创伤性骨折术后脂肪栓塞综合征患者临床特点与影像学诊断意义

Clinical characteristics and imaging diagnostic significance of postoperative fat embolism syndrome in traumatic fractures

目的探讨创伤性骨折术后并发脂肪栓塞综合征患者临床特点与影像学诊断价值。方法收集2014年3月～2018年2月本院骨伤科收治的14例创伤性骨折并经手术治疗后并发脂肪栓塞综合征患者临床资料进行回顾性分析,包括患者发病的临床症状及体征、治疗前后影像学检查等,总结归纳其临床特点与影像学特征在患者早期诊断中的意义。结果 (1)临床特点:脂肪栓塞综合征多并发于严重创伤性骨折或骨折术后(1～3)d内,主要表现为呼吸系统及神经系统症状;(2)影像学特征:胸部影像学提示双肺呈大片或斑片状弥漫性非感染性浸润性阴影,严重者呈"暴风雪样"改变,头颅影像学提示急性弥漫性脑组织肿胀变化。结论 FES在临床并发症中虽然极为少见,但容易误诊、漏诊,死亡率高;对于有严重创伤性骨折或骨折手术病史者,应结合临床表现及常规影像学检查早期对FES进行诊断,及时采取有效治疗措施,使患者预后得到进一步改善。

Objective To investigate the clinical characteristics and imaging diagnostic value of patients with fat embolism syndrome after traumatic fracture. Methods The clinical data of 14 patients with traumatic fractures treated with orthopedics in our hospital from March 2014 to February 2018 were retrospectively analyzed, including the clinical symptoms, signs of the patients, before and after the treatment of imaging examination, clinical features and imaging features in the early diagnosis of patients in the significance were summarized. Results（1）Clinical features： Fat embolism syndrome was mostly complicated by severe traumatic fractures or fractures within 1～3 days after operation. It mainly manifests as respiratory and nervous system symptoms.（2）Imaging features： Chest imaging suggested large lungs or plaques in both lungs. Diffuse non-infectious infiltrative shadows were present in severe cases, with＂storm-like＂changes. Skull imaging suggested changes in acute diffuse brain tissue swelling. Conclusion Although FES is extremely rare in clinical complications, it is easy to be misdiagnosed and missed. The mortality rate is high. For patients with severe traumatic fractures or fracture surgery, FES should be diagnosed in combination with clinical manifestations and routine imaging examinations. Effective treatment measures will further improve the patients＇ prognosis.