有限切开固定治疗复杂胫骨平台骨折

目的探讨采用有限切开固定治疗复杂胫骨平台骨折的临床效果。方法采用间接复位有限切开固定治疗复杂胫骨平台骨折37例,SchatzkerⅣ型骨折采用前内侧小切口,T型钢板固定,SchatzkerⅤ、Ⅵ型骨折采用前外侧小切口联合后内侧切口,后内侧用1/3管型钢板固定支撑,外侧以高尔夫棒型钢板固定。结果随访6-30个月,37例均于12周内骨折愈合。所有患者均恢复了患肢的正常力线及患膝的骨性稳定。采用Sanders膝关节评分法评估疗效：优13例,良20例,可4例。结论有限切开固定治疗复杂胫骨平台骨折是一种安全有效的生物学固定方法,创伤小,骨折愈合快,可早期功能锻炼,膝关节功能恢复满意。     

治疗SchatzkerⅤ、Ⅵ型胫骨平台骨折手术方法的选择

目的探讨双钢板固定术和经皮复位外固定术治疗SchatzkerⅤ、Ⅵ型胫骨平台骨折的临床疗效。方法2003年3月至2005年5月．根据软组织损伤程度，分别采用双钢板固定植骨术或经皮复位有限固定术治疗SchatzkerⅤ、Ⅵ型胫骨平台骨折33例。结果术后33例获得随访，随访8～26个月，平均16个月。参照Merchant评分，优16例．良12例，可5例，优良率为85％。结论治疗胫骨平台骨折应重视软组织损伤程度的评估。软组织损伤较轻者可采用切开复位双钢板固定植骨术，软组织损伤严重者应行经皮复位有限内固定结合外固定术。采用适当手术方法，可减少软组织并发症，使骨折固定长期的稳定性良好．关节功能恢复满意。     

双钢板结合外固定支架间接复位技术治疗SchatzkerⅤ、Ⅵ型胫骨平台骨折

[目的]探讨双钢板结合可调式外固定支架间接复位技术治疗SchatzkerⅤ、Ⅵ型胫骨平台骨折的临床效果。[方法]对2002年4月～2006年2月期间在本院应用双钢板结合可调式外固定支架间接复位技术治疗的SchatzkerⅤ、Ⅵ型胫骨平台骨折病例进行回顾,对有良好随访的34例临床效果进行分析。男22例,女12例;左侧18例,右侧16例;年龄32～67岁(平均47岁)。分型:Ⅴ型20例,Ⅵ型14例。术中先利用可调试外固定支架间接复位技术,基本恢复下肢良好的力线;胫骨平台后内侧短节段1/3管状钢板固定内侧柱,膝关节前外侧切口,用胫骨平台外侧高尔夫棒形钢板固定骨折端,取自体髂骨植骨。[结果]所有患者获12～26个月随访,平均随访时间18月。骨折全部愈合。按Honkonen-Jarvinen标准对患者进行评分:患者的影像学、客观表现、主观感觉、日常功能评分优良率分别为80%、82%、79%、73%。[结论]双钢板结合可调式外固定支架间接复位技术治疗SchatzkerⅤ、Ⅵ型胫骨平台骨折,通过间接复位,有限切开及有效内固定,能最大程度地保护骨折端及周围血供为骨折愈合提供良好的生物学环境,又能为术后膝关节早期功能锻炼提供足...     

双钢板结合经皮微创置入技术治疗Schatzker Ⅴ、Ⅵ型胫骨平台骨折

目的研究双钢板结合经皮微创置入技术治疗SchatzkerⅤ、Ⅵ型胫骨平台骨折的内固定方法,并评估其疗效。方法2003年2月～2005年1月收治23例严重胫骨平台骨折患者,根据Schatzker分型:Ⅴ型14例,Ⅵ型9例,均采用小切口,术中先利用跨关节外固定支架牵引和点状复位钳间接复位技术恢复膝关节的力学轴线,待恢复关节面平整后植骨,采用双钢板结合经皮微创置入技术进行可靠的内固定,所有患者术后第1天即进行膝关节功能锻炼。结果所有患者术后获6～32个月(平均16.2个月)随访,无骨折延迟愈合、畸形愈合。临床骨愈合时间平均为12.6周,X线片检查胫骨平台均未发生二期塌陷,无膝关节机械轴对线不良,膝关节屈曲125°～135°(平均128.5°)。膝关节功能采用Iowa膝关节评分标准评定:优13例,良8例,可2例,优良率为91.3%。结论对于由高能量损伤导致的软组织损伤严重的SchatzkerⅤ、Ⅵ型胫骨平台骨折患者,采用双钢板结合经皮微创置入技术进行内固定,既能避免对胫前皮瓣和骨折端血供的过分破坏,又能避免术后胫骨平台发生二期塌陷和膝关节机械轴对线不良,是恢复患肢功能的有效治疗方法。     

治疗Schatzker Ⅴ、Ⅵ型胫骨平台骨折手术方法的选择

目的 探讨双钢板固定术和经皮复位外固定术治疗SchatzkerⅤ、Ⅵ型胫骨平台骨折的临床疗效.方法 2003年3月至2005年5月,根据软组织损伤程度,分别采用双钢板固定植骨术或经皮复位有限固定术治疗SchatzkerⅤ、Ⅵ型胫骨平台骨折33 例.结果 术后33 例获得随访,随访8～26个月,平均16个月.参照Merchant评分,优16 例,良12 例,可5 例,优良率为85%.结论 治疗胫骨平台骨折应重视软组织损伤程度的评估.软组织损伤较轻者可采用切开复位双钢板固定植骨术,软组织损伤严重者应行经皮复位有限内固定结合外固定术.采用适当手术方法,可减少软组织并发症,使骨折固定长期的稳定性良好,关节功能恢复满意.     

