Lindström T, Gullichsen E, Aho A, Helenius H, Niinikoski J
Department of Surgery, University of Turku, Finland.
Ann Chir Gynaecol. 1998;87(4):317-20.
To measure noninvasively the effect of circulative changes caused by fracture and intramedullary nailing on tibialis posterior (TPA), dorsalis pedis (DPA) and sum (TPA + DPA) arterial peak signals, transcutaneous oxygen tension (PtcO2) as well as local skin temperature (T) in patients with tibial shaft fractures.
PATIENTS, MATERIAL AND METHODS: A total of thirty tibias consisting of ten closed, reamed, intramedullary nailed simple tibial shaft fractures (Type AO A), ten contralateral tibias and as controls, ten intact tibias of healthy volunteers. The measurements took place one day before and immediately after nailing, six hours later and during five days postoperatively. The values were compared to those of contralateral legs and to control legs.
In the nailed legs the mean TPA and PtcO2 remained at a significantly lower level compared to the contralateral legs throughout the study (p < 0.003 in both cases). However, the alterations in DPA and TPA + DPA were not statistically significant. Additionally, skin temperature on the fracture site was averagely 3 degrees C warmer than that of the contralaterals (p < 0.001). All the measured parameters were statistically significantly higher in control legs compared to contralateral legs. There were no statistically significant differences between pre- and postoperative values in any measured parameters.
The changes in the local tissue perfusion variables measured in the present study reflect rather the injury mechanism itself than the effect of reaming and intramedullary nailing in simple tibial fractures. Additionally, arterial circulation was reduced in the contralateral legs.
非侵入性测量胫骨干骨折及髓内钉固定引起的循环变化对胫后动脉（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）以及局部皮肤温度（T）的影响。
患者、材料与方法：共纳入30条胫骨，包括10例闭合性、扩髓、髓内钉固定的单纯胫骨干骨折（AO A型），10例对侧胫骨以及作为对照的10例健康志愿者的完整胫骨。在钉固定术前1天、术后即刻、术后6小时以及术后5天进行测量。将测量值与对侧腿以及对照腿的值进行比较。
在整个研究过程中，与对侧腿相比，髓内钉固定侧的平均TPA和PtcO2显著降低（两种情况均p < 0.003）。然而，DPA和TPA + DPA的变化无统计学意义。此外，骨折部位的皮肤温度平均比对侧高3℃（p < 0.001）。与对侧腿相比，对照腿的所有测量参数在统计学上均显著更高。任何测量参数的术前和术后值之间均无统计学显著差异。
本研究中测量的局部组织灌注变量的变化更多反映的是损伤机制本身，而非单纯胫骨干骨折扩髓和髓内钉固定的影响。此外，对侧腿的动脉循环减少。
