Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway.
World J Surg. 2013 Feb;37(2):349-55. doi: 10.1007/s00268-012-1817-4.
The fields of surgery and trauma care have largely been neglected in the global health discussion. As a result the idea that surgery is not safe or cost effective in resource-limited settings has gone unchallenged. The SIGN Online Surgical Database (SOSD) is now one of the largest databases on trauma surgery in low- and middle-income countries (LMIC). We wished to examine infection rates and risk factors for infection after IM nail operations in LMIC using this data.
The SOSD contained 46,722 IM nail surgeries in 58 different LMIC; 46,113 IM nail operations were included for analysis.
The overall follow-up rate was 23.1 %. The overall infection rate was 1.0 %, 0.7 % for humerus, 0.8 % for femur, and 1.5 % for tibia fractures. If only nails with registered follow-up (n = 10,684) were included in analyses, infection rates were 2.9 % for humerus, 3.2 % for femur, and 6.9 % for tibia fractures. Prophylactic antibiotics reduced the risk of infection by 29 %. Operations for non-union had a doubled risk of infection. Risk of infection was reduced with increasing income level of the country.
The overall infection rates were low, and well within acceptable levels, suggesting that it is safe to do IM nailing in low-income countries. The fact that operations for non-union have twice the risk of infection compared to primary fracture surgery further supports the use of IM nailing as the primary treatment for femur fractures in LMIC.
外科和创伤护理领域在全球卫生讨论中基本上被忽视了。因此，手术在资源有限的环境中不安全或没有成本效益的观点一直没有受到挑战。SIGN 在线外科数据库（SOSD）现在是低收入和中等收入国家（LMIC）创伤外科最大的数据库之一。我们希望利用这些数据，检查在 LMIC 中进行 IM 钉操作后的感染率和感染风险因素。
SOSD 包含 58 个不同的 LMIC 中 46722 例 IM 钉手术；纳入了 46113 例 IM 钉手术进行分析。
总的随访率为 23.1%。总的感染率为 1.0%，肱骨为 0.7%，股骨为 0.8%，胫骨骨折为 1.5%。如果仅对有登记随访的钉子（n=10684）进行分析，肱骨的感染率为 2.9%，股骨为 3.2%，胫骨骨折为 6.9%。预防性使用抗生素可降低 29%的感染风险。非愈合手术的感染风险增加一倍。感染风险随着国家收入水平的提高而降低。
总的感染率较低，在可接受的范围内，这表明在低收入国家进行 IM 钉固定是安全的。非愈合手术的感染风险是原发性骨折手术的两倍，这进一步支持了在 LMIC 中将 IM 钉固定作为股骨骨折的主要治疗方法。
