背景:在过去的几十年中,手术治疗的锁骨骨折的数量有所增加。因此,这导致治疗骨折相关感染(FRI)等并发症所需的二次手术增加.这项研究的主要目的是评估接受锁骨FRI治疗的患者的临床和功能结果。次要目标是评估医疗保健成本,并为该并发症的手术管理提出标准化方案。
方法:对2015年1月1日至2022年3月1日期间接受切开复位内固定术(ORIF)的所有锁骨骨折患者进行回顾性评估。这项研究包括根据鲁汶大学医院多学科小组的建议进行诊断和治疗的FRI患者,比利时。
结果:我们评估了626例接受ORIF治疗的630例锁骨骨折患者。总的来说,28例患者被诊断为FRI。其中,八人(29%)接受了明确的植入物移除,5人(18%)接受清创,抗菌治疗和植入物滞留,14名患者(50%)在单阶段手术中更换了植入物,两阶段程序或多次修订后。一名患者(3.6%)接受了锁骨切除术。12例患者(43%)接受了自体骨移植(三骨髂棘植骨(n=6),游离血管化腓骨移植(n=5),松质骨移植(n=1))重建骨缺损。中位随访时间为32.3个月(P25-P75:23.9-51.1)。两名患者(7.1%)经历了感染复发。功能结果令人满意,28例患者中有26例(93%)具有全范围运动。每位患者的医疗费用中位数为11.506欧元(P25-P75:7.953-23.798欧元)。
结论:FRI是锁骨骨折手术治疗后可发生的严重并发症。在我们看来,当使用多学科患者特异性方法充分治疗时,锁骨FRI患者的预后良好.与未经感染的手术治疗的锁骨骨折相比,这些患者的医疗费用中位数高达3.5倍。虽然没有单独研究,我们考虑骨缺损的大小等因素,软组织的状况,在骨缺损的情况下,患者的需求对于指导我们的手术决策很重要。
BACKGROUND: The number of operatively treated clavicle fractures has increased over the past decades. Consequently, this has led to an increase in secondary procedures required to treat complications such as fracture-related infection (FRI). The primary objective of this study was to assess the clinical and functional outcome of patients treated for FRI of the clavicle. The secondary objectives were to evaluate the healthcare costs and propose a standardized protocol for the surgical management of this complication.
METHODS: All patients with a clavicle fracture who underwent open reduction and internal fixation (ORIF) between 1 January 2015 and 1 March 2022 were retrospectively evaluated. This study included patients with an FRI who were diagnosed and treated according to the recommendations of a multidisciplinary team at the University Hospitals Leuven, Belgium.
RESULTS: We evaluated 626 patients with 630 clavicle fractures who underwent ORIF. In total, 28 patients were diagnosed with an FRI. Of these, eight (29%) underwent definitive implant removal, five (18%) underwent debridement, antimicrobial treatment and implant retention, and fourteen patients (50%) had their implant exchanged in either a single-stage procedure, a two-stage procedure or after multiple revisions. One patient (3.6%) underwent resection of the clavicle. Twelve patients (43%) underwent autologous bone grafting (tricortical iliac crest bone graft (n = 6), free vascularized fibular graft (n = 5), cancellous bone graft (n = 1)) to reconstruct the bone defect. The median follow-up was 32.3 (P25-P75: 23.9-51.1) months. Two patients (7.1%) experienced a recurrence of infection. The functional outcome was satisfactory, with 26 out of 28 patients (93%) having full range of motion. The median healthcare cost was € 11.506 (P25-P75: € 7.953-23.798) per patient.
CONCLUSIONS: FRI is a serious complication that can occur after the surgical treatment of clavicle fractures. In our opinion, when treated adequately using a multidisciplinary patient-specific approach, the outcome of patients with an FRI of the clavicle is good. The median healthcare costs of these patients are up to 3.5 times higher compared to non-infected operatively treated clavicle fractures. Although not studied individually, we consider factors such as the size of the bone defect, condition of the soft tissue, and patient demand important when it comes to guiding our surgical decision making in cases of osseous defects.