Saw A, Chan C K, Penafort R, Sengupta S
Department of Orthopaedic Surgery, University Malaya Medical Center, Kuala Lumpur, Malaysia.
Med J Malaysia. 2006 Feb;61 Suppl A:62-5.
Patients treated with external fixation for limb reconsturciton or fracture stabilization equire regular and prolongedperiod of pin-tract care involving frequent visits to clinic and dressing traditionally carried out by trained nurses or medical assistants. A simple method of do-it-yourself dressing was introduced in our institution and this study was undertaken to evaluate the effectiveness of the protocol. Sixty patients (40 trauma-related problems and 20 congenital or developmental disorders) were enrolled into the study. Following application of external fixation, the patients and/or their caretakers were taught on how to do pin-site dressing using normal saline or drinking water as cleansing solution on daily basis. Patients were discharged on the second or third post-operative day and were followed-up every two weeks for an average 182 days (range 66 to 379 days) with special attention on identifying pin-tract infection. A simple grading system for pin-tract infections was proposed. Of 40 patients with trauma-related problems. 65% were post-traumatic infections. There were 788 metal-skin interfaces (239 half-pin fixations and 549 tensioned wire fixations. A total 143 metal-skin interface infections (18.1%) involving half-pin sites (41.3%) and tensioned wire sites (58.7%) was noted. Majority were grade I infections (79.7%), 18.8% grade II and only 1.4% grade III. Most infections (81%)were caused by Staphylococcus aureus. Grade I infections were successfully treated with frequent dressing, grade II by adjunctive oral antibiotic but grade III infections required removal of fixator. All eventually healed. Do yourself non-sterile dressing of metal-skin interfaces is a cost-effective method of pin-site care with a low infection rate. The infections were sucessfully treated using guidelines according to the proposed classification of pin-tract infections.
接受外固定治疗以进行肢体重建或骨折固定的患者需要定期且长时间的针道护理，这包括频繁前往诊所，传统上由训练有素的护士或医疗助理进行换药。我们机构引入了一种简单的自行换药方法，并开展了本研究以评估该方案的有效性。60名患者（40例创伤相关问题和20例先天性或发育性疾病）纳入研究。应用外固定后，教导患者和/或其护理人员如何使用生理盐水或饮用水作为清洁溶液，每天进行针道换药。患者在术后第二天或第三天出院，每两周随访一次，平均随访182天（范围66至379天），特别关注识别针道感染情况。提出了一种简单的针道感染分级系统。在40例创伤相关问题的患者中，65%为创伤后感染。共有788个金属-皮肤界面（239个半针固定和549个张力钢丝固定）。共发现143个金属-皮肤界面感染（18.1%），涉及半针部位（41.3%）和张力钢丝部位（58.7%）。大多数为I级感染（79.7%），18.8%为II级，仅1.4%为III级。大多数感染（81%）由金黄色葡萄球菌引起。I级感染通过频繁换药成功治疗，II级通过辅助口服抗生素治疗，但III级感染需要去除固定器。所有患者最终均愈合。自行进行金属-皮肤界面的非无菌换药是一种具有成本效益的针道护理方法，感染率低。根据所提出的针道感染分类指南，感染得到了成功治疗。
