Ostermann P A, Henry S L, Seligson D
Dept of Orthopedic Surgery, School of Medicine, University of Louisville, KY 40292.
Orthopedics. 1994 May;17(5):397-9. doi: 10.3928/0147-7447-19940501-04.
In a consecutive series of 1085 open fractures treated from May 1983 to July 1992, 381 severe compound fractures in 335 patients were managed with the antibiotic bead pouch technique. There were 27 grade I (marked swelling, compartment syndrome), 115 grade II, and 239 grade III open fractures (94 type IIIA, 114 type IIIB, and 31 type IIIC). These fractures were managed with early administration of broad spectrum antibiotics, copious wound irrigation, serial debridements, and external skeletal stabilization. Tobramycin-PMMA beads were placed in the wound, and porous plastic film (Opsite, Smith and Nephew Medical, Limited, Hall, England) covered the soft tissue defect. This dressing was changed every 48 to 72 hours until wound coverage/closure could be obtained. Infection rate, either on an acute or chronic basis, was 2.6% in grade II open fractures and 8.4% in grade III compound fractures. There was no infected wound or bone in the grade I category. Those fractures that did not develop an infection were closed at a mean time of 7.6 days; those that developed an infection were closed at a mean time of 17.9 days. The difference was statistically significant (P < 0.001). When severe open fractures are managed with the antibiotic bead pouch technique, wound closure should be obtained within 1 week to prevent infectious complications.
在1983年5月至1992年7月间连续治疗的1085例开放性骨折中，335例患者的381例严重复合性骨折采用了抗生素珠袋技术进行处理。其中有27例I级（明显肿胀、骨筋膜室综合征）、115例II级和239例III级开放性骨折（94例IIIA型、114例IIIB型和31例IIIC型）。这些骨折的处理方法包括早期给予广谱抗生素、大量伤口冲洗、多次清创以及外骨骼固定。将妥布霉素 - 聚甲基丙烯酸甲酯珠置于伤口内，并用多孔塑料薄膜（Opsite，英国史密斯和侄子医疗有限公司霍尔分公司）覆盖软组织缺损处。这种敷料每48至72小时更换一次，直到伤口能够覆盖/闭合。II级开放性骨折的急性或慢性感染率为2.6%，III级复合性骨折为8.4%。I级骨折中没有感染的伤口或骨骼。未发生感染的骨折平均在7.6天闭合；发生感染的骨折平均在17.9天闭合。差异具有统计学意义（P < 0.001）。当采用抗生素珠袋技术处理严重开放性骨折时，应在1周内实现伤口闭合以预防感染并发症。
