Negative Pressure Wound Therapy Reduces Deep Infection Rate in Open Tibial Fractures
Negative Pressure Wound Therapy Reduces Deep Infection Rate in Open Tibial Fractures
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DOI：
10.1097/bot.0b013e31824133e3
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发表时间：
2012-09-01
影响因子：
2.3
通讯作者：
Rosenfeldt, Franklin L.
中科院分区：
文献类型：
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作者：
Blum, Martin L.;Esser, Max;Rosenfeldt, Franklin L.
目的：评价负压创伤治疗(NPWT)对开放性胫骨骨折深部感染率的影响。设计：回顾性队列研究。数据收集自病历和X线片。地点：两个一级创伤中心。患者/参与者：2002年1月至2007年12月期间因胫骨开放性骨折延迟软组织覆盖的患者。排除标准包括接受NPWT和传统敷料联合治疗的开放性骨折，接受初次截肢治疗的骨折，以及与死亡率相关的骨折。干预：NPWT使用网状开放细胞泡沫或传统敷料，由外科医生自行决定。主要观察指标：深度感染率。结果：220名患者共229例开放性胫骨骨折符合纳入标准，接受NPWT(166/229-72%)或传统敷料(63/229-28%)。NPWT组深部感染发生率为8.4%(14/166)，低于常规敷料组的20.6%(13/63)，P=0.01。深部感染的单因素预测因素包括Gustilo类型[优势比(OR)：3.13[95%可信区间(CI)：1.74~5.64]；P，0.001}和是否使用NPWT[OR：0.35(95%CI：0.16~0.80)；P=0.01]。在对Gustilo型进行多因素分析后，发现使用NPWT可将深度感染的风险降低近80%[OR：0.22(95%CI：0.09~0.55)；P=0.001]。结论：NPWT用于胫骨开放性骨折创面的敷料可降低深度感染的发生率。
Objectives: To evaluate the effect of negative pressure wound therapy (NPWT) on deep infection rate in open tibial fractures.Design: Retrospective cohort study. Data was collected from medical records and radiographs.Setting: Two level-1 trauma centers.Patients/Participants: Patients who sustained an open tibial fracture which underwent delayed soft tissue coverage between January 2002 and December 2007 were included. Exclusion criteria included open fractures receiving a combination of NPWT and conventional dressings, fractures which were treated with a primary amputation, and fractures associated with mortality.Intervention: NPWT with reticulated open cell foam or conventional dressings at surgeon's discretion.Main Outcome Measurement: Deep infection rate.Results: A total of 229 open tibial fractures in 220 patients met the inclusion criteria and received either NPWT (166/229-72%) or conventional dressings (63/229-28%). There was a decreased rate of deep infection in the NPWT group compared with the conventional dressing group [8.4% (14/166) vs. 20.6%(13/63); P = 0.01]. Univariate predictors of deep infection included Gustilo type {odds ratio (OR): 3.13 [95% confidence interval (CI): 1.74-5.64]; P, 0.001} and use of NPWT [OR: 0.35 (95% CI: 0.16-0.80); P = 0.01]. When adjustment was performed for Gustilo type with multivariate analysis, use of NPWT was found to reduce the risk of deep infection by almost 80% [OR: 0.22 (95% CI: 0.09-0.55); P = 0.001].Conclusions: These results suggest that NPWT reduces the rate of deep infection when used for the dressing of traumatic wounds in open tibial fractures.