Journal of orthopaedic trauma · 1998
Effect of limited and standard reaming on cortical bone blood flow and early strength of union following segmental fracture.
Сравнительное исследованиеСтатьяПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Hupel T M, Aksenov S A, Schemitsch E H
Аннотация
OBJECTIVE: To quantitatively determine the extent to which limited and standard intramedullary reaming disrupts cortical circulation and to evaluate the effect on the biomechanical properties of the united fracture.
DESIGN: Midshaft tibial osteotomies to create a 2.5-centimeter segment of diaphyseal bone were performed in ten adult dogs. Before insertion of a locked intramedullary nail, the tibia was reamed to either 7.0 millimeters (n = 5) or 9.0 millimeters (n = 5). Blood flow was measured using laser Doppler flowmetry during the nailing procedure and at eleven weeks postnailing. Bending stiffness and load to failure were determined for each healed tibia.
RESULTS: Tibial blood flow was reduced for the limited and the standard ream groups by 63 percent (p = 0.002) and 83 percent (p = 0.0008), respectively. After canal reaming, perfusion was reduced to a greater extent in the standard ream group (p = 0.009). At eleven weeks postnailing, tibial perfusion increased to the same levels in both groups (p = 0.43) and returned to base-line values. Bending stiffness and load to failure were reduced after limited reaming (p = 0.002, p = 0.003) and standard reaming (p = 0.01, p = 0.002) were performed. Stiffness and load to failure were reduced to the same extent in both groups (p = 0.12, p = 0.25).
CONCLUSIONS: Both limited reaming and standard reaming negatively affect diaphyseal cortical circulation. Limited reaming spares cortical perfusion compared with standard reaming at the time of nail insertion. No long-term advantage for limited reaming was demonstrated. Limited reaming may be advantageous acutely for the stabilization of tibial fractures in which the circulation is already compromised.
DESIGN: Midshaft tibial osteotomies to create a 2.5-centimeter segment of diaphyseal bone were performed in ten adult dogs. Before insertion of a locked intramedullary nail, the tibia was reamed to either 7.0 millimeters (n = 5) or 9.0 millimeters (n = 5). Blood flow was measured using laser Doppler flowmetry during the nailing procedure and at eleven weeks postnailing. Bending stiffness and load to failure were determined for each healed tibia.
RESULTS: Tibial blood flow was reduced for the limited and the standard ream groups by 63 percent (p = 0.002) and 83 percent (p = 0.0008), respectively. After canal reaming, perfusion was reduced to a greater extent in the standard ream group (p = 0.009). At eleven weeks postnailing, tibial perfusion increased to the same levels in both groups (p = 0.43) and returned to base-line values. Bending stiffness and load to failure were reduced after limited reaming (p = 0.002, p = 0.003) and standard reaming (p = 0.01, p = 0.002) were performed. Stiffness and load to failure were reduced to the same extent in both groups (p = 0.12, p = 0.25).
CONCLUSIONS: Both limited reaming and standard reaming negatively affect diaphyseal cortical circulation. Limited reaming spares cortical perfusion compared with standard reaming at the time of nail insertion. No long-term advantage for limited reaming was demonstrated. Limited reaming may be advantageous acutely for the stabilization of tibial fractures in which the circulation is already compromised.