骨科手术操作对长骨血供影响的实验研究

Changes of the Blood Supply of the Long Bones Following Orthopaedic Procedures:An Experimental Study

骨膜剥离和髓腔扩大是骨科手术中常用的操作方法，滋养动脉在手术中受到损伤时也需结扎。为了解以上三种操作对股骨血供的影响，作者对２４只兔采用核素标记化合物（９９ｍＴｃ－ＭＤＰ）骨显像的方法进行了研究。实验结果显示：三种手术后当天手术侧放射性计数均少，其中以滋养动脉结扎组减少最多（Ｐ值＜０．０１）；髓腔扩大组次之（Ｐ＜值０．０１）；骨膜剥离组最少（Ｐ值＜０．０１）。第４天后骨膜剥离组手术侧计数增加幅度较大（Ｐ值＜０．０１），明显高于健侧；滋养动脉结扎组术后第４天，计数已接近健侧（Ｐ值＞０．０５），第９天高于健侧（Ｐ值＜０．０１），髓腔扩大组在实验的第１２天内计数一直低于健侧，第１２天时计数为０．８９（Ｐ值＜０．０５）。由此表明：三种手术后当天血供均有不同程度的减少，此后以不同的速度恢复，其中以骨膜剥离组恢复最快；滋养动脉结扎组次之；髓腔扩大组最慢。

It is a general practice of the orthopaedic surgeons to strip the periosteum,to ream the medullary cavity etc, which may easily cause injury of the nutrient artery of the long bones. Sometimes even ligatures are required for the nutrient artery. In order to elucidate the effect of the blood supply of the long bones following the above mentioned procedures, the authors carried out an experimental study in 24 rabbits,using radioisotope( 99m Tc-MDP) imaging method. The results revealed that, there were a significant decrease of the radioactive counts at the same day of surgery. The figures respectively for the nutrient artery ligated femurs. The reamed medullary cavities and the periosteal stripping were 0.66、0.72 and 0.76 (P<0.01). The counts were greatly increased in the stripped femurs as compared with the contralateral sides on day 4 (1.26, P<0.01). In the nutrient ligated femurs,the counts were close to the normal level on day 4(0.98, P<0.05), and greater than the normal level on day 9 (1.16, P<0.05).The counts were always slow in the femurs with the medullary cavity reamed on day 12 (0.72, 0.88, 0.89). These results showed that the femurs with the periosteum stripped showed the most rapid recovery of the blood supply and then followed the femurs with the nutrient artery ligated and the medullary cavity reamed.