University Hospital Zurich, Department of Trauma, Raemistrasse 100, 8091 Zurich, Switzerland; University of Zurich, University Hospital Zurich, Department of Surgical Research, Harald Tscherne Laboratory for Orthopaedic and Trauma research, Sternwartstrasse 14, 8091 Zurich, Switzerland.
University Hospital Zurich, Department of Trauma, Raemistrasse 100, 8091 Zurich, Switzerland.
Injury. 2021 Jan;52(1):26-31. doi: 10.1016/j.injury.2020.10.027. Epub 2020 Oct 6.
The effects of reaming for preparation of intramedullary fixation in long bone fractures have been widely studied. We compared pulmonary and systemic effects between conventional reaming with reamer irrigator aspirator and unreamed nailing in an acute porcine trauma model with a standardized femur fracture.
In a standardized porcine model, (moderate blunt chest trauma, abdominal injury and femoral shaft fracture), the femur was submitted to intramedullary nailing after resuscitation and normalization of pulmonary function. The treatment groups included 3 reamer types (Group RFN: conventional reaming with Synream; group RIA1; reamer irrigator aspirator, version 2005; group RIA 2; reamer irrigator aspirator, version 2019) and were compared to unreamed femoral nailing (Group UFN). Pulmonary function measurements included arterial partial carbon-dioxide pressure (paCO [kPa]) (baseline, post reaming, 2,4,6 h) and volumetric measures of contusion in chest computer tomography (CT) (at 6 hrs.). Systemic inflammatory response was measured at baseline and every second hour until six hours after trauma.
This study included 24 male animals, mean weight 50.76 ± 4.1 kg n = 6 per group). Group RFN developed a significantly higher partial CO (pCO) at one hour after reaming when compared with all other groups (7.4 ± 0.4 kPa versus 5.4 ± 0.6 RIA 1, 5.6 ± 0.4 RIA 2, and 5.5 ± 0.5 UFN, p < 0.001), along with a had lower pO (12.3 ± 1.3 kPa versus 17.2 ± 1.9 RIA 1, 17.4 ± 1.6 RIA 2, and 16.4 ± 0.7 UFN, p < 0.001) and the degree of pulmonary hyperdense changes in the CT analysis was higher in RFN (485.2 ± 98.5 cm versus 344.4 ± 74.4 cm RIA 1 and 335.2 ± 58.1 cm RIA 2, p < 0.01). The inflammatory reaction was lowest in both RIA groups when compared with group RFN or UFN (p < 0.001).
Both RIA 1 and RIA 2 protect the lung from reaming induced dysfunction and have no systemic inflammatory effects, while the negative effects were more sustained after reamed or unreamed nailing. Both RIA 1 and RIA II appear to be of value in terms of a Safe Definitive Surgery (SDS) strategy.
扩髓准备髓内固定在长骨骨折中的作用已被广泛研究。我们比较了常规扩髓与髓内冲洗吸引器（reamer irrigator aspirator，RIA）和非扩髓髓内钉在标准化猪创伤模型中对肺和全身的影响，该模型具有股骨骨折。
在标准化的猪模型中（中度钝性胸部创伤、腹部损伤和股骨干骨折），在复苏和肺功能正常化后，对股骨进行髓内钉固定。治疗组包括 3 种扩髓类型（RFN 组：Synream 常规扩髓；RIA1 组；2005 版 RIA 冲洗吸引器；RIA2 组：2019 版 RIA 冲洗吸引器），并与非扩髓股骨钉（UFN 组）进行比较。肺功能测量包括动脉部分二氧化碳分压（paCO[kPa]）（基线、扩髓后 2、4、6 小时）和胸部计算机断层扫描（CT）的挫伤容积测量（6 小时）。在创伤后每两小时测量一次基础和系统炎症反应。
本研究纳入 24 只雄性动物，平均体重 50.76±4.1kg n=6 只/组）。与其他组相比，RFN 组在扩髓后 1 小时的 CO 部分（pCO）显著升高（7.4±0.4kPa 与 5.4±0.6RIA1、5.6±0.4RIA2 和 5.5±0.5UFN 相比，p<0.001），pO 较低（12.3±1.3kPa 与 17.2±1.9RIA1、17.4±1.6RIA2 和 16.4±0.7UFN 相比，p<0.001），CT 分析中肺高密度变化程度更高（485.2±98.5cm 与 344.4±74.4cmRIA1 和 335.2±58.1cmRIA2 相比，p<0.01）。与 RFN 或 UFN 相比，两组 RIA 中的炎症反应最低（p<0.001）。
RIA1 和 RIA2 均可防止扩髓引起的肺功能障碍，且无全身炎症反应，而扩髓或非扩髓后其负面效应更持久。RIA1 和 RIA II 似乎在安全确定性手术（Safe Definitive Surgery，SDS）策略方面具有价值。
