腓肠肌腱膜松解联合跟腱断端瘢痕组织缝合治疗陈旧性跟腱断裂

目的:探讨腓肠肌腱膜松解后跟腱断端瘢痕组织缝合治疗陈旧性跟腱断裂的临床疗效.方法:回顾性分析2017年1月至2019年12月收治的17例陈旧性跟腱断裂患者的临床资料,其中男15例,女2例,年龄26～53(35.2±11.6)岁,受伤至手术时间37～92(49.3±13.3)d.Myerson分型Ⅱ型6例,Ⅲ型11例.术...     

超声引导下小切口横穿联合交叉固定技术治疗急性闭合性跟腱断裂

目的:探讨超声引导下小切口横穿联合交叉固定技术治疗急性闭合性跟腱断裂的临床疗效。方法 :自2015年1月至2017年5月,采用超声引导下小切口横穿联合交叉固定技术治疗20例急性闭合性跟腱断裂患者,其中男13例,女7例;年龄28～49(31.3±4.5)岁;20例均为单侧;左侧15例,右侧5例。受伤至手术时间1～5(2.5±0.7) d。观察并记录患者手术时间、术后并发症情况,比较术前及术后12个月AOFAS评分。结果:所有患者获得随访,时间12～27(15.2±4.9)个月。手术时间33～65(43.7±5.6) min。20例中1例创口局部持续渗出,经换药好转,其余均Ⅰ期愈合。术后均未出现腓肠神经激惹症状及跟腱再断裂。AOFAS评分由术前的65.2±7.4提高到术后12个月的97.7±4.7 (t=22.5,P0.01);优18例,良2例。结论:超声引导下小切口横穿联合交叉固定技术治疗跟腱断裂,在保证小切口优势的同时,保护了腓肠神经,确保了跟腱吻合固定的质量,是治疗急性闭合性跟腱断裂的理想方法。     

断端横切口微创治疗急性跟腱断裂的临床疗效

目的 探讨采用断端横切口的手术方法治疗急性跟腱断裂的临床效果.方法 选取2016年1月至2020年6月我院采用断端横切口手术治疗的42例急性跟腱断裂患者,其中男29例,女13例;年龄22～55岁,平均(34.0±2.0)岁;受伤至手术时间2～8 d,平均(32±02)d;均为单侧跟腱损伤,无其他合并损伤及内科疾病.患者...     

跟健龙治疗急性跟腱断裂的近期临床疗效

目的:探讨应用跟健龙吻合器治疗急性跟腱断裂的临床效果。方法:自2009年4月至2010年4月,应用跟健龙治疗19例急性跟腱断裂,男17例,女2例;年龄30～58岁,平均40.2岁;运动伤17例,摔伤2例;受伤至手术时间0～8d,平均2.2d。所有患者术前Thompson试验、单足提锺试验为阳性。术后采用患者满意度和美国足踝外科协会(AOFAS)踝与后足评分对跟腱恢复情况进行评估。结果:所有患者获随访,时间12～28个月,平均19.9个月。平均手术时间41min,所有切口Ⅰ期愈合,无感染、局部不良反应、跟腱再断裂、腓肠神经损伤等并发症发生。18例对手术结果满意,1例感觉一般(跑步时感觉轻度疼痛),至最终随访时所有患者对工作及生活满意。小腿中段周径萎缩平均(0.82±0.85)cm(0～3.0cm)。最终随访AOFAS评分平均(98.42±3.29)分(89～100分)。结论:跟健龙装置治疗急性跟腱断裂安全有效,并发症发生率低,术后可早期功能锻炼,是治疗闭合性跟腱断裂的较好方法。     

小切口微创技术治疗急性闭合性跟腱断裂

目的:探讨采用小切口行微创缝合治疗急性闭合性跟腱断裂的临床效果。方法:2012年4月至2013年10月,对14例14足急性闭合性跟腱断裂的患者采用小切口微创技术修复跟腱,其中男9例,女5例;年龄25～49岁,平均30.5岁;受伤至手术时间1～13 d,平均8 d.在跟腱断裂处正中偏内侧行1.5～2.0 cm小切口,用卵圆钳导入缝针,微创缝合修复跟腱断裂。术后常规康复锻炼。结果:14例中2例创口局部持续渗出,经换药好转,其余均Ⅰ期愈合。所有患者获随访,时间6～24个月,平均11个月。美国足踝外科协会(AOFAS)踝与后足评分92.71±6.58(82～100分).结论:小切口微创修复急性闭合性跟腱断裂损伤小,并发症少,恢复快,操作简单,适合在基层医院开展。     

急性闭合性跟腱断裂的微创手术治疗

目的 探讨采用Achillon行微创缝合治疗急性跟腱断裂的临床疗效. 方法 2010年12月至2011年5月收治7例7足急性跟腱断裂患者,男5例,女2例;年龄21～53岁,平均34 2岁.均为闭合性损伤,受伤至手术时间为1～11 d,平均3.8d.手术切口在跟腱断裂处内侧行2.0～3.5 cm长切口,以Achillon插入行微创手术缝合跟腱断端.术后康复锻炼.结果 所有患者伤口均获Ⅰ期愈合,所有患者获5～11个月(平均7.2个月)随访.术后3个月时患者均正常下地负重,无再发跟腱断裂,美国足踝外科协会(AOFAS)踝与后足评分93.2分,患处疼痛的视觉模拟评分为1.2分.结论 对急性跟腱断裂采用Achillon行微创手术缝合具有损伤小,并发症少,恢复快等优点,是跟腱修复方法的较好选择.     

