骨伤科病人急性肺动脉栓塞

目的　探讨骨伤科患者继发急性肺动脉栓塞的发病率、临床特征和高危因素 ,以及早期诊断和预防肺栓塞。方法　统计1998年 3月～ 2 0 0 2年 7月骨科患者合并致死性肺栓塞 15例 ,进行临床资料回顾性研究分析。结果　肺栓塞死亡数占死亡患者总数的 2 0 8%仅次于颅脑外伤 (4 7 2 % ) ,其中大于 5 0岁、合并髋部或下肢外伤病例有明显统计学意义 (P <0 0 1)。结论　大于 5 0岁、合并髋部或下肢外伤、长期制动、合并心血管疾患患者 ,肺动脉栓塞发病率明显增高。病人可因用力、搬动等诱因突然发病。故本病起病急骤、凶险 ,且治疗手段有限 ,故病死率极高。尸检资料表明 ,肺栓塞发病率远较实际临床诊断为高 ,漏诊率达 80 %以上 ,应引起骨科医生的高度重视

The Pulmonary Embolism in the Patients with Injury of Bone and Joint

Objective To evaluate the morbidity, the clinical features and high risk factors of acute pulmonary embobism caused by injury of bone and Joint ,so as to diagnose in early time and to prevent pulmonary embolism(PE).Methods The material of 15 patients with injury of bone and joint was analysed, and retrospective analysis is used in Clinical data statistics.Results Twenty point eight per cent of tatal patients died from PE, which is only secondary to 47.2% of craniocerebral trauma. Among them whose age were above 50 with trauma of hip or lower limb are of significent statistic difference(P<0.01).Conclusion The patients have significent high morbidity of PE whose age are above 50,with complication of hip, lower limb trauma, angiocardiopathy, or with long term external fixation, The patients may be sudden onset when forcing or moved. Accordingly the PE are rapidly onset and of few methods of therapy, which lead to high mortality. Thanatopsy data shows that morbidity of PE are higher than clinical diagnosis number. The rate of missed diagnosis is above 80%, whichtherefore clinical orthopedist should pay great attention to.