小儿Gustilo-Anderson I型上肢开口骨折的初始管理:抗生素是否足够?
Olufemi Olatigbe1, Sabba Hussain1,2, Anna Bridgens1
1Department of Trauma and Orthopaedics, St George's University Hospitals NHS Foundation Trust, London, UK.
Journal of children's orthopaedics
|October 28, 2024
概括
手术除似乎没有降低小儿Gustilo-Anderson I型上肢骨折的感染率. 非手术治疗显示出类似的低感染率,这表明个性化治疗决策至关重要.
科学领域:
- 整形外科手术 整形外科手术
- 儿科创伤 儿童创伤
- 传染性疾病 传染性疾病
背景情况:
- 英国骨科协会创伤标准-4建议为儿科Gustilo-Anderson型I上肢开口骨折进行手术脱bridement.
- 支持脱bridement的证据是微弱的,因为在这个特定的伤害模式中报告的感染率很低.
研究的目的:
- 在患有Gustilo-Anderson I型上肢骨折的儿童中,非手术治疗和手术脱bridement之间的感染率进行比较.
- 为了评估那些不需要为骨折进行手术固定的儿童.
主要方法:
- 按照系统审查和元分析指南的首选报告项目进行了系统审查.
- 包括的患者年龄在18岁以下,Gustilo-Anderson I型上肢骨折,非手术或脱bridement治疗,不包括那些手术固定.
- 非随机研究中的偏差风险 - 干预研究工具评估了研究偏差.
主要成果:
- 十一项回顾性研究分析了537名儿科患者 (466名前臂,70名手腕,1名手腕).
- 非手术治疗 (293名患者) 导致一次表面感染 (0.3%).
- 手术除 (244名患者) 也导致了一个表面感染 (0.4%).
结论:
- 对于Gustilo-Anderson I型儿科上肢骨折的最佳管理仍然不清楚.
- 目前的证据表明,手术除菌并不能显著降低感染率.
- 建议个性化治疗决策,考虑患者的年龄,损伤机制和临床程度.
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