经前路手术治疗Tile C型骨盆环损伤

目的 介绍经骨盆前入路手术治疗Tile C型骨盆骨折的方法。方法 采用经髂骨内侧弧形切口和Pfannenstiel切口入路，骨盆骨折脱位复位后，分别用重建钢板内固定。临床治疗19例，其中C1 15例，C2 2例，C3 2例。结果 19例随访时间6个月～2．5年，平均1．5年。17例骨盆骨折3个月达骨性愈合，2例4个月达骨性愈合。无感染、血管神经损伤等并发症。结论 经前入路手术治疗Tile C型骨折是一种安全、疗效好的治疗方法。     

不稳定性骨盆骨折的内固定治疗

目的:探讨不稳定性骨盆骨折手术治疗的临床疗效。方法:自2000年5月至2006年3月手术内固定治疗不稳定性骨盆骨折39例,男25例,女14例;年龄16～61岁,平均38.6岁。根据Tile分型,B1型8例,B2型16例,B3型5例,C1型7例,C2型3例。B型和部分C1型骨折,采用耻骨联合上方弧形切口或经髂腹股沟入路,应用钛合金重建钢板内固定。C1型骨折,主要采用闭合复位,经皮骶髂拉力螺钉内因定。C2型骨折,采用闭合复位,经皮骶髂拉力螺钉内固定,再前方入路内固定。结果:术后随访时间2～68个月,平均18.6个月,骨折愈合时间平均2.4个月。术后并发症:切口感染1例,创伤性湿肺1例,神经牵拉伤1例,均治愈,无死亡病例。按Mears术后影像评定标准:解剖复位31例,复位满意7例,复位不满意1例。按照Majeed的疗效评定标准:优32例,良7例。结论:不稳定性骨盆骨折采用手术内固定,可以有效恢复骨盆的稳定性,远期疗效好,极大地降低其致残率。     

不稳定型骨盆骨折的救治及手术治疗

[目的]探讨不稳定型骨盆骨折的早期救治和二期手术治疗经验.[方法]回顾性分析总结2006年7月～ 2009年12月救治的21例不稳定型骨盆骨折的临床资料.平均年龄37岁(19～58岁);男13例,女8例;平均创伤严重性评分(ISS)为34分(16 ～59分);按照Tile分型:B型16例(B1型7例,B2型6例,B3型3例),C型5例;17例患者合并其他部位损伤.一期行稳定骨盆、抗休克、处理合并伤等,待生命体征稳定后行切开复位内固定治疗.术后通过Majeed量表评估患者功能愈后.[结果]本组病例平均随访27个月(16～ 42个月).平均手术时间为195 min (60～510 min);平均输血量为700 ml (400 ～1 800 ml);平均骨折愈合时间为13周(11 ～ 17周);平均Majeed评分为84.3分(62 ～ 100分),其中优10例,良9例,中2例,优良率为90.4％.有1例存在明显步态异常,1例存在马蹄足畸形,均为神经损伤患者.[结论]不稳定型骨盆骨折的合理术前急救处理非常重要,对于此类损伤,应及时稳定骨盆骨折并处理合并伤,在合适的手术时机二期行切开复位内固定治疗,多可获得满意的疗效.     

重建钢板内固定治疗Tile C型骨盆骨折

目的探讨前路或前后联合人路重建钢板内固定治疗Tile C型骨盆骨折的疗效。方法2006年6月至2009年6月,采用前路或前后联合入路重建钢板内固定治疗骨盆骨折24例,均为Tile C型,其中C1型8例,C2型2例,C3型14例。结果无围手术期死亡病例,24例切口均Ⅰ期愈合,无感染、血管神经损伤及内固定失败等并发症。全部病例随访10～46月,平均23．5月。所有患者术后8-12周可完全负重行走,骨折愈合时间为8-18周,平均14周。根据Majeed骨盆功能评分,本组优17例,良3例,可4例,优良率83．3％。结论前路或前后联合入路重建钢板内固定可较好的重建骨盆的稳定性,能获得良好的功能康复,是治疗TileC型骨盆骨折较理想的方法之一。     

有限切开复位钢板内固定治疗Tile C型骨盆骨折

目的探讨有限切开复位钢板内固定治疗Tile C型骨盆骨折的方法和疗效。方法 2010年6月至2012年5月,采用有限切开复位钢板内固定治疗Tile C型骨盆骨折15例。其中:C1型10例,C2型4例,C3型1例。评估术中出血量、手术时间及术后患者功能恢复情况。结果 15例患者术后获12~24个月(平均15个月)随访。骨盆前环手术的手术时间和出血量平均分别为61 min、92 mL;后环手术平均分别为71 min、165 mL。术中均无重要血管、神经损伤等并发症发生。1例耻骨处伤口发生浅表感染,经换药治愈。骨折复位按Matta影像学评分标准评定:解剖复位10例,满意复位4例,可1例。骨折愈合时间为2~6个月,平均2.9个月。末次随访时采用Majeed骨盆骨折评分标准评定疗效:优12例,良2例,可1例。结论通过有限切开复位和钢板内固定可以对Tile C型骨盆骨折进行良好的显露和牢靠的固定,并且不需要暴露神经、血管等结构,具有微创特点,疗效显著。     

