合并股骨干骨折的多发伤患者并发脂肪栓塞综合征的高危因素

High risk factors of fat embolism syndrome in multiple trauma patients combined with femoral shaft fractures

目的探讨合并股骨干骨折的多发伤患者并发脂肪栓塞综合征（FES）的高危因素。方法采用回顾性病例对照研究分析2010年1月-2015年12月收治的36例合并股骨干骨折的多发伤患者并发FES的临床资料，其中男30例，女6例；年龄18～52岁，平均36．2岁。根据是否合并有胸、腹、脑等其他部位损伤将其分为两组：A组（9例）为股骨干骨折合并其他部位骨折的多发性骨折患者；B组（27例）为股骨干骨折合并胸、腹、颅脑等其他部位损伤的多发性骨折患者。采用改良创伤严重度评分（RISS）进行量化评估，并对股骨干骨折类型进行AO分型，分析RISS值域范围及股骨干骨折类型与FES之间的关系。结果所有患者RISS≥11分：A组RISS值主要分布在11～18分，股骨干AO分型c型占67％，B型占33％；B组RISS值主要分布在18～24分，股骨干AO分型c型占78％，A型占4％，B型占19％。合并股骨干骨折的多发伤患者并发FES与其RISS值具有明显的正相关性（r：0．684，P〈0．01），且股骨干骨折以C型多见。结论当股骨干骨折合并其他部位骨折的多发性骨折患者RISS≥11分，伴胸、腹、颅脑等其他部位损伤的多发性骨折患者RISS≥18分，并且股骨干骨折类型为c型骨折是发生FES的高危因素，应作为重点预防对象。

Objective To investigate the high risk factors of fat embolism syndrome （FES） in multiple trauma patients combined with femoral shaft fractures. Methods A case series retrospective study was employed to evaluate 36 patients with FES after multiple fractures of femoral shaft fracture admitted from January 2010 to December 2015, including 30 males and six females aged 18-52 years （mean, 36.2 years）. According to whether the patients were combined with other parts injuries such as in chest, abdomen and brain, the patients can be divided into two groups, namely, Group A （9 cases） were simple femoral fractures patients with multiple fractures, and Group B （27 cases） were femoral shaft fracture associated with other parts of the fracture or splanchnocoele injury or craniocerebral injury. The quantitative assessment was used by revised trauma severity score （RISS） and the types of the femoral shaft fracture were classified by At. The relationship of RISS range and types of femoral shaft fractures were evaluated. Results RISS was over 11 points in all cases. Among them, the RISS range of Group A patients was from 11 to 18 points （mean, 13 points）, with type C in At classification accounting for 67% and type B for 33%. The RISS range of Group B patients was from 18 to 25 points （mean, 21 points）, with type C in AO classification accounting for 78% and type B for 19%. FES occurrence was positively correlated with the RISS （ r = 0. 684, P 〈 0. 01 ） , with type C the most common classification. Conclusions Clinical doctors should raise vigilance and take the following indicators as high risk factors for FES, ie, the multiple trauma patients combined with femoral shaft fractures plus RISS over 11 points, the multiple trauma patients combined with other parts of the fractures or splanchuocoele injury or craniocerebral injury plus RISS over 18 points, mainly type C femoral shaft fracture.