摘要
目的探讨多发伤中股骨干骨折一期扩髓髓内钉固定是否会增加并发症的发生率及死亡率.方法采用回顾性对比研究,依据下列标准选择病例:(1)年龄为14～65岁;(2)多发伤,且ISS＞16;(3)住院时间不少于48 h;(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手术,不包含外固定支架或钢板、牵引及石膏固定和非扩髓髓内钉固定者.将符合上述标准的192例按受伤至手术时间划分为两组,A组为≤24 h手术者(一期扩髓组,76例),B组为＞24 h手术者(116例),将两组间合并伤情况、ISS、住院时间、ICU时间、并发症、死亡率及合并休克率情况进行比较.结果经统计学处理,两组的股骨开放伤发生率(A组56.6%,B组34.5%,X2=7.545,P＜0.001)、合并休克率(A组48.7%,B组31.0%,X2=6.078,P＜0.001)及住院时间[A组(16.1±6.5)d,B组(29.3±9.3)d,t=10.766,P＜O.001]差异有显著性,而在其他方面差异均无统计学意义.结论在多发伤患者中,只要能控制休克,保证生命体征平稳,对股骨干骨折行一期扩髓髓内钉固定不会增加患者的并发症发生率及死亡率,可促进患者早日康复,缩短住院时间,从而减少住院费用.
Objective To investigate complications and mortality of primarily reamed intramedullary nailing for femoral shaft fracture in patients with multiple injuries. Methods This was a retrospective analysis of trauma registry data. The criteria for case sample enrollment in this study were discribed as the following: 1) patients aged 14 to 65 years, 2) patients must have multiple injury and ISS>16, 3) duration of hospital stay >48 hours, 4) there were no major preexisting medical problems before injury, 5) the multiple injuries were associated with femoral shaft fractures which were treated with reamed intramedullary nailing fixation. All the fractures treated with methods other than reamed intramedullary nailing were excluded. All those patients met the criteria were divided into two groups based on the interval from injury to operation, group A≤ 24 hours, group B >24 hours. Results There were totally 192 patients met the criteria for the investigation. Group A consisted of 76 patients, group B 116 patients. No significant differences between the two groups were found in terms of associated injury, ISS, ICU length of hospital stay,complication or mortality, while significant difference existed between two groups in terms of associated shock (χ2=6.078,P< 0.001) and duration of hospital stay(t=10.766, P< 0.001). Conclusion This study indicates there is no increased complication or mortality associated with primary reamed intramedullary nailling for femoral shaft fracture in patient with multiple injuries.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2002年第11期671-674,共4页
Chinese Journal of Orthopaedics
