后外侧入路微创髋关节置换术治疗老年股骨颈骨折

目的探讨一种安全、创伤小的髋关节置换术治疗老年股骨颈骨折。方法观察后外侧入路微创髋关节置换术治疗老年股骨颈骨折的手术时间,切口大小,出血量等指标,并与传统髋关节置换术治疗老年股骨颈骨折相比较。结果后外侧入路微创髋关节置换术治疗老年股骨颈骨折具有创伤小,出血少,术后疼痛轻,康复快等优点。结论后外侧入路微创髋关节置换术治疗老年股骨颈骨折较传统术式更安全。     

外侧小切口髋关节置换术治疗老年股骨颈骨折效果

目的分析经外侧小切口行髋关节置换术治疗老年股骨颈骨折的效果。方法选择2017-03—2019-01间安阳市人民医院收治的100例老年股骨颈骨折患者,随机分为2组,各50例。对照组采用传统切口髋关节置换术,观察组采用外侧小切口髋关节置换术。比较2组的疗效。结果观察组手术时间、术中出血量,以及术后引流量、总并发症发生率和随访6个月时的髋关节功能评分等指标,均显著优于对照组,差异均有统计学意义(P0.05)。结论采用外侧小切口实施髋关节置换术治疗老年股骨颈骨折患者,创伤小、并发症少,可有效改善髋关节功能。     

前外侧小切口与后外侧切口人工股骨头置换术治疗高龄股骨颈骨折的疗效对比

目的比较研究前外侧小切口和后外侧切口人工股骨头置换术治疗高龄股骨颈骨折的临床疗效。方法2006年9月-2011年1月,我院对80例75岁以上高龄股骨颈骨折患者施行前外侧小切口（43例）和后外侧切口（37例）人工股骨头置换术,对两组患者的手术切口长度、手术出血量、末次随访髋关节评分、术后并发症及住院时间等进行回顾性研究。结果两组间手术切口长度、手术出血量、术后并发症发生率及住院时间方面差异有统计学意义（P〈O．05）;在末次随访髋关节评分方面差异无统计学意义（尸〉0．05）。结论前外侧小切口微创人工股骨头置换术切口小,创伤小,出血量少,恢复快,并发症少,治疗高龄股骨颈骨折效果好。     

改良切口髋关节置换术治疗老年股骨颈骨折

目的 探讨改良外侧斜行小切口髋关节置换术治疗老年股骨颈骨折的可行性.方法 2006年7月至2009年5月,采用改良外侧斜行小切口治疗高龄股骨颈骨折患者38 例,其中30 例患者行全髋关节置换术,8 例患者行单纯股骨头置换术.结果 手术切口长度7～10 cm,平均9 cm;手术时间50～80 min,平均65 min;术中出血量150～350 mL,平均250 mL,术后引流量80～240 mL,平均140 mL,术后3～11 d部分负重行走.切口愈合时间12～14 d,无严重并发症.所有病例随访6～34个月,平均17.4个月.Harris评分优33 例,良4 例,中1 例,优良率达98%.结论 改良外侧斜行小切口全髋关节置换术治疗老年股骨颈骨折,具有手术时间短、创伤小、出血少、切口愈合快、并发症少、恢复快等优点.     

后路小切口全髋关节置换术治疗老年股骨颈骨折的临床效果

目的探讨后路小切口全髋关节置换术治疗老年股骨颈骨折的临床效果。方法回顾性分析2018-01—2020-06间淮阳县人民医院骨科行全髋关节置换术治疗的86例老年股骨颈骨折患者的临床资料,根据切口方法分为后路小切口组和外侧小切口组,各43例。比较2组患者的基线资料、手术情况,以及术后临床指标。术后3个月时以Harris髋关节功能评分量表(HHS)评分标准评价髋关节功能。结果2组患者的基线资料、手术时间差异无统计学意义(P>0.05)。后路小切口组的术中失血量和术后疼痛视觉模拟评分(VAS)、下床时间、并发症和住院时间均优于外侧小切口组,差异有统计学意义(P<0.05)。术后3个月时2组髋关节功能优良率均达80%以上,差异无统计学意义(P>0.05)。结论后路小切口和外侧小切口全髋关节置换术治疗老年股骨颈骨折的效果相当,但前者具有术中失血量少、术后疼痛轻、并发症少,以及术后患者恢复快等优势。     

