CAJ | 학술논문

目的探讨损伤控制骨科学在双侧股骨干骨折合并失血性休克动物模型中应用的必要性.方法将36只新西兰大白兔随机分为3组,制作双侧股骨干骨折合并失血性休克和复苏模型;A组兔骨折行扩髓髓内钉固定(ETC组),B组兔骨折行外固定架固定(DCO组),C组为对照组(CON组).分析比较3组兔骨折治疗后平均动脉压(MAP)、呼吸频率(RR)、心率 (HR)、炎性因子浓度[白细胞介素(IL)-6、IL-10、肿瘤坏死因子(TNF)-α]以及主要器官(肺、肝、肾、心)组织学表现的变化.结果 3组动物骨折治疗后出现的生命体征变化和炎性因子浓度的升高在ETC组最明显(P<0.05).ETC组和DCO组肺组织学表现与对照组比较差异有统计学意义(P<0.01);在肝脏,ETC组与对照组差异有统计学意义(P<0.01),而DCO组与对照组差异无统计学意义(P>0.05);在肾脏和心脏,3组动物之间差异无统计学意义(P>0.05).结论双侧股骨干骨折合并失血性休克骨折治疗,早期扩髓髓内钉固定会引起更强烈的生命体征变化和炎性反应,以及对肺脏和肝脏产生更多的组织学损害.
목적 탐토손상공제골과학재쌍측고골간골절합병실혈성휴극동물모형중응용적필요성.방법 장36지신서란대백토수궤분위3조,제작쌍측고골간골절합병실혈성휴극화복소모형;A조토골절행확수수내정고정(ETC조),B조토골절행외고정가고정(DCO조),C조위대조조(CON조).분석비교3조토골절치료후평균동맥압(MAP)、호흡빈솔(RR)、심솔 (HR)、염성인자농도[백세포개소(IL)-6、IL-10、종류배사인자(TNF)-α]이급주요기관(폐、간、신、심)조직학표현적변화.결과 3조동물골절치료후출현적생명체정변화화염성인자농도적승고재ETC조최명현(P<0.05).ETC조화DCO조폐조직학표현여대조조비교차이유통계학의의(P<0.01);재간장,ETC조여대조조차이유통계학의의(P<0.01),이DCO조여대조조차이무통계학의의(P>0.05);재신장화심장,3조동물지간차이무통계학의의(P>0.05).결론 쌍측고골간골절합병실혈성휴극골절치료,조기확수수내정고정회인기경강렬적생명체정변화화염성반응,이급대폐장화간장산생경다적조직학손해.
Objective To explore the necessity of damage control orthopedics (DCO) in managing a model of bilateral femoral fractures associated or complicated with shock. Methods Thirty-six male New Zealand White rabbits were divided into three groups. A model of bilateral femoral shaft fractures associated with shock was made. A reamed intramedullary nailing fixation was performed in group A (ETC group), an external fixation device was applied in group B (DCO group), and group C served as the control group (CON group). Changes of the mean arterial pressures (MAP), respiratory rate (RR), heart rate (HR), inflammatory mediators [interleukin (IL)-6, IL-10, tumor necrosis factor (TNF)-α] concentrations, and histological changes of main organs after the procedures were compared and analyzed between the groups. Results Compared to group B and CON group, the extent of vital signs changes and the exaggerated levels of the inflammatory mediators in ETC group were most significant (P<0.05). As to histological appearances, there was very significant difference between ETC group or DCO group and CON group as far as lungs were concerned (P<0.01). As to the liver, there was significant difference between ETC group and CON group (P<0.01), but no significant difference was found between DCO group and CON group (P>0.05). In terms of the kidney and heart, there was no significant difference among the groups (P>0.05). Conclusion An early reamed intramedullary nailing fixation procedure resulted in more adverse effects on vital signs, inflammatory response, and the injuries also cause histological damages to the lungs and liver.