小儿股骨骨折并发脂肪栓塞综合征1例

患儿 ,4岁 ,女性 ,于 1 998年 1 0月 2 1日 ,因“车撞后左大腿肿痛、畸形、活动受限 2h”入院。神志清 ,精神可 ,肥胖。X线片示 :左侧股骨干短斜型螺旋形骨折且明显移位。经查体及结合X线表现确诊为“左侧股骨干斜形螺旋型骨折”。于次日在氯胺酮麻醉下行切开复位螺钉单臂支架外固定术 ,手术历 4h。术后 3h时突然出现神志不清 ,呼吸急促 ,口吐泡沫少许 ,呕吐胃内容物一次、量少 ,四肢抽搐 ,脉搏 1 35次 /min以上 ,双肺可闻及少量细罗音 ,双侧瞳孔等大等圆 ,对光反射灵敏。HB 87g/K、PLT 1 0 0× 1 0 9/L ,心电图提示 :频发房性早搏 ,尿…     

严重多发性骨折并发脑型脂肪栓塞综合征1例

1　病例资料患者 ,男 ,4 6岁。因港口机械绞伤四肢急诊入院。查体 :意识存在 ,血压10 7/ 6 7kPa ,面色苍白 ,四肢湿冷 ,脉搏细速 ,呼吸急促。肢体多部位挫裂伤、出血、畸形 ,无颅脑外伤体征。结合X线片诊断为 :失血性休克 ,右股骨干骨折 ,右胫腓骨骨折 ,右肱骨干骨折 ,左肱骨外科颈骨折 ,左外踝骨折。经补液、输血、面罩给氧等抗休克治疗生命体征恢复正常后 ,急诊在全麻下行右股骨干骨折、右胫骨开放性骨折、右肱骨干骨折清创术、有限切开 (扩髓 )交锁髓内钉内固定术 ,左上下肢石膏固定 ,术中输液2 2 0 0ml,输血 12 0 0ml。术毕继续给予…     

股骨干骨折并发脂肪栓塞综合征的防治体会

股骨干骨折是创伤外科中的常见骨折。随着交通快速发展 ,亦有逐渐增多的趋势。而脂肪栓塞 (Fat Embolism Syn-drom,FES)是股骨干骨折的一种严重并发症 ,死亡率高达 6%～ 35 % [1]。 1993年～ 2 0 0 1年我院收治股骨干骨折病人共4 2 7例 ,其中并发 FES仅 1例。本文通过回顾性分析提出FES的发病特点、预防性治疗措施及防治体会。1　临床资料1.1　一般资料　股骨干骨折病人共 4 2 7例 ,男 32 0例 ,女10 7例 ,年龄 3～ 80岁 ,平均 36 .8岁。致伤原因 :车祸伤 2 5 0例 ,压砸伤 6 2例 ,高处坠落伤 5 6例 ,其他 4 8例。骨折治疗 :器械内固定 3…     

骨折术后并发脑脂肪栓塞综合征2例

例1，男，62岁，因车祸2h后入院，患者神志清、生命体征稳定，右股骨中段及右小腿中段肿胀，X线片示右股骨干中段骨折，右胫腓骨中下1／3处粉碎性骨折。入院后急诊行切开复位钢板内固定，术后4h患者突然出现神志不清，呼吸急促，T38．8℃，P130次／分，R32次／分，BP120／85mmHg(1mmHg=0．133kPa)，双侧瞳孔缩小至1．5mm，眼底可见     

骨折并发脂肪栓塞综合征的护理

脂肪栓塞综合征（FatEmbolismSyndromeFES）是由于长骨骨折及多发性骨折后骨髓或软组织局部的游离脂肪滴由破裂的静脉进人血循环，机械地栓塞小血管和毛细血管，以进行性低氧血症、皮下及内脏出血点、意识障碍为特征的严重并发症。由于血中脂肪栓栓塞心、肺、脑、肾等重要器官，病死率高，且常易误诊为颅脑损伤，目前尚无可直接消除脂肪栓疗法，故以症状治疗为主。我科1990—1996年收治FES6例，住院26-38d，经呼吸支持，药物治疗及对症处理等综合治疗、护理均痊愈出院。现报告如下。1临床资料6例中男5例．女1例，年龄18～45岁。双侧胫腓…     

股骨干骨折并发脂肪栓塞综合征的诊断与治疗

目的 探讨股骨干骨骨折后脂肪栓塞综合征(EES)的诊断治疗方法。方法 1989—1998年收治的股骨干骨折病人212例,对并发EES的8例病人的临床表现、治疗方法及结果进行描述。结果 184例单股骨骨折病人发生EES4例28例双股骨骨折病人发生EES4例,发生率分别为2.2％和16.7％,统计学处理P<0.05。结论 EES更好发于双股骨骨折病人;骨折的早期开放复位固定可降低EES的发生率,而骨折髓内钉固定有增加EES发生的危险:呼吸支持和循环维持是治疗EES的关键,早期大剂量激素应用有肯定的治疗效果。     

