Aoki Shinichi, Yokoyama Kazuhiko, Itoman Moritoshi
Department of Orthopaedic Surgery, School of Medicine, Kitasato University, Sagamihara, Kanagawa, Japan.
J Trauma. 2005 Sep;59(3):647-58.
Pulmonary damage after reamed or unreamed femoral nailing has been controversial in clinical and experimental studies. We investigated changes in pulmonary function and coagulatory response in normal lungs of sheep after reamed or unreamed intramedullary nailing of an unfractured femur.
We used three groups of sheep (each group, n = 6): reamed femoral nailing (RFN); unreamed femoral nailing (UFN); and sham control group. Femoral osteotomies and lung contusions were not made. Hemodynamic monitoring data and blood gas data (BGD) were recorded, and blood samples for biochemistry (antithrombin III, lipid peroxidase and fibrinogen) were collected 0 to 6 hours after nailing. Bronchoalveolar lavage fluid (BALF) and myeloperoxidase (MPO) activity in pulmonary tissue were analyzed 6 hours after nailing.
There were no significant differences in time course of hemodynamic monitoring data, BGD, or biochemical data among the three groups. In BALF analysis, the lipid-laden cell count in the RFN group was higher than those of the other groups, and MPO activity was highest in the RFN group.
RFN did not affect pulmonary function at the physiologic level or affect the coagulatory system at the acute stage, but RFN under non-damaged conditions could lead to leukocyte activation in lung tissue without worse alteration of alveolar permeability in the acute post-operative course.
扩髓或非扩髓股骨髓内钉固定术后的肺损伤在临床和实验研究中一直存在争议。我们研究了在未骨折的股骨进行扩髓或非扩髓髓内钉固定后，绵羊正常肺脏的肺功能和凝血反应变化。
我们使用三组绵羊（每组n = 6）：扩髓股骨髓内钉固定组（RFN）；非扩髓股骨髓内钉固定组（UFN）；假手术对照组。未进行股骨截骨和肺挫伤。记录血流动力学监测数据和血气数据（BGD），并在钉固定后0至6小时采集血液样本进行生化分析（抗凝血酶III、脂质过氧化物酶和纤维蛋白原）。在钉固定后6小时分析支气管肺泡灌洗液（BALF）和肺组织中的髓过氧化物酶（MPO）活性。
三组之间的血流动力学监测数据、BGD或生化数据的时间进程无显著差异。在BALF分析中，RFN组的载脂细胞计数高于其他组，且RFN组的MPO活性最高。
RFN在生理水平上不影响肺功能，在急性期也不影响凝血系统，但在未受损情况下，RFN可导致肺组织中的白细胞活化，而在术后急性期肺泡通透性无更严重改变。
