置钉与弯棒技术操作规范对腰椎滑脱复位影响的临床观察

目的在腰椎滑脱手术病例中应用“置钉与弯棒技术操作规范”,与以往未实施该规范患者比较,观察其对腰椎滑脱复位的影响。方法选取滑脱手术病例（实验组）,制定并实施“置钉与弯棒技术操作规范”,与未实施该规范患者（对照组）作比较;对比2组滑脱矫正率、椎间隙后缘高度增加值、椎间节段前凸角增加值,进行统计学分析。结果实验组在滑脱矫正率、椎间节段前凸角增加值方面均优于对照组,差异有统计学意义（P〈0．05）;在椎间隙后缘高度增加值方面实验组优于对照组,但差异无统计学意义（P〉0．05）。结论实施“置钉与弯棒技术操作规范”能使腰椎滑脱复位效果得到显著提高。甚至可达到解剖复位。     

椎弓根钉棒系统治疗腰椎滑脱的置钉技巧

目的通过改良椎弓根钉棒系统置钉方法使腰椎滑脱术中复位更加容易。方法回顾性分析采用改良后的置钉技巧行后路椎弓根钉棒系统复位固定、减压和椎问植骨融合治疗的腰椎滑脱32例的临床资料。结果32例获得12-42个月的随访．术后1年X线片检查提示滑脱无进展,椎间隙全部达到骨性融合。采用Nakai评分标准进行评定：优25例,良4例．可3例,优良率90．6％。结论改良椎弓根钉棒系统置钉方法可以使滑脱复位更加容易;对于腰椎I度滑脱不强求完全复位,主要是获得椎间植骨融合稳定脊柱和防止滑脱进展;对于腰椎滑脱Ⅱ度以上尽可能复位,同时进行椎间植骨融合稳定脊柱和防止滑脱进展。     

360°植骨融合钉棒固定治疗腰椎滑脱症

目的探讨360°植骨融合加单枚Cage及四钉两棒固定手术治疗腰椎滑脱症的临床疗效。方法采用后路椎弓根提拉螺钉复位滑脱椎体,单节段椎板减压,摘除椎间盘、刮除椎体终板,撑开恢复椎间高度,将碎骨粒加压夯实置入椎间隙内并放置单枚插入型Cage,双侧横突间植骨方法治疗39例腰椎滑脱症患者。结果术后3～24个月随访,平均15个月。手术完全复位33例,不完全复位3例,4例原位融合,椎间高度未丢失,Cage无松动、钉棒无断钉,平均出血量410mL。结论 360°植骨融合加单枚Cage及钉棒固定手术治疗腰椎滑脱症,复位效果满意,出血量少,经济,并发症少。     

腰椎滑脱手术复位相关因素探析

[目的]回顾性分析2011年12月~2014年9月在本院行腰椎滑脱复位手术患者的临床资料,探讨了解影响腰椎滑脱手术复位的相关因素。[方法]根据患者术后滑脱椎体复位情况,分为完全复位组35例,未复位或复位不理想组28例,对比分析两组患者年龄、性别、滑脱节段、滑脱原因(峡部裂或退行性)、矢状面下位椎体椎弓根钉与终板角度、矢状面滑脱椎体椎弓根钉与终板角度、提拉钉规格、椎间融合方式、双侧纵棒角度、双侧纵棒直径等相关影响因素。[结果]两组患者在年龄、性别、滑脱节段、滑脱原因(峡部裂或退行性)、矢状面滑脱椎体椎弓根钉与终板角度、提拉钉规格、椎间融合方式等因素对比差异无统计学意义(P0.05),两组对比差异具有统计学意义(P0.05)的为双侧纵棒角度、双侧纵棒直径;差异最为显著(P=0.001)的因素为矢状面下位椎体椎弓根钉与终板角度。[结论]下位椎弓钉置钉角度、纵棒的弧度及粗细等因素与腰椎滑脱术中复位有一定相关性,腰椎滑脱手术中需注意此类因素,以利于滑脱椎体复位。     

Steffee钢板内固定治疗胸腰椎骨折脱位及腰椎滑脱

目的探讨治疗胸腰椎骨折脱位及腰椎滑脱的最佳方法。方法 应用 Ｓｔｅｆｆｅｅ椎弓 螺钉钢板内固定系统治疗胸腰椎骨折脱位及腰椎滑脱３２例。手术行相应椎板切除减压，探查，采用在纵向对抗牵引脊柱的基础上垂直提拉椎弓根螺钉，拉顶复位相结合的方法复位。结果 平均随访２６个月，复位满意，固定牢固，植骨均融合，平均脱位改善程度７４％。     

