影响髋臼骨折手术预后的因素分析

[目的]探讨影响髋臼骨折手术预后的因素。[方法]收集2010年5月~2014年10月本院收治的169例髋臼骨折并接受手术治疗的患者,其中138例(81.7%)预后较好,31例(18.3%)预后不好。记录所有患者的性别、年龄、体重指数(BMI)、受伤原因、骨折形式、骨折侧别、是否陈旧性骨折、骨折类型、手术入路、内固定、是否高压氧治疗和吸烟(吸烟判断:曾有吸烟史,戒烟或未戒烟)等资料,并进行比较。[结果]单因素分析显示影响髋臼骨折手术预后的因素有手术入路、陈旧性骨折、复杂髋臼骨折、双侧髋臼骨折和内固定材料(技术)(P0.05、P0.01),年龄、性别、体重指数、受伤原因、骨折开放、高压氧治疗和是否抽烟对髋臼骨折手术预后影响较小(P0.05)。多因素Logistic分析显示,影响髋臼骨折手术预后的因素有手术入路、陈旧性骨折、复杂髋臼骨折和双侧髋臼骨折(P0.01、P0.05)。[结论]影响髋臼骨折手术预后的因素主要有手术入路、陈旧性骨折和复杂髋臼骨折。     

手术治疗复杂髋臼骨折疗效的评价

目的探讨手术治疗复杂髋臼骨折的临床疗效。方法对我院1996年4月～2002年3月收治的19例复杂髋臼骨折的患者进行切开复位重建钢板固定术,并对术后疗效进行回顾性分析。结果19例患者中15例达到解剖复位,14例疗效优,4例疗效良,术后均无严重并发症发生。结论:手术治疗复杂髋臼骨折效果良好,及时手术和尽可能解剖复位并予以可靠的固定是影响预后的关键。     

96例髋臼骨折手术治疗临床分析

目的对移位复杂的髋臼骨折采用不同手术入路与方法,探讨提高髋臼骨折复位质量的方法,制定对移位复杂的髋臼骨折的治疗程序。方法我院自2001年10月至2006年10月对96例有移位的髋臼骨折根据不同的情况选择合适的手术方法,疗效满意。本文通过对本组患者的随访结果,探讨髋臼骨折的治疗方法及效果。结果96例平均随访18个月,采用美国矫形外科医生学会髋关节功能评价标准和Matta标准进行评定,优72例（75%）,良18例（18.75%）,可6例（6.25%）。结论术前正确判断骨折类型及移位方向,选择恰当的手术入路,切开复位采取合适的内固定治疗是行之有效的方法,手术医师的经验、内固定的选择、骨折的类型、手术的时机和切口的选择直接影响到手术后的疗效。     

髋臼骨折的手术治疗(附24例报告)

髋臼骨折的治疗以往多采用牵引非手术治疗,而近年来髋臼骨折的手术治疗越来越受到重视,很多学提出了手术内固定治疗的必要性。我科自1996年1月～2003年10月手术治疗髋臼骨折24例,报告如下：     

96例髋臼骨折的手术治疗

目的探讨手术复位及内固定治疗髋臼骨折的疗效。方法1987年1月～2004年12月,根据96例髋臼骨折患者的骨折类型,选择合理的手术入路,行髋臼的复位与内固定,同时处理合并症。结果所有患者获4个月～3年随访,平均10.9个月。髋臼骨折复位质量按照Matta标准:达到解剖复位54例,满意复位30例,不满意复位12例。髋关节功能依据DAubingne-postel评分标准:优42例,良35例,可11例,差8例,优良率为80.2%。结论手术复位和内固定治疗髋臼骨折可获得良好的临床效果。     

联合手术入路治疗复杂型髋臼骨折

目的总结复杂型髋臼骨折联合手术入路的治疗经验。方法对19例复杂型髋臼骨折行联合手术入路治疗。结果术后以M atta复位标准:优4例,良13例,中2例。经6个月~3年随访,患者均下地行走,按照M atta功能评分:优5例,良11例,中2例,差1例。结论联合手术入路治疗复杂型髋臼骨折可以取得满意疗效。医师的临床经验对于提高复位质量、改善疗效十分重要。     

髋臼骨折的手术治疗体会

髋臼骨折属于高能量损伤所致的髋关节骨折,一般移位大,复位困难.近年来,随着对髋臼骨折认识的提高,内固定材料和手术器械的改进和发展,手术治疗逐渐得到了推广和普及,现将我们自1999年至2005年手术治疗资料完整的20例髋臼骨折报道如下:     

髋臼骨折手术患者创伤性关节炎防治的研究进展

髋臼骨折手术患者创伤性关节炎发生率高,危害大。本文对髋臼骨折患者创伤性关节炎的预防及治疗进行了系统的综述,系统而全面地分析了手术时机、手术入路的正确选择,如何提高复位质量,手术后减轻体重,减轻体力劳动对预防创伤性关节炎的作用,分析了发生创伤性关节炎后如何通过保守治疗、药物治疗和全髋置换手术来治疗患者,描述了全髋置换手术中注意事项。旨在为临床医生提供参考。     

髋臼骨折的手术治疗

目的探讨内固定手术治疗有移位的髋臼骨折（移位〉3mm）的临床疗效。方法 2005年9月至2009年9月,对35例有移位的髋臼骨折（移位〉3 mm）的患者应用重建型接骨板及螺钉内固定治疗。结果 35例患者骨折复位及固定均满意,所有患者均获得随访,随访时间4～14个月,平均10.5个月。患者均在3～7个月达到骨性愈合,未发现接骨板及螺钉松动、断裂现象。结论内固定手术治疗具有复位良好,固定牢固,卧床时间短,并发症少等优点,是治疗有移位的髋臼骨折（移位〉3 mm）的一种有效的治疗方法。     

髋臼骨折手术并发症的防治及疗效分析

髋臼骨折多为高能量损伤，且移位大、复位困难、手术出血量多，所以过去多采用牵引等非手术治疗。近年来，随着对髋臼骨折的认识进一步提高，内固定材料和手术器械的改进和发展，在治疗上也从有非手术治疗到手术治疗的转变。自1998年12月～2002年12月，手术治疗36例髋臼骨折，报告如下。     

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.