创伤性双侧股骨干骨折的早期临床治疗

Early clinical protocols for traumatic bilateral femoral shaft fracture

目的探讨双侧股骨干骨折致伤机制、损伤特点，以制订正确的早期治疗策略。方法2009年12月—2012年6月收治双侧股骨干骨折患者25例，其中男18例，女7例；年龄17—40岁，平均31.2岁。致伤原因：交通伤19例，重物砸伤6例。闭合性骨折47侧，开放性骨折3侧。32侧股骨干骨折行髓内钉固定，18侧行钢板固定。记录患者ISS、血常规和血液生化指标、住院期间应用血液及血浆数量及患者住院时间。结果患者ISS（14.6±5.2）分，术前准备时间（10.1±3.7）d，住院治疗时间（28.9±8.4）d。人院后患者红细胞（3.0±0.4）×10-12／L，血红蛋白（86.0±13.5）g/L，血浆总蛋白（47.0±10.6）g/L，血浆白蛋白（31.4±6.5）g／L，谷草转氨酶（124.1±95.1）U／L，谷丙转氨酶（114.2±107.1）U／L，肌酸激酶（1848.7±1044.8）U／L；与标准值比较差异均有统计学意义（P〈0.05或0.01）。23例术前输血（1444.4±726.5）ml，19例输血浆（305.6±98.3）ml。患者术中及术后输血（2005.7±1153.1）ml。结论双侧股骨干骨折早期治疗以稳定生命体征为主，待病情稳定后，可同期行髓内钉或钢板固定。

Objective To investigate the mechanism, injury characteristics, and early interventions of bilateral femoral shaft fracture. Methods Twenty-five cases of bilateral femoral shaft fracture treated between December 2009 and June 2012 were enrolled in the study. Eighteen patients were males and 7 were females with mean age of 31.2 years （range, 17-40 years）. Nineteen cases were injured due to traffic accidents and 6 due to the hit by heavy objects. There were 47 sides with closed fracture and 3 sides with open fracture. Intramedullary nailing was performed at 32 sides and plate fixation was used at 18 sides. ISS, blood routine, some blood biochemical items, blood or plasma use, and hospitalization days were measured. Results ISS was （14.6±5.2） points. Preoperative readiness time and hospital stay were （ 10.1±3.7 ） days and （28.9±8.4） days respectively. After hospitalization, measured values were （3.0±0.4）×10^12/L for red blood cells, （ 86.0±13.5 ） g/L for hemoglobin, （47.0±10.6） g/L for total protein, （31.4±6.5） g/L for albumin, （ 124.1±95.1 ） U/L for aspartate aminotransferase, （ 114.2±107.1 ） U/L for alanine aminotransferase, and （ 1 848.7±1 044.8 ） U/L for ereatine kinase with significant differences from the reference ranges （ P 〈 0.05 or 0.01 ）. Amount of blood transfused for 23 cases was （ 1 444.4±726.5） ml and plasma transfused for 19 cases was （305.6±98.3） ml before operation. Volume of intra- and post-operative blood transfusion was （2 005.7±1 153.1 ） ml. Conclusions Stabilization of vital signs predominates the early treatment of bilateral femoral shaft fracture. After the condition is stable, intramednlary nailing or plating can be performed concurrently.