Département de chirurgie osseuse, CHU Angers, 4, rue Larrey, 49933 Angers cedex 9, France.
Département de chirurgie osseuse, CHU Angers, 4, rue Larrey, 49933 Angers cedex 9, France.
Orthop Traumatol Surg Res. 2019 Sep;105(5):1021-1024. doi: 10.1016/j.otsr.2019.04.020. Epub 2019 Jul 31.
Treatment of open tibial shaft fracture is controversial due to the risk of infection. We assessed results in a continuous series of open tibial shaft fractures treated by primary intramedullary nailing.
Factors can be determined for non-union and onset of infection following primary intramedullary nailing in open tibial shaft fracture.
A retrospective study assessed open tibial shaft fractures treated by primary intramedullary nailing between January 2007 and December 2013. Fractures were classified on the AO and Gustilo classifications. Infection rates and time to union were compared.
Eighty-five patients (85 fractures) were included: 13 Gustilo type I, 43 type II, 19 type III-A and 10 type III-B. Eight patients had infection (9%). Healing and union were obtained after nail exchange and reaming in 5 cases, and after bone transport in 2. One patient showed non-union at last follow-up. Infection risk did not correlate with Gustilo (p=0.55) or AO type (p=0.69). The interval between trauma and wound debridement was significantly longer in infected patients (p=0.048). Eighty-three fractures (97.6%) healed, at a mean 6.9±6.1 months (range, 2-40). Non-union was associated with AO type (p=0.04), and showed a non-significant association with Gustilo type (p=0.06).
Time to treatment was the only factor influencing risk of infection. Non-union was related to AO comminution grade. Primary intramedullary nailing seemed reliable if treatment was early, with rigorous debridement. The advantages then are early resumption of weight-bearing and low patient burden.
V, retrospective study.
由于感染的风险，开放性胫骨骨干骨折的治疗存在争议。我们评估了一系列连续的开放性胫骨骨干骨折患者经髓内钉治疗的结果。
在开放性胫骨骨干骨折患者经髓内钉治疗后，可确定导致非愈合和感染的因素。
回顾性研究评估了 2007 年 1 月至 2013 年 12 月期间接受髓内钉治疗的开放性胫骨骨干骨折患者。骨折按 AO 和 Gustilo 分类。比较感染率和愈合时间。
85 例患者（85 处骨折）纳入研究：13 例 Gustilo Ⅰ型，43 例Ⅱ型，19 例Ⅲ-A 型和 10 例Ⅲ-B 型。8 例患者（9%）发生感染。在 5 例患者中通过更换髓内钉和扩髓获得愈合和愈合，在 2 例患者中通过骨搬运获得愈合。最后一次随访时，1 例患者出现不愈合。感染风险与 Gustilo（p=0.55）或 AO 类型（p=0.69）无关。感染患者的创伤与清创之间的时间间隔明显更长（p=0.048）。83 处骨折（97.6%）愈合，平均愈合时间为 6.9±6.1 个月（范围，2-40）。不愈合与 AO 类型相关（p=0.04），与 Gustilo 类型相关（p=0.06）但无显著相关性。
治疗时间是影响感染风险的唯一因素。不愈合与 AO 粉碎程度有关。如果治疗及时，清创彻底，髓内钉固定似乎是可靠的。那么，其优点是早期恢复负重和降低患者负担。
V，回顾性研究。
