Riding G, Daly K, Hutchinson S, Rao S, Lovell M, McCollum C
Academic Surgery Unit, South Manchester University Hospital, Southmoor Road, Manchester M23 9LT, England, UK.
J Bone Joint Surg Br. 2004 Jan;86(1):95-8.
Fat embolism occurs following fractures of a long bone or arthroplasty. We investigated whether paradoxical embolisation through a venous-to-arterial circulation shunt (v-a) could lead to cerebral embolisation during elective hip or knee arthroplasty. Transcranial Doppler ultrasound (TCD), following the intravenous injection of microbubble contrast, identified the presence of a shunt in 41 patients undergoing hip (n = 20) or knee (n = 21) arthroplasty. Intra-operative cerebral embolism was detected during continuous TCD monitoring. Of the 41 patients, 34 had a v-a shunt of whom 18 had an embolism and embolism only occurred in patients with a shunt (p = 0.012). Spontaneous and larger shunts were associated with a greater number of emboli (rs = 0.67 and rs = 0.71 respectively, p < 0.01). Observations in two patients with large spontaneous shunts revealed 368 and 203 emboli and unexplained post-operative confusion and pancreatitis. Paradoxical cerebral embolisation only occurred in patients with a shunt and may explain both postoperative confusion and fat embolism syndrome following surgery.
脂肪栓塞发生于长骨骨折或关节置换术后。我们研究了在择期髋关节或膝关节置换术中，通过静脉-动脉循环分流（v-a）的反常栓塞是否会导致脑栓塞。在静脉注射微泡造影剂后，经颅多普勒超声（TCD）在41例行髋关节（n = 20）或膝关节（n = 21）置换术的患者中发现了分流的存在。在持续TCD监测过程中检测到术中脑栓塞。在这41例患者中，34例存在v-a分流，其中18例发生了栓塞，且栓塞仅发生在有分流的患者中（p = 0.012）。自发性和较大的分流与更多的栓子相关（rs分别为0.67和0.71，p < 0.01）。对两名有大的自发性分流患者的观察发现分别有368个和203个栓子，以及术后不明原因的意识障碍和胰腺炎。反常性脑栓塞仅发生在有分流的患者中，这可能解释了术后意识障碍和术后脂肪栓塞综合征。
