环形外固定器治疗下肢长骨骨不连畸形

198 7年 4月以来我们应用自行设计的环形外固定器[1]治疗股骨、胫骨骨不连 ,畸形 5 8例 ,效果良好 ,报告如下 :1　临床资料临床应用 5 8例 ,男 36例 ,女 2 2例 ;年龄 12～ 6 1岁 ,平均38岁 ;骨不连 39例 ,其中股骨 18例 ,胫骨骨不连 2 1例。骨折不连时间 6月～ 3年 4个月 ,平均 1年 2个月。骨折畸形愈合19例 ,股骨 9例。胫骨骨折畸连 10例。 2例 12岁和 14岁男孩患有胫腓骨下段畸连同时伴有下肢短缩 5～ 5 5ｃｍ。骨折畸形愈合时间 2 5月～ 5年 4个月。平均 8 5月 ,5 8例骨不连及畸连病人属内固定失败 2 8例 ,外固定失效 2 6例 ,4例病人由…     

带蒂骨痂移植植骨治疗硬化型骨不连

骨不连是创伤骨科的常见并发症,目前的治疗方法多倾向于植骨内固定手术治疗。本院1999年1月-2004年10月采用不同的固定方式联合带蒂骨痂和自体髂骨植骨术治疗硬化型骨不连20例,随访12~72个月,平均48个月,所有病例骨不连完全愈合,现报告如下。1临床资料本组20例,男12例,女8例;年龄26~64岁,平均45岁。其中闭合骨折8例,开放性骨折12例。致伤原因:车祸伤10例,重物砸伤6例,挤压伤4例。斜型2例,蝶型3例,粉碎型15例。肱骨干骨折2例,股骨干骨折4例,胫骨干骨折14例。原固定方式:切开复位内固定16例,其中接骨板内固定12例,髓内钉内固定4例;手法复位或…     

可膨胀髓内钉在下肢长管状骨干骨不连治疗中的应用

[目的]探讨可膨胀髓内钉FixionTM系统治疗股骨、胫骨干骨折骨不连的手术方法及临床效果。[方法]2004年6月~2006年1月,运用可膨胀髓内钉FixionTM系统加植骨治疗股骨、胫骨干骨不连19例,其中男11例,女8例,年龄19~65岁,平均39.6岁;股骨骨不连12例,胫骨骨不连7例,骨不连合并骨缺损16例,合并低毒性感染1例,初次骨折为开放性骨折11例。[结果]19例患者均获得随访,随访时间8~22个月,平均13.6个月。骨不连端在术后4~8个月获得骨性愈合,平均愈合时间6.2个月,术后无植入物松动、折弯、断裂等并发症发生。[结论]可膨胀髓内钉F ixionTM系统固定加充分自体植骨,是治疗股骨、胫骨干骨不连的一种有效的治疗方法。     

附加钢板固定治疗下肢骨折髓内钉固定术后肥大性骨不连

目的探讨附加钢板固定治疗股骨、胫骨干骨折髓内钉固定后出现肥大性骨不连的临床疗效。方法自2008年1月至2009年9月我科采用附加钢板固定治疗股骨、胫骨干骨折髓内钉固定后肥大性骨不连的患者12例,其中男8例,女4例;年龄24～52岁,平均36.3岁。术中钢板置于骨干外侧偏前或偏后,骨折两端各用2～4枚螺钉固定,骨折间隙较大的行自体髂骨植骨。结果 12例患者均在二次手术后12～29周（平均14周）X线显示有连续性骨痂通过,16～46周（平均28.6周）出现骨性愈合。所有病例无切口感染、无内固定物断裂及松动等并发症发生。结论采用附加钢板能解决骨折端不稳定问题,具有创伤小、操作简单、费用少,是治疗股骨、胫骨干骨折髓内钉固定后出现肥大性骨不连的一种有效方法。     

大块病损骨切除与一期经皮截骨延长治疗感染性长骨骨不连

感染性骨不连的外科治疗较为困难,如何在彻底控制感染的的基础上达到骨愈合,一直是骨科医师探寻的方向[1]。笔者自1997~2004年共收治感染性长骨骨不连8例,采用大块病损骨切除、应用“针锯”经皮一期截骨延长、多平面双轨多功能延长器固定的手术方法治疗,获得满意疗效。报告如下。1临床资料1·1一般资料本组8例,均为男性;年龄23~67岁,平均38岁。部位:股骨下段1例,胫骨中段3例,胫骨下段4例;其中左侧3例,右侧5例。8例均为车祸伤其中外院转入7例,全部病例均经过病灶清除、灌注冲洗、皮瓣移植等2~5次手术治疗,所有病例创面有脓性分泌物、窦道或骨…     

