Brumback R J, Virkus W W
Program in Trauma, University of Maryland School of Medicine, Baltimore, MD, USA.
J Am Acad Orthop Surg. 2000 Mar-Apr;8(2):83-90. doi: 10.5435/00124635-200003000-00002.
All intramedullary nailing creates some loss of endosteal blood supply and an increase in intramedullary pressure, resulting in marrow embolization. In laboratory studies, both reamed and nonreamed intramedullary nailing have led to alteration in selected pulmonary variables. This effect, although transient, appeared more pronounced with reamed techniques than with nonreamed techniques. Concern about the systemic pulmonary effects of reamed intramedullary nailing has led to an increase in the use of nonreamed nailing. The authors of most clinical studies have reported that reamed intramedullary nailing has not been associated with a concomitant increase in pulmonary complications in multiply injured patients, although this point is still controversial. Femoral shaft fractures treated with nonreamed nailing have been shown to have slightly higher rates of delayed union and nonunion compared with those treated with reamed nails. Reamed interlocking intramedullary fixation remains the treatment of choice for femoral shaft fractures in adults. Further study is required to determine whether an identifiable subgroup of trauma patients is adversely affected by intramedullary reaming, which would suggest the need for alternative fixation techniques.
所有髓内钉固定都会造成一定程度的骨内膜血供丧失和髓内压力升高，从而导致骨髓栓塞。在实验室研究中，扩髓和非扩髓髓内钉固定均会引起某些肺功能指标的改变。这种影响虽然是暂时的，但在扩髓技术中似乎比非扩髓技术更为明显。对扩髓髓内钉固定的全身肺部影响的担忧导致非扩髓钉固定的使用增加。大多数临床研究的作者报告称，扩髓髓内钉固定与多发伤患者肺部并发症的相应增加并无关联，尽管这一点仍存在争议。与使用扩髓钉治疗的股骨干骨折相比，使用非扩髓钉治疗的股骨干骨折的延迟愈合和不愈合发生率略高。扩髓交锁髓内固定仍然是成人股骨干骨折的首选治疗方法。需要进一步研究以确定是否存在可识别的创伤患者亚组会受到髓内扩髓的不利影响，这将提示需要采用替代固定技术。
