Jones Jenna K, Ngo Daniel, Cardon Morgan, Mullis Brian H, Weaver Bree A, Slaven James E, McCaskey Meghan, Mir Hassan R, Warner Stephen J, Achor Timothy S, Natoli Roman M
Department of Orthopaedic Surgery, Indiana University School of Medicine, IU Health Methodist Hospital, Indianapolis, IN.
McGovern Medical School at UTHealth, Department of Orthopaedic Surgery, Houston, TX.
J Orthop Trauma. 2023 Nov 1;37(11):574. doi: 10.1097/BOT.0000000000002653.
To compare debridement, antibiotics, and implant retention (DAIR) and intramedullary nail (IMN) removal with subsequent strategy for fracture stabilization in the treatment of tibia fracture-related infections (FRIs) occurring within 90 days of initial IMN placement.
Retrospective case-control.
Four academic, Level 1 trauma centers.
Sixty-six patients who subsequently received unplanned operative treatment for FRI diagnosed within 90 days of initial tibia IMN.
DAIR versus IMN removal pathways.
Fracture union.
Twenty-eight patients (42.4%) were treated with DAIR and 38 (57.6%) via IMN removal with subsequent strategy for fracture stabilization. Mean follow-up was 16.3 months. At final follow-up, ultimate bone healing was achieved in 75.8% (47/62), whereas 24.2% (15/62) had persistent nonunion or amputation. No significant difference was observed in ultimate bone healing ( P = 0.216) comparing DAIR and IMN removal. Factors associated with persistent nonunion or amputation were time from injury to initial IMN ( P < 0.001), McPherson systemic host grade B ( P = 0.046), and increasing open-fracture grade, with Gustilo-Anderson IIIB/IIIC fractures being the worst ( P = 0.009). Fewer surgeries after initial FRI treatment were positively associated with ultimate bone healing ( P = 0.029).
Treatment of FRI within 90 days of tibial IMN with DAIR or IMN removal with subsequent strategy for fracture stabilization results in a high rate, nearly 1 in 4, of persistent nonunion or amputation, with neither appearing superior for improving bone healing outcomes.
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
比较清创、抗生素及植入物保留（DAIR）和髓内钉（IMN）取出术以及后续骨折稳定策略在治疗初次IMN置入后90天内发生的胫骨骨折相关感染（FRI）中的效果。
回顾性病例对照研究。
四个一级学术创伤中心。
66例在初次胫骨IMN置入后90天内被诊断为FRI并随后接受非计划手术治疗的患者。
DAIR与IMN取出途径。
骨折愈合。
28例患者（42.4%）接受了DAIR治疗，38例（57.6%）接受了IMN取出术及后续骨折稳定策略。平均随访时间为16.3个月。在末次随访时，75.8%（47/62）实现了最终骨愈合，而24.2%（15/62）出现持续性骨不连或截肢。比较DAIR和IMN取出术，最终骨愈合情况无显著差异（P = 0.216）。与持续性骨不连或截肢相关的因素包括受伤至初次IMN的时间（P < 0.001）、麦克弗森全身宿主分级B级（P = 0.046）以及开放性骨折分级增加，其中Gustilo-Anderson IIIB/IIIC型骨折情况最差（P = 0.009）。初次FRI治疗后手术次数较少与最终骨愈合呈正相关（P = 0.029）。
胫骨IMN置入后90天内采用DAIR或IMN取出术及后续骨折稳定策略治疗FRI，导致持续性骨不连或截肢的发生率较高，近四分之一，且两者在改善骨愈合结局方面均未显示出优势。
治疗性III级。有关证据水平的完整描述，请参阅作者指南。
