Department of Orthopaedics and Trauma Surgery, RWTH Aachen University Medical Center, Pauwels Street 30, 52074, Aachen, Germany.
Institute for Research in Operative Medicine (IFOM), Witten/Herdecke University, Cologne, Germany.
Eur J Trauma Emerg Surg. 2019 Jun;45(3):445-453. doi: 10.1007/s00068-018-0916-9. Epub 2018 Feb 2.
Open tibia fractures usually occur in high-energy mechanisms and are commonly associated with multiple traumas. The purposes of this study were to define the epidemiology of open tibia fractures in severely injured patients and to evaluate risk factors for major complications.
A cohort from a nationwide population-based prospective database was analyzed (TraumaRegister DGU). Inclusion criteria were: (1) open or closed tibia fracture, (2) Injury Severity Score (ISS) ≥ 16 points, (3) age ≥ 16 years, and (4) survival until primary admission. According to the soft tissue status, patients were divided either in the closed (CTF) or into the open fracture (OTF) group. The OTF group was subdivided according to the Gustilo/Anderson classification. Demographic data, injury mechanisms, injury severity, surgical fracture management, hospital and ICU length of stay and systemic complications (e.g., multiple organ failure (MOF), sepsis, mortality) were collected and analyzed by SPSS (Version 23, IBM Inc., NY, USA).
Out of 148.498 registered patients between 1/2002 and 12/2013; a total of 4.940 met the inclusion criteria (mean age 46.2 ± 19.4 years, ISS 30.4 ± 12.6 points). The CTF group included 2000 patients (40.5%), whereas 2940 patients (59.5%) sustained open tibia fractures (I°: 49.3%, II°: 27.5%, III°: 23.2%). High-energy trauma was the leading mechanism in case of open fractures. Despite comparable ISS and NISS values in patients with closed and open tibia fractures, open fractures were significantly associated with higher volume resuscitation (p < 0.001), more blood (p < 0.001), and mass transfusions (p = 0.006). While the rate of external fixation increased with the severity of soft tissue injury (37.6 to 76.5%), no major effect on mortality and other major complications was observed.
Open tibia fractures are common in multiple trauma patients and are therefore associated with increased resuscitation requirements, more surgical procedures and increased in-hospital length of stay. However, increased systemic complications are not observed if a soft tissue adapted surgical protocol is applied.
开放性胫骨骨折通常发生在高能机制中，常伴有多发创伤。本研究的目的是定义严重创伤患者开放性胫骨骨折的流行病学，并评估主要并发症的危险因素。
对全国人群前瞻性数据库（TraumaRegister DGU）中的队列进行分析。纳入标准为：（1）开放性或闭合性胫骨骨折，（2）损伤严重程度评分（ISS）≥16 分，（3）年龄≥16 岁，（4）存活至首次入院。根据软组织状况，患者分为闭合性（CTF）或开放性骨折（OTF）组。OTF 组根据 Gustilo/Anderson 分类进一步细分。收集并分析人口统计学数据、损伤机制、损伤严重程度、手术骨折管理、住院和 ICU 住院时间以及全身并发症（如多器官功能衰竭（MOF）、败血症、死亡率）。采用 SPSS（版本 23，IBM Inc.，NY，USA）进行分析。
在 2002 年 1 月至 2013 年 12 月期间注册的 148498 名患者中，共有 4940 名符合纳入标准（平均年龄 46.2±19.4 岁，ISS 30.4±12.6 分）。CTF 组包括 2000 名患者（40.5%），2940 名患者（59.5%）发生开放性胫骨骨折（I°：49.3%，II°：27.5%，III°：23.2%）。高能创伤是开放性骨折的主要机制。尽管闭合性和开放性胫骨骨折患者的 ISS 和 NISS 值相当，但开放性骨折与更高的容量复苏（p<0.001）、更多的血液（p<0.001）和大量输血（p=0.006）显著相关。虽然外固定架的使用率随着软组织损伤程度的增加而增加（37.6%至 76.5%），但对死亡率和其他主要并发症没有显著影响。
开放性胫骨骨折在多发创伤患者中很常见，因此与复苏需求增加、更多手术程序和住院时间延长有关。然而，如果应用软组织适应的手术方案，全身性并发症不会增加。
