双髁胫骨平台骨折：哪些因素可预测感染？

Bicondylar Tibial Plateau Fractures: What Predicts Infection?

作者信息

Olszewski Nathan, Manzano Givenchy, Wilson Eleanor, Joseph Noah, Vallier Heather, Pawlak Amanda, Kottmeier Stephen, Miller Adam, Gary Joshua, Namm Joshua, Miller Anna, Gupte Guarang, Rodriguez-Buitrago Andre, Obremskey William, Willier Donald, Marcantonio Andrew, Phieffer Laura, Sheridan Elizabeth, Li Katerine, Karunakar Madhav, Vargas-Hernandez Juan, Yuan Brandon, Shapiro Joshua, Pratson Lincoln, Friess Darin, Jenkins David, Leighton Ross, Alqudhaya Rashed, Aljilani Waael, Mullis Brian, Gruenwald Konstantin, Ollivere Benjamin, Myint Yulanda, Odom Christopher, Spitler Clay, Suwak Patrik, Shah Sagar, Rocha Daniela, Horwitz Daniel, Tornetta Paul

机构信息

From the Boston Medical Center, Boston, MA, (Olszewski, Tornetta III), MetroHealth Medical Center , Cleveland, OH, (Manzano, Wilson, Joseph, Vallier), Stony Brook University, Setauket- East Setauket, NY, (Pawlak, Kottmeier), University of Houston, Houston, TX, (Adam Miller, Gary), Washington University, St. Louis, MO, (Namm, Anna Miller, Gupte), Vanderbilt University Medical Center, Nashville, TN, (Rodriguez-Buitrago, Obremskey), the Division of Orthopaedic Surgery Lahey Hospital & Medical Center, Burlington, MA, (Willier III, Marcantonio), The Ohio State Wexner Medical Center, Columbus, OH, (Phieffer, Sheridan), Carolinas Medical Center, Charlotte, NC, (Li, Karunakar), Mayo Clinic, Rochester, MN, (Vargas-Hernandez, Yuan), the Department of Orthopaedics (Shapiro, Pratson), University of North Carolina, Chapel Hill, NC, Oregon Health & Science University, Portland, OR, (Friess, Jenkins), Dalhousie University-Halifax, Canada, (Leighton, Alqudhaya, Aljilani), Indiana University Orthopedics, Indianapolis, IN, (Mullis, Gruenwald), Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom, (Ollivere, Myint), University Alabama Birmingham, Birmingham, AL, (Odom, Spitler), LSUHSC Department of Orthopaedic Surgery, New Orleans, LA, (Suwak, Shah), and the Geisinger Musculoskeletal Institute, Danville, PA (Rocha, Horwitz).

出版信息

J Am Acad Orthop Surg. 2022 Oct 15;30(20):e1311-e1318. doi: 10.5435/JAAOS-D-21-00432. Epub 2022 Aug 16.

DOI:10.5435/JAAOS-D-21-00432

PMID:36200819

Abstract

OBJECTIVES

The purpose of this study was to identify the patient, injury, and treatment factors associated with infection of bicondylar plateau fractures and to evaluate whether center variation exists.

DESIGN

Retrospective review.

SETTING

Eighteen academic trauma centers.

PATIENTS/PARTICIPANTS: A total of 1,287 patients with 1,297 OTA type 41-C bicondylar tibia plateau fractures who underwent open reduction and internal fixation were included. Exclusion criteria were follow-up less than 120 days, insufficient documentation, and definitive treatment only with external fixation.

INTERVENTION

Open reduction and internal fixation.

MAIN OUTCOME MEASUREMENTS

Superficial and deep infection.

RESULTS

One hundred one patients (7.8%) developed an infection. In multivariate regression analysis, diabetes (DM) (OR [odds ratio] 3.24; P ≤ 0.001), alcohol abuse (EtOH) (OR 1.8; P = 0.040), dual plating (OR 1.8; P ≤ 0.001), and temporary external fixation (OR 2.07; P = 0.013) were associated with infection. In a risk-adjusted model, we found center variation in infection rates (P = 0.030).

DISCUSSION

In a large series of patients undergoing open reduction and internal fixation of bicondylar plateau fractures, the infection rate was 7.8%. Infection was associated with DM, EtOH, combined dual plating, and temporary external fixation. Center expertise may also play a role because one center had a statistically lower rate and two trended toward higher rates after adjusting for confounders.

LEVEL OF EVIDENCE

Level IV-Therapeutic retrospective cohort study.

摘要

目的

本研究旨在确定与双髁平台骨折感染相关的患者、损伤及治疗因素，并评估是否存在中心差异。

设计

回顾性研究。

地点

18个学术创伤中心。

患者/参与者：共纳入1287例接受切开复位内固定术的OTA 41-C型双髁胫骨平台骨折患者，共1297处骨折。排除标准为随访时间少于120天、记录不充分以及仅采用外固定进行确定性治疗。

干预措施

切开复位内固定术。

主要观察指标

浅表和深部感染。

结果

101例患者（7.8%）发生感染。多因素回归分析显示，糖尿病（DM）（比值比[OR] 3.24；P≤0.001）、酗酒（EtOH）（OR 1.8；P = 0.040）、双钢板固定（OR 1.8；P≤0.001）以及临时外固定（OR 2.07；P = 0.013）与感染相关。在风险调整模型中，我们发现感染率存在中心差异（P = 0.030）。