Anglen Jeffrey O, Luber Kurre, Park Tom
Bone Orthopaedic Association, Columbia, Missouri, USA.
J Trauma. 2003 Jun;54(6):1166-70. doi: 10.1097/01.TA.0000057232.66613.AC.
The timing of fracture fixation in patients with head trauma is controversial. Early fracture fixation may be associated with secondary brain injury. We undertook this study to investigate the effect of reamed intramedullary nailing on cerebral perfusion.
Seventeen patients were identified who had placement of an intracranial pressure monitor and reamed rodding of the femur. Retrospective chart review was performed.
Average Injury Severity Score was 35 (range, 17-50). Cerebral perfusion pressure (CPP) decreased intraoperatively for all except one. The average decrease in CPP from pre- to intraoperative values was 17 mm Hg (p = 0.0012). Seventy percent had an average intraoperative CPP below 75 mm Hg, and all patients had a minimum CPP below 75 mm Hg. The decrease in CPP was mostly attributable to a corresponding decrease in mean arterial pressure.
Patients with head trauma undergoing femoral rodding need careful attention paid to managing blood pressure to minimize CPP decreases.
颅脑外伤患者骨折固定的时机存在争议。早期骨折固定可能与继发性脑损伤有关。我们进行这项研究以调查扩髓髓内钉固定对脑灌注的影响。
确定17例放置了颅内压监测器并接受股骨扩髓髓内钉固定术的患者。进行回顾性病历审查。
平均损伤严重度评分是35分（范围为17 - 50分）。除1例患者外，所有患者术中脑灌注压（CPP）均下降。CPP从术前值到术中值的平均下降幅度为17 mmHg（p = 0.0012）。70%的患者术中平均CPP低于75 mmHg，所有患者的最低CPP均低于75 mmHg。CPP下降主要归因于平均动脉压相应降低。
接受股骨髓内钉固定术的颅脑外伤患者需要密切关注血压管理，以尽量减少CPP下降。
