肱骨小头冠状面骨折的手术治疗

目的 探讨肱骨小头冠状面骨折的手术治疗方法及其疗效.方法 2000年2月～2007年12月手术治疗肱骨小头冠状面骨折19例,3例行骨块摘除术,其余16例行切开复位内固定术.结果 对患者进行了X线及肘关节功能随访,随访时间6～54个月.内固定患者骨折愈合时间为6～10周,无肱骨小头缺血性坏死.术后疗效优7例、良10例、可2例,优良率为89%.结论 及早手术治疗、选用适合的手术方式、解剖复位、牢固固定、早期进行功能锻炼是肱骨小头冠状面骨折获得良好疗效的保证.     

可吸收材料内固定治疗Bryan-Morrey Ⅰ型肱骨小头骨折疗效分析

目的观察可吸收材料内固定治疗Bryan-MorreyⅠ型肱骨小头骨折的临床疗效。方法回顾性分析自2010-06—2016-01采用切开复位可吸收材料内固定治疗的14例Bryan-MorreyⅠ型肱骨小头骨折。如果骨折块较大,前后位置入2枚可吸收螺钉或2枚可吸收棒固定肱骨小头骨折块;如果骨块较小,采用1枚可吸收螺钉和1根可吸收棒固定。结果 14例均获得随访,随访时间10~12个月,平均11个月。末次随访时屈肘活动度平均132°,伸肘活动度平均12°,前臂旋转活动度平均170°。骨折均骨性愈合,愈合时间8~12周,平均10周。末次随访时疗效根据肘关节功能Mayo评分标准评定:优9例,良3例,可2例。结论可吸收材料内固定治疗Bryan-MorreyⅠ型肱骨小头骨折临床疗效满意,在骨折愈合过程中无腐蚀及刺激作用,允许骨折断端局部产生微动,有利于骨痂生长和骨折愈合,且无需二次手术取出。     

可吸收螺钉治疗肱骨小头骨折13例体会

目的:探讨可吸收螺钉内固定治疗肱骨小头骨折的方法及临床疗效.方法:采用可吸收螺钉治疗肱骨小头新鲜骨折13例.结果:所有患者切口均Ⅰ期愈合.X线片显示骨折解剖复位.13例均获得随访,时间6～24个月.骨折临床愈合的时间为6～9周.采用Morrey评分标准进行疗效评价:优9例,良3例,差1例.结论:可吸收螺钉内固定治疗肱骨小头骨折复位满意,固定牢靠,有利于骨折的愈合,避免二次手术,疗效满意.     

肱骨小头骨折的手术疗效分析

[目的]探讨肱骨小头骨折手术治疗的疗效及其影响因素.[方法]自2006年1月～2009年5月采用切开复位内固定治疗29例肱骨小头骨折,其中空心钉固定18例;可吸收钉固定4例;空心钉结合可吸收钉固定4例;克氏针固定1例;克氏针结合可吸收钉固定1例;克氏针结合星形钢板固定1例.[结果]本组28例病人,29肘随访时间平均26.2个月(11 ～37个月),骨折于随访期内全部愈合.Ⅰ型对比Ⅲ型和Ⅳ型肱骨小头骨折术后肘关节平均伸曲度的差异有统计学意义(分别t=3.411,P=0.004;t=3.327,P=0.005).Ⅲ型对比Ⅳ型肱骨小头骨折术后肘关节平均伸曲度的差异无统计学意义(分别t=-0.278,P=0.784).本组出现3例异位骨化,2例迟发性尺神经炎,无肱骨小头缺血性坏死病例.按照Broberg和Morrey的肘关节评分标准进行评分:优13例;良11例;可5例,优良率82.76％.[结论]Ⅰ型肱骨小头骨折手术解剖复位内固定,早期功能锻炼能达到满意疗效,Ⅲ、Ⅳ型肱骨小头骨折常合并肘关节其他骨折,肘关节韧带损伤或肘关节脱位预后较差.     

移位肱骨小头骨折的手术治疗

目的：探讨手术治疗移位肱骨小头骨折的方法及疗效。方法：肘关节外侧入路手术治疗移位肱骨小头骨折18例,Ⅱ型2例行骨折片切除,其余病例行空心螺钉内固定。结果：术后伤口Ⅰ期愈合,无神经、血管损伤。X线显示骨折解剖复位。骨折愈合4～8周,平均6周。根据改良Cassebaum评分系统进行功能评价,优10例,良6例,可2例,优良率89％。结论：肱骨小头骨折为囊内骨折,应采用切开复位内固定治疗,对于骨折片极小,无法固定者可行骨折碎片切除术。术后早期功能锻炼对于肘关节功能恢复有促进作用。     

