Impact of the method of initial stabilization for femoral shaft fractures in patients with multiple injuries at risk for complications (borderline patients)
Impact of the method of initial stabilization for femoral shaft fractures in patients with multiple injuries at risk for complications (borderline patients)
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DOI：
10.1097/sla.0b013e3181485750
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发表时间：
2007-09-01
影响因子：
9
通讯作者：
Giannoudis, Peter
中科院分区：
文献类型：
--
作者：
Pape, Hans-Christoph;Rixen, Dieter;Giannoudis, Peter
目的：多发伤患者严重骨折的确定性固定时机存在争议。为了解决这一问题，我们将钝性多发伤患者随机分为两组，一组采用髓内钉固定股骨干，另一组采用外固定器固定股骨干，随后转为髓内钉固定，并记录术后临床情况。方法：股骨干骨折的多重损伤患者被随机分配到两组中的任一组，（16分，或3处骨折且简明损伤量表评分>= 2分和另一处损伤（简明损伤量表评分>= 2分），且年龄为18至65岁。排除：病情不稳定或危重的患者。结果：急性肺损伤的发生率。结果：10个欧洲中心，165例患者，平均年龄32.7 ± 11.7岁。髓内钉组94例，外固定组71例。术前，121例患者病情稳定，44例患者处于临界状态。调整两组患者初始损伤严重程度差异后，行髓内钉固定的临界患者发生急性肺损伤的几率是行外固定的患者的6.69倍，P <0.05。结论：股骨骨折髓内固定可影响多发伤患者的预后。在病情稳定的患者中，初次股骨髓内钉固定与较短的通气时间相关。在临界患者中，与那些接受外固定并随后转换为髓内钉的患者相比，其与肺功能障碍的发生率较高相关。因此，在决定对多发性钝性损伤患者进行初始固定时，应考虑术前情况。
Objectives: The timing of definitive fixation for major fractures in patients with multiple injuries is controversial. To address this gap, we randomized patients with blunt multiple injuries to either initial definitive stabilization of the femur shaft with an intramedullary nail or an external fixateur with later conversion to an intermedullary nail and documented the postoperative clinical condition.Methods: Multiply injured patients with femoral shaft fractures were randomized to either initial ( 16 points, or 3 fractures and Abbreviated Injury Scale score >= 2 points and another injury (Abbreviated Injury Scale score >= 2 points), and age 18 to 65 years. Exclusion: patients in unstable or critical condition. Patients were graded as stable or borderline (increased risk of systemic complications).Outcomes: Incidence of acute lung injuries.Results: Ten European Centers, 165 patients, mean age 32.7 +/- 11.7 years. Group intramedullary nailing, n = 94; group external fixation, n = 71. Preoperatively, 121 patients were stable and 44 patients were in borderline condition. After adjusting for differences in initial injury severity between the 2 treatment groups, the odds of developing acute lung injury were 6.69 times greater in borderline patients who underwent intramedullary nailing in comparison with those who underwent external fixation, P < 0.05.Conclusion: Intramedullary stabilization of the femur fracture can affect the outcome in patients with multiple injuries. In stable patients, primary femoral nailing is associated with shorter ventilation time. In borderline patients, it is associated with a higher incidence of lung dysfunctions when compared with those who underwent external fixation and later conversion to intermedullary nail. Therefore, the preoperative condition should be when deciding on the type of initial fixation to perform in patients with multiple blunt injuries.