胫骨骨折相关骨筋膜室综合征切开减压术后的感染与骨不连：配对队列比较

Infection and Nonunion After Fasciotomy for Compartment Syndrome Associated With Tibia Fractures: A Matched Cohort Comparison.

作者信息

Blair James A, Stoops Thomas Kyle, Doarn Michael C, Kemper Dan, Erdogan Murat, Griffing Rebecca, Sagi H Claude

机构信息

*Department of Orthopaedics and Rehabilitation, William Beaumont Army Medical Center, El Paso, TX; †Orthopaedic Trauma Service, Florida Orthopaedic Institute, Tampa, FL; ‡Department of Orthopaedics and Sports Medicine, University of South Florida, Tampa, FL; §Kaiser Permanente, Walnut Creek, CA; ‖Department of Orthopaedics and Traumatology, Ondokuz Mayis Üniversitesi, Samsun, Turkey; and ¶Department of Orthopedics and Sports Medicine, Harborview Medical Center, University of Washington, Seattle, WA.

出版信息

J Orthop Trauma. 2016 Jul;30(7):392-6. doi: 10.1097/BOT.0000000000000570.

DOI:10.1097/BOT.0000000000000570

PMID:26978131

Abstract

OBJECTIVES

The objective was to compare the rates of union and infection in patients treated with and without fasciotomy for acute compartment syndrome (ACS) in operatively managed tibia fractures.

DESIGN

This was a retrospective review.

SETTING

The study was conducted at both a Level 1 and Level II trauma center.

PATIENTS/PARTICIPANTS: Patients operated for tibial plateau fractures (group 1) and tibial shaft fractures (group 3) with ACS requiring fasciotomy were matched to patients without ACS (plateau: group 2, shaft: group 4) in a 1:3 ratio for age, sex, fracture pattern, and open/closed injury.

INTERVENTION

Surgical treatment was provided with plates/screws (plateau fractures) or intramedullary rod (shaft fractures). Patients with ACS were treated with a 2-incision 4-compartment fasciotomy.

MAIN OUTCOME MEASUREMENTS

Time to union and incidence of deep infection, nonunion, and delayed union.

RESULTS

One hundred eighty-four patients were included-group 1: 23 patients, group 2: 69 patients, group 3: 23 patients, and group 4: 69 patients. Time to union averaged 26.8 weeks for groups 1 and 3 and 21.5 weeks for groups 2 and 4 (P > 0.05). Nonunion occurred in 20% for groups 1 and 3 and in 5% for groups 2 and 4 (P = 0.003). Deep infection developed in 20% for groups 1 and 3 and in 4% for groups 2 and 4 (P = 0.001). There was a significant increase in infection in group 1 versus group 2 and nonunion in group 3 versus group 4. There were significantly more smokers for those with fasciotomies (46%) than without (20%, P < 0.001), though all statistical results remained similar after a binary regression analysis.

CONCLUSION

Four-compartment fasciotomies in patients with tibial shaft or plateau fractures is associated with a significant increase in infection and nonunion.

LEVEL OF EVIDENCE

Prognostic level III. See Instructions for Authors for a complete description of levels of evidence.

摘要

目的

比较接受和未接受筋膜切开术治疗的急性骨筋膜室综合征（ACS）合并手术治疗的胫骨骨折患者的骨愈合率和感染率。

设计

这是一项回顾性研究。

背景

该研究在一级和二级创伤中心进行。

患者/参与者：因胫骨平台骨折（1组）和胫骨干骨折（3组）合并ACS需要进行筋膜切开术的患者，按照年龄、性别、骨折类型和开放性/闭合性损伤以1:3的比例与未合并ACS的患者（平台骨折：2组，胫骨干骨折：4组）进行匹配。

干预措施

采用钢板/螺钉（平台骨折）或髓内钉（胫骨干骨折）进行手术治疗。合并ACS的患者采用双切口四骨筋膜室切开减压术。

主要观察指标

骨愈合时间以及深部感染、骨不连和延迟愈合的发生率。

结果

共纳入184例患者——1组：23例，2组：69例，3组：23例，4组：69例。1组和3组的平均骨愈合时间为26.8周，2组和4组为21.5周（P>0.05）。1组和3组的骨不连发生率为20%，2组和4组为5%（P=0.003）。1组和3组的深部感染发生率为20%，2组和4组为4%（P=0.001）。1组与2组相比感染显著增加，3组与4组相比骨不连显著增加。接受筋膜切开术的患者中吸烟者（46%）明显多于未接受者（20%，P<0.001），不过二元回归分析后所有统计结果仍相似。