Bederman S Samuel, Bhandari Mohit, McKee Michael D, Schemitsch Emil H
Department of Orthopaedic Surgery, University of California at San Francisco, Calif 94143-0728, USA.
Can J Surg. 2009 Oct;52(5):386-93.
Fat embolism syndrome (FES) is a potentially lethal condition most commonly seen in polytrauma patients with multiple long-bone fractures. Treatment has centred around supportive care and early fracture fixation. Several small clinical trials have suggested corticosteroids benefit patients with FES, but this treatment remains controversial. Our objective was to determine the effect of corticosteroids in preventing FES in patients with long-bone fractures.
We conducted a meta-analysis of published studies of patients with long-bone fractures who were randomly assigned to groups receiving corticosteroids or standard treatment for the prevention of FES (1966-2006). Data were extracted on quality, population, intervention and outcomes. Our primary outcome was the development of FES. We used random-effects models to pool results across studies, assessing for study heterogeneity.
Of the 104 studies identified, 7 met our eligibility criteria. Overall, the quality of the trials was poor. Our pooled analysis of 389 patients found that corticosteroids reduced the risk of FES by 78% (95% confidence interval [CI] 43%-92%) and that only 8 patients needed to be treated (95% CI 5-13 patients) to prevent 1 case of FES. Similarly, corticosteroids significantly reduced the risk of hypoxia. We found no differences in the rates of mortality or infection. Rates of avascular necrosis were not reported in any of these studies.
Evidence suggests that corticosteroids may be beneficial in preventing FES and hypoxia but not mortality in patients with long-bone fractures. The risk of infection is not increased with the use of corticosteroids. However, methodological limitations of these trials necessitate a large confirmatory randomized trial.
脂肪栓塞综合征（FES）是一种潜在致命性疾病，最常见于伴有多发性长骨骨折的多发伤患者。治疗主要围绕支持治疗和早期骨折固定。几项小型临床试验表明，皮质类固醇对FES患者有益，但这种治疗仍存在争议。我们的目的是确定皮质类固醇在预防长骨骨折患者发生FES中的作用。
我们对已发表的关于长骨骨折患者的研究进行了荟萃分析，这些患者被随机分配到接受皮质类固醇或标准治疗以预防FES的组中（1966 - 2006年）。提取了有关质量、人群、干预措施和结局的数据。我们的主要结局是FES的发生。我们使用随机效应模型汇总各研究结果，评估研究的异质性。
在确定的104项研究中，7项符合我们的纳入标准。总体而言，试验质量较差。我们对389例患者的汇总分析发现，皮质类固醇使FES风险降低了78%（95%置信区间[CI] 43% - 92%），且仅需治疗8例患者（95% CI 5 - 13例患者）即可预防1例FES。同样，皮质类固醇显著降低了缺氧风险。我们发现死亡率和感染率没有差异。这些研究均未报告无血管性坏死的发生率。
有证据表明，皮质类固醇可能有助于预防长骨骨折患者发生FES和缺氧，但不能降低死亡率。使用皮质类固醇不会增加感染风险。然而，这些试验存在方法学局限性,需要进行一项大型验证性随机试验。
