全国开放性骨折患者评估（OPEN）研究：英国开放性骨折治疗的管理。
The Open-Fracture Patient Evaluation Nationwide (OPEN) study: the management of open fracture care in the UK.
机构信息
South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK.
Oxford University Hospitals Trust, Oxford, UK.
出版信息
Bone Joint J. 2022 Sep;104-B(9):1073-1080. doi: 10.1302/0301-620X.104B9.BJJ-2022-0202.R1.
AIMS
The Open-Fracture Patient Evaluation Nationwide (OPEN) study was performed to provide clarity in open fracture management previously skewed by small, specialist centre studies and large, unfocused registry investigations. We report the current management metrics of open fractures across the UK.
METHOD
Patients admitted to hospital with an open fracture (excluding phalanges or isolated hand injuries) between 1 June 2021 and 30 September 2021 were included. Institutional information governance approval was obtained at the lead site and all data entered using Research Electronic Data Capture software. All domains of the British Orthopaedic Association Standard for Open Fracture Management were recorded.
RESULTS
Across 51 centres, 1,175 patients were analyzed. Antibiotics were given to 754 (69.0%) in the emergency department, 240 (22.0%) pre-hospital, and 99 (9.1%) as inpatients. Wounds were photographed in 848 (72.7%) cases. Median time to first surgery was 16 hrs 14 mins (interquartile range (IQR) 8 hrs 29 mins to 23 hrs 19 mins). Complex injuries were operated on sooner (median 12 hrs 51 mins (IQR 4 hrs 36 mins to 21 hrs 14 mins)). Of initial procedures, 1,053 (90.3%) occurred between 8am and 8pm. A consultant orthopaedic surgeon was present at 1,039 (89.2%) first procedures. In orthoplastic centres, a consultant plastic surgeon was present at 465 (45.1%) first procedures. Overall, 706 (60.8%) patients required a single operation. At primary debridement, 798 (65.0%) fractures were definitively fixed, while 734 (59.8%) fractures had fixation and coverage in one operation through direct closure or soft-tissue coverage. Negative pressure wound therapy was used in 235 (67.7%) staged procedures. Following wound closure or soft-tissue cover, 509 (47.0%) patients received antibiotics for a median of three days (IQR 1 to 7).
CONCLUSION
OPEN provides an insight into care across the UK and different levels of hospital for open fractures. Patients are predominantly operated on promptly, in working hours, and at specialist centres. Areas for improvement include combined patient review and follow-up, scheduled operating, earlier definitive soft-tissue cover, and more robust antibiotic husbandry.Cite this article: 2022;104-B(9):1073-1080.
目的
开放式骨折患者全国评估（OPEN）研究旨在提供开放式骨折管理方面的明确信息，此前这方面的信息受到小型专业中心研究和大型非聚焦登记调查的影响。我们报告了英国目前开放式骨折的管理指标。
方法
纳入 2021 年 6 月 1 日至 2021 年 9 月 30 日期间因开放性骨折（不包括指骨或单独手部损伤）住院的患者。在牵头机构获得机构信息治理批准，并使用研究电子数据捕获软件输入所有数据。记录了英国矫形协会开放式骨折管理标准的所有领域。
结果
在 51 个中心中，分析了 1175 名患者。754 名（69.0%）患者在急诊科接受了抗生素治疗，240 名（22.0%）患者在院前接受了抗生素治疗，99 名（9.1%）患者在住院期间接受了抗生素治疗。848 例（72.7%）患者的伤口进行了拍照。首次手术的中位时间为 16 小时 14 分钟（四分位距 8 小时 29 分钟至 23 小时 19 分钟）。复杂损伤的手术时间更早（中位时间为 12 小时 51 分钟（四分位距 4 小时 36 分钟至 21 小时 14 分钟））。初次手术中，1053 例（90.3%）发生在上午 8 点至晚上 8 点之间。1039 例（89.2%）首次手术有矫形外科顾问医生在场。在矫形成形中心，465 例（45.1%）首次手术有整形外科顾问医生在场。总体而言，706 例（60.8%）患者需要进行一次手术。在初次清创时，798 例（65.0%）骨折得到了确定性固定，而 734 例（59.8%）骨折通过直接闭合或软组织覆盖在一次手术中得到了固定和覆盖。负压伤口治疗在 235 例（67.7%）分期手术中得到了应用。在伤口闭合或软组织覆盖后，509 例（47.0%）患者接受了中位时间为 3 天（四分位距 1 至 7 天）的抗生素治疗。
结论
OPEN 提供了英国不同医院和不同层次的开放性骨折治疗的见解。患者主要在工作时间在专门中心迅速接受手术。需要改进的领域包括联合患者评估和随访、计划手术、更早的确定性软组织覆盖和更严格的抗生素管理。
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