良好复位,截骨处一期愈合,平均愈合时间4周;采用Mackay进行效果评定:优9例,良3例,差3例。结论采用尺骨截骨延长较桡骨短缩截骨操作简单且能获得更好的临床疗效。     

儿童陈旧性孟氏骨折环状韧带重建术

孟氏骨折是儿童肘关节常见的一种损伤,如处理不当,常遗留畸形及肘关节功能障碍.自1976至1987年我科手术治疗陈旧性孟氏骨折74例,其中60例桡骨小头复位后利用残余组织修复环状韧带;另14例因缺损多无法修复而行环状韧带重建术.现将14例中有随访结果的10例报道如下.     

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.