【摘要】 目的　探讨开放性股骨干骨折急诊扩髓腔及髓内钉固定是否增加感染和其他并发症。方法　采用回顾性对比分析 ,依据下列标准选择病例 :①年龄在 17～ 6 5岁 ;②住院不少于 4 8h ;③病史中无明显影响全身状况的疾病 ,如糖尿病 ,慢性心、肺、肾功能不全等 ;④必须为开放性股骨干骨折 ,且进行了髓内钉固定。然后按受伤至手术时间划分为两组 ,A组为≤ 2 4h手术者 (定为急诊扩髓组 ) ,B组为 >2 4h手术者 ,再进行两组间合并伤情况、开放损伤严重度、ISS评分、住院时间、ICU时间、并发症、死亡及合并休克情况比较。结果　有 14 7例符合上述标准 ,其中A组有 6 8例 ,B组有 79例 ,两组间经统计学处理比较 ,仅在合并休克率 (A组占 5 5 9% ,B组占 2 2 6 % ,χ2 =13 0 6 0 ,P <0 0 0 1)及住院时间 (A组为 (15 8± 6 3)d ,B组为 (2 7 8± 9 1)d ,t=9 14 0 ,P <0 0 1)、开放伤严重程度 (以Ⅲ型比较A组 19例 ,B组 7例 ,χ2 =8 0 32 ,P <0 0 1)上两组间差异有显著性意义 ,而在其他方面差异均无统计学意义。结论　只要能控制休克 ,保证生命体征平稳 ,严格清创 ,开放性股骨干骨折急诊扩髓及髓内钉固定不增加患者的感染率和其他并发症及死亡率 ,并可促使患者早日康复 ,缩短住院时间 ,从而减少费用。但对Gustilo分类Ⅲ型更多还原

【Abstract】 Objective To investigate infection and other complications of primary reamed intramedullary nailing for open femoral shaft fracture Methods This study is a retrospective analysis of trauma registry data.The criteria for inclusion in the study were as follows:①patients age 17 to 65 years:②hospital length of stay more than 48 hours:③there are no marked preexisting medical diseases in history:④the cases must be open femoral shaft fracture treated with intramedullary nailing.These patients were divided into two groups based on the time of the injury to operation,group A not more than 24 hours,group B more than 24 hours.Results During the study period,147 patients met the criteria for the investigation in which group A were 68 patients,group B were 79 patients.No differences between two groups were found in associated injury,ISS,ICU length of stay,infection and other complication or mortality.There is significant difference in associated shock rate(χ 2=13.060,P<0.001),hospital length of stay(t=9.140,P<0.01),Ⅲ-type of open injury(χ 2=8.032,P<0.01) between two groups.Conclusion This study has not demonstrated an increased complication or mortality associated with primary reamed intramedullary nailing for open femoral shaft fracture.更多还原