模拟骨水泥型人工关节阻塞骨髓腔远侧骨干内压力变化及复方丹参的干预

Effect of compound Danshen on intraosseous pressure of the distal femoral shaft following blocking of the proximal and middle femoral medullary cavity with bone cement

背景:骨水泥阻塞股骨近中段骨干髓腔后严重破坏了骨内和髓内的血液循环状态,可引起了一系列血流动力学变化,导致股骨远端的骨内压持续升高并长期存在。目的:观察骨水泥阻塞兔股骨近中段骨干髓腔后复方丹参对股骨远端骨内压的影响。设计、时间及地点:随机对照动物实验,于2007-07/2008-04在重庆医科大学实验动物中心完成。材料:选用成年新西兰大白兔42只,采取兔左侧股骨髓腔内灌注聚甲基丙烯酸甲酯骨水泥的方法,制作骨水泥阻塞股骨近中段骨干髓腔的动物模型。方法:按随机数字表法选出6只作为造模后即刻组。其余36只兔随机分为2组,复方丹参注射组及生理盐水注射组各18只,再根据不同观察时点分为造模后4,8,16周组,每时点6只。复方丹参注射组造模后每只兔肌肉注射复方丹参注射液2mL/d,共4周;生理盐水注射组造模后每只兔肌肉注射氯化钠生理盐水注射液2mL/d,共4周。主要观察指标:测量两组兔造模后即刻、4,8,16周实验侧骨内压。结果:造模后4,8,16周生理盐水注射组兔实验侧骨内压显著高于复方丹参注射组(P<0.05)。生理盐水注射组兔实验侧各时点骨内压均处于骨内高压状态,造模后16周骨内压有所下降。造模后4周实验侧骨内压显著高于造模后16周(P<0.05),其他各时点两两比较差异无显著性意义(P>0.05)。复方丹参注射组兔实验侧骨内压在造模后4周基本恢复正常骨内压水平,造模后8,16周继续保持正常骨内压水平不变。造模后4,8,16周实验侧骨内压均显著低于造模后即刻(P<0.05),造模后4,8,16周3个时点两两比较差异无显著性意义(P>0.05)。结论:复方丹参可以有效降低骨水泥阻塞骨干髓腔后引起的骨内高压。

BACKGROUND： The intraosseous and intramedullary blood circulation is severely damaged after blocking of the proximal and middle femoral medullary cavity with bone cement, causing a series of changes in blood flow dynamics, and leading to continuous high intraosseous pressure on the distal femoral. OBJECTIVE： To explore the effects of compound Danshen on the distal femoral intraosseous pressure after blocking of proximal and middle femoral medullary cavity with bone cement. DESIGN, TIME AND SETTING： Randomized controlled animal experiment was performed at the Experimental Animal Center of Chongqing Medical University from July 2007 to April 2008. MATERIALS： Forty-two New Zealand rabbits were selected. The rabbit model was established by infusing femoral medullary cavity of left side with polymethyl methacrylate （PMMA）. METHODS： Six rabbits were randomly selected as postoperative 0 day （To） group, and the rest were randomly divided into 2 groups （n=18）： compound Danshen and normal saline groups. According to the following observational time-points, each group were subdivided into 4^th week （T4）, 8^th week （T8） and 16^th week （T16） groups with 6 animals at each time point. The compound Danshen group was injected with 2 mL daily compound Danshen after modeling, while normal saline group was injected with normal saline 2 mL daily for consecutive 4 weeks. MAIN OUTCOME MEASURES： Intraosseous pressure of two groups on To, T4, T8 and T16. RESULTS： On T4,T8 and T16, the experimental side presented significantly higher intraosseous pressure in normal saline group than compound Danshen group （P 〈0.05）. The experimental sides of normal saline group presented continuous high intraosseous pressure state at each time point while declined at T16; there was no statistical difference between any two time points （P 〉 0.05） except T4 significantly higher than T16 （P 〈 0.05）. In compound Danshen group, the pressure of experimental sides kept at normal level after 8 and 16 weeks of modeling. The pressure at T4, T8, and T16 was significantly lower than To （P 〈 0.05）, but there was no different between any two time points after modeling （P 〉0.05）. CONCLUSION： Compound Danshen is effective to lower the high intraosseous pressure after blocking of the proximal and middle femoral medullary cavity with bone cement.