96例髋臼骨折手术治疗临床分析

目的对移位复杂的髋臼骨折采用不同手术入路与方法,探讨提高髋臼骨折复位质量的方法,制定对移位复杂的髋臼骨折的治疗程序。方法我院自2001年10月至2006年10月对96例有移位的髋臼骨折根据不同的情况选择合适的手术方法,疗效满意。本文通过对本组患者的随访结果,探讨髋臼骨折的治疗方法及效果。结果96例平均随访18个月,采用美国矫形外科医生学会髋关节功能评价标准和Matta标准进行评定,优72例（75%）,良18例（18.75%）,可6例（6.25%）。结论术前正确判断骨折类型及移位方向,选择恰当的手术入路,切开复位采取合适的内固定治疗是行之有效的方法,手术医师的经验、内固定的选择、骨折的类型、手术的时机和切口的选择直接影响到手术后的疗效。     

移位髋臼骨折的手术治疗

目的探讨手术治疗移位髋臼骨折的最佳时机、入路选择、复位方法与技巧,以提高髋臼骨折的诊疗水平。方法对38例移位髋臼骨折术前大部分行CT图像三维重建,确定骨折类型并制定手术方案,选择最佳手术入路进行骨折复位,用骨盆重建钢板或螺丝钉固定。结果36例获得6个月～3年,平均14个月的随访。按M atta疗效评定标准评定,优28例,良4例,可4例,优良率88.9%。并发症主要有坐骨神经损伤、髋关节黏连和异位骨化。结论CT图像三维重建对判断髋臼骨折的部位、移位方向和损伤程度有重要意义,对手术入路选择和手术复位固定有指导作用。对移位髋臼骨折的治疗应该采取积极的态度,只要骨折移位大于3 mm都应切开复位内固定,术前正确判断骨折类型,选择最佳入路,术中准确复位和妥善固定是提高髋臼骨折疗效的关键。     

髋臼骨折的手术治疗

目的探讨髋臼骨折的诊断和手术治疗方法与技巧,以提高髋臼骨折的诊疗水平.方法对32例移位髋臼骨折行术前CT平扫或三维重建确定骨折类型和制定手术方案,选择最佳手术入路进行骨折复位,以骨盆重建钢板和螺丝钉固定.结果32例全部获得6月-4年,平均15月的随访,按Maffa的疗效标准评定.临床标准优26例、良3例、可3例.优良率87.8%,X线标准优24例、良4例、可4例、优良率84.6%.并发症主要有坐骨神经损伤、股骨头坏死和异位骨化.结论CT三维重建对判断髋臼骨折的部位、移位方向和损伤程度具有重要意义,对手术入路选择和手术复位、固定具有指导作用.对于髋臼骨折的治疗应该采取更为积极的态度,只要移位大于2-3mm,都应切开复位内固定.术前正确判断骨折类型、选择最佳入路,术中准确复位和妥善固定是提高髋臼骨折疗效的关键.     

髋关节后脱位并髋臼骨折21例治疗体会

髋关节后脱位并髋臼骨折足一种负重关节内的骨折，外伤暴力一般较重，骨片往往移位，股骨头脱位，多需要切开复位内固定治疗。总结我院自2000年2月～2004年10月采用切开复位及内固定治疗髋关节后脱位并髋臼骨折的经验，探讨骨折类型的判断，手术入路及固定方法的选择，以期提高治疗效果。     

髋臼骨折的手术治疗

目的：探讨髋臼骨折的诊断和手术治疗方法与技巧,以提高髋臼骨折的诊疗水平。方法：对32例移位髋臼骨折行术前CT平扫或三维重建确定骨折类型和制定手术方案,选择最佳手术入路进行骨折复位,以骨盆重建钢板和螺丝钉固定。结果：32例全部获得6月－4年,平均15月的随访,按Maffa的疗效标准评定。临床标准：优26例、良3例、可3例。优良率87．8％,X线标准：优24例、良4例、可4例、优良率84．6％。并发症主要有坐骨神经损伤、股骨头坏死和异位骨化。结论：CT三维重建对判断髋臼骨折的部位、移位方向和损伤程度具有重要意义,对手术入路选择和手术复位、固定具有指导作用。对于髋臼骨折的治疗应该采取更为积极的态度,只要移位大于2－3mm,都应切开复位内固定。术前正确判断骨折类型、选择最佳入路,术中准确复位 和妥善固定是提高髋臼骨折疗效的关键。     

