股骨头开瓣植骨治疗非创伤性股骨头坏死

目的报道成人非创伤性股骨头坏死的手术治疗。方法自1997年2月至1999年6月,采用经股骨头负重区开瓣死骨清除取髂骨植骨术治疗FicatⅡ～Ⅲ期非创伤性股骨头坏死10例,其中男8例,女2例;年龄30～47岁,平均39岁。Ficat分期Ⅱ～Ⅲ期,其中Ⅱa期3例,Ⅱb期5例,Ⅲ期2例。采用经股骨头负重区开瓣死骨清除,取髂骨植骨术。结果所有病人均获随访,平均随访10年,根据Harris临床评分,Ⅱa、Ⅱb期8例效果满意,优良率达85．5％。结论该手术对Ⅱa、Ⅱb期软骨面完好的病人效果优良。     

头颈部开窗个体化病灶清除打压植骨治疗股骨头缺血性坏死体会

目的 探讨利用高速磨钻行头颈部开窗、个体化病灶清除联合打压植骨治疗成人股骨头缺血性坏死的临床疗效.方法 根据手术前MRI上坏死骨的体积测量以及CT片上坏死部位的测定,采用头颈部开窗个体化病灶清除联合打压植骨治疗成人Ⅰ-Ⅲ期股骨头缺血性坏死22例34髋,按照世界骨循环研究学会(ARCO)分期本组Ⅰ期6髋,Ⅱ期22髋,Ⅲ期...     

病灶清除结合自体骨植入支撑治疗股骨头早中期坏死

目的 探讨病灶清除结合自体骨植入支撑治疗成人股骨头坏死初步疗效.方法 42例57髋经大粗隆下通过股骨颈钻隧道至股骨头骨坏死区,将自体腓骨经隧道植入骨坏死区达软骨下骨约5 mm处.结果 随访14～36个月,按Haaris评分标准评价疗效,优良率为84.2%.结论 病灶清除结合自体骨植人支撑治疗成人股骨头坏死具有以下优点:①手术操作简单,不破坏患者股骨头的血液供应,创伤小,且不增加日后行人工关节置换的难度;②自体骨移植避免排异反应,愈合能力强;③隧道的建立缓解了关节囊内压力,同时腓骨瓣植入增加股骨头负重区软骨下骨的机械支撑,降低局部应力,有利于股骨头坏死的修复及重建.     

开窗病灶清除植骨术治疗股骨头缺血性坏死

目的　寻求治疗股骨头缺血性坏死的简便而有效的手术方法。方法　设计一种于股骨头颈交界处开窗、坏死骨清除减压、髂骨松质骨填充植骨术 ,术后配合牵引髋关节 ,早期持续被动功能锻炼的方法 ,治疗股骨头缺血性坏死 2 0例 2 9个股骨头。结果　 2 0例 2 9个股骨头经 1～ 3年随访 ,效果满意。髋痛消失 ,髋关节功能良好 ,行走及下蹲正常或基本正常。结论　此术式可彻底清除坏死骨 ,消除血供障碍因素 ,为重建血运修复骨质创造条件 ,在病灶清除后的股骨头空腔内 ,填充大量松质骨支撑软骨面 ,为骨修复提供成骨条件。早期髋关节持续被动功能锻炼对关节软骨的修复和预防关节粘连是极为有利的。此法操作简便 ,创伤小 ,效果好。     

带血管蒂髂骨瓣转移术治疗成人股骨头无菌性坏死

目的观察带旋股外侧动脉升支血管蒂髂骨瓣转移加游离植骨术治疗成人中晚期股骨头无菌坏死的疗效。方法采用带旋股外侧动脉升支血管蒂髂骨瓣转移加游离植骨术治疗中、晚期股骨头无菌坏死32例38髋。术中在膝关节镜下彻底清除坏死骨．切取带血管蒂骨瓣及用游离植骨将坏死腔填满充实。结果32例38髋随访24～72个月。按成人股骨头无菌性坏死的疗效百分评价法，优良率达94.7％(36／38)。结论应用带旋股外侧动脉升支血管蒂髂骨瓣转移加游离植骨术治疗成人股骨头无菌性坏死具有以下优点：①青壮年患者避免行人工髋关节置换术后假体下沉、关节附近骨破坏等并发症；②彻底清除坏死骨及减压；③重建股骨头血运，形成自体骨的股骨头有利于股骨头的修复与重建。该术式适用于50岁以下股骨头坏死FicatⅡ、Ⅲ期患者，Ⅱ期病例远期效果更佳。     

