经改良髂腹股沟入路治疗髋臼骨折的疗效观察

目的探讨经改良髂腹股沟入路治疗髋臼骨折的优缺点及疗效观察。方法经改良髂腹股沟入路(部分联合K-L入路)应用骨盆重建钢板内固定治疗髋臼骨折12例。结果术后8~14个月显示骨折骨性愈合,按Matta标准评估:解剖复位9例,满意复位2例,复位欠佳1例。结论改良髂腹股沟入路具有解剖相对简单,创伤小,复位质量高,并发症少等优点。     

髋臼骨折的CT分型与手术入路选择

目的探讨应用髋臼骨折的CT分型指导手术入路选择，提高髋臼骨折的治疗水平。方法2002年12月至2007年9月间对21例髋臼骨折患者术前应用CT扫描，按髋臼骨折的Judet—Letoumel分型选择手术入路，4例后壁骨折、5例后柱骨折及2例横行骨折采用Kocher—Langeneback入路，2例前柱骨折、5例双柱骨折采用髂腹股沟入路；2例移位较重双柱骨折，采用前后联合入路；1例前壁骨折伴股骨头前上方骨折，采用髂股入路。采用专用器械及骨盆重建钢板和螺丝钉对骨折进行复位和固定；骨折距手术的时间为6—10d。结果随访6～57个月，平均18个月。术后骨折复位的质量按Matta影像学评定：解剖复位12例，良好复位8例，不满意复位1例。根据Merledd’Aubigne和Postel评分标准：临床疗效优13例，良5例，一般2例，差1例。结论CT扫描能明确髋臼骨折移位和粉碎程度，用术前CT分型指导手术入路的选择能提高手术治疗的临床效果。     

髋臼骨折的手术治疗

目的：评价手术治疗髋臼移位骨折的效果。方法：总结对38例有移位髋臼骨折手术治疗的经验。根据骨折类型选用髂腹股沟入路、Kocher-Langenbeck入路、延长髂股入路，复位后用骨盆钢板和可吸收钉固定。结果：38例中22例（57.9%），完全复位，8例（21.05%）满意复位，8例（21.05%）复位不满意。30例获得随访，平均随访时间2.5年。根据Matta评分标准：优9例（30％),良13例（37％），一般6例（20％）。差4例（13％）。结论：对于髋臼骨折，联合应用三个方向的X片和CT扫描，准确诊断，尽早予以解剖复位，牢固固定，骨折愈合后负重运动。     

手术内固定治疗复杂髋臼骨折的体会

目的探讨手术治疗Letournel分型复杂髋臼骨折的疗效。方法11例Letournel分型复杂髋臼骨折经术前X线和CT明确诊断和分型后,分别采用Kocher—Langenbeck人路、髂腹股沟人路、前后联合入路显露和复位,应用重建钢板内固定。结果随访4～24个月,平均12个月,复位按Matta标准解剖复位者8例,满意复位者3例。根据美国矫形外科研究院标准评估疗效：优8例,良2例,可1例,优良率90．9％。结论术前完善的影像学资料,对骨折进行正确的分型,选择合适的手术人路,骨盆模型体外对照,良好的复位和内固定,采取有效的措施防范并发症是提高髋臼骨折手术疗效的关键。     

前后联合入路治疗移位的复杂髋臼骨折

目的研究经髂腹股沟入路和Kocher-Langenbeck（K-L）联合切口手术内固定治疗移位的累及髋臼双柱的复杂髋臼骨折的临床疗效。方法分析我院自2003年1月至2008年12月通过前后联合切口手术内固定治疗的38例移位的累及髋臼双柱的复杂髋臼骨折患者。本组患者均获得随访,随访时间6～48个月,平均30个月。术后骨折复位质量、X线表现按Matta标准评估,远期髋关节功能和异位骨化率按D′Aubigne和Brooker标准评估。结果解剖复位29例,满意复位6例,不满意复位3例。髋关节功能优32例,良4例,可2例,优良率94.7%。髂腹股沟入路无一例异位骨化;K-L入路～度异位骨化4例,度异位骨化1例,无一例感染。结论前后联合入路手术内固定治疗移位的累及髋臼双柱的复杂髋臼骨折术中能更好的显露,便于骨折复位,固定稳定,临床效果好,并发症少。     

髋臼骨折的手术治疗

目的 探讨髋臼骨折的分型、手术入路的选择及手术效果.方法 手术治疗22例髋臼骨折患者,后壁骨折和后柱加后壁骨折选择K-L入路,前柱、前壁骨折及横断骨折选择髂腹股沟入路,前后移位明显的横断骨折、T形骨折、双柱骨折选择前后联合入路.结果 22例均获随访,时间6个月~5年,骨折6~9个月均愈合.按Matta评定标准:解剖复位 9例,满意复位13例.根据改良的Merle d′Aubigne-Poster髋关节功能评分标准:优7例,良10例,可4例,差1例.1例股骨头坏死,3例创伤性关节炎,2例异位骨化.结论 按髋臼骨折的分型选择合适的手术入路和良好的骨折复位内固定是获得满意疗效的前提.     