后路多节段固定结合经椎弓根椎间融合治疗胸腰椎爆裂性骨折

[目的]用多节段椎弓根螺钉或椎弓根螺钉加钩棒系统后路固定,结合经椎弓根椎间融合治疗胸腰椎爆裂性骨折的临床疗效.[方法]对25例Denis分类Type B型胸腰椎爆裂性骨折实施了后路椎弓根钉系统固定术.受伤至手术间隔时间平均7 d,平均年龄38.6岁.平均随访时间28个月.采用多节段椎弓根螺钉或椎弓根螺钉加钩棒系统的后路固定法.植骨采用经椎弓根切除椎间盘椎体间植骨的方法.[结果]局部后弯从术前的Cobb角平均15.5°改善到4.7°.术后平均28个月随访时为9.4°,平均损失4.7°.[结论]多节段椎弓根螺钉或椎弓根螺钉加钩棒系统,经椎弓根椎体间植骨,加强前柱的支持性是治疗胸腰椎爆裂性骨折的有效方法.     

选择性增加伤椎单侧置钉内固定治疗胸腰段椎体骨折

目的探讨选择性增加经伤椎椎弓根置钉短节段钉棒内固定治疗胸腰段椎体骨折的临床效果。方法选择22例胸腰段椎体骨折,采用增加经伤椎椎弓根置钉短节段钉棒内固定,观察患者术前、术后伤椎前缘高度、脊柱Cobb角、神经恢复情况。结果术后伤椎前缘高度、脊柱Cobb角较术前明显恢复(P<0.01),无断钉、断棒。结论选择性增加经伤椎椎弓根置钉短节段钉棒内固定治疗胸腰椎严重骨折,术中伤椎复位满意、术后固定牢固、脊柱稳定性好,有利于伤椎骨折愈合和患者早期功能锻炼与康复。     

经伤椎钉棒系统节段固定治疗多节段胸腰椎骨折

目的 总结钉棒系统经伤椎固定治疗多节段胸腰椎骨折的优越性.方法 采用经伤椎钉棒系统节段固定治疗多节段胸腰椎骨折12例,其中2个椎体11例,3个椎体1例,伤椎均为相邻椎体,除椎弓根损伤椎体外,所有伤椎及邻近上-正常椎体均置钉.结果 所有置入螺钉位置及稳定性良好,椎体高度及脊柱生理曲度恢复良好,未出现内固定松动或断钉现象.结论 使用钉棒系统经伤椎多节段固定胸腰椎骨折可以提高生物力学稳定性,帮助骨折复位和矫正后凸.     

椎弓根提拉螺钉复位内固定治疗腰椎退变性滑脱

目的 探讨椎弓根提拉螺钉复位内固定治疗腰椎退变性滑脱的临床疗效。方法 对自2011-03-2012-09收治的43例腰椎退变性滑脱采取后路减压椎弓根提拉螺钉复位内固定结合椎间植骨融合手术治疗的情况进行回顾性分析。结果本组随访（9.5±3.2）个月,测量随访时VAS、JOA值,患者随访3个月、半年时与术前相比明显改善（P〈0.05）;患者术后滑脱程度由19.3%下降到3.5%（P〈0.05）;局部腰椎前凸角由术前11.5°增加到16.1°（P〈0.05）。结论 对腰椎退变性滑脱采用椎弓根提拉螺钉提拉复位内固定结合椎间植骨融合术可有效复位腰椎解剖结构,获得稳定的下腰椎力学重建。     

后路单节段内固定结合椎体间支撑植骨治疗腰椎滑脱症

目的探讨经后路单节段内固定结合椎体间支撑植骨治疗腰椎滑脱症的临床疗效。方法对46例腰椎滑脱症患者进行经后路减压、单节段椎弓根螺钉内固定复位、椎体间植骨融合,并进行定期随诊和影像学检查观察。结果经平均24个月的随访,优良率91.3%,固定节段滑脱无复发,植骨椎间隙全部融合,无断钉断棒发生。结论采用后路单节段椎弓根螺钉内固定结合椎体间支撑植骨治疗腰椎滑脱症固定节段短,临床效果可靠满意。     

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.