多发伤并发脂肪栓塞综合征

１病例资料患者，男，４２岁，因重物压伤后，左大腿疼痛、畸形、不能活动２ｈ入院。查体：一般情况差，脉搏细弱，血压１０．６／８．０ｋＰａ，面色苍白，意识清楚，心、肺、腹无异常，骨盆挤压分离试验（＋），左大腿肿胀、畸形、压痛，触摸有骨擦感。Ｘ线片示骨盆左耻...     

胫腓骨骨折并发脂肪栓塞综合征1例

脂肪栓塞综合征（fat embolism syndrome，FES）是骨折的严重并发症，是以急性呼吸功能紊乱，伴有脑部或全身症状的临床综合征，国内有关脂肪栓塞报道不多。我院收治1例双侧胫腓骨骨折后脂肪栓塞患者，现报告如下。     

骨折后并发脂肪栓塞综合征的诊治

脂肪栓塞综合征 (ｆａｔｅｍｂｏｌｉｓｍｓｙｎｄｒｏｍｅ ,ＦＥＳ)是骨折最严重的并发症之一。笔者对近年我院 5 5 1例创伤性骨折患者进行回顾性总结 ,其中 11例并发ＦＥＳ ,现分析如下。1　材料与方法1.1　病例资料　本组 11例 ,男 7例 ,女4例 ,年龄 17～ 75岁。车祸伤 8例 ,坠落伤 3例。 11例均有长骨干骨折 ,股骨干单发骨折 2例 ,股骨干合并胫腓骨骨折 3例 ,股骨合并骨盆骨折 1例 ,股骨干合并肱骨骨折 2例 ,单发胫腓骨骨折 1例 ,双侧胫腓骨骨折 2例。后 3例入院前经反复手法复位未成功。开放性骨折4例 ,闭合性骨折 7例。受伤至ＦＥＳ出…     

股骨骨折伴发脂肪栓塞综合征的诊治分析

脂肪栓塞综合征是指直径为10～40μm的血管内脂肪颗粒阻塞血管腔而引起一系列病理生理改变的临床综合征.脂肪栓塞综合征是创伤后发生的严重并发症之一,临床上常表现为呼吸困难和低氧血症、意识障碍、皮肤黏膜出血点和发热等,如患者得不到及时的诊断和治疗,可出现严重后果,甚至导致死亡[1].2003年1月至2007年12月,我科收治10例股骨骨折伴发脂肪栓塞综合征患者,回顾性研究其临床资料,对其诊断及治疗结果进行分析,总结如下.     

股骨颈骨折并发肺栓塞1例

1 病例资料 患者,女,70岁.因跌伤致右髋部疼痛7 d,于2007年2月1日入院.既往有高血压和糖尿病史.入院查体:BP 21.9/12.3 kPa,神志清醒,说话流利,心、肺、腹未见异常.右下肢外旋短缩畸形,右髋有压痛及纵向叩击痛,双下肢无明显肿胀,Homans征阴性.     

Early intramedullary nailing of femoral shaft fractures: A cause of fat embolism syndrome

Results of our retrospective review of 100 consecutive patients show that early intramedullary nailing can be accomplished in severely injured patients without increasing the risk of fat embolism syndrome. No cases of fat embolism syndrome were seen after immediate (less than 24 hours) intramedullary nailing of femoral shaft fractures. In contrast, five cases of fat embolism syndrome were found in the patients treated in the traditional manner with initial balanced skeletal traction and delayed intramedullary nailing. There was a trend toward more pulmonary complications in the immediate group. This is attributed to the greater severity of injury present in the patients selected for immediate intramedullary nailing (injury severity scores 23.2 in immediate group; 12.4 in delayed group). The incidence of critical hypoxemia in the immediate group was equivalent to that in another group of injured patients who did not have fractures, but who did have similar injury severity scores.     

