Orthopedics. 2021 Jan 1;44(1):48-53. doi: 10.3928/01477447-20201202-03. Epub 2020 Dec 7.
Open tibia fractures are often associated with considerable soft tissue injuries. Management of open tibia fractures can be challenging, and some patients require amputation. The patient and treatment factors have not been described on a population level in the United States. A retrospective analysis was completed using the 2000 to 2011 Nationwide Inpatient Sample. Amputation rates during the index hospitalization after open tibia fracture were computed based on injury, patient, and hospital characteristics in patients 18 years or older. The overall amputation rate in open tibia fractures during the index hospitalization was 2.2% (n=3769). Patients with midshaft tibia fractures comprised the largest portion of patients undergoing amputation (46.8% of total amputations) compared with distal tibia (34.0%) and proximal tibia (19.3%) fractures. Patients with no neurovascular injury comprised the largest portion of patients undergoing amputation (85.9%), followed by isolated arterial injury (11.1%), combined neurovascular injury (1.9%), and isolated nerve injury (1.1%). Amputation rates were significantly increased for midshaft tibia fractures with neurovascular injury (odds ratio, 12.39; 95% CI, 5.52-27.83) and distal tibia fractures with neurovascular injury (odds ratio, 5.45; 95% CI, 1.73-17.19) compared with tibia fractures with no neurovascular injury while controlling for confounders. On the basis of a review of the Nationwide In-patient Sample during the past decade, the authors have shown that the early amputation rate in open tibia fractures for all-comers is 2.2%. Rates of amputation varied based on fracture site, associated neurovascular injury, medical comorbidities, and hospital location. [Orthopedics. 2021;44(1):48-53.].
开放性胫骨骨折常伴有严重的软组织损伤。开放性胫骨骨折的治疗具有挑战性，部分患者需要截肢。在美国，尚未在人群水平上描述患者和治疗因素。本研究使用 2000 年至 2011 年全国住院患者样本进行回顾性分析。根据损伤、患者和医院特征，计算 18 岁及以上患者开放性胫骨骨折初次住院期间的截肢率。初次住院期间开放性胫骨骨折的总体截肢率为 2.2%（n=3769）。与胫骨远端（34.0%）和胫骨近端（19.3%）骨折相比，中段胫骨骨折患者接受截肢的比例最高（占总截肢的 46.8%）。无神经血管损伤的患者接受截肢的比例最高（85.9%），其次是单纯动脉损伤（11.1%）、合并神经血管损伤（1.9%）和单纯神经损伤（1.1%）。在控制混杂因素的情况下，与无神经血管损伤的胫骨骨折相比，中段胫骨骨折合并神经血管损伤（比值比，12.39；95%置信区间，5.52-27.83）和胫骨远端骨折合并神经血管损伤（比值比，5.45；95%置信区间，1.73-17.19）的截肢率显著升高。基于对过去十年全国住院患者样本的回顾，作者表明，所有开放性胫骨骨折患者的早期截肢率为 2.2%。截肢率根据骨折部位、合并神经血管损伤、合并内科疾病和医院位置而有所不同。[骨科。2021;44(1):48-53.]。