改良跟腱内侧弧形切口治疗闭合性陈旧性跟腱断裂的临床疗效

目的探讨采用改良跟腱内侧弧形切口在闭合性陈旧性跟腱断裂手术治疗中的临床疗效。方法 2011年1月至2017年5月我科收治闭合性陈旧性跟腱断裂患者20例,男14例,女6例;年龄20~51岁,平均(37.7±8.9)岁;踢足球12例,打篮球3例,打羽毛球2例,跑步1例,跳高1例,下楼梯1例。受伤至入院时间为4~8周,平均(5.0±1.3)周。手术采取改良跟腱内侧弧形切口治疗陈旧性跟腱断裂,术后观察切口皮肤情况,出院后根据Arner-Lindholm评分标准进行随访评价。结果术后随访4~36个月,平均16个月。术后切口均为Ⅰ期甲级愈合,未见切口皮肤坏死、感染及深部感染,无跟腱再次断裂发生,根据Arner-Lindholm评分标准评定,优19例,良1例。结论采取改良跟腱内侧弧形切口治疗陈旧性跟腱断裂,可有效保护腱周血运,避免皮肤切口的相关并发症。     

小切口Kessler缝合法治疗新鲜闭合性跟腱断裂

目的 探讨应用小切口Kessler缝合法治疗新鲜闭合性跟腱断裂的临床疗效.方法2005年1月至2007年12月共收治37例新鲜闭合性跟腱断裂患者,男22例,女15例;年龄21～59岁,平均41.3岁.跟腱断裂部位:止点断裂8例,断端距止点<1.5 cm 5例,体部断裂20例,断端距止点3～6 cm 4例.37例患者均于伤后7 d内(平均4.6 d)采用小切口Kessler缝合法治疗,术后早期进行功能锻炼.根据Arner-Lindholm评分标准评定疗效.结果 37例患者术后获18～36个月(平均27个月)随访.术后无切口表浅或深部感染、皮缘坏死等并发症发生,无跟腱再断裂.术后疗效根据Arner-Lindholm评分标准评定:优30例,良7例,优良率为100%.结论应用小切口暴露方法修复新鲜跟腱断裂并结合早期功能锻炼可获得满意的临床疗效.     

采用束间缝合法治疗急性跟腱断裂的疗效观察

目的 :观察采用束间缝合法治疗急性跟腱断裂的临床疗效。方法 :2013年4月至2015年1月治疗15例急性闭合性跟腱断裂病例,其中男12例,女3例,年龄27~56岁,平均37.5岁。患者入院后均采用束间缝合法修复跟腱,术后6周石膏制动,门诊随访指导功能锻炼。结果:所有例患者获得完整随访,时间9~17.5个月,平均13.5个月,按美国足踝外科协会(AOFAS)踝与后足评分评价疗效,术后6个月(93.3±3.5)分。患者完全负重活动时间平均1.6个月,返回至原工作岗位时间平均4.7个月。所有手术切口Ⅰ期愈合,无切口感染、切口皮缘坏死病例,无跟腱再次断裂,未出现腓肠神经损伤。结论:利用束间缝合法治疗急性跟腱断裂具有手术创伤小、手术时间短、跟腱吻合修复可靠、术后并发症少、跟腱功能恢复良好等优点,在急性跟腱断裂治疗中取得良好治疗效果,值得临床推广使用。     

逆行腓肠肌肌腱瓣加强修复急性闭合性跟腱断裂

目的 探讨应用逆行腓肠肌肌腱瓣加强修复急性闭合性跟腱断裂的临床疗效. 方法 对自2007年1月至2011年6月收治的42例急性闭合性跟腱断裂患者进行回顾性分析,男40例,女2例;年龄26～44岁,平均35岁.根据Kuwade分类法:Ⅲ型13例,Ⅳ型29例.所有患者在编织缝合马尾状撕裂的跟腱后,应用逆行腓肠肌肌腱瓣反转加强修复.术后踝关节采用美国足踝外科协会(AOFAS)踝-后足功能评分系统进行评定. 结果 39例患者术后获11～53个月(平均32个月)随访.26例患者能用患足前足站立30s,11例能站立20～29 s,2例不能坚持20 s;32例患者能用患足完成单足跳行走,7例不能完成;28例能双足跟着地完全下蹲,11例不能完成此动作;36例患者可以无不适正常行走,1例行走有疼痛不适,2例有跛行;1例患者切口渗液,其他患者切口愈合良好.患者术后踝关节AOFAS踝-后足功能评分优良率为92.3％ (36/42).患者恢复工作时间4～6个月(平均5个月),恢复从事伤前体育活动的时间6～8个月(平均7个月). 结论 应用逆行腓肠肌肌腱瓣加强修复急性闭合性跟腱断裂可获得良好疗效,有利于患者早期恢复工作和正常生活.     

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.     

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.     

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.