半组合式人工半骨盆地研制及其临床应用

根据正常人体骨盆的形态结构和生物力学特点研制的一种以髋臼部为主体，髂骨翼部和耻，坐骨部为附件的半组合式钛质全表面喷涂陶瓷人工半骨盆，经临床初步应用和随访检查证明，其整体结构符合仿生要求，术中安装方便，固定可靠，适应性较强，术后骨盆和下肢功能恢复良好。     

人工半骨盆置换术结合自体骨移植1例

在半骨盆假体置换术后若发生假体松动,处理非常棘手。为了延缓半骨盆假体松动,我们曾在术中加用自体骨移植1例,随访至今,疗效满意。1　病例资料患者,女,24岁,因左髋臼部骨巨细胞瘤行刮除加骨胶填塞术,术后2年肿瘤复发(见图1),于1992年4月行人工半骨盆置换加全髋关节置换术。利用术中切下的股骨头、颈及大转子部骨质修剪成2ｃｍ×2ｃｍ×5ｃｍ的骨条块,列队移植于假体内侧,分别与耻骨及髂骨残端相连,用钛丝将其与假体捆扎固定。见图2。2　结果患者术后随访至今已8年(现32岁)。术后第2年Ｘ线检查发现移植的自体骨块融合,形成了具有生物活性的…     

髋骨恶性肿瘤的人工半骨盆置换:4例随访报告

[目的]对髋骨恶性肿瘤切除人工半骨盆置换的疗效进行临床研究.[方法]在2000年1月～2010年12月,对4例髋骨恶性肿瘤患者男3例,女1例,进行广泛切除和人工半骨盆置换后,经术后2年4个月～6年随访,患者手术年龄54、59、61和64岁(平均59.5岁).术前在DSA下栓堵相关血管和准备合适的人工半骨盆假体.[结果]3例髋骨肉瘤在术后2年4个月～3年内死亡,1例髋骨软骨肉瘤术后6年,尚健在.[结论]认为早期诊断,借助CAD/CAM技术制作人工半骨盆假体,术前充分准备,是使手术成功的重要条件.     

不同手术方式治疗原发性髋臼周围骨盆恶性肿瘤疗效比较

目的比较不同手术方式治疗原发性髋臼周围骨盆恶性肿瘤疗效。方法对15例手术治疗的骨盆肿瘤进行回顾性分析,人工半骨盆置换4例,内半骨盆切除9例,半骨盆切除2例。结果随访6-60个月,按Enneking方法进行评估：人工半骨盆置换组（4例）：优1例,一般2例,差1例;内半骨盆切除组（9例）：良5例,一般2例,差1例,死亡1例;半骨盆切除组（2例）：死亡2例。人工半骨盆置换和内半骨盆切除组疗效差异无显著性（P〉0.05）。结论人工半骨盆置换手术困难,内半骨盆切除仍是治疗骨盆肿瘤的有效方法。     

半骨盆内切除术后重建

骨盆截除后骨盆结构和功能的重建对于提高骨盆痰患的治疗与康复水平具有十分重要的意义。本文综述了多种丰骨盆内切除术后重建方法，着重讨论了半骨盆假体置换技术与研究方向。     

组合式骨外固定器治疗骨盆不稳定骨折脱位

我科自 1995年应用夏和桃教授研制的组合式骨外固定器治疗骨盆不稳定性骨折脱位 11例 ,效果满意。1　临床资料本组共 11例 ,男 7例 ,女 4例 ,年龄 2 3～ 47岁 (平均 31 7岁 ) ,均为车祸伤。其中合并颅脑损伤 4例 ,脊柱及四肢损伤4例 ,2例合并内脏损伤 ,7例合并创伤性休克 ,2例坐骨神经损伤但膀胱功能正常 ,2例鞍区麻木及二便失禁。患者受伤距手术时间 2～ 14天 ,平均 4天。分型 :ＡＯ分型 ,Ｂ1型 (翻书样损伤 ,外旋损伤 ) 4例 ,耻骨联合开口小于 2 5ｃｍ 1例 ,大于2 5ｃｍ 3例 ;Ｂ2 型损伤 (侧方挤压损伤内旋损伤 ) 4例 ,单侧型损伤 3例 ,…     

组合式螺柄人工股骨头的研制及临床应用

针对人工髋关节置换术后假体松动,下沉发生率比较高的特点,作者研制一种新型的人工股骨头,试图减少术后并发症的发生。设计出一种组合式螺纹柄结构的人工股骨头由头颈部和螺柄部组成,假体柄呈圆锥型表面有螺纹,能与髓腔充分接触以减少应力分布。     

