Zhang Joanne Y, Tornetta Paul, Dale Kevin M, Jones Clifford B, Mullis Brian H, Egol Kenneth A, Robinson Elliot, Bosse Michael J, Schmidt Andrew H, Hymes Robert A
Department of Orthopaedic Surgery, Boston Medical Center, Boston, MA.
Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN.
J Orthop Trauma. 2021 Apr 1;35(4):211-216. doi: 10.1097/BOT.0000000000001953.
To determine the factors associated with successful union and eradication of infection in the setting of staged procedures to treat obviously infected nonunions of long bones. We hypothesize that patients with positive intraoperative cultures obtained at the time of definitive surgery for infected nonunions are more likely to have persistent nonunion than those with negative cultures.
Multicenter retrospective review.
Eight academic Level 1 trauma centers.
PATIENTS/PARTICIPANTS: Patients who underwent staged management for obviously infected nonunion of a long bone.
For each patient, initial fracture management, management of retained implants, number of debridements, grafting, bacteriology, antibiotic course, bone defect management, soft-tissue coverage, and definitive surgery performed were reviewed.
A total of 134 patients were treated with staged procedures for obviously infected nonunion of a long bone (mean age 49 years, 60% open fractures, and mean follow-up 22 months). During definitive procedures, 120 patients had intraoperative cultures taken with 43% having positive cultures. For culture-positive patients, 41 patients achieved eventual union and 10 had persistent nonunion. Of 69 culture-negative patients, 66 achieved eventual union and 3 had persistent nonunion. The number of patients with union versus persistent nonunion was statistically significant between culture-positive and culture-negative groups (P = 0.015).
Management of infected nonunion in long bones with staged treatments before definitive fixation are beneficial but ultimately less effective when performed in the setting of positive bacterial cultures at the time of definitive management.
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
确定在分阶段治疗明显感染的长骨骨不连过程中，与骨愈合成功及感染根除相关的因素。我们假设，在对感染性骨不连进行确定性手术时术中培养结果为阳性的患者比培养结果为阴性的患者更易出现持续性骨不连。
多中心回顾性研究。
8家一级学术创伤中心。
患者/参与者：接受分阶段治疗明显感染的长骨骨不连的患者。
回顾每位患者的初始骨折治疗、保留植入物的处理、清创次数、植骨、细菌学、抗生素疗程、骨缺损处理、软组织覆盖情况以及进行的确定性手术。
共有134例患者接受了分阶段治疗明显感染的长骨骨不连（平均年龄49岁，60%为开放性骨折，平均随访22个月）。在确定性手术期间，120例患者进行了术中培养，其中43%培养结果为阳性。培养结果为阳性的患者中，41例最终实现骨愈合，10例仍为持续性骨不连。69例培养结果为阴性的患者中，66例最终实现骨愈合，3例仍为持续性骨不连。培养结果为阳性和阴性的两组患者中，骨愈合与持续性骨不连的患者数量差异具有统计学意义（P = 0.015）。
在进行确定性固定之前，采用分阶段治疗方法处理长骨感染性骨不连是有益的，但在确定性治疗时细菌培养结果为阳性的情况下，最终效果较差。
预后性III级。有关证据级别的完整描述，请参阅《作者须知》。
