开放性骨折修复：创面感染、植入物选择及预后评价

Open fracture repair:wound infection,implant selection and evaluation of prognosis

背景:开放性骨折多伴随软组织损伤严重甚至缺损、高风险感染、骨折骨缺损等特点,往往导致修复术后并发症多、肢体功能受限,给临床治疗带来极大困难,修复此类骨折的方方面面也因此存在着一些争议,相对应的动物实验以及临床研究成为近年来研究的热点。目的:综述近年来关于开放性骨折修复方面存在的一些争议以及与之相对应的最新研究进展。方法:第一作者应用计算机检索2005年1月至2015年1月Pub Med数据库、中国知网等中英文期刊全文数据库相关内容文章,英文检索词"Open fracture,Evaluation and prognosis of injury,Antibiotics,Debirdement,Treatment of fracture,Wound repair";中文检索词"开放性骨折,损伤及预后评估,抗生素,清创,骨折治疗,创面修复"。共检索到100余篇相关文献,47篇文献符合纳入标准。结果与结论:经过大量动物试验以及临床应用,开放性骨折的清创、预防感染、植入物选择及预后评价等方面的研究也越来越深入,尤其是治疗骨缺损的植入物研究方面,金属3D打印机的出现改变了传统植入物的观念,纳米二氧化钛/PEEK生物活性复合材料等骨代替材料也成为近年的研究热点。

BACKGROUND：Open fractures often present soft-tissue defects,high-risk infection,and fracture with bone defect,often lead to more postoperative complication,defect of limb function,and bring great difficulties to clinical treatment.There is some controversy in the treatment of such fracture.Relevant animal experiment and clinical study become the hotspot in recent years.OBJECTIVE：To review some controversy about open fracture treatment and latest research.METHODS：A computer-based online search of China National Knowledge Infrastructure database and PubM ed was performed for articles published from January 2005 to January 2015.Key words included ＂Open fracture,Evaluation and prognosis of injury,Antibiotics,Debirdement,Treatment of fracture,Wound repair＂.More than 100 literatures were retrieved,and 47 articles met the inclusion criteria.RESULTS AND CONCLUSION：After a large number of animal experiments and clinical application,open fracture debridement,prevention of infection,implant selection and evaluation of prognosis had been deeply studied,especially the study of implant treatment of bone defects.Metal three-dimensional printer has changed the traditional concept of implant.Nano titanium dioxide /PEEK bioactive composite materials have become a hot research in recent years.