Division of General Surgery, Department of Surgery, Stanford University, Stanford, California, USA.
Division of Acute Care Surgery, Department of Surgery, NYU Grossman School of Medicine, New York, New York, USA.
Surg Infect (Larchmt). 2022 May;23(4):321-331. doi: 10.1089/sur.2022.025.
Surgical stabilization of rib fractures is recommended in patients with flail chest or multiple displaced rib fractures with physiologic compromise. Surgical stabilization of rib fractures (SSRF) and surgical stabilization of sternal fractures (SSSF) involve open reduction and internal fixation of fractures with a plate construct to restore anatomic alignment. Most plate constructs are composed of titanium and presence of this foreign, non-absorbable material presents opportunity for implant infection. Although implant infection rates after SSRF and SSSF are low, they present a challenging clinical entity often requiring prolonged antibiotic therapy, debridement, and potentially implant removal. The Surgical Infection Society's Therapeutics and Guidelines Committee and Chest Wall Injury Society's Publication Committee convened to develop recommendations for antibiotic use during and after surgical stabilization of traumatic rib and sternal fractures. Clinical scenarios included patients with concomitant infectious processes (sepsis, pneumonia, empyema, cellulitis) or sources of contamination (open chest, gross contamination) incurred as a result of their trauma and present at the time of their surgical stabilization. PubMed, Embase, and Cochrane databases were searched for pertinent studies. Using a process of iterative consensus, all committee members voted to accept or reject each recommendation. For patients undergoing SSRF or SSSF in the absence of pre-existing infectious process, there is insufficient evidence to suggest existing peri-operative guidelines or recommendations are inadequate. For patients undergoing SSRF or SSSF in the presence of sepsis, pneumonia, or an empyema, there is insufficient evidence to provide recommendations on duration and choice of antibiotic. This decision may be informed by existing guidelines for the concomitant infection. For patients undergoing SSRF or SSSF with an open or contaminated chest there is insufficient evidence to provide specific antibiotic recommendations. This guideline document summarizes the current Surgical Infection Society and Chest Wall Injury Society recommendations regarding antibiotic use during and after surgical stabilization of traumatic rib or sternal fractures. Limited evidence exists in the chest wall surgical stabilization literature and further studies should be performed to delineate risk of implant infection among patients undergoing SSSRF or SSSF with concomitant infectious processes.
建议对连枷胸或多处移位性肋骨骨折合并生理功能受损的患者进行肋骨骨折切开复位内固定术。肋骨骨折切开复位内固定术（SSRF）和胸骨骨折切开复位内固定术（SSSF）涉及骨折的切开复位和钢板内固定，以恢复解剖对线。大多数钢板结构由钛制成，这种外来的不可吸收材料为植入物感染提供了机会。虽然 SSRF 和 SSSF 后的植入物感染率较低，但它们是一种具有挑战性的临床实体，通常需要长期抗生素治疗、清创和潜在的植入物去除。外科感染学会治疗和指南委员会和胸壁损伤学会出版委员会召开会议，制定了关于创伤性肋骨和胸骨骨折手术固定期间和之后使用抗生素的建议。临床情况包括同时存在感染过程（败血症、肺炎、脓胸、蜂窝织炎）或因创伤而导致的污染源（开放性胸部、严重污染）的患者，且这些情况在其手术固定时存在。在 PubMed、Embase 和 Cochrane 数据库中搜索相关研究。所有委员会成员通过迭代共识的过程，对每个建议进行投票，决定接受或拒绝。对于没有先前感染过程的患者进行 SSRF 或 SSSF，没有足够的证据表明现有的围手术期指南或建议不足。对于因败血症、肺炎或脓胸而行 SSRF 或 SSSF 的患者，没有足够的证据提供关于抗生素持续时间和选择的建议。这一决定可能受到伴随感染的现有指南的影响。对于因开放性或污染性胸部而行 SSRF 或 SSSF 的患者，没有足够的证据提供具体的抗生素建议。本指南文件总结了外科感染学会和胸壁损伤学会目前关于创伤性肋骨或胸骨骨折手术固定期间和之后使用抗生素的建议。在胸壁外科固定术文献中，证据有限，应进一步研究以确定同时存在感染过程的患者进行 SSSRF 或 SSSF 时的植入物感染风险。
