钢丝环扎与张力带钢丝内固定治疗髌骨骨折的比较

髌骨骨折手术方式以前以钢丝环扎内固定或部分切除为主,目前以张力带钢丝内固定为主。我院1987～1998年行髌骨骨折手术638例,其中钢丝环扎内固定382例,张力带钢丝内固定217例,其他方式39例,报道如下。1　材料与方法11　病例资料　本组皆为新鲜闭合骨折。钢丝环扎内固定382例,男267例,女115例,年龄19～73岁;其中粉碎性骨折216例,占565%。张力带钢丝内固定217例,男136例,女81例,年龄20～68岁,其中粉碎性骨折119例,占548%。12　手术方式121　钢丝环扎组　非粉碎性骨折在髌骨上下骨片横形钻孔后环扎。粉碎性骨折用巾钳将骨折块复位后,用1ｍｍ钢…     

可吸收缝线张力带环扎绑扎髌骨骨折的临床研究

我院2005年以来采用可吸收缝线张力带环扎绑扎法治疗髌骨骨折57例,现报道如下。一、对象与方法1.一般资料:2005年8月至2011年3月收治闭合性有手术指征(根据X线表现)的髌骨骨折共114例,随机分成可吸收缝线张力带及环扎绑扎法治疗组患者57例(观察组Ⅰ),克氏针钢丝张力带固定治疗组患者57例(对照组Ⅱ),两组病例均得到随访,随访时间6～18个月。组Ⅰ 57例,男39例,女18例,年龄(45.46±13.69)岁,骨折类型:横行骨折30例,粉碎骨折49例,其中骨折块3块以上18例。对照组57例,男40例,女17例,年龄(52.25±15.28)岁,骨折类型:横行骨折25例,粉碎骨折32例,其中骨折块3块以上15例。两组患者性别、年龄比较,差异均无统计学意义(P＞0.05)。     

关节镜监视下可吸收缝线固定治疗髌骨粉碎骨折

目的 :探讨关节镜监视下复位 ,可吸收缝线张力带固定治疗髌骨粉碎骨折的方法。方法 :15例髌骨粉碎骨折在关节镜下复位 ,达到关节面平整 ,然后经皮用可吸收缝线行张力带固定。结果 :15例髌骨粉碎骨折全部经临床随访 ,平均 15个月。日常生活均无疼痛 ,12例屈膝 12 0°以上 ,3例 90°～ 110°,X线检查示骨折愈合良好 ,无明显创伤性关节炎表现。结论 :关节镜下治疗髌骨粉碎骨折 ,使关节面平整 ,减少创伤性骨关节炎的发生 ,经皮可吸收缝线张力带固定 ,有利于早期活动 ,减少关节僵直的发生 ,不用第二次手术取出     

二、三部分肱骨近端移位骨折的手术治疗

目的探讨二、三部分肱骨近端移位骨折的手术治疗方法。方法肱骨近端移位骨折29例,二部分骨折22例,三部分骨折7例,闭合复位经皮克氏针固定7例,切开复位,不可吸收缝线固定1例,单纯螺钉固定6例,普通4孔钢板固定3例,张力带固定2例,髓内针张力带固定5例,“T”钢板固定5例。结果平均随访18月,采用Neer分类及评分对各手术疗效进行评价。其中二部分骨折优良率为72.7%,未出现骨折不愈合及肱骨头坏死;三部分骨折优良率为42.9%,肱骨头坏死率28.6%。结论二、三部分骨折尽量采用有限切开复位,其中二部分骨折可选择单纯螺钉、张力带或髓内针张力带固定,三部分骨折可选择髓内针张力带固定。     

可吸收双重内固定材料治疗髌骨骨折

2003年3月～2008年6月,笔者采用可吸收张力带内固定治疗髌骨骨折55例,疗效满意。1材料与方法1.1病例资料本组55例,男23例,女32例,年龄45～86岁。闭合性骨折54例,开放骨折1例;横形骨折18例,斜形和纵形骨折12例,粉碎性骨折25例;     

