Crowley D J, Kanakaris N K, Giannoudis P V
Academic Department of Trauma & Orthopaedics, Leeds General Infirmary, Clarendon Wing, Great George Street, Leeds, LS1 3EX, UK.
J Bone Joint Surg Br. 2007 May;89(5):580-5. doi: 10.1302/0301-620X.89B5.19286.
Modern principles for the treatment of open fractures include stabilisation of the bone and management of the soft tissues. Wound debridement and irrigation is thought to be the mainstay in reducing the incidence of infection. Although numerous studies on animals and humans have focused on the type of irrigation performed, little is known of the factors which influence irrigation. This paper evaluates the evidence, particularly with regard to additives and the mode of delivery of irrigation fluid. Normal saline should be used and although many antiseptics and antibiotics have been employed, no consensus has been reached as to the ideal additive. Despite the advocates of high-pressure methods highlighting the improved dilutional ability of such techniques, the results are inconclusive and these irrigation systems are not without complications. New systems for debridement are currently being investigated, and an ideal method has yet to be determined.
开放性骨折的现代治疗原则包括骨骼固定和软组织处理。伤口清创和冲洗被认为是降低感染发生率的主要方法。尽管针对动物和人类进行了大量关于冲洗类型的研究，但对于影响冲洗效果的因素却知之甚少。本文评估了相关证据，特别是关于添加剂和冲洗液输送方式的证据。应使用生理盐水，虽然已经使用了许多防腐剂和抗生素，但对于理想的添加剂尚未达成共识。尽管高压冲洗方法的支持者强调此类技术具有更好的稀释能力，但其结果尚无定论，而且这些冲洗系统并非没有并发症。目前正在研究新的清创系统，理想的方法尚未确定。
