开放性高能下肢创伤后手术清创时间与感染发生率的关系。
The relationship between time to surgical debridement and incidence of infection after open high-energy lower extremity trauma.
机构信息
University of Maryland School of Medicine, 22 South Greene Street, Suite T3R54, Baltimore, MD 21201, USA.
出版信息
J Bone Joint Surg Am. 2010 Jan;92(1):7-15. doi: 10.2106/JBJS.H.00984.
BACKGROUND
Urgent débridement of open fractures has been considered to be of paramount importance for the prevention of infection. The purpose of the present study was to evaluate the relationship between the timing of the initial treatment of open fractures and the development of subsequent infection as well as to assess contributing factors.
METHODS
Three hundred and fifteen patients with severe high-energy lower extremity injuries were evaluated at eight level-I trauma centers. Treatment included aggressive débridement, antibiotic administration, fracture stabilization, and timely soft-tissue coverage. The times from injury to admission and operative débridement as well as a wide range of other patient, injury, and treatment-related characteristics that have been postulated to affect the risk of infection within the first three months after injury were studied, and differences between groups were calculated. In addition, multivariate logistic regression models were used to control for the effects of potentially confounding patient, injury, and treatment-related variables.
RESULTS
Eighty-four patients (27%) had development of an infection within the first three months after the injury. No significant differences were found between patients who had development of an infection and those who did not when the groups were compared with regard to the time from the injury to the first débridement, the time from admission to the first débridement, or the time from the first débridement to soft-tissue coverage. The time between the injury and admission to the definitive trauma treatment center was an independent predictor of the likelihood of infection.
CONCLUSIONS
The time from the injury to operative débridement is not a significant independent predictor of the risk of infection. Timely admission to a definitive trauma treatment center has a significant beneficial influence on the incidence of infection after open high-energy lower extremity trauma.
背景
开放性骨折的紧急清创术被认为是预防感染的重中之重。本研究旨在评估开放性骨折初始治疗的时间与随后感染的发展之间的关系，并评估相关因素。
方法
在 8 个一级创伤中心评估了 315 例严重高能下肢损伤患者。治疗包括积极清创、抗生素治疗、骨折固定和及时软组织覆盖。研究了从受伤到入院和手术清创的时间以及其他广泛的患者、损伤和与治疗相关的特征，这些特征被认为会影响受伤后前 3 个月内感染的风险，并计算了组间差异。此外，还使用多变量逻辑回归模型来控制潜在混杂的患者、损伤和与治疗相关的变量的影响。
结果
84 例患者（27%）在受伤后 3 个月内发生感染。在感染组和未感染组之间，从受伤到第一次清创的时间、从入院到第一次清创的时间或从第一次清创到软组织覆盖的时间，差异均无统计学意义。从受伤到确定性创伤治疗中心的入院时间是感染可能性的独立预测因素。
结论
从受伤到手术清创的时间并不是感染风险的显著独立预测因素。及时入住确定性创伤治疗中心对高能开放性下肢创伤后感染的发生率有显著的有益影响。
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