OBJECTIVES:To determine whether previously reported high mortality rates associated with bilateral femoral fractures have decreased over time. DESIGN:Retrospective review. SETTING:Urban academic trauma center. PATIENTS: STUDY GROUP:54 adults with bilateral femoral fractures treated at our center from 2000 to 2006. The 108 fractures were initially treated with external fixation (11%), reamed antegrade nailing (23%), and reamed retrograde nailing (67%). Unilateral control group: 461 patients with unilateral femoral fractures treated at our center from 2002 to 2005. INTERVENTION:Univariate analysis compared our results with those of a published historical control group from the same center approximately 15 years ago (study period, 1984-1990). MAIN OUTCOME MEASUREMENTS:Mortality rates. RESULTS:We noted marked differences between the current mortality rate associated with bilateral femoral fractures and that of the historical control group. The mortality rate decreased over time at our center for both bilateral (26%-7%, P = 0.002) and unilateral (12%-2%, P = 0.0001) fractures. Mortality rates were still significantly higher (P = 0.037) for bilateral (7%) than for unilateral (2%) fractures. CONCLUSIONS:Mortality rates and Injury Severity Scores were reduced for bilateral and unilateral femoral fractures compared with data reported 15 years ago from the same center. The improved outcome might be related in part to changes in resuscitation, triage, intensive care, and orthopaedic management of the patients. However, considering that the Injury Severity Score also significantly decreased, the improvement might have occurred because of changes in injury patterns, perhaps secondary to improved safety features in motor vehicles. LEVEL OF EVIDENCE:Prognostic level III. See instructions for authors for a complete description of levels of evidence.

译文

目的:确定先前报道的与双侧股骨骨折相关的高死亡率是否随时间降低。
设计:回顾性审查。
单位:城市学术创伤中心。
耐心:
研究小组:2000年至2006年,我们中心对54例成年人的双侧股骨骨折进行了治疗。最初对108例骨折进行了外固定(11%),顺行扩钉(23%)和逆行扩钉(67%)。单侧对照组:2002年至2005年在我中心接受治疗的461例单侧股骨骨折患者。
干预:单变量分析将我们的结果与大约15年前(研究期,1984-1990年)同一中心的已发表历史对照组的结果进行了比较。
主要观察指标:死亡率。
结果:我们注意到当前与双侧股骨骨折相关的死亡率与历史对照组之间存在显着差异。在我们中心,双侧(26%-7%,P = 0.002)和单侧(12%-2%,P = 0.0001)骨折的死亡率均随时间降低。双侧(7%)的死亡率仍显着高于单侧(2%)的骨折(P = 0.037)。
结论:与15年前同一中心报道的数据相比,双侧和单侧股骨骨折的死亡率和严重程度评分降低。改善的结局可能部分与患者的复苏,分诊,重症监护和整形外科治疗有关。但是,考虑到伤害严重性评分也显着降低,可能是由于伤害模式的改变而导致的改善,这可能是机动车安全性得到改善之后的结果。
证据级别:预后等级III。有关证据水平的完整说明,请参见作者说明。

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