摘要
目的分析骨水泥聚合反应及冷却与松质骨及骨骼肌热损伤的关系。方法选取60例膝关节炎患者作为研究对象,收集患者膝关节置换术截骨后的离体胫骨平台骨块或股骨踝截骨块,每例患者收集4份样本。根据骨水泥处理方法不同将患者分为A组(单纯将骨水泥注入离体标本松质骨及周围骨骼肌组织界面)、B组(将骨水泥注入离体标本松质骨及周围骨骼肌组织界面的同时给予常温生理盐水冷却处理)、C组(将骨水泥注入离体标本松质骨及周围骨骼肌组织界面给予4℃生理盐水冷却处理),每组20例(80份样本)。术后对标记好的样本进行石蜡切片与苏木精-伊红染色。比较三组局部最高温度、混匀至最高温度时间、温度40℃以上的持续时间,分析肉眼观察下骨水泥与松质骨及周围骨骼肌组织界面改变及显微镜观察下骨水泥与松质骨及周围骨骼肌组织界面的细胞形态学改变。结果与A组的局部最高温度(61.58±2.75)℃、温度40℃以上的持续时间(227.83±22.21)s对比,B组、C组的局部最高温度(50.08±2.05)、(44.73±1.45)℃更低,温度40℃以上的持续时间(127.64±12.83)、(53.33±10.79)s更短(P<0.05);且与C组对比,B组的局部最高温度更高,温度40℃以上的持续时间更长(P<0.05);在混匀至最高温度时间上,三组差异不大(P>0.05)。肉眼观察发现,同A组比较,B组、C组的松质骨及周围骨骼肌组织改变较轻,且C组最轻;显微镜下观察发现,同A组相比,B组、C组镜下炎性细胞浸润较少,且C组镜下炎性细胞浸润最少。结论针对行膝关节置换术的膝关节炎患者,在注入骨水泥的同时给予冷却处理,有利于降低局部最高温度,缩短40℃以上持续时间。同使用常温生理盐水冷却处理相比,使用4℃生理盐水冷却处理的效果更佳,更能有效减轻松质骨及骨骼肌热损伤和局部炎症反应,且机体组织热损伤后的修复时间更短,值得临床加大推广力度。
Objective To analyze the correlation of bone cement polymerization and cooling with thermal damage of cancellous bone and skeletal muscle.Methods 60 patients with knee osteoarthritis were selected as the study subjects,and their isolated tibial plateau block or femoral and ankle osteotomy were collected,and 4 samples were collected from each patient.According to the different methods of bone cement treatment,the patients were divided into group A(injecting bone cement into the interface of cancellous bone and surrounding skeletal muscle tissues of the isolated specimen alone),group B(injecting bone cement into the interface of cancellous bone and surrounding skeletal muscle tissues of the isolated specimen while cooling with normal saline at room temperature),group C(injecting bone cement into the interface of cancellous bone and surrounding skeletal muscle tissues of the isolated specimen while cooling with 4℃normal saline),with 20 cases in each group(80 samples).Paraffin sectioning and hematoxylin eosin staining were performed on labeled samples after surgery.The three groups were compared in terms of maximum local temperature,time of mixing to the maximum temperature,and duration of temperature above 40℃.The changes at the interface between the bone cement and cancellous bone and the surrounding skeletal muscle tissues under the naked eye and the cellular morphological changes at the interface between the bone cement and cancellous bone and the surrounding skeletal muscle tissues under the microscope were analyzed.Results The maximum local temperature and duration of temperature above 40℃of group A were(61.58±2.75)℃and(227.83±22.21)s,the maximum local temperature of group B and group C were(50.08±2.05)and(44.73±1.45)℃,which were lower than that of group A;the duration of temperature above 40℃of group B and group C were(127.64±12.83)and(53.33±10.79)s,which were shorter than that of group A(P<0.05);compared with group C,the maximum local temperature of group B was higher,and the duration of temperature above 40℃was longer(P<0.05).There was little difference between the three groups in the time of mixing to maximum temperature(P>0.05).Gross observation revealed that the cancellous bone and surrounding skeletal muscle tissue was less altered in group B and group C compared with group A,and group C was the least altered;microscopic observation revealed that compared with group A,group B and group C had less microscopic inflammatory cell infiltration,and group C had the least microscopic inflammatory cell infiltration.Conclusion For patients with knee arthritis undergoing knee replacement,the cooling treatment with the injection of bone cement is helpful to reduce the maximum local temperature and shorten the duration of temperature above 40℃.Compared with the cooling treatment with normal saline at room temperature,the effect of cooling treatment with 4℃normal saline is better,which can more effectively reduce the thermal damage and local inflammatory reaction of cancellous bone and skeletal muscle,and the repair time after thermal damage of the body tissue is shorter,which can be further applied in clinical practice.
作者
黄小华
张源林
彭观荣
杨德盛
陶可
HUANG Xiao-hua;ZHANG Yuan-lin;PENG Guan-rong(Yudu County People's Hospital,Ganzhou 342300,China)
出处
《中国实用医药》
2024年第18期77-80,共4页
China Practical Medicine
基金
2022年度赣州市社会发展指导性科技计划项目一般课题(项目编号:GZ2022ZSF505)项目名称:冷却与骨水泥聚合反应对松质骨及骨骼肌热损伤的关系。
关键词
骨水泥
松质骨
骨骼肌
热损伤
Bone cement
Cancellous bone
Skeletal muscle
Thermal damage
