颈前路带锁钛板在脊髓型颈椎病手术中的应用

目的评价脊髓型颈椎病前路减压后应用带锁钛板内固定的价值。方法对51例脊髓型颈椎病患者采用前路减压、取自体髂骨植骨和颈椎带锁钛板内固定治疗。结果随访43例,平均随访时间2a,术后3个月植骨块获得骨性融合,颈椎椎间高度和生理曲度维持满意,感觉、肌力明显恢复,钛板及螺钉无松动及断裂现象。结论脊髓型颈椎病前路减压术后应用带锁钛板内固定能促使植骨块融合,有效地维持椎间高度和颈椎生理曲度,有较高的应用价值。     

颈前路椎间融合术限制型与半限制型钢板内固定治疗颈椎病的比较研究

目的比较颈前路椎间融合术中限制型与半限制型钢板内固定治疗颈椎病术后维持颈椎前凸和椎间高度的差异。方法回顾性分析自2002-01—2014-12诊治的62例脊髓型颈椎病,其中28例行颈前路减压+钛网植骨融合+限制型钢板内固定术(限制型钢板组),34例行颈前路减压+钛网植骨融合+半限制型钢板内固定术(半限制型钢板组),比较2组术后植骨融合率、颈椎曲度、椎间高度及JOA评分。结果 62例均获得随访8~12个月,平均11个月。2组植骨材料(钛网)均与相邻椎体骨性融合。半限制型钢板组术后1年Cobb角较术后3 d增加幅度更大,差异有统计学意义(t=-9.894,P0.001)。2组术后1年与术后3 d的D值与融合节段椎体高度变化差异无统计学意义(P0.05)。2组术后3 d(t=0.801,P=0.426)与术后1年(t=0.437,P=0.663)的JOA评分比较差异无统计学意义(P0.05)。结论限制型与半限制型钢板均可提供颈前路椎间融合术后颈椎的稳定性直至植骨材料(钛网)与相邻椎体骨性融合。钛网植骨和半限制型钢板共同使用时,更容易发生融合节段曲度的丢失。     

钛质外科网和自体髂骨块在颈椎前路减压融合术中应用的对比性研究

目的:比较钛质外科网(简称“钛网”)与自体髂骨块在颈椎前路减压融合术中恢复、维持颈椎曲度及椎间高度上的差异。方法:对59例确诊为脊髓型颈椎病的患者行颈椎前路减压融合术,其中22例行钛网植骨加AO纯钛带锁钢板内固定,37例行自体髂骨块植入加AO纯钛带锁钢板内固定。分别摄术前、术后即刻、术后随访时的颈椎标准侧位X线片,以Cobb角测量融合节段的前凸(或后凸),以D值评价颈椎的前凸(或后凸),同时测量融合节段椎体前缘高度(HAB)、后缘高度(HPB)。对各参数不同时期间差值分别行组间配对t检验。结果:经9~18个月随访(平均10.8个月),所有病例均获骨性融合。术后3个月钛网组及自体髂骨块组融合节段后高(HPB)和前凸Cobb角相对于术后即刻变化有显著性差异(P<0.01);术后6个月钛网组及自体髂骨块组融合节段后高(HPB)和前凸Cobb角相对于术后3个月变化有显著性关(P<0.01)。但两组的D值无显著性差异。结论:在维持融合节段椎体后缘高度和前凸上钛网优于自体髂骨块,但在维持颈椎曲度上无显著性差异。     

颈椎前路钛板在颈椎前路减压融合术中的应用

目的 探讨前路钛板在手术治疗颈椎创伤、脊髓型颈椎病、颈椎肿瘤等病变中的作用。方法 应用前路钛板治疗颈椎创伤与疾病22例，其中脊髓型颈椎病(包括颈椎间盘突出)13例，颈椎骨折5例，后纵韧带骨化症2例，颈椎肿瘤2例。结果 本组22例均获随访，随访时间5个月～3年5个月，平均1.5年，21例植骨块与上下椎体融合(95.5％)，1例不融合(4.5％)。无钛板松动断裂、移位，亦无植骨块脱出压迫食道。术后除1例脊柱骨折脱位脊髓损伤症状无恢复，其它均有不同程度的恢复，优良率86.1％。结论 颈椎前路钛板内固定具有显的优越性，可起到术后即刻稳定、防止植骨块移位、术后无需行石膏外固定、明显提高植骨融合率等作用。但应严格掌握手术指征和操作技术，以减少或避免并发症发生。     

前路椎体次全切钛网植骨钢板内固定治疗颈椎病的疗效观察

[目的]探讨前路椎体次全切减压钛网植骨钛板内固定治疗颈椎病的临床方法和疗效.[方法]2002年1月～2008年7月,作者采用颈前路椎体次全切除减压、钛网植骨融合、钛板内固定术治疗颈椎病69例.观察手术前后的症状、体征,使用JOA法进行神经功能评定,摄颈椎正侧位X线片,测量椎间高度.[结果]69例均得到随访,除2例术后出现短暂神经根症状加重外,其他患者术后临床症状均有不同程度的改善.术后3个月和24个月随访JOA评分都较术前明显提高,X线片显示全部病例术后颈椎生理曲度得到明显恢复,在术后24个月时均获得植骨融合,且椎间高度均有较好的恢复和维持.未发生伤口感染、钛板断裂、螺钉松动以及钛网下沉或移位等并发症.[结论]钛网植骨在重建颈椎稳定、维持椎间高度和生理曲度、提高植骨融合率等方面具有优势,为颈前路植骨提供了一种选择.     

