开放性骨折清创术中冲洗液的应用与研究热点
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摘要
背景:清创是开放骨折治疗的关键手段,而清创术中对伤口的冲洗是重要环节。相关的动物实验以及临床研究多年来一直是研究热点,但是清创术中冲洗液种类的选择依然存在着一些争议。目的:对开放性骨折清创术中冲洗液选择的最新研究进展进行综述。方法:第一作者应用计算机检索1959年1月至2018年5月PubMed数据库、中国知网的相关文章,英文检索词"open fracture,debridement,irrigation solution";中文检索词"开放性骨折,清创术,冲洗液"。最终选择44篇重要文献进行综述。结果与结论:①经过大量动物实验以及临床应用,开放性骨折的清创、预防感染、冲洗液种类及预后评价等方面的研究也越来越深入,尤其是清创术中冲洗液种类的研究方面;②传统的无菌生理盐水依旧是最便捷、有效的选择,抗菌消毒剂、表面活性剂、抗生素等添加物也成为近年的研究热点。
BACKGROUND: Debridement is the key to open fracture treatment, and the irrigation of the wound is an important step. There are some controversies about the selection of irrigation solution in debridement, and the corresponding animal experiments and clinical studies have become the focus of research in recent years.OBJECTIVE: To review the latest research progress of the selection of irrigation solution for open fractures debridement.METHODS: A computer-based online search of PubMed and CNKI databases was performed for the articles published from January 1959 to May 2018. The keywords were "open fracture, debridement, irrigation solution" in English and Chinese, respectively. Finally 44 eligible articles were included to review.RESULTS AND CONCLUSION:(1) After a large number of animal experiments and clinical application, open fracture debridement,prevention of infection, irrigation solution and evaluation of prognosis have been deeply studied, especially the study of the type of irrigation solution in debridement.(2) Traditional sterile saline is still the most convenient and effective choice, antiseptics, surfactants, antibiotics and other additives have also become the research focus in recent years.
BACKGROUND: Debridement is the key to open fracture treatment, and the irrigation of the wound is an important step. There are some controversies about the selection of irrigation solution in debridement, and the corresponding animal experiments and clinical studies have become the focus of research in recent years.OBJECTIVE: To review the latest research progress of the selection of irrigation solution for open fractures debridement.METHODS: A computer-based online search of PubMed and CNKI databases was performed for the articles published from January 1959 to May 2018. The keywords were "open fracture, debridement, irrigation solution" in English and Chinese, respectively. Finally 44 eligible articles were included to review.RESULTS AND CONCLUSION:(1) After a large number of animal experiments and clinical application, open fracture debridement,prevention of infection, irrigation solution and evaluation of prognosis have been deeply studied, especially the study of the type of irrigation solution in debridement.(2) Traditional sterile saline is still the most convenient and effective choice, antiseptics, surfactants, antibiotics and other additives have also become the research focus in recent years.
引文
[1]余斌.开放性骨折治疗进展[J].国际骨科学杂志,2013,34(1):6-10.
[2]Buckwalter JA.Advancing the science and art of orthopaedics:Lessons from history.J Bone Joint Surg.2000;82A:1782-1803.
[3]Barnes S,Spencer M,Graham D,et al.Surgical wound irrigation:A call for evidence-based standardization of practice.Am J Infect Control.2014;42(5):525-529.
[4]Singleton AO,Davis D,Julian J.The prevention of wound infection following contamination with colon organisms.Surg Gynecol Obstet.1959;108:389.
[5]Petrisor B,Jeray K,Schemitsch E,et al.Fluid lavage in patients with open fracture wounds(FLOW):an international survey of 984 surgeons.BMC Musculoskelet Disord.2008;9:7
[6]Kamal A,Kanakeshwar RB,Shyam A,et al.Variation in practice preferences in management of open injuries of extremities-an international survey by SICOT research academy.Int Orthop.2016;41(1):1-9.
[7]Owens BD,White DW,Wenke JC.Comparison of irrigation solutions and devices in a contaminated musculoskeletal wound survival model.J Bone Joint Surg.2009;91:92-98.
[8]Dire DJ,Welsh AP.A comparison of wound irrigation solutions used in the emergency department.Ann Emerg Med.1990;19(6):704-708.
[9]FLOW Investigators,Bhandari M,Jeray KJ,et al.A trial of wound irrigation in the initial management of open fracture wounds.New Eng J Med.2015;10:1056.
[10]Olufemi OT,Adeyeye AI.Irrigation solutions in open fractures of the lower extremities:evaluation of isotonic saline and distilled water.SICOT J.2017;3:7.
[11]Moscati RM,Reardon RF,Lerner EB,et al.Wound irrigation with tap water.Acad Emerg Med.1998;5:1076-1080.