一期有轨加压延长治疗股骨骨不连伴骨短缩畸形

目的探讨一期有轨加压延长治疗骨不连伴骨短缩畸形的可行性及效果。方法对6例股骨骨不连伴短缩畸形(短缩:5~7 cm,平均5.6 cm)采用断端修整、加压,近端或远端截骨延长,髓内针与外固定架为加压及延长提供轨道和动力。结果 6例均获得随访平均11.8(8~18)个月,骨不连部位获得骨愈合,患肢恢复长度。平均外固定时间7.4(6~9)个月,外固定指数平均1.48(1.34~1.58)months/cm。结论一期行骨不连部位修整加压,另一部位截骨延长治疗骨不连伴骨短缩畸形是可行的,髓内针固定的同时使用外固定支架延长可以减少并发症,缩短戴架时间。     

异体骨板与钢板联合固定治疗萎缩性骨不连

目的 观察异体骨板与钢板联合固定治疗萎缩性骨不连的临床效果。方法 用新鲜冷冻异体长骨段,术中制备与钢板类似的长骨板,置于钢板对侧皮质骨表面联合固定骨折端。结果 治疗9例股骨和4例肱骨骨不连,获得良好的骨愈合。其中骨不连一次手术8例,二次手术5例。结论 通过异体骨板的骨强度,可提高螺钉对萎缩骨的骨把持力,同时利用异体骨的骨诱导作用,获得机械固定和生物学固定的双重效果,提高骨愈合率。     

经皮骨钻孔加自体骨髓移植治疗骨延迟愈合及骨不连14例

目前对骨延迟愈合及骨不连尚无确切、有效的治疗方法。笔者F自1991年7月～1995年4月采用经皮骨钻孔加自体骨髓移植的方法治疗骨延迟愈合及骨不这14例，疗效显著，现报告如下。临床资料本组14例中男11例，女S例；年龄22～65岁。开放性骨折IO例，均I期清创后内固定，闭合骨折4例，l周内切开复位内固定。部位；股骨中下1／3骨折2例，胜骨中下1／S骨折6例，胜骨下段2例，肽骨中段3例，挠骨中上段1例。术后时间：4～8个月12例，9－－11个月2例。治疗方法选用骨折侧骼骨做供区、受、供区皮肤消毒、铺巾。首先在X线荧光屏监控下找准骨折部位，局…     

无植骨Ilizarov外固定技术治疗股骨萎缩性骨不连

目的探讨无植骨Ilizarov外固定技术治疗股骨萎缩性骨不连的临床疗效。方法回顾分析2010年10月—2017年1月收治的12例股骨萎缩性骨不连患者临床资料,男8例,女4例;年龄24～61岁,平均41.7岁。7例骨不连位于股骨中上段,5例位于股骨远端或髁上。病程1～9年,平均3.7年。既往手术1～9次,平均2.8次。手术取出原固定物,清理骨不连骨折端,安装Ilizarov环形外固定器,骨缺损长度4 cm者术中直接加压固定;患侧肢体较健侧短缩2.5 cm者术中行股骨近端闭合截骨加装骨延长组件,备术后肢体延长;所有患者未植骨。记录患者外固定器佩戴时间、骨不连临床愈合时间、并发症发生情况;采用Paley等的骨不连评价标准评价疗效。结果术后患者均获随访,随访时间24～50个月,平均30个月。12例骨不连均达临床愈合,愈合时间6.0～23.5个月,平均11.5个月。外固定器佩戴时间为7～25个月,平均13.5个月。末次随访时采用Paley等的骨不连评价标准,优6例、良4例、可2例,优良率83.3%。4例股骨成角畸形7°,伸膝功能无明显影响,未再行截骨手术等特殊处理。2例术后患侧肢体短缩2.5 cm,通过穿补高鞋替代;4例跨膝关节固定患者术后膝关节活动度丢失10～30°;10例发生针道感染,其中4例感染并固定针松动者给予拔针后更换位置重新固定,余6例感染但固定针未松动者通过局部换药、针道护理及口服抗炎药物感染控制。无深部感染和血管神经损伤等并发症发生。结论 Ilizarov外固定技术治疗股骨萎缩性骨不连骨愈合率较高,相对微创、无需植骨,初步临床效果确切,对于多次手术失败的患者同样有效。治疗时需要重视术后外固定器护理及康复训练。     

双钢板内固定治疗下肢骨干骨折术后骨不连

目的观察双钢板内固定治疗下肢骨干骨折术后骨不连的临床效果。方法自2010-03—2013-05诊治股骨、胫腓骨骨折术后骨不连13例,采用原骨断端病灶清除并打毛断端、再通髓腔、自体髂骨移植、双钢板内固定治疗。结果本组12例均获得随访14~42个月,平均26.6个月。术后6个月2例因肥胖扶拐杖复查,10例可步行。股骨骨不连2例因多次手术导致跛行。1例胫骨骨不连因外固定架及石膏固定导致膝伸屈功能受限。1例术后伴疼痛,复查内固定稳定,但植骨吸收,目前仍卧床。末次随访时疗效按标准评定:优5例,良6例,差1例,优良率91.7%。结论下肢骨干骨折术后骨不连采用双钢板内固定治疗效果确切,固定稳固,骨折愈合好。     

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.