摘要
目的 探讨合并胸部损伤的股骨干骨折早期扩髓及髓内钉固定是否增加并发症及死亡率。 方法 采用回顾性对比分析 ,依据下列标准选择病例 :(1)年龄在 17～ 65岁 ;(2 )必须有胸部损伤 [简明损伤定级 (AIS)≥ 2 ] ,且损伤严重度评分 (ISS)≥ 16;(3 )住院时间≥ 48h ;(4)病史中无明显影响全身状况的疾病 ,如糖尿病 ,慢性心、肺、肾功能不全等 ;(5)有股骨干骨折 ,且进行了扩髓髓内钉固定 ,不含钢板、外固定支架或牵引及石膏固定者。并按受伤至手术时间划分为两组 ,A组为 <2 4h手术者 (早期扩髓组 ) ,B组为≥ 2 4h手术者 (延期扩髓组 ) ,将两组间合并伤情况、ISS、住院时间、ICU时间、并发症、死亡及合并休克情况进行比较。 结果 有 96例符合上述标准 ,其中A组 57例 ,B组 3 9例 ,经统计学处理 ,两组间仅在股骨开放性骨折发生率 (A组53 % ,B组 3 1% ,χ2 =4.496,P <0 .0 5)、合并休克率 (A组 51% ,B组 2 8% ,χ2 =4.895,P <0 .0 5)及住院时间 [A组为 (17.5± 6.5)d ,B组为 (3 1.5± 9.5)d ,t =8.599,P <0 .0 0 1]上差异有显著性意义和非常显著性意义 ,而两组并发症发生率和死亡率等方面比较 ,差异无显著性意义 (P >0 .0 5)。 结论 在合并胸部损伤的股骨干骨折中 ,只要能控制休克 ,保证生命体征平稳 ,对股?
Objective To investigate complications and mortality of primary reamed intramedullary nailing for femoral shaft fractures in patients a ssociated with thoracic injuries. Methods A retrospective a nalysis of trauma data was performed and the case selection based on the followi ng criteria: (1) patient age of 17-65 years, (2) patients with multiple injury ( ISS≥16) as well as complicated thoracic trauma (AIS≥2), (3) hospitalization stay ≥48 hours, (4)no serious pre-existing medical diseases in history, (5) as sociated femoral shaft fractures treated with reamed intramedullary nailing, ext ernal fixation, plate, cast, traction and unreamed intramedullary nailing. The s elected patients were divided into two groups according to the interval from inj ury to operation, ie, those within 24 hours as Group A and beyond 24 hours as Gr oup B. Results During the study period, 96 patients met the criteria for the investigation. There were 57 patients in the Group A and 39 pa tients in the Group B. In two groups, there was significant difference in incide nce of open femoral shaft fractures (53% in the Group A and 31% in the Group B, χ 2=4.496, P <0.05), associated shock (51% in the Group A and 28% in the Gr oup B, χ 2=4.895, P <0.05) and hospitalization stay [(17.5±6.5) d in the Group A and (31.5±9.5) d in the Group B, t =8.599, P <0.001]. No differe nces between both groups were found in regard of complication and mortality. Conclusions During treatment of femoral shaft fractures assoc iated with thoracic injuries, control of shock and stable vital signs are import ant; intramedullary nailing can not only avoid increasing complication or mortal ity, but help early rehabilitation and shorten the hospitalization stay.
出处
《中华创伤杂志》
CAS
CSCD
北大核心
2004年第1期15-18,共4页
Chinese Journal of Trauma
关键词
髓内钉固定术
合并症
胸部损伤
股骨干骨折
创伤
并发症
Multiple trauma
Thoracic injuries
Femoral fracture s
Fracture fixation, intramedullary
Injury severity score
