Eifinger Frank, Scaal Martin, Wehrle Lukas, Maushake Stien, Fuchs Zeynep, Koerber Friederike
Department of Pediatric Critical Care Medicine and Neonatology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str.62, 50937 Cologne, Germany.
Institute of Anatomy II, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str.62, 50937 Cologne, Germany.
Resuscitation. 2021 Jun;163:57-63. doi: 10.1016/j.resuscitation.2021.04.004. Epub 2021 Apr 20.
Intraosseous (IO)-access plays an alternative route during resuscitation. Our study in preterm and term stillborns was performed to find alternative IO puncture sites beside the recommended proximal tibia.
The cadavers used were legal donations. 20 stillborns (mean: 29.2weeks, IQR 27.1-39.6) were investigated. Spectral-CT were analysed to calculate the diameter and circumferences of: i) proximal humerus ii) distal femur iii) proximal tibia iv) diaphyseal tibial. Contrast medium was applied under video documentation to investigate the drainage into the vascular system.
In term newborns, diameter of the cortex of the proximal humeral head is 12.1 ± 1.8 mm, distal end of the femur 11.9 ± 3.4 mm and the proximal tibial bone 12.0 ± 2.4 mm with cross-sectional diameter of 113.5 ± 19.7 mm, 120.6 ± 28.2 mm and 111.6 ± 29.5 mm, respectively. Regarding the preterm groups, there is a strong age-related growth in diameter and cross -sectional size. The diaphyseal area is the smallest in all measured bones with an age-dependent increase and is about half of that of metaphyseal diameters (proximal and distal) and about one third of that of metaphyseal cross sectional areas. The proximal femoral head region has the largest diameter of all measured bones with an egg-shaped formation with an extensive joint capsula. All investigated metaphyseal areas lack a clearly enclosed bone marrow cavity. Infusion of contrast medium into the distal femoral end and the proximal humerus head demonstrate the drainage of contrast medium into the central venous system within seconds.
Proximal humeral head and distal femoral end might be alternative IO areas which may lead to further IO puncture sites in neonates.
骨内（IO）通路是复苏过程中的一种替代途径。我们对早产和足月死产儿进行了研究，以寻找除推荐的胫骨近端之外的其他IO穿刺部位。
使用的尸体为合法捐赠。对20例死产儿（平均：29.2周，四分位距27.1 - 39.6）进行了研究。分析光谱CT以计算以下部位的直径和周长：i）肱骨近端；ii）股骨远端；iii）胫骨近端；iv）胫骨干。在视频记录下注入造影剂，以研究其向血管系统的引流情况。
在足月新生儿中，肱骨头近端皮质直径为12.1±1.8毫米，股骨远端为11.9±3.4毫米，胫骨近端骨为12.0±2.4毫米，其横截面直径分别为113.5±19.7毫米、120.6±28.2毫米和111.6±29.5毫米。对于早产组，直径和横截面大小与年龄有很强的相关性增长。骨干区域在所有测量的骨骼中最小，且随年龄增加，约为干骺端直径（近端和远端）的一半，约为干骺端横截面积的三分之一。股骨头近端区域在所有测量的骨骼中直径最大，呈椭圆形，关节囊广泛。所有研究的干骺端区域均缺乏清晰封闭的骨髓腔。向股骨远端和肱骨头近端注入造影剂后，数秒内造影剂即排入中央静脉系统。
肱骨头近端和股骨远端可能是替代的IO区域，这可能会为新生儿带来更多的IO穿刺部位。