可吸收螺钉内固定治疗成人肱骨小头骨折

目的探讨可吸收螺钉内固定治疗成人肱骨小头骨折的方法及临床疗效。方法采用可吸收螺钉治疗成人肱骨小头新鲜骨折12例。结果所有患者切口均Ⅰ期愈合。X线片显示骨折解剖复位。12例均获得随访,时间6—42个月。骨折临床愈合的时间为6～9周。采用Morrey评分标准进行疗效评价：优9例,良2例,差1例。结论可吸收螺钉内固定治疗成人肱骨小头骨折复位满意,固定牢靠,有利于骨折的愈合,避免二次手术,疗效满意。     

Herbert钉联合铰链式外固定架固定治疗肱骨小头骨折的疗效分析

目的探讨切开复位Herbert钉联合铰链式外固定架固定治疗肱骨小头骨折的临床疗效。方法回顾性分析自2013-01—2015-12采用切开复位Herbert钉联合铰链式外固定架固定治疗的9例肱骨小头骨折,观察术后骨折愈合、肘关节功能恢复情况。结果 9例获得平均13.9(9~24)个月随访。术后X线片显示骨折愈合时间平均8.8(8~12)周。末次随访时均无疼痛及关节不稳定,肘关节屈伸活动度平均120°(100°~145°),前臂旋转活动度平均135°(90°~180°)。末次随访时改良Mayo肘关节功能评分:优8例,良1例;Broberg-Morrey肘部骨折疗效评分:优8例,良1例。结论切开复位Herbert钉联合铰链式外固定架固定治疗肱骨小头骨折固定可靠,患者可早期进行功能锻炼促进骨折愈合,可有效预防关节僵硬、异位骨化等并发症。     

经肘前入路软骨钉治疗肱骨小头骨折

目的探讨经肘前人路软骨钉治疗肱骨小头骨折内固定手术的方法和疗效。方法 2008年6月至2011年8月,采用经肘关节前侧＂S＂形入路可吸收软骨钉内固定治疗肱骨小头骨折12例,男8例,女4例,年龄12～52岁,平均28.5岁,Ⅰ型骨折5例,Ⅱ型骨折3例,Ⅲ型2例,Ⅳ型2例;其中有3例合并有桡骨小头骨折,1例合并有尺骨冠状突骨折。结果随访6～36个月,平均25个月。骨折临床愈合时间4～10周,平均6周。根据Morrey肘关节功能评分标准,良好（满意）9例,一般3例,无骨不连及肱骨小头缺血性坏死发生。结论肘前人路损伤小,暴露清楚,可直视下对肱骨小头的骨折块进行解剖复位;可吸收软骨钉对关节软骨面的损伤小,固定牢靠,可早期进行功能锻炼,无需二次取出,有利于肘关节功能的良好恢复。     

成人肱骨小头冠状面骨折的手术治疗

[目的]探讨采用手术治疗成人肱骨小头冠状面骨折的固定方法和疗效。[方法]自2001年1月-2005年7月，采用手术切开直视下复位骨折，分别于肱骨小头、滑车置人螺钉固定治疗肱骨小头骨折6例。男2例，女4例，年龄27—48岁，平均38岁，左侧4例，右侧2例。所有患者均为新鲜闭合性骨折，无神经、血管损伤。手术时间为伤后3—9d。[结果]6例手术中均无血管、神经损伤，术后伤口Ⅰ期愈合，X线片显示骨折解剖复位。全部病例均获得随访，随访时间为术后12—52个月，平均32个月。骨折临床愈合时间为6—9周，平均7周。未见肘关节骨化性肌炎、肱骨小头缺血性坏死等并发症。疗效评估在使用Broberg—Morrey评分系统标准进行评价，结果极好5例，好1例。[结论]肱骨小头冠状面骨折应行切开复位内固定术，达到解剖复位和牢固固定并早期行肘关节主动伸屈功能锻炼，疗效满意。     

MehdianⅣ型肱骨小头骨折八例手术治疗体会

目的 探讨肱骨小头MehdianⅣ型骨折经肘外侧人路治疗的固定方法和疗效.方法 对8例MehdianⅣ型肱骨小头骨折,行经肘外侧人路复位骨折,采用冠状位细克氏针结合矢状位螺钉固定治疗.结果 患者均获得随访,随访时间为术后3个月～4年,平均32个月.疗效评估采用MaYo肘关节评分系统:优5例,良2例,可1例.结论 肱骨小头骨折为囊内骨折,采用肘外侧手术人路,冠状位细克氏针结合矢状位螺钉固定能达到解剖复位和牢固固定,可早期功能锻炼,近期疗效较佳.     

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.