两枚拉力螺钉固定治疗内踝骨折

内踝骨折属关节内骨折,为了最大限度地恢复踝关节功能,就要进行早期功能锻炼。为达到此目的,骨折常需要进行牢固固定,内踝多钉固定犤1犦就是基于这样的目的。本组采用手术治疗22例,报告如下。1临床资料1.1一般资料:本组22例,男16例,女6例;年龄19～56岁。采取两枚螺钉固定者12例,其中10例为单纯内踝骨折,伴有高位腓骨骨折2例。按lauge-hansen分型,其中旋后内收型2度4例,旋前外展型1度2例,旋前外旋型1度4例,旋前外旋型3度2例。采取一枚螺钉固定者10例,其中旋前外展型1度2例,旋后内收型2度2例,旋前外旋型1度6例。1.2两枚螺钉固定手术方法:采用…     

几丁糖预防踝关节骨折后粘连42例报告

1　一般资料　本组资料共 42例 ,其中男 14例 ,女 2 8例 ,年龄 16～ 62岁 ,平均 3 5 .5岁 ;开放性骨折 10例 ,闭合性骨折 3 2例 ;本组皆由外伤所致。单踝骨折 11例 ,双踝骨折 2 5例 ,三踝骨折 6例 ;伤后 2 4ｈ内接受手术者 3 8例。随机分为实验组与对照组 ,实验组 2 2例 ,对照组 2 0例 (几丁糖采用上海其胜公司生产的医用几丁糖 )。2　治疗方法在硬膜外麻醉下 ,应用止血带 ,复位固定顺序依次为内踝、后踝、外踝 ;内踝固定采用张力带方法 ,后踝采用松质骨螺钉 ,外踝采用钢板 ;在闭合创、切口前 ,皆经Ｃ形臂Ｘ线机透视证实解剖复位后 ,实验组…     

Maisonneuve骨折手术治疗13例

Maisonneuve骨折是一种特殊类型的踝部旋前外旋型骨折,包括下胫腓联合分离,内踝骨折,腓骨高位螺旋型骨折,位置可高达腓骨颈.我院自1994年至今共手术治疗13例,取得满意疗效,现报告如下. 1 临床资料 本组13例,男9例,女4例.年龄最大48岁,最小21岁.扭伤5例,交通事故6例,运动损伤2例.受伤到就诊时间30分钟～6天. 2 治疗方法 本组13例全部采用连硬外麻醉下,行手术切开复位.先固定腓骨,再固定下胫腓联合,最后固定内踝.8例腓骨骨折端重叠超过5mm,用4孔或5孔钢板固定;5例骨折端重叠移位在3mm以下,行克氏针固定.用1～2枚螺钉固定分离的下胫腓联合和胫腓下段,内踝骨折用1枚螺钉固定.术后石膏固定4周,8周开始拄拐逐渐负重锻炼,10～12周取出内固定物.     

可吸收螺钉治疗踝关节骨折

目的:探讨可吸收螺钉治疗踝关节骨折的临床疗效。方法:应用可吸收螺钉治疗踝关节骨折58例,男31例,女27例;平均年龄28岁。三踝骨折5例,内踝骨折27例,外踝骨折26例,其中内外踝骨折9例,合并下胫腓联合分离6例,合并腓骨下段骨折4例。单纯内、外踝骨折采用2枚可吸收螺钉固定;同时内外踝骨折各骨折分别用2枚可吸收螺钉固定;合并下胫腓联合分离者,从腓骨向胫骨拧入1枚可吸收拉力螺钉固定胫腓关节;内踝合并腓骨下段骨折者,内踝用1或2枚可吸收螺钉,腓骨骨折用重建钢板内固定;三踝骨折者据骨折片大小分别每一骨折用1或3枚螺钉内固定。结果:50例均获得随访,时间1～4年,平均26个月,经Kennedy踝关节功能标准评分,优30例,良20例。无骨折延迟愈合及骨折不愈合、固定钉松动、踝穴不稳定、畸形愈合,无明显创伤性关节炎等严重并发症。结论:可吸收螺钉是种新型内固定材料,内固定治疗踝关节骨折疗效好,可免除二次手术,值得推广。     

可吸收内固定物治疗关节内骨折

近十几年来,许多学者纷纷探索开发生物降解可吸收骨折内固定物,并应用于临床。我院自1996年6月至1997年1月应用可吸收骨折内固定物治疗关节内骨折18例,取得了满意疗效,报告如下。 1 材料与方法 1.1 材料 采用芬兰生产的高分子聚合物-聚已交酯(SR-PGA)和聚丙交酯(SR-PLLA)制成的自身增强拉力螺钉和内固定棒。手术共使用拉力螺钉33枚,内固定棒9根。 1.2 临床资料 本组18例,男11例,女7例。年龄12～65岁,平均37岁。踝关节骨折12例(WeberB型8例,C型4例),胫骨平台骨折2例,尺骨鹰嘴骨折3例,肱骨头骨折1例,均为新鲜骨折。手术指征①严重的不稳定性关节内骨折;②闭合手法复位失败者;③开放性关节内骨折, 1.3 手术方法 以踝关节骨折为例:首先将骨折解剖复位,用可吸收拉力螺钉固定骨折断端,若合并有下胫腓关节分离,再用一可吸收内固定棒固定,以防骨折断端旋转。本组单纯内踝骨折2例,内、外踝骨折5例,内外踝及后踝骨折5例;内踝和外踝骨折复位后各用一枚拉力螺钉固定;后踝骨折<25％胫骨关节面时再加用一枚拉力螺钉固定(本组2例),后踝骨折>25％胫骨关节面时加用一根内固定棒(本组3例)。术后采用“U”型石膏托固定6周。     

