Nassif J M, Gorczyca J T, Cole J K, Pugh K J, Pienkowski D
Division of Orthopaedics, University of Kentucky, Lexington, USA.
J Orthop Trauma. 2000 Nov;14(8):554-8. doi: 10.1097/00005131-200011000-00006.
To compare anterior and deep posterior compartment pressures during reamed and unreamed intramedullary nailing of displaced, closed tibial shaft fractures.
Randomized prospective study.
University Hospital/Level I trauma center.
Forty-eight adults with forty-nine fractures treated with intramedullary nailing within three days of injury.
After intraoperative placement of compartment pressure monitors, the tibia fractures were treated by either unreamed intramedullary nailing or reamed intramedullary nailing. A fracture table and skeletal traction were not used in any of these procedures.
Compartment pressures and deltaP ([diastolic blood pressure] - [compartment pressure]) were measured immediately preoperatively, intraoperatively, and for twenty-four hours postoperatively.
Compartment syndrome did not occur in any patient. Peak average pressures were obtained during reaming in the reamed group (30.0 millimeters of mercury anterior compartment, 34.7 millimeters of mercury deep posterior compartment) and during nail insertion in the unreamed group (33.9 millimeters of mercury anterior compartment, 35.2 millimeters of mercury deep posterior compartment). The average pressures quickly returned to less than thirty millimeters of mercury and remained there for the duration of the study. The deep posterior compartment pressures were lower in the reamed group than in the unreamed group at ten, twelve, fourteen, sixteen, eighteen, twenty, twenty-two, and twenty-four hours postoperatively (p < 0.05 at each of these times. A statistically significant difference between anterior compartment pressures could not be shown with the numbers available. The deltaP values were greater than thirty millimeters of mercury at all times after nail insertion in both the reamed and unreamed groups.
These data support acute (within three days of injury) reamed intramedullary nailing of closed, displaced tibial shaft fractures without the use of a fracture table.
比较闭合性移位胫骨干骨折行扩髓与非扩髓髓内钉固定时前侧和后侧深部骨筋膜室压力。
随机前瞻性研究。
大学医院/一级创伤中心。
48例成人，共49处骨折，于受伤后3天内行髓内钉固定治疗。
术中放置骨筋膜室压力监测器后，胫骨干骨折采用非扩髓髓内钉固定或扩髓髓内钉固定治疗。所有手术均未使用骨折手术台及骨牵引。
术前即刻、术中及术后24小时测量骨筋膜室压力及压差（舒张压 - 骨筋膜室压力）。
所有患者均未发生骨筋膜室综合征。扩髓组扩髓时获得最高平均压力（前侧骨筋膜室30.0 mmHg，后侧深部骨筋膜室34.7 mmHg），非扩髓组插钉时获得最高平均压力（前侧骨筋膜室33.9 mmHg，后侧深部骨筋膜室35.2 mmHg）。平均压力迅速恢复至30 mmHg以下，并在研究期间维持该水平。术后10、12、14、16、18、20、22及24小时，扩髓组后侧深部骨筋膜室压力低于非扩髓组（各时间点p < 0.05）。根据现有数据，前侧骨筋膜室压力未显示出统计学显著差异。扩髓组和非扩髓组插钉后各时间点压差均大于30 mmHg。
这些数据支持在受伤后3天内对闭合性移位胫骨干骨折行急诊扩髓髓内钉固定，无需使用骨折手术台。
