解剖型钢板治疗股骨粗隆间粉碎性骨折

目的探讨解剖型钢板对于股骨粗隆间粉碎性骨折的治疗效果。方法对16例股骨粗隆间粉碎性骨折采用骨折切开复位,解剖钢板内固定。结果16例患者中15例随访6个月-3年,1例发生轻度髋内翻,余14例骨折愈合,髋关节功能恢复满意。结论应用解剖型钢板治疗股骨粗隆间粉碎性骨折操作简单方便,固定牢靠,是一种效果良好的内固定方法。     

蛇形解剖钢板固定治疗老年人股骨粗隆间粉碎性骨折

目的探讨蛇形解剖钢板固定治疗老年人股骨粗隆间粉碎性骨折的疗效。方法16例老年人股骨粗隆间粉碎性骨折采用切开复位蛇形解剖钢板内固定治疗。骨折按Tronzo分类：Ⅲ型9例，Ⅳ型6例，V型1例。结果优10例，良4例，差2例，优良率87．5％。结论蛇形解剖钢板固定治疗老年人股骨粗隆间粉碎性骨折，可获得满意疗效。     

偏髓分型及其指导应用锁定钢板治疗股骨粗隆间粉碎性骨折

目的介绍股骨粗隆间骨折的偏髓分型,探讨和分析偏髓分型指导应用解剖型锁定钢板内固定手术治疗股骨粗隆间粉碎性骨折的疗效。方法回顾性分析2007年1月～2010年2月间行锁定钢板内固定手术治疗的39例股骨粗隆间骨折患者的临床资料。结果术后随访33例,随访时间9～22个月,平均14.5个月。疗效按Ander标准:优23例,良8例,差2例。结论偏髓分型指导下应用股骨粗隆间解剖型锁定钢板治疗股骨粗隆间粉碎性骨折,具有内固定坚强,损伤小,允许早期活动,减少关节僵直,有利于骨折愈合等优点。偏髓分型是一种有效、方便、实用的分型方法。     

May解剖钢板固定治疗股骨粗隆间骨折

目的 对May解剖型钢板内固定治疗股骨粗隆间骨折疗效进行探讨。方法 21例股骨粗隆间骨折患者采用髋关节外侧入路，May解剖型钢板内固定治疗。结果 21例患者，随访10个月～2年，无骨折不愈合、内固定松动、断裂者，无逐渐负重后松质骨螺钉进入髋关节者。14例患者已取出内固定，无再骨折者。术后髋关节功能：优15例，良4例，可2例，差0例。优良率占90％。结论 May解剖型钢板内固定治疗股骨粗隆间骨折固定可靠，符合人体生物学要求，操作简单，是一种良好的治疗方法。     

解剖型钢板和DHS治疗股骨粗隆间骨折的对比研究

目的 对比股骨粗隆间骨折解剖型钢板和DHS内固定治疗的临床疗效和并发症.方法 回顾手术治疗股骨粗隆间骨折130例,解剖型钢板固定36例,DHS固定94例.对比两组的临床效果及并发症.结果 在稳定性骨折中两种内固定临床疗效满意;不稳定骨折术后并发症解剖型钢板以髋内翻、内固定失效多见,DHS以股骨颈变短、加压钉切出股骨头为主.结论 两种固定治疗股骨粗隆间骨折均可取得良好的固定,合理选择内固定,制定正确的康复锻炼,能有效减少并发症.     

解剖钢板内固定治疗股骨粗隆间骨折

目的总结分析解剖钢板内固定治疗股骨粗隆间骨折的疗效。方法观察23例股骨粗隆间骨折应用解剖钢板内固定的肢体功能和全身情况。结果经6个月~3年随访全部病例骨折愈合,且髋关节功能恢复满意。结论解剖钢板内固定治疗股骨粗隆间骨折固定牢固,便于早期功能锻炼,是治疗股骨粗隆间骨折的一种效果良好的内固定方法。     

DHS和解剖型锁定钢板治疗股骨粗隆间骨折的疗效比较

目的 分析比较DHS和解剖型锁定钢板治疗股骨粗隆间骨折的疗效,探讨两种方法的优缺点.方法 回顾性分析2006年1月～2008年12月接受DHS内固定或解剖型锁定钢板治疗股骨粗隆间骨折65例,两组患者均获1年以上的随访.其中DHS内固定39例(DHS组),解剖型锁定钢板内固定26例(解剖钢板组);病例选择时排除病理性骨折...     

新型股骨近端解剖锁定钢板内固定治疗老年股骨粗隆间骨折疗效分析

目的探讨新型股骨近端解剖锁定钢板内固定治疗老年患者股骨粗隆间骨折的疗效。方法采用新型股骨近端解剖锁定钢板内固定治疗老年股骨粗隆间骨折36例,所有患者均为单侧闭合性骨折且均获得随访。结果36例获平均14．5个月随访,所有患者骨折均愈合,均未出现感染、下肢静脉血栓。疗效按Sanders评分标准评定：优25例,良10例,可1例,优良率97．2％。结论新型股骨近端解剖锁定钢板内固定治疗老年股骨粗隆间骨折具有固定效果可靠、生物力学特性佳及关节功能恢复好等优点。     

股骨近端锁定钢板内固定治疗老年股骨粗隆间粉碎性骨折

目的探讨股骨近端锁定加压钢板(LCP)内固定治疗老年股骨粗隆间粉碎性骨折的疗效,并总结治疗经验。方法对56例股骨粗隆间粉碎性骨折应用LCP治疗,随访观察骨折愈合时间、有无内固定松动、断裂、感染等并发症的发生。结果 56例术后随访3~36个月,除3例骨折延迟愈合以外,其余的均获得骨性愈合,2例出现下肢深静脉血栓,经治疗好转。结论选用LCP治疗股骨粗隆间骨折,符合生物力学固定(BO)原则,有利于骨折的愈合及软组织的修复,尤其适合老年粉碎性骨折及骨质疏松骨折患者。     

两种髓外固定方法治疗股骨粗隆间粉碎性骨折疗效对比

目的探讨不同内固定方法治疗老年股骨粗隆间粉碎性骨折的临床效果。方法回顾分析82例老年股骨粗隆间粉碎性骨折分别应用动力髋螺钉(DHS组)38例,股骨近端锁定加压钢板(LCP组)44例。结果 DHS内固定组钢板松动断裂1例,主钉切割出股骨头2例,均为EvansⅢ型骨折。LCP内固定组44例骨折均全部愈合,未出现并发症。结论 DHS和LCP均是治疗稳定型股骨粗隆间骨折的有效的方法;但LCP内固定存在明显优势。     

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.     

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.     

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.