Behrman S W, Fabian T C, Kudsk K A, Taylor J C
Department of Surgery, University of Tennessee, College of Medicine, Memphis 38163.
J Trauma. 1990 Jul;30(7):792-7; discussion 797-8. doi: 10.1097/00005373-199007000-00005.
Prior studies documented that early fixation of femur fractures results in a decreased incidence of adult respiratory distress syndrome (ARDS), fat embolism syndrome, and pneumonia. This study evaluates the impact of magnitude of injury on pulmonary complications and length of ICU and hospital stays in 339 trauma patients with femur fracture undergoing early (n = 121) vs. late (n = 218) operative fixation. Groups were similar with respect to transfusions, hypotension, and associated injuries, but more patients over age 50 years underwent early fixation. Patients were categorized according to Injury Severity Score (ISS): 1) less than 15 (n = 202), 2) 16-35 (n = 104), and 3) greater than 36 (n = 33). Delayed fixation significantly increased the incidence of pulmonary shunt in ISS (3) patients and of pneumonia in patients older than 50. Late fixation resulted in significantly longer hospital stays in all groups and more ICU days in the ISS (3) group. We believe that early femur fixation should be performed on all patients. Pulmonary complications were decreased and health care costs reduced.
先前的研究表明，早期固定股骨骨折可降低成人呼吸窘迫综合征（ARDS）、脂肪栓塞综合征和肺炎的发病率。本研究评估了损伤严重程度对339例接受早期（n = 121）与晚期（n = 218）手术固定的股骨骨折创伤患者肺部并发症以及ICU和住院时间的影响。两组在输血、低血压和合并损伤方面相似，但50岁以上接受早期固定的患者更多。患者根据损伤严重程度评分（ISS）进行分类：1）小于15分（n = 202），2）16 - 35分（n = 104），3）大于36分（n = 33）。延迟固定显著增加了ISS为3分的患者的肺分流发生率以及50岁以上患者的肺炎发生率。晚期固定导致所有组的住院时间显著延长，ISS为3分的组在ICU的天数更多。我们认为，所有患者均应进行早期股骨固定。这样可减少肺部并发症并降低医疗费用。
