Pape H C, Dwenger A, Grotz M, Kaever V, Negatsch R, Kleemann W, Regel G, Sturm J A, Tscherne H
Department of Trauma Surgery, Hannover Medical School, Germany.
J Orthop Trauma. 1994 Aug;8(4):300-9. doi: 10.1097/00005131-199408000-00005.
In multiple trauma patients with lung contusion, pulmonary complications have been reported that were attributed to intramedullary stabilization of the femur. The reaming procedure of the medullary canal is thought to play a major role. We investigated whether different types of reamers might exert different amounts of fat mobilization into the vascular system and different degrees of pulmonary dysfunction. Adult female Merino sheep were submitted to hemorrhagic shock (2 h, 50 mm Hg) and a unilateral lung contusion; in addition, a lung lymph fistula was created. Pulmonary capillary permeability, central venous triglyceride levels, 11-dehydro-thromboxane B2 (dh-TXB2) levels, and pulmonary artery pressure were determined. After recovery, animals were randomly assigned to intramedullary femoral nailing using several types of reamers: group A, AO reamer (n = 8); group B, Biomet reamer (n = 7); group H, Howmedica reamer (n = 6); group C, controls, no reaming (n = 4). Intramedullary reaming caused a significant (p < 0.05) increase in pulmonary artery pressure in groups A and B; dh-TXB2 levels increased in all groups. Statistically significant (p < 0.05) pulmonary capillary permeability damage was measured in group A only. Intramedullary femoral nailing can cause transient pulmonary hemodynamic and mediator effects as well as increased pulmonary capillary permeability. In the present study, this effect was evident in group A reamer systems only, which may be due to reamer construction.
在伴有肺挫伤的多发伤患者中，已有报道称股骨髓内固定会引发肺部并发症。髓腔扩髓操作被认为起主要作用。我们研究了不同类型的扩髓器是否会使不同量的脂肪进入血管系统以及导致不同程度的肺功能障碍。成年雌性美利奴羊遭受失血性休克（2小时，50毫米汞柱）和单侧肺挫伤；此外，还建立了肺淋巴瘘。测定肺毛细血管通透性、中心静脉甘油三酯水平、11-脱氢血栓素B2（dh-TXB2）水平和肺动脉压力。恢复后，动物被随机分组，使用几种类型的扩髓器进行股骨髓内钉固定：A组，AO扩髓器（n = 8）；B组，Biomet扩髓器（n = 7）；H组，Howmedica扩髓器（n = 6）；C组，对照组，不进行扩髓（n = 4）。髓内扩髓导致A组和B组肺动脉压力显著升高（p < 0.05）；所有组的dh-TXB2水平均升高。仅在A组测量到具有统计学意义（p < 0.05）的肺毛细血管通透性损伤。股骨髓内钉固定可导致短暂的肺血流动力学和介质效应以及肺毛细血管通透性增加。在本研究中，这种效应仅在A组扩髓器系统中明显，这可能归因于扩髓器的构造。
