老年股骨粗隆间骨折外固定术

作者从1994年3月～1999年6月利用解放军304医院研制的单侧成角外固定器治疗老年股骨粗隆间骨折26例,随访6～18个月,骨愈合时间平均11.8周,无脱针、断针,无髋内翻、再手术、深部感染和死亡等。本外固定具有创伤小、操作简单、手术时间短、固定可靠、允许早期负重、功能恢复快、并发症少,通过调节固定器,使骨折部位内翻剪力转变为压应力,促进骨折愈合等优点。对于治疗老年体弱多病,手术耐受力差的股骨粗隆间骨折患者,具有明显优势。     

经皮微创锁定加压钢板内固定治疗老年股骨粗隆间骨折

[目的]探讨经皮微创钢板接骨术(MIPPO)结合锁定加压钢板(LCP)内固定治疗老年股骨粗隆间骨折的手术方法及临床效果.[方法]对2008年4月～2009年10月本院收治的20例股骨粗隆间骨折患者采用MIPPO技术结合LCP进行内固定治疗.其中男9例,女11例,年龄72～92岁,平均81岁.Tronzo-Evans分型:Ⅰ型2例,Ⅱ型3例,Ⅲ型10例,Ⅳ型3例,Ⅴ型2例.[结果]20例均获随访,随访时间12～30个月,平均18个月.愈合时间11～14周,仅1例不愈合.无感染、深静脉血栓、骨折不愈合、内固定松动、断钉并发症.术后功能按Hams评分:优15例、良4例、可1例,优良率95%.[结论]MIPPO技术结合LCP内固定治疗老年股骨粗隆间骨折,手术时间短,术中创伤小,固定简约可靠,术后骨折愈合率高,并发症少,功能良好,是治疗老年股骨粗隆间骨折的良好方法.     

微创股骨近端锁定加压钢板治疗老年股骨粗隆间骨折

目的探讨微创锁定加压钢板(LCP)治疗老年股骨粗隆间骨折的疗效。方法应用股骨近端LCP内固定治疗老年股骨粗隆间骨折21例,骨折按AO分类:A1型8例,A2型9例,A3型4例。结果切口长度4～6cm,手术时间40～75min,术中出血50～200ml。21例获3～14个月随访,骨折愈合时间2～4个月,无髋内翻、骨不连和内固定失效。结论微创股骨近端LCP治疗老年股骨粗隆间骨折创伤小,固定可靠,有利于老年患者全身状况和肢体功能恢复。     

高危股骨粗隆间骨折患者的外固定器治疗

目的:探讨合并高危因素股骨粗隆间患者的固定方法。方法:对37例患者行单臂外固定器治疗。结果:27例随访6月到1年,全部治愈,仅有一点活动不便。结论:作者认为,外固定器治疗方法简单、安全,创伤小,骨折愈合快,能早期活动,符合“BO”固定原则,是治疗合并高危因素股骨粗隆间骨折患者的理想方法。     

滑动加压股骨粗隆间骨折外固定器的设计和临床应用

目的报告股骨粗隆间骨折滑动加压外固定器的设计和初步临床应用结果。方法在单侧成角外固定器和动力髋螺钉（DHS）的基础上，设计制作滑动加压外固定器。自2003年5月～2005年12月，用此新型外固定器治疗老年股骨粗隆间骨折22例。结果获随访20例，时间2～30个月，平均12个月。骨折全部愈合，愈合时间10～13周，平均12周。术后针孔感染4例，无深部感染发生，无骨折不愈合及髋内翻，髋关节功能恢复良好。结论滑动加压外固定器使用方便、灵活，兼有加压和滑动双重功能，能根据临床需求进行动静力固定转换，使固定更合理，能防止髋内翻及固定针滑脱或穿越股骨头等情况发生，是治疗高龄股骨粗隆间骨折患者较理想方法。     

自制螺纹针骨水泥外固定器在92例股骨粗隆间骨折手术中的应用

目的 探讨自制螺纹针、骨水泥外固定器在股骨粗隆间骨折手术中的应用疗效.方法 对股骨粗隆间骨折92例,应用自制螺纹针、骨水泥外固定器在C型臂X线机透视下微创手术.结果 本组随访6～24个月.疗效按Harris评定标准:优68例,良21例,可3例.结论 自制外固定器结合C型臂X线机透视下手法复位治疗股骨粗隆间骨折,具有操作...     

