CAJ | 학술논문

目的：模拟骨水泥外溢在周围骨骼肌中的固化放热过程，研究其聚合放热对骨骼肌的损伤作用及加予4℃生理盐水局部灌注冷却对损伤的影响。方法选取健康清洁级SD大鼠12只，雌雄不限，体重220~250 g，采用左右侧对照，分别在左右侧臀大肌注入现配骨水泥1 mL，同时右侧加予4℃生理盐水局部灌注冷却。采用针式温度计连续测量两组骨水泥固化过程中骨水泥-肌肉界面的温度变化情况。分别于术后1d、4d、7d各处死4只，切取与骨水泥接触部位的肌肉，行常规石蜡切片，HE染色镜检。对比两组局部温度的变化情况以及肉眼、镜下观察骨水泥-肌肉界面的肌肉组织形态学的改变。结果两组局部最高温度分别为（61.58±2.75）℃和（44.73±2.03）℃，40℃以上持续时间分别为（227.83±22.21）s和（53.33±15.79）s，均P﹤0.01，有显著统计学意义。混匀至最高温度时间分别为（571.67±7.92）s和（575.00±8.00）s，P﹥0.05，无统计学意义。组织学上，与骨水泥组相比，骨水泥＋4℃水组的局部肌肉组织细胞形态改变较轻，炎性细胞浸润少，组织修复时间短。结论骨水泥聚合反应可对周围骨骼肌造成热损伤，加于4℃水局部冷却可明显降低局部最高温度及缩短40℃以上持续时间，有效减少炎症反应和缩短修复时间。若能合理地应用于临床，将对预防术后感染有一定的参考价值。
목적：모의골수니외일재주위골격기중적고화방열과정，연구기취합방열대골격기적손상작용급가여4℃생리염수국부관주냉각대손상적영향。방법선취건강청길급SD대서12지，자웅불한，체중220~250 g，채용좌우측대조，분별재좌우측둔대기주입현배골수니1 mL，동시우측가여4℃생리염수국부관주냉각。채용침식온도계련속측량량조골수니고화과정중골수니-기육계면적온도변화정황。분별우술후1d、4d、7d각처사4지，절취여골수니접촉부위적기육，행상규석사절편，HE염색경검。대비량조국부온도적변화정황이급육안、경하관찰골수니-기육계면적기육조직형태학적개변。결과량조국부최고온도분별위（61.58±2.75）℃화（44.73±2.03）℃，40℃이상지속시간분별위（227.83±22.21）s화（53.33±15.79）s，균P﹤0.01，유현저통계학의의。혼균지최고온도시간분별위（571.67±7.92）s화（575.00±8.00）s，P﹥0.05，무통계학의의。조직학상，여골수니조상비，골수니＋4℃수조적국부기육조직세포형태개변교경，염성세포침윤소，조직수복시간단。결론골수니취합반응가대주위골격기조성열손상，가우4℃수국부냉각가명현강저국부최고온도급축단40℃이상지속시간，유효감소염증반응화축단수복시간。약능합리지응용우림상，장대예방술후감염유일정적삼고개치。
Objective To establish the model of polymethylmethacrylate curing process in surrounding skeletal muscle,to research the thermal injury to muscle cells and evaluate the effect of fluid cooling with 4℃ saline. Methods There weere 12 SD rats in each group. Group A were injected with 1 mL bone cement in the left gluteus maximus,while group B were injected with 1 mL bone cement in the right gluteus maximus and continuous irrigation cooling with 4℃ saline at the same time. The temperature at the muscle-cement interface of both groups were recorded with needle thermometer. Each 4 of the Rats in both groups were euthanized at 1,4,7 days following the injury. The muscle at the muscle-cement interface was sectioned,stained with hematoxylin,and submitted to histological analysis. Results The maximum temperature of both groups respectively were (61. 58 ±2. 75)℃ and(44. 73 ±2. 03)℃. The time with temperature above 40 ℃ were(227. 83 ±22. 21)s and(53. 33 ±15. 79)s(P ﹤0. 01). Time from start of mixing to maximum temperature were(571. 67 ±7. 92)s and(575 ±8. 00)s( P ﹥0. 05). In histology,compared with group A,the muscle tissue of group B had lighter morphological changes,less inflammatory cell infiltration and shorter tissue repair time. Conclusion Bone cement polymerization can cause thermal injury to the surrounding skeletal muscle,continuous irrigation cooling with 4 ℃ saline can significantly reduce the the maximum temperature ,shorten seconds with temperature above 40 ℃,reduce inflammatory cell infiltration and shorten tissue repair time. It will have value in preventing postoperative infection.