Johnson Taylor R, Oquendo Yousi A, Seltzer Ryan, Van Rysselberghe Noelle L, Bishop Julius A, Gardner Michael J
Department of Orthopaedic Surgery, Stanford University, 450 Broadway, Redwood City, CA, 94063, USA.
Eur J Orthop Surg Traumatol. 2024 Feb;34(2):1173-1181. doi: 10.1007/s00590-023-03782-w. Epub 2023 Nov 22.
To determine if incisional negative pressure wound therapy is protective against post-operative surgical site complications following definitive fixation of bicondylar tibial plateau fractures.
A retrospective analysis of patients diagnosed with an acute bicondylar tibial plateau fracture (AO/OTA 41-C) undergoing ORIF from 2010 to 2020 was performed. Patients received either a standard sterile dressing (SD) or incisional negative pressure wound therapy (iNPWT). Primary outcomes included surgical site infection, osteomyelitis, and wound dehiscence. Secondary outcomes included non-union and return to the operating room. Multivariate logistic regression analyses were performed.
180 patients were included and 22% received iNPWT (n = 40) and 78% received standard dressings (n = 140). iNPWT was more common in active smokers (24.7% vs. 19.3%, p = 0.002) and the SD group was more likely to be lost to follow up (3.6% vs. 0%, p = 0.025). iNPWT was not protective against infection or surgical site complications, and in fact, was associated with higher odds of post-operative infection (OR: 8.96, p = 0.005) and surgical site complications (OR:4.874, p = 0.009) overall. Alcohol abuse (OR: 19, p = 0.005), tobacco use (OR: 4.67, p = 0.009), and time to definitive surgery (OR = 1.21, p = 0.033) were all independent risk factors for post-operative infection.
In this series of operatively treated bicondylar tibial plateau fractures, iNPWT did not protect against post-operative surgical site complications compared to conventional dressings. Tobacco use, alcohol abuse, and time to definitive surgery, were independent risk factors for post-operative infection. Further studies are needed to determine if iNPWT offers a protective benefit in exclusively high-risk patients with relevant medical and social history.
确定切开负压伤口治疗对双髁胫骨平台骨折确定性固定术后手术部位并发症是否具有预防作用。
对2010年至2020年期间诊断为急性双髁胫骨平台骨折（AO/OTA 41-C型）并接受切开复位内固定术（ORIF）的患者进行回顾性分析。患者分别接受标准无菌敷料（SD）或切开负压伤口治疗（iNPWT）。主要结局包括手术部位感染、骨髓炎和伤口裂开。次要结局包括骨不连和返回手术室。进行多因素逻辑回归分析。
共纳入180例患者，22%接受iNPWT（n = 40），78%接受标准敷料（n = 140）。iNPWT在主动吸烟者中更常见（24.7%对19.3%，p = 0.002），SD组失访的可能性更大（3.6%对0%，p = 0.025）。iNPWT对感染或手术部位并发症并无预防作用，事实上，总体而言，其与术后感染（比值比：8.96，p = 0.005）和手术部位并发症（比值比：4.874，p = 0.009）的较高发生率相关。酗酒（比值比：19，p = 0.005）、吸烟（比值比：4.67，p = 0.009）以及至确定性手术的时间（比值比 = 1.21，p = 0.033）均为术后感染的独立危险因素。
在这一系列接受手术治疗的双髁胫骨平台骨折患者中，与传统敷料相比，iNPWT并未预防术后手术部位并发症。吸烟、酗酒以及至确定性手术的时间是术后感染的独立危险因素。需要进一步研究以确定iNPWT是否仅对具有相关医学和社会史的高危患者具有预防益处。
