Femoral and cruciate blood flow after retrograde femoral reaming: A canine study using laser Doppler flowmetry
Femoral and cruciate blood flow after retrograde femoral reaming: A canine study using laser Doppler flowmetry
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DOI：
10.1097/00005131-199805000-00007
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发表时间：
1998-05-01
影响因子：
2.3
通讯作者：
Richards, RR
中科院分区：
文献类型：
--
作者：
ElMaraghy, AW;Schemitsch, EH;Richards, RR
目的：确定股骨逆行扩髓对股骨远端和交叉韧带血流的影响。设计：犬实验研究。设置：加拿大多伦多的三级转诊和教学医院。参与者：13只雄性成熟的杂交犬。主要结果测量：用激光多普勒血流仪测量股骨远端三个骨部位的红细胞流量（RCF结果：与扩髓前值相比，股骨远端所有骨部位的平均血流后RCF均显著增加：股骨髁沟（p = 0.0247）、内侧髁（p = 0.0440）和外侧髁（p = 0.0042）。我们还发现，与扩髓前相比，两个交叉韧带部位的平均术后RCF显著降低（前交叉韧带，p = 0.0004;后交叉韧带，p = 0.0006）。股骨逆行扩髓和髓内钉固定已成为治疗股骨远端和某些股骨干骨折的流行选择，但是已经提出了关于通过关节内入口进行扩孔的影响的问题。我们的实验研究发现，扩髓后前交叉韧带的灌注减少了52%，后交叉韧带的灌注减少了49%。扩髓后灌注减少可能会延迟愈合或加重交叉韧带的现有损伤，并对股骨骨折后膝关节的康复产生不利影响。
Objective: To determine the effect of retrograde femoral reaming on the blood flow of the distal femur and the cruciate ligaments.Design: Canine experimental study.Setting: Tertiary referral and teaching hospital in Toronto, Canada.Participants: Thirteen skeletally mature, cross-bred dogs.Main Outcome Measure: Red cell flux (RCF) was measured by using a laser Doppler flowmetry probe at three bone sites in the distal femur (trochlear groove, medial condyle, and lateral condyle) and at the midportion of both the anterior and posterior cruciate ligaments before and after retrograde femoral reaming.Results: There was a significant increase in the mean postreaming RCF at all the bone sites of the distal femur compared with prereaming values: trochlear groove (p = 0.0247), medial condyle (p = 0.0440), and lateral condyle (p = 0.0042). We also found a significant decrease in the mean postreaming RCF at both cruciate ligament sites compared with prereaming values (anterior cruciate, p = 0.0004; posterior cruciate, p = 0.0006).Conclusions: Retrograde femoral reaming and intramedullary nailing has become a popular option for the treatment of distal femoral and some femoral shaft fractures, but concerns regarding the effect of reaming through an intraarticular entry portal have been raised. Our experimental study found that after reaming perfusion of the anterior cruciate Ligament decreased by 52 percent and perfusion of the posterior cruciate ligament decreased by 49 percent. Diminished perfusion after reaming may delay healing or exacerbate existing injury to the cruciate Ligaments and adversely affect rehabilitation of the knee after femoral fracture.