多发伤股骨骨折的低感染率和不愈合率：一项回顾性研究。
LOW INFECTION AND NON-UNION RATES IN POLYTRAUMA FEMORAL FRACTURES: A RETROSPECTIVE STUDY.
作者信息
de Freitas Matheus Trindade Bruxelas, Martins Gabriel Benevides Valiate, Santiago Matheus Augusto Maciel, Silva Isaac Rocha, Leonhardt Marcos de Camargo, Silva Jorge Dos Santos, Kojima Kodi Edson
机构信息
Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas (HC-FMUSP), Institute of Orthopedics and Traumatology, São Paulo, SP, Brazil.
出版信息
Acta Ortop Bras. 2024 Jun 24;32(2):e278586. doi: 10.1590/1413-785220243202e278586. eCollection 2024.
OBJECTIVE
Assess complications and risks in staged femoral shaft fracture treatment using external fixation and intramedullary nailing (DCO).
METHODS
Analysis involved 37 patients with 40 fractures, mostly male (87.5%), average age 32.9 years. Data included ASA score, AO/OTA and Gustilo classifications, Glasgow Coma Score, Injury Severity Score, times to external fixation and conversion, ICU duration, nail type, and reaming status. Complications tracked were mortality, deep infection, and non-union.
RESULTS
Predominant fracture type was AO/OTA A (45%), with 40% open (Gustilo A, 93.8%). Average ISS was 21; GCS was 12.7. Median ICU stay was 3 days; average time to conversion was 10.2 days. Retrograde nails were used in 50% of cases, with reaming in 67.5%. Complications included deep infections in 5% and non-union in 2.5%.
CONCLUSION
DCO strategy resulted in low infection and non-union rates, associated with lower GCS and longer ICU stays.
目的
评估采用外固定和髓内钉分期治疗股骨干骨折（损伤控制骨科，DCO）的并发症和风险。
方法
分析纳入37例患者的40处骨折，其中男性居多（87.5%），平均年龄32.9岁。数据包括美国麻醉医师协会（ASA）评分、AO/OTA和 Gustilo 分类、格拉斯哥昏迷评分、损伤严重程度评分、外固定及转换时间、重症监护病房（ICU）住院时间、髓内钉类型及扩髓情况。追踪的并发症包括死亡率、深部感染和骨不连。
结果
主要骨折类型为AO/OTA A型（45%），开放性骨折占40%（Gustilo A型，93.8%）。平均损伤严重程度评分为（ISS）21分；格拉斯哥昏迷评分为12.7分。ICU中位住院时间为3天；平均转换时间为10.2天。50%的病例使用逆行髓内钉，67.5%进行了扩髓。并发症包括5%的深部感染和2.5%的骨不连。
结论
损伤控制骨科策略导致感染率和骨不连率较低，但与较低的格拉斯哥昏迷评分及较长的ICU住院时间相关。
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