Starr A J, Hunt J L, Chason D P, Reinert C M, Walker J
Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas 75235-8883, USA.
J Orthop Trauma. 1998 Jan;12(1):38-45. doi: 10.1097/00005131-199801000-00007.
The aim of this study was to determine (a) whether delay in femur fracture stabilization beyond twenty-four hours in patients with head injury increased the risk of pulmonary complications and (b) whether immediate (up to twenty-four hours) femur fracture stabilization increased the risk of central nervous system (CNS) complications.
Retrospective analysis.
Thirty-two patients with femur fracture and head injury were identified. Fourteen underwent immediate stabilization of their fractures, and eighteen underwent delayed (four-teen patients) or no (four patients) stabilization of their fractures.
In the immediate stabilization group, five patients had severe head injuries [Glasgow Coma Score (GCS) < or = 8] and nine had mild head injuries (GCS > 8). In the mild head injury group, no patient had a pulmonary complication and one had a CNS complication. In the severely head-injured group, one patient had a pulmonary complication and no patient had a CNS complication. In the delayed stabilization group, six patients had mild head injuries (GCS > 8) and twelve had severe head injuries (GCS < or = 8). In the mildly head injured group, one patient had a pulmonary complication, two patients had CNS complications, and one patient died. In the severely head injured group, nine patients had pulmonary complications, three patients had CNS complications, and one patient died. Logistic regression identified delay in femur stabilization as the strongest predictor of pulmonary complication (p = 0.0042), followed by severity of chest Abbreviated Injury Score (AIS; p = 0.0057) and head AIS (p = 0.0133). Delaying fracture stabilization made pulmonary complications forty-five times more likely. Each point increase in the chest AIS and head/neck AIS increased the risk of pulmonary complication by 300 percent and 500 percent, respectively. A statistically significant predictor of CNS complications could not be identified by using logistic regression.
Delay in stabilization of femur fracture in head-injured patients appears to increase the risk of pulmonary complications. However, due to selection bias in this patient sample, this question cannot be definitively answered. Early fracture stabilization did not increase the prevalence of CNS complications.
本研究旨在确定：(a) 头部受伤患者股骨骨折固定延迟超过24小时是否会增加肺部并发症的风险；(b) 立即（在24小时内）进行股骨骨折固定是否会增加中枢神经系统（CNS）并发症的风险。
回顾性分析。
确定了32例股骨骨折合并头部受伤的患者。其中14例患者立即进行了骨折固定，18例患者延迟（14例）或未（4例）进行骨折固定。
在立即固定组中，5例患者头部严重受伤[格拉斯哥昏迷评分（GCS）≤8]，9例患者头部轻度受伤（GCS>8）。在轻度头部受伤组中，无患者发生肺部并发症，1例患者发生中枢神经系统并发症。在头部严重受伤组中，1例患者发生肺部并发症，无患者发生中枢神经系统并发症。在延迟固定组中，6例患者头部轻度受伤（GCS>8），12例患者头部严重受伤（GCS≤8）。在轻度头部受伤组中，1例患者发生肺部并发症，2例患者发生中枢神经系统并发症，1例患者死亡。在头部严重受伤组中，9例患者发生肺部并发症，3例患者发生中枢神经系统并发症，1例患者死亡。逻辑回归分析确定股骨固定延迟是肺部并发症的最强预测因素（p = 0.0042），其次是胸部简明损伤评分（AIS）的严重程度（p = 0.0057）和头部AIS（p = 0.0133）。延迟骨折固定使肺部并发症的发生可能性增加45倍。胸部AIS和头部/颈部AIS每增加1分，肺部并发症的风险分别增加300%和500%。通过逻辑回归分析无法确定中枢神经系统并发症的统计学显著预测因素。
头部受伤患者股骨骨折固定延迟似乎会增加肺部并发症的风险。然而，由于该患者样本存在选择偏倚，这个问题无法得到确切答案。早期骨折固定并未增加中枢神经系统并发症的发生率。
