Prolonged operative time increases infection rate in tibial plateau fractures.
Prolonged operative time increases infection rate in tibial plateau fractures.
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DOI：
10.1016/j.injury.2012.10.032
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发表时间：
2013-02
影响因子：
2.5
通讯作者：
Tarkin, Ivan
中科院分区：
文献类型：
--
作者：
Colman, Matthew;Wright, Adam;Gruen, Gary;Siska, Peter;Pape, Hans-Christoph;Tarkin, Ivan
胫骨平台骨折是一项治疗挑战，并且容易延长手术时间和术后感染率。对于采用开放钢板治疗的骨折，我们试图确定手术部位感染与手术时间延长之间的关系，以及确定其他手术风险因素。我们对近五年来在我院一级创伤中心采用开放钢板接骨术治疗的309例连续单髁和双髁胫骨平台骨折进行了回顾性对照分析。我们记录了手术时间，损伤特征，手术治疗，以及由于感染而需要手术清创。感染病例的手术时间与无并发症的手术病例进行比较。采用多因素Logistic回归分析确定术后感染的独立危险因素。感染组的平均手术时间为2.8小时，而非感染组为2.2小时（p=0.005）。15例骨折（4.9%）接受了四间隔筋膜切开术作为治疗的一部分，感染率显著高于未接受筋膜切开术的患者（26.7% vs. 6.8%，p=0.01）。开放性骨折分级也与感染率显著相关（闭合性骨折：5.3%，1级：14.3%，2级：40%，3级：50%，p<0.0001）。在双柱骨折组中，与单切口外侧锁定钢板相比，使用双切口内侧和外侧钢板的感染率在统计学上相似（13.9% vs. 8.7%，p=0.36）。整个研究组的多变量逻辑回归分析确定手术时间延长（OR 1.78，p=0.013）和开放性骨折（OR 7.02，p<0.001）是手术部位感染的独立预测因素。手术时间接近3小时和开放性骨折与胫骨平台开放性钢板固定后手术部位感染的总体风险增加有关。与单切口入路相比，双切口入路双柱钢板似乎不会增加患者的风险。
Fractures of the tibial plateau present a treatment challenge and are susceptible to both prolonged operative times and high postoperative infection rates. For those fractures treated with open plating, we sought to identify the relationship between surgical site infection and prolonged operative time as well as identify other surgical risk factors. We performed a retrospective controlled analysis of 309 consecutive unicondylar and bicondylar tibial plateau fractures treated with open plate osteosynthesis at our institution’s level I trauma center during a recent five year period. We recorded operative times, injury characteristics, surgical treatment, and need for operative debridement due to infection. Operative times of infected cases were compared to uncomplicated surgical cases. Multivariable logistic regression analysis was performed to identify independent risk factors for postoperative infection. Mean operative time in the infection group was 2.8 hours vs. 2.2 hours in the non-infected group (p=0.005). 15 fractures (4.9%) underwent four compartment fasciotomies as part of their treatment, with a significantly higher infection rate than those not undergoing fasciotomy (26.7% vs. 6.8%, p=0.01). Open fracture grade was also significantly related to infection rate (closed fractures: 5.3%, grade 1: 14.3%, grade 2: 40%, grade 3: 50%, p<0.0001). In the bicolumnar fracture group, use of dual-incision medial and lateral plating as compared to single incision lateral locked plating had statistically similar infection rates (13.9% vs. 8.7%, p=0.36). Multivariable logistic regression analysis of the entire study group identified longer operative times (OR 1.78, p=0.013) and open fractures (OR 7.02, p<0.001) as independent predictors of surgical site infection. Operative times approaching three hours and open fractures are related to an increased overall risk for surgical site infection after open plating of the tibial plateau. Dual incision approaches with bicolumnar plating do not appear to expose the patient to increased risk compared to single incision approaches.
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