可吸收螺钉在踝关节骨折中的应用

目的 探讨可吸收螺钉治疗踝关节骨折的疗效. 方法 2004年6月至2010年12月采用可吸收螺钉治疗16例踝关节骨折患者,男9例,女7例;年龄21～62岁,平均35岁;其中三踝骨折4例(AO分型:B型2例,C型2例),内外踝骨折8例(AO分型均为B型),单纯内踝骨折2例,单纯外踝骨折2例(1例为AO分型A型,另1例为外踝Maisonneuve骨折合并下胫腓联合和内侧三角韧带损伤).所有涉及外踝的骨折患者只有AO分型A型骨折采用2枚2.7 mm可吸收螺钉或1枚2.7mm可吸收螺钉辅助1枚1.5 mm可吸收棒固定,其余均采用接骨板螺钉固定.内踝骨折采用2～3枚3.5mm或4.0mm可吸收螺钉固定.1例下胫腓联合损伤采用2枚4.5 mm可吸收螺钉贯穿下胫腓固定.后踝骨折采用l～2枚4.0mm或4.5 mm可吸收螺钉从前向后固定.结果 16例患者术后获1.5～4.0年(平均28个月)随访.骨折愈合时间平均为3.0个月,无骨折延迟愈合及骨折不愈合,未出现伤口并发症.按美国足踝外科协会踝与后足功能标准评分评定疗效:优14例,良2例. 结论 可吸收螺钉内固定治疗踝关节骨折疗效好,无需行二次内固定取出手术,但要慎重选择骨折类型.     

胫骨Pilon骨折37例手术治疗

自 1 993～ 2 0 0 2年手术治疗Pilon骨折 37例 ,分别采取拉力螺钉 ,三叶草钢板或T型钢板 ,拉力螺钉和外固定架固定 ,经随访治疗效果令人满意。现报告如下。1　临床资料1 1　一般资料　本组 37例 ,男 2 8例 ,女 9例 ;年龄 1 8～5 9岁 ,平均 36 7岁。致伤原因 :交通伤 1 7例 ,坠落伤 1 4例 ,重物击伤 2例 ,摔伤 4例 ,开放性骨折 7例 ,闭合性骨折 30例。1 2　骨折分类　根据Vadia和Beals[1 ] 分型 ,Ⅰ型 :骨折块移位 3例 ,Ⅱ型 :骨折轻度移位 4例 ;Ⅲ型 :数块大骨片移位 1 0例 ;Ⅳ型 :多块粉碎骨折移位 ,干骺端较大缺损 1 1例 ;Ⅴ型 :严重…     

旋前--外旋型踝关节损伤42例生物力学临床分析

我院 92年以来共收治 1 2 2例踝关节损伤 ,从临床资料中对 42例旋前—外旋型进行生物力学临床机理分析。旨在给其治疗提供依据。报告如下 :临床资料一、一般资料　本组 42例 ,男 3 0例 ,女 1 2例 ,年龄 1 1～ 6 3岁 ,平均 3 2岁 ,损伤原因 :车祸 1 8例 ,坠落伤 1 2例 ,扭伤 1 0例 ,其中开放性骨折 1 5例。旋前—外旋型按 L auge— Hansen分度分　度 ° ° ° °病例数 36 1815　　二、治疗方法　本组病例行石膏外固定 7例 ,3 5例手术治疗 ,术中外踝骨折均行 4孔普通钢板螺钉固定 ,内踝骨折用松质骨螺钉固定。三、结果　经 1 0～ 48个月…     

跟骨骨折开放复位切口感染的原因分析

自 1997年 3月～ 2 0 0 3年 6月开放复位内固定治疗跟骨关节内骨折 4 7例 4 9足。其中切口感染 13例 ,占 2 6 5 %。现对切口感染的原因进行分析探讨。1　临床资料1 1　一般资料　本组 4 7例 ,男 39例 4 1足 ,女 8例 8足。年龄 2 4～ 6 2岁 ,平均 32岁。右侧 2 7例 ,左侧 2 2例 ,2例为双侧跟骨骨折。致伤原因 :高处坠落伤 36例 ,交通伤 9例 ,挤压伤 2例。其中开放骨折 2例。合并股骨干骨折 2例 ,腰椎骨折 3例。骨折类型 :根据Paley分类[1] :舌型骨折 7例 ,中央塌陷型骨折 18例 ,粉碎型骨折 2 4例。伤后距手术时间 ,除 2例开放骨折急诊清创…     

经皮可吸收螺钉内固定治疗Maisonneuve骨折

M aisonneuve骨折是一种特殊类型的踝关节损伤,表现为腓骨近段(上1/3部位)骨折,下胫腓韧带撕裂,外踝与胫骨下端分离,向外后方移位,三角韧带前部纤维撕裂或内踝骨折,内踝与距骨分离。自1999年7月至2005年7月采用可吸收螺钉经皮内固定治疗18例,术后配合U形石膏固定,疗效满意,现报告如下。1临床资料本组18例,男13例,女5例;年龄18~65岁,平均32·7岁;致伤原因:摩托车伤7例,行走扭伤6例,运动伤5例。伤后至手术时间2 h~13 d,平均2·3 d。腓骨损伤部位为腓骨干上段骨折11例,腓骨颈骨折5例,上胫腓联合分离2例。合并内踝骨折4例,内踝并后踝骨折1例。2…     

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.     

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.