开放性骨折的清创时间或许不是骨折感染率增加的独立危险因素

摘要

目的：开放性骨折损伤后到清创治疗的时间或许不是骨折感染率增加的独立危险因素，但随着清创时间的延迟会增加其感染的风险。开放性骨折感染与骨折分型和抗菌药物使用情况有着密切相关性，评估骨折分型和预防性使用抗菌药物，比探讨损伤后到清创治疗的时间更有意义。从预防和控制感染的角度考虑，开放性骨折行清创治疗是有必要的，且越早行清创治疗其并发症的发生率就越低。开放性骨折损伤后时间＜6 h，认为是黄金清创时间，感染率最低；而临床实践证实开放性骨折损伤后在6～24 h 内行清创治疗，其疗效显著，感染率并不增高；开放性骨折损伤后时间＞24 h，则应根据患者全身情况、营养状况、骨折损伤程度和骨折后紧急处理措施等来决定是否立即行清创治疗，对于不能立即行清创术的患者应行损伤控制性手术；对于一次性难以彻底清创的开放性骨折，应根据需求在48～72 h 内重复清创，冲洗创面，直到创口清洁为止。%Open fractures are common diseases of orthopedic trauma,usually caused by car accident,high fall injuries and sports injuries.Infection is a common complication of open fractures.Factors leading to infection are complex.The time from injury to surgical debridement is not a significant independent predictor of the risk of infection.Fractures of infection have close correlation with Gustilo-Anderson classification of open fracture and antimicrobial prophylaxis.Classification of open fracture and antibiotic prophylaxis is more important than the time from injury to surgical debridement.Surgical debridement of open fracture is necessary to prevent infec-tion.If the open fracture is early debridement,fewer complications arise.The early debridement (<6 hours)versus the delayed de-bridement (>6 hours),the infection rate of open fracture was no significant difference.If the injury time is greater than 24 hours,im-mediate surgical debridement should be based on the general condition of the patient,such as nutritional status,degree of damage and emergency measures.If the patient's general condition is poor,damage control surgery should be immediate performed.If the initial surgical debridement is difficult to make the wound clean,repeated operative debridement should be performed within 72 hours,until the wound clean.