[12]Gaines RJ,DeMaio M,Peters D,et al.Management of contaminated open fractures:A comparison of two types of irrigation in a porcine model.J Trauma.2012;72(3):733-736.
[13]Marberry KM,Kazmier P,Simpson WA,et al.Surfactant wound irrigation for the treatment of staphylococcal clinical isolates.Clin Orthop Relat Res.2002;(403):73-79.
[14]Dirschl DR.Surgical irrigation of open fractures-a change in practice?New Eng J Med.2015;373:27.
[15]Urban MV,Rath T,Radtke C.Hydrogen peroxide(H2O2):a reviewof itsuse in surgery.Wiener Medizinische Wochenschrift.2017;(9):1-4.
[16]Lu M,Hansen EN.Hydrogen peroxide wound irrigation in orthopaedic surgery.J Bone Jt Infect.2017;2(1):3-9.
[17]Lüdemann M,Munoz P,Wagner M,et al.The effect of antiseptics in the prophylaxis of infection in orthopaedic surgery.Z Orthop Unfall.2018;156(5):567-573.
[18]Cheng Q,Zhang XF,Di DH,et al.Efficacy of different irrigation solutions on the early debridement of open fracture in rats.Exp Ther Med.2015;9(5):1589-1592.
[19]Chung J,Jeong M.Oxygen embolism caused by accidental subcutaneous injection of hydrogen peroxide during orthopedic surgery-A case report.Medicine(Baltimore).2017;96(43):e8342.
[20]张阳春,肖建红,张紫机.负压封闭式引流联合碘伏灌洗治疗人工关节置换后假体感染[J].中国组织工程研究,2016,20(44):6549-6556.
[21]Kellam NK.Effect of wound irrigation solutions on osteoblast function.J Orthop Trauma.1994;8(2):201-203.
[22]Bhandari M,Adili A,Schemitsch EH.The efficacy of low-pressure lavage with different irrigating solutions to remove adherent bacteria from bone.J Bone Joint Surg.2001;83-A(3):412.
[23]Lineaweaver W,McMorris S,Soucy D,et al.Cellular and bacterial toxicities of topical antimicrobials.Plast Reconstr Surg,1985,75:394-396.
[24]Gravett A,Sterner S,Clinton JE,et al.A trial of povidone-iodine in the prevention of infection in sutured lacerations.Ann Emerg Med.1987;16:167-171.
[25]张志宏,王辉,孙效棠,等.术前碘伏纱布包扎减少开放性胫腓骨骨折感染的临床意义[J].中国骨与关节损伤杂志,2016,31(12):1321-1322.
[26]Whithouse JS,Gourlay DM,Masonbrink AR,et al.Conservative management of giant omphalocele with topical povidone-iodine and its effect on thyroid function.J Pediatr Surg.2010;45(6):1192-1197.
[27]Anglen JO.Wound irrigation in musculoskeletal injury.J Am Acad Orthop Surg.2001;9(4):219.
[28]Anglen JO,Apostoles S,Christensen G,et al.The efficacy of various irrigation solutions in removing slime-producing staphylococcus.J Orthop Trauma.1994;8(5):390.
[29]Anglen J,Apostoles PS,Christensen G,et al.Removal of surface bacteria by irrigation.J Orthop Res.1996;14:251-254.
[30]Anglen JO,Gainor BJ,Simpson WA,et al.The use of detergent irrigation for musculoskeletal wounds.Int Orthop.2003;27(1):40-46.
[31]Anglen JO.Comparison of soap and antibiotic solutions for irrigation of lower-limb open fracture wounds:a prospective,randomized study.J Bone Joint Surg Am.2005;87:141-122.
[32]Huyette DR,Simpson WA,Walsh R,et al.Eradication by surfactant irrigation of staphylococcus aureus from infected complex wounds.Clin Orthop Relat Res.2004;427:28-36.
[33]Gainor GJ,Hockman DE,Anglen JO,et al.Benzalkonium chloride:A potential disinfecting irrigation solution.J Orthop Trauma.1997;11:121-125.
[34]Moussa FW,Gainor GJ,Anglen JO,et al.Disinfecting agents for removing adherent bacterin from orthopaedic hardware.Clin Orthop.1996;329:255-262.
[35]Tarbox BB,Conroy BP,Malicky ES,et al.Benzalkonium Chloride--A potential disinfecting irrigation solution for orthopaedic wounds.Clin Orthop Relat Res.1998;346(346):255-261.
[36]Conroy BP,Anglen JO,Simpson WA,et al.Comparison of castile soap,benzalkonium chloride,and bacitracin as irrigation solutions for complex contaminated orthopaedic wounds.J Orthop Trauma.1999;13:332-337.
[37]Burd TA,Christensen GD,Anglen JO,et al.Sequential irrigation with common detergents:a promising new method for decontaminating orthopaedic wounds.Am JOrtho.1999;28:156-160.
