What Factors Affect Outcome in the Treatment of Fracture-Related Infection?
What Factors Affect Outcome in the Treatment of Fracture-Related Infection?
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DOI：
10.3390/antibiotics11070946
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发表时间：
2022-07-14
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这项国际多中心研究调查了手术的各个组成部分对接受尿道相关感染（FRI）治疗的患者临床结局的影响。所有经手术治疗的FRI患者，经FRI共识定义确认，均纳入研究。收集了人口统计学数据，从受伤到FRI手术的时间，软组织重建，稳定以及全身和局部抗菌治疗。患者至少随访一年。共433例患者接受治疗，平均年龄为49.7岁（17-84岁）。平均随访时间为26个月（范围12-72）。86.4%的病例成功根除感染，86.0%的未愈合感染骨折在最终审查时愈合。总的来说，3.3%需要截肢。结果不依赖于年龄、BMI、金属制品的存在或受伤时间（受伤后1-10周接受FRI治疗的复发率为16.5%; 11-52周为13.1%;>52周为12.1%：p = 0.52）。清创和固定稳定植入物（DAIR）的失败率为21.4%;植入物更换为新内固定的失败率为12.5%;转换为外固定的失败率为10.3%（调整后风险比（aHR）DAIR vs. Ext Fix 2.377; 95% C.I. 0.96-5.731）。使用游离皮瓣治疗的胫骨FRI成功率为92.1%，未使用游离皮瓣治疗的成功率为80.4%（HR 0.38; 95% C.I. 0.14-1.0），而使用NPWT与较高的复发率相关（HR 3.473; 95% C.I. 1.852-6.512）。局部抗生素的植入使复发率从18.7%降至10.0%（HR 0.48; 95% CI）。0.29-0.81）。FRI的成功治疗是多因素的。这些数据表明，治疗决定不应仅基于受伤的时间，因为其他因素也会影响结果。进一步的工作，以确定最佳的适应症DAIR，游离皮瓣重建和局部抗生素是必要的。
This international, multi-center study investigated the effect of individual components of surgery on the clinical outcomes of patients treated for fracture-related infection (FRI). All patients with surgically treated FRIs, confirmed by the FRI consensus definition, were included. Data were collected on demographics, time from injury to FRI surgery, soft tissue reconstruction, stabilization and systemic and local anti-microbial therapy. Patients were followed up for a minimum of one year. In total, 433 patients were treated with a mean age of 49.7 years (17–84). The mean follow-up time was 26 months (range 12–72). The eradication of infection was successful in 86.4% of all cases and 86.0% of unhealed infected fractures were healed at the final review. In total, 3.3% required amputation. The outcome was not dependent on age, BMI, the presence of metalwork or time from injury (recurrence rate 16.5% in FRI treated at 1–10 weeks after injury; 13.1% at 11–52 weeks; 12.1% at >52 weeks: p = 0.52). The debridement and retention of a stable implant (DAIR) had a failure rate of 21.4%; implant exchange to a new internal fixation had a failure rate of 12.5%; and conversion to external fixation had a failure rate of 10.3% (adjusted hazard ratio (aHR) DAIR vs. Ext Fix 2.377; 95% C.I. 0.96–5.731). Tibial FRI treated with a free flap was successful in 92.1% of cases and in 80.4% of cases without a free flap (HR 0.38; 95% C.I. 0.14–1.0), while the use of NPWT was associated with higher recurrence rates (HR 3.473; 95% C.I. 1.852–6.512). The implantation of local antibiotics reduced the recurrence from 18.7% to 10.0% (HR 0.48; 95% C.I. 0.29–0.81). The successful treatment of FRI was multi-factorial. These data suggested that treatment decisions should not be based on time from injury alone, as other factors also affected the outcome. Further work to determine the best indications for DAIR, free flap reconstruction and local antibiotics is warranted.