Division of Trauma and Critical Care, Medical College of Wisconsin, 8701 Watertown Plank Rd. Milwaukee, WI 53226, United States.
Injury. 2024 Nov;55(11):111918. doi: 10.1016/j.injury.2024.111918. Epub 2024 Sep 24.
Although treatments have improved dramatically in recent years, mortality following gunshot wounds (GSW) to the pelvis continue to range between 3 and 20 %. This project was designed to determine the incidence and risk factors associated with pelvic fracture-related infection (FRI) following GSWs to the pelvis given the paucity of evidence regarding this complication.
A retrospective review of 13 years (1/2010-12/2022) of patients with GSW to the pelvis was performed. Patients meeting inclusion criteria underwent chart review for the development of pelvic FRI and the following additional data elements were extracted: demographics, presence and type of bowel injury, operations performed, complications, use of postoperative antibiotics (≤24 h vs. >24 h), surgical osseous debridement, presence of retained bullet fragments, and bullet trajectory. Discrete variables were analyzed using Wilcoxon rank-sum test, chi-square, and Fischer's exact test. Pearson correlation coefficients were calculated for continuous variables.
242 patients were included in the study. Concomitant bowel injury was present in 108 patients (45 %). Eleven patients (4.5 %) developed FRI, all of whom had a concomitant bowel injury (p < 0.001). Neither the presence of retained bullet fragments nor the bullet trajectory (through bowel before the bone) was associated with FRI. Antibiotic duration >24 h was not associated with a lower rate of pelvic FRI.
Development of FRI after a GSW to the pelvis occurs in 4.5 % of patients and is significantly associated with concomitant bowel injury, specifically colonic injury. These findings can be used to help guide further studies on the role of prophylactic antibiotics or other strategies to prevent pelvic FRI.
尽管近年来治疗方法有了显著改善，但骨盆枪伤（GSW）后的死亡率仍在 3%至 20%之间。鉴于有关这种并发症的证据很少，本项目旨在确定与骨盆 GSW 相关的骨盆骨折相关感染（FRI）的发生率和相关风险因素。
对 13 年来（2010 年 1 月至 2022 年 12 月）骨盆 GSW 患者进行回顾性研究。符合纳入标准的患者进行骨盆 FRI 发展情况的图表审查，并提取以下附加数据元素：人口统计学特征、肠损伤的存在和类型、进行的手术、并发症、术后抗生素使用（≤24 小时与>24 小时）、手术骨清创、弹片残留情况以及弹丸轨迹。离散变量采用 Wilcoxon 秩和检验、卡方检验和 Fischer 精确检验进行分析。连续变量采用 Pearson 相关系数进行计算。
本研究共纳入 242 名患者。108 名患者（45%）存在合并性肠损伤。11 名患者（4.5%）发生 FRI，所有患者均伴有合并性肠损伤（p<0.001）。弹片残留和弹丸轨迹（在骨之前穿过肠）均与 FRI 无关。抗生素使用时间>24 小时与较低的骨盆 FRI 发生率无关。
骨盆 GSW 后 FRI 的发生率为 4.5%，与合并性肠损伤（特别是结肠损伤）显著相关。这些发现可用于指导进一步研究预防性抗生素或其他预防骨盆 FRI 策略的作用。
