骨折固定的时间在脚骨折-脱位
Diederick Penning1, Jasper Tausendfreund2, M Azad Naryapragi1
1Trauma Unit, Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
Foot & ankle specialist
|October 5, 2024
概括
急性与延迟的开放缩减和内部固定 (ORIF) 对于脚骨折脱位显示了重复手术和手术部位感染 (SSI) 的类似结果. 对ORIF的时间不那么关键,而不是管理诸如开口骨折和糖尿病等因素.
科学领域:
- 整形外科手术 整形外科手术
- 创伤外科 手术 创伤外科
- 足部医学 足部医学
背景情况:
- 脚骨折-脱位症往往会带来复杂的管理挑战.
- 手术干预的最佳时间,特别是开放式缩减和内部固定 (ORIF),仍然是争论的主题.
研究的目的:
- 为了比较急性ORIF与延迟ORIF (使用外部固定或造 splint) 的结局,用于脚骨折移位.
- 确定影响这些患者重新手术和手术部位感染 (SSI) 率的因素.
主要方法:
- 一项回顾性队列研究,涉及447名受ORIF治疗的脚骨折移位患者.
- 使用多变量分析来评估手术时间 (<48小时 vs 延迟) 和其他患者因素对结果的影响.
主要成果:
- 在48小时内手术和延迟固定之间,没有发现非计划的重新手术或SSI率的显著差异.
- 较高的身体质量指数 (BMI) 和开放性骨折与重新手术风险的增加相关.
- 糖尿病 (DM) 和开口骨折是SSI的重要风险因素.
- 开放性骨折的结果在急性和延迟的内部固定之间没有显著差异.
结论:
- 如果在48小时内进行,并且允许软组织损伤,关节骨折移位的初级ORIF是安全的.
- 对于具有明显胀但没有软组织损伤的减少良好的骨折,保守的造治疗直到延迟ORIF是一个安全的选择.
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