Orthopaedic and Traumatology Department, Policlinico Umberto I Hospital-Sapienza, University of Rome, Piazzale A. Moro, 3, 00185 Rome, Italy.
M.I.T.O. Group (Infectious Diseases in Traumatology and Orthopedics Surgery), Policlinico Umberto I Hospital, Viale del Policlinico, 155,00161 Rome, Italy.
Molecules. 2020 Nov 23;25(22):5471. doi: 10.3390/molecules25225471.
The incidence of a fracture-related infection (FRI) can reach 30% of open tibia fractures (OTF). The use of antibiotic-coated implants is one of the newest strategies to reduce the risk of infection in orthopedic surgery. The aim of this study was to investigate the efficacy and safety of a gentamicin-coated tibia nail in primary fracture fixation (FF) and revision surgery (RS) of nonunion cases in terms of FRI incidence. We conducted a systematic review according to the PRISMA checklist on Pub-Med, Cochrane, and EMBASE. Of the 32 studies, 8 were included, for a total of 203 patients treated: 114 were FF cases (63% open fractures) and 89 were RS cases, of which 43% were infected nonunion. In the FF group, four FRI were found (3.8%): three OTF (Gustilo-Anderson III) and one closed fracture; bone healing was achieved in 94% of these cases. There were four relapses of infection and one new onset in the RS group; bone healing occurred in 88% of these cases. No side effects were found. There were no significant differences in terms of FRI, nonunion, and healing between the two groups. Gentamicin-coated tibia nail is an effective therapeutic option in the prophylaxis of high-risk fracture infections and in complex nonunion cases.
骨折相关感染（FRI）的发生率可达开放性胫骨骨折（OTF）的 30%。使用抗生素涂层植入物是减少骨科手术感染风险的最新策略之一。本研究旨在调查庆大霉素涂层胫骨钉在非愈合病例的初次骨折固定（FF）和翻修手术（RS）中的疗效和安全性，以评估 FRI 的发生率。我们根据 PRISMA 清单在 Pub-Med、Cochrane 和 EMBASE 上进行了系统评价。在 32 项研究中，有 8 项被纳入，共纳入 203 例患者：114 例为 FF 病例（63%为开放性骨折），89 例为 RS 病例，其中 43%为感染性不愈合。在 FF 组中，发现 4 例 FRI（3.8%）：3 例为 OTF（Gustilo-Anderson III），1 例为闭合性骨折；这些病例中 94%的骨愈合。RS 组中有 4 例复发感染和 1 例新发病例；这些病例中 88%的骨愈合。未发现副作用。两组在 FRI、不愈合和愈合方面无显著差异。庆大霉素涂层胫骨钉是预防高危骨折感染和复杂不愈合病例的有效治疗选择。
