Mousavi M, David R, Ehteshami J, Pajenda G, Vécsei V
University Clinic for Trauma Surgery, Vienna, Austria.
Clin Orthop Relat Res. 2000 Apr(373):295-303. doi: 10.1097/00003086-200004000-00036.
Reaming increases intramedullary pressure and can cause fat intravasation. This study investigated the influence of reaming parameters on pressure changes using the AO, Gray, and Howmedica reamers. Silicone cylindrical shells with 10-, 11-, 16-, 19-, and 20-mm inner diameters were filled with a 1:2 ratio of paraffin and petroleum jelly. The 10- and 11-mm shells were reamed using a 9-mm reamer, the 16-mm shells with a 14-mm reamer, and the 19- and 20-mm shells with an 18-mm reamer. Each experiment was performed seven times while singularly varying driving speeds of 15, 30, and 50 mm per second, with a revolution rate of 150, 250, and 500 revolutions per minute. Using stepwise linear regression analysis, driving speed was the most significant parameter. The lowest pressure increases occurred at the lowest driving speed and the highest revolution rate in all cylinders. The model used for this study did not take into consideration the interaction between the cortical shell and reamer head. The results of this study suggest that reaming should be done at a low driving speed and a high revolution rate using a small cored reamer head, especially during the first reaming steps.
扩髓会增加髓内压力并可导致脂肪进入血管。本研究使用AO、Gray和Howmedica扩髓器研究了扩髓参数对压力变化的影响。内径为10毫米、11毫米、16毫米、19毫米和20毫米的硅胶圆柱壳填充了石蜡与凡士林比例为1:2的混合物。内径10毫米和11毫米的圆柱壳用9毫米扩髓器扩髓，内径16毫米的圆柱壳用14毫米扩髓器扩髓，内径19毫米和20毫米的圆柱壳用18毫米扩髓器扩髓。每个实验进行7次，每次单独改变驱动速度，分别为每秒15毫米、30毫米和50毫米，转速分别为每分钟150转、250转和500转。使用逐步线性回归分析，驱动速度是最显著的参数。在所有圆柱壳中，最低的压力增加发生在最低驱动速度和最高转速时。本研究使用的模型未考虑皮质壳与扩髓器头部之间的相互作用。本研究结果表明，扩髓应使用小芯径扩髓器头部，以低驱动速度和高转速进行，尤其是在首次扩髓步骤期间。
