Lismore Base Hospital, Lismore, Australia.
John Hunter Hospital, New Lambton Heights, Australia.
Bone Joint J. 2018 Sep;100-B(9):1234-1240. doi: 10.1302/0301-620X.100B9.BJJ-2017-1531.R1.
Little is known about the effect of haemorrhagic shock and resuscitation on fracture healing. This study used a rabbit model with a femoral osteotomy and fixation to examine this relationship.
A total of 18 male New Zealand white rabbits underwent femoral osteotomy with intramedullary fixation with 'shock' (n = 9) and control (n = 9) groups. Shock was induced in the study group by removal of 35% of the total blood volume 45 minutes before resuscitation with blood and crystalloid. Fracture healing was monitored for eight weeks using serum markers of healing and radiographs.
Four animals were excluded due to postoperative complications. The serum concentration of osteocalcin was significantly elevated in the shock group postoperatively (p < 0.0001). There were otherwise no differences with regard to serum markers of bone healing. The callus index was consistently increased in the shock group on anteroposterior (p = 0.0069) and lateral (p = 0.0165) radiographs from three weeks postoperatively. The control group showed an earlier decrease of callus index. Radiographic scores were significantly greater in the control group (p = 0.0025).
In a rabbit femoral osteotomy model with intramedullary fixation, haemorrhagic shock and resuscitation produced larger callus but with evidence of delayed remodelling. Cite this article: Bone Joint J 2018;100-B:1234-40.
关于失血性休克及其复苏对骨折愈合的影响知之甚少。本研究通过兔股骨切开复位内固定模型来研究这种关系。
共 18 只雄性新西兰白兔行股骨切开复位髓内固定术，分为休克组（n = 9）和对照组（n = 9）。在研究组中，通过在复苏前 45 分钟去除总血量的 35%来诱发休克。使用愈合的血清标志物和 X 线片监测 8 周的骨折愈合情况。
由于术后并发症，有 4 只动物被排除。术后休克组血清骨钙素浓度明显升高（p < 0.0001）。在其他方面，骨愈合的血清标志物没有差异。术后 3 周，休克组前后位（p = 0.0069）和侧位（p = 0.0165）X 线片上的骨痂指数持续增加，而对照组则较早地减少了骨痂指数。对照组的 X 线评分明显更高（p = 0.0025）。
在兔股骨切开复位髓内固定模型中，失血性休克及其复苏导致更大的骨痂形成，但有证据表明其重塑延迟。
