第1 跖趾关节融合术治疗中重度足拇外翻合并第1 跖趾关节炎

目的 探讨第1 跖趾关节融合术治疗中重度足拇外翻合并第1 跖趾关节炎的临床疗效.方法 2016 年6 月至2018 年9 月北京中医药大学第三附属医院采用第 1 跖趾关节融合术治疗中重度足拇外翻合并第 1 跖趾关节炎患者26 例.手术前后于足负重位X线片上测量足拇外翻角(HVA)和第1 、2 跖骨间角(IMA),采用疼...     

类风湿前足畸形第5跖骨头是否切除成形的临床对比研究

目的 ：比较类风湿性关节炎(rheumatoid arthritis,RA)前足畸形重建术第5跖骨头切除成形与不切除的临床疗效。方法：回顾性分析2015年5月至2019年1月收治的50例(76足)女性RA致前足中重度畸形患者,依据第5跖趾关节退变情况,行RA前足重建第5跖骨头保留或切除术,分为第5跖骨头保留组(保留组)和第5跖骨头切除组(切除组)。保留组24例,年龄47～81(60.37±8.60)岁;病程13～22(19.00±3.06)年;身体质量指数(body mass index,BMI)21～28(23.53±2.47) kg·m^-2;中度拇外翻畸形6例(6足),重度拇外翻畸形18例(30足);采用第1跖趾关节融合联合第2-4跖趾关节成形及第5跖趾关节清理术治疗。切除组26例,年龄30～80(58.53±13.70)岁;病程8～25(17.94±3.92)年;BMI为20～28(24.60±2.03) kg·m^-2;中度拇外翻畸形4例(4足),重度拇外翻畸形22例(36足);采用第1跖趾关节融合联合2-5跖趾关节跖骨头切除成形术治疗...     

第1跖趾关节融合结合Weil截骨或关节成形术治疗重度拇外翻

目的探讨第1跖趾关节融合结合Weil截骨或关节成形术治疗重度拇外翻的临床疗效。方法对12例重度拇外翻畸形患者(14足)采用第1跖趾关节融合结合Weil截骨或关节成形术治疗。结果患者均获得随访,时间6~44个月。术后患足外形均得到良好改善,13足拇外翻疼痛及跖痛消失,第2~5跖骨头下顽固性角化症、硬性胼底消失;1足出现第5跖骨外侧转移性跖痛,经垫前足减压垫缓解。术后患者跖趾关节有不同程度僵硬,经主、被动关节锻炼后,足趾活动度均有改善,未影响日常活动,患者步态及穿鞋要求均获得明显改善。末次随访时,患足AOFAS评分85.48分±2.97分,VAS评分2.41分±0.47分,HVA 14.93°±5.35°,IMA 9.68°±1.87°,各项指标均较术前明显改善(P0.01)。结论采用第1跖趾关节融合结合Weil截骨或关节成形术治疗重度拇外翻畸形,能明显改善前足外形,缓解前足行走疼痛,改善肢体功能,提高患者生活质量。     

(足母)外翻籽骨位置变化及与跖趾关节功能关系的相关研究

[目的]探讨拇外翻足手术前、后籽骨位置的变化，及其与跖趾关节功能的关系。[方法]选取80只足（外翻足39只、正常足41只）作为研究对象，参考正常足籽骨位置，对拇外翻手术前、后籽骨到第2跖骨的距离、籽骨相对于第1跖骨的位置、第1跖趾关节功能的评分别行t检验。[结果]正常足、拇外翻足手术前、后，籽骨到第2跖骨干的距离比较P值均大于0．05，差异无统计学意义；拇外翻足手术前后，籽骨相对于第1跖骨的位置变化、第1跖趾关节功能评分比较P值均小于0．01，差异有统计学意义。[结论]籽骨相对于第1跖骨的位置和跖趾关节评分关系密切，手术前、后发生显著变化，籽骨相对于第2跖骨位置不发生变化。     

第1跖趾关节融合术对第1、2跖骨间角的影响

目的探讨第1跖趾关节融合术是否能够有效减少第1、2跖骨间角,从而减少前足宽度。方法笔者自2010-06—2015-06行第1跖趾关节融合术治疗75例拇僵硬、拇外翻、拇内翻。分别测量术前、术后正位负重X线片,根据术前跖骨间角分为3组:A组(≤13°),B组(14°~20°),C组(≥20°)。结果本组获得随访12~36个月,平均17.5个月。第1跖趾关节均达到骨性融合,6例由于内固定刺激拆除内固定。末次随访3组跖骨间角分别为(5.6±2.3)°、(7.8±3.2)°、(9.5±4.5)°,各组与术前比较差异有统计学意义(P0.05)。A、B、C 3组AOFAS评分术前分别为(49±7.5)、(48±6.5)、(42±3.5)分;术后分别为(75±6.5)、(74±5.5)、(73±7.5)分。A、B、C 3组术后AOFAS评分与术前比较差异有统计学意义(P0.05)。结论第1跖趾关节融合术不仅可以减小拇外翻角度,也能有效减小第1、2跖骨间角,从而避免不必要的跖骨截骨。     

