在分期切开复位内固定治疗双髁胫骨平台骨折时，原位准备外固定架是否安全？一项回顾性对比队列研究。

Is It Safe to Prep the External Fixator In Situ During Staged ORIF of Bicondylar Tibial Plateau Fractures? A Retrospective Comparative Cohort Study.

机构信息

Harvard Medical School Orthopedic Trauma Initiative, Boston, MA.

Harvard Combined Orthopaedic Residency Program, Boston, MA.

出版信息

J Orthop Trauma. 2022 Aug 1;36(8):382-387. doi: 10.1097/BOT.0000000000002334.

DOI:10.1097/BOT.0000000000002334

PMID:34962237

Abstract

OBJECTIVES

To compare the risk of deep infection and unplanned reoperation after staged open reduction internal fixation (ORIF) of bicondylar tibial plateau (BTP) fractures whether elements of the temporizing external fixator were prepped into the surgical field or completely removed before definitive fixation.

DESIGN

Retrospective comparative cohort study.

SETTING

Two academic Level 1 trauma centers.

PATIENTS/PARTICIPANTS: One hundred forty-seven OTA/AO 41-C (Schatzker 6) BTP fractures treated with a 2-stage protocol of acute spanning ex-fix followed by definitive ORIF between 2001 and 2018.

INTERVENTION

Seventy-eight fractures had retained elements of the original ex-fix prepped in situ during surgery for definitive internal fixation, and 69 had the ex-fix construct completely removed before prepping and draping.

MAIN OUTCOME MEASURES

Deep infection and unplanned reoperation.

RESULTS

Among 147 patients treated with staged ORIF, the overall deep infection rate was 26.5% and the reoperation rate was 33.3%. There were high rates of deep infection (26.9% vs. 26.1%, P = 0.909) and unplanned reoperation (30.8% vs. 36.2%, P = 0.483) in both groups, but no difference whether the ex-fix was prepped in or completely removed. Within the retained ex-fix group, there was no difference in infection with retention of the entire ex-fix compared with only the ex-fix pins (28.1% vs. 26.1%, P = 0.842).

CONCLUSIONS

We observed high complication rates in this cohort of OTA/AO 41C BTP fractures treated with staged ORIF, but prepping in the ex-fix did not lead to a significant increase in rates of infection or reoperation. This study provides the treating surgeon with clinical data about a common practice used to facilitate definitive fixation of unstable BTP fractures.

LEVEL OF EVIDENCE

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

摘要

目的

比较分期切开复位内固定（ORIF）治疗双髁胫骨平台（BTP）骨折时，临时外固定架的元件是否在准备进行确定性固定之前预置于手术野中或完全移除后，深部感染和计划外再次手术的风险。

设计

回顾性比较队列研究。

地点

两家学术性 1 级创伤中心。

患者/参与者：2001 年至 2018 年间，147 例 OTA/AO 41-C（Schatzker 6）BTP 骨折患者采用急性跨外固定架固定后分期手术的 2 期方案治疗。

干预

78 例骨折患者在确定性内固定术中保留了原始外固定架的元件，而 69 例患者在准备和铺巾前完全移除了外固定架。

主要观察指标

深部感染和计划外再次手术。

结果

在接受分期 ORIF 治疗的 147 例患者中，总体深部感染率为 26.5%，再次手术率为 33.3%。两组深部感染率（26.9%比 26.1%，P=0.909）和计划外再次手术率（30.8%比 36.2%，P=0.483）均较高，但外固定架是否预置于手术野中并无差异。在外固定架保留组中，保留整个外固定架与仅保留外固定架钉相比，感染率无差异（28.1%比 26.1%，P=0.842）。