创伤性浮膝损伤手术方法的选择

目的　探讨创伤性浮动膝关节损伤的手术方法。方法　通过对 1 2 7例浮膝损伤病人的手术治疗方法进行回顾性分析 ,得出不同手术方法的利弊。结果　 1 1 4例患者随访 1 2～ 4 3个月 ,膝关节功能的优良率 :早期一次手术为 78 7% ;分次手术为6 1 5 %。 3例胫骨骨折不愈合经再次手术植骨外固定支架固定后获得愈合。 3例出现伤口感染经治疗后愈合。另 1例合并股动脉损伤经大隐静脉移植后出现感染而截肢。 1例合并坐骨神经损伤的患者后遗足下垂。结论　浮动膝损伤在条件允许的情况下应尽早手术治疗 ,并根据骨折的不同类型选择手术方法。早期两处一次手术较分次手术膝关节功能恢复好     

创伤性浮膝损伤手术方法的选择

目的 探讨创伤性浮动膝关节损伤的手术方法。方法 通过对127例浮膝损伤病人的手术治疗方法进行回顾性分析，得出不同手术方法的利弊。结果 114例患者随访12～43个月，膝关节功能的优良率：早期一次手术为78．7％；分次手术为61．5％。3例胫骨骨折不愈合经再次手术植骨外固定支架固定后获得愈合。3例出现伤口感染经治疗后愈合。另1例合并股动脉损伤经大隐静脉移植后出现感染而截肢。1例合并坐骨神经损伤的患者后遗足下垂。结论 浮动膝损伤在条件允许的情况下应尽早手术治疗，并根据骨折的不同类型选择手术方法。早期两处一次手术较分次手术膝关节功能恢复好。     

儿童浮膝损伤的手术治疗

目的：探讨儿童浮膝损伤手术治疗的必要性和优越性，方法：回顾性分析了12例浮膝损伤病例，对其中11例患儿至少一处骨折行手术治疗。随访时间从16个月至6年，平均26个月，治疗效果按Karlstrom标准评分。结果：12例患儿全部得到随访，1全部骨折一次性愈合，没有发生骨不愈合，治疗效果。优7例，良3例，中2例，无差病例，优良率为83．3％，结论：对于6岁以上的浮膝损伤患儿，至少一处骨折予手术固定可达消除治疗上的矛盾，便于整体护理、减少住院日及早期负重，降低后遗症发生率的效果。     

椎间盘镜系统辅助下微创髓内钉固定治疗浮膝损伤

目的 探讨椎间盘镜系统辅助下置入髓内钉内固定治疗浮膝损伤的方法及临床疗效.方法 2005年12月至2008年12月收治浮膝损伤16例,骨折按Frasert分型均为Ⅰ型,均采用膝关节前正中经髌腱入路在椎间盘镜系统辅助下进行股骨逆行髓内钉及胫骨髓内钉内固定术治疗.术后评价骨折愈合、膝关节功能恢复情况.结果 术后随访10～25个月,15例骨折正常愈合,1例胫骨骨折延期愈合,平均骨折愈合时间为4.2个月:末次随访平均膝关节活动度为117°,按Karlstrom膝关节功能分级评价标准进行评价,优13例,良2例,可1例,优良率94.7%.2例股骨骨折端出现轻度向后成角畸形,平均成角6.5°,其余均未出现神经血管损伤、髌骨撞击痛、感染及内固定松动、断裂等相关并发症.结论 椎间盘镜系统辅助下髓内钉微创内固定治疗浮膝损伤,具有创伤小,置钉准确、并发症少等优点,有利于促进骨折愈合及膝关节功能恢复.     

带锁髓内钉治疗创伤性浮膝骨折18例体会

目的探讨带锁髓内钉治疗浮膝损伤的临床疗效。方法我院自1998~2003年共收治浮膝损伤26例28侧,总结其中18例19侧使用带锁髓内钉治疗的病例,对病人经过手术治疗后的合并症、骨折愈合及下肢功能恢复进行统计分析和评定。随访12~36个月,平均13.5个月。结果18例患者均获得愈合,无延迟愈合、无感染、无内固定断裂等并发症。膝关节功能恢复良好,优良率92.3%。结论浮膝骨折是一种严重的骨折损伤,带锁髓内钉对骨折坚强内固定疗效明显优于其它治疗方法。     

