A systematic review of outcomes and complications of reconstruction and amputation for type IIIB and IIIC fractures of the tibia.
A systematic review of outcomes and complications of reconstruction and amputation for type IIIB and IIIC fractures of the tibia.
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DOI：
10.1097/prs.0b013e31818d69c3
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发表时间：
2008-12
影响因子：
3.6
通讯作者：
Chung KC
中科院分区：
文献类型：
--
作者：
Saddawi-Konefka D;Kim HM;Chung KC
IIIB和IIIC胫骨骨折后是否建议截肢或挽救的问题仍然没有答案。本研究的目的是进行一项系统评价，以获得关于IIIB和IIIC开放性胫骨骨折的初次截肢与保肢的循证建议。纳入来自Medline、Cinahl和Embase的符合预定标准的文章。关注的结果包括：住院时间、并发症、康复时间、生活质量、肢体功能、疼痛和重返工作数据。在可能的情况下，对统计数据进行汇总。我们回顾了1，947篇文章，纳入了28项观察性研究。抢救患者的住院时间为56.9天，截肢患者为63.7天。最常见的并发症是骨髓炎（17.9%）、骨不连（15.5%）、二次截肢（7.3%）和皮瓣失败（5.8%）。报告的挽救患者的康复时间为愈合时间（10.2个月）和完全负重时间（8.1个月）。不同研究对疼痛、生活质量和肢体功能结局的评估不同，不能合并。恢复工作的患者百分比为挽救患者的63.5%和截肢者的73%。目前的文献没有提供证据支持IIIB和IIIC胫骨骨折的保肢或初次截肢的上级结局。当两种治疗策略的结果相似时，结合成本和偏好（效用）的经济分析可以定义最佳治疗策略，以指导医生和患者。
The question of whether to recommend amputation or salvage after IIIB and IIIC tibial fractures remains unanswered. The purpose of this study is to conduct a systematic review to derive evidence-based recommendation concerning primary amputation versus limb salvage for IIIB and IIIC open tibial fractures. Articles from Medline, Cinahl and Embase that met pre-determined criteria were included. Outcomes of interest included: hospital stay duration, complications, rehabilitation time, quality of life, limb function, pain, and return to work data. Pooling of statistical data was performed when possible. We reviewed 1,947 articles, and 28 observational studies were included. Length of hospital stay was 56.9 days for salvage patients and 63.7 days for amputees. The most common complications after salvage attempt were osteomyelitis (17.9%), nonunion (15.5%), secondary amputation (7.3%) and flap failure (5.8%). Rehabilitation time for salvaged patients was reported as time to union (10.2 months) and time to full weight-bearing (8.1 months). Pain, quality of life and limb function outcomes were assessed differently among studies and could not be combined. Percent of patients who returned to work was 63.5% for salvage patients and 73% for amputees. The current literature offers no evidence to support superior outcomes of either limb salvage or primary amputation for IIIB and IIIC tibial fractures. When outcomes are similar between two treatment strategies, economic analysis that incorporates cost and preference (utility) may define an optimal treatment strategy to guide physicians and patients.