脂肪栓塞综合征1例

1　病例资料患者 ,男 ,30岁。因双小腿外伤后肿痛、反常活动、不能站立行走 6ｈ入院。查体 :一般情况尚可 ,生命体征平稳 ,神志清楚。右小腿前侧有一斜形皮肤裂口 ,长 3ｃｍ ,渗血 ,边缘不整 ,深及骨质 ;左小腿前侧青紫 ;双小腿中段压痛 ,有骨擦感及反常活动 ;被动活动膝、踝关节无异常 ;Ｘ线片示双侧胫腓骨骨折、骨折端移位。入院诊断 :左胫腓骨骨折、开放性右胫腓骨骨折。入院后即刻行清创缝合 ,闭合右小腿前侧伤口 ,手法复位后暂时用石膏托固定 ,准备行交锁髓内钉内固定。患者于入院后 10ｈ突然高热、呼吸困难、昏睡 ,呼吸困难逐渐加重 ,…     

骨折并发脑型脂肪栓塞临床报告

目的探讨并发于骨折的脑型脂肪栓塞的诊断、鉴别诊断和治疗。方法回顾性分析了7例骨折并发的脑型脂肪栓塞的诊治经过,股骨干骨折3例,胫腓骨骨折3例,四肢多发骨折1例,均无颅脑外伤,于伤后9h～3d内出现嗜睡或浅昏迷,并伴有体温升高(37.7～39°C),呼吸、心率加快,贫血,胸部有少许散在的出血点。重点讨论与颅脑外伤的鉴别诊断。治疗方法采取以激素(地塞米松20mg～80mg/d)为主的综合治疗。结果7例经1d～7d的治疗,均完全清醒,生命体征恢复正常。结论对于四肢骨折病人伤后或术后早期突发的非颅脑损伤引起的嗜睡或昏迷,应高度怀疑脑型脂肪栓塞,与脑外伤颅内出血等鉴别后,应尽早采用以大剂量地塞米松(地塞米松40mg～80mg/d)为主的综合治疗,疗效满意。     

Pulmonary fat embolism after reamed and unreamed nailing of femoral fractures

Background

To determine whether reamed or unreamed intramedullary nailing of femoral fractures results in higher incidence of pulmonary fat embolism, three different methods of intramedullary nailing were compared in sheep. To analyze the presence of bone marrow fat embolism in pulmonary arteries, histological evaluation was undertaken using a quantitative computer-assisted measurement system.

Methods

In this experimental model of 27 female Swiss alpine sheep, an osteotomy of the proximal femur was conducted in each animal. Then, the animals were divided into three groups according to the method of treatment: two different reamed intramedullary nailing techniques and an unreamed nailing technique were used.In the first group “ER” (experimental reamer; n = 9), the nail was inserted after reaming with an experimental reamer; in the second group “CR” (conventional reamer; n = 7), the intramedullary nail was inserted after reaming with the conventional AO-reamer. In the third group “UN” (unreamed; n = 8) unreamed nailing was performed. During the operation procedure intramedullary pressure was measured in the distal fragment.After sacrificing the animals, quantitative histological analyses of bone marrow fat embolism in pulmonary arteries were done using osmium tetroxide fixation and staining of the fat.

Results

The measurement of intramedullary pressure showed significantly lower values for reamed nailing than for the unreamed technique. The quantitative histological evaluation of lung vessels concerning bone marrow fat embolism revealed a statistically significant difference between reamed and unreamed insertion of the nail: 7.77% ± 6.93 (ER) and 6.66% ± 5.61 (CR) vs. 16.25% ± 10.05 (UN) (p < 0.05) of the assessed lung vessels were filled with fat emboli. However, no difference was found between the traditional and experimental reamer.

Conclusions

Intramedullary nailing after reaming is a safe procedure with low systemic embolisation when compared to the unreamed insertion of the nail.     

左下肢多发性骨折合并完全性脂肪栓塞综合征1例

患者,女,39岁,车祸致左下肢多发性骨折并失血性休克.入院检查：T 37.2℃,P 82次/min,R 22次/min,Bp85/55mmHg.神清,双侧瞳孔等大等圆,对光反应存在,两肺呼吸音清,未闻及干湿罗音,腹平软,肝脾肋下未及,无压痛及反跳痛,左足背外侧见10 cm的创口,渗血较多.入院后在输血、补液抗休克的同时,急诊全麻下行左足清创缝合骨折内固定术（克氏针）,术中探查胫前动脉有挫伤,予以左下肢长腿石膏固定.     

Treatment of femoral supracondylar unstable comminuted fractures

Summary A prospective study was done of 66 consecutive unstable comminuted supracondylar femoral fractures in adults, fixed with either plates (28 cases) or Grosse-Kempf interlocking nails (38 cases). Patients were followed up for at least 1 year (average 44 months). Interlocking nails led to a higher union rate and more satisfactory functional results. Nevertheless, the first distal transverse screw hole took a potential risk of breakage due to stress concentration. The authors conclude that for a cooperative patient, a closed static interlocking nail with strict non-weight-bearing should be the treatment of choice, and for an uncooperative patient, a closed static interlocking nail should be supplemented with a cast brace to reduce the complication rate.