背景:骨与关节外科杂志(JBJS)的最新概念综述概述了控制复合性骨折围手术期感染的证据。然而,文献中缺乏证据表明采用一项方案结合有一些证据的措施会产生影响。乔治国王医科大学(KGMU)的当前治疗方法代表了印度常规治疗复合性骨折的做法,并且是针对实验循证方案(EBP)进行试验的适当对照。
目的:研究采用基于证据的方案对定义感染率和骨愈合参数的额外影响。
方法:本随机对照研究在KGMU骨科进行。二百二十六位双骨腿复合性骨折患者,年龄>12岁被随机分为两组.一组接受标准治疗,实验组根据JBJS审查接受治疗。
方法:通过比较两组的基线特征来测试随机分配。比较两组在伤口培养阴性时间方面的所有结果变量,伤口愈合的时间,骨折部位的愈合时间和膝关节达到完整活动范围的时间。
结果:随机分配成功。EBP组报告伤口培养报告阴性的时间明显较短(常规平均值=4.619,实验平均值=1.9146,p=0.0006),骨性愈合时间较短(常规平均值=23.8427周,实验=22.8125周,p=0.0027),伤口愈合时间较短(常规平均值=14.4425周,实验性平均值=10.4513周,p=0.0032),住院时间较短(常规平均值=6.5982天,实验=4.5000天,p=0.0343)。
结论:EBP基于Fletcher等人建议的指南。,显着缩短了获得阴性培养所需的时间,并加快了伤口和骨折的愈合。因此,建议在KGMU创伤中心等环境中使用EBP。
BACKGROUND: A recent concept review in Journal of Bone and Joint Surgery (JBJS) outlines evidence to control peri-operative infections in compound fractures. However, evidence for impact of adopting a protocol combining measures that have some evidence is lacking in literature. The present method of treatment at King George\'s Medical University (KGMU) is representative of the conventional practice of managing compound fractures in India and is an appropriate control for trial against the Experimental Evidence Based Protocol (EBP).
OBJECTIVE: To study the additional impact of adopting Evidence Based Protocol on parameters defining infection rate and bone union.
METHODS: This randomized controlled study was conducted at the orthopaedics department of KGMU. Two hundred and twenty six patients of compound fractures of both bone leg, age > 12y were randomized to two groups. One group received standard treatment and the experimental group received treatment as per JBJS review.
METHODS: Random allocation was tested by comparing baseline characteristics of the two groups. The two groups were compared for all the outcome variables in terms of time to a negative wound culture, time to wound healing, time to union at fracture site and time to achieve complete range of motion at knee joint.
RESULTS: Random allocation was successful. EBP group reported significantly lesser time to a negative culture report from wound (mean in conventional=4.619, experimental=1.9146, p=0.0006), lesser time to bony union (mean in conventional=23.8427 weeks, experimental=22.8125 weeks, p=0.0027), lesser time to wound healing (mean in conventional=14.4425 weeks experimental=10.4513 weeks, p=0.0032), and a lesser duration of hospital stay (mean in conventional=6.5982 days, experimental=4.5000 days, p=0.0343).
CONCLUSIONS: EBP based on the guidelines suggested by Fletcher et al., significantly shorten the time taken for achieving a negative culture and hasten wound and fracture healing. Therefore EBP is recommended for use in settings like the KGMU trauma center.