[Intervention effect of injury control orthopedic strategy on fat embolism syndrome associated with long shaft fracture of lower limb].

OBJECTIVE

To observe the intervention effect of damage control orthopaedic(DCO) strategy on fat embolism syndrome(FES) associated with long shaft fracture of lower limbs.

METHODS

Retrospective analysis was made on the clinical data of 163 patients with FES associated with lower limb long shaft fractures admitted from January 2015 to May 2021. They were divided into two groups based on the time point of implementing DCO strategy in January 2018. Total of 92 patients were admitted from January 2015 to December 2017 as the control group, and other 71 patients were admitted from January 2018 to May 2021 as the intervention group. The hospital mortality, arterial oxygen saturation (SaO), arterial partial pressure of oxygen (PaO) and oxygenation index (OI), hemoglobin (Hb), platelet count(PLT), Harris score of hip joint, HSS score of knee joint, AOFAS score of ankle joint, clinical efficacy and complications were observed and compared between two groups.

RESULTS

Total of 163 patients were followed up for 12 to 18 months with an average of (16.91±1.22) months. The in-hospital mortality rate in the intervention group was 2.82% (2/71), and that in the control group was 16.30% (15/92), the difference between two groups was statistically significant(χ=6.455, <0.05). After the intervention, SaO, PaO and OI in two groups were higher than those before the intervention(<0.05), and after the intervention, SaO, PaO and OI in two groups were statistically significant(<0.05). Hb and PLT in two groups after intervention were higher than those before intervention (<0.001), and there was statistically significant difference in Hb and PLT between two groups after intervention (<0.05). The Harris score of hip joint, HSS score of knee joint and AOFAS score of ankle joint in both groups after 3 months of treatment were better than those before treatment (<0.05). The total clinical effective rate of the intervention group was higher than that of the control group(χ=4.194, <0.05). The total incidence of complications in the intervention group was lower than that in the control group(χ=4.747, <0.05).

CONCLUSION

DCO strategy is helpful to reduce the in-hospital mortality of patients with FES associated with long shaft fracture of lower extremities, eliminate FES symptoms and stabilize vital signs, gain time advantage for phase Ⅱ definitive surgery, and has significant clinical intervention effect, which is worth popularizing.