卷式钛网融合器在颈椎爆裂骨折前路手术中的应用

目的 探讨卷式钛网融合器在颈椎爆裂骨折前路手术中的应用。方法 对12例颈椎爆裂骨折患者行前路减压卷式钛网融合器植入 前路钛钢板内固定术，根据Frankel神经功能分级，评定手术前后功能改变情况。结果 随访6～12个月，术后神经功能平均改善率为90％，无一例发生钛网滑移松动，植骨融合良好。结论 卷式钛网融合器应用于颈椎前路手术，具有操作简便、价格低廉、植骨融合率高及可避免取髂骨部位疼痛等优点，值得推广应用。     

自体椎体骨钛网支架融合器在颈椎病治疗中的应用

目的　探讨前路钛网支架自体椎体骨移植替代髂骨进行颈椎前路减压融合治疗脊髓型颈椎病的可行性。方法　采用颈椎前路开槽减压钛网支架自体椎体骨颗粒嵌压植骨结合前路钛钢板固定治疗颈椎病 2 8例。分型 :脊髓型 1 8例 ,神经根型 5例 ,混合型 5例。累及二个椎间隙 2 3例 ,三个椎间隙 5例。在前路减压完成后 ,选择合适长度和直径的钛网支架植入 ,其中加压填充术中所取椎体骨颗粒 ;前路钛钢板固定以获得早期稳定。按JOA评分评定手术效果 ,颈椎正侧位及屈伸位X线检查判定融合效果。结果　JOA评分从术前 (1 2 6 2± 1 5 4 )提高到术后 (1 5 1 2± 1 2 5 )分 ,无一例患者症状加重 ;按照Odom标准评定 ,优良率达 89%。经X线片检查证实椎体间隙高度得到恢复 ,植入物无移位脱落、钛钢板及螺钉无移位及松动 ,植骨融合良好。 1例钢板位置不正 ,1例 2枚螺丝钉进入椎间隙 ,未引起不良并发症。结论　脊髓型颈椎病前路手术中采用钛网包容的自体椎体骨颗粒行植骨融合结合前路钛钢板固定术可替代自体髂骨融合术 ,治疗效果近期是肯定的。可以缩短手术时间 ,避免取髂骨的并发症     

颈椎前路低切迹钛板系统的研制和初步临床应用

目的对自行研制的颈椎前路低切迹钛板系统(anterior cervical low-profile plate system，ACLPS)进行临床应用评价。方法颈椎前路低切迹钛板系统由医用钛合金材料制成，组件包括钛板、锁固片、固定螺钉及挽救螺钉，切迹低平、锁固简捷、规格多样，并以松质骨螺纹自攻螺钉单皮质固定为特点。临床应用治疗颈椎疾患37例，男23例，女14例；年龄35—74岁，平均50．7岁。颈椎病8例，颈椎间盘突出症12例，颈椎骨折和(或)脱位伴截瘫14例，颈椎转移性肿瘤伴截瘫3例。均行颈前路减压、植骨融合及ACLPS内固定术。单间隙融合22例，双间隙15例。单纯自体髂骨块植骨29例40个间隙，结合椎间融合器植骨8例12个间隙。钛板固定椎体最高为C，，最低达T1。结果37例均获随访，随访时间6—12个月，平均9．6个月。全部病例术后均无颈部异物感，舒适度满意。未发生切口感染、血肿、窒息、神经损伤、硬脊膜破裂及脑脊液漏、切口渗液不愈合等现象。全部病例均获骨性融合，根据JOA评分术后总有效率94．6％，优良率83．8％。术后影像学资料显示无植骨块脱出或塌陷、椎间高度明显丢失、钛板或螺钉断裂、螺钉松动脱落及钛板螺钉整体松动等并发症。结论ACLPS具有较高的强度和紧固能力，能够提供较好的生物力学稳定作用，且操作简便，可以满足颈椎前路固定的需要。     

颈椎前路减压带锁钛板内固定治疗颈椎损伤

目的评价颈椎前路减压带锁钛板内固定治疗颈椎骨折并脊髓损伤的临床疗效。方法对46例颈椎骨折并脊髓拟伤的患皙施行颈椎前路臧压、自体髂骨植骨和颈椎带锁钛板内固定。术后定期复查X线片,判定脊髓功能恢复情况,结果随访41例,平均随访时间2．5年。术后3个月植骨块获得骨性融合,颈椎椎间高度和生理曲度维持满意,无内置物并发症,脊髓功能平均提高1级。结论颈椎骨折并脊髓损伤前路减压、应用带锁钛板内崮定有利植骨融合和事建颈椎稳定。     

卷式钛网融合器在颈椎爆裂骨折前路手术中的应用

目的　探讨卷式钛网融合器在颈椎爆裂骨折前路手术中的应用。方法　对 12例颈椎爆裂骨折患者行前路减压卷式钛网融合器植入 +前路钛钢板内固定术 ,根据Frankel神经功能分级 ,评定手术前后功能改变情况。结果　随访 6～ 12个月 ,术后神经功能平均改善率为 90 % ,无一例发生钛网滑移松动 ,植骨融合良好。结论　卷式钛网融合器应用于颈椎前路手术 ,具有操作简便、价格低廉、植骨融合率高及可避免取髂骨部位疼痛等优点 ,值得推广应用     

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.