强直性脊柱炎脊柱骨折的特点及诊断

目的：探讨强直性脊柱炎脊柱骨折的特点，为其临床诊断与治疗提供参考。方法：回顾性分析1994年1月～2001年10月收治的19例强直性脊柱炎脊柱骨折病例。结果：所有19例患者均符合强直性脊柱炎的诊断标准，其中17例骨折前有平均20．6年的强直性脊柱炎病史，另2例方确诊有强直性脊柱炎。19例中15例有外伤史，其中9例为平地跌倒或扭伤，另4例无外伤史。损伤机制：过伸伤7例，垂直挤压伤2例，侧屈损伤l例，屈曲伤1例，4例不详。颈椎骨折11例，9例发生在C5～C7；包括剪力骨折lO例，应力骨折1例。胸腰椎骨折8例，7例为应力骨折，均发生在T10～L2，1例为L3剪力骨折。19例中经椎间隙骨折12例，经椎体骨折7例。三柱骨折16例，骨折伴脱位5例。9例并发脊髓损伤，其中8例为颈椎骨折。外伤至诊断为骨折的间隔时间为10h～7个月，平均29．6d。2例曾被误诊为脊柱结核。结论：导致强直性脊柱炎患者发生脊柱骨折的外力往往较轻。损伤机制多为过伸伤。骨折好发于下颈椎及胸腰段。剪力骨折多发生在颈椎，大多为三柱骨折，容易伴发脱位，脊髓损伤的发生率较高；应力骨折多发生在胸腰段，脊髓损伤不多见。此类骨折多为经椎间隙骨折，易发生诊断延误。     

胸腰段陈旧性压缩型骨折继发脊髓神经损伤的临床分析

由于无脊髓神经损伤的单纯压缩型脊柱胸腰段骨折的治疗尚未得到应有的重视 ,临床上常能见到治疗不当的压缩型胸腰段骨折 ,晚期胸腰段后凸畸形加重 ,严重者继发脊髓神经损伤。自 1 999年 2月～ 2 0 0 2年 6月收治了 1 1例继发脊髓神经损伤的脊柱胸腰段陈旧性压缩型骨折患者 ,通过回顾性分析 ,探讨其脊髓神经损伤原因、重新认识压缩型胸腰段骨折的稳定性概念 ,并据此提出相应的早期预防处理意见。1　临床资料1 1　一般资料　本组 1 1例 ,男 9例 ,女 2例。受伤时年龄为 1 9～ 4 8岁 ,平均 36 2岁。损伤原因 :高度坠落伤 8例 ,重物砸伤 2例 ,…     

重建胸腰段爆裂性骨折椎管矢状径的手术时间效应

胸腰椎骨折是脊柱损伤最常见的部位 ,爆裂性胸腰椎骨折占其发病率 15 % ,造成椎管狭窄 ,超过一半以上的病例合并脊髓神经的损伤[1] 。本文回顾性的分析 5 9例胸腰段爆裂性骨折的影像学和临床资料 ,探讨手术时间对重建胸腰段椎管矢状径的影响 ,以指导临床选择最佳手术治疗时间。1　临床资料1.1　一般资料　自 1992年 1月至 1999年 12月我院共收治脊柱骨折 438例 ,选取符合下列标准 5 9例病人为研究对象。(1)有完整的初诊病史、术前Ｘ线ＣＴ摄片常规检查。 (2 )脊柱骨折类型按Ｄｅｎｓｉｓ分型属于爆裂性骨折 ,损伤平面胸12腰1～ 2 ,排除脱位…     

胸腰段脊柱骨折合并脊髓损伤的早期治疗

目的探讨早期手术治疗胸腰段脊柱骨折合并脊髓损伤的重要性。方法应用前路或后路手术入路减压、复位．合理的短节段内固定及植骨98例。随访时间10～36个月，平均16个月。结果本组98例，男91例，女7例。骨折部位：T10 1例，T11 3例，T12 48例，L1 46例。骨折类型：爆裂型骨折43例。屈曲牵拉型骨折41例，骨折脱位型14例。全部合并脊髓损伤截瘫。Frankel分级A级79例，B级19例，均采取手术治疗。损伤至手术时间4～20h，平均9h。结论早期手术治疗胸腰段脊柱骨折合并脊髓损伤。效果满意：神经功能恢复78％，不全瘫基本恢复。     

胸腰段脊柱脊髓损伤后期的MRI研究

目的：观察胸腰段脊柱脊髓损伤后期MRI遥表,咱升性脊髓病变的主要相关因素,方法：选取胸腰段脊仍髓损伤1年以上患者144例的MRI,进行观察,测量工进行统计学处理。结果：本组病例的MRI表现依次有变性、粘连、萎缩、囊变、空洞和外伤性拴系,上升性脊髓病变发生率47．2％,包括变性,萎缩和这洞三种表现。结论：完全性脊髓损伤、脊髓严重受压以及T11、T12骨折的患者更易出现上升性脊髓病变;完全性脊髓损伤、脊髓严重受压的患者更易出现脊髓萎缩。     

