形状记忆锯齿臂环抱内固定器治疗长管状骨骨折

目的 分析镍钛形状记忆锯齿臂环抱内固定器治疗长管状骨骨折的疗效。方法 采用镍钛形状记忆锯齿臂环抱内固定器治疗长管状骨骨折４２例。术后随访３８例,时间２￣２４个月,平均９个月。结果 骨折均达骨性愈合,功能 恢复至健侧水平。结论该环抱器治疗长管状骨骨折,操作方便、固定坚固、技体功能恢复较好为治疗长管状骨骨折的有效方法之一。     

镍钛形状记忆合金锯齿环抱器治疗管状骨折分析

寻找早期具有良好固定作用，后期较少骨质疏松的骨折内固定方法。方法：采用镍钛形状记忆合金锯齿环抱器治疗管状骨骨折40例，股骨干骨折l0例，尺骨骨折6例，桡骨骨折8例，掌骨骨折ll例。结果：采用综合评定标准：优34例，占85％，良6例，占15％。结论：镍钛形状记忆合金锯齿环抱器具有良好的抗弯、抗扭作用，有利于骨性愈合并减少术后骨质疏松，为管状骨骨折手术提供了一种较好的方法。     

钛镍形状记忆合金环抱接骨板治疗四肢管状粉碎性骨折

目的 探讨钛镍形状记忆合金(TiNiSMA)环抱接骨板治疗四肢管状骨粉碎性骨折的临床也用价值。方法 对按AO分型的BI～C3型37例四肢管状骨骨折患者行切开复位，TiNiSMA环抱接骨板(部分加骨卡环)内固定。结果 术后随访10～31个月(平均15个月)，骨折均愈合良好，无内固定松脱及折断。结论 TiNiSMA环抱接骨板(部分加卡环)治疗四肢管状骨粉碎性骨折疗效满意，固定可靠；部分C3型骨折注意选择性使用，对中老年患者术后不必二次取出者更适用。     

镍钛形状记忆合金锯齿臂环抱器治疗尺桡骨骨折

目的 寻求治疗尺桡骨骨折的理想内固定方法。方法 采用镍钛形状记忆合金锯齿臂环抱器治疗28例尺桡骨骨折。结果 术后随访4－27个月（平均15个月）。功能恢复优17例,良7例,可4例。结论 镍钛形状记忆合金锯齿臂环抱器治疗尺桡骨骨折有利于促进骨折愈合时肘、腕关节功能康复,降低骨不连和再骨折发生率,是治疗尺桡骨骨折的较好方法。     

经皮钢板内固定下肢长管状骨骨折18例

目的：探讨经皮钢板内固定下肢长管状骨骨折的优缺点。方法：经皮钢板内固定下肢管状骨骨折18例，其中，股骨干骨折6例，胫骨骨折12例；经皮取出内固定钢板8例，股骨干骨折1例，胫骨骨折6例。结果：术后骨折对位对线优良率达91％，经过7-15个月随访，92％的病例疗效满意，平均72d骨折坚强愈合，患肢功能恢复良好。结论：经皮钢板内固定下肢长管状骨骨折较其他的内固定方式有一定的优越性。     

重建带锁髓内钉结合环抱器治疗股骨干骨折合并股骨上端骨折

目的 探讨股骨重建带锁髓内钉(PFN)结合镍钛形态记忆合金环抱内固定器(NT环抱器)治疗股骨干骨折合并股骨上端骨折的临床效果。方法 42例复杂股骨骨折中，股骨干骨折合并同侧股骨颈骨折16例，合并转子问骨折22例，合并转子下骨折4例。A组，应用PFN动力型内固定9例；B组．应用PFN静力型内固定14例；C组，应用动力型PFN结合NT环抱器内固定19例；对三组不同固定方法的手术时间、术中出血量、复位情况、术后下床时间、骨折愈合时问、并发症等方面进行了比较，从而观察PFN结合NT合金环抱器的临床应用效果和实用性。随访时间3～24个月，平均7．6个月。结果或C组在骨折复位、骨折愈合时间、功能恢复方面优于A、B两组。在手术时间、住院时间、手术并发症和术后下床负荷时间方面与A、B两组无明显区别。C组术中出血量平均540ml，A、B组术中平均出血量为245ml。结论 PFN结合NT环抱器治疗股骨干伴股骨上端骨折有利于骨折解剖复位和愈合，其固定方法更符合生物力学，临床效果满意。     

