截骨术治疗内翻型膝关节骨性关节炎远期疗效观察研究

目的 :为评价应用高位胫骨截骨术治疗内翻型膝关节骨关节炎的远期疗效 ,对 2 4例 ( 2 9膝 )进行平均 1 0 .6年的随访。结果 :82 .6 %疗效优良或满意。疗效与年龄有关 ,理想的股胫外侧角度 1 6 8～ 1 72°。 50岁以下 ,术后股胫外侧角度为 1 6 5～ 1 75°者多能获得满意以上结果。术式选用胫骨结节上楔形截骨术或倒V截骨 ,应根据有无髌股关节炎而定。只要选择好截骨的角度 ,无论什么术式 ,皆能得到满意效果。结论 :治疗 6 0岁以下内翻型膝关节炎应首选高位胫骨截骨术     

两种截骨术治疗膝内侧间室骨关节炎的近期疗效比较

目的 比较腓骨截骨和内侧开放楔形胫骨高位截骨治疗膝内侧间室骨关节炎的近期临床疗效.方法 将40例膝内侧骨关节炎患者按截骨方式的不同分为腓骨截骨组(18例,采用腓骨截骨治疗)与胫骨截骨组(22例,采用内侧开放楔形胫骨高位截骨治疗).记录术后并发症发生情况和胫骨近端内侧角(MPTA),比较两组术后各时间点疼痛VAS评分、H...     

胫骨高位截骨术后髌骨低位

目的探讨胫骨高位截骨术治疗膝关节内侧间室骨性关节炎后髌骨低位与胫骨近端关节面后倾角度改变之间的关系,并提出预防和控制髌骨低位的措施。方法41例(48膝)膝关节内侧间隙骨性关节炎患者,男30例(33膝),女11例(15膝);年龄45～56岁,平均52岁。所有病例均行胫骨外侧高位楔形截骨术。根据术前测量的截骨角度(内翻角+正常外翻角+过度矫形3°～5°),在槽刀和导向器等辅助下切除楔形骨块,用改良Giebel槽式钢板拉力螺钉内固定,术后不需外固定。测量48膝行胫骨高位截骨术患者术前及术后X线片的Insall-Salvati比值、胫骨近端关节面后倾角度、胫骨结节高度、患肢解剖轴线角度,并用χ2检验和直线回归分析进行统计学处理。检验时假定术后胫骨近端关节面后倾角度减小≥5°以及髌骨高度下降≥10%具有临床意义。结果术后胫骨近端关节面后倾角度比术前平均减小6.14°,Insall-Salvati比值术前、术后相对变化率为10.6%,胫骨结节高度比术前平均下降3.13mm。64.6%的病例胫骨近端关节面后倾角度减小≥5°。按Insall-Salvati比值结果,56.2%的病例髌骨高度相对下降率≥10%。胫骨近端关节面后倾角度的减小与髌骨高度的相对下降具有显著的统计学相关性。结论胫骨近端关节面后倾角度的减小与髌骨低位具有相关性,提示在施行胫骨高     

胫骨高位截骨术治疗内翻型膝关节骨关节炎远期疗效观察

为评价应用高位胫骨截骨术治疗内翻型膝关节骨关节炎的远期疗效，对２４例（２９膝）进行平均１０６年的随访。结果显示，８２６％疗效优良或满意。疗效与年龄有关，理想的股胫外侧角度（简称ＦＴＡ）１６８°～１７２°。５０岁以下，ＦＴＡ为１６５°～１７５°者多能获得满意以上结果。术式选用胫骨结节上楔形截骨抑或倒Ｖ截骨，应根据有无髌股关节炎而定。只要选择恰当，疗效与术式无关。本文结论是治疗６０岁以下内翻型膝关节骨关节炎应首选高位胫骨截骨术     

改良胫骨高位截骨治疗膝内侧骨性关节炎

[目的]探讨改良胫骨高位楔形截骨治疗膝内侧骨性关节炎的可行性及疗效。[方法]采用小腿上段外侧弧形切口,游离上胫腓关节,显露胫骨上段,于胫骨平台下2 cm处楔形截骨,林克胫骨高位截骨板内固定。[结果]术后随访1~4年,平均3.2年。其中1例因内科疾病长期卧床而功能欠佳,1例内固定失败改为石膏外固定。无感染及不愈合,无上胫腓关节不稳。参照窦宝信评分标准,优9例(11膝),良2例(3膝),可1例(1膝),优良率为93.75%。[结论]改良胫骨高位截骨治疗膝内侧骨性关节炎,术式简单,组织创伤小,手术时间短,术后无需外固定,下床活动早,功能恢复快,效果满意。     

