Zalavras Charalampos G, Marcus Randall E, Levin Lawrence Scott, Patzakis Michael J
Department of Orthopaedic Surgery, LAC and USC Medical Center, University of Southern California, Los Angeles, California, USA.
Instr Course Lect. 2008;57:51-63.
Early, systemic, wide-spectrum antibiotic therapy is necessary for the treatment of open fractures. The bead pouch technique delivers antibiotics locally and prevents secondary wound contamination. The open fracture wound should be thoroughly débrided. To avoid the complication of gas gangrene, the wound should not be closed. Extensive soft-tissue damage may necessitate the use of local or free flaps. Techniques of fracture stabilization depend on the anatomic location of the fracture and the characteristics of the injury. Early bone grafting and supplemental procedures may be needed to achieve healing. Management of the infected open fracture is based on radical débridement, skeletal stabilization, microbial-specific antibiotics, soft-tissue coverage, and reconstruction of bone defects.
早期、全身性、广谱抗生素治疗对于开放性骨折的治疗是必要的。珠袋技术可局部递送抗生素并防止伤口继发污染。开放性骨折伤口应彻底清创。为避免气性坏疽并发症，伤口不应缝合。广泛的软组织损伤可能需要使用局部或游离皮瓣。骨折固定技术取决于骨折的解剖位置和损伤特征。可能需要早期植骨和辅助手术以实现愈合。感染性开放性骨折的处理基于彻底清创、骨骼固定、针对微生物的抗生素、软组织覆盖以及骨缺损重建。
