开放性胫骨骨折治疗后膝关节脓毒症的风险：髌上入路与髌下入路的多中心比较

Risk of Knee Sepsis After Treatment of Open Tibia Fractures: A Multicenter Comparison of Suprapatellar and Infrapatellar Approaches.

作者信息

Marecek Geoffrey S, Nicholson Luke T, Broghammer Frances H, Talerico Michael, Tougas Caroline, Donegan Derek J, Scolaro John A

机构信息

Department of Orthopaedic Surgery, University of Southern California Keck School of Medicine, Los Angeles, CA.

University of California-Irvine, Orange, CA.

出版信息

J Orthop Trauma. 2018 Feb;32(2):88-92. doi: 10.1097/BOT.0000000000001024.

DOI:10.1097/BOT.0000000000001024

PMID:28906305

Abstract

OBJECTIVES

The suprapatellar approach for medullary nailing of the tibia is increasing. This requires intra-articular passage of instruments, which theoretically places the knee at risk of postoperative sepsis in the setting of open fracture. We hypothesized that the risk of knee sepsis is similar after suprapatellar or infrapatellar nailing of open tibia fractures.

DESIGN

Retrospective, multicenter.

SETTING

Three urban level 1 trauma centers.

PATIENTS

All patients treated with medullary nailing for open diaphyseal tibia fractures (OTA 42) from 2009 to 2015. Patients younger than 18 years of age and with less than 12 weeks of follow-up were excluded. We identified 289 fractures in 282 patients.

INTERVENTION

Suprapatellar (SP) or infrapatellar (IP) medullary nailing of open tibia fractures.

MAIN OUTCOME MEASUREMENT

Occurrence of ipsilateral knee sepsis, defined as presence of a positive culture from knee aspiration or arthrotomy. Deep infection requiring operative debridement, superficial infection requiring antibiotic therapy alone, and all-cause reoperation were also recorded.

RESULTS

IP nailing was used for 142 fractures. There were 20 infections (14.1%), of which 14 (9.8%) were deep. Fourteen tibias (9.8%) required reoperation for noninfectious reasons for 28 total reoperations (19.7%). SP nailing was used in 147 fractures. There were 24 infections (16.2%), of which 16 (10.8%) were deep. Fourteen additional tibias (9.5%) required reoperation for noninfectious reasons for a total of 30 reoperations (20.4%). There were no differences in the rates of infection, deep infection, or reoperation between groups. There were 2 cases of knee sepsis after SP nailing (1.4%) but zero cases after IP nailing (P = 0.5).

CONCLUSIONS

There was no significant difference in the rate of knee sepsis with SP or IP approaches. The risk of knee sepsis after SP nailing of open fractures is low, but present.

LEVEL OF EVIDENCE

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

摘要

目的

用于胫骨髓内钉固定的髌上入路正在增多。这需要器械经关节内操作，理论上在开放性骨折情况下会使膝关节有术后发生脓毒症的风险。我们假设开放性胫骨骨折采用髌上或髌下入路进行髓内钉固定后，膝关节发生脓毒症的风险相似。

设计

回顾性、多中心研究。

地点

三个市级一级创伤中心。

患者

2009年至2015年期间所有接受开放性胫骨干骨折（OTA 42型）髓内钉固定治疗的患者。排除年龄小于18岁及随访时间少于12周的患者。我们共纳入282例患者的289处骨折。

干预措施

开放性胫骨骨折采用髌上（SP）或髌下（IP）髓内钉固定。

主要观察指标

同侧膝关节脓毒症的发生情况，定义为膝关节穿刺抽吸液或关节切开术培养结果呈阳性。还记录了需要手术清创的深部感染、仅需抗生素治疗的浅表感染以及所有原因导致的再次手术情况。

结果

142处骨折采用髌下入路。发生感染20例（14.1%），其中深部感染14例（9.8%）。14例胫骨（9.8%）因非感染性原因需要再次手术，共进行了28次再次手术（19.7%）。147处骨折采用髌上入路。发生感染24例（16.2%），其中深部感染16例（10.8%）。另有14例胫骨（9.5%）因非感染性原因需要再次手术，共进行了30次再次手术（20.4%）。两组之间在感染率、深部感染率或再次手术率方面无差异。髌上入路后有2例膝关节脓毒症（1.4%），而髌下入路后无病例发生（P = 0.5）。