Christie J, Robinson C M, Pell A C, McBirnie J, Burnett R
Royal Infirmary of Edinburgh, Scotland, UK.
J Bone Joint Surg Br. 1995 May;77(3):450-5.
We performed transoesophageal echocardiography in 111 operations (110 patients) which included medullary reaming for fresh fractures of the femur and tibia, pathological lesions of the femur, and hemiarthroplasty of the hip. Embolic events of varying intensity were seen in 97 procedures and measured pulmonary responses correlated with the severity of embolic phenomena. Twenty-four out of the 25 severe embolic responses occurred while reaming pathological lesions or during cemented hemiarthroplasty of the hip and, overall, pathological lesions produced the most severe responses. Paradoxical embolisation occurred in four patients, all with pathological lesions of the femur (21%); two died. In 12 patients large coagulative masses became trapped in the heart. Extensive pulmonary thromboembolism with reamed bone and immature clot was found at post-mortem in two patients; there was severe systemic embolisation of fat and marrow in one who had a patent foramen ovale and widespread mild systemic fat embolisation in the other without associated foraminal defect. Sequential analysis of blood from the right atrium in five patients showed considerable activation of clotting cascades during reaming.
我们对111例手术（涉及110名患者）进行了经食管超声心动图检查，这些手术包括对股骨和胫骨新鲜骨折进行髓腔扩髓、股骨病理病变以及髋关节半关节置换术。在97例手术中观察到不同强度的栓塞事件，并且所测量的肺部反应与栓塞现象的严重程度相关。25例严重栓塞反应中的24例发生在扩髓处理病理病变时或髋关节骨水泥型半关节置换术中，总体而言，病理病变产生的反应最为严重。4例患者发生反常栓塞，均为股骨病理病变（发生率21%）；2例死亡。12例患者心脏中出现大量凝固性团块。两名患者尸检时发现扩髓骨和未成熟血栓导致广泛的肺血栓栓塞；一名卵圆孔未闭患者发生严重的脂肪和骨髓全身栓塞，另一名无相关孔道缺损患者发生广泛轻度全身脂肪栓塞。对5例患者右心房血液的连续分析显示，扩髓过程中凝血级联反应有显著激活。
