Difference in influences of between reamed and unreamed intramedullary femoral nailing on lung function

目的：髓内钉术后肺部并发症一直是外科医生关注的焦点。我们调查是否扩髓或非扩髓股骨髓内钉固定后的肺功能和凝血反应在正常的肺状态的绵羊是改变材料和方法：共15只成年绵羊。实验分为3组，每组5只羊，分别为扩髓股骨髓内钉（RFN）组、非扩髓股骨髓内钉（UFN）组和假手术对照（SOC）组。所有实验均在钉内和钉后0 ~ 6 h进行血流动力学监测、血气分析和生化采样（ATIII、LPO、甘油三酯、纤维蛋白原）。支气管肺泡灌洗液（BALF）在每只动物进行分析后6小时钉。BALF后检测肺组织髓过氧化物酶（MPO）活性。结果如下：3组间血流动力学监测指标（肺血管阻力、体循环阻力、AaDO 2）及生化指标的时程差异均无统计学意义。BALF中白细胞计数RFN组和UFN组均高于SOC组，脂质细胞计数RFN组高于UFN组和SOC组。肺组织MPO活性以RFN组最高，与其他两组比较差异有统计学意义。结论：在急性期，正常肺状态下的RFN对肺功能无生理性影响，不引起高凝反应。然而，RFN可能是有害的肺在亚临床水平的基础上的BALF结果和MPO测定结果。

Objective: Pulmonary complicate after intramedullary nailing have been focused by many surgeons. We investigated whether the pulmonary function and the coagulatory response after reamed or unreamed intramedullary femoral nailing in normal lung status of sheep is altered Materials and Methods: A total of 15 adult sheeps were used. This experiment involved three groups (each, n=5) of sheep: reamed femoral nailing (RFN) groups, unreamed femoral nailing (UFN) group, and sham operation control (SOC) group. All experiments involved hemodynamic monitoring, blood gas analysis, and biochemical sampling (ATIII, LPO, triglyceride, fiblinogen during and 0 to 6 hours after the nailing. Bronchoalveolar lavage fluid (BALF) in each animal was analyzed 6 hours after nailing. Myeloperoxidase (MPO) activity in the pulmonary tissue was also examined after BAL. Results: There were no significant differences in both the time courses of hemodynamic monitoring data including pulmonary vascular resistance, systemic vascular resistance, and AaDO2, and those of biochemical data among three groups. In BALF analysis the leukocyte cell counts of RFN and UFN groups were higher than that of SOC group, and the lipid-laden cells of RFN group was higher than those of UFN and SOC groups. The MPO activity in puImonary tissue of RFN group was the highest, compared to those of the other two groups. Conclusion: RFN m normal lung status does not influence on pulmonary function in physiological level, and does not induce hyper-coagulatory response, at acute stage. However, RFN could be detrimental to lung in subclinical level on the basis of both the BALF results and the MPO assay results.