PROBLEMS IN THE MANAGEMENT OF TYPE-III (SEVERE) OPEN FRACTURES - A NEW CLASSIFICATION OF TYPE-III OPEN FRACTURES
PROBLEMS IN THE MANAGEMENT OF TYPE-III (SEVERE) OPEN FRACTURES - A NEW CLASSIFICATION OF TYPE-III OPEN FRACTURES
复制标题
DOI：
10.1097/00005373-198408000-00009
复制
发表时间：
1984-01-01
影响因子：
--
通讯作者：
WILLIAMS, DN
中科院分区：
文献类型：
--
作者：
GUSTILO, RB;MENDOZA, RM;WILLIAMS, DN
III型开放性骨折（87例）（75例患者）接受了治疗。导致III型骨折发病率增加的因素有：大量软组织损伤;血管供应受损;严重的伤口污染;和明显的骨折不稳定。这项研究表明，由于不同的严重程度和预后，目前的III型开放性骨折的名称过于包容。III型开放性骨折按预后恶化的顺序分为3个亚型：IIIA型，尽管有广泛的软组织撕裂或皮瓣，或高能量创伤，但骨折骨的软组织覆盖充分，而与伤口大小无关; IIIB型，广泛的软组织损伤丢失伴骨膜剥离和骨暴露;通常与大量污染有关; IIIC型，与动脉损伤相关的开放性骨折，需要修复。3种亚型的伤口脓毒症为：IIIA型，4%，IIIB型，52%; IIIC型，42%;而截肢率分别为0%，16%和42%。仅2例患者发生骨髓炎，12例患者出现延迟愈合或骨不连。5名患者死亡，均为多系统创伤所致。近年来，感染性开放性骨折中的细菌病原体发生了巨大变化。感染（77%）是由于革兰氏阴性菌，而以前（1961-1975年）为24%。抗生素治疗从第一代头孢菌素单药改为头孢菌素和氨基糖苷类或第三代头孢菌素联合治疗，目前适用于III型开放性骨折。
Type III open fractures (87) (in 75 patients) were treated. Factors leading to increased morbidity in type III fractures were: massive soft-tissue damage; compromised vascularity; severe wound contamination; and marked fracture instability. This study demonstrates, because of varied severity and prognosis, that the current designation of type III open fracture is too inclusive. That type III open fractures be divided is recommended in order of worsening prognosis into 3 subtypes: type IIIA, adequate soft-tissue coverage of a fractured bone despite extensive soft-tissue laceration or flaps, or high-energy trauma irrespective of the size of the wound; type IIIB, extensive soft-tissue injury loss with periosteal stripping and bone exposure; and is usually associated with massive contamination; type IIIC, open fracture associated with arterial injury requiring repair. Wound sepsis in the 3 subtypes were: type IIIA, 4%, IIIB, 52%; and IIIC, 42%; while amputation rates were, respectively, 0%, 16% and 42%. Only 2 patients developed osteomyelitis, and 12 patients had delayed or nonunions. Five patients died, all as a result of multisystem trauma. The bacterial pathogens in infected open fractures have changed dramatically over the years. Infections (77%) were due to Gram-negative bacteria, compared with 24% previously (1961-1975). A change of antibiotic therapy from a 1st-generation cephalosporin alone to a combination of a cephalosporin and an aminoglycoside, or a 3rd-generation cephalosporin, is currently indicated in type III open fractures.