Faculty of Medicine, Nursing, and Health Sciences, Monash University, Melbourne, Australia.
J Orthop Trauma. 2012 Sep;26(9):499-505. doi: 10.1097/BOT.0b013e31824133e3.
To evaluate the effect of negative pressure wound therapy (NPWT) on deep infection rate in open tibial fractures.
Retrospective cohort study. Data was collected from medical records and radiographs.
Two level-1 trauma centers.
PATIENTS/PARTICIPANTS: Patients who sustained an open tibial fracture which underwent delayed soft tissue coverage between January 2002 and December 2007 were included. Exclusion criteria included open fractures receiving a combination of NPWT and conventional dressings, fractures which were treated with a primary amputation, and fractures associated with mortality.
: NPWT with reticulated open cell foam or conventional dressings at surgeon's discretion.
Deep infection rate.
A total of 229 open tibial fractures in 220 patients met the inclusion criteria and received either NPWT (166/229-72%) or conventional dressings (63/229-28%). There was a decreased rate of deep infection in the NPWT group compared with the conventional dressing group [8.4% (14/166) vs. 20.6% (13/63); P = 0.01]. Univariate predictors of deep infection included Gustilo type {odds ratio (OR): 3.13 [95% confidence interval (CI): 1.74-5.64]; P < 0.001} and use of NPWT [OR: 0.35 (95% CI: 0.16-0.80); P = 0.01]. When adjustment was performed for Gustilo type with multivariate analysis, use of NPWT was found to reduce the risk of deep infection by almost 80% [OR: 0.22 (95% CI: 0.09-0.55); P = 0.001].
These results suggest that NPWT reduces the rate of deep infection when used for the dressing of traumatic wounds in open tibial fractures.
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
评估负压伤口治疗（NPWT）对开放性胫骨骨折深部感染率的影响。
回顾性队列研究。数据来自病历和 X 光片。
两家 1 级创伤中心。
患者/参与者：纳入 2002 年 1 月至 2007 年 12 月期间接受延迟软组织覆盖的开放性胫骨骨折患者。排除标准包括接受 NPWT 和常规敷料联合治疗的开放性骨折、接受一期截肢治疗的骨折以及与死亡率相关的骨折。
NPWT 采用网状开孔泡沫或根据外科医生的判断使用常规敷料。
深部感染率。
共有 220 名患者的 229 例开放性胫骨骨折符合纳入标准，其中 166 例（72%）接受 NPWT，63 例（28%）接受常规敷料治疗。NPWT 组的深部感染率低于常规敷料组[8.4%（14/166）比 20.6%（13/63）；P=0.01]。深部感染的单因素预测因素包括 Gustilo 分型{比值比（OR）：3.13[95%置信区间（CI）：1.74-5.64]；P<0.001}和 NPWT 的使用[OR：0.35（95%CI：0.16-0.80）；P=0.01]。多元分析调整 Gustilo 分型后，NPWT 的使用可使深部感染风险降低近 80%[OR：0.22（95%CI：0.09-0.55）；P=0.001]。
这些结果表明，NPWT 可降低开放性胫骨骨折创伤性伤口敷料治疗的深部感染率。
治疗性 III 级。有关完整的证据水平说明，请参见作者指南。
