【摘要】 目的探究 Pilon 骨折外固定支架与后期植入内固定物之间的距离与感染风险的相关性。方法收集我院 2010 年 6 月至 2018 年 9 月收治的 122 例行骨折切开复位内固定术治疗的胫骨远端骨折患者临床资料。其中男 89 例,女 33 例。平均年龄 (46.2±5.6) (23～65) 岁。根据感染情况分为感染组 (20 例) 和未感染组 (102 例)。根据致伤原因分为:交通事故伤 76 例,高处坠落伤或其它意外伤 46 例。根据骨折分型分为:A 型 7 例、B 型 19 例、C 型 96 例。48 例骨折为开放性骨折并在安装外固定支架时进行初步的冲洗和清创术,74 例为闭合性骨折并先行安装外固定支架。有 7 例钢板与最近的钉道重叠。对外固定支架钉道位置 (相对于内固定物位置) 与术后感染的相关性进行分析。结果感染组中,距钢板最近的钉道与钢板之间的距离为(61.8±43.1) mm,而未感染组中,其距离为 (62.5±46.7) mm。钉道与钢板之间的距离与术后感染无相关性,差异无统计学意义 (P>0.05)。在外院使用临时外固定支架固定治疗的病例与在我院治疗的病例其感染风险相比,差异无统计学意义 (P=0.272)。口服抗生素治疗钉道感染对感染发生率无明显影响 (P=0.244)。90%(18 / 20) 的术后感染是因为持续的开放性骨折,因此开放性骨折对感染的发生有显著影响 (P<0.0001)。结论Pilon 骨折外固定支架与后期植入内固定物之间的距离对术后感染无明显影响。外固定支架靠近内固定物的钉道并不是影响术后感染发生的风险因素。更多还原

【Abstract】 Objective To determine correlations between infection risks and the distance from external fixator to internal implant in Pilon fracture.Methods Clinical data of 122 distal tibial fracture patients after open reduction and internal fixation were collected from June,2010 to September,2018,including 89 males and 33 females.The average age was (46.2±5.6) years (range:23-65 years).All patients were divided into infection group (n=20)and non-infection group (n=102).Causes of injury:76 patients were of traffic accidents;46 patients were of fall from height and other accidents.Classification of fractures:7 patients were of type A;19 patients were of type B;96 patients were of type C.Forty-eight patients (58.6%) of open fractures were applied with initial wound irrigation and debridement while placing the external fixator.Seventy-four patients (41.4%) of closed fractures were applied with prior placement of external fixator.Seven patients’ implants overlapped with the pin-sites.Correlations between pin location (to the definitive implant location) and postoperative infections were analyzed retrospectively.Results The distance between the closest pin site and plate was (61.8±43.1) mm in the infection group and (62.5±46.7) mmin the non-infection group (P=0.991).There were no correlations between infection risks and pin locations,and the differences were not statistically significant (P > 0.05).Differences of infection risks after temporary placement of external fixator in our hospital and other hospitals were not statistically significant (P=0.272).Oral antibiotics didn’t affect the infection rate obviously (P=0.244).Infection occurred in 90% (18 / 20) of patients because of the persistent open fracture.Therefore,open fracture could influence the infection significantly (P < 0.0001).Conclusions No significant correlations between infection risks and the distance from external fixator to internal implant are observed in Pilon fracture.The screw path near the internal fixator is not a risk factor for postoperative infection.更多还原