Department of Orthopaedic Surgery, Hong Hui Hospital, Xi'an Jiaotong University, Xi'an, China.
Yan'an University School of Medicine, Yan'an, China.
Orthop Surg. 2020 Apr;12(2):524-532. doi: 10.1111/os.12653. Epub 2020 Mar 22.
To analyze the relationship between the length from injury to first debridement (LFITFD) of open tibial fractures and perioperative infection, and explore independent risk factors related to infection.
This retrospective study focused on 215 clinical patients with open tibial fractures who were admitted from January 2012 to January 2017. According to the time from injury to the operation, the patients were categorized into four groups: LFITFD ≤ 6 h, 6 < LFITFD ≤ 12 h, 12 < LFITFD≤24 h, and (LFITFD > 24 h). Infection risk factors were screened by univariate analysis, and multivariate logistic regression analysis was used to determine independent risk factors.
The infection rates of four groups were 9.2%, 9.5%, 11.1%, and 10.5% with six of 65, nine of 95, four of 36, and two of 19 patients being infected, respectively. There was no statistical significance between the four groups. The infection rates among fractures of different Gustilo-Anderson classifications were as follows. Of 62 cases of type I fractures, two were infected, and the infection rate was 3.2%. Among those with type II fractures, eight were infected, and the infection rate was 8.2%. Three of 26 cases of type IIIA fracture were infected, yielding an infection rate of 11.5%, seven of 25 cases of type III B fracture were infected (28% infection rate), and one of four cases of type III C fracture was infected (25% infection rate). There was a statistically significant difference between the five groups. Multivariate regression analysis showed that smoking, combined diabetes, surgical time, and fracture Gustilo-Anderson classification were independent risk factors for perioperative infection of open tibial fractures, and the difference in time from injury to first debridement was not related to infection.
The incidence of perioperative infection in patients with open tibial fractures has little to do with the time of the first debridement, which is mainly related to the level of the fracture's Gustilo-Anderson classification. At the same time, smoking is prohibited before the operation, the patient's blood glucose is managed, and the debridement operation time is minimized conducive to reducing the incidence of infection.
分析开放性胫骨骨折从受伤到首次清创（LFITFD）的时间与围手术期感染之间的关系，并探讨与感染相关的独立危险因素。
本回顾性研究纳入了 2012 年 1 月至 2017 年 1 月期间收治的 215 例开放性胫骨骨折患者。根据受伤至手术的时间，将患者分为 4 组：LFITFD≤6h、6<LFITFD≤12h、12<LFITFD≤24h 和（LFITFD>24h）。通过单因素分析筛选感染危险因素，采用多因素 logistic 回归分析确定独立危险因素。
4 组的感染率分别为 9.2%、9.5%、11.1%和 10.5%，分别有 6/65、9/95、4/36 和 2/19 例患者发生感染。4 组间差异无统计学意义。不同 Gustilo-Anderson 分型的骨折感染率如下：62 例 I 型骨折中，2 例感染，感染率为 3.2%；26 例 IIIA 型骨折中，3 例感染，感染率为 11.5%；25 例 IIIB 型骨折中，8 例感染，感染率为 8.2%；4 例 IIIC 型骨折中，1 例感染，感染率为 25.0%。5 组间差异有统计学意义。多因素回归分析显示，吸烟、合并糖尿病、手术时间和骨折 Gustilo-Anderson 分型是开放性胫骨骨折围手术期感染的独立危险因素，而首次清创时间的差异与感染无关。
开放性胫骨骨折患者围手术期感染的发生率与首次清创时间关系不大，主要与骨折 Gustilo-Anderson 分型的严重程度有关。同时，术前禁止吸烟，管理好患者的血糖，尽量缩短清创手术时间，有利于降低感染发生率。