张力带固定治疗髌骨粉碎骨折16例

张力带固定治疗髌骨骨折已被大多骨科医师认可 ,粉碎性骨折或下极骨折的治疗方法尚有争议 ,我们 96年 3月至2 0 0 0年 3月收治粉碎骨折及下极骨折 16例 ,采用张力带固定治疗取得了较满意临床效果。临床资料一、一般资料　本组 16例 ,男 13例 ,女 3例 ,年龄 2 5～70岁 ,平均年龄 47岁 ,闭合骨折 15例 ,开放骨折 1例 ,伤后2 4h内入院 14例 ,伤后 5 d内入院 2例 ,伤后急诊手术治疗14例 ,1w内手术治疗 2例。影像学检查 :粉碎骨折 (星状型或3块骨折 ) 12例 ,髌骨下极骨折 2例。二、手术方法　本组 16例采用蛛网膜下腔阻滞麻醉 (单侧 ) ,在气压止…     

空心钉加钢丝张力带固定治疗髌骨骨折

2009年5月～2012年10月,我科应用空心加压螺钉结合钢丝张力带固定治疗47例髌骨骨折患者,取得了满意疗效,报道如下。1材料与方法1.1病例资料本组47例,男27例,女20例,年龄22～75岁。移位明显的单纯横断闭合骨折32例,斜形骨折4例,粉碎骨折(粉碎不严重)11例。均为新鲜骨折。手术时间为伤后2 h～7     

开放与闭合复位张力带治疗AO Ⅲ型髌骨粉碎性骨折的疗效比较

目的比较开放与闭合复位张力带治疗AOⅢ型髌骨粉碎性骨折的临床疗效。方法将2013年5月至2018年5月云浮市人民医院收治的80例AOⅢ型髌骨粉碎性骨折患者随机分为开放组和闭合组,每组40例。开放组予开放复位张力带内固定治疗,闭合组予闭合复位张力带内固定治疗,所有患者均进行术后6个月的跟踪随访,比较两组患者临床疗效的差异。结果闭合组患者手术时间、术中出血量、切口长度、住院时间、骨折愈合时间及术后并发症发生率均明显少于开放组,术后2周,1、3、6个月美国特种外科医院(HSS)膝关节评分均明显高于开放组(P 0.05)。结论与开放术式比较,闭合复位张力带内固定治疗AOⅢ型髌骨粉碎性骨折创伤小,骨折愈合快,膝关节功能恢复良好,术后并发症发生率低,短期疗效显著。     

国产钛制空心钉结合张力带钢丝内固定手术治疗髌骨骨折

2003年1月～2009年3月,我科采用钛制空心拉力螺钉结合张力带钢丝内固定髌骨骨折治疗61例髌骨骨折,取得较好疗效。 1材料与方法1.1病例资料本组61例,男38例,女23例,年龄15～85岁。横形骨折21例（图1A）,粉碎性骨折36例,纵形骨折2例,髌骨下极撕脱骨折2例。1.2手术方法全部采用硬膜外麻醉。     

多向张力带治疗髌骨粉碎性骨折的临床应用

1996年1月～2 0 0 2年1月,针对髌骨粉碎性骨折6 8例采用了多向张力带固定的手术治疗,术后不使用外固定并能早期进行膝关节的主动功能锻炼,并发症甚少,手术操作简单,疗效满意。现报道如下。1　临床资料1 1　一般资料　1 0 3例粉碎程度严重的髌骨骨折,其中6 8例采用多向张力带固定,35例采用其它手术方法固定,其骨折类型以髌骨体部及下极粉碎为多见。所有病例均在伤后30min～1 2h内就诊。1 2　手术方法　切口采用髌前横(弧向下)或直切口,开放性者根据具体情况沿长。清除血肿充分显露髌前腱膜及股四头肌扩张部和髌骨骨折块及关节面,骨折形态以…     

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.     

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.