Department of Orthopaedic Surgery, University of Southern California, Keck School of Medicine, 1200 N State Street, GNH-3900, Los Angeles, CA, 90033, USA.
Clin Orthop Relat Res. 2013 Dec;471(12):3937-44. doi: 10.1007/s11999-013-2884-z.
Low-velocity gunshots are often associated with extremity fractures. There is no consensus, however, on the use of antibiotics for these injuries.
QUESTIONS/PURPOSES: We performed a literature review to answer the following questions: (1) Are antibiotics needed for the treatment of these fractures? (2) Is gram-negative coverage necessary? (3) How long should antibiotics be administered? And (4) which is the optimal administration route?
We conducted a MEDLINE(®) search and found only two relevant prospective, randomized studies. Further searches identified all case series with information on the use of antibiotics in gunshot fractures. In total, 33 studies provided enough data to answer the study questions. An assessment of the quality of the identified studies was performed. Twenty-three studies met at least ½ of the quality items of the assessment tool.
Antibiotics did not significantly reduce the infection rate for fractures treated nonoperatively (1.7% with antibiotics versus 5.1% without) with the numbers available. There was no significant difference in infection rates when gram-negative coverage was added, either in nonoperatively treated fractures (1.7% versus 2.8%) or in operatively treated fractures (0% versus 2.5%). Duration of antibiotic administration did not significantly affect the infection rate. No difference was found between intravenous and oral antibiotic administration for nonoperatively treated fractures.
This literature review could not demonstrate a significant benefit with the use of antibiotics for low-velocity gunshot fractures treated nonoperatively; however, the statistical power for these comparisons was low in the available literature, which is insufficiently strong to recommend a treatment. Gram-negative coverage did not alter the infection rates in gunshot fractures, nor did longer duration of antibiotic administration. For fractures treated nonoperatively, oral antibiotics are as efficacious as intravenous antibiotics.
低速枪击常导致四肢骨折。然而，对于这些损伤是否使用抗生素尚无共识。
问题/目的：我们进行文献回顾，以回答以下问题：（1）这些骨折是否需要抗生素治疗？（2）是否需要革兰氏阴性菌覆盖？（3）抗生素应使用多长时间？以及（4）哪种给药途径最佳？
我们进行了 MEDLINE（®）检索，仅发现两项相关的前瞻性、随机研究。进一步的检索确定了所有有关在枪击伤骨折中使用抗生素的病例系列研究。共有 33 项研究提供了足够的数据来回答研究问题。对确定研究的质量进行了评估。有 23 项研究至少符合评估工具的一半质量项目。
抗生素不能显著降低非手术治疗骨折的感染率（抗生素组为 1.7%，无抗生素组为 5.1%），但现有数据数量不足。添加革兰氏阴性菌覆盖也不能降低感染率，无论是非手术治疗的骨折（抗生素组为 1.7%，无抗生素组为 2.8%）还是手术治疗的骨折（抗生素组为 0%，无抗生素组为 2.5%）。抗生素使用时间也不能显著影响感染率。非手术治疗骨折时，静脉内和口服抗生素给药之间无差异。
本文献回顾未能证明对于非手术治疗的低速枪击伤骨折使用抗生素有显著益处；但是，现有文献中的这些比较的统计学效力较低，不足以推荐治疗。革兰氏阴性菌覆盖并不能改变枪击伤骨折的感染率，也不能延长抗生素使用时间。对于非手术治疗的骨折，口服抗生素与静脉内抗生素同样有效。
