Husebye Elisabeth Ellingsen, Lyberg Torstein, Opdahl Helge, Laurvik Helene, Røise Olav
Department of Orthopedics, Oslo University Hospital, Ullevaal, Norway.
J Trauma. 2010 Oct;69(4):E6-14. doi: 10.1097/TA.0b013e3181d27928.
Intramedullary reaming and nailing increases intramedullary pressure. This may cause intravasation of bone marrow contents, leading to bone marrow embolization and altered cardiopulmonary function. Possible beneficial effects of attenuation of the intramedullary pressure increase by the use of a reamer-irrigator-aspirator (RIA) system were studied with the hypothesis that the RIA technique would cause lower numbers of pulmonary embolisms (PEs) and lesser cardiopulmonary affection than traditional reaming (TR).
Intramedullary reaming and nailing was performed in intact femora of young Norwegian landrace pigs using either a standard intramedullary nailing technique (n = 8) or a RIA technique (n = 7). The hemodynamic and pulmonary effects were investigated during the reaming and nailing procedure and for 2 hours postoperatively. The animals were killed after 72 hours, and the lung/carcass weight ratio and the numbers of PEs were investigated.
The pattern of the procedure-related hemodynamic and pulmonary effects did not differ significantly between the RIA and the TR groups. The RIA group had lower numbers (ns) of embolisms per square centimeter lung area than the TR group. After reaming with the TR device, two animals died of PEs, the first postoperative day. The patients with femoral shaft fracture and additional cardiopulmonary injury or preexisting reduced cardiopulmonary function, however, need special attention, and the use of RIA may, in these cases, represent a better operative alternative with a lesser operative burden.
髓内扩髓和髓内钉固定会增加髓内压力。这可能导致骨髓内容物进入血管，从而引起骨髓栓塞并改变心肺功能。本研究探讨了使用扩髓-冲洗-吸引（RIA）系统减轻髓内压力升高可能带来的有益效果，其假设为RIA技术导致的肺栓塞（PE）数量比传统扩髓（TR）少，对心肺的影响也更小。
使用标准髓内钉固定技术（n = 8）或RIA技术（n = 7），在挪威长白猪幼猪完整的股骨上进行髓内扩髓和髓内钉固定。在扩髓和髓内钉固定过程中以及术后2小时，研究其血流动力学和肺部影响。72小时后处死动物，研究肺/胴体重量比和PE数量。
RIA组和TR组在与手术相关的血流动力学和肺部影响模式上无显著差异。RIA组每平方厘米肺面积的栓塞数量（无统计学意义）低于TR组。使用TR装置扩髓后，有两只动物在术后第一天死于PE。然而，对于股骨干骨折合并额外心肺损伤或已有心肺功能减退的患者，需要特别关注，在这些情况下，使用RIA可能是一种更好的手术选择，手术负担较小。
