扩髓交锁髓内钉治疗胫骨不稳定性骨折 (附42例报告)

目的探讨扩髓交锁髓内钉治疗胫骨不稳定性骨折的治疗效果.方法对42例胫骨不稳定性骨折病人行扩髓交锁髓内钉治疗,闭合性骨折22例,开放性骨折20例,全部应用静力性固定.结果平均随访时间12个月(6～20个月),采用Johner-Wruh评分标准,治疗结果优32例,良8例,一般2例,骨折平均愈合时间闭合性骨折15周(10～23周),开放性骨折19周(13～36周),3例延迟愈合,无深部感染、骨髓炎、畸形愈合及骨不连.结论扩髓交锁髓内钉是治疗胫骨不稳定性骨折较理想的方法,可促进骨折愈合,并发症较少.     

扩髓交锁髓内钉治疗胫骨不稳定性骨折（附42例报告）

目的：探讨扩髓交锁髓内钉治疗胫骨不稳定性骨折的治疗效果。方法：对42例胫骨不稳定性骨折病人行扩髓交锁髓内钉治疗，闭合性骨折22例，开放性骨折20例，全部应用静力性固定。结果：平均随访时间12个月（6-20个月），采用Johner-Wruh评分标准。治疗结果：优32例，良8例，一般2例，骨折平均愈合时间；闭合性骨折15周（10-23周），开放性骨折19周（13-36周）。3例延迟愈合，无深部感染，骨髓炎，畸形愈合及骨不连。结论：扩髓交锁髓内钉是治疗胫骨不稳定性骨折较理想的方法，可促进骨折愈合。并发症较少。     

交锁髓内钉治疗股骨、胫骨干粉碎性骨折

目的：交锁髓内钉治疗股骨、胫骨干粉碎性骨折临床观察。方法：应用小切口切开复位，选择性扩髓，交锁髓内钉内固定治疗股骨，胫骨干粉碎性骨折26例，结果：本组26例随访时间6－24个月，平均14个月，骨折平均愈合时间14周，无术后感染，脂肪栓塞，断钉，骨折不愈合，畸形愈合，关节僵硬，再骨折等严重并发症发生，结论：本组股骨、胫骨干粉碎性骨均属不稳定型骨折，交锁髓内钉固定疗效是确切的，可采用小切口切开复位并选择性扩髓，不主张早期负重或做动力化处理。     

应用扩髓交锁髓内钉治疗胫骨不稳定性骨折

目的 探讨扩髓交锁髓内钉治疗胫骨不稳定性骨折的治疗效果。方法 对42例胫骨不稳定性骨折患行扩髓交锁髓内钉固定，闭合性骨折22例，开放性骨折20例，均应用静力性固定。结果 平均随访时间12个月，采用Johner—Wruh评分标准，治疗结果：优32例，良8例，一般2例。骨折平均愈合时间：闭合性骨折15周，开放性骨折19周，3例延迟愈合，无深部感染、骨髓炎、畸形愈合及骨不连发生。结论 扩髓交锁髓内钉是治疗胫骨不稳定性骨折较理想的方法，可促进骨折愈合，并发症少。     

顺行扩髓交锁髓内钉治疗股骨干骨折(附237例报告)

目的：探讨顺行扩髓交锁髓内钉治疗股骨干骨折的治疗效果。方法：对1996年6月～2002年7月应用顺行扩髓交锁髓内钉治疗237例股骨干骨折进行回顾分析。骨折类型根据AO／ASIF分类，A型骨折88例，B型124例，C型25例。其中开放性骨折36例，包括Gustilo Ⅰ型至ⅢA型，闭合性骨折201例。全部应用静力固定。结果：平均随访时间12个月(6～22个月)，闭合性骨折平均愈合时间15周(10～22周)，开放性骨折18周(13～36周)。12例延迟愈合，无深部感染、骨髓炎、畸形愈合、骨不连及断钉等并发症。全部患者术后邻近关节的功能均恢复正常。结论：扩髓交锁髓内钉是治疗股骨干骨折较理想的方法，骨折愈合率高，并发症较少。     

