Nguyen Mai P, Como John J, Golob Joseph F, Reich Michael S, Vallier Heather A
Case Western Reserve University, Cleveland, OH, USA.
Case Western Reserve University, Cleveland, OH, USA.
Injury. 2018 Mar;49(3):570-574. doi: 10.1016/j.injury.2018.01.027. Epub 2018 Jan 31.
The purpose of this study was to determine current practice patterns in the treatment of low energy gunshot wounds involving bones and joints. One hundred seventy-three Orthopaedic Trauma Association (OTA) members completed a web-based survey. The survey included practices for antibiotic therapy and operative treatment for different types of low-energy gunshot injuries. Six different scenarios of soft tissue injury, intra-articular injury, and fractures were described. Several permutations of antibiotic therapy and operative or non-operative management options were given as choices on the survey. Survey responses had a high degree of heterogeneity with only two treatment options receiving more than 50% agreement among responders: 54% agreed on joint exploration with perioperative antibiotics for gunshot wounds (GSWs) traversing a joint and 55% agreed on treating operative tibial shaft fractures from GSWs with fixation, along with debridement and irrigation of the GSW tract, and perioperative antibiotics. The majority of participants (69%) were either not aware of or not sure of an established protocol for treatment of GSW to bones and joints at their institution. Moreover, there is still wide variation in treatments among 31% of the participants who reported a protocol in place at their institutions. We conclude there is wide variation among orthopaedic surgeons in the antimicrobial prophylaxis and treatment of GSWs. Opportunity exists to develop standardized practices to minimize related infections, other complications, and costs.
本研究的目的是确定当前治疗涉及骨骼和关节的低能量枪伤的实践模式。173名骨科创伤协会（OTA）成员完成了一项基于网络的调查。该调查包括针对不同类型低能量枪伤的抗生素治疗和手术治疗方法。描述了六种不同的软组织损伤、关节内损伤和骨折情况。调查提供了几种抗生素治疗以及手术或非手术管理选项的排列组合供选择。调查结果具有高度异质性，只有两种治疗方案在应答者中获得了超过50%的认同：54%的人同意对穿过关节的枪伤进行关节探查并使用围手术期抗生素，55%的人同意对枪伤导致的胫骨骨干骨折进行手术治疗，包括固定、清创和冲洗枪伤通道以及使用围手术期抗生素。大多数参与者（69%）要么不知道要么不确定其所在机构针对骨骼和关节枪伤的既定治疗方案。此外，在报告其所在机构有治疗方案的31%的参与者中，治疗方法仍存在很大差异。我们得出结论，骨科医生在枪伤的抗菌预防和治疗方面存在很大差异。有机会制定标准化做法，以尽量减少相关感染、其他并发症和成本。
