髓腔高压引发的骨水泥植入综合征的预防研究

目的：分别观察髓腔减压和肾上腺皮质激素应用对由髓腔填塞面团期骨水泥引起的骨水泥植入综合征的预防作用。方法：以新西兰白兔为研究对象,实验分为3组。对照组为一侧股骨髓腔填塞面团期骨水泥,髓腔减压组在股骨近端钻一直径2mm的减压孔,然后同样填塞面团期骨水泥。肾上腺皮质激素预防组在填塞面团期骨水泥之前30min静脉注射地塞米松10mg。动态观察骨水泥植入综合征的发生情况以及动脉血压、动脉血氧分压的变化,并对实验动物的肺标本进行病理观察。结果：对照组10只动物均发生典型的骨水泥植入综合征。对照组动脉血压平均下降62.5/53.8mmHg,动脉血氧分压平均下降33.0mmHg。髓腔减压组10只动物均未发生典型的骨水泥植入综合征,动脉血压平均下降19.9/10.3mmHg,动脉血氧分压平均下降3.7mmHg。皮质激素预防组10只动物也均发生典型的骨水泥植入综合征。动脉血压平均下降47.5/43.3mmHg。动脉血氧分压平均下降23.2mmHg,病理检查发现对照组肺标本可见大量肺脂肪栓塞,甚至可见骨碎屑栓塞。髓腔减压组肺标本中未见脂肪等栓塞表现。皮质激素预防组肺标本见大量脂肪栓塞形成。结论：髓腔高压是骨水泥植入综合征发生的主要原因。髓腔减压可以有效预防其发生,皮质激素不能有效预防＂骨水泥植入综合征＂的发生,但对血压和血氧分压的下降有一定的保护作用。

Reach on prevention of bone cement implantion syndrome caused by high intramedullary pressure

Objective：To observe the effect of intramedullary decompression and the use of adrenal cortex hormone on the prevention of bone cement implantion syndrome caused by plugging curing cement into medullary cavity.Methods：30 New Zealand rabbits were randomly divided into three groups.In control group,curing cement was plugged into rabbit’s unilateral femoral medullary cavity.In decompression group,the medullary cavity was decompressed by drilling a hole with a diameter of 2 mm on the proximal part of the femur before pressing curing cement into medullary cavity.In hormone prevention group,10 mg dexamethasone was injected into vein 30 minutes before plugging curing cement into femoral medually cavity.The occurrence of bone cement implantion syndrome and the change of arterial blood pressure and arterial oxygen saturation can be observed dynamically.Pathological examinations of the lung samples were carried out postoperatively.Results：Bone cement implantion syndrome was found in all of control group.Significant decrease of blood pressure was 62.5/53.8mmHg in average,and the average value of oxygen saturation decreased 33.0mmHg.No typical bone cement implantion syndrome can be observed in decompression group.Blood pressure declined an average of 19.9/10.3mmHg,and the average value of oxygen saturation went down 3.7mmHg.In hormone prevention group,the bone cement implantion Syndrome happened in all rabbits.The average blood pressure decreased 47.5/43.3mmHg and the average value of oxygen saturation was declined 23.2mmHg.Pulmonary fat embolism can be seen in control group and hormone group,and even bone fragment embolism can be seen in control group.There was no fat embolism in decompress ion group.Conclusion：High pressure in medullary cavity is the major factor leading to bone cement implantion syndrome.Decompression of the intramedullary pressure can prevent this syndrome effectively.Even it cannot prevent the occurrence of this syndrome,adrenal cortex hormone can partly protect decrease of blood pressure and oxygen saturation.