医学
脂肪栓塞
髓内棒
瘀点疹
脂肪栓塞综合征
栓塞
栓塞
苦恼
肺栓塞
外科
重症监护医学
放射科
临床心理学
作者
David L. Rothberg,Christopher A Makarewich
出处
期刊:Journal of The American Academy of Orthopaedic Surgeons
日期:2019-04-15
卷期号:27 (8): e346-e355
被引量:71
标识
DOI:10.5435/jaaos-d-17-00571
摘要
Fat embolism (FE) occurs frequently after trauma and during orthopaedic procedures involving manipulation of intramedullary contents. Classically characterized as a triad of pulmonary distress, neurologic symptoms, and petechial rash, the clinical entity of FE syndrome is much less common. Both mechanical and biochemical pathophysiologic theories have been proposed with contributions of vascular obstruction and the inflammatory response to embolized fat and trauma. Recent studies have described the relationship of embolized marrow fat with deep venous thrombosis and postsurgical cognitive decline, but without clear treatment strategies. Because treatment is primarily supportive, our focus must be on prevention. In trauma, early fracture stabilization decreases the rate of FE syndrome; however, questions remain regarding the effect of reaming and management of bilateral femur fractures. In arthroplasty, computer navigation and alternative cementation techniques decrease fat embolization, although the clinical implications of these techniques are currently unclear, illustrating the need for ongoing education and research with an aim toward prevention.
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