Kortram Kirsten, Bezstarosti Hans, Metsemakers Willem-Jan, Raschke Michael J, Van Lieshout Esther M M, Verhofstad Michael H J
Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Room H820, PO Box 2040, 3000CA, Rotterdam, The Netherlands.
Department of Trauma Surgery, University Hospitals Leuven, Herestraat 49, B-3000, Leuven, Belgium.
Int Orthop. 2017 Oct;41(10):1965-1982. doi: 10.1007/s00264-017-3556-5. Epub 2017 Jul 25.
The purpose of this study was to identify risk factors for the development of infection after open fracture fixation.
A comprehensive search in all scientific literature of the last 30 years was performed in order to identify patient-, trauma-, diagnosis- and treatment-related risk factors. Studies were included when infectious complications were assessed in light of one or more risk factors. A meta-analysis was performed. Risk ratios (RR) or risk differences (RD) with 95% confidence intervals were calculated.
A total of 116 manuscripts were included. Male gender (RR 1.42), diabetes mellitus (DM) (RR 1.72), smoking (RR1.29), a lower extremity fracture (RR 1.94), Gustilo-Anderson grade III open fracture (RR 3.01), contaminated fracture (RR 7.85) and polytrauma patients (RR 1.49) were identified as statistically significant risk factors for the development of infectious complications. Of the treatment-related risk factors, only pulsatile lavage was associated with a higher infectious complication rate (RR 2.70).
A number of risk factors for the development of infections after open fractures have been identified in the available literature. These factors should still be tested for independence in a multivariable model. Prospective, observational studies are needed to identify and quantify individual risk factors for infection after open fracture fixation.
本研究旨在确定开放性骨折内固定术后感染发生的危险因素。
对过去30年的所有科学文献进行全面检索，以确定与患者、创伤、诊断和治疗相关的危险因素。当根据一个或多个危险因素评估感染性并发症时纳入相关研究。进行荟萃分析。计算95%置信区间的风险比（RR）或风险差（RD）。
共纳入116篇手稿。男性（RR 1.42）、糖尿病（RR 1.72）、吸烟（RR 1.29）、下肢骨折（RR 1.94）、Gustilo-Anderson III级开放性骨折（RR 3.01）、污染性骨折（RR 7.85）和多发伤患者（RR 1.49）被确定为感染性并发症发生的统计学显著危险因素。在与治疗相关的危险因素中，只有脉冲冲洗与较高的感染性并发症发生率相关（RR 2.70）。
现有文献中已确定了开放性骨折术后感染发生的一些危险因素。这些因素仍需在多变量模型中检验其独立性。需要进行前瞻性观察研究，以确定和量化开放性骨折内固定术后感染的个体危险因素。