半骨盆置换术治疗骨盆恶性肿瘤的初步应用

目的探讨半骨盆置换术在骨盆恶性肿瘤广泛切除和功能性保肢手术中的应用。方法回顾中山大学附属第一医院骨肿瘤科2003年至2006年18例半骨盆切除和重建手术治疗案例，评估骨盆恶性肿瘤广泛切除和假体置换术的疗效和并发症。结果中山大学附属第一医院骨肿瘤科18例骨盆原发性恶性骨肿瘤患者，接受了骨盆Ⅰ区＋Ⅱ区＋（Ⅲ区）切除和人工半骨盆假体置换手术。患者平均年龄为19岁，病理类型包括12例骨肉瘤、3例尤文肉瘤和3例纤维肉瘤，外科分期均为ⅡB。患者经过术前肿瘤评估，MRI显示肿瘤尚未侵犯髂血管和坐骨神经，全身骨扫描未显示肿瘤跳跃或转移，肺部CT显示肿瘤无转移；同时患者接受两个循环规范化术前化疗后，初步化疗评估为良好。术前充分准备，常规切除骨盆Ⅰ区＋Ⅱ区＋（Ⅲ区），安装组合式半骨盆。组合式半骨盆假体设计突出骶骨座、无髂骨、可调髋臼及耻骨支。术中平均出血3000ml（1500～6000m1）。1例术后腓总神经损伤，5例有伤口并发症，其中1例感染和1例残腔愈合不良的患者接受了股外侧肌（皮）瓣转移，伤口均一期愈合。术后3周开始功能锻炼，2至3个月可扶拐行走。平均随访36．73个月（15-58个月），2例局部复发，3例死于远处转移，MSTS功能评分平均65％。结论在骨盆原发性恶性肿瘤的治疗中，广泛切除是治愈肿瘤的关键，应用半骨盆假体置换能有效重建骨骼缺损，联合肌皮瓣移植可以解决困难的伤口并发症，患肢功能可以接受。改进假体设计，改善患肢功能是今后努力的方向。     

半骨盆截肢术后废弃肢体的再利用

近二十年来,随着骨盆肿瘤分区概念的提出,外科手术方法的进步,影像学技术的革新,各种骨盆重建方法的发展以及化疗方案的改进,半骨盆内切除术的保肢手术已经成为治疗骨盆肿瘤的主要方法[1-4].     

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.     

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.     

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.     

Intrathecal administration of sameridine to patients subjected to arthroscopic knee joint surgery

Background: Sameridine, a new substance with both local anesthetic and opioid effects, was administered intrathecally for the first time to humans, i. e. in patients subjected to arthroscopic knee joint surgery.
Method: A dose-escalating (10, 15, 20 and 25 mg), open study was performed in 33 patients. Only two patients were included in the 25 mg group.
Results: Sameridine provided good quality of surgical anesthesia in all patients except those receiving 10 mg. The maximum level of sensory block, Th5–Th7, was reached within 30 min with a median duration of 3.6–3.9 h. The motor block was more profound with increasing dose, but never lasted longer than the sensory block. The influence on heart rate and blood pressure was minor and atropine and ephedrine were needed in four patients. No clinically significant ECG-changes were detected and no arrhythmias were recorded. Oxygen saturation and respiratory rate did not decrease in a clinically significant way and were not affected by concomitant morphine given i. v. postoperatively. There were few side-effects, the most frequent being mild pruritus (10/33).
Conclusion: Sameridine provided clinically adequate anesthesia for the patients receiving the doses of 15, 20 and 25 mg. Further studies are needed to evaluate the substance and it is of great interest to clinically investigate the opioid component with respect to postoperative analgesia.     

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.     

Anesthésie du patient épileptique

Although surgery of brain tumors and epilepsy are restricted to few specialized centers, anaesthesia for a patient with epilepsy is commonly encountered. Surgical treatments of epilepsy are currently soaring due to the lack of significant progress about effectiveness of antiepileptic drugs (AEDs). Theoretical principles for the anaesthesiologist are quite complex, involving interactions between physiological and pharmacological anaesthesia and AEDs, such as enzyme induction with the first generation molecules mainly (phenytoin, carbamazepin, phenobarbital). The latest generation AEDs (levetiracetam, lamotrigine, gabapentin, oxcarbazepin, vigabatrin, lacosamide...) are better tolerated and induce fewer drug interactions. Practically, the risk of severe perioperative complications is low, provided that the administration of AEDs is kept as close as possible to its usual dosage, and that metabolic disturbances are prevented. The main anaesthetic drugs to avoid are alfentanil, remifentanil and sevoflurane, although their contraindication are only relative, since the clinical benefit might be clear and the doses should remain moderate.     

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.     

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.