The University of Leeds, Woodhouse Lane, Leeds, UK, LS2 9JT.
The University of Leeds, Woodhouse Lane, Leeds, UK, LS2 9JT; Department of orthopaedic surgery, Leeds Teaching Hospitals NHS Trust, Great George Street, Leeds, UK, LS1 3EX.
Injury. 2022 Nov;53(11):3833-3837. doi: 10.1016/j.injury.2022.08.044. Epub 2022 Aug 24.
Current surgical paradigms for ortho-plastic management of IIIB open tibial fractures make compromises. Often, definitive circular frame stabilisation is delayed until the soft tissue envelope is secure to allow access for further soft tissue reconstruction if required. This delay has potential clinical and cost implications. A previous study showed acute circular frame stabilisation performed concurrently or before soft tissue reconstruction was feasible without additional soft tissue reconstruction problems. This study examines potential resource savings using this approach.
All open tibial fractures managed by circular fixator and microsurgical soft tissue reconstruction between April 2015 and June 2019 were identified from a prospectively maintained database. Those receiving circular frame stabilisation with synchronous microsurgical soft tissue reconstruction were considered cases; those in whom the frame stabilisation was delayed were controls. Cost data were derived from the Patient Level Information and Costing System. Salvage cases and those with incomplete treatment were excluded.
Nine cases and 25 controls were evaluated. No statistically significant difference was observed between groups in terms of age, sex, injury severity score, time to debridement, time to coverage, length of follow up, or time to union. Median length of stay was 13.3 and 19.7 days for cases and controls respectively (p<0.01). Cases required fewer procedures (2.3) compared to controls (4.5) (p<0.001). The cost of care was less for cases (£25,527) than controls (£32,952) (p <0.05). No cases returned to theatre with flap failure or flap compromise. Complications were similar between groups.
In suitable patients, synchronous circular frame stabilisation and microsurgical soft tissue reconstruction is a safe, clinically effective, and cost-saving option.
目前针对 IIIB 型开放性胫骨骨折的矫形治疗的手术模式存在妥协。通常，为了确保软组织覆盖的安全性，以便在需要时进一步进行软组织重建，会延迟对确定性环形框架进行稳定。这种延迟可能会产生临床和成本方面的影响。先前的一项研究表明，在不增加软组织重建问题的情况下，急性环形框架稳定可以与软组织重建同时或之前进行。本研究检查了这种方法的潜在资源节省。
从一个前瞻性维护的数据库中确定了 2015 年 4 月至 2019 年 6 月期间通过环形固定器和显微外科软组织重建治疗的所有开放性胫骨骨折。那些接受环形框架稳定与同步显微外科软组织重建的患者被视为病例；那些环形框架稳定延迟的患者被视为对照组。成本数据来自患者水平信息和成本系统。排除了挽救病例和治疗不完整的病例。
共评估了 9 例病例和 25 例对照组。两组在年龄、性别、损伤严重程度评分、清创时间、覆盖时间、随访时间或愈合时间方面均无统计学显著差异。病例组的中位住院时间为 13.3 天，对照组为 19.7 天（p<0.01）。病例组所需的手术次数（2.3 次）少于对照组（4.5 次）（p<0.001）。病例组的治疗费用（£25,527）低于对照组（£32,952）（p<0.05）。无病例因皮瓣失败或皮瓣受损而返回手术室。两组并发症相似。
在合适的患者中，同步环形框架稳定和显微外科软组织重建是一种安全、临床有效且节省成本的选择。
