| 下肢长骨干骨折伴发脂肪栓塞综合征应用损伤控制骨科策略的干预效果观察 |
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投稿时间：2022-11-01
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| 作者 | Author | 单位 | Address | E-Mail |
| 张雪 |
ZHANG Xue |
唐山市第二医院, 河北 唐山 063000 |
The Second Hospital of Tangshan, Tangshan 063000, Hebei, China |
dfh158gh@163.com |
| 陈伟伟 |
CHEN Wei-wei |
唐山市第二医院, 河北 唐山 063000 |
The Second Hospital of Tangshan, Tangshan 063000, Hebei, China |
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| 李翠花 |
LI Cui-hua |
唐山市第二医院, 河北 唐山 063000 |
The Second Hospital of Tangshan, Tangshan 063000, Hebei, China |
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| 期刊信息：《中国骨伤》2023年，第36卷，第3期，第236-241页 |
| DOI：10.12200/j.issn.1003-0034.2023.03.008 |
| 基金项目:河北省医学科学研究课题计划(编号:20201443) |
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中文摘要:
目的:观察损伤控制骨科(damage control orthopaedic,DCO)策略对下肢长骨干骨折伴发脂肪栓塞综合征(fat embolism syndrome,FES)的干预效果。
方法:回顾性分析2015年1月至2021年5月收治的163例下肢长骨干骨折伴发FES患者临床资料,以2018年1月实施DCO策略为时间点分为两组,2015年1月至2017年12月收治92例为对照组,2018年1月至2021年5月收治71例为干预组。观察并比较两组患者院内死亡率、动脉血氧饱和度(arterial oxygen saturation,SaO2)、动脉血氧分压(arterial partial pressure of oxygen,PaO2)和氧合指数(oxygenation index,OI)、血红蛋白(hemoglobin,Hb)、血小板计数(platelet count,PLT)、髋关节Harris评分、美国特种外科医院膝关节评分(Hospital for Special Surgery Knee Score,HSS)评分、美国骨科足与踝关节协会(American Orthopaedic Foot and Ankle Society,AOFAS)评分、临床疗效及并发症。
结果:163例患者获随访,时间12~18(16.91±1.22)个月。干预组院内死亡率为2.82%(2/71),对照组院内死亡率为16.30%(15/92),两组差异有统计意义(χ2=6.455,P<0.05);两组干预后SaO2、PaO2和OI均较干预前升高(P<0.05),且两组干预后SaO2、PaO2和OI比较差异有统计意义(P<0.05)。两组干预后Hb、PLT均较干预前升高(P<0.001),且两组干预后Hb、PLT比较差异有统计意义(P<0.05)。两组患者治疗3个月后髋关节Harris评分、膝关节HSS评分、踝关节AOFAS评分均优于治疗前(P<0.05)。干预组临床总有效率高于对照组(χ2=4.194,P<0.05)。干预组并发症总发生低于对照组(χ2=4.747,P<0.05)。
结论:DCO策略有助于降低下肢长骨干骨折伴发FES患者院内死亡率,有利于消除FES症状和平稳生命体征,可为Ⅱ期确定性手术争取时间优势,临床干预效果显著,值得推广应用。 |
| 【关键词】下肢 长骨干骨折 脂肪栓塞综合征 损伤控制骨科策略 干预效果 |
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| Intervention effect of injury control orthopedic strategy on fat embolism syndrome associated with long shaft fracture of lower limb |
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ABSTRACT
Objective To observe the intervention effect of damage control orthopaedic(DCO) strategy on fat embolism syndrome(FES) associated with long shaft fracture of lower limbs.
Methods Retrospective analysis was made on the clinical data of 163 patients with FES associated with lower limb long shaft fractures admitted from January 2015 to May 2021. They were divided into two groups based on the time point of implementing DCO strategy in January 2018. Total of 92 patients were admitted from January 2015 to December 2017 as the control group,and other 71 patients were admitted from January 2018 to May 2021 as the intervention group. The hospital mortality,arterial oxygen saturation (SaO2),arterial partial pressure of oxygen (PaO2) and oxygenation index (OI),hemoglobin (Hb),platelet count(PLT),Harris score of hip joint,HSS score of knee joint,AOFAS score of ankle joint,clinical efficacy and complications were observed and compared between two groups.
Results Total of 163 patients were followed up for 12 to 18 months with an average of (16.91±1.22) months. The in-hospital mortality rate in the intervention group was 2.82% (2/71),and that in the control group was 16.30% (15/92),the difference between two groups was statistically significant(χ2=6.455,P<0.05). After the intervention,SaO2,PaO2 and OI in two groups were higher than those before the intervention(P<0.05),and after the intervention,SaO2,PaO2 and OI in two groups were statistically significant(P<0.05). Hb and PLT in two groups after intervention were higher than those before intervention (P<0.001),and there was statistically significant difference in Hb and PLT between two groups after intervention (P<0.05). The Harris score of hip joint, HSS score of knee joint and AOFAS score of ankle joint in both groups after 3 months of treatment were better than those before treatment (P<0.05). The total clinical effective rate of the intervention group was higher than that of the control group(χ2=4.194,P<0.05). The total incidence of complications in the intervention group was lower than that in the control group(χ2=4.747,P<0.05).
Conclusion DCO strategy is helpful to reduce the in-hospital mortality of patients with FES associated with long shaft fracture of lower extremities,eliminate FES symptoms and stabilize vital signs,gain time advantage for phase Ⅱ definitive surgery,and has significant clinical intervention effect,which is worth popularizing. |
| KEY WORDS Lower limbs Long bone fracture Fat embolism syndrome Damage control orthopaedic strategies Intervention effect |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 张雪,陈伟伟,李翠花.下肢长骨干骨折伴发脂肪栓塞综合征应用损伤控制骨科策略的干预效果观察[J].中国骨伤,2023,36(3):236~241 |
| 英文格式: | ZHANG Xue,CHEN Wei-wei,LI Cui-hua.Intervention effect of injury control orthopedic strategy on fat embolism syndrome associated with long shaft fracture of lower limb[J].zhongguo gu shang / China J Orthop Trauma ,2023,36(3):236~241 |
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