经肱三头肌两侧入路内固定术治疗肱骨髁间骨折临床分析

目的探讨经肱三头肌两侧入路行双钢板、螺钉或Y型板内固定术治疗肱骨髁间骨折的方法及效果。方法对38例肱骨髁间骨折患者实施经肱三头肌两侧入路内固定术,回顾性分析患者的临床资料。结果 38例患者术后均获18个月随访,骨性愈合良好,肘关节功能恢复优良率92.11%。结论对肱骨髁间骨折患者经肱三头肌两侧入路行肱骨髁双钢板、螺钉或Y型钢板内固定治疗,内固定稳定,利于早期功能锻炼及肘关节功能恢复,是肱骨髁间骨折较理想的治疗方法。     

成年肱骨髁间髁上骨折切开复位内固定术后影响肘关节功能恢复的相关因素

目的探讨成年肱骨髁间髁上骨折切开复位内固定术后影响肘关节功能恢复的相关因素。方法回顾性分析自2013-01—2015-12行切开复位内固定治疗的98例成年肱骨髁间髁上骨折,于术后6个月骨折愈合后采用Mayo评分标准评定肘关节功能。将患者性别、年龄、损伤侧别、损伤类型、骨折AO分型、合并损伤(同侧骨折或神经损伤)、合并糖尿病、受伤至手术时间、手术入路、开始功能锻炼时间、术后并发症作为影响术后肘关节功能恢复的相关因素进行多因素Logistic回归分析。结果 98例随访6个月后骨折均愈合,肘关节功能Mayo评分:优41例,良35例,可14例,差8例,优良率77.6%。多因素Logistic回归分析显示年龄45岁、开放性骨折、AO-C3型骨折、合并同侧骨折、合并神经损伤、合并糖尿病、开始功能锻炼时间≥14 d、术后出现并发症是术后肘关节功能恢复的独立危险因素。结论成年肱骨髁间髁上骨折切开复位内固定术后部分患者肘关节功能恢复较差,这与高龄、开放性骨折、粉碎性骨折、合并损伤、合并糖尿病、未早期功能锻炼及术后出现并发症有关。     

双钢板法治疗肱骨髁间骨折

肱骨髁间骨折一直是创伤骨科中较难治疗的关节骨折之一。处理方法有非手术治疗、手术复位和广泛内固定。近 10年来,由于内固定材料和暴露方法的改进,手术复位加坚强内固定的方法已被广泛接受,患者可早期进行功能锻炼,尽快恢复肘关节功能 [1－ 3]。在此,我们复习 19例应用双钢板法 [4]切开复位内固定治疗肱骨髁间骨折的病例,以探讨此方法在肱骨髁间骨折治疗中的意义。 临 床 资 料 一、一般资料 对我院 1997年 10月～ 1999年 4月收治的 19例因肱骨髁间骨折而行切开复位、双钢板内固定术的患者进行回顾性分析。女 8例,男 11例;年龄 …     

肱三头肌劈开入路治疗肱骨髁间骨折

目的探讨改良肱三头肌劈开入路治疗肱骨髁间骨折的临床效果。方法对35例肱骨髁间骨折采用改良的肱三头肌劈开入路,不同内固定方法进行治疗。结果32例获得平均9.5个月的随访。按照Jupiter肘关节功能评分系统评价肘关节功能:优8例,良15例,可7例,差2例,优良率为71.9%。结论改良的肱三头肌劈开入路切开复位内固定治疗肱骨髁间骨折,不损伤关节软骨面及神经,手术创伤小,早期进行肘关节功能锻炼,是一种较好的手术显露方法。     

