骨折并脂肪栓塞综合征内固定术后复发的临床分析

Clinical analysis of relapse of fat embolism syndrome in patients after fracture internal fixation

目的探讨骨折并脂肪栓寒综合征（FES）内固定术后复发的临床对策。方法回顾性分析自2000年1月至2011年11月收治的35例骨折合并FES内固定术后7例复发FES患者的临床资料，男6例，女1例；年龄24～46岁，平均36岁；均为多发伤，股骨骨折6例（双股骨骨折1例），胫骨骨折5例（双胫骨骨折1例，浮膝损伤2例），肱骨骨折2例，尺桡骨骨折2例，骨盆骨折3例。创伤严重度评分平均为19分，创伤严重度改良评分平均为21分。给予对症处理，补充白蛋白、改善微循环、机械通气等处理。根据Gurd标准及改良FES早期评分法进行诊断并给予相应治疗。结果本组7例患者经治疗后病情逐渐平稳，血常规及生化检验结果正常，呼吸功能正常，各部位骨折均得到妥善固定，术后14～20d患者病情稳定出院。根据GuM标准及改良FES早期评分法诊断标准：典型复发2例，不典型复发5例，典型复发患者均符合Gurd诊断标准，不典型复发患者多表现为未发现感染灶的发热、贫血、脉搏增快、氮分压下降等，经对症支持治疗后症状缓解。结论骨折合并FES患者在骨折内固定术中、术后均有复发的风险，应注意骨折手术的时机和内固定方法以减少或防止复发。

Objective To explore the mechanism of and clinical strategy for the relapse of fat embolism syndrome （FES） in patients after fracture internal fixation. Methods A retrospective study was conducted to analyze the clinical data of 7 cases of FES relapse which had occurred after fracture internal fixation from January 2000 to November 2011 in our department. They were 5 men and 2 women, 24 to 46 years of age （average, 36 years） . They all had muhiple injuries. Femoral fracture occurred in 6 cases （including one case of double femoral fractures）, tibial fracture in 5 cases （including one case of double tibial fractures and 2 cases of floating knee）, humeral fracture in 2 cases, ulna and radius fractures in 2 cases, and pelvic fi＇acture in 3 cases. Their injury severity scores （ISS） averaged 19 points and their revised injury severity scores （RISS） 21 points. They were diagnosed and treated with the Gurd criteria and modified grading of early FES. Results In this group all the 7 cases achieved, after treatment, gradual and steady recovery, normal results of blood and biochemical tests, normal respiratory function and stable fixation of all the fractures. They were discharged 14 to 20 days postoperatively. By the Gurd criteria and modified grading of early FES, 2 cases had typical relapse and 5 untypical relapse. Typical cases were consistent with all the Gurd criteria and untypical ones presented with fever with no infection focus identified, anemia, increased pulse and decreased oxygen partial pressure which were relieved by symptomatic and supporting treatment. Conclusion Since the recurrence risk of FES exists during and alter internal fixation in patients with fracture and FES, we should be more careful in the tinting and surgical skills of the internal fixation as to reduce or block the recurrence of FES.