Panteli Michalis, Vun James S H, West Robert M, Howard Anthony, Pountos Ippokratis, Giannoudis Peter V
Academic Department of Trauma & Orthopaedics, School of Medicine, University of Leeds, Leeds LS2 9LU, UK.
Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds LS7 4SA, UK.
J Clin Med. 2021 Jul 28;10(15):3331. doi: 10.3390/jcm10153331.
To investigate the incidence, risk factors and pathogenic micro-organisms causing superficial and deep infection in subtrochanteric femoral fractures managed with an intramedullary nail. Following institutional board approval, all consecutive patients presenting with a subtrochanteric fracture were retrospectively identified, over an 8-year period. Basic demographics, fracture characteristics, fracture union, revision operation, mortality and other complications were reported and analysed. Variables deemed statistically significant (-value < 0.05) were then included into a revised adjusted model of logistic regression analysis, where we reported on the odds ratio (OR). The overall incidence of infection was 6.4% ( = 36/561; superficial: 3.7%; deep: 2.7%). Associations with deep infection included: non-union (OR 9.29 (2.56-3.38)), the presence of an open fracture (OR 4.23 (3.18-5.61)), the need for massive transfusion (OR 1.42 (2.39-8.39)), post-operative transfusion (OR 1.40 (1.10-1.79)) and prolonged length of stay (OR 1.04 (1.02-1.06)). The Commonest causes of superficial infection were (28.5%), enteric flora (23.8%) and mixed flora (23.8%); whereas coliforms (60%) and (26.7%) were the commonest micro-organisms isolated in deep infection. Polymicrobial infection was identified in 38.5% and 80% of superficial and deep infections, respectively. Causative micro-organisms identified in both superficial and deep infection were similar to those reported in post-traumatic osteomyelitis. In an attempt to minimise infection, the treating clinician should focus on modifiable risk factors with adequate patient optimisation, prompt surgical treatment, adequate antibiotic coverage and wound care when treating patients with subtrochanteric femur fracture.
探讨使用髓内钉治疗股骨转子下骨折时浅表和深部感染的发生率、危险因素及致病微生物。经机构委员会批准，对8年间所有连续出现股骨转子下骨折的患者进行回顾性识别。报告并分析基本人口统计学、骨折特征、骨折愈合、翻修手术、死亡率及其他并发症。将具有统计学意义（P值<0.05）的变量纳入修订后的逻辑回归分析调整模型，并报告比值比（OR）。感染总发生率为6.4%（n = 36/561；浅表感染：3.7%；深部感染：2.7%）。与深部感染相关的因素包括：骨折不愈合（OR 9.29（2.56 - 3.38））、开放性骨折（OR 4.23（3.18 - 5.61））、大量输血需求（OR 1.42（2.39 - 8.39））、术后输血（OR 1.40（1.10 - 1.79））及住院时间延长（OR 1.04（1.02 - 1.06））。浅表感染最常见的原因是金黄色葡萄球菌（28.5%）、肠道菌群（23.8%）和混合菌群（23.8%）；而大肠菌群（60%）和金黄色葡萄球菌（26.7%）是深部感染中最常分离出的微生物。浅表和深部感染中分别有38.5%和80%为多微生物感染。浅表和深部感染中鉴定出的致病微生物与创伤后骨髓炎中报告的相似。为尽量减少感染，治疗临床医生在治疗股骨转子下骨折患者时应关注可改变的危险因素，对患者进行充分优化，及时进行手术治疗，给予充分的抗生素覆盖及伤口护理。
