Hysa Elida
orthopedics-Traumatology Service, University Hospital Center "Mother Teresa", Tirana, Albania.
Mater Sociomed. 2012;24(4):248-50. doi: 10.5455/msm.2012.24.248-250.
The aim of this study was to assess the incidence and the effectiveness of treatment of fat embolism in patients with hip and long bone fractures (femur and tibia) in Albania.
229 patients (68% men) with combined hip and long bone fractures (femur and tibia) hospitalized at the Orthopedics-Traumatology Services of the University Center "Mother Teresa" during 2004-2006 were included in the study. Patients were classified into three groups based on astrupogram data: PaO2<60mmHg, 65mmHg<PaO2<75mmHg, and PaO2>75mmHg. Chi square test was used to compare fracture differences between men and women and the effectiveness of combined use of metilprednisolon and anticoagulants vs. anticoagulants alone.
Poly traumas combined with femur fracture were more frequent in 2005. These combined poly traumas combined were more frequent among men than women (P<0.001). Remarkably, femur fractures were more frequent among men than women (9:1). Coli femur fractures peaked in the age-group 76-85 years. In general, poly traumas were less frequent in the older age groups, with a peak between 36-55 years, being more frequent among men, but the difference was not statistically significant. Fractures of coli femur and those of tibia were more frequent in 2006, while in 2004 femur fractures were more frequent. In almost all age groups fractures of coli femur were more frequent, followed by fractures of femur and tibia. In general, poly traumas were more frequent among men than women, ranging from 6:1 for fractures of femur to 2:1 for tibia fractures. The incidence of fat embolism ranged from 4.9% to 8.9% for the period 2004-2006. Among fat embolism patients, 100% of them had tachycardia, 88.2% had petechia, 84% tachipnea, 23.5% cyanosis and blood sputum, and 41.2% obnubilation. In general, during 2004-2006 the frequency of combined use of metilprednisolon and anticoagulants has increased.
Clinical diagnosis remains the most important element for the detection of fat embolism syndrome. The incidence of fat embolism was 8-9 times higher than the rates reported in literature. This finding is linked with trauma gravity in Albania. Combined use of metilprednisolon with anticoagulants seems to be more effective than use of anticoagulants alone in preventing fat embolism (P<0.05) and patients using the combined therapy have experienced milder forms of disease. Therefore, the combined treatment should be preferred over the single treatment for the prevention of fat embolism.
本研究旨在评估阿尔巴尼亚髋部和长骨（股骨和胫骨）骨折患者脂肪栓塞的发生率及治疗效果。
纳入2004年至2006年期间在“圣德肋撒嬷嬷”大学中心骨科 - 创伤科住院的229例合并髋部和长骨（股骨和胫骨）骨折的患者（68%为男性）。根据动脉血气分析数据将患者分为三组：动脉血氧分压（PaO2）<60mmHg、65mmHg<PaO2<75mmHg以及PaO2>75mmHg。采用卡方检验比较男性和女性之间的骨折差异，以及甲基强的松龙与抗凝剂联合使用相对于单独使用抗凝剂的效果。
2005年多发伤合并股骨骨折更为常见。这些合并的多发伤在男性中比女性更常见（P<0.001）。值得注意的是，股骨骨折在男性中比女性更常见（9:1）。股骨干骨折在76 - 85岁年龄组达到高峰。总体而言，多发伤在老年组中较少见，在36 - 55岁之间达到高峰，在男性中更常见，但差异无统计学意义。2006年股骨干骨折和胫骨骨折更为常见，而2004年股骨骨折更为常见。在几乎所有年龄组中，股骨干骨折更为常见，其次是股骨和胫骨骨折。总体而言，多发伤在男性中比女性更常见，股骨骨折为6:1，胫骨骨折为2:1。2004年至2006年期间脂肪栓塞的发生率在4.9%至8.9%之间。在脂肪栓塞患者中，100%有心动过速，88.2%有瘀点，84%有呼吸急促，23.5%有发绀和血痰，41.2%有昏迷。总体而言，在2004年至2006年期间，甲基强的松龙与抗凝剂联合使用的频率有所增加。
临床诊断仍然是检测脂肪栓塞综合征最重要的因素。脂肪栓塞的发生率比文献报道的高出8 - 9倍。这一发现与阿尔巴尼亚的创伤严重程度有关。甲基强的松龙与抗凝剂联合使用在预防脂肪栓塞方面似乎比单独使用抗凝剂更有效（P<0.05），并且接受联合治疗的患者病情较轻。因此，在预防脂肪栓塞方面，联合治疗应优于单一治疗。
