Schult Marc, Küchle Raphael, Hofmann Alexander, Schmidt-Bräkling Tom, Ortmann Christian, Wassermann Esther, Schmidhammer Robert, Redl Heinz, Joist Alexander
Department of Trauma-, Hand-, and Reconstructive Surgery, University Hospital Münster, Waldeyerstrasse 1, D-48129 Münster, Germany.
J Orthop Res. 2006 Jun;24(6):1186-92. doi: 10.1002/jor.20106.
Although reamed intramedullary nailing has been one of the greatest advances in modern fracture care, the concomitant increase in medullary cavity pressure leads to intravasation of bone marrow content into the blood stream, an effect that can evoke serious systemic reactions. A newly developed rinsing-suction-reamer (RSR) was able to substantially reduce the pressure and bone marrow intravasation content during experimental femoral nailing. We investigated the pathophysiological effects using the RSR, testing the hypothesis that by reducing marrow fat embolization, RSR would also reduce the activation of coagulation compared with the universal AO-Reamer (AOR) and comparable to external fixation. Twenty-two pigs were treated with either simulated external fixation or reamed femoral nailing using AOR or RSR. During surgery, the intramedullary pressure was measured and intravasation of medullary material was quantified. After surgery, the pigs were kept anaesthetised and monitored for 6 h. At defined intervals, serological, hematological, and hemodynamic parameters were evaluated. The RSR was significantly superior when compared to AOR with regard to the generation of intramedullary pressure and fat embolization; however, with external fixation the values were even lower. The evaluation of other parameters revealed no clear differences between the two reamers and the external fixator. The pig model showed that RSR led to a significant reduction of the intramedullary increase in pressure and fat intravasation compared to AOR. Although the reduction of fat embolism by RSR is not associated with pathophysiological changes, RSR can have advantages for the treatment of femoral fractures.
尽管扩髓髓内钉固定术是现代骨折治疗中最重大的进展之一，但随之而来的髓腔压力升高会导致骨髓成分进入血流，这种效应可能引发严重的全身反应。一种新开发的冲洗-抽吸-扩孔钻（RSR）在实验性股骨钉固定过程中能够显著降低压力和骨髓内渗物。我们使用RSR研究其病理生理效应，检验以下假设：与通用的AO扩孔钻（AOR）相比，通过减少骨髓脂肪栓塞，RSR还能降低凝血激活，且与外固定相当。22头猪接受模拟外固定或使用AOR或RSR进行扩髓股骨钉固定术治疗。手术过程中，测量髓内压力并对髓内物质的内渗进行定量。术后，猪保持麻醉状态并监测6小时。在规定的时间间隔，评估血清学、血液学和血流动力学参数。在产生髓内压力和脂肪栓塞方面，RSR与AOR相比有显著优势；然而，外固定时这些值更低。对其他参数的评估显示，两种扩孔钻与外固定器之间没有明显差异。猪模型显示，与AOR相比，RSR可显著降低髓内压力升高和脂肪内渗。尽管RSR减少脂肪栓塞与病理生理变化无关，但RSR在股骨骨折治疗中可能具有优势。
