Boulanger B R, Stephen D, Brenneman F D
Department of Surgery, Sunnybrook Health Science Centre, University of Toronto, Ontario, Canada.
J Trauma. 1997 Jul;43(1):24-8. doi: 10.1097/00005373-199707000-00008.
It has been reported that early intramedullary nailing (IMN) of a femur fracture in the presence of thoracic injury increases morbidity and mortality. The purpose of the present study was to determine if IMN < or = 24 hours after multisystem injury (Injury Severity Score (ISS) > 16) is associated with a poor hospital outcome in the presence of blunt thoracic trauma (Abbreviated Injury Scale (AIS) thorax score > or = 2).
Retrospective cohort study at a single adult trauma center.
In a 6-year period, 149 blunt trauma patients had both an ISS > 16 and a femur fracture managed by IMN. These 149 patients were divided into four groups based on thoracic injury (T = AIS thorax score > or = 2; N = AIS thorax score < 2) and the timing of IMN (E = < or = 24 hours; L = > 24 hours). There were 68 TE, 57 NE, 15 TL, and 9 NL patients. The TE and NE groups were similar in age and ISS. TE and NE groups had similar durations of ventilation, critical care, hospital stay, and mortality. Furthermore, TE patients were no more likely to be intubated after IMN than NE patients. TE patients were matched with similar patients without a femur fracture and found to have similar hospital outcomes.
This study has not demonstrated an increased morbidity or mortality associated with early IMN in the presence of thoracic trauma.
据报道，在存在胸部损伤的情况下，早期对股骨骨折进行髓内钉固定（IMN）会增加发病率和死亡率。本研究的目的是确定在多系统损伤（损伤严重程度评分（ISS）>16）后≤24小时进行IMN，在存在钝性胸部创伤（简明损伤定级标准（AIS）胸部评分≥2）的情况下是否与不良的医院结局相关。
在一家成人创伤中心进行回顾性队列研究。
在6年期间，149例钝性创伤患者的ISS>16且股骨骨折采用IMN治疗。根据胸部损伤情况（T = AIS胸部评分≥2；N = AIS胸部评分<2）和IMN的时机（E =≤24小时；L =>24小时），将这149例患者分为四组。有68例TE、57例NE、15例TL和9例NL患者。TE组和NE组在年龄和ISS方面相似。TE组和NE组在通气时间、重症监护时间、住院时间和死亡率方面相似。此外，TE组患者在IMN后插管的可能性并不比NE组患者高。将TE组患者与无股骨骨折的类似患者进行匹配，发现他们的医院结局相似。
本研究未证明在存在胸部创伤的情况下早期IMN会增加发病率或死亡率。
