Schaefer Edward H, Caterson Edward J
Harvard School of Dental Medicine and †Division of Plastic Surgery, Brigham and Women's Hospital, Boston, MA 02115, USA.
J Craniofac Surg. 2013 Jan;24(1):85-8. doi: 10.1097/SCS.0b013e318275ef21.
Many mandible fractures are treated using open reduction internal fixation (ORIF) because of its superior stabilization of the fracture line, better healing, and faster recovery while minimizing the duration of immobilization of the mandible. However, ORIF requires an incision, which can lead to one of the most common complications of a mandibular fracture repair: postoperative wound infection. Historical controls have shown the infection rate after such surgeries to be anywhere from 6% to 32%. Most of the infections are due to normal oral flora, which is a mix of diverse facultative and obligate anaerobes. The current study was undertaken to determine whether a specific antibiotic regimen should be recommended to cover the normal flora. A retrospective review of 79 patients treated with ORIF mandibular repair was completed. The overall infection rate with use of antibiotic prophylaxis was 7.59%, but patients treated with clindamycin had an infection rate of 19.35%. The infection rate when using ampicillin/sulbactam was significantly lower than clindamycin. On the basis of this review, proper antibiotic prophylaxis should cover both potential aerobes and anaerobes.
许多下颌骨骨折采用切开复位内固定术（ORIF）进行治疗，因为该方法能使骨折线获得更好的稳定，愈合更佳，恢复更快，同时能将下颌骨固定的时间减至最短。然而，ORIF需要进行切口，这可能导致下颌骨骨折修复最常见的并发症之一：术后伤口感染。历史对照研究表明，此类手术后的感染率在6%至32%之间。大多数感染是由正常口腔菌群引起的，这些菌群是多种兼性厌氧菌和专性厌氧菌的混合体。本研究旨在确定是否应推荐特定的抗生素方案来覆盖正常菌群。对79例行ORIF下颌骨修复术的患者进行了回顾性研究。使用抗生素预防的总体感染率为7.59%，但使用克林霉素治疗的患者感染率为19.35%。使用氨苄西林/舒巴坦时的感染率显著低于克林霉素。基于此项研究，恰当的抗生素预防应覆盖潜在的需氧菌和厌氧菌。
