Department of Trauma and Orthopaedics, Academic Unit, Clarendon Wing, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom.
Injury. 2009 Nov;40(11):1231-6. doi: 10.1016/j.injury.2009.07.070. Epub 2009 Sep 23.
Although reamed intramedullary nailing has long been considered a safe procedure, pulmonary complications have been reported in some groups of patients. Concerns over fat embolisation, adult respiratory distress syndrome (ARDS), and sudden intraoperative death have prompted some authors to question whether the benefits of reaming are outweighed by its potential adverse effects to the patient. In response to these complications, recent evaluations have focused on alternative systems that reduce intramedullary pressure during reaming. The Reamer/Irrigator/Aspirator (RIA) system (Synthes, Inc., West Chester, PA) was developed as a simultaneous reaming and aspiration system to reduce the intramedullary pressure, heat generation, operating time, and systemic effects of reaming. It was designed with an aggressive one-pass reamer head which is connected to a hand-held reamer via a drive shaft, simultaneously irrigating and aspirating femoral canal contents during reaming, thus preventing thermal necrosis and fat embolisation. After its early use, investigators examined the "aspirate" captured by the RIA which appeared to be loaded with osteogenic substrates. This discovery revealed a second potential use for the RIA-a bone graft harvester. The different design characteristics and technicalities of the RIA system necessitate a deep and clear understanding of its technique, a meticulous preoperative planning and a strict adherence to its principles intraoperatively. We present our current approach to the use of the RIA system, including the preoperative planning, the details of the operative procedure, the pitfalls and the potential complications that could be encountered.
尽管扩髓髓内钉固定术长期以来被认为是一种安全的手术方法，但在某些患者群体中已经报道了肺部并发症。由于担心脂肪栓塞、成人呼吸窘迫综合征（ARDS）和术中突然死亡，一些作者质疑扩髓的益处是否超过了其对患者的潜在不良影响。为了应对这些并发症，最近的评估集中在减少扩髓过程中髓内压力的替代系统上。扩髓冲洗吸引器（RIA）系统（Synthes，Inc.，West Chester，PA）的开发是一种同时扩髓和吸引系统，旨在降低髓内压力、产热、手术时间和扩髓的全身影响。它的设计采用了激进的一次性扩髓头，通过传动轴与手动扩髓器连接，在扩髓过程中同时冲洗和抽吸股骨髓腔内容物，从而防止热坏死和脂肪栓塞。在早期使用后，研究人员检查了 RIA 捕获的“吸出物”，这些吸出物似乎含有成骨基质。这一发现揭示了 RIA 的第二个潜在用途——骨移植物收集器。RIA 系统的不同设计特点和技术要求对其技术有深刻而清晰的理解、术前精心规划和术中严格遵守其原则。我们介绍了目前使用 RIA 系统的方法，包括术前规划、手术细节、潜在的陷阱和可能遇到的并发症。
