Lindström T, Gullichsen E, Lertola K, Niinikoski J
Department of Surgery, University of Turku, Finland.
Undersea Hyperb Med. 1998 Summer;25(2):87-91.
We evaluated the effect of hyperbaric oxygen (HBO2) therapy on tibialis posterior (TPA), dorsalis pedis (DPA), and sum (TPA + DPA) arterial peak signals, as well as transcutaneous oxygen (PtcO2) tension and leg skin temperature (T) after intramedullary nailing of tibial shaft fractures. Twenty consecutive patients with closed and simple tibial shaft fractures treated with reamed intramedullary nailing were assigned randomly to HBO2 or control groups. HBO2 therapy was given postoperatively at 2.5 atm abs pressure for 90 min daily for a total of five treatments. The first HBO2 therapy was given 1 h after the operation. In both groups, measurements were performed preoperatively, 30 min and 6 h postoperatively, and on the following 5 days. There was a statistically significant improvement in TPA values in the nailed legs in the HBO2 treatment group after the first postoperative day, and these values remained at a significantly higher level until the end of the study when compared to the nailed legs in the control group. Further, there was a statistically significant improvement in PtcO2 values in the nailed legs in the HBO2 group after the third HBO2 treatment. However, there were no statistically significant differences in DPA and TPA + DPA values within or between the nailed legs in HBO2 and control groups. HBO2 therapy seemed to decrease the skin temperature of the nailed legs, but this alteration was not statistically significant. In addition to the clearly documented advantages in the management of crush injuries and compartment syndromes, HBO2 therapy has a positive effect on the perfusion parameter (TPA) and PtcO2 in patients with low energy, intramedullary nailed simple tibial shaft fractures. The improvement in TPA and PtcO2 values may result from the vasoconstrictive and edema reductive effect on HBO2 with concomitant inhibition of inflammatory reactions with slight cooling.
我们评估了高压氧（HBO₂）疗法对胫骨干骨折髓内钉固定术后胫后动脉（TPA）、足背动脉（DPA）以及两者之和（TPA + DPA）动脉峰值信号、经皮氧分压（PtcO₂）和腿部皮肤温度（T）的影响。20例接受扩髓髓内钉固定治疗的闭合性单纯胫骨干骨折患者被随机分为HBO₂组和对照组。HBO₂疗法在术后以2.5绝对大气压进行，每天90分钟，共治疗5次。首次HBO₂治疗在术后1小时进行。两组均在术前、术后30分钟和6小时以及随后5天进行测量。术后第一天后，HBO₂治疗组中接受髓内钉固定的腿部TPA值有统计学意义的改善，与对照组中接受髓内钉固定的腿部相比，这些值在研究结束前一直保持在显著更高的水平。此外，第三次HBO₂治疗后，HBO₂组中接受髓内钉固定的腿部PtcO₂值有统计学意义的改善。然而，HBO₂组和对照组中接受髓内钉固定的腿部之间或内部，DPA和TPA + DPA值没有统计学意义的差异。HBO₂疗法似乎降低了接受髓内钉固定的腿部的皮肤温度，但这种变化没有统计学意义。除了在挤压伤和骨筋膜室综合征治疗中已明确记录的优势外，HBO₂疗法对低能量、髓内钉固定的单纯胫骨干骨折患者的灌注参数（TPA）和PtcO₂有积极影响。TPA和PtcO₂值的改善可能源于HBO₂的血管收缩和减轻水肿作用，同时伴有轻微降温对炎症反应的抑制。
