Department of Trauma and Orthopaedics, Academic Unit, Clarendon Wing, Leeds Teaching Hospitals NHS Trust, Great George Street, Leeds, LS1 3EX, UK.
Int Orthop. 2011 Jul;35(7):951-6. doi: 10.1007/s00264-010-1189-z. Epub 2011 Jan 18.
The 'reamer-irrigator-aspirator' (RIA) is an innovation developed to reduce fat embolism (FE) and thermal necrosis (TN) that can occur during reaming/nailing of long-bone fractures. Since its inception its indications have expanded to include the treatment of long-bone osteomyelitis and as a harvester of bone graft/mesenchymal stem cells (MSCs).
This study involved a systematic review, via Pubmed® and Google Scholar®, of English language sources (nine non-clinical studies, seven clinical studies and seven case reports) using the keywords: 'reamer', 'irrigator', 'aspirator' (1st May 2010). Sources were reviewed with reference to the RIAs efficacy in (1) preventing FE/TN, (2) treating long-bone osteomyelitis, (3) harvesting bone graft/MSCs, and (4) operating safely. Experimental data supports the use of the RIA in preventing FE and TN, however, there is a paucity of clinical data.
The RIA is a reliable method in achieving high volumes of bone graft/MSCs, and high union rates are reported when using RIA bone-fragments to treat non-unions. Evidence suggests possible effectiveness in treating long-bone osteomyelitis. The RIA appears relatively safe, with a low rate of morbidity provided a meticulous technique is used. When complications occur they respond well to conventional techniques. The RIA demands further investigation especially with respect to the optimal application of MSCs for bone repair strategies.
“扩髓冲洗吸引器”（RIA）是为减少扩髓/钉固定长骨骨折时可能发生的脂肪栓塞（FE）和热坏死（TN）而开发的创新技术。自发明以来，其适应证已扩展到包括长骨骨髓炎的治疗以及作为骨移植物/间充质干细胞（MSCs）的采集器。
本研究通过 Pubmed® 和 Google Scholar® 对英语语言来源进行了系统评价（9 项非临床研究、7 项临床研究和 7 项病例报告），使用的关键词为：“扩髓器”、“冲洗器”、“吸引器”（2010 年 5 月 1 日）。参考 RIAs 在以下方面的疗效对来源进行了审查：（1）预防 FE/TN，（2）治疗长骨骨髓炎，（3）采集骨移植物/MSC，和（4）安全操作。实验数据支持 RIA 在预防 FE 和 TN 中的应用，但临床数据很少。
RIA 是一种可靠的方法，可获得大量的骨移植物/MSC，并且当使用 RIA 骨碎片治疗骨不连时，报告的愈合率很高。有证据表明，在治疗长骨骨髓炎方面可能有效。RIA 看起来相对安全，如果使用精细的技术，发病率较低。发生并发症时，它们对常规技术反应良好。RIA 需要进一步研究，特别是在骨修复策略中优化 MSC 的应用方面。
