Müller C, McIff T, Rahn B A, Pfister U, Perren S M, Weller S
AO Research Institute, Davos, Switzerland.
Injury. 1993;24 Suppl 3:S36-9. doi: 10.1016/0020-1383(93)90005-q.
The reaming process is considered the main damage factor in intramedullary nailing, as there are repeated increases in intramedullary pressure and cortical temperature, which can lead to aseptic cortex necroses and fat embolisms. In this study, the influence of the compression force on the increase in pressure is to be examined. The intramedullary pressure was measured in the middle of the diaphysis and in the metaphysis of human femora reamed under various compression forces. The compression force exerted by the surgeon was measured on polyurethane femora. It was observed that an increase in the compression force of 1.8 times led to an increase in the diaphyseal pressure of 4.7 times and of the metaphyseal pressure of 3.1 times. As surgeons exert high compression forces, peak pressures of 970 mmHg diaphyseally and 1150 mmHg metaphyseally must be expected in the hospital. If reaming is carried out with less compression force, the intramedullary pressure can easily be reduced by 79% in the area of the diaphysis and by 68% in the metaphysis.
扩髓过程被认为是髓内钉固定术中的主要损伤因素，因为髓内压力和皮质温度会反复升高，这可能导致无菌性皮质坏死和脂肪栓塞。在本研究中，将研究压缩力对压力升高的影响。在不同压缩力下对人股骨进行扩髓时，在骨干中部和干骺端测量髓内压力。在聚氨酯股骨上测量外科医生施加的压缩力。观察到压缩力增加1.8倍会导致骨干压力增加4.7倍，干骺端压力增加3.1倍。由于外科医生施加的压缩力较大，预计在医院中骨干的峰值压力为970 mmHg，干骺端为1150 mmHg。如果以较小的压缩力进行扩髓，在骨干区域髓内压力可轻松降低79%，在干骺端区域可降低68%。