经股骨头开瓣植骨术治疗股骨头缺血性坏死

目的：观察和分析经股骨头开瓣植骨术治疗股骨头缺血性坏死的疗效。方法：对8例成人非创伤性股骨头坏死进行Ficat分期Ⅱ-Ⅲ，其中Ⅱa期2例，Ⅱb期4例，Ⅲ期2例，均采用经股骨头负重区开瓣死骨清除，取髂骨植骨术进行治疗，结果：平均随访32个月，根据Harris临床评分，Ⅱ b期前6例效果优良，结果：经股骨头开瓣植骨术对于Ficat分期Ⅱb期以前软骨面较完好的病人效果优良。     

纳米晶胶原基骨加自体骨移植治疗早期股骨头坏死的临床疗效分析

目的 回顾性分析经股骨头颈交界处开窗、灯泡状病灶清除、打压植骨术结合纳米晶胶原基骨和自体骨移植治疗早期股骨头坏死(osteonecrosis offemoral head,ONFH)的临床疗效. 方法 2001年1月-2005年7月,收治26例35髋ONFH患者,男16例,女10例;年龄19～54岁,平均33.5岁.病程12～36个月,平均18个月.ONFH病因:激素性15例22髋,酒精性10例12髋,特发性1例1髋.ARCO分期:Ⅱ B期6髋,Ⅱ C期16髋,ⅢA期9髋,Ⅲ B期3髋,ⅢC期1髋.Harris评分为(62.2±7.5)分.术中采用经股骨头颈交界处开窗、灯泡状病灶清除,按1:l比例行纳米晶胶原基骨和自体骨移植治疗. 结果 患者术后切口均I期愈合.术中2例髂骨取骨伤及股外侧皮神经,术后3～6个月神经支配区麻木症状自行缓解消失:2例术后3个月出现异位骨化并发症,未行特殊处理.患者均获随访,随访时间2～7年,平均3.5年.术后3个月患者植骨愈合.术后Harris评分为(85.1±16.2)分,与术前比较差异有统计学意义(P<0.001).其中优15髋,良11髋,可5髋,差4髋.获差的4例患者均于随访期末行全髋关节置换术.影像学检查示5髋由术前Ⅱ C期进展至ⅢA期;余髋关节影像学表现稳定,ONFH分期无进展. 结论 经股骨头颈交界处开窗、灯泡状病灶清除、打压植骨术,结合纳米晶胶原基骨和自体骨移植治疗早期ONFH临床效果满意,纳米晶胶原基骨有利于骨坏死的修复和重建,适于Ⅱ期ONFH的患者保存股骨头手术.     

Trapdoor手术治疗股骨头缺血性坏死

目的 报道成人非创伤性股骨头坏死的手术治疗。方法 非创伤性：股骨头坏死10例，平均年龄39岁，Ficat分期Ⅱ～Ⅲ期。其中Ⅱa3例，Ⅱb5例，Ⅲ期2例。采用经股骨头负重区开瓣死骨清除，取髂骨植骨术，结果 平均随访32个月。根据Harris临床评分，Ⅱb以前8例效果满意，优良率达85.5％。结论 该手术对于Ⅱb以前软骨面完好的病人效果优良。     

头颈开窗带血供蘑菇状植骨治疗股骨头缺血坏死

目的 探讨应用一种新的带血供植骨方法治疗股骨头缺血坏死的疗效。方法 采用头颈开窗，死骨清除，带血供磨菇状植骨治疗股骨头缺血坏死患者31例，按Ficat分期；ⅡA期10例，ⅡB期13例，Ⅲ期8例，旋髂深骨瓣移植13例，缝匠肌骨瓣5例，阔筋膜张肌骨瓣4例，大转子骨瓣9例，结果 随访1.5-4年，根据王岩等的诊断标准综合评价；优20例，良7例，可2例，差2例，优良率为87.1%。结论 头颈 开窗磨菇状植骨可以改善和重建股骨头的血供，避免股骨头应力集中，预防和治疗股骨头塌陷。     

用改进的血管束植入法治疗成人股骨头无菌性坏死

作者用旋股外侧动脉的3个分支,组成一束或两束.从单道或V型骨道植入缺血性坏死股骨头,治疗29例30髋成人股骨头无菌性坏死.术后平均随访23个月,按百分评分法评定疗效、结果优7髋.良17髋,优良率80%.通过对其中部分病例进行DSA及ECT的在体观察以及1例术后14月的离体股骨头动脉墨汁灌注和病理学观察,均证实植入的血管束可以新生血管网.改善坏死股骨头血运,并促进其修复,文章还就本术式的优点及适应症进行了讨论.     

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.