前环固定结合后环TSRH固定治疗不稳定性骨盆骨折

目的总结骨盆骨折的治疗经验。方法回顾性总结了2001~2004年收治的资料完整的B型及C型骨盆骨折68例,治疗采用前环重建钢板、或耻骨空心螺钉固定,后环采用TSRH固定。结果68例获平均18个月随访,均骨性愈合,骨盆畸形均得以纠正,无下肢不等长,治愈率为94·5%。结论不稳定性骨盆骨折在固定前环的同时,还应进行后环的固定,TSRH在骨盆后环的固定中有较好的疗效,适用于B型骨盆骨折及C型、C型和C型骨盆骨折的内固定治疗。     

重组核因子κB活化因子受体蛋白预防小鼠骨质疏松的研究

目的:探讨Stoppa入路结合后方经皮钢板技术治疗C型骨盆骨折的临床疗效.方法:2009年6月至2011年7月,采用Stoppa入路重建钢板固定骨盆前环骨折结合后方经皮重建锁定钢板固定骨盆后环骨折的技术治疗16例C型骨盆骨折患者,男11例,女5例;年龄22～59岁,平均38.8岁.按照Tile分型:C1型10例,C2型4例,C3型2例.采用Tometta评估标准评定骨折复位情况,采用Majeed评分标准评定术后功能情况.结果:16例患者均获随访,时间4～13个月,平均7.3个月.手术时间80～140 min,平均100 min.术中出血量200～500 ml,平均280 ml.骨盆骨折的愈合时间为12～16周,平均14周.骨折复位按照Tometta评估标准:优9例,良6例,可1例.术后功能评定按Majeed评分标准:优9例,良5例,可2例.结论:Stoppa入路重建钢板固定骨盆前环骨折结合后方经皮重建锁定钢板固定骨盆后环骨折技术治疗C型骨盆骨折具有创伤小、手术操作安全、并发症少、固定牢靠、可早期活动的优点,是一种比较理想的微创手术方法.     

外固定联合有限内固定治疗不稳定型骨盆骨折

目的探讨骨盆外固定架联合有限内固定治疗不稳定型骨盆骨折的效果及可行性。方法对15例不稳定型骨盆骨折行骨盆外固定架联合有限内固定治疗，根据Tile分型分类，B2型3例，B3型4例，C1型5例，C2型3例。结果本组15例，1例未获得随访，14例获得平均21．3个月的随访。1例有骶髂关节部疼痛，1例足下垂畸形，其余12例获得骨性愈合，恢复行走功能，无下肢短缩。结论对于不稳定性骨盆骨折，使用骨盆外固定架联合有限内固定既可恢复解剖序列的连续性，又加强了骨盆整体结构的稳定性，两者的互补作用，提供了骨盆生物力学双重固定效应，有利于患者康复。     

Stoppa联合髂窝入路钢板内固定一期治疗不稳定性骨盆骨折

目的探讨Stoppa联合髂窝入路钢板内固定一期治疗不稳定性骨盆骨折的临床疗效。方法回顾性分析2009年10月至2014年5月南方医科大学附属南方医院收治的15例不稳定性骨盆骨折患者的临床资料,均采用Stoppa联合髂窝入路切开复位钢板内固定。记录手术时间、术中出血量及输血情况,应用Matta标准和Majeed评分系统对骨折复位情况和术后功能进行评价。结果平均手术时间137 min(100~480 min),平均出血量430 m L(200~1 200 m L),术中平均输悬浮红细胞3.2个单位(0~6个单位)。术后当天按照Matta标准:解剖复位8例、满意复位5例、不满意复位2例。平均随访时间14.3个月(5~38个月),均达骨性愈合,骨折愈合时间2~6个月(平均3.6个月)。末次随访时Majeed评分:优8例、良4例、可1例、差2例。1例患者术后出现会阴部脓肿,1例术后手术切口有尿液流出,伴窦道形成,对症治疗后伤口均愈合。结论 Stoppa联合髂窝入路钢板内固定一期治疗不稳定性骨盆骨折,具有操作简单、损伤较小、临床效果良好等优点。     

皮下前环内固定支架联合后环骑跨钢板固定治疗不稳定型骨盆骨折

目的探讨皮下前环内固定支架联合后环骑跨钢板固定治疗不稳定型骨盆骨折的疗效。方法 2015年1月—2019年1月,对26例不稳定型骨盆骨折行皮下前环内固定支架联合后环骑跨钢板固定治疗。其中男16例,女10例;年龄25～66岁,平均42.8岁。骨折根据Tile分型:B2型9例,B3型6例,C1型7例,C2型3例,C3型1例。创伤严重度评分(ISS)为6～43分,平均18.3分。合并脑外伤4例,四肢骨折7例,血气胸3例,坐骨神经损伤1例。受伤至手术时间为4～12 d,平均6.4 d。记录术中出血量及手术时间,观察骨折复位及愈合情况、有无并发症发生,以及骨盆功能恢复情况等。结果术后患者均获随访,随访时间12～26个月,平均16.8个月。手术时间为65～142 min,平均72.5 min;术中出血量为42～124 mL,平均64.2 mL。术后出现2例单侧股外侧皮神经激惹、1例股神经麻痹、1例切口浅表感染,均经相应处理后治愈或症状消失。术后3个月X线片复查示骨折均愈合。末次随访时,骨折复位质量根据Matta评价标准评定:优8例、良15例、可2例、差1例,优良率为88.5%;骨盆功能根据Majeed评分系统评定:优10例、良12例、可4例,优良率为84.6%。结论应用皮下前环内固定支架联合后环骑跨钢板固定治疗不稳定型骨盆骨折,并发症较少、安全性较高,可获得较好疗效。     

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.