Department of Orthopaedics & Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou, PR China.
Department of Orthopaedics, The Sixth People's Hospital of Shanghai Jiao Tong University, Shanghai, PR China.
Injury. 2019 Nov;50(11):1952-1958. doi: 10.1016/j.injury.2019.08.002. Epub 2019 Aug 6.
Currently, accurate diagnosis and successful treatment of infection after fracture fixation (IAFF) still impose great challenges. According to the onset of infection symptoms after implantation, IAFF is classified as early infection (<2 weeks), delayed infection (2∼10 weeks) and late infection (>10 weeks). Confirmation of IAFF should be supported by histopathological tests of intraoperative specimens which confirm infection, cultures from at least two suspected infection sites which reveal the same pathogen, a definite sinus or fistula which connects directly the bone or the implant, and purulent drainage from the wound or presence of pus during surgery. Diagnosis of IAFF is built on comprehensive assessment of medical history, clinical signs and symptoms of the patient, and imaging and laboratory tests. The gold standard of diagnosis is histopathological tests. Treatment of IAFF consists of radical debridement, adequate irrigation, implant handling, systematic and local antibiotics, reconstruction of osseous and/or soft tissue defects, and functional rehabilitation of an affected limb. Early accurate diagnosis and appropriate treatment of IAFF play a key role in increasing the cure rate, reducing infection recurrence and disability risk, restoring limb function and improving quality of life of the patient.
目前，骨折固定术后感染（IAFF）的准确诊断和成功治疗仍然面临巨大挑战。根据植入后感染症状的出现时间，IAFF 可分为早期感染（<2 周）、延迟感染（2∼10 周）和晚期感染（>10 周）。IAFF 的确诊应依据术中标本的组织病理学检查来确认感染，至少两个疑似感染部位的培养物显示相同的病原体，直接连接骨骼或植入物的明确窦道或瘘管，以及伤口脓性引流或手术中存在脓液。IAFF 的诊断基于对患者病史、临床症状和体征以及影像学和实验室检查的综合评估。诊断的金标准是组织病理学检查。IAFF 的治疗包括彻底清创、充分冲洗、植入物处理、系统和局部使用抗生素、骨和/或软组织缺损的重建以及受累肢体的功能康复。早期准确诊断和适当治疗 IAFF 对于提高治愈率、降低感染复发和残疾风险、恢复肢体功能和提高患者生活质量至关重要。
