开放性下肢骨折治疗中临时外固定使用的实践模式差异
Differences in Practice Patterns in the Use of Temporary External Fixation for the Management of Open Lower-Extremity Fractures.
作者信息
Saiz Augustine M, Stennett Christina A, Romeo Nicholas M, Phelps Kevin D, Gary Joshua L, Domes Christopher M, Gage Mark J, O'Hara Nathan N, Sprague Sheila, Slobogean Gerard P, Warner Stephen J
机构信息
Department of Orthopaedic Surgery, UC Davis Health, Sacramento, California.
Center for Orthopaedic Injury Research and Innovation, Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland.
出版信息
J Bone Joint Surg Am. 2025 Jun 18;107(Suppl 1):43-50. doi: 10.2106/JBJS.24.01250.
BACKGROUND
External fixation is often used in the management of open lower-extremity fractures. The objectives of this study were to identify hospital characteristics that are associated with greater use of temporary external fixation and to determine if external fixation reduces the odds of surgical site infection (SSI) and unplanned reoperation among patients with open lower-extremity fractures.
METHODS
This is a secondary analysis of the Aqueous-PREP and PREPARE-Open trials involving open lower-extremity fractures. Wilcoxon rank-sum and Fisher exact tests were used to assess if temporary external fixation use varied between hospital clusters. Mixed-effects logistic regression models controlling for hospital cluster and participant characteristics estimated the associations between temporary external fixation and SSI or unplanned reoperation.
RESULTS
There were 2,438 patients with an open lower-extremity fracture identified, with 568 (23.3%) undergoing temporary external fixation. There were 34 participating hospitals with a median external fixation rate of 21.5%. Hospitals with higher temporary external fixation use had a higher number of surgeons treating patients with fracture (p = 0.02). There was no difference in SSI at 90 days (odds ratio [OR], 1.16 [95% confidence interval (CI), 0.82 to 1.66]; p = 0.40) or 1 year (OR, 1.30 [95% CI, 0.97 to 1.75]; p = 0.08) between patients who did and did not undergo temporary external fixation. Patients who underwent temporary external fixation were more likely to have unplanned reoperations within 1 year (OR, 1.40 [95% CI, 0.96 to 1.79]; p = 0.05).
CONCLUSIONS
More temporary external fixation for open lower-extremity fractures was performed at hospitals with more surgeons treating fractures. There was no difference in SSI at 90 days or 1 year between patients who did and did not undergo temporary external fixation. Temporary external fixation tended to be used in more critically ill patients and patients with more severe fractures but was not associated with increased unplanned reoperations at 90 days or at 1 year.
LEVEL OF EVIDENCE
Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
背景
外固定常用于开放性下肢骨折的治疗。本研究的目的是确定与更多使用临时外固定相关的医院特征，并确定外固定是否能降低开放性下肢骨折患者手术部位感染（SSI）和非计划再次手术的几率。
方法
这是一项对涉及开放性下肢骨折的Aqueous-PREP和PREPARE-Open试验的二次分析。采用Wilcoxon秩和检验和Fisher精确检验来评估临时外固定的使用在医院集群之间是否存在差异。控制医院集群和参与者特征的混合效应逻辑回归模型估计了临时外固定与SSI或非计划再次手术之间的关联。
结果
共识别出2438例开放性下肢骨折患者，其中568例（23.3%）接受了临时外固定。有34家参与医院，临时外固定率中位数为21.5%。临时外固定使用较多的医院治疗骨折患者的外科医生数量较多（p = 0.02）。接受和未接受临时外固定的患者在90天（优势比[OR]，1.16[95%置信区间（CI），0.82至1.66]；p = 0.40）或1年（OR，1.30[95%CI，0.97至1.75]；p = 0.08）时的SSI无差异。接受临时外固定的患者在1年内更有可能进行非计划再次手术（OR，1.40[95%CI，0.96至1.79]；p = 0.05）。
结论
在治疗骨折的外科医生较多的医院，对开放性下肢骨折进行了更多的临时外固定。接受和未接受临时外固定的患者在90天或1年时的SSI无差异。临时外固定倾向于用于病情更严重的患者和骨折更严重的患者，但与90天或1年时非计划再次手术的增加无关。
证据水平
治疗性II级。有关证据水平的完整描述，请参阅作者指南。
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