Bøgehøj Morten, Emmeluth Claus, Overgaard Søren
Odense University Hospital, Odense, Denmark.
Acta Orthop. 2007 Feb;78(1):56-62. doi: 10.1080/17453670610013420.
If it would be possible to detect lack of flow and/or the development of ischemia in bone, we might have a way of predicting whether a broken bone will heal. We established microdialysis (MD) and laser Doppler (LD) flow measurement in the human femoral head in order to be able to detect ischemia and measure changes in blood flow.
In 9 patients undergoing total hip arthroplasty for primary osteoarthrosis, two MD catheters were inserted into the femoral head through two drill holes after the blood flow had been visualized by LD. Then primary samples were collected with the femoral head in situ; thereafter, the head was removed and samples were collected over the following 4 hours ex vivo. The variables obtained by MD were concentrations of glucose, lactate, pyruvate, and glycerol in extracellular fluid.
The results showed development of ischemia with a statistically significant decrease in glucose concentration and elevation of the lactate/pyruvate ratio over time. The LD showed flow with the femoral head in situ and lack of flow when the femoral head was removed.
The use of MD was established in the human femoral head. Ischemic levels were detected within 2 h of cessation of blood flow in most patients.
如果能够检测骨骼中的血流缺失和/或缺血的发展，我们或许就能找到预测骨折是否会愈合的方法。我们在人股骨头中建立了微透析（MD）和激光多普勒（LD）血流测量技术，以便能够检测缺血情况并测量血流变化。
在9例因原发性骨关节炎接受全髋关节置换术的患者中，在通过LD观察到血流后，通过两个钻孔将两根MD导管插入股骨头。然后在股骨头原位采集初始样本；此后，将股骨头取出，并在接下来的4小时内进行体外样本采集。通过MD获得的变量是细胞外液中葡萄糖、乳酸、丙酮酸和甘油的浓度。
结果显示随着时间推移出现缺血情况，葡萄糖浓度有统计学意义的下降，乳酸/丙酮酸比值升高。LD显示股骨头原位时有血流，而股骨头取出后无血流。
在人股骨头中建立了MD的应用。大多数患者在血流停止后2小时内检测到缺血水平。
