骨水泥聚合反应与冷却对骨骼肌热损伤的关系  

Relationship between Cooling and Thermal Injury on Skeletal Muscle Induced by Bone Cement Polymerization

作　　者：曹建飞[1,2] 张晟[2] 叶海明[2] 王超[2] 熊奡[2] 辛风[2] 张波[2] 

机构地区：[1]安徽医科大学北大深圳医院临床学院,广东深圳518036 [2]北京大学深圳医院骨关节科,广东深圳518036

出　　处：《实用骨科杂志》2014年第6期524-527,共4页Journal of Practical Orthopaedics

基　　金：深圳市科技计划项目(201202012)

摘　　要：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220～250g，采用左右侧对照，分别在左右侧臀大肌注入现配骨水泥1mL，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）8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。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.

关 键 词：骨水泥 骨骼肌 热损伤 冷却 

分 类 号：R318.08[医药卫生—生物医学工程]