摘要
目的探讨损伤控制骨科学在双侧股骨干骨折合并失血性休克动物模型中应用的必要性。方法将36只新西兰大白兔随机分为3组，制作双侧股骨干骨折合并失血性休克和复苏模型；A组兔骨折行扩髓髓内钉固定（ETC组），B组兔骨折行外固定架固定（DCO组），C组为对照组（CON组）。分析比较3组兔骨折治疗后平均动脉压（MAP）、呼吸频率（RR）、心率（HR）、炎性因子浓度[白细胞介素（IL）-6、IL-10、肿瘤坏死因子（TNF）-α]以及主要器官（肺、肝、肾、心）组织学表现的变化。结果3组动物骨折治疗后出现的生命体征变化和炎性因子浓度的升高存ETC组最明显（P〈0．05）。ETC组和DCO组肺组织学表现与对照组比较差异有统计学意义（P〈0．01）；在肝脏，ETC组与对照组差异有统计学意义（P〈0．01），而DCO组与对照组差异无统计学意义（P〉0．05）；在肾脏和心脏，3组动物之间差异无统计学意义（P〉0．05）。结论双侧股骨干骨折合并失血性休克骨折治疗，早期扩髓髓内钉固定会引起更强烈的生命体征变化和炎性反应，以及对肺脏和肝脏产生更多的组织学损害。
Objective To explore the necessity of damage control orthopedics （DCO） in managing a model of bilateral femoral fractures associated or complicated with shock. Methods Thirty-six male New Zealand White rabbits were divided into three groups. A model of bilateral femoral shaft fractures associated with shock was made. A reamed intramedullary nailing fixation was performed in group A （ETC group） , an external fixation device was applied in group B （DCO group） , and group C served as the control group （CON group）. Changes of the mean arterial pressures （MAP） , respiratory rate （RR） , heart rate （HR）, inflammatory mediators [ interleukin （IL）-6, IL-10, tumor necrosis factor （TNF）-α] concentrations, and histological changes of main organs after the procedures were compared and analyzed between the groups. Results Compared to group B and CON group, the extent of vital signs changes and the exag- gerated levels of the inflammatory mediators in ETC group were most significant （ P 〈 0. 05 ）. As to histological appearances, there was very significant difference between ETC group or DCO group and CON group as far as lungs were concerned （P 〈0. 01 ）. As to the liver, there was significant difference between ETC group and CON group （P 〈 0. 01 ）, but no significant difference was found between DCO group and CON group （ P 〉 0.05 ）. In terms of the kidney and heart, there was no significant difference among the groups （P 〉 0. 05）. Conclusion An early reamed intramedullary nailing fixation procedure resulted in more ad- verse effects on vital signs, inflammatory response, and the injuries also cause histological damages to the lungs and liver.
出处
《中华实验外科杂志》
CAS
CSCD
北大核心
2011年第7期1090-1092,F0003,共4页
Chinese Journal of Experimental Surgery
关键词
兔
股骨干骨折
损伤控制骨科学
失血性休克
髓内钉
Rabbits
Femoral fractures
Damage control orthopedics
Hemorrhagic shock
Intramedullary nailing
