伤口缺陷的危险因素 在初级关闭后,IIIA类型的开放骨折的伤口缺陷
Orthopedics
|August 10, 2023
概括
严重的开放骨折的初级关闭可能会导致需要片覆盖的并发症. 关键的风险因素包括多次脱皮,伤口关闭延迟和长时间的外部固定,影响治疗的成功.
科学领域:
- 整形外科手术 整形外科手术
- 创伤管理 创伤管理
- 重建性手术是一种重建性手术.
背景情况:
- 类型IIIA开放的骨断裂对初始管理提出了复杂的挑战.
- 通常尝试关闭初级伤口,但可能会因感染和组织损失而复杂化.
- 由于初级关闭的并发症,可能需要进行后续的盖覆盖.
研究的目的:
- 为了确定风险因素,预测在IIIA型开放骨折的初级关闭后需要片覆盖.
- 在这个患者群体中分析片覆盖的结果.
- 为了告知严重的开放骨折的治疗策略.
主要方法:
- 对278名IIIA型开放骨折患者进行了回顾性研究,这些患者接受了初级关闭治疗.
- 对治疗因素的分析:脱bridements,外部固定持续时间,伤口关闭时间.
- 主要结局:并发症需要计划外的手术和随后的片覆盖.
主要成果:
- 20%的患者 (55/278) 需要由于并发症而进行盖.
- 盖覆盖的重要预测因素: ≥3次脱皮 (OR 29.8),损伤后关闭>2天 (OR 9.8),外部固定>14天 (OR 7.3).
- 患有≥3次脱bridements的患者的并发症率为70.7%,而患有≤2次脱bridements (P<.001) 的患者的并发症率为6.8%.
结论:
- 多次脱皮,伤口关闭延迟和长时间的外部固定是IIIA型骨折的初级关闭后盖的重要风险因素.
- 在需要≥3次脱皮的伤口中,初级关闭后高失败率 (70.7%) 建议考虑替代的重建方法.
- 优化初始管理可能会减少对二次重建程序的需求,并改善结果.
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