多发伤并股骨干骨折患者内固定手术治疗时机选择及疗效比较

Treatment timing of the internal fixation in the treatment of multiple injuries complicated with femoral shaft fracture and its curative effect comparsion

目的：讨论多发伤并股骨干骨折患者内固定手术治疗的最佳时机选择,并比较其疗效。方法：选择90例接受多发伤合并股骨干骨折治疗的患者,按受伤后接受手术时间分为甲、乙和丙组,各30例。甲组在受伤后的24 h内接受治疗,乙组在受伤后24~72 h接受治疗,丙组在受伤后3~30 d内接受治疗。对3组患者的骨折部位都进行相同的切开复位内固定处理。根据3组患者在不同时间段内接受相同的手术治疗,观察和比较后期各组患者的死亡率,讨论多发伤并股骨干骨折患者内固定手术治疗的最佳时机选择,并比较其疗效。结果：甲组死亡2例（6.67%）,为轻度骨折1例,重度骨折1例;乙组死亡3例（10.00%）,为轻度骨折1例,重度骨折2例;丙组死亡7例（23.33%）,为轻度骨折3例,重度骨折4例。甲组死亡率低于乙组,乙组死亡率低于丙组,但差异无统计学意义（P〉0.05）。结论：多发伤并股骨干骨折的患者在接受治疗时,越晚进行手术,手术以及患者死亡的风险越高,应使患者在最佳的时机接受治疗,以获得最好的治疗效果。

Objective： To discuss the optimal timing of the internal fixation in the treatment of multiple injuries complicated with femoral shaft fracture,and compare its curative effect. Methods： Ninety patients with multiple injuries complicated with femoral shaft fracture were divided into groups A,B and C（ 30 cases each group）. The groups A,B and C were treated within 24 h,24 h to 72 h and3 to 30 d after injury,respectively. Three groups were treated with open reduction combined with internal fixation. The mortality rate of surgery between three groups were compared. The optimal timing of the internal fixation in the treatment of multiple injuries complicated with femoral shaft fracture and its curative effects were analyzed. Results： Two cases（ including 1 case with mild fracture and 1 case with severe fracture） died in group A（ 6. 67%）. Three cases（ including 1 case with mild fracture and 2 cases with severe fracture） died in group B（ 10. 00%）. Seven cases（ including 3 cases with mild fracture and 4 cases with severe fracture） died in group C（ 23. 33%）.The mortality rates in groups A,B and C were from high to low in turn,but the difference of which was not statistically significant（ P〉0. 05）. Conclusions： The later operation is,the higher the risk of operation and death in patients with multiple injuries and femoral shaft fracture is. The optimal treatment timing can obtain good treatment effects.