Safran M R, Kody M H, Kabo J M, Dorey F J, Meals R A
Wadsworth Veterans Administration Medical Center, Division of Orthopaedic Surgery, Los Angeles, California.
Clin Orthop Relat Res. 1994 May(302):284-9.
Periarticular long bone fractures usually result in soft-tissue swelling because of edema and hemorrhage, as well as progressive, often permanent joint stiffness. The authors evaluated the effects of chlorothiazide, a commonly used diuretic, and acetazolamide, a weaker diuretic with a different mechanism of action, on joint stiffness and swelling using an established rabbit hindlimb model. Bilateral distal tibial fractures were produced in 30 adolescent New Zealand white rabbits. Twelve rabbits served as age-matched controls and received no treatment, 11 were treated with chlorothiazide, and seven were treated with acetazolamide, each for five days at doses adjusted for body weight but equivalent to human dosing. Eleven limbs were excluded from study because of fracture angulation in excess of 10 degrees. The mean stiffness ratios, comparing preoperative stiffness with stiffness at the end of the three-week study period, for diuretic-treated rabbits were significantly less than those in the control rabbits; there was no difference between the two treated groups. The total swelling and time to peak swelling did not differ among the three groups; however, peak swelling was least in the chlorothiazide group, the strong diuretic, when compared with the control and acetazolamide groups. The marked effect of diuretics on joint stiffness and their minimal effect on limb swelling were unexpected results and, taken in conjunction with previous treatment modalities tested in this model, indicate a complex, still poorly understood sequence of events leading to joint stiffness after periarticular injury.
关节周围的长骨骨折通常会因水肿和出血导致软组织肿胀，以及出现逐渐加重且往往是永久性的关节僵硬。作者使用已建立的兔后肢模型，评估了常用利尿剂氢氯噻嗪和作用机制不同的较弱利尿剂乙酰唑胺对关节僵硬和肿胀的影响。在30只青春期新西兰白兔身上造成双侧胫骨远端骨折。12只兔子作为年龄匹配的对照组，未接受任何治疗；11只接受氢氯噻嗪治疗；7只接受乙酰唑胺治疗，均按体重调整剂量，但相当于人类用药剂量，各治疗5天。11条肢体因骨折成角超过10度而被排除在研究之外。与术前僵硬程度相比，利尿剂治疗组兔子在为期三周的研究期末的僵硬程度比值显著低于对照组兔子；两个治疗组之间没有差异。三组之间的总肿胀程度和肿胀达到峰值的时间没有差异；然而，与对照组和乙酰唑胺组相比，强效利尿剂氢氯噻嗪组的肿胀峰值最小。利尿剂对关节僵硬有显著作用，而对肢体肿胀作用极小，这是出乎意料的结果，结合此前在该模型中测试的治疗方式来看，表明关节周围损伤后导致关节僵硬的一系列事件复杂且仍未得到充分理解。
