Reasoner Kaitlyn, Desai Mihir J, Lee Donald H
Department of Orthopaedic Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee, United States.
Division of Hand and Upper Extremity, Department of Orthopaedic Surgery, Vanderbilt Orthopaedic Institute, Vanderbilt University Medical Center, Nashville, Tennessee, United States.
J Hand Microsurg. 2020 Apr;12(1):56-61. doi: 10.1055/s-0039-3399488. Epub 2019 Nov 22.
Open hand fractures are anecdotally reported to have lower infection rates than open long bone fractures. Although a 3-hour rule for antibiotic administration and a 6-hour rule for operative debridement have historically been upheld as ideal management for open fractures, other factors may be more influential in the development of infection. The purpose of this study was to investigate factors associated with open hand fracture infections. We retrospectively reviewed 67 patients with 107 open hand fractures between 2012 and 2017. Time from injury to antibiotic administration and operative debridement, modified Gustilo-Anderson classification, and patient characteristics including age, smoking status, and presence of chronic disease were examined for each patient. Outcome parameters were the development of infection and fracture union. The overall rate of infection was 9% (6 of 67 patients). No type 1 or type 2 fractures developed infection in contrast to 12.2% of type 3 fractures. Patients who received antibiotics in less than 3 hours and underwent debridement in less than 6 hours did not have lower infection or nonunion rates than those who did not. The association between the modified Gustilo-Anderson classification and the development of infection or nonunion was statistically significant. Factors including time to antibiotics, time to operative debridement, smoking status, and chronic disease comorbidities were not predictive of either infection or nonunion in open hand fractures. Fracture type as defined by a modified Gustilo-Anderson classification was the factor most strongly related to the development of infection or nonunion in these fractures.
据传闻，开放性手部骨折的感染率低于开放性长骨骨折。尽管抗生素给药的3小时规则和手术清创的6小时规则在历史上一直被视为开放性骨折的理想治疗方法，但其他因素可能对感染的发生更具影响力。本研究的目的是调查与开放性手部骨折感染相关的因素。
我们回顾性分析了2012年至2017年间67例患者的107例开放性手部骨折。对每位患者检查了从受伤到抗生素给药和手术清创的时间、改良的 Gustilo-Anderson 分类以及包括年龄、吸烟状况和慢性病存在情况在内的患者特征。结果参数为感染的发生和骨折愈合。
总体感染率为9%（67例患者中的6例）。1型或2型骨折均未发生感染，而3型骨折的感染率为12.2%。在3小时内接受抗生素治疗且在6小时内接受清创的患者，其感染率或骨不连率并不低于未接受治疗的患者。改良的 Gustilo-Anderson 分类与感染或骨不连的发生之间的关联具有统计学意义。
包括抗生素给药时间、手术清创时间、吸烟状况和慢性病合并症在内的因素，均不能预测开放性手部骨折的感染或骨不连。改良的 Gustilo-Anderson 分类所定义的骨折类型是与这些骨折感染或骨不连发生最密切相关的因素。