儿童移位肱骨髁间骨折的手术治疗

目的：回顾性评估切开复位内固定术治疗儿童移位肱骨髁间骨折的临床效果。方法：自2007年3月至2009年2月,我科应用切开复位及内固定治疗了8例移位的肱骨髁间骨折患儿,其中男7例、女1例,平均年龄8．2岁（6-12岁）。按照Riseborough—Radin分型系统,其中Ⅲ型6例、Ⅳ型2例;受伤机制包括：5例滑板车摔伤、1例摩托车摔伤、1例高处坠落伤、1例自行车摔伤。方法为采用Bryan—Morrey后内侧手术入路切开复位内固定术,应用克氏针钢丝或钉板系统内固定治疗。结果：术后无一例伤口感染及尺神经损伤,骨折均解剖对位。7例应用克氏针钢丝固定,1例行钉板系统固定。8例患儿均获得随访,平均随访时间2．2年（1．5-3年）。肘关节X线片显示无一例出现骨折的延迟愈合、不愈合,无一例肱骨远端骨骺坏死发生,2例合并肘关节异位骨化,肘关节屈伸活动度平均-10．6°131．3°,日常生活无明显影响。结论：移位的肱骨髁间骨折患儿,应用Bryan—Morrey后内侧手术入路切开复位内固定术可获得较好的治疗效果。     

儿童移位肱骨髁间骨折的手术治疗

目的：回顾性评估切开复位内固定术治疗儿童移位肱骨髁间骨折的临床效果。方法：自2007年3月至2009年2月,我科应用切开复位及内固定治疗了8例移位的肱骨髁间骨折患儿,其中男7例、女1例,平均年龄8．2岁（6-12岁）。按照Riseborough—Radin分型系统,其中III型6例、IV型2例;受伤机制包括：5例滑板车摔伤、1例摩托车摔伤、I例高处坠落伤、1例自行车摔伤。方法为采用Bryan～Morrey后内侧手术入路切开复位内固定术,应用克氏针钢丝或钉板系统内固定治疗。结果：术后无一例伤口感染及尺神经损伤,骨折均解剖对位。7例应用克氏针钢丝固定,1例行钉板系统固定。8例患儿均获得随访,平均随访时间2．2年（1．5～3年）。肘关节X线片显示无一例出现骨折的延迟愈合、不愈合,无一例肱骨远端骨骺坏死发生,2例合并肘关节异位骨化,肘关节屈伸活动度平均-10．6°-131．3°,日常生活无明显影响。结论：移位的肱骨髁间骨折患儿,应用Bryan—Morrey后内侧手术入路切开复位内固定术可获得较好的治疗效果。     

双柱理论在治疗肱骨髁间骨折中的临床应用

目的探讨应用双柱理论治疗肱骨髁间骨折的临床疗效。方法对37例肱骨髁间骨折采用肘关节内外侧联合入路双侧钢板内固定术,术后配合中药熏洗,早期行肘关节功能锻炼。结果患者均获得8～34个月(平均21.7个月)随访,骨折均一期临床愈合,优良率为86.5%。结论采用肘关节内外侧联合入路双钢板法治疗肱骨髁间骨折固定可靠,术后可早期进行功能锻炼,有利于肘关节功能的恢复。     

双重建钢板治疗肱骨髁间骨折

肱骨髁间骨折是青壮年严重的肘部损伤，近年来发生率明显增多。过去多采用牵引复位，克氏针加石膏外固定的方法治疗肱骨髁间骨折，后期肘关节功能恢复较差。1999-2004年．我们采用切开复位重建钢板内固定及早期功能锻炼治疗肱骨髁间骨折，术后取得了满意的疗效。     

手术治疗21例成人肱骨髁间骨折

目的 回顾总结应用肱三头肌舌形皮瓣入路治疗肱骨髁间骨折的经验.方法 应用肱三头肌舌形皮瓣入路钢板内固定治疗肱骨髁间骨折患者21例.结果 本组均获随访,骨折全部愈合,没有骨不连发生,Mayo肘关节功能评分89.6分,其中优9例,良8例,中3例,差1例.结论 肱骨髁间骨折行经肱三头肌舌形皮瓣入路切开复位钢板内固定治疗可以获得良好疗效.     

经尺骨鹰嘴入路治疗成人肱骨髁间C型骨折

[目的]探讨切开复位,双钛板内固定治疗肱骨髁间骨折的疗效.[方法]2004年1月～2007年12月,通过尺骨鹰嘴截骨入路,双钛板螺钉内固定术治疗成人肱骨髁间C型骨折21例,经过平均1年4个月的随访,以Jupiter评分校准评估患者肘关节功能.[结果]Jupiter评分优3例,良15例,可3例,优良率达85%,2例术后5个月出现尺骨鹰嘴克氏针退针.[结论]经尺骨鹰嘴入路双钛板固定是治疗肱骨髁间骨折的良好方法.     

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.