外固定支架加压牵开再加压治疗长管状骨非感染性不愈合

目的 探讨不进行植骨,单纯通过外固定支架进行加压-牵开-再加压的方法治疗长管状骨非感染性不愈合的疗效.方法 2007年3月至2009年7月对5例长管状骨(4例股骨,1例胫腓骨)非感染性不愈合患者,通过带延长装置的单边外固定支架,先对不愈合端加压并维持2周,然后以1 mm/d的速度(每天分4次进行)逐渐牵开10～14 mm,维持2周后再以1 mm/d的速度(每天分4次进行)进行短缩,直到骨不愈合端加压.通过X线评价骨不愈合端的成骨情况,若成骨反应活跃,则维持加压直至愈合;若成骨反应差,则重复上述过程1～2个周期,直至愈合.结果 1例胫腓骨不愈合患者出现针道深部感染、松动并导致对位异常,给予全身抗生素应用,经过3个周期的加压-牵开-再加压后骨折愈合.1例股骨干不愈合患者在第2次加压时出现内翻、向后成角.另3例患者只出现针道并发症.经过相应治疗,5例患者均达到骨性愈合,平均愈合时间为7.6个月(6～10个月),平均带架时间为12.2个月(6～17个月),拆除外固定支架后平均随访5.8个月(1～10个月),无再骨折发生.结论 对于不合并肢体长度异常、有良好接触面积、骨折端形态适合加压的长管状骨非感染性不愈合,通过单纯应用外固定架固定并依次加压、牵开再加压可使骨折愈合,且减少了术中出血和对不愈合端的剥离,避免了植骨.     

Fixion可膨胀髓内钉内固定系统治疗下肢长管状骨骨折

目的探讨一种新型F ixion可膨胀髓内钉内固定系统治疗下肢长管状骨骨折的疗效。方法采用新型F ixion可膨胀髓内钉内固定系统治疗下肢长管状骨骨折14例。结果经4~12个月随访,骨折全部愈合,无不良并发症发生。结论可膨胀髓内钉内固定具有微创、操作简单、固定强度大、骨折愈合快等优点。     

交锁髓内钉治疗下肢长管状骨骨折不愈合及延迟愈合

目的 分析导致下肢长管状骨骨折不愈合和延迟愈合的原因及治疗方法。方法 对13例下肢长管状骨骨折不愈合及延迟愈合患者均采用交锁髓内钉治疗。闭合穿钉2例，切开复位内固定11例，术中同时植骨9例。所有病例术中均行静力型交锁，其中4例后期动力化。结果 13例患者均达到骨性愈合，愈合时间12～23个月，平均14．5个月。结论 扩髓型交锁髓内钉治疗下肢长管状骨骨折的不愈合及延迟愈合效果满意，治疗的关键在于扩髓、选择合适的髓内钉、必要时动力化锁定。     

形状记忆锯齿臂环抱内固定器治疗股骨假体周围骨折

目的总结采用形状记忆锯齿臂环抱内固定器治疗股骨假体周围骨折的临床效果。方法自1994年以来应用上海第二医科大学附属第九人民医院设计和研制的形状记忆锯齿臂环抱内固定器在7所医院中治疗股骨假体周围骨折患者21例。男12例,女9例;年龄42~83岁,平均57.8岁。其中18例骨折发生于术后2周~10年,为斜形、螺旋形或粉碎性骨折,骨折线位于小转子至假体柄末端以远5cm区域内。另外3例为翻修病例,分别是术中骨折和长节段截骨。21例患者,除1例为“Z”形股骨截骨外,其余20例中JohannsonⅠ型4例、Ⅱ型9例、Ⅲ型7例,均为完全骨折并有移位。术中将环抱器在冰水中降温至4~7℃,撑开环抱臂,于骨折复位后将环抱器体部置于张力侧,热敷后锯齿臂因记忆效应而收拢,紧抱股骨而获得牢固固定。结果手术过程均顺利。固定后骨折部稳定,术后不需要外固定,有4例术后进行了2周的皮肤牵引,术后2~4周可下床扶双拐行走。术后随访1~7年,平均4年,骨折无移位,均获良好愈合,功能恢复到术前状态。结论对股骨假体周围骨折,形状记忆锯齿臂环抱内固定器安装方便,固定可靠,可作为首选治疗方法。     

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.     

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.