第1跖骨头内侧骨赘测量及其临床意义

目的探讨足拇外翻畸形与第1跖骨头内侧骨赘的关系。方法实验组选取2009年1月至2013年6月因足拇外翻畸形行手术治疗患者118例,其中男性15例,女性103例,年龄28~85岁,平均58.2岁。所有患者均在术前和术后12周摄足部正位X线片。对照组选取因足部其他疾病摄足部正位X线片的118例患者,其中男性15例,女性103例,年龄27~81岁,平均年龄56.3岁。测量实验组术前、术后12周及对照组足拇外翻角、跖骨间角、第1跖骨头内侧骨赘突出程度。结果实验组术前足拇外翻角、跖骨间角、第1跖骨头内侧骨赘突出分别为38.4°±12.3°、15.5°±6.3°、(3.8±2.3)mm,术后12周足拇外翻角、跖骨间角、第1跖骨头内侧骨赘突出分别为14.4°±6.3°、8.4°±5.3°、(1.4±1.4)mm。对照组足拇外翻角、跖骨间角、第1跖骨头内侧骨赘突出分别为10.5°±4.3°、6.7°±2.3°、(3.5±2.5)mm。实验组手术前后第1跖骨头内侧骨赘突出程度有统计学差异(P<0.05)。实验组术前与对照组第1跖骨头内侧骨赘突出程度无统计学差异(P>0.05)。实验组足拇外翻角、跖骨间角与第1跖骨头内侧骨赘增生不相关(P>0.05)。结论足拇外翻畸形内侧突出可能由于软组织增生、跖骨内侧偏斜及跖趾关节半脱位所致,因此足拇外翻畸形手术治疗需进行跖骨截骨和重建。     

Chevron截骨治疗中度拇外翻是否保留拇收肌的疗效分析

目的:比较Chevron截骨治疗足拇外翻术中切断拇收肌和保留拇收肌的疗效.方法:回顾性分析Chevron截骨治疗拇外翻畸形31例39足,术中拇收肌切断组15例20足(A组),保留拇收肌组1 6例19足(B组).结果:A组:拇外翻角、第1、2跖骨闻夹角分别改善(16.7±2.0)°、(5.1±0.7)°,第一跖趾关节功能评分提高(44.4±4.4),术后1足拇趾背内侧出现麻木,2足拇趾外侧麻木,1足出现跖骨头坏死,1足出现截骨端延迟愈合;B组:拇外翻角、第1、2跖骨间夹角分别改善(17.1±1.5)°、(5.6±0.8)°第一跖趾关节功能评分提高44.0±3.9,1足拇趾背内侧出现麻木.两组比较拇外翻角、第1、2跖骨间夹角差异无统计学意义(P＞0.05);第一跖趾关节功能评分差异无统计学意义(P＞0.05).结论:Chevron截骨治疗中度足拇外翻术中切断拇收肌和保留拇收肌的临床疗效相近,但是术中切断拇收肌存在并发症增加的风险.     

类风湿性前足畸形的手术治疗体会

目的探讨第1跖趾关节融合联合跖骨头切除术治疗类风湿性前足畸形的临床疗效。方法回顾性分析自2018-01—2020-04诊治的16例(24足)类风湿性前足畸形,采用第1跖趾关节融合术矫正足拇外翻畸形,采用跖骨头切除术治疗类风湿性前足畸形中第2~5趾畸形。结果 15例(23足)获得随访,1例(1足)失访,随访时间平均13(6~20)个月。术后患足畸形获得不同程度改善,足部疼痛明显缓解,末次随访时跖侧胼胝体消失。末次随访时疼痛VAS评分、AOFAS评分、足拇外翻角、跖骨间角较术前明显改善,差异有统计学意义(P0.05)。1例术后第2天换药时发现第3趾发黑,予以截趾。1足第1跖趾关节不愈合,翻修手术中予以自体髂骨植骨内固定,术后18周愈合;其余20足第1跖趾关节获得骨性融合,融合时间平均13(10~15)周。结论第1跖趾关节融合联合跖骨头切除术治疗类风湿性前足畸形手术操作简单,近期疗效满意,并发症少,但该术式是一种挽救性手术而不是解剖重建,难以恢复足部全部功能。     

拇外翻畸形的评估与手术治疗进展

<正>拇外翻（hallux valgus,HV）畸形是足部常见的一种畸形,主要表现为拇趾外翻及第1跖趾关节半脱位或完全性脱位。随着畸形的进展,会表现出一系列的病理改变,如第1跖骨内收、拇趾外翻、第1跖骨头骨软骨损伤、第1跖趾关节炎、籽骨脱位、拇囊炎、跖籽关节炎、第1跖骨旋转、跖骨头倾斜以及交叉趾、     

第1跖趾关节融合术联合跖趾关节成形术治疗老年拇外翻

目的总结第1跖趾关节融合术联合跖趾关节成形术治疗老年拇外翻的临床疗效。方法采用第1跖趾关节融合术矫正18例老年拇外翻患者(20足),并对第2～5趾畸形行跖趾关节成形术,比较术前及末次随访时拇外翻角(HVA)和第1、2跖骨间角(IMA),应用AOFAS评分系统评价临床疗效。结果患者均获得随访,时间9～24个月。末次随访时,矫形足负重正、侧位X线片显示HVA和IMA均较术前显著减小(P 0. 001);根据AOFAS评分标准评价临床疗效:优1足,良17足,可2足,治疗优良率为18/20。结论第1跖趾关节融合术联合跖趾关节成形术可有效矫正老年拇外翻前足畸形,减轻疼痛,降低术后前足疼痛的复发率。     

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.