ElMaraghy A W, Humeniuk B, Anderson G I, Schemitsch E H, Richards R R
Department of Surgery, St. Michael's Hospital and the University of Toronto, Ontario, Canada.
J Arthroplasty. 1999 Feb;14(2):220-6. doi: 10.1016/s0883-5403(99)90130-4.
This study was conducted to determine the effect of intramedullary reaming and canal preparation on bone blood flow in the proximal femur. Thirty-five adult dogs were randomly assigned to have their intramedullary canals prepared after reaming in the following manner: group 1, ream only; group 2, lavage; group 3, methylmethacrylate cement introduction; group 4, cement pressurization after placing a cement restrictor; group 5, lavage then cement introduction; and group 6, lavage then cement pressurization. Bone blood flow was measured at both metaphyseal and diaphyseal sites by using laser Doppler flowmetry before reaming, after reaming, after lavage, after cementing, and at 6 weeks after the procedure just before euthanasia. Reaming significantly decreased bone blood flow in the diaphysis (P = .046) but not in the metaphysis. Cement introduction and cement pressurization both significantly decreased bone blood flow in the metaphysis (P = .035, P = .004) and diaphysis (P = .007, P = .029). Pressurization of cement had a significantly greater relative effect than cement introduction alone in the diaphysis (P = .006) but not in the metaphysis. Lavage had no effect on bone perfusion. Bone blood flow was significantly increased at 6 weeks after the initial procedure in both the metaphysis (P = .049) and the diaphysis (P = .004). The results suggest that reaming decreases diaphyseal cortical but not metaphyseal bone blood flow significantly, whereas lavage has no effect. Cement introduction with or without pressurization has a significant detrimental effect on metaphyseal and diaphyseal blood flow. These findings have implications for intramedullary nailing and for canal preparation when performing arthroplasty.
本研究旨在确定股骨近端髓内扩髓和髓腔准备对骨血流的影响。35只成年犬被随机分配，按以下方式在扩髓后进行髓腔准备：第1组，仅扩髓；第2组，冲洗；第3组，注入甲基丙烯酸甲酯骨水泥；第4组，放置骨水泥限制器后进行骨水泥加压；第5组，冲洗后注入骨水泥；第6组，冲洗后进行骨水泥加压。在扩髓前、扩髓后、冲洗后、注入骨水泥后以及在处死前6周时，使用激光多普勒血流仪测量干骺端和骨干部位的骨血流。扩髓显著降低了骨干的骨血流（P = 0.046），但对干骺端无影响。注入骨水泥和骨水泥加压均显著降低了干骺端（P = 0.035，P = 0.004）和骨干（P = 0.007，P = 0.029）的骨血流。在骨干中，骨水泥加压的相对影响比单纯注入骨水泥显著更大（P = 0.006），但在干骺端并非如此。冲洗对骨灌注无影响。在初始手术后6周时，干骺端（P = 0.049）和骨干（P = 0.004）的骨血流均显著增加。结果表明扩髓显著降低骨干皮质骨而非干骺端的骨血流，而冲洗无影响。无论是否加压，注入骨水泥对干骺端和骨干血流均有显著不利影响。这些发现对髓内钉固定及关节置换术时的髓腔准备具有重要意义。
