Department of Orthopaedics, University of Szeged, 6725 Szeged, Semmelweis u.6, Szeged, Hungary.
Department of Traumatology, University of Szeged, 6725 Szeged, Semmelweis u.6, Szeged, Hungary.
Injury. 2021 Mar;52 Suppl 1:S3-S6. doi: 10.1016/j.injury.2020.11.053. Epub 2020 Nov 28.
We examined the endosteal and periosteal circulations in a patient with fracture non-union who had undergone excessive osteosynthesis applications (two long plates had been placed medially and laterally on the left tibia extending from the proximal 2/7 to the distal 6/7 parts of the bone, while a tibial component of a total knee prosthesis with a long stem had been inserted at the same time).
Concomitant perfusion changes were determined in the anterolateral and anteromedial periosteal sheath of the non-united bone ends and intramedullary nearest the osteosynthesis materials during their surgical removal on re-operation. The blood flow in the periosteum and endosteum was recorded by a laser-Doppler flowmetric device using a novel approach. Control measurements were made at identical points of the right tibia.
Considerably lower blood flow values were measured along the tibial periosteal region of the re-operated limb than on the contralateral side (the average perfusion unit (PU) was 76 vs. 106 PU, respectively). Perfusion values were markedly lower in the endosteal region (average values of approx. 30 PU) in the control tibia and were even more diminished in the re-operated tibial endosteum (average 9 PU).
Our study was conducted to characterize the microcirculatory changes of a long bone in response to intramedullary implantation and to provide quantitative data on the insufficiency of local perfusion in a patient with fracture non-union. Our results highlight the association between local perfusion failure and the unfavorable outcome (i.e. fracture non-union), confirming that the vital aspects of the microcirculation should not be disregarded when aiming for mechanical stability. Microcirculatory measurements constitute a new area of improvement in planning the adequate treatment for fracture non-unions with an unclear aetiology. Further refinement of the laser-Doppler technique could have potential benefits for bone surgery and postoperative trauma care in the future.
我们研究了一位经历过度骨愈合应用（在左腿胫骨的内侧和外侧放置了两块长板，从近端的 2/7 延伸到骨的远端 6/7 部分，同时在同一位置插入了全膝关节假体的胫骨部件，带有长柄）后发生骨折不愈合的患者的骨内膜和骨膜循环。在再次手术中去除骨愈合材料时，同时确定了未愈合骨端的前外侧和前内侧骨膜鞘以及最靠近骨愈合材料的骨髓内的并发灌注变化。使用一种新方法，通过激光多普勒流量测量仪记录骨膜和骨内膜中的血流。在右侧胫骨的相同位置进行对照测量。
与对侧相比，手术肢体的胫骨骨膜区域的血流值明显较低（平均灌注单位（PU）分别为 76 和 106 PU）。在对照胫骨的骨内膜区域的灌注值明显较低（平均约为 30 PU），在手术肢体的胫骨骨内膜中甚至更低（平均 9 PU）。
我们的研究旨在描述长骨对骨髓内植入的微循环变化，并提供骨折不愈合患者局部灌注不足的定量数据。我们的结果强调了局部灌注衰竭与不良结果（即骨折不愈合）之间的关联，证实了在追求机械稳定性时不应忽视微循环的重要方面。微循环测量构成了改善对病因不明的骨折不愈合进行适当治疗的新领域。激光多普勒技术的进一步改进可能对未来的骨外科手术和术后创伤护理具有潜在益处。
