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两个大骨头,一个大决定:什么时候修复双侧股骨骨折

Suzanne C Arnold¹, Emanuele Lagazzi², Robert K Wagner³

¹Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, 165 Cambridge St, Suite 810, Boston, MA 02114, USA; Department of Trauma Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands.

|June 11, 2024

概括

双边大腿骨骨折的早期确定 (24小时内) 可以减少整体发病率和住院时间. 早期阶段的修复是优于延迟固定,当早期固定是不可能的.

科学领域:

整形外科手术整形外科手术
创伤外科手术创伤外科
临床结果研究研究

背景情况:

在多创伤患者中,双侧大腿骨骨折 (BFSF) 的最佳手术时间尚不清楚.
目前的文献缺乏关于早期与延迟的最终固定策略的共识.
本研究探讨了手术时间对BFSF患者临床结果的影响.

研究的目的:

评估早期 (≤24小时) 与延迟 (>24小时) 的最终固定对BFSF多创伤患者临床结果的影响.
为了比较BFSF的并发与分阶段维修时间.
为了确定早期的最终固定是否会降低死亡率和发病率.

主要方法:

利用了2017-2020创伤质量改善计划数据库.
包括年龄≥16岁的BFSF正在进行最终固定的患者.
雇员倾向得分匹配和多层混合效应回归模型来比较早期最终固定 (EDF),延迟最终固定 (DDF) 和早期阶段固定 (ESF).

主要成果:

与DDF相比,EDF (≤24小时) 与总体发病率显著降低 (12.9%与22.6%) 和深静脉血栓形成率 (2.2%与6.5%) 相关.
EDF导致了更短的ICU LOS (5vs7天) 和医院 LOS (10vs15天).
对于每24小时延迟到最终固定,并发症概率增加1.05,医院延长LOS增加27小时.

结论:

对于双边大腿骨轴骨折,早期的最终固定 (≤24小时) 是首选的,可减少发病率和停留时间.
早期阶段的修复是DDF的一个可行的替代方案,当两个股骨的立即固定是不可行的.
手术时间显著影响结果,延迟增加并发症风险.

关键词:

双边大腿骨骨折双边大腿骨骨折延迟的最终固定时间.早期的最终固定是早期的.股骨轴骨折股骨轴骨折股骨轴骨折阶段性维修是分阶段进行的.

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