弹性髓内钉内固定治疗低龄儿童Ⅰ型浮膝损伤

目的探讨采用弹性髓内钉内固定治疗低龄儿童(10岁以下)Ⅰ型浮膝损伤的疗效。方法回顾性分析自2008-06—2015-06采用弹性髓内钉内固定治疗的11例儿童Ⅰ型浮膝损伤,先固定胫骨骨折,于胫骨近端骺板以远2~3 cm、胫骨结节骨骺后侧2~3 cm开孔置入弹性髓内钉;再固定股骨骨折,于股骨远端骺板近侧2~3 cm处开孔置入弹性髓内钉。结果本组11例均获得随访,随访时间平均16.5(12~24)个月。骨折均达骨性愈合,愈合时间平均14(8~24)周。末次随访时疗效根据Flynn评分系统评定,均为优良;根据Yue等的评分标准评定均为优。结论采用弹性髓内钉内固定治疗低龄儿童Ⅰ型浮膝损伤具有微创、手术时间短、外形美观、功能恢复快等优点。     

浮膝损伤的诊断与治疗

目的 :探讨浮膝损伤的临床诊断标准及最佳治疗方法。方法 :对 1 993～ 1 996年间 2 5例浮膝损伤病人的临床诊断及治疗方法进行回顾性研究。结果 :2 3例骨折骨性愈合 ,2例胫骨骨折不愈合经再次手术植骨外固定架固定获得骨性愈合。术后随访平均 2 6个月。 1 0例术后伸膝装置粘连 ,取内固定物时行伸膝装置松解术 ,效果满意。膝关节功能优良率 80 %。结论 :膝关节内骨折破坏了膝关节本身的完整性 ,不适用浮漆的诊断。浮膝伤多合并其他损伤 ,优先处理致命伤 ,同时固定胫骨骨折 ,将浮膝变为单一骨折 ,即“部分固定”原则     

有限切开交锁髓内钉治疗浮膝损伤

目的 探讨有限切开交锁髓内钉内固定治疗浮膝损伤的治疗效果。方法 采用有限切开交锁髓内钉内固定治疗浮膝损伤22例。结果 经平均23个月（15～37个月）的随访。根据Karlstrom制定的膝关节功能评价标准评定，优18例。良2例，可1例，差1例。结论 有限切开交锁髓内钉内固定治疗浮膝损伤，具有损伤小、固定坚强、便于早期功能锻炼及有利于骨折愈合的优点。是一种有效的治疗方法。     

56例浮动膝关节损伤的治疗

目的 :探讨浮膝损伤的最佳治疗方法及时机 ,以及固定物的选择。方法 :收治的 5 6例浮膝损伤病人的临床情况、治疗经过、方法及预后肢体功能情况的回顾性研究。结果 :5 6例病人 ,5 9侧患肢 ,均经手术内固定或外固定治疗。术后X线显示 5 9例骨折对位、对线良好。术后平均随访 3 0个月 ,5 8例骨折愈合良好 ,1例感染二次手术外固定冲洗后获骨性愈合 ;2例内固定物外露 ,未经特殊处理 ,骨性愈合后取出。膝关节功能优良率 80 .4%。结论 :在治疗全身症状的同时 ,早期简单坚强的内固定、外固定 ,尽早的CPM锻炼 ,对预防骨性关节炎及膝关节的纤维僵直非常有效。 3周内完成骨折治疗手术 ,早期的部分固定对治疗浮膝损伤非常重要     

创伤性浮膝的治疗策略和预后影响因素

目的探讨创伤性浮膝损伤的手术治疗及预后影响因素。方法回顾性分析我院2000年6月至2010年6月处理的27例创伤性浮膝患者的手术治疗方式和合并伤对膝关节功能恢复的影响。结果 27例患者中有35处合并伤,16例患者行交锁髓内钉—交锁髓内钉固定。浮膝的并发症主要是膝僵硬、足下垂、骨折延迟愈合和感染。按Karlstrom标准对膝关节功能评定,优12例,良10例,中3例,差2例,优良率81.5%。伴有膝关节韧带损伤或血管损伤的患者预后差。结论浮膝患者需早期有效地手术固定,术后循序渐进的膝关节康复训练,能获得良好的结果.骨折类型和合并伤影响浮膝的预后。     

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.