背景:深部手术部位感染(SSI)可能是跟骨骨折切开复位内固定(ORIF)的并发症。本研究旨在描述通过可伸展外侧入路(ELA)的跟骨骨折ORIF后深部SSI患者的特征。我们比较了这些患者的临床结果,与对照组匹配的深SSI成功治疗后至少随访一年。
方法:在这项回顾性病例对照研究中,人口统计数据,断裂特征,细菌病原体,收集了药物治疗和手术方法,还通过疼痛的视觉模拟量表(VAS)评估结果,足部功能指数(FFI)和AOFAS踝足-后足评分。测量了感染脚和对侧脚之间的Böhler和Gissane角度的差异。通过匹配未感染病例的对照组,采用Mann-WhitneyU检验比较2组的临床结局.
结果:在308例患者的331例跟骨骨折中(平均年龄,38.0±13.1;男女比例,5.5),21名患者有较深的SSI(6.3%)。男性16例(76.2%),女性5例(23.8%),平均年龄为35.1±11.7岁。13例(61.9%)患者出现单侧骨折。最常见的桑德斯类型是II型。检测到的最常见的微生物类型是葡萄球菌物种。静脉抗生素治疗,主要是克林霉素,亚胺培南和万古霉素,根据微生物结果,处方的平均±SD持续时间为28.1±16.5天。手术清创术的平均次数为1.8±1.3。16例(76.2%)需要切除植入物。3例(14.3%)应用了抗生素浸渍的骨水泥。15例患者的临床结果(随访,35.5±13.8;范围,12.6-64.5个月)分别为疼痛VAS的4.1±2.0、16.7±12.3和77.5±20.8,FFI%和AOFAS踝足-后足评分,分别。与对照组相比(疼痛的VAS,2.3±2.7;FFI%,12.2±16.6和AOFAS,84.6±18.0),本组仅VAS疼痛在统计学上较低(p值:0.012).感染病例的双脚之间的Böhler和Gissane角度差异为-14.3±17.9和-7.7±22.5(感染侧更差),分别。
结论:跟骨骨折ORIF后深部感染的适当及时方法可能导致可接受的临床和功能结果。有时采用静脉抗生素治疗的积极方法,多次手术清创,去除植入物和抗生素浸渍水泥对于根除深部感染是必要的。
方法:三级。
BACKGROUND: Deep surgical site infection (SSI) may be a complication of open reduction and internal fixation (ORIF) of calcaneal fractures. This study aimed to describe the characteristics of patients with deep SSI following ORIF of calcaneal fractures via extensile lateral approach (ELA). We compared clinical outcomes of these patients, with a minimum follow-up of one year after successful treatment of deep SSI with a matched control group.
METHODS: In this retrospective
case-control study, demographic data, fracture characteristics, bacterial pathogens, medical treatments and surgical approaches were collected, also the outcome was evaluated by the visual analog scale (VAS) for pain, foot function index (FFI) and AOFAS ankle-hindfoot score. The differences in Böhler and Gissane\'s angles between infected and contralateral feet were measured. By matching a control group of uninfected cases, clinical outcomes were compared between 2 groups using the Mann-Whitney U test.
RESULTS: Among 331 calcaneus fractures in 308 patients (mean age, 38.0 ± 13.1; male/female ratio, 5.5), 21 had deep SSI (6.3 %). There were 16 (76.2 %) males and 5 (23.8 %) females with a mean age of 35.1 ± 11.7 years. Thirteen (61.9 %) patients had unilateral fractures. The most common Sanders Type was found to be type II. The most frequent type of detected microorganisms was Staphylococcus species. Intravenous antibiotic therapy, mostly clindamycin, imipenem and vancomycin, based on the microbiological results, was prescribed with a mean±SD duration of 28.1 ± 16.5 days. The mean number of surgical debridements was 1.8 ± 1.3. Implants needed to be removed in 16 (76.2 %) cases. Antibiotic-impregnated bone cement was applied in three (14.3 %) cases. The clinical outcomes of 15 cases (follow up, 35.5 ± 13.8; range, 12.6-64.5 months) were 4.1 ± 2.0, 16.7 ± 12.3 and 77.5 ± 20.8 for VAS for pain, FFI % and AOFAS ankle-hindfoot score, respectively. Comparing with the control group (VAS for pain, 2.3 ± 2.7; FFI %, 12.2 ± 16.6, and AOFAS, 84.6 ± 18.0), only VAS pain was statistically lower in this group (p-value: 0.012). The differences in Böhler and Gissane\'s angles between both feet of infected cases were - 14.3 ± 17.9 and - 7.7 ± 22.5 (worse in the infected side), respectively.
CONCLUSIONS: Proper on-time approaches to deep infection following ORIF of calcaneal fractures may lead to acceptable clinical and functional outcomes. Sometimes aggressive approaches with intravenous antibiotic therapy, multiple sessions of surgical debridement, removal of implants and antibiotic impregnated cement are necessary to eradicate deep infection.
METHODS: Level III.