Zhang Xue, Chen Wei-Wei, Li Cui-Hua
The Second Hospital of Tangshan, Tangshan 063000, Hebei, China.
Zhongguo Gu Shang. 2023 Mar 25;36(3):236-41. doi: 10.12200/j.issn.1003-0034.2023.03.008.
To observe the intervention effect of damage control orthopaedic(DCO) strategy on fat embolism syndrome(FES) associated with long shaft fracture of lower limbs.
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.
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).
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.
观察损伤控制骨科（DCO）策略对下肢长骨干骨折合并脂肪栓塞综合征（FES）的干预效果。
回顾性分析2015年1月至2021年5月收治的163例下肢长骨干骨折合并FES患者的临床资料。根据2018年1月实施DCO策略的时间点将其分为两组。2015年1月至2017年12月收治的92例患者作为对照组，2018年1月至2021年5月收治的71例患者作为干预组。观察并比较两组患者的医院死亡率、动脉血氧饱和度（SaO）、动脉血氧分压（PaO）和氧合指数（OI）、血红蛋白（Hb）、血小板计数（PLT）、髋关节Harris评分、膝关节HSS评分、踝关节AOFAS评分、临床疗效及并发症情况。
163例患者均随访12～18个月，平均（16.91±1.22）个月。干预组院内死亡率为2.82%（2/71），对照组为16.30%（15/92），两组差异有统计学意义（χ=6.455，P<0.05）。干预后，两组患者的SaO、PaO和OI均高于干预前（P<0.05），且干预后两组间比较差异有统计学意义（P<0.05）。两组干预后的Hb和PLT均高于干预前（P<0.001），且干预后两组间Hb和PLT比较差异有统计学意义（P<0.05）。两组治疗3个月后的髋关节Harris评分、膝关节HSS评分和踝关节AOFAS评分均优于治疗前（P<0.05）。干预组临床总有效率高于对照组（χ=4.194，P<0.05）。干预组并发症总发生率低于对照组（χ=4.747，P<0.05）。
DCO策略有助于降低下肢长骨干骨折合并FES患者的院内死亡率，消除FES症状，稳定生命体征，为Ⅱ期确定性手术赢得时间优势，具有显著的临床干预效果，值得推广。