21例胫骨平台骨折的手术治疗

目的 探讨胫骨平台骨折内固定治疗的方法及效果。方法 回顾性总结用单纯螺钉、单侧钢板及双侧钢板对不同类型的胫骨平台骨折的内固定治疗效果。结果 本组共21例，随访10～36个月，总优良率为85%。结论 单纯螺钉可用于Ⅰ～Ⅲ型骨折，但稳定性差，单侧钢板适用于Ⅰ～Ⅳ型骨折，双侧钢板适用于Ⅴ～Ⅵ型骨折。手术时机在受伤1周后局部水肿消退时为最佳，术中植骨可减少术后胫骨平台的下陷，并能早期屈膝及负重功能锻炼，促进骨折愈合及功能恢复。     

关节镜辅助下治疗胫骨平台骨折38例

目的探讨关节镜辅助治疗胫骨平台骨折手术效果。方法胫骨平台骨折38例，包括Schatzker Ⅰ型8例，Ⅱ型10例，Ⅲ型11例，Ⅳ型4例，Ⅴ型3例，Ⅵ型2例。常规膝关节镜检查，合并半月板损伤15例，前交叉韧带部分或完全断裂12例，内侧副韧带损伤7例，在关节镜监视下进行复位和固定。对于Ⅰ～Ⅲ型骨折选用松质骨拉力螺钉固定，Ⅳ～Ⅵ型骨折则应用微创法植入支持钢板。结果本组手术时间30～72min，平均40min，术中出血量均少于20ml。术后36例随访4个月～3年，平均15个月。术后3个月X线片显示骨折均愈合，无切口及关节感染、皮肤坏死或创口延迟愈合。术后3个月HSS评分：优28例，良6例，中2例。此期主要表现为肌力不够及膝关节主动伸屈功能较差。术后6个月HSS评分：优33例，良3例。结论关节镜辅助治疗胫骨平台骨折，有助于骨折的正确复位和固定，并早期发现和处理关节内其他结构损伤。根据不同的骨折类型选用不同的内固定，能较好地微创处理多种类型的胫骨平台骨折。     

关节镜下辅助治疗胫骨平台骨折38例

目的 探讨关节镜在微创治疗胫骨平台骨折术中应用的方法及意义.方法 应用关节镜辅助下治疗有手术指征的胫骨平台骨折患者38例,按Schatzker分类法:Ⅰ型10例、Ⅱ型12例、Ⅲ型8例、Ⅳ型3例、Ⅴ型3例、 Ⅵ型2例,按照骨折的不同类型和损伤程度,采用关节镜监视下有限切开复位,可吸收螺钉、空心螺钉或钢板内固定,关节镜下处...     

有限切开置入胫骨近端外侧锁定接骨板治疗SchatzkerⅠ~Ⅲ型胫骨平台骨折

目的探讨有限切开经皮置入胫骨近端外侧锁定钢板治疗SchatzkerⅠ～Ⅲ型胫骨平台骨折的临床疗效和可行性。方法39例SchatzkerⅠ～Ⅲ型骨折均采用有限切开,经皮置入胫骨近端外侧锁定钢板治疗,并对有塌陷的骨折行开窗植骨。结果术后随访35例,均骨性愈合,无骨折再移位、塌陷。术后12个月膝关节HSS评分标准评分65～96分,平均90.5分,优良率为94.3%。结论对于SchatzkerⅠ～Ⅲ型胫骨平台骨折采用有限切开经皮置入胫骨近端锁定钢板能够减少软组织损伤,实现膝关节功能早期锻炼,是一种有效的治疗方法。     

闭合复位有限固定治疗胫骨平台骨折

目的探讨采用闭合复位有限固定治疗胫骨平台骨折的可行性及疗效。方法自1999年10月~2002年1月,共治疗胫骨平台骨折42例,男29例,女13例;年龄26~67岁,平均41岁。按照Schatzker分类法,Ⅰ型9例,Ⅱ型5例,Ⅲ型13例,Ⅳ型3例,Ⅴ型6例,Ⅵ型6例。对胫骨平台骨折中劈裂骨折块采用闭合复位,塌陷骨折块采用经皮空心钉导针撬拨复位,复位后均用直径6.5mm空心钉固定,对不稳定性骨折加用Bastiani单臂外固定器。结果术后随访37例,随访时间6~30个月,平均15个月;骨折均在12周内愈合,无一例术后发生神经血管损伤及深部感染等并发症。本组37例患者中有21例解剖复位,Sanders膝关节评分法评定结果为优8例,良11例,可2例;16例非解剖复位均属SchatzkerⅡ、Ⅴ、Ⅵ型,其疗效评定为优5例,良9例,可2例。两组之间比较差异无显著性意义(Wilzoxon检验,P>0.05)。所有病例均恢复了患肢的正常力线,患膝稳定。结论闭合复位有限固定是治疗胫骨平台骨折的有效方法之一,其对膝关节创伤小,可恢复患肢的正常力线及患膝的稳定,固定可靠,术后可早期进行膝关节功能锻炼,患肢功能恢复好,并发症少。     

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.