单边外固定器在老年股骨转子间骨折治疗中的应用

目的回顾分析闭合复位、单边外固定器固定治疗老年股骨转子间骨折的疗效。方法1997年6月～2003年6月，用单边外固定器治疗老年股骨转子间骨折63例，年龄65～93岁，平均77．8岁，所有患者至少合并一种以上系统性内科疾病。骨折类型包括顺转子间线骨折(Evan’s分型)：Ⅰ型1例，Ⅱ型7例，ⅢA型27例，ⅢB型6例，Ⅳ型18例；逆转子间线骨折4例。结果所有患者随访5～30个月，平均17个月。骨折全部愈合，愈合时间8～20周，平均12周。最后一次随访时患者髋关节功能情况(创伤性髋关节评分系统)：优33例、良24例、差6例。术后有8例出现针道感染，经口服抗生素及局部换药等处理好转，无深部感染及骨髓炎发生，无骨折不愈合及髋内翻，无肢体短缩等畸形愈合．结论单边外固定器治疗老年股骨转子间骨折可获得满意的骨折愈合和髋关节功能，对伴有系统性内科疾病的高危股骨转子间骨折患者是有价值的替代治疗方法。     

外固定器结合高压氧治疗老年股骨粗隆间骨折

目的 :老年股骨粗隆间骨折用外固定支架结合高压氧疗法治疗 ,为骨折的早期愈合奠定基础。方法 :手法复位后 ,C型臂下用力臂式外固定器固定结合术后高压氧治疗。结果 :本组 52例 ,平均年龄 70岁 ,经 1～ 2 .5年的随访 ,有 2例针道感染 ,感染率 3 .8%,骨折愈合良好 ,外固定有 2例松动 ,髋内翻 2例。结论 :外固定器结合高压氧治疗老年股骨粗隆间骨折疗效显著 ,有效的降低了手术的并发症的发生 ,是治疗骨折可行的好方法。     

微创闭合复位结合外固定架治疗老年股骨粗隆间骨折

目的:探讨微创闭合复位结合外固定架治疗老年股骨粗隆间骨折的临床疗效。方法:2007年8月至2013年9月,采用微创闭合复位结合外固定架固定治疗股骨粗隆间骨折43例,男26例,女17例;年龄68～92岁,平均78岁;受伤至手术时间1～8 d,平均3 d.按照AO分型:A1型22例,A2型15例,A3型6例。观察术后骨折的愈合时间,并采用Harris评分系统对治疗效果进行评价。结果:43例患者均获得随访,时间10～18个月,平均13个月。手术切口在拔除外固定后Ⅰ期/甲级愈合,骨折均愈合,愈合时间12～18周,平均16周。2例股骨粗隆部螺纹针松动,2例髋内翻畸形,1例延迟愈合。无骨不连、外固定物断裂、血管神经损伤病例。术后Harris髋关节评分为85.89±7.36,优18例,良19例。结论:微创闭合复位结合外固定架治疗老年股骨粗隆间骨折可获得良好的临床疗效,对不能耐受麻醉和手术创伤的老年患者是一种简单、有效的治疗方法。     

微创改良DHS内固定治疗老年股骨粗隆间骨折

目的 观察微创改良DHS内固定治疗老年股骨粗隆间骨折的临床疗效.方法 应用微创闭合复位改良DHS(DHS联合空心拉力螺钉)内固定治疗老年股骨粗隆间骨折治疗38例.结果 38例随访6～36个月,骨折全部愈合.功能评定:优28例,良8例,可2例.结论 微创改良DHS内固定治疗老年股骨粗隆间骨折,具有操作简单、创伤小,固定牢靠、可以早期功能锻炼,有利于骨折愈合等优点,疗效满意.     

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.     

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.