可吸收螺钉治疗股骨头骨折伴髋关节后脱位

目的探讨应用可吸收螺钉治疗股骨头骨折伴髋关节后脱位的效果。方法髋后外侧入路手术治疗26例股骨头骨折伴髋关节后脱位患者,股骨头骨折均采用可吸收螺钉固定;Ⅲ型合并股骨颈骨折者采用钛质空心螺钉固定,Ⅳ型合并髋臼骨折者采用髋臼三维记忆内固定系统固定髋臼骨折。结果26例均获随访,时间15～48个月。按D′Aubigue-Postel评分法：优10例,良13例,中1例,差2例（1例股骨头缺血性坏死,1例股骨头缺血性坏死合并髋周异位骨化）。未出现可吸收螺钉断裂及异物反应现象,无深部感染及创伤性关节炎等并发症发生。结论股骨头骨折伴髋关节后脱位采用髋后外侧入路、可吸收螺钉及髋臼三维记忆内固定可获得理想的治疗效果。     

可吸收螺钉内固定治疗PipkinⅡ型股骨头骨折

目的探讨应用可吸收螺钉内固定治疗PipkinⅡ型股骨头骨折的效果。方法对13例PipkinⅡ型股骨头骨折患者采用Smith-Peterson入路切开复位、可吸收螺钉内固定进行治疗。结果患者均获随访,时间18～36（25±4.1）个月。按Thompson-Epstein评分法评定疗效：优8例,良4例,中1例。未出现可吸收螺钉断裂及异物反应现象,无深部感染、股骨头缺血性坏死及创伤性关节炎等并发症发生。结论采用Smith-Peterson入路、可吸收螺钉内固定治疗PipkinⅡ型股骨头骨折效果显著,该方法手术简单,是一种可推荐的治疗方法。     

可吸收螺钉治疗股骨头骨折12例报告

目的 探讨应用可吸收螺钉治疗股骨头骨折的效果。方法 对12例股骨头骨折患使用可吸收螺钉行内固定治疗。结果 术后平均随访1．5年，患髋关节功能恢复良好，无骨折部位感染和股骨头坏死等并发症。结论 可吸收螺钉不需再次手术取出内固定，是股骨头骨折理想的内固定材料。     

可吸收螺钉内固定在治疗股骨头骨折中的临床应用

目的 探讨可吸收螺钉内固定治疗股骨头骨折的效果.方法 1997年3月至2011年9月应用可吸收螺钉治疗股骨头骨折16例,其中男13例,女3例;年龄21～53岁,平均31.6岁,均为外伤所致的新鲜骨折.骨折均有不同程度移位,术后行骨牵引或下肢皮套牵引5～6周.结果 随访4个月至4年7个月,1例患者发生股骨头坏死,根据髋关节功能评定标准,优良率为93.7％.结论 可吸收螺钉内固定治疗股骨头骨折固定可靠,避免了患者二次手术取出内固定物的创伤和痛苦,最大限度地恢复了患者髋关节的功能,是一种有效和较为理想的方法.     

后外侧入路可吸收螺钉内固定治疗股骨头骨折

目的探讨髋关节后外侧入路(Kocher-Langenbeck入路)及可吸收螺钉在股骨头骨折治疗中的应用。方法2001年1月～2003年6月收治7例股骨头骨折患者,按Pipkin法分型：Ⅱ型2例,Ⅲ型2例,Ⅳ型3例。采用髋关节Kocher-Langenbeck入路切开复位,股骨头骨折均采用可吸收螺钉内固定；Ⅲ型股骨颈骨折采用钛质空心螺钉固定,Ⅳ型髋臼后壁骨折采用重建钢板内固定。结果7例患者获2～4年(平均3．2年)随访。术后1年,按Brumback和Kenzora股骨头骨折功能评定标准评定：优4例,良2例,差1例。其中1例差者为Ⅳ型骨折,最终因股骨头的软骨下骨塌陷、疼痛进行性加重而于术后14个月行人工全髋关节置换术。结论股骨头骨折可选择手术治疗,Kocher-Langenbeck入路有显露好、复位方便的优点,可吸收螺钉是股骨头骨折理想的内固定材料。     

