钻孔减压术后骨内高压兔骨内压和骨髓血液流变学变化(英文)

Changes in intraosseous pressure and medullary blood rheology following drilling decompression in rabbits with intraosseous hypertension

背景:临床上许多骨科疾病与骨内压异常增高有关,如股骨头缺血性坏死、骨性关节炎等,采用经皮骨穿刺等方法,可降低骨内压,使临床症状立即缓解。分析钻孔减压术后骨内压和骨髓血液流变学改变可进一步认识骨内压的发生和发展。目的:观察钻孔减压术后骨内高压兔骨内压和骨髓血流流变学变化。设计:随机对照实验。单位:右江民族医学院附属医院骨科。材料:实验于2005-03/12在右江民族医学院附属医院骨科完成。30只新西兰纯种大白兔,雌雄不拘,体质量(2.16±0.35)kg,由广西医科大学实验动物中心提供。方法:①动物分组及造模:30只兔采用数字表法随机分为2组:模型组和实验组,每组各15只。两组兔制作成右胫骨上端骨内高压模型,实验组行胫骨上端钻孔减压术。②胫骨上端骨内压测量:动物麻醉后,将测压针在右胫骨结节上方约0.5cm内侧平坦面刺入骨髓腔内,采用BL-410生物机能实验系统于减压术前及术后第2天测量2组骨内压。③骨髓内血液流变学测量:实验组于钻孔减压术前和术后第2天,抽取骨髓血,采用血液仪R80(椎板式)Version5.0测量血液流变学数值。主要观察指标:右胫骨上端钻孔减压术前后骨内压测量值和骨髓血液流变学数值。结果:30只兔均进入结果分析。①骨内压测量结果:实验组右胫骨上端钻孔减压术后骨内压值明显低于模型组(P<0.01),接近正常值非固定侧骨内压值(2.50±0.39)kPa,实验组钻孔减压术后骨内压值明显低于钻孔减压术前(P<0.01)。②骨髓内血液流变学测量结果:实验组钻孔减压术后胫骨上端骨髓内全血黏度值、血浆黏度值、全血低切还原度、红细胞刚性指数、全血高切相对黏度、全血低切相对黏度、红细胞变形指数和红细胞聚集指数低于钻孔减压术前(P<0.05或0.01),而钻孔减压术前后骨髓内红细胞沉降率和红细胞压积变化不明显(P>0.05)。结论:右胫骨上端钻孔减压术可明显降低骨内压,稀释骨髓内血液,降低血液黏度。

BACKGROUND： In clinic, many orthopaedic diseases are related to abnormal increase of intraosseous pressure, such as, avascular necrosis of femoral head and osteoarthritis and so on. Percutaneous bone puncture and other methods can decrease intraosseous pressure and release clinical symptoms immediately. Analysis on the changes in intraosseous pressure and medullary blood rheology following drilling decompression can further recognize the occurrence and development of intraosseous pressure. OBJECTIVE： To observe the changes in intraosseous pressure and medullary blood rheology following drilling decompression in rabbits. DESIGN： A randomized and controlled trial. SETTING： Department of Orthopaedics, Affiliated Hospital of Youjing Medical College for Nationalities. MATERIALS： This experiment was carried out at Orthopaedic Department, Affiliated Hospital of Youjing Medical College for Nationalities between March and December 2005. Totally 30 New Zealand purebred white rabbits, of either gender, weighing （2.16±0.35） kg, were provided by Experimental Animals Center of Guangxi Medical University. METHODS： ①Animals grouping and modeling ： 30 rabbits were randomly divided into 2 groups： model group and experiment group with 15 in each group. Intraosseous pressure .models of the proximal right tibia were created on the rabbits in the two groups and drilling decompression was performed in the proximal tibia of rabbits in the experiment group. ② Measurement of intraosseous pressure of proximal tibia： After rabbits were anesthetized, needle for measuring blood pressure was pricked into the medullary canal at 0.5 cm internal plane up at the tubercle of right tibia. Intraosseous pressure of two groups was measured before and 2 days after decompression with BL-410 biologic functional system. ③ Measurement of medullary blood rheology： Before and 2 days after drilling decompression, medullary blood was extracted and blood rheology was measured with Blood Perfusion Monitor R80 （Vertebral plate type, Version 5.0） in the experiment group. MAIN OUTCOME MEASURES： Value of intraosseous pressure and medullary blood rheology before and after drilling decompression in the proximal right tibia. RESULTS： All the 30 rabbits entered the stage of result analysis. ① Measurement of intraosseous pressure： intraosseous pressure was significantly lower after drilling decompression in the proximal right tibia in the experiment group than in the model group （P 〈 0.01）. It approached normal value of intraosseous pressure of control side [（2.50±0.39） kPa]. Intraosseous pressure in the experiment group was significantly lower after than before drilling decompression （P 〈 0.01）.② Measurement of medullary blood rheology： Medullary blood viscosity, plasm viscisity, whole blood reduced low-shear viscosity, red cell rigidity index, whole blood high-shear relative viscosity, whole blood low-shear relative viscosity, erythrocyte deformation index and erythrocyte aggregation index at the proximal end of tibia following drilling decompression were significantly lower than those before drilling decompression （P 〈 0.05 or 0.01）. Medullary erythrocyte sediment rate and erythrocyte hematocrit did not change significantly （P 〉 0.05）. CONCLUSION： Drilling decompression in proximal right tibia can obviously decrease intraosseous pressure, dilute medullary blood and decrease blood viscosity.