Maruenda J I, Barrios C, Gomar-Sancho F
Department of Surgery, Valencia University Medical School, Spain.
Clin Orthop Relat Res. 1997 Jul(340):172-80. doi: 10.1097/00003086-199707000-00022.
A consecutive series of 34 patients with femoral neck fractures was included in a prospective study aimed at evaluating preoperative variations in intracapsular pressure after changes in hip position, hip traction, and aspiration of hemarthrosis and their influence on the development of femoral head necrosis. Patients were observed for 7 years after surgery. Before aspiration, the mean intracapsular pressure in the antalgic physiologic position was 44.4 mm Hg. There were no differences between displaced and undisplaced fractures. The pressure was a maximum (mean value, 124.8 mm Hg) with the hip in extension and inward rotation, this pressure being greater than the blood systolic pressure in most cases. Hip traction of 3 kg in the antalgic physiologic position was found to be highly effective in preventing any bone flow tamponade effect in displaced and undisplaced femoral neck fractures: the mean intracapsular pressure decreased to 28.5 mm Hg. Aspiration of the hemarthrosis induced a significant decrease in intracapsular pressure only in cases with impaired vascularity of the femoral head as measured by scintigraphy using 99mTc labeled methyldiphosphonate. Aspiration of the hemarthrosis therefore is indicated only in the above cases, although it is less effective than hip traction in the antalgic position. There was no significant correlation between intracapsular pressure and the scintigraphy ratio. Avascular necrosis of the femoral head was detected in six cases. Among these, five patients had an intracapsular pressure below their diastolic blood pressure. This could indicate that vascular damage related to the fracture could be an important cause of bone necrosis despite that blood supply can be decreased by a tamponade effect.
一项前瞻性研究纳入了连续的34例股骨颈骨折患者，旨在评估髋关节位置改变、髋关节牵引以及关节积血抽吸后囊内压的术前变化及其对股骨头坏死发生发展的影响。术后对患者进行了7年的观察。在抽吸前，止痛生理位的平均囊内压为44.4 mmHg。移位骨折和未移位骨折之间无差异。髋关节伸展内旋时压力最大（平均值为124.8 mmHg），在大多数情况下该压力大于收缩压。发现在止痛生理位进行3 kg的髋关节牵引对防止移位和未移位股骨颈骨折出现任何骨血流填塞效应非常有效：平均囊内压降至28.5 mmHg。仅在使用99mTc标记的亚甲基二膦酸盐闪烁扫描测量显示股骨头血运受损的病例中，关节积血抽吸才导致囊内压显著降低。因此，关节积血抽吸仅适用于上述情况，尽管其在止痛位的效果不如髋关节牵引。囊内压与闪烁扫描比值之间无显著相关性。6例患者检测到股骨头缺血性坏死。其中，5例患者的囊内压低于其舒张压。这可能表明，尽管填塞效应可减少血液供应，但与骨折相关的血管损伤可能是骨坏死的重要原因。