移位型髋臼骨折手术治疗的临床分析

目的探讨手术治疗移位型髋臼骨折的临床疗效。方法自2003年6月-2008年10月,根据髓臼骨折的类型采用髂腹股沟入路、Kocher-Langenbeck路、Sminl-Pertersen入路和前后联合入路,运用重建钢板、可吸收螺钉及中空拉力螺钉内固定治疗髋臼骨折32例。结果本组随访8个月～4年,平均24个月。关节功能按刘利民标准进行评定：优18例,良10例,可4例,优良率87．5％。术后并发异位骨化3例,深静脉血栓4例。结论对移位型髋臼骨折采用手术切开复位内固定治疗,成功率高,并发症少,疗效满意。     

切开复位内固定治疗髋臼骨折的体会

目的探讨髋臼骨折的手术治疗方法。方法回顾36例有移位的髋臼骨折患者进行手术的经验,所有骨折均按L etourne l-Judet方法进行分型,根据不同骨折类型,分别采用K ocher-L angnebeck入路、髂腹股沟入路及前后联合入路进行骨折复位,以骨盆重建钢板和/或螺丝钉进行固定。结果36例有移位的髋臼骨折术后骨折复位的效果采用M atta X线评定标准,优17例(47.2%),良15例(41.7%),一般3例(8.3%),差1例(2.8%)。临床效果的评估采用改良的M erleDA ub igne和Poste l评分系统,本组随访32例,随访时间13个月~7年,平均3年2个月。随防结果:优12例(37.5%),良14例(43.8%),一般4例(12.5%),差2例(6.3%)。结论及时手术,选择正确的手术入路,高质量的切开复位和可靠的内固定,早期功能锻炼和术者的经验是获得良好临床结果的关键。     

手术治疗26例髋臼骨折的体会

目的总结髋臼骨折的治疗经验，探讨手术方法和如何提高疗效。方法对26例髋臼骨折进行手术切开复位内固定的临床资料进行回顾性分析。结果26例均获得5～63个月的随访，平均28个月，骨折全部愈合。1例发生创伤性骨关节炎，1例发生股骨头缺血性坏死，2例发生坐骨神经损伤。结论对有移位的髋臼骨折，只要病情允许，应尽早选择切开复位内固定手术，有利于获得良好的治疗效果。     

前、后联合入路治疗骨盆、髋臼骨折

目的探讨前、后联合入路切开复位钢板螺钉内固定治疗骨盆、髋臼骨折的临床疗效。方法应用前、后联合入路切开复位钢板螺钉内固定治疗39例移位的骨盆、髋臼骨折患者。记录手术时间、术中出血量、并发症情况;术后7 d根据Matta复位标准评估骨折复位质量;末次随访时采用Majeed评分标准评估骨盆功能。结果手术时间100～180 min,术中出血量500～1 200 ml。切口均一期愈合。无并发症发生。患者均获得随访,时间12～18个月。术后7 d骨折复位满意率为97.44%。末次随访时根据Majeed评分标准评估骨盆功能:优30例,良8例,可1例,优良率为97.44%。结论前、后联合入路治疗移位的骨盆、髋臼骨折是一种有效的术式。     

髋臼骨折的手术治疗

目的：探讨髋臼骨折的手术治疗效果和影响疗效因素。方法：对31例髋臼骨折患进行切开复位由固定治疗。结果：平均随访18个月(6～36月)，根据Matta评分标准优16例，良8例，一般4例，差3例。1例术后发生深部感染，1例术后18个月发生股骨头坏死。结论：髋臼骨折，特别是有移位的髋臼骨折应及时手术治疗。手术医师的经验、骨折类型、手术时机和入路会影响髋臼骨折的疗效。     

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.