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1、InfectionsinOrthopaedicTrauma Minimizing Infections AfterOpen FracturesBarnabyDedmond,MDGUSTILO&ANDERSON19761Types1,2,3Updated19842Types3A,3B,3C1.GustiloRB,AndersonJT.“PreventionofInfectionintheTreatmentofOneThousandandTwenty-fiveOpenFracturesofLongBones.”JBJS-A19
2、76.58(4):453-458.2.GustiloRB,MendozaRM,WilliamsDN.“ProblemsintheManagementofTypeIII(Severe)OpenFractures:ANewClassificationofTypeIIIOpenFractures.”JTrauma1984.24(8):742-746.Classification— Whydowecare?ClassificationcorrelateswithprognosisGRADEIIIIIIAIIIBIIICINFECTION0-2%
3、2-7%10-25%10-50%25-50%FRACTUREHEALING21-28WKS26-28WKS30-35WKS30-35WKSAntibioticsin OpenFracturesTheuseofantibioticsinopenfractureshasaprotectiveeffectagainstearlyinfectioncomparedwithnoantibioticsorplacebo(Relativerisk0.41)GosselinRA,RobertsI,GillespieWJ.“Antibioticsforp
4、reventinginfectioninopenlimbfractures.”CochraneDatabaseSystemReview2004.1:CD003764.Choiceof Antibioticsin OpenFracturesNodifferenceininfectionratesbetweenclindamycinandcefazolin(anythingvsS.aureuswillwork)BensonDR,RigginsRS,LawrenceRM,HoeprichPD,HustonAC,HarrisonJA.“Trea
5、tmentofOpenFractures:AProspectiveStudy.”JTrauma1983.23:25-30.Choiceof Antibioticsin OpenFracturesDuetogramnegativecontamination,addaminoglycosideforGrade3FarminjuriesandVascularinjuries,giveampicillinorpenicillinDon’tforgettetanusDurationof Antibioticsin OpenFracturesIna
6、doubleblind,prospectivetrial,nodifferenceininfectionratesbetween1and5daysofpostoperativeantibioticsinopenfracturesDellingerEP,CaplanES,WeaverLD,WertzMJ,DroppertBM,HoytN,BrumbackR,BurgessA,PokaA,BenirschkeSK.“Durationofpreventiveantibioticadministrationforopenextremityfra
7、ctures.”ArchSurg.1988Mar.123(3):333-339.InitialI&DTimingClassic:within6hoursRecentlybeingchallengedNoinfectionsin91isolatedopenType1fracturestreatedwithoutI&D(exceptattimeoffixationonavg5daysafterinjury)1Nodifferenceininfectionrateinchildrenwillalltypesofopenfracturestre
8、ated0-6hoursand7-24hoursfromtimeofinjury2IstillconsiderallopenfracturesemergenciesYangEC,EislerJ.“Treat
