Hofmann A A, Wyatt R W, Gilbertson A A, DeKoss L, Miller J
Clin Orthop Relat Res. 1987 May(218):290-6.
A canine laboratory and clinical study was designed to determine the effect of air embolism during hip arthroplasty. Canine femurs were pressurized with air to 250-300 mm Hg or with low-viscosity cement to 300-900 mm Hg. Pressurization with low-viscosity cement from distal to proximal with a plugged femur revealed no change in pO2, pCO2, pulmonary artery pressure, or end-tidal CO2. Air pressurization resulted in significant increases in pCO2, pulmonary artery pressure, and end-tidal CO2, and a decrease in pO2. Pressurization of the medullary canal with xenon-labeled air was used to document pulmonary embolism. In a clinical setting, two different femoral cementing techniques during total hip arthroplasty were studied to determine their effect on hemodynamic parameters associated with embolic phenomenon. Five patients had a plugged femoral canal filled from proximal to distal with a vent tube, followed by finger-packing. Three of the patients demonstrated a significant drop in pO2 and blood pressure and a rise in pCO2 and end-tidal CO2. Five other patients had their plugged femoral canals filled from distal to proximal, three with regular cement and two with low-viscosity cement, with no significant cardiopulmonary changes. The adverse cardiopulmonary effects reported during hip arthroplasty appear to be avoided by eliminating air during the cementing procedure, by filling a plugged canal from distal to proximal.
一项犬类实验室和临床研究旨在确定髋关节置换术中空气栓塞的影响。用空气将犬类股骨加压至250 - 300毫米汞柱，或用低粘度骨水泥加压至300 - 900毫米汞柱。在股骨堵塞的情况下，从远端向近端用低粘度骨水泥加压，结果显示动脉血氧分压（pO2）、动脉血二氧化碳分压（pCO2）、肺动脉压或呼气末二氧化碳分压（EtCO2）均无变化。空气加压导致pCO2、肺动脉压和EtCO2显著升高，pO2降低。用氙标记的空气对髓腔进行加压，以记录肺栓塞情况。在临床环境中，研究了全髋关节置换术中两种不同的股骨骨水泥固定技术，以确定它们对与栓塞现象相关的血流动力学参数的影响。五名患者的堵塞股骨髓腔从近端向远端填充通气导管，随后进行手指填塞。其中三名患者的pO2和血压显著下降，pCO2和EtCO2升高。另外五名患者的堵塞股骨髓腔从远端向近端填充，三名使用普通骨水泥，两名使用低粘度骨水泥，未出现明显的心肺变化。通过在骨水泥固定过程中消除空气，从远端向近端填充堵塞的髓腔，似乎可以避免髋关节置换术中报告的不良心肺影响。
