股骨干骨折扩髓腔髓内钉固定对凝血机能和肺换气功能的影响

The Influence of Reamed Femoral Intramedullary Nailing on Coagulative Responses and Pulmonary Gas Exchange

【目的】探讨股骨干骨折扩髓与不扩髓髓内钉固定对凝血机能和肺换气功能的影响。【方法】 38例股骨干骨折分别采用扩髓 (RFN)和不扩髓 (UFN)髓内钉固定 ,在手术开始前至术后 4 8h内 7个不同时间段监测血小板、纤维蛋白原、凝血酶原时间 (PT)和部分凝血活酶激活时间 (APTT)的变化 ,并动脉血气分析 ,计算肺泡 动脉血氧分压递差 [P(A aDO2 ) ]。【结果】RFN组 ,扩髓后血小板开始减少 ,P(A aDO2 )升高 (P<0 0 5 ) ;髓钉插入后 30min纤维蛋白原减少 ,PT、APTT延长 (P <0 0 5 ) ;UFN组表现出同样的趋势 ;两组中各项指标均在 2 4～ 4 8h内恢复正常 ;动脉血气分析各时间段和组间差异无显著性 (P >0 0 5 )。【结论】扩大髓腔的髓内钉固定 ,和不扩髓相比 ,并不影响肺换气功能 ,对凝血机能的影响是一个自限过程 ,单纯股骨干骨折 ,可耐受扩髓固定手术。

To investigate the influence of reamed and unreamed femoral intramedullary nailing on coagulative responses and pulmonary gas exchange 38 cases with femoral fractures were diveded into two groups prospectively and fixed with reamed or unreamed intramedullarly nailing respectively During the operating procedure and 48 h after the operation,venous blood samples were taken at seven consecutive time points for the measurements of platelets count, fibrinogen levels, prothrombin time(PT) and activated partial thromboplastin time (APTT) The arterial blood gas were analysed and then the alveola arterial oxygen gradients [P(A a DO 2)] were calculated In the reamed group(RFN), there was a decrease in platelets count when the canal was reamed There was a decrease in fibrinogen levels and increases in APTT and PT 30 min after nailing when compared with the preoperative level (P<0 05) The unreamed group(UFN)had the same trend of changes They all returned to normal levels within 48 h The increases of P(A a DO 2) occurred when the canal was reamed in the RFN and 30 min after nailing in the UFN group (P<0 05) They all restored to normal levels 60 min after the insertion of nail The analysis of arterial blood gas had no significant difference between two groups at every time points [Conclusion] Reamed femoral intramedullary nailing has no negative impact on pulmonary gas exchange The influence on coagulative responses is mild and self limited For isolated femoral fractures, the reamed femoral intramedullary nailing procedure is tolerable