University of Alabama at Birmingham, Birmingham, AL, USA.
Injury. 2010 Nov;41 Suppl 2:S90-3. doi: 10.1016/S0020-1383(10)70017-6.
To measure the amount of fat presented to the right heart during reaming and nail placement using two different reamer systems.
Prospective, randomized clinical trial.
University-based Level I Trauma Center.
20 patients with femur fractures.
Patients with femur fractures were treated with intramedullary nailing using either reamer-irrigator-aspirator or a conventional reamer.
four-chamber trans-esophageal echocardiogram was used to quantify the amount of fat presented to the right atrium.
There were 2 female and 18 male patients enrolled, 10 in each group. There was no significant difference (p = 0.10) between reaming systems on the opening reamer, which was expected since both trial limbs used the same opening reamer. However, during the first pass of the reamer, the RIA showed a nearly-significant decrease in the volume of fat in the right atrium (p = 0.06). During passage of the nail, there was a significant difference with Group B having less fat embolus than Group A (p = 0.01). The power of this study is 0.81. The mean ISS was not significantly different between the two groups, nor was the sex, age or race. There was one death from cardiac complications in a patient who showed no fat during any phase of the procedure. This patient had significant mitral and aortic regurgitation pre-operatively. There was one patient with clinical fat embolism syndrome and one patient with a nonunion.
There is a statistically significant difference in the amount of fat presented to the lungs using a RIA versus conventional reamer.
使用两种不同扩孔器系统测量扩孔和钉钉过程中右心所接受的脂肪量。
前瞻性、随机临床试验。
大学一级创伤中心。
20 名股骨骨折患者。
股骨骨折患者使用髓内钉治疗，分别使用扩孔冲洗吸引器或传统扩孔器。
四腔经食管超声心动图用于定量右心房内出现的脂肪量。
共纳入 2 名女性和 18 名男性患者，每组 10 名。两种扩孔系统在开口扩孔器上没有显著差异（p=0.10），因为两个试验组都使用相同的开口扩孔器。然而，在第一次扩孔过程中，RIA 显示右心房内脂肪量有显著减少的趋势（p=0.06）。在钉道通过过程中，B 组的脂肪栓塞明显少于 A 组（p=0.01）。本研究的功率为 0.81。两组间的 ISS 均值无显著差异，性别、年龄或种族也无显著差异。在手术过程中没有出现脂肪的一位患者死于心脏并发症。该患者术前存在明显的二尖瓣和主动脉瓣反流。有 1 例患者出现临床脂肪栓塞综合征，1 例患者出现骨不连。
与传统扩孔器相比，使用 RIA 时肺部出现的脂肪量有统计学上的显著差异。
