Intramedullary nailing is the preferred treatment method for stabilizing femoral diaphyseal fractures. Despite its superior biomechanical advantages over other implants, its use, particularly in selected groups of patients, has been questioned because of the possible harmful systemic effects of intramedullary reaming. The increase in intramedullary canal pressure during intramedullary nailing can result in intravasation of bone marrow and fat into the venous blood system. The subsequent consequences can be fat embolism syndrome (FES), adult respiratory distress syndrome (ARDS), and multiple organ failure. The lung seems to be the primary target for fat embolization and for the mediated effects primed by inflammatory reactions. In laboratory studies, both reamed and unreamed intramedullary nailing has been shown to alter selected pulmonary variables. Although transient, this effect appears to be more prominent with reamed than unreamed techniques. Additional studies are required to determine whether a subgroup of trauma patients is adversely affected by intramedullary reaming, thus necessitating other fixation techniques.

译文

:髓内钉是稳定股骨干骨骨折的首选治疗方法。尽管它具有比其他植入物优越的生物力学优势,但由于髓内铰孔可能产生有害的全身性作用,尤其是在特定的患者组中,其使用受到了质疑。髓内钉术中髓内管压力的增加可能导致骨髓和脂肪渗入静脉血液系统。随后的后果可能是脂肪栓塞综合征(FES),成人呼吸窘迫综合征(ARDS)和多器官衰竭。肺似乎是脂肪栓塞和炎症反应引发的介导作用的主要靶标。在实验室研究中,已显示扩孔和未扩髓髓内钉均会改变选定的肺部变量。尽管是暂时的,但扩孔后的效果似乎比未扩口的技术更为突出。需要进行更多的研究来确定一小组创伤患者是否受到髓内扩孔的不利影响,因此需要其他固定技术。

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