Boriani Filippo, Ul Haq Ata, Baldini Tommaso, Urso Roberto, Granchi Donatella, Baldini Nicola, Tigani Domenico, Tarar Moazzam, Khan Umraz
Laboratory of Orthopaedic Pathophysiology and Regenerative Medicine, Rizzoli Orthopaedic Institute, Alma Mater Studiorum - University of Bologna, Bologna, Italy.
Plastic Surgery Department, Jinnah Hospital, Lahore, Pakistan.
J Plast Reconstr Aesthet Surg. 2017 Jun;70(6):715-722. doi: 10.1016/j.bjps.2017.02.017. Epub 2017 Feb 28.
Open fractures are severe, complex, limb-threatening and high-energy injuries, often involving lesions of both bone and soft tissues. Traditionally, treatment has been piecemeal by orthopaedic and plastic surgeons. This study aimed to prospectively investigate whether combining orthopaedic and plastic surgery in treating these injuries is more effective than the conventional orthopaedic care. A prospective multi-centre cohort study was conducted. Differences in the type of approach to severe limb trauma allowed a comparison between combined orthoplastic and traditional exclusively orthopaedic treatment. Time for fracture and soft tissue healing and the recovery of limb function were the main outcome measures studied. All patients suffering from a severe open tibial fracture were prospectively included between January 2012 and December 2013 and followed until December 2014. Recruiting units were as follows: (1) an established orthoplastic centre, (2) a unit without experience in the orthoplastic approach and (3) a unit where the orthoplastic approach has been recently introduced in a developing country (Pakistan). A total of 160 patients were included in the study. Of these, 70% were treated with an orthoplastic approach, whereas 30% were treated by an orthopaedic team. All outcome measures were statistically improved by the orthoplastic approach. A coordinated, combined pathway to both the bony and the soft tissue components of open tibial fractures through orthoplastic surgery can be successfully delivered with attention to important timelines to achieve better patient outcomes in different socio-economic settings.
开放性骨折是严重、复杂、危及肢体且高能量的损伤，常累及骨骼和软组织损伤。传统上，治疗由骨科和整形外科医生分步进行。本研究旨在前瞻性调查骨科与整形外科联合治疗这些损伤是否比传统的骨科治疗更有效。进行了一项前瞻性多中心队列研究。严重肢体创伤治疗方法的差异使得能够对联合整形骨科治疗与传统单纯骨科治疗进行比较。骨折和软组织愈合时间以及肢体功能恢复是研究的主要结局指标。2012年1月至2013年12月前瞻性纳入所有患有严重开放性胫骨骨折的患者，并随访至2014年12月。招募单位如下：（1）一个成熟的整形骨科中心，（2）一个没有整形骨科治疗经验的单位，（3）一个在发展中国家（巴基斯坦）最近引入整形骨科治疗方法的单位。共有160例患者纳入研究。其中，70%接受整形骨科治疗方法，而30%由骨科团队治疗。整形骨科治疗方法使所有结局指标在统计学上得到改善。通过整形骨科手术对开放性胫骨骨折的骨骼和软组织成分采用协调的联合治疗途径，关注重要时间节点，能够在不同社会经济环境中成功实现更好的患者预后。