胫骨高位截骨术后胫骨后倾角度的变化

目的测量胫骨高位截骨术后胫骨后倾角度,并与术前比较,探讨其改变的临床意义。方法1998～2001年,对38例(58膝)膝关节内侧间室骨性关节炎患者行胫骨高位截骨术,男8例(11膝),女30例(47膝);年龄41～65岁,平均55.2岁。采用Gieble槽式钢板内固定的闭合楔形截骨。截骨线位于胫骨结节上方,距关节面约2 cm。在术前、术后侧位X线片上测量胫骨后倾角度,即胫骨平台关节面与胫骨纵轴的垂直线的夹角;使用Insall-Salvati指数测量髌骨高度,即髌腱长度(从髌骨下极到胫骨结节)和髌骨长度(髌骨的最长径)的比值,并计算胫骨后倾角度和髌骨高度在手术前后的变化。采用配对t检验进行统计学分析,以P<0.01为差异有显著性意义。结果胫骨高位截骨术前胫骨后倾角度平均为9.4°±3.0°,术后平均为5.6°±2.6°,术后较术前平均减小3.8°±2.0°。手术前、后胫骨后倾角度比较差异有显著性意义(P<0.01)。Insall-Salvati比值术前平均为1.05±0.16,均大于0.8;术后平均为0.94±0.18,有7膝小于0.8;术后较术前平均减小0.15±0.10。手术前、后Insall-Salvati比值,即髌骨高度,比较差异有显著性意义(P<0.01)。结论胫骨后倾角度在胫骨高位截骨术后明显减小,可导致髌骨低位等一系列并发症,将对再行全膝关节置换术产生不良影响。     

关节镜联合内侧开放楔形胫骨高位截骨术后的步态分析

目的 探讨关节镜联合内侧开放楔形胫骨高位截骨术治疗膝关节内侧间室骨关节炎的短期治疗效果及步态分析.方法 选择2018年5月-2019年6月接受关节镜联合内侧开放楔形胫骨高位截骨术治疗膝关节内侧间室骨关节炎的18例患者,所有患者膝关节OA分级在Ⅱ～Ⅲ,术前常规摄下肢负重位力线片,并测量胫骨近端内侧角(MPTA)、股骨远端...     

膝关节周围截骨术治疗膝外翻性骨关节炎研究进展北大核心CSCD

目的对近年膝关节周围截骨术治疗膝外翻性骨关节炎的手术方式研究进展进行综述。方法查阅近年国内外膝外翻性骨关节炎截骨手术治疗相关文献,对膝关节周围截骨术不同手术方式的优缺点、疗效进行总结。结果对于有症状且年轻、活动度大的膝外翻性骨关节炎患者,膝关节周围截骨术是一种安全、可靠的治疗选择。目前,临床应用的主要手术方式有股骨远端内侧闭合楔形截骨术、股骨远端外侧张开楔形截骨术、胫骨近端内侧闭合楔形截骨术、胫骨近端外侧张开楔形截骨术。不同截骨手术方式的适应证和优缺点不同,选择正确的截骨手术方式对取得良好的临床疗效至关重要。结论膝关节周围截骨术治疗膝外翻性骨关节炎有多种手术方式,为获得良好预后、提高生存率、减少并发症发生,需要根据不同情况制定最合理的手术策略。     

胫骨近端截骨联合异体股骨头植骨治疗膝骨关节炎

[目的]介绍胫骨近端开放楔形截骨联合同种异体股骨头植骨治疗膝骨性关节炎的手术技术与临床疗效。[方法] 2014年6月～2016年4月对20例膝内翻合并内侧间室骨关节炎患者进行胫骨近端开放楔形截骨联合同种异体股骨头植骨治疗。采用Miniaci法进行冠状平面矫正的术前设计,行胫骨近端内侧弧形切口,打入3枚导针,透视确定骨圆针位置满意后,采用摆锯和截骨骨凿,至距离胫骨外侧皮质1cm处,逐步撑开内侧胫骨截骨处,至力线杆应通过胫骨髁间棘外侧1/3的位置。按截骨间隙张开程度截取同种异体股骨头骨块,植入胫骨内侧截骨间隙,采用胫骨近端加压锁定钢板内固定。[结果] 20例患者均顺利手术,无严重并发症。术后平均随访(14.62±5.84)个月。VAS评分从术前的(2.48±1.82)分降至末次随访时的(0.63±1.21)分,差异有统计学意义(P0.05)。术后所有患者截骨处均达到骨性愈合。胫股角由术前(192.58±3.77)°显著矫正至末次随访时(173.62±2.43)°(P0.05),平均矫正度(10.02±4.29)°。[结论]应用胫骨近端开放楔形截骨结合同种异体股骨头植骨治疗膝内翻合并单间室骨关节炎可获得良好的临床效果。     

胫骨结节上与结节下截骨治疗膝单间室骨关节炎对比

目的探讨膝内侧胫骨结节上截骨与胫骨结节下截骨治疗膝关节单间室骨关节炎的临床疗效对比分析。方法从2006年6月至2013年6月期间,于我院行内侧胫骨高位截骨的病例中,随机抽取50例胫骨结节上截骨患者,50例胫骨结节下截骨患者,平均随访时间20.5个月,回顾分析其病例特点、HSS评分、股胫角变化、髌骨高度变化,对比两种截骨方式的临床疗效。结果两种手术在矫正角度方面没有明显差异。然而,胫骨结节下截骨比胫骨结节上截骨术后矫正角度丢失的更少。胫骨结节下截骨对髌骨高度没有影响。结论对于膝关节内侧间室骨关节炎和内翻膝的治疗,胫骨结节下截骨比胫骨结节上截骨疗效更好。     

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.     

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.