多发伤并脂肪栓塞综合征中长骨干骨折的内固定治疗

A study on internal fixation for long bone fractures in polytraumatized patients with fat embolism syndrome

目的探讨多发伤并脂肪栓塞综合征(FES)患者中长骨干骨折的内固定治疗方法与时机。方法回顾性分析1990年1月～2004年8月期间28例多发伤合并FES患者中长骨干骨折的内固定方法及手术时机。FES临床表现消失后5～7d首次手术治疗27例;FES临床表现明显减轻、呈浅昏迷状态及生命体征稳定后5d首次手术治疗1例。采用开放复位不扩髓或轻度扩髓髓内钉内固定11例,钢板内固定27例。结果27例FES缓解5～7d后手术治疗患者中,22例术后恢复良好,5例首次手术后出现不同程度发热、脉搏加快等。1例FES期间手术治疗患者首次手术后出现类FES复发。结论对于多发伤并FES患者中的长骨干骨折,以钢板或非扩髓髓内钉内固定较安全;首次手术时间以FES缓解后5～7d较为安全。

Objective To study method and timing of internal fixation for long bone fractures in polytraumatized patients with fat embolism syndrome （FES）. Methods Twenty-eight cases of polytraumatized patients with FES received internal fixation for their long bone fractures in our hospital from January 1990 to August 2004. The method and timing of internal fixation were analyzed retrospectively. The long bone fractures in 27 cases were treated 5 to 7 days after their clinic FES symptoms disappeared, while one fracture was treated five days after the FES symptoms were relieved and the vital signs became stable. Eleven cases of long bone fracture were treated with open fixation by unreamed or slightly reamed intramedullary nailing while 27 cases were fixated with plate internally. Results Of the 27 patients who received open reduction and internal fixation for their fractures 5 to 7 days after disappearance of FES symptoms, 22 cases experienced no postoperative complications but fever and quickened pulse reoccurred in five cases after the first osteosynthesis. However, FES-like symptoms reoccurred in the one case who received the first operation when FES did not disappear. Conclusions Internal fixation by plate and intramedullary nailing without reaming are safe for polytraumatized patients with FES and long bone fractures. Proper timing of the first surgery for this kind of patient should be 5 to 7 days after the disappearance of FES.