Hak David J, Lee Mark, Gotham David R
Department of Orthopaedic Surgery, Denver Health/University of Colorado, Denver, Colorado, USA.
J Trauma. 2010 Oct;69(4):886-8. doi: 10.1097/TA.0b013e3181b83fe9.
High-energy tibial plateau fractures may present with an acute or impending compartment syndrome requiring emergent fasciotomy. There is little information regarding the optimal management of the fasciotomy wound with respect to the subsequent definitive internal fixation of the tibial plateau fracture. The purpose of this study was to compare the rate of infection complication after internal fixation of tibial plateau fractures in patients requiring fasciotomy for compartment syndrome with patients in whom a fasciotomy was not required.
We retrospectively reviewed all tibial plateau fractures presenting over a 55-month period. Fourteen patients who presented with an associated compartment syndrome requiring fasciotomy and 128 patients in whom a fasciotomy was not performed met inclusion criteria. Patients age, sex, mechanism of injury, management of their fasciotomy, operative treatment of their plateau fracture, follow-up surgical procedures, follow-up complications, and length of follow-up were reviewed. Infection complications were defined as cellulitis requiring treatment with intravenous or oral antibiotics, patients requiring operative debridement after definitive fixation, and documentation of osteomyelitis.
In the fasciotomy group, two patients developed cellulitis that was treated with a short course on oral antibiotics. There were no documented deep infections. In the no fasciotomy group, eight patients (6.25%) had a documented culture-positive deep infection. Additionally, six patients had documented occurrences of cellulitis managed with oral or intravenous antibiotics.
Definitive internal fixation of tibial plateau fractures in the presence of open fasciotomy wounds does not seem to be associated with an increased infection risk.
高能胫骨平台骨折可能伴有急性或即将发生的骨筋膜室综合征，需要紧急行筋膜切开术。关于骨筋膜室综合征行筋膜切开术后伤口的最佳处理方法以及随后胫骨平台骨折的确定性内固定，相关信息较少。本研究的目的是比较因骨筋膜室综合征需要行筋膜切开术的患者与无需行筋膜切开术的患者在胫骨平台骨折内固定术后感染并发症的发生率。
我们回顾性分析了55个月期间所有的胫骨平台骨折患者。14例伴有骨筋膜室综合征需要行筋膜切开术的患者和128例未行筋膜切开术的患者符合纳入标准。对患者的年龄、性别、损伤机制、筋膜切开术的处理、平台骨折的手术治疗、后续手术操作、随访并发症以及随访时间进行了回顾。感染并发症定义为需要静脉或口服抗生素治疗的蜂窝织炎、确定性固定后需要手术清创的患者以及骨髓炎的记录。
在筋膜切开术组，2例患者发生蜂窝织炎，接受了短期口服抗生素治疗。没有深部感染的记录。在未行筋膜切开术组，8例患者（6.25%）有记录显示深部感染培养阳性。此外，6例患者有记录显示发生了经口服或静脉抗生素治疗的蜂窝织炎。
在存在开放性筋膜切开术伤口的情况下，胫骨平台骨折的确定性内固定似乎与感染风险增加无关。
