感染并发锁定髓内钉治疗开放性下肢骨折:发病率,相关危险因素,以及在低资源环境下改善预后的经验教训

IF 1.8 Q3 INFECTIOUS DISEASES Journal of Bone and Joint Infection Pub Date : 2023-02-14 eCollection Date: 2023-01-01 DOI:10.5194/jbji-8-71-2023
Stephen A Adesina, Isaac O Amole, Akinsola I Akinwumi, Adepeju O Adegoke, James I Owolabi, Imri G Adefokun, Adewumi O Durodola, Olufemi T Awotunde, Samuel U Eyesan
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引用次数: 0

摘要

摘要感染是开放性骨折难以治疗的主要并发症。大多数低收入和中等收入国家(LMICs)正在错失为在高收入国家(HICs)取得更好成果而开发的现代管理技术。其中之一是使用锁定髓内钉(IM)。本研究旨在确定尼日利亚一家三级医院外科植入物生成网络(SIGN)钉治疗开放性骨折感染的相关因素。方法:前瞻性地收集了8年来101例股骨和胫骨开放性骨折的资料。对每位患者进行主动感染监测。感染被诊断为存在伤口破裂或脓性分泌物从(或附近)伤口或手术切口。检测与感染相关的潜在危险因素。结果:94例患者101例骨折,平均年龄37.76岁。以下治疗相关因素与感染有显著相关性:抗生素给药时间(p<0.001)和骨折固定时间(p=0.002);最终伤口闭合(p<0.001)、骨折复位方法(p=0.005)和手术时间(p=0.007)。结论:尽管本研究存在局限性,无法得出最终结论,但研究结果表明,中低收入国家钉开骨折感染的危险因素与高收入国家相似。因此,如果中低收入国家以科学合理的方式采用高收入国家使用的管理原则,其人民可以负担得起并为社会所接受,那么结果可能会有所改善。建议进一步的研究来证实我们的发现。
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Infection complicating locked intramedullary nailing of open lower-extremity fractures: incidence, associated risk factors, and lessons for improving outcome in a low-resource setting.

Introduction: Infection is the chief complication that makes open fractures difficult to treat. Most low- and middle-income countries (LMICs) are missing out on modern management techniques developed to achieve better outcomes in high-income countries (HICs). One of these is the use of locked intramedullary (IM) nails. This study aimed to determine the factors associated with infection of open fractures treated with the surgical implant generation network (SIGN) nail at a Nigerian tertiary hospital. Methods: Data were collected prospectively on 101 open fractures of the femur and tibia over an 8-year period. Active surveillance for infection was done on each patient. Infection was diagnosed as the presence of wound breakdown or purulent discharge from (or near) the wound or surgical incision. Potential risk factors were tested for association with infection. Results: There were 101 fractures in 94 patients with a mean age of 37.76 years. The following treatment-related factors demonstrated significant associations with infection - timings of antibiotic administration (p<0.001) and definitive fracture fixation (p=0.002); definitive wound closure (p<0.001), fracture-reduction methods (p=0.005), and surgery duration (p=0.007). Conclusions: Although this study has limitations precluding the drawing up of final conclusions, the findings suggest that the risk factors for infection of nailed open fractures in LMICs are similar to those in HICs. Consequently, outcomes can potentially improve if LMICs adopt the management principles used in HICs in scientifically sound ways that are affordable and socially acceptable to their people. Further studies are suggested to establish our findings.

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CiteScore
3.70
自引率
0.00%
发文量
29
审稿时长
12 weeks
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