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与固定和关闭相比,计划,分阶段治疗开口骨折的更高的复苏率:一个倾向性得分匹配分析

Yohan Jang¹, Roman M Natoli¹, Gregory J Della Rocca²

¹Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana.

The Journal of bone and joint surgery. American volume

|June 18, 2025

概括

对于古斯蒂洛-安德森类型I至IIIA开口骨折,修复和关闭手术方法减少了与分阶段治疗相比的一年内深部手术部位感染 (SSI) 和与感染相关的重新手术. 这种方法对于管理有污染的开口骨折是安全的,只要进行彻底的除.

科学领域:

整形外科手术整形外科手术
创伤管理创伤管理
传染性疾病传染性疾病

背景情况:

开放性骨折 (古斯蒂洛-安德森型I-IIIA) 的手术管理有所不同,决策通常基于污染和骨折严重程度.
传统的方法包括立即关闭 (修复和关闭) 或分阶段骨折和伤口管理.

研究的目的:

为了比较手术部位感染 (SSI) 率,伤口并发症,非联合和1年重复手术率之间的修复和关闭和计划,分阶段治疗类型I到IIIA开口骨折.

主要方法:

对具有I-IIIA型开口骨折的水性PREP和PREPARE-Open研究参与者的二次分析.
倾向性得分匹配用于比较固定和关闭与计划的分阶段治疗组.
分析的结果包括深度SSI,伤口并发症,非工会和重新手术率.

主要成果:

在一组匹配的1672名患者中,分阶段治疗与90天内深度SSI的更高几率 (OR 2.0) 和1年内感染相关的重新手术 (OR 1.47) 相关.
两组之间没有发现伤口枯,亡,愈合失败,盖重开手术或非联合率的显著差异.
固定和关闭治疗显示,深度SSI和与感染有关的再手术的几率降低,而不会增加其他并发症的风险.

结论:

对IIIA类型和下部开口骨折的修复和关闭治疗与一年内较少的深度SSI和与感染有关的再手术有关.
这种方法可以考虑开放骨折,即使有污染,如果进行适当的除.
与分阶段管理相比,固定和关闭治疗在伤口并发症和非联合率方面提供了可比的安全性.

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