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开放性骨折治疗的当前理念
Treatmentofopenfracture
—CurrentconceptreviewFirstHospitalofLanzhouUniversityWangYongpingMDPhD
OpenFractureGuideline
Openfracturescreatetwoproblems:WoundsFractureOpenfracture
Openfracturesareoftencomplicatedby:DeepinfectionNon-unionOpenfracture
Consider????Whyexisttherehighinfectionand/ornon-union
ratesinopenfracture?
Consider????OpenfractureClosedfracture
FracturesFracture
Wounds?
Infection/non-union?
WoundsInfection/non-union＝＝＝＝
Openfracture：fracturethathavecommunicationwiththeenvironmentWhat‵stheopenfracture?
OpenfracturesofttissueinjuryassociatedwithfractureWhat‵stheopenfracture?
SofttissueinjuryFractureNeuro-vascularinjuryContaminationCharacteristicsoftheopenfracture
OpenFracture
OpenFractureUncontrolledinfectionOrFracturenon-unionAmputationFailureofsofttissuereconstruction
OpenFracture
—someimportantissue
IncidenceAnnualincidence:11.5per100,000persons3-4%ofallfracturesareopenfracturesCourt-BrownCM,etal.Theepidemiologyofopenlongbonefractures.Injury,1998,29(7):529–534.
Mechanismofinjurylow-energyinjuryindirectviolenceinside-outwounds
high-energyinjuryDirectviolence,eg,vehicleaccident、falloutside-inwoundsMechanismofinjury
ContaminationTheoriginofbacterialeadingtoinfectioninopenfracturesAtthetimeofinjuryorshortlyaftertheinjury/originatedfromtheenvironment(60to70%)Duringhospitalization/fromthehospitalenvironment
ContaminationThegram-positiveorganismspredominateinthelowergradeinjuriesInhigh-gradefracturescausedbygram-negativeorganisms
invasivetypes/suppurativetypeprimary/secondaryContamination
Question??Arebacterialcultures
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