埃塞俄比亚亚的斯亚贝巴圣保罗医院千禧医学院阿贝特医院长骨骨折患者髓内钉固定术后感染的患病率及相关因素

Prevalence and associated factors of infection after intramedullary nailing of long bone fractures among patients attending St. Paul's Hospital Millennium Medical College, AaBET Hospital, Addis Ababa, Ethiopia.

作者信息

Desta Tilahun, Lodamo Teshale, Mulat Habtewold, Demissie Dereje Bayissa, Ayalew Kalkidan

机构信息

Consultant Orthopaedic Surgeon, St. Paul's Hospital Millennium Medical College (SPHMMC), Addis Ababa, Ethiopia.

Consultant Orthopaedic Surgeon, Sodo University Hospital, Sodo, Wolayita, Ethiopia.

出版信息

SAGE Open Med. 2023 Jun 17;11:20503121231181648. doi: 10.1177/20503121231181648. eCollection 2023.

DOI:10.1177/20503121231181648

PMID:37342615

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10278399/

Abstract

OBJECTIVES

The intramedullary nailing of long bone fractures is a major challenge for orthopedic surgeons, with increased risk of infection in third-world countries. Research gaps remain in Ethiopia, determining the magnitude of the problem. This study aimed to determine the prevalence and associated factors of infection after intramedullary nailing of long bone fractures in Ethiopia.

METHODS

This was a descriptive, cross-sectional, retrospective design study with a total census of 227 cases of long bone fractures treated with intramedullary Surgical Implant Generation Network nails at Addis Ababa Burn Emergency and Trauma Hospital from August 2015 to April 2017. Data were collected from 227 patients and descriptive analyses were done to summarize the study variables. Binary and multivariable logistic regression analyses were performed at a value of 0.05 with a 95% confidence interval and adjusted odds ratio.

RESULTS

The mean age of patients was 32.9 years, with a male-to-female ratio of 3.5:1. Only 22 (9.3%) of the 227 patients with long bone fractures treated with intramedullary nails developed a surgical site infection, and 8 (3.4%) were developed deep (implant) infections requiring debridement. Road traffic injuries were the leading cause of trauma (60.9%), followed by falls from a height (22.7%). Debridement was done within 24 h for 52 (61.9%) and within 72 h for 69 (82.1%) patients with open fractures. Only 19 (22.4%) and 55 (64.7%) patients with open fractures and tibial long bone fractures received antibiotics within 3 h. Open fractures and tibial fractures had higher percentages of infection, 18.6% and 12.1%, respectively. Previous use of an external fixator (44.4%) and prolonged surgery (12.5%) were associated with higher proportions of infection.

CONCLUSION

This study found that the prevalence of infections after intramedullary nailing of long bone fractures in Ethiopia was 44.4% after external fixation, compared to 6.4% after intramedullary nail was inserted directly. Proper control measures are needed to reduce morbidity and complications related to long fracture treatment, such as open fractures, tibial fractures, the use of an external fixator, delayed debridement and skin closure, and prolonged surgery developed surgical site infection rate.

摘要

目的

长骨骨折的髓内钉固定术对骨科医生来说是一项重大挑战，在第三世界国家感染风险更高。埃塞俄比亚仍存在研究空白，尚未确定该问题的严重程度。本研究旨在确定埃塞俄比亚长骨骨折髓内钉固定术后感染的患病率及相关因素。

方法

这是一项描述性、横断面、回顾性设计研究，对2015年8月至2017年4月在亚的斯亚贝巴烧伤急诊与创伤医院接受髓内外科植入物生成网络髓内钉治疗的227例长骨骨折病例进行了全面普查。收集了227例患者的数据，并进行描述性分析以总结研究变量。采用二元和多变量逻辑回归分析，α值为0.05，95%置信区间和调整后的优势比。

结果

患者的平均年龄为32.9岁，男女比例为3.5:1。在227例接受髓内钉治疗的长骨骨折患者中，只有22例（9.3%）发生了手术部位感染，8例（3.4%）发生了需要清创的深部（植入物）感染。道路交通事故伤是创伤的主要原因（60.9%），其次是高处坠落伤（22.7%）。52例（61.9%）开放性骨折患者在24小时内进行了清创，69例（82.1%）在72小时内进行了清创。只有19例（22.4%）开放性骨折患者和55例（64.7%）胫骨长骨骨折患者在3小时内接受了抗生素治疗。开放性骨折和胫骨骨折的感染率较高，分别为18.6%和12.1%。既往使用外固定架（44.4%）和手术时间延长（12.5%）与较高的感染比例相关。