Peter R E, Schopfer A, Le Coultre B, Hoffmeyer P
Clinique d'Orthopédie et de Traumatologie de l'Appareil Moteur, Hôpital Cantonal, Universitaire de Genève, Switzerland.
J Orthop Trauma. 1997 Apr;11(3):233-4. doi: 10.1097/00005131-199704000-00018.
We report a case of cardiovascular collapse and death occurring intraoperatively during the prophylactic nailing of a metastatic femur using an unreamed femoral nail. The cause of death, as documented by the autopsy, was a massive fat embolism. The risk of fat embolism while performing intramedullary nailing is well known and has been linked to the process of medullary reaming. Unreamed femoral interlocking nails recently have become available. Although recent reports in the literature have concluded that the risk of fat embolism appears less likely while using unreamed implants, the surgeon should carefully consider the indications for any type of intramedullary fixation, particularly when dealing with unbroken femurs exhibiting impending pathologic fracture, or when preexisting pulmonary disease such as metastasis is present.
我们报告一例在使用非扩髓股骨钉对转移性股骨进行预防性钉固定术过程中发生术中心血管衰竭并死亡的病例。尸检记录的死亡原因是大量脂肪栓塞。进行髓内钉固定时脂肪栓塞的风险是众所周知的，并且与髓腔扩孔过程有关。非扩髓股骨交锁钉最近已可获得。尽管文献中最近的报告得出结论，使用非扩髓植入物时脂肪栓塞的风险似乎较小，但外科医生应仔细考虑任何类型髓内固定的适应症，特别是在处理表现出即将发生病理性骨折的完整股骨时，或存在如转移等既往肺部疾病时。
