摘要
目的观察减压型髓腔锉能否减轻髋关节置换术中扩髓诱发的脂肪栓塞,为预防人工关节置换过程中的脂肪栓塞提供参考。方法12只杂种犬随机分为实验组和对照组,每组6只。模拟髋关节置换术的扩髓过程,实验组使用减压型髓腔锉扩髓,其外表面刻有齿槽,主要作用部分呈锥形,尖端直径6.4mm。沿其中央纵轴有一直径4mm的孔与两端相通,在距离尖端77mm处有一侧向支管。对照组使用普通髓腔锉扩髓。扩髓过程中记录髓腔内压力峰值、血液动力学指标。动物处死后,Leica图像分析仪计算肺组织内脂肪栓塞的面积,进行t检验。结果实验组、对照组髓内压力分别为(22.4±7.7)kPa和(34.5±10.2)kPa,两者间差异有非常显著性意义(P<0.01);肺组织内脂肪栓塞面积百分比分别为0.21%和0.64%,两者间差异有显著性意义(P<0.05);平均肺动脉压分别为(1.7±0.4)kPa和(2.2±0.4)kPa,差异有显著性意义(P<0.05)。结论普通髓腔锉可诱发脂肪栓塞,并造成对血流动力学的影响;减压型髓腔锉使扩髓时髓腔内压力得到释放,减少了肺组织内的脂肪栓塞,降低了肺动脉压的增加。
Objective To describe the effect of cannualted rasps in reduc in g the fat embolic risks during preparation for femoral canal in experimental tot al hip arthroplasty. Methods Twelve mongrels were used to perform resection of b ilateral femoral heads, and randomly assigned to one of two groups with six each . In experiment group, impacting cannulated rasp was used in preparing femoral c anal; while, in control group, impacting traditional rasp was used. Both the ras ps were of same shape; however, there was a 4 mm diameter canal inside the cannu lated rasp connecting its two ends. A bone hole was made through the lateral fem oral cortex to the femoral canal at a point 12 cm distal to the greater trochant er in order to measure the intramedullary pressure of femoral canal when the fem oral canal was prepared with either rasp. The pathology of the postmortem pulmon ary tissue was analyzed. Using quantitative morphometry, the size of fat embolus in the lung tissues and the volume proportion of lung tissues occluded by fat w ere measured respectively. The statistical differences between the two groups we re analyzed using t test. Results In control group, the intramedullary pressure during preparation of femoral canal with traditional rasp increased with a peak of (34.5±10.2)kPa, pulmonary fat emboli were found in all mongrels, the volum e proportion of postmortem lung tissue occluded by fat was 0.64%, and pulmonary arterial pressure increased to (2.2±0.4)kPa[the normal value was (0.8±0.3 )kPa]; while in the experiment group, the intramedullary pressure peak increas ed to (22.4±7.7)kPa, significantly lower than that of the control group; the volume proportion of lung tissue occluded by fat was 0.21% which was also signif icantly lower than that of the control group, and pulmonary arterial pressure wa s (1.7±0.4)kPa. The differences between the two groups were significant in al l measured values. Conclusion The present study suggests that conventional prepa ration of canal can cause an increase of intramedullary pressure, which may lead to pulmonary fat embolism and cardiopulmonary impairment. However, the cannulat ed rasp can decrease the volume proportion of lung tissue occluded by fat and al leviate the influence of preparation of canal on cardiopulmonary function.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2003年第12期752-755,共4页
Chinese Journal of Orthopaedics