胸腰段脊柱脊髓重度损伤及相关解剖学研究

目的：了解腰段脊神经的解剖特点及这些解剖特点在胸腰段脊柱脊髓重度损伤时的诊断和治疗意义。方法：通过20例局解研究观测腰段脊神经与椎体平面之间的关系，脊神经的形态及移位情况。随访143例胸腰段脊柱脊髓损伤病人，对比观测环行减压和单纯椎板减压的效果。结果：腰段脊神经与椎体平面有相对固定关系，L1脊神经到L5脊神经逐渐增粗，它们在冠状面上虽可向对侧移位但不超过中线，环行减压组有8例术后神经功能障碍进一步加重。结论：胸腰段骨折行环行减压时要特别注意保护脊神经，避免过分牵拉加重损伤。     

胸椎无骨折脱位脊髓损伤

脊柱骨折脱位合并脊髓损伤一般表现为同一平面损伤 ,Ｄｅｎｉｓ[1] 报道少数脊髓损伤平面高于骨折脱位平面 ,其发生率约 1% ,并命名为上升性截瘫。亦有将胸段脊柱无骨折脱位的胸段脊髓损伤称为胸椎无放射线影像异常的脊髓损伤[2 ] 。其原因可能为脊髓缺血坏死。结合我科诊治 3例 ,就其发生机制、诊断和治疗报道如下 :1　临床资料例 1,×× ,男 ,41岁。腰部车祸伤致Ｌ3 椎体压缩骨折卧硬板床 5 0天 ,双下肢活动障碍 5天来院。自诉伤后双下肢感觉运动正常 ,卧硬板床 5 0天后出现双下肢不能活动 ,伴麻木。入院查体 :脊柱无畸形压痛 ,双下肢浅深…     

椎体压缩性骨折减压Dick棒内固定术的护理

1996年4月～1997年1月我科以减压Dick棒内固定术治疗胸腰段脊柱骨折脱位合并脊髓损伤30例，手术通过顺利，术后恢复满意，住院天数少，感染率低，现报告如下。临床资料本组30例中男22例，女8例；年龄18～63岁；病变部位：T9、T11椎体各1例，T12椎体5例，L1椎体17例，L2、3椎体5例，L5椎体1例。骨折类型：均为压缩屈曲型。30例中截瘫21例，不全瘫9例。均在局麻下行Dick棒内固定术。住院时间最短10天，最长29天，平均16．8天。期间未发生1例切口感染及其它护理并发症。护理措施1．术前护理：①心理护理。②练习深呼吸：胸腰段骨折后因后腹…     

胸腰段椎体爆裂骨折并完全性瘫痪的治疗

[目的] 探讨胸腰段椎体爆裂骨折并完全性瘫痪是否有必要行前路手术。[方法] 14例胸腰段椎体爆裂骨折并完全性瘫痪病人均行前路手术，采用左侧经胸膜后，腹膜后入路椎管前方减压去除压迫物，内植物植人加钢板内固定。术后定期严密随访每4个月1次，包括详细的症状体征记录，X线片俭查，部分病人行CT俭查。与既往胸腰段骨折并完全性瘫痪行后路减压椎弓根钉内固定7例（资料完整）行历史对照：[结果]　14例获得随访时间6个月～3年8个月（平均16个月），术前肋缘下至腹股沟束榨感及腰背痛全部消失，感觉平面下降8～18cm 3例，而且分别在术后4、8、12个月恢复部分排尿功能。全组病人双下肢肌力无恢复，8例于3个月之后出现不同程度肌张力升高。对照组7例术后腰间榨感及腰背痛完全消失仅1例，感觉平面全部无下降，1例于术后8个月恢复部分排尿功能。双下肢肌力均无恢复，肌张力均明显升高。[结论]　胸腰段椎体爆裂骨折并完全性瘫痪行前路手术对缓解术前腰背痛及腰间束榨，减轻肌张力增高及稳定脊柱有一定效果，但感觉平面的下降及下肢肌力的改善效果不明显。     

脊髓后正中沟造口内引流术治疗脊髓空洞症的效果观察

目的：探讨脊髓后正中沟造13内引流术治疗脊髓空洞症的临床疗效。方法：2004年-2006年对12例脊髓空洞症患者行脊髓后正中沟造口内引流术治疗，男9例，女3例；年龄19—57岁，平均26．8岁。术前均行MRI检查，空洞部位：颈段7例（C2-C61例，C2-C72例，C3-C73例，C4-C71例），颈胸段4例（C4-T82例，C4-T101例，C5-T91例），颈胸腰段（C5-L2）1例。其中伴Chiari—Ⅰ畸形6例，合并髓内肿瘤1例，合并脊髓蛛网膜炎2例，余无脊柱脊髓畸形。按Tator标准判定手术效果。结果：术中无严重头痛及死亡等并发症，术后发热2例，3d后体温正常；术后头痛2例，术后7d缓解。随访6—25个月，平均10个月，手术效果优9例，良2例，差1例。1例患者术后15个月时因髓内室管膜瘤复发压迫致临床症状加重。末次随访时复查MRI示空洞消失1例、明显缩小或呈裂隙状8例，无变化2例，扩大1例。结论：应用脊髓后正中沟造13内引流术治疗脊髓空洞症近期效果好．是合理且有效的手术方法。     

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.