扩髓带锁髓内钉治疗胫骨干骨折不愈合

目的：探讨使用扩髓带锁髓内钉治疗胫骨干骨骨折不愈合的临床治疗效果。方法：回顾本院自2000年1月～2003年6月应用扩髓带锁髓内钉治疗胫骨干骨折不愈合病人38例。其中钢板固定术后21例，普通髓内针8例，石膏固定6例，外固定架3例。均采用有限切口切开复位并扩髓，静力锁定加植骨术。结果：平均髓访时间18．5个月(7～30个月)。骨折均愈合，骨折愈合时间3．5～13．5个月，平均5．5个月。临近关节功能较术前明显改善，无感染、断钉等并发症。结论：扩髓带锁髓内钉治疗胫骨干骨折不愈合，具有稳定性可靠、利于骨折愈合及早期关节活动的优点，是治疗胫骨干骨折不愈合的有效方法之一。     

应用交锁髓内钉治疗胫骨骨折68例报告

目的观察交锁髓内钉治疗胫骨骨折的疗效。方法自1997年至2003年，采用交锁髓内钉技术治疗68例胫骨骨折患者，其中男49例，女19例，年龄19-74岁，平均37．4岁。新鲜骨折51例，陈旧性骨折17例，其中已行手术后骨不连11例。闭合插钉46例，开放插钉22例。采用扩髓插钉法43例，不扩髓插钉法25例。结果65例获随访，随访时间9～36个月。骨折一期愈合59例。平均骨折愈合时间为18周。并发症：2例骨延迟愈合，2例骨不连，1例感染，1例远端锁钉断裂。结论交锁髓内钉治疗胫骨骨折具有创伤小、骨折愈合率高、感染率低、早期功能活动等优点。对胫骨多段粉碎骨折、胫骨开放性骨折、胫骨骨折术后骨不连尤为适合。但应注意必须正确使用，降低手术并发症的发生率。     

不扩髓交锁髓内钉治疗胫骨开放性骨折

目的 :评估不扩髓交锁髓内钉治疗胫骨开放性骨折的疗效。方法 :应用不扩髓交锁髓内钉治疗胫骨开放性骨折 46例 ,CustiloⅠ型 15例 ,CustiloⅡ型 17型 ,CustiloⅢA型 7例 ,CustiloⅢB型 5例。结果 :平均随访 17.1个月 ,平均愈合时间 2 5周 ,采用Joher Wruh评分 :优 3 0例、良 13例、中 1例、差 2例 ;无主钉弯、断、旋 ,锁钉脱出现象 ,感染 2例 ,骨折全部愈合。结论 :不扩髓交锁髓内钉在治疗胫骨开放性骨折中具有创伤小、固定坚强、感染率低、骨折愈合率高等优点 ,只要掌握好适应证及手术时机 ,是治疗胫骨开放性骨折的较好方法。     

扩髓带锁髓内钉治疗胫骨干骨折不愈合

目的:探讨使用扩髓带锁髓内钉治疗胫骨干骨骨折不愈合的临床治疗效果.方法:回顾本院自2000年1月～2003年6月应用扩髓带锁髓内钉治疗胫骨干骨折不愈合病人38例.其中钢板固定术后21例,普通髓内针8例,石膏固定6例,外固定架3例.均采用有限切口切开复位并扩髓,静力锁定加植骨术.结果:平均髓访时间18.5个月(7～30个月).骨折均愈合,骨折愈合时间3.5～13.5个月,平均5.5个月.临近关节功能较术前明显改善,无感染、断钉等并发症.结论:扩髓带锁髓内钉治疗胫骨干骨折不愈合,具有稳定性可靠、利于骨折愈合及早期关节活动的优点,是治疗胫骨干骨折不愈合的有效方法之一.     

扩髓交锁髓内钉治疗股骨及胫骨干骨折

目的:总结使用扩髓交锁髓内钉治疗股骨及胫骨干骨折的临床经验。方法:回顾2000年2月～2003年1月使用扩髓交锁髓内钉治疗股骨干骨折49例,其中股骨18例,胫骨31例;闭合性骨折40例,开放性骨折9例,均采用国产带瞄准器交锁髓内钉,以小切口开放复位,顺行扩髓并静力锁钉。结果:随访时间8～12以上,骨折均骨性愈合,平均愈合时间19.5周,邻近关节功能恢复好,无深部感染、断钉及脂肪栓塞等并发症。结论:采用小切口开放复位、扩髓、静力锁定治疗股骨及胫骨干骨折,具有骨折固定强度大、愈合快,邻近关节活动早,无断钉、骨折再移位、感染明显升高等优点,是治疗股骨及胫骨干骨折的理想方法之一。     

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.