在多次长骨折固定后的心肺结果的全国性分析
Gable Moffitt1, Laura Krech, Maxwell Phillips
1From the Corewell Health Butterworth Hospital (Moffitt), the Corewell Health Trauma Research Institute, Grand Rapids, MI (Krech), the McLaren Flint Orthopaedic Surgery Residency, Grand Blanc, MI (Phillips), the Trauma Research Institute, Grand Rapids, MI (Fisk), the Research Operations, Bioinformatics Core, Grand Rapids, MI (Parker), and the Division Chief Acute Care Surgery (Parker), Corewell Health Butterworth Hospital, Grand Rapids, MI (Chapman).
概括
对于多次下肢骨折,同时进行骨髓内钉 (IMN) 是安全的. 与高风险患者分阶段固定相比,这种方法没有增加ARDS或肺炎等心肺并发症.
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
- 关键护理医学 关键护理医学
背景情况:
- 多重长骨下肢骨折,用内指甲固定 (IMN) 进行治疗,可能会造成严重的心肺风险.
- 患者面临脂肪栓塞综合征,肺栓塞,急性呼吸困扰综合征 (ARDS) 和肺炎的风险增加.
- 有限的数据存在,比较骨和大腿骨骨折的同时固定与分阶段固定.
研究的目的:
- 为了比较多个长骨下肢骨折的同时和分阶段IMN固定之间的心肺结局.
- 评估高风险创伤患者单阶段手术干预的安全性和有效性.
主要方法:
- 使用了美国外科医生学院创伤质量改善计划数据库 (2016-2019).
- 识别了多个长骨下肢骨折 (骨和/或股骨) 的患者.
- 进行同步固定 (全部在一天内) 和分阶段固定 (间隔>24小时) 的对比队列.
主要成果:
- 在3202名符合条件的患者中,75.9%患有同时固定,24.1%患有分阶段固定.
- 阶段化组年龄较大,呼吸机相关肺炎,ARDS和急性损伤的发生率明显较高.
- 阶段化组经历了更长的手术时间和住院时间.
结论:
- 对多个下肢骨折同时进行IMN固定与心肺并发症增加无关.
- 同时固定并没有增加ARDS,呼吸机相关肺炎或急性损伤的风险.
- 同时的IMN固定是一种可行的选择,在高风险患者心肺并发症方面,其安全性与分阶段程序相美.
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