经前后联合入路治疗复杂髋臼骨折28例分析

目的探讨经髂腹股沟联合K-L,入路治疗复杂髋臼骨折的疗效。方法自1999年7月至2007年6月，采用前后联合入路手术治疗复杂髋臼骨折28例，统计平均手术时间和出血量，术后X线表现按Matta标准评估，远期髋关节功能和异位骨化分别按d’Aubigne和Brooker标准评估。结果平均手术时间3．5h，平均失血量为1000mL。术后以Matta复位标准评价，优18例，良7例，中3例。术后随访6个月～3年，平均16个月。髋关节功能按d’Aubigne标准评定，优19例．良7例。中2例。异位骨化按Brooker标准评定，髂腹股沟人路无一例异位骨化，K—L入路发生异位骨化6例，无一例感染。结论前后联合手术入路有利于复杂髋臼骨折的显露和复位，临床效果好，并发症少     

前柱钢板固定结合后柱逆行拉力螺丝钉治疗复杂髋臼骨折16例

[目的]探讨经髂腹股沟入路治疗复杂髋臼骨折的手术技巧。[方法]经髂腹股沟入路以重建钢板固定前柱、逆行拉力螺丝钉固定后柱治疗复杂髋臼骨折16例，其中双柱骨折10例，前柱伴后半横行骨折5例，“T”形骨折1例。[结果]解剖复位（移位〈1mm）11例，复位欠佳（移位3mm）4例，复位不满意（移位〉3mm）1例。随访11～37个月，根据改良的Merle d Aubigne及Postel髋关节得分进行功能评价，优9例、良4例、可3例。[结论]前柱钢板固定结合后柱逆行拉力螺丝钉固定，使经髂腹股沟入路治疗大部分髋臼双柱骨折、前柱伴后半横行骨折、T形骨折成为可能，避免了联合应用后方切口，减少了手术创伤。     

手术治疗髋臼骨折的临床效果观察

[目的]探讨根据骨折分型﹑移位情况,采用适合的手术入路治疗髋臼骨折的临床效果。[方法]选择2010年2月~2014年8月就诊的髋臼骨折患者47例,术前均行骨盆正位、髋臼闭孔位及髂骨斜位X线片与CT扫描及三维重建检查,以确定骨折分型﹑移位情况,根据Judet-Letournel分型选择手术入路,观察骨折复位情况、髋关节功能恢复及并发症发生情况。[结果]47例患者中,选择Kocher-Langenbeck手术入路34例(后壁骨折8例,后柱骨折3例,后柱骨折+后壁骨折12例,横形骨折+后壁骨折11例),髂腹股沟手术入路8例(前壁骨折3例,前柱骨折2例,横形骨折1例,"T"型骨折2例),前后联合入路5例("T"型骨折2例,双柱骨折3例)。手术时间平均(3.7±0.8)h,平均住院时间(15.6±3.1)d,所有患者均获得6~24个月的随访,骨折复位效果按Matta放射性radioactivity评估标准进行评价:解剖复位31例,满意复位15例,不满意复位1例,复位满意率97.9%(46/47);髋臼骨折功能Merled Aubigne-Postel评分:优24例,良19例,可3例,差1例,优良率91.5%。2例患者出现不同程度的异位骨化,5例发生Ⅰ度~Ⅱ度髋关节疼痛,无感染﹑骨折畸形愈合﹑内固定松动等并发症发生。[结论]根据骨折分型﹑移位情况,选择适合的手术时机,采用正确的手术入路和良好的骨折复位及固定,是手术治疗髋臼骨折的关键。     

复杂移位型髋臼骨折的临床研究

目的：探讨复杂移位型髋臼骨折的临床治疗效果。方法：从2000年2月—2002年7月收治23例髋臼骨折患者，其中后柱合并后壁骨折11例，前柱合并后半横形骨折6例，双柱骨折5例，“T”形骨折1例。本组复杂移位型髋臼骨折均采用手术治疗。手术采用髂腹股沟入路11例，Kocher—Langen—beck(K—L)入路5例，髂骨股骨入路4例，前后联合入路3例。结果：根据Matta评分标准，解剖复位16例(69．6％)，满意复位6例(26．1％)，不满意复位1例(4．3％)。昕有病例随访6～26个月，平均19．6个月，随访疗效与X线优良率分别为81．8％，83．9％。结论：复杂移化型髋臼骨折尽早手术治疗可取得满意的骨折复位和临床疗效，手术医师的手术技巧和临床经验与疗效密切相关。     

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.     

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.     

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.     

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.