微创小切口髋关节置换术治疗老年股骨颈骨折的临床研究

目的探讨侧前方入路微创小切口髋关节置换术治疗老年股骨颈骨折的可行性。方法2003年2月至2007年3月，采用前外侧小切口对59例59髋行髋关节置换术，其中48为新鲜骨折，11例为陈旧骨折。49例患者行全髋关节置换术，10例患者行单纯股骨头置换术。患者取平卧位，患侧半边臀部略悬空于手术床边，使臀大肌及臀部软组织自然下垂，患侧下肢内收10°，使大粗隆突出部份充分暴露；股骨颈及大粗隆暴露后，先截骨清除股骨颈残端，再前脱位取出股骨头；术毕伤口不放引流，弹力绷带臀部以下均匀包扎。结果手术切口长度7—9cm，平均8cm；手术时间50～70min，平均62min；出血量150～420ml，平均300ml；无严重并发症，3～11d部分负重行走。全部患者获得6—49个月的随访。Harris评分优52例，良6例，中1例，优良率达98％。结论侧前方微创小切口全髋关节置换术治疗老年股骨颈骨折可行，具有创伤小、出血少、安全、并发症少、恢复快等优点。     

小切口全髋关节置换治疗高龄股骨颈骨折

目的 对比后外侧小切口和后外侧标准入路全髋关节置换术治疗高龄股骨颈移位骨折的早期疗效.方法 60例新鲜移位的股骨颈骨折老年患者,平均年龄77.5岁,随机分成2组,A组30例,经后外侧小切口行全髋关节置换术;B组30例,经后外侧标准入路.对比的指标包括:切口长度、手术时间、失血量、住院时间、应用助步器的时间、并发症(术后关节脱位和深静脉血栓形成)发生率、术后关节功能.结果 除并发症和关节功能无显著差异外,A组各项指标均优于B组,并且具有显著性差异.结论 经后外侧小切口行全髋关节置换术治疗高龄股骨颈移位骨折比经后外侧标准入路术后早期疗效优越.     

经后路小切口髋关节置换术治疗老年股骨颈骨折患者的临床体会

目的 探讨采用经后路小切口髋关节置换术治疗老年股骨颈骨折患者的临床应用效果。方法 回顾性分析沈丘县人民医院骨科2020-01—2021-06行髋关节置换术的80例老年股骨颈骨折患者的临床资料,根据不同入路术式分为外侧小切口组和后路小切口组,每组40例。比较2组患者的临床指标、疼痛程度、髋关节功能,以及并发症发生率。结果 2组患者的手术时间、并发症发生率差异无统计学意义(P>0.05)。后路小切口组患者的术中出血量、术后引流量少于外侧小切口组,术后住院时间短于外侧小切口组,差异均有统计学意义(P<0.05)。术后第3天2组患者的VAS评分均比术前降低,且后路小切口组低于外侧小切口组,差异均有统计学意义(P<0.05)。术后3个月时2组患者的Harris评分均比术前增高,且后路小切口组高于外侧小切口组,差异均有统计学意义(P<0.05)。结论 后路小切口髋关节置换术治疗老年股骨颈骨折患者,手术创伤小,患者术后疼痛轻,并可促进髋关节功能获得良好恢复,且安全性高,应用效果确切。     

不同切口全髋置换术治疗老年股骨颈骨折患者的效果

目的比较不同切口全髋置换术治疗老年股骨颈骨折患者的效果。方法选取2017-04—2018-12间淮阳县人民医院收治的82例老年股骨颈骨折患者,按照不同切口分为2组,各41例。对照组采取外侧小切口行全髋关节置换术,观察组采取后侧小切口行全髋置换术。回顾性分析患者的临床资料。结果2组手术时间及并发症发生率差异无统计学意义(P>0.05)。观察组术中出血量、术后2 h视觉模拟量表(VAS)评分均低于对照组,差异有统计学意义(P<0.05)。结论与外侧小切口比较,后侧小切口全髋置换术治疗老年股骨颈骨折创伤更轻,有利于促进术后早期康复。     

外侧小切口人工股骨头置换术治疗老年股骨颈骨折

目的探讨采用外侧小切口技术行人工股骨头置换治疗老年股骨颈骨折的疗效。方法采用外侧小切口人工股骨头置换术,治疗老年股骨颈骨折56例。结果手术切口8~12.0 cm;手术时间25~35 min。术后髋关节功能恢复快,Harris评分由术前的平均42分,提高到术后的平均94分。结论对于老年股骨颈骨折,采用外侧小切口人工股骨头置换可获得较好的临床效果,能够减少手术创伤,缩短手术时间,术中出血少,患者易接受。     

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.