Black Loren O, Rushkin Megan, Lancaster Karalynn, Cheesman J Samuel, Meeker James E, Yoo Jung U, Friess Darin M, Working Zachary M
Department of Orthopaedics and Rehabilitation, Oregon Health and Science University, Portland, OR.
OTA Int. 2023 May 4;6(2 Suppl):e248. doi: 10.1097/OI9.0000000000000248. eCollection 2023 May.
Many investigations have evaluated local and systemic consequences of intramedullary (IM) reaming and suggest that reaming may cause, or exacerbate, injury to the soft tissues adjacent to fractures. To date, no study has examined the effect on local muscular physiology as measured by intramuscular pH (IpH). Here, we observe in vivo IpH during IM reaming for tibia fractures.
Adults with acute tibia shaft fractures (level 1, academic, 2019-2021) were offered enrollment in an observational cohort. During IM nailing, a sterile, validated IpH probe was placed into the anterior tibialis (<5 cm from fracture, continuous sampling, independent research team). IpH before, during, and after reaming was averaged and compared through repeated measures ANOVA. As the appropriate period to analyze IpH during reaming is unknown, the analysis was repeated over periods of 0.5, 1, 2, 5, 10, and 15 minutes prereaming and postreaming time intervals.
Sixteen subjects with tibia shaft fractures were observed during nailing. Average time from injury to surgery was 35.0 hours (SD, 31.8). Starting and ending perioperative IpH was acidic, averaging 6.64 (SD, 0.21) and 6.74 (SD, 0.17), respectively. Average reaming time lasted 15 minutes. Average IpH during reaming was 6.73 (SD, 0.15). There was no difference in IpH between prereaming, intrareaming, and postreaming periods. IpH did not differ regardless of analysis over short or long time domains compared with the duration of reaming.
Reaming does not affect IpH. Both granular and broad time domains were tested, revealing no observable local impact.
许多研究评估了髓内（IM）扩髓的局部和全身影响，并表明扩髓可能导致或加重骨折附近软组织的损伤。迄今为止，尚无研究通过肌内pH值（IpH）来检测对局部肌肉生理的影响。在此，我们观察了胫骨骨折髓内扩髓过程中的体内IpH值。
招募2019 - 2021年急性胫骨干骨折的成年人进入观察性队列。在髓内钉固定期间，将一个无菌、经过验证的IpH探头置于胫骨前肌（距骨折处<5 cm，连续采样，独立研究团队）。扩髓前、扩髓期间和扩髓后的IpH值进行平均，并通过重复测量方差分析进行比较。由于扩髓期间分析IpH的合适时间段未知，因此在扩髓前和扩髓后的0.5、1、2、5、10和15分钟时间段内重复进行分析。
在髓内钉固定期间观察了16例胫骨干骨折患者。从受伤到手术的平均时间为35.0小时（标准差，31.8）。围手术期开始和结束时的IpH值呈酸性，分别平均为6.64（标准差，0.21）和6.74（标准差，0.17）。平均扩髓时间持续15分钟。扩髓期间的平均IpH值为6.73（标准差，0.15）。扩髓前、扩髓期间和扩髓后各时间段的IpH值无差异。与扩髓持续时间相比，无论在短时间域还是长时间域进行分析，IpH值均无差异。
扩髓不影响IpH值。对颗粒状和宽泛的时间域均进行了测试，未发现明显的局部影响。
