全髋关节置换术中扩髓前冲洗对扩髓时髓内压影响探究.docVIP

全髋关节置换术中扩髓前冲洗对扩髓时髓内压影响探究 　 作者：赵德勇,王业华,辛力,陈向阳,柯明池 【摘要】 目的 观察全髋关节置换术（THR）中扩髓前冲洗、吸取髓腔内容物能否降低扩髓时髓内压（IMP）及IMP的变化情况。方法 选取20例具备THR手术指征的患者，按入院先后顺序随机分为常规扩髓组和扩髓前冲洗组，每组10例。扩髓前冲洗组先行扩髓前冲洗、吸取髓腔内容物，然后再常规扩髓。监测整个手术过程中IMP的变化情况。将2组的IMP峰值进行对比分析。结果 扩髓前冲洗组IMP峰值小于常规扩髓组(Plt;0.01) 。2组内髓腔锉锉髓腔时平均髓内压峰值均较髓腔钻扩髓时平均IMP峰值高(Plt;0.01)。结论 扩髓前冲洗较常规扩髓能降低扩髓时IMP峰值。 【关键词】 全髋关节置换术；髓内压；扩髓；脂肪栓塞 　　Abstract:Objective To investigate the effect of irrigation/suction of the medullary contents before reaming on intramedullary pressure (IMP) in total hip replacement (THR) and the variations of IMP during reaming of the femoral medullary cavity.Methods 20 patients indicative of THR were randomly allocated into the conventional reaming group and the irrigation before reaming group according to their admission sequence, with 10 patients in each group. The irrigation before reaming technique refers to irrigation/suction of the medullary contents before reaming, and then conventional reaming technique was applied. The variations of IMP during reaming of the femoral medullary cavity were monitored. The peak values of IMP at different time points in the two groups were compared and analyzed.Results The average peak value of IMP in the irrigation before reaming group was lower than that in the conventional reaming group (Plt;0.01). Compared with the average peak value of IMP with pulp canal drill in each group, the average peak value of IMP with pulp canal rasp was higher (Plt;0.01).Conclusions The irrigation before reaming can decrease the peak value of IMP during reaming of the femoral medullary cavity. 　　Key words： total hip replacement; intramedullary pressure; reaming; fat embolism 全髋关节置换术（THR）是关节外科领域常见的手术之一。手术中髓内压（IMP）的增加可以诱发脂肪栓塞，肺部的脂肪栓子来源于骨髓脂肪，而且脂肪栓塞的严重程度与IMP增加的幅度成正比，随着累积IMP的增加，肺部脂肪栓塞的情况就越严重［1］。由于发生脂肪栓塞最根本的原因是IMP升高,致使髓腔内脂肪和其他骨髓成分的溢出,所以采用各种方法避免手术和其他操作过程中IMP过度升高,就能有效地预防脂肪栓塞综合征(fat embolism syndrome,FES)的发生。本研究试图采用扩髓前冲洗降低IMP，减轻脂肪栓塞，使扩髓过程更安全。 　　1 资料和方法 　　1.1 一般资料 　　2007年2月—2008年2月选取20例具备THR手术指征的患者，按入院先后顺序随机分为常规扩髓组和