Roth Sandra E, Rebello Mary M, Kreder Hans, Whyne Cari M
Orthopaedic Biomechanics Laboratory, Sunnybrook and Women's College Health Sciences Centre, Toronto, Ontario, Canada.
J Trauma. 2004 Aug;57(2):333-9. doi: 10.1097/01.ta.0000082157.29723.16.
Venting during prophylactic nailing of metastatic femoral lesions may decrease intramedullary pressures and the risk of fat and tumor embolization. This study aimed to quantify maximum intramedullary pressure levels and durations, and to examine tumor displacement during prophylactic reamed intramedullary nailing of vented and nonvented metastatically involved femora.
Proximal metastatic defects were simulated in six pairs of cadaveric femora and prophylactically treated using reamed intramedullary nailing with or without proximal and distal vents. Maximum pressures, durations of pressure exceeding embolic threshold levels (25 and 200 mm Hg), and tumor displacement were recorded.
Maximum pressures and durations of pressure exceeding embolic thresholds decreased more than 50% with venting (p < 0.05). Distal pressures surpassed the 25-mm Hg threshold even with venting. Post-test sectioning showed increased tumor disbursement in vented specimens.
Venting reduces pressurization during prophylactic reamed intramedullary nailing of femoral metastases, but may increase the spread of tumor to extraskeletal tissue if vented tissue is not contained.
对转移性股骨病变进行预防性髓内钉固定时进行排气，可降低髓内压力以及脂肪和肿瘤栓塞的风险。本研究旨在量化最大髓内压力水平和持续时间，并检查在有排气孔和无排气孔的转移性受累股骨进行预防性扩髓髓内钉固定期间的肿瘤移位情况。
在六对尸体股骨中模拟近端转移性缺损，并使用有或无近端和远端排气孔的扩髓髓内钉进行预防性治疗。记录最大压力、超过栓塞阈值水平（25和200毫米汞柱）的压力持续时间以及肿瘤移位情况。
排气时，最大压力和超过栓塞阈值的压力持续时间降低超过50%（p < 0.05）。即使有排气孔，远端压力仍超过25毫米汞柱阈值。术后切片显示有排气孔标本中的肿瘤扩散增加。
排气可降低股骨转移瘤预防性扩髓髓内钉固定期间的压力升高，但如果排气组织未得到控制，可能会增加肿瘤向骨骼外组织的扩散。
