成人肱骨髁间粉碎性骨折56例疗效分析

目的探讨成人肱骨髁间粉碎性骨折的治疗。本人指的是Jupititer分类的双柱骨折。通过尺骨鹰嘴截骨或肱三头肌腱双侧入路,切开复位内固定治疗后的中长期疗效分析。方法自2002年8月至2008年11月,收治肱骨远端双柱骨折67例,经切复内固定56例,所有病例采用肘后正中入路。45例采用尺骨鹰嘴截骨内固定（其中4例合并同侧鹰嘴骨折）;11例采用肱三头肌腱双侧入路。45例患者采用双钢板固定。11例患者用Y型钢板固定。经过2年以上诊治,进行回顾性分析。按Riseborough and Radin＂s分类：二型骨折17例,三型骨折25例,四型骨折14例。结果随诊21～97个月,平均42.7个月,肘关节活动度：屈：108.6°,伸-27.8°。评分结果：双钢板组45例,平均83.25分,平均屈110°,伸-25.2°,优良率77.7%;Y型钢板组11例,平均75.32分,平均屈103.2°,伸-38.6°,优良率63.6%。按入路途径：尺骨鹰嘴截骨入路45例,平均屈112°,伸-22.8°,优良率80%,肱三头肌腱双侧入路11例,平均屈92.4°,伸-42°,优良率45.4%。结论尺骨鹰嘴截骨入路结合双钢板固定治疗肱骨髁间粉碎性骨折有许多优势：充分暴露,容易解剖复位,有效固定及早期锻炼。     

经肱三头肌旁入路双侧重建钢板固定治疗肱骨下段骨折

目的探讨经肱三头肌旁入路双侧重建钢板固定治疗肱骨下段骨折的疗效。方法采用经肱三头肌旁入路双侧重建钢板固定治疗32例成年肱骨下段骨折患者。结果 32例均获得随访,时间12～36个月。骨折均愈合,愈合时间12～18周。1例伴桡骨远端关节面粉碎骨折患者肘关节固定于屈曲50°,无法伸直; 31例末次随访时肘关节活动范围为屈100°～140°、伸0°～10°。末次随访时,肘关节功能按改良Cassebaum评分标准评价疗效:优23例,良6例,可2例,差1例,优良率90. 62%。结论双侧重建钢板固定治疗肱骨下段骨折,固定可靠,术后可以早期行功能锻炼,肘关节功能恢复满意。     

肱骨远端C型骨折术后伸肘功能丢失原因分析

目的探讨采用经肱三头肌两侧入路内固定治疗肱骨远端C型骨折伸肘功能丢失的可疑因素。方法自2002年4月至2008年12月采用经肱三头肌两侧入路双钢板内固定治疗肱骨远端骨折30例,其中男8例,女22例;年龄12～80岁,平均41.4岁。按AO肱骨远端骨折分型标准评价,其中C2型12例,C3型18例（其中C3.1型11例,C3.2型4例,C3.3型3例）。结果 30例获得12～40个月随访,平均26个月。参照HSS肘关节评分标准评价术后功能,优11例,良13例,可2例,差4例,优良率80%（肘关节屈伸范围平均为18°～114°）。结论采用经肱三头两侧入路治疗肱骨髁间骨折,缩短手术操作时间,解剖重建冠状窝及滑车旋转轴,清理肘后肱三头肌下机化组织,早期功能锻炼,可以减少伸肘功能丢失。     

经肱三头肌劈开入路治疗C型肱骨远端骨折的疗效分析

目的 探讨经肱三头肌劈开入路内固定治疗C型肱骨远端骨折的疗效。方法 回顾分析2011年1月至2013年1月期间收治的43例C型肱骨远端骨折(C1型17例,C2型15例,C3型11例),均为闭合性新鲜骨折,对该型骨折均采取经肱三头肌劈开入路“Y”形钢板或双重建钢板内固定治疗。所有患者在取出内固定前均采用Mayo肘关节功能评分标准(MEPS)进行临床疗效评定。结果 本组43例患者中40例切口Ⅰ/甲愈合,余3例经换药及抗感染治疗,均延迟愈合。所有患者均获得随访,随访时间24.0~36.0个月,平均(29.5±4.3)个月,无骨不愈合及内固定断裂等并发症的发生。MEPS评分结果:优18例,良20例,中3例,差2例,优良率:88.4%。结论 经肱三头肌劈开入路治疗C型肱骨远端骨折,入路简单、创伤小、保存了伸肘装置,且能满足对骨折关节面的有效显露,内固定物安放方便、合理有效,临床疗效好,可作为治疗C型肱骨远端骨折的手术入路之一。     

经肱三头肌侧方入路治疗肱骨远端骨折

目的;探讨经肱三头肌侧方入路治疗肱骨远端骨折的应用和疗效。方法：对38例肱骨远端骨折采用经肘后肱三头肌侧方入路显露肱骨内、外髁间骨折采用拉力螺钉固定,髁上骨折采用经内、外髁逆行交叉克氏针固定。结果：经1-6年随访,骨折均愈合,无骨化性肌炎发生。结论：经肱三头肌侧方入路是肱骨远端骨折较好的手术入路。     

