Department of Orthopaedics, Oslo University Hospital, Ullevaal, Norway.
Injury. 2010 Nov;41 Suppl 2:S9-15. doi: 10.1016/S0020-1383(10)70003-6.
Intramedullary orthopaedic procedures may increase the intramedullary pressure (IMP) and thereby cause intravasation of bone marrow contents. In recent studies by the authors the reamer-irrigator-aspirator (RIA) has been demonstrated to reduce IMP and coagulation-, fibrinolysis- and cytokine responses, but did not prove any significant difference in cardiopulmonary function parameters or numbers of emboli when compared to a traditional reaming (TR) system. The correlations between IMP increase, regardless type of reamer, and inflammatory- and coagulation responses, pulmonary embolization, and cardiopulmonary alterations have, however, not previously been analyzed in this material. Our hypothesis was that a lower IMP would result in reduced occurrence of pulmonary embolization, reduced inflammatory-and coagulation responses, as well as reduced cardiopulmonary alterations.
Twenty-eight young Norwegian landrace pigs were exposed to femoral intramedullary reaming, with either the TR (n = 10) or the RIA (n = 10) system, or used as controls (n = 8). IMP was recorded during reaming and nailing. Serial blood samples for demonstration of coagulation-, fibrinolysis-, and cytokine activation were withdrawn peroperatively and until 72 hours post nail insertion. Circulatory and pulmonary effects were monitored peroperatively and until two hours postoperatively. The animals were sacrificed 72 hours post nail insertion and lung tissue biopsies were harvested and examined for lung emboli.
A strong correlation between increased IMP and increased coagulation-and cytokine responses was found. The number of emboli was not significantly correlated to IMP, but was strongly correlated to changes in the coagulation- and cytokine responses. No clinical relevant correlations were observed between increased IMP or numbers of lung emboli and changes in hemodynamic- or pulmonary function parameters. A correlation between coagulation activation and cytokine activation was observed. This study confirms the connection between increased IMP, increased coagulation activation and the magnitude of pulmonary emboli in a model evaluating the effects of intramedullary reaming of intact pig femora. In this model, the lowering of IMP during reaming, as obtained with RIA, reduced the magnitude of and the effects of bone marrow extravasation.
髓内骨科手术可能会增加髓内压力（IMP），从而导致骨髓内容物的血管内渗。在作者最近的研究中，扩孔冲洗抽吸（RIA）已被证明可降低 IMP 以及凝血、纤溶和细胞因子反应，但与传统扩孔（TR）系统相比，在心肺功能参数或栓塞数量方面并未证明任何显著差异。然而，在该材料中，之前尚未分析过与 IMP 增加相关的因素，无论使用哪种类型的扩孔器，与炎症和凝血反应、肺栓塞以及心肺改变之间的相关性。我们的假设是，较低的 IMP 会导致肺栓塞的发生减少，炎症和凝血反应减少，以及心肺改变减少。
28 头年轻的挪威兰德瑞斯猪暴露于股骨髓内扩孔，使用 TR（n = 10）或 RIA（n = 10）系统，或作为对照组（n = 8）。在扩孔和钉钉过程中记录 IMP。术中每小时抽取系列血液样本以证明凝血、纤溶和细胞因子激活，并在钉钉后 72 小时内抽取。术中监测循环和肺功能，直到术后两小时。钉钉后 72 小时处死动物，采集肺组织活检并检查肺栓塞。
发现 IMP 增加与凝血和细胞因子反应增加之间存在很强的相关性。栓塞数量与 IMP 无显著相关性，但与凝血和细胞因子反应的变化密切相关。在增加的 IMP 或肺栓塞数量与血液动力学或肺功能参数的变化之间未观察到临床相关的相关性。观察到凝血激活与细胞因子激活之间存在相关性。本研究在评估完整猪股骨髓内扩孔影响的模型中证实了 IMP 增加、凝血激活增加与肺栓塞数量之间的联系。在该模型中，RIA 获得的扩孔过程中 IMP 的降低，减少了骨髓外渗的程度和影响。
