CAJ | 학술논문

目的探讨骨折并脂肪栓塞综合征(FES)内固定术后复发的临床对策. 方法回顾性分析自2000年1月至2011年11月收治的35例骨折合并FES内固定术后7例复发FES患者的临床资料,男6例,女1例；年龄24～46岁,平均36岁；均为多发伤,股骨骨折6例(双股骨骨折1例),胫骨骨折5例(双胫骨骨折1例,浮膝损伤2例),肱骨骨折2例,尺桡骨骨折2例,骨盆骨折3例.创伤严重度评分平均为19分,创伤严重度改良评分平均为21分.给予对症处理,补充白蛋白、改善微循环、机械通气等处理.根据Gurd标准及改良FES早期评分法进行诊断并给予相应治疗. 结果本组7例患者经治疗后病情逐渐平稳,血常规及生化检验结果正常,呼吸功能正常,各部位骨折均得到妥善固定,术后14～20 d患者病情稳定出院.根据Gurd标准及改良FES早期评分法诊断标准:典型复发2例,不典型复发5例,典型复发患者均符合Gurd诊断标准,不典型复发患者多表现为未发现感染灶的发热、贫血、脉搏增快、氧分压下降等,经对症支持治疗后症状缓解. 结论骨折合并FES患者在骨折内固定术中、术后均有复发的风险,应注意骨折手术的时机和内固定方法以减少或防止复发.
목적 탐토골절병지방전새종합정(FES)내고정술후복발적림상대책. 방법 회고성분석자2000년1월지2011년11월수치적35례골절합병FES내고정술후7례복발FES환자적림상자료,남6례,녀1례；년령24～46세,평균36세；균위다발상,고골골절6례(쌍고골골절1례),경골골절5례(쌍경골골절1례,부슬손상2례),굉골골절2례,척뇨골골절2례,골분골절3례.창상엄중도평분평균위19분,창상엄중도개량평분평균위21분.급여대증처리,보충백단백、개선미순배、궤계통기등처리.근거Gurd표준급개량FES조기평분법진행진단병급여상응치료. 결과 본조7례환자경치료후병정축점평은,혈상규급생화검험결과정상,호흡공능정상,각부위골절균득도타선고정,술후14～20 d환자병정은정출원.근거Gurd표준급개량FES조기평분법진단표준:전형복발2례,불전형복발5례,전형복발환자균부합Gurd진단표준,불전형복발환자다표현위미발현감염조적발열、빈혈、맥박증쾌、양분압하강등,경대증지지치료후증상완해. 결론 골절합병FES환자재골절내고정술중、술후균유복발적풍험,응주의골절수술적시궤화내고정방법이감소혹방지복발.
Objective To explore the mechanism of and clinical strategy for the relapse of fat embolism syndrome (FES) in patients after fracture internal fixation.Methods A retrospective study was conducted to analyze the clinical data of 7 cases of FES relapse which had occurred after fracture internal fixation from January 2000 to November 2011 in our department.They were 5 men and 2 women,24 to 46years of age (average,36 years).They all had multiple injuries.Femoral fracture occurred in 6 cases (including one case of double femoral fractures),tibial fracture in 5 cases (including one case of double tibial fractures and 2 cases of floating knee),humeral fracture in 2 cases,ulna and radius fractures in 2 cases,and pelvic fracture in 3 cases.Their injury severity scores (ISS) averaged 19 points and their revised injury severity scores (RISS) 21 points.They were diagnosed and treated with the Gurd criteria and modified grading of early FES.Results In this group all the 7 cases achieved,after treatment,gradual and steady recovery,normal results of blood and biochemical tests,normal respiratory function and stable fixation of all the fractures.They were discharged 14 to 20 days postoperatively.By the Gurd criteria and modified grading of early FES,2 cases had typical relapse and 5 untypical relapse.Typical cases were consistent with all the Gurd criteria and untypical ones presented with fever with no infection focus identified,anemia,increased pulse and decreased oxygen partial pressure which were relieved by symptomatic and supporting treatment.Conclusion Since the recurrence risk of FES exists during and after internal fixation in patients with fracture and FES,we should be more careful in the timing and surgicai skills of the internal fixation as to reduce or block the recurrence of FES.