Afshar Ahmadreza
Department of Orthopedics, Urmia University of Medical Sciences, Imam Khomeini Hospital, Urmia, Iran.
J Hand Surg Am. 2017 Feb;42(2):128-134. doi: 10.1016/j.jhsa.2016.11.024. Epub 2016 Dec 28.
Replacing an extruded segment of bone in an open fracture imposes a challenging decision concerning the best and safest patient management. There are numerous advantages to restoring the patient's own extruded bone segment to its original location, particularly when the bone segment is of structural importance. However, reimplantation of contaminated and avascular extruded bone segments can potentially result in serious infection or nonunion. There is no conclusive evidence regarding the best decontamination protocol for the safest use of the recovered bone segment as an autologous graft. Among the different chemical sterilization solutions 10% povidone-iodine and chlorhexidine gluconate solutions are the author's most preferred solutions. Regarding cellular toxicity, 10% povidone-iodine has been found to be the most favorable among the readily available solutions.
在开放性骨折中替换一段挤出的骨段，对于最佳且最安全的患者管理而言是一个具有挑战性的决策。将患者自身挤出的骨段恢复到其原始位置有诸多益处，尤其是当骨段具有结构重要性时。然而，重新植入受污染且无血供的挤出骨段可能会导致严重感染或骨不连。关于将回收的骨段作为自体移植物进行最安全使用的最佳去污方案，尚无确凿证据。在不同的化学消毒溶液中，10%聚维酮碘溶液和葡萄糖酸氯己定溶液是作者最为青睐的溶液。就细胞毒性而言，10%聚维酮碘在现有溶液中被发现是最有利的。