骨软骨原位覆盖可吸收螺钉治疗股骨头骨折

目的总结骨软骨原位覆盖可吸收螺钉治疗股骨头骨折的效果。方法 28例股骨头骨折,按Pipkin分型：Ⅰ型8例,Ⅱ型13例,Ⅲ型1例,Ⅳ型6例。均采用骨软骨原位覆盖可吸收螺钉固定股骨头骨折;Ⅲ型骨折采用股骨近端支撑钢板固定股骨颈骨折;Ⅳ型骨折髋臼骨折片较小可去除,骨折片较大时可采用可吸收螺钉或重建钢板固定。结果所有患者术后无伤口感染发生,均伤愈出院。术后随访25例,平均随访25（2～63）个月,疗效评价：优16例,良5例,可3例,差1例。结论应用骨软骨原位覆盖可吸收螺钉治疗股骨头骨折突破了可吸收材料禁用于关节内骨折的禁忌,是一种实用、有效的方法。     

髋关节后脱位合并股骨头骨折的治疗

目的探讨髋关节后脱位合并股骨头骨折的治疗方法及疗效。方法回顾分析13例髋关节后脱位合并股骨头骨折的分型及治疗并评估其疗效。结果13例中2例非手术治疗,11例手术治疗,中游离骨折块切除2例,可吸收螺钉内固定6例,可吸收螺钉加空心螺钉内固定1例,可吸收螺钉加髋臼重建钢板内固定1例,人工全髋关节置换1例。按Epstein评价:优5例,良6例,可2例,优良率84·6%。结论髋关节后脱位合并股骨头骨折应根据分型及复位后影像学表现决定治疗方法,尽早手术疗效满意。     

SR—PLLA可吸收拉力螺钉治疗松质骨骨折

可吸收内固定材料近年来发展迅速 ,和金属内固定材料相比 ,可吸收材料在松质骨骨折内固定上存在明显的优势 ,并可免除患者的二次手术痛苦。近 3年来我院开展ＳＲ ＰＬＬＡ可吸收拉力螺钉治疗松质骨骨折 17例 ,疗效满意 ,报告如下。临床资料一、一般资料 :本组 17例 ,其中男性 10例 ,女性 7例 ,年龄12～ 72岁 ,平均 37岁。 4例为股骨头纵形骨折 ,均合并有髋关节脱位 ,其中有 2例还合并有股骨颈骨折。 13例为内踝或外踝骨折。术中所使用的为芬兰生产的自增强聚左旋乳酸 (ＳＲ ＰＬＬＡ)可吸收拉力螺钉。二、治疗方法 :17例患者均在入院 1周左…     

可吸收螺钉治疗不稳定型手舟骨骨折26例体会

目的总结可吸收螺钉治疗不稳定型腕舟骨骨折临床疗效的体会。方法通过分析26例不稳定型腕舟骨骨折患者的临床资料．均采用切开复位、可吸收螺钉内固定治疗。结果26例均获随访,时间6-21月,均获骨性愈合,骨折愈合时间平均2．5-5．5月。疗效评价：优21例,良5例,差0例。结论可吸收螺钉内固定对腕舟骨骨折治疗效果良好,且可避免二次手术取出内固定,对腕关节损伤小,是治疗不稳定型腕舟骨骨折的有效方法。     

髋关节后脱位合并股骨头骨折的治疗

目的探讨髋关节后脱位合并股骨头骨折的治疗方法及疗效。方法回顾分析13例髋关节后脱位合并股骨头骨折的分型及治疗并评估其疗效。结果13例中2例非手术治疗，11例手术治疗，中游离骨折块切除2例，可吸收螺钉内固定6例，可吸收螺钉加空心螺钉内固定1例，可吸收螺钉加髋臼重建钢板内固定1例，人工全髋关节置换1例。按Epstein评价：优5例，良6例，可2例，优良率84．6％。结论髋关节后脱位合并股骨头骨折应根据分型及复位后影像学表现决定治疗方法，尽早手术疗效满意。     

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.     

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.     

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.