孤立下肢长骨骨折中脂肪栓塞的流行病学和危险因素。

Epidemiology and risk factors for fat embolism in isolated lower extremity long bone fractures.

机构信息

Division of Trauma and Surgical Critical Care, Los Angeles General Medical Center, University of Southern California, Los Angeles, CA, USA.

Division of Trauma Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.

出版信息

Eur J Trauma Emerg Surg. 2024 Aug;50(4):1775-1781. doi: 10.1007/s00068-024-02516-9. Epub 2024 Apr 17.

DOI:10.1007/s00068-024-02516-9

PMID:38630127

Abstract

PURPOSE

Fat embolism syndrome (FES) is a serious complication after orthopedic trauma. The aim of this study was to identify risk factors for FES in isolated lower extremity long bone fractures.

METHODS

The National Trauma Data Bank "NTDB" study included patients with isolated femoral and tibial fractures. A total of 344 patients with FES were propensity score matched with 981 patients without FES. Multivariate logistical regression was used to identify independent risk factors for FES.

RESULTS

FES was diagnosed in 344 (0.03%) out of the 1,251,143 patients in the study populations. In the two matched groups, the mortality was 7% in the FES group and 1% in the No FES group (p < 0.001). FES was associated with an increased risk of ARDS, VTE, pneumonia, AKI, and stroke. Younger age, femur fractures, obesity, and diabetes mellitus were independent predictors of FES. Early operative fixation (≤ 48 h) was protective against FES.

CONCLUSION

FES increases mortality by seven times. Young age, obesity, and diabetes mellitus are significant independent risk factors for FES. Early fixation is independently associated with a reduced risk of FES.

LEVEL OF EVIDENCE

Level III.

STUDY TYPE

Prognostic study.

摘要

目的

脂肪栓塞综合征（FES）是骨科创伤后的一种严重并发症。本研究旨在确定单纯下肢长骨骨折并发 FES 的危险因素。

方法

国家创伤数据库（NTDB）研究纳入了单纯股骨和胫骨骨折患者。共纳入 344 例 FES 患者，并与 981 例无 FES 患者进行倾向评分匹配。采用多变量逻辑回归分析确定 FES 的独立危险因素。

结果

在研究人群的 1251143 例患者中，有 344 例（0.03%）诊断为 FES。在两组匹配的患者中，FES 组的死亡率为 7%，无 FES 组为 1%（p<0.001）。FES 与 ARDS、VTE、肺炎、AKI 和中风的风险增加相关。年龄较小、股骨骨折、肥胖和糖尿病是 FES 的独立预测因素。早期手术固定（≤48 小时）可预防 FES。