摘要
目的探讨海水浸泡开放性膝关节骨折早期不同骨折固定方法对血清心肌酶谱变化影响的特点及意义。方法成年家兔30只,体重(2.25±0.23)kg,采用随机数字表法分为骨折内固定对照组(A组)、骨折伴海水浸泡内固定组(B组)和骨折伴海水浸泡外固定组(C组),每组10只。制成开放性膝关节股骨内髁骨折模型后,A组伤口旷置2 h,B组和C组海水浸泡伤口2h。随后A、B组清创并行钢板螺钉内固定术,C组清创后行外固定、伤口延期缝合。于伤前、伤后6、12、24、48 h测定血清CK、CK-MB、LDH含量,记录动物死亡率。结果各组血清CK、CK-MB和LDH值均较伤前显著升高(P<0.01)。A组血清CK、CK-MB值在伤后24 h出现高峰,达伤前值的8倍;B、C组伤后48 h内持续升高,且显著高于A组(P<0.01),伤后48 h时B组的CK和CK-MB值达到伤前值的50倍左右,非常显著地高于A组和C组(P<0.01)。A、C组LDH值在伤后12 h出现高峰;B组伤后48 h内LDH值持续升高,伤后6 h后均较A组显著升高(P<0.05),伤后24 h后均较C组显著升高(P<0.01)。A组、B组和C组的死亡率分别为0、40%和10%,各组死亡率之间有明显统计学差异(P<0.05)。结论海水浸泡将显著加重开放性骨折后的心肌损害,一期骨折内固定术将加重其心肌损害,骨折外固定术、伤口延期缝合法可有效减轻心肌损害的发生,早期心肌酶谱监测对伤情预后判断有重要意义。
Objective To study the effects and significances of internal and external fixations for open knee joint fracture after seawater immersion on myocardial enzymes.Methods Totally 30 adult rabbits,weight（2.25±0.23） kg,were randomly divided into three groups（10 rabbits in each group）： internal fixation group（group A）,internal fixation with seawater immersion group（group B） and external fixation with seawater immersion group（group C）.The wounded legs of group B and C were immersed in seawater for two hours while those in group A received no treatment after the open femoral condyle fracture was made.Internal fixations with steel plate and screw were done in group A and B while external fixations and wound delay sutures were used in group C after the debridement in each group.The value of serum CK,CK-MB and LDH were detected before wounded and at 6,12,24,and 48 hours after wounded.The death rates were recorded.ResultsThe value of serum CK、CK-MB and LDH in each group all increased significantly after wounded（P0.01）.The value of serum CK and CK-MBA in group A came to the peaks（eight times of normal value） at 24 hours after wounded.The value of serum CK and CK-MBA in group B and C continually increased and were significantly higher than those in group A（P0.01）.The values of serum CK and CK-MB in group B were 50 times higher than the normal value at 48 hours after wounded,significantly higher than those in group A and C（P0.01）.The peaks of LDH in group A and C were detected at 12 hours after wounded.The value of LDH in group B increased persistently and were significantly higher than that in group A after 6 hours and that in group C after 24 hours（P0.01）.The death rates in group A,B and C were 0,40% and 10% respectively（P0.05）.Conclusion Seawater immersion would significantly aggravate the myocardial damage caused by open fracture,one-stage internal fixation will aggravate the myocardial damage while external fixation companied with wound delay sutures could alleviate the myocardial damage effectively.Myocardial enzymes detection in the early stage is useful in forecasting the wound severity.
出处
《局解手术学杂志》
2010年第5期397-400,共4页
Journal of Regional Anatomy and Operative Surgery
基金
南京军区重点课题基金资助项目(2007036010)
关键词
海水浸泡伤
开放性骨折
心肌酶谱
骨折固定术
兔
seawater immersion
open fracture
myocardial enzyme
fracture fixation
rabbit