掀起肱三头肌入路钢板固定治疗成人肱骨远端骨折

目的 掀起肱三头肌入路钢板固定治疗成人肱骨远端骨折的手术方法 和疗效.方法 对本院2007年10月至2010年12月,12例成人肱骨远端骨折应用掀起肱三头肌入路钢板固定治疗的手术入路、内固定的选择、术后的疗效进行回顾性分析,骨折按AO/ASIF分型法分型,其中B1型3例,B2型5例,B3型3例,C1型3例C2型1例.结果 12例成人肱骨远端骨折患者,参照改良关节功能评定标准Cassebaum评分系统,优5例,良5例,可1例,差1例,优良83.3%.结论 掀起肱三头肌两侧入路钢板固定治疗成人肱骨远端骨折临床上目前较理想的治疗方法.     

肱骨髁间C3型骨折的手术治疗

目的探讨经肱三头肌双侧入路治疗肱骨髁间C3型骨折的效果。方法采用经肱三头肌双侧入路结合尺骨鹰嘴附着点局部纵向切开显露、双钢板内固定治疗33例肱骨髁间C3型骨折患者。结果 33例均获随访,时间12～18个月。骨折愈合时间3～6个月。按Cassebaum评分标准评价肘关节功能:优10例,良16例,可5例,差2例,优良率为78.9%。结论经肱三头肌双侧入路结合其肘后鹰嘴附着点局部纵向切开,有效显露肱骨髁间C3型骨折、双钢板内固定,术后个体化早期主动功能锻炼,可促进肘关节功能恢复。     

双钢板内固定治疗C3型肱骨髁间骨折疗效分析

目的探讨肱三头肌舌状瓣入路平行双钢板内固定结合尺神经皮下前置术治疗C3型肱骨髁间骨折的临床效果。方法采用肱三头肌舌状瓣入路平行双钢板固定结合尺神经皮下前置术治疗C3型肱骨髁间骨折27例,根据改良Cassebaum评分系统评定肘关节疗效。结果随访12~24个月(平均18个月),术后未出现迟发性尺神经炎,无内固定物松动及断裂,无骨化性肌炎,骨折全部愈合。根据改良Cassebaum评分系统:优15例,良6例,可4例,差2例,优良率77.78%。结论肱三头肌舌状瓣入路平行双钢板固定结合尺神经皮下前置术治疗C3型肱骨髁间骨折临床疗效满意。     

经肱三头肌两侧入路双钢板内固定治疗肱骨远端骨折

目的 探讨经肱三头肌两侧入路双钢板内固定治疗肱骨远端骨折的疗效。方法 采用经肱三头肌两侧入路双钢板内固定治疗33例骨质疏松性C3型肱骨远端骨折患者。记录手术情况、骨折愈合时间、肘关节及前臂活动度以及术后并发症发生情况，末次随访时采用MEPS评分评价功能恢复情况。结果 患者均获得随访，时间8～15个月。手术时间80～120(93.5±11.6)min。术后3～8个月X线片显示骨折内固定位置良好，骨折线模糊，可见连续性骨痂通过骨折线，提示骨折均愈合。术后无内固定松动或断裂、骨折复位丢失、骨折畸形愈合以及尺神经炎等并发症发生，4例发生骨化性肌炎。末次随访时，肘关节活动度：屈曲100°～140°,伸直5°～30°;前臂旋转活动度：旋前60°～80°,旋后55°～75°;肘关节MEPS评分为55～95分，其中优10例，良16例，可3例，差4例，优良率78.8%(26/33)。结论 经肱三头肌两侧入路能够为骨质疏松性C3型肱骨远端骨折双钢板固定提供良好的手术显露，避免尺骨鹰嘴截骨所带来的二次损伤，术后患者能够获得良好的肘关节功能。     

基于双柱理论的平行钢板固定技术在肱骨远端C型骨折治疗中的应用

目的探讨采用肘关节经三头肌舌形瓣入路或尺骨鹰嘴截骨入路钢板平行放置,固定肱骨远端内、外侧柱方法治疗肱骨远端C型骨折的临床疗效。方法对32例肱骨远端C型骨折采用肘关节经三头肌舌形瓣入路或尺骨鹰嘴截骨入路,AO解剖钢板平行放置,固定肱骨远端内、外侧柱,重建肱骨远端三角形框架结构的稳定性。结果 29例获得9~36个月的随访,骨折均愈合。按照Jupiter等肘关节功能评分标准:优12例,良14例,可2例,差1例,优良率89.7%。结论基于双柱理论的平行双钢板固定技术治疗肱骨远端C型骨折固定可靠,允许早期功能锻炼,疗效确切。     

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.