[38]杜晓龙,宋涛,欧学海,等.苯扎氯铵溶液在GustiloⅢA型开放性胫腓骨骨折中应用的效果观察[J].中国骨与关节损伤杂志,2018,33(2):190-191.
[39]Carver DC,Kuehn SB,Weinlein JC.Role of systemic and local antibiotics in the treatment of open fractures.Orthop Clin North Am.2017;48(2):137-153.
[40]Ince A,Schütze N,Karl N,et al.Gentamicin negatively influenced osteogenic function in vitro.Int Orthop.2007;31:223-228.
[41]Patzakis MJ,Bains RS,Lee J,et al.Prospective,randomized,double-blind study comparing single-agent antibiotic therapy,ciprofloxacin,to combination antibiotic therapy in open fracture wounds.J Orthop Trauma.2000;14:529-533.
[42]Zhu H,Bao B,Zheng X.Is NS-EDTA effective in clearing bacteria from infected wounds in a rat model?Clin Orthop Relat Res.2018;476:1083-1090.
[43]Potter BK.From bench to bedside:irrigation-time for something better than salt water?Clin Orthop Relat Res.2018;476(8):1573-1574.
[44]马翔宇,王东.开放性骨折修复:创面感染、植入物选择及预后评价[J].中国组织工程研究,2015,19(26):4258-4264.
[2]Buckwalter JA.Advancing the science and art of orthopaedics:Lessons from history.J Bone Joint Surg.2000;82A:1782-1803.
[3]Barnes S,Spencer M,Graham D,et al.Surgical wound irrigation:A call for evidence-based standardization of practice.Am J Infect Control.2014;42(5):525-529.
[4]Singleton AO,Davis D,Julian J.The prevention of wound infection following contamination with colon organisms.Surg Gynecol Obstet.1959;108:389.
[5]Petrisor B,Jeray K,Schemitsch E,et al.Fluid lavage in patients with open fracture wounds(FLOW):an international survey of 984 surgeons.BMC Musculoskelet Disord.2008;9:7
[6]Kamal A,Kanakeshwar RB,Shyam A,et al.Variation in practice preferences in management of open injuries of extremities-an international survey by SICOT research academy.Int Orthop.2016;41(1):1-9.
[7]Owens BD,White DW,Wenke JC.Comparison of irrigation solutions and devices in a contaminated musculoskeletal wound survival model.J Bone Joint Surg.2009;91:92-98.
[8]Dire DJ,Welsh AP.A comparison of wound irrigation solutions used in the emergency department.Ann Emerg Med.1990;19(6):704-708.
[9]FLOW Investigators,Bhandari M,Jeray KJ,et al.A trial of wound irrigation in the initial management of open fracture wounds.New Eng J Med.2015;10:1056.
[10]Olufemi OT,Adeyeye AI.Irrigation solutions in open fractures of the lower extremities:evaluation of isotonic saline and distilled water.SICOT J.2017;3:7.
[11]Moscati RM,Reardon RF,Lerner EB,et al.Wound irrigation with tap water.Acad Emerg Med.1998;5:1076-1080.
[12]Gaines RJ,DeMaio M,Peters D,et al.Management of contaminated open fractures:A comparison of two types of irrigation in a porcine model.J Trauma.2012;72(3):733-736.
[13]Marberry KM,Kazmier P,Simpson WA,et al.Surfactant wound irrigation for the treatment of staphylococcal clinical isolates.Clin Orthop Relat Res.2002;(403):73-79.
[14]Dirschl DR.Surgical irrigation of open fractures-a change in practice?New Eng J Med.2015;373:27.
[15]Urban MV,Rath T,Radtke C.Hydrogen peroxide(H2O2):a reviewof itsuse in surgery.Wiener Medizinische Wochenschrift.2017;(9):1-4.
[16]Lu M,Hansen EN.Hydrogen peroxide wound irrigation in orthopaedic surgery.J Bone Jt Infect.2017;2(1):3-9.
[17]Lüdemann M,Munoz P,Wagner M,et al.The effect of antiseptics in the prophylaxis of infection in orthopaedic surgery.Z Orthop Unfall.2018;156(5):567-573.
[18]Cheng Q,Zhang XF,Di DH,et al.Efficacy of different irrigation solutions on the early debridement of open fracture in rats.Exp Ther Med.2015;9(5):1589-1592.
[19]Chung J,Jeong M.Oxygen embolism caused by accidental subcutaneous injection of hydrogen peroxide during orthopedic surgery-A case report.Medicine(Baltimore).2017;96(43):e8342.
[20]张阳春,肖建红,张紫机.负压封闭式引流联合碘伏灌洗治疗人工关节置换后假体感染[J].中国组织工程研究,2016,20(44):6549-6556.
[21]Kellam NK.Effect of wound irrigation solutions on osteoblast function.J Orthop Trauma.1994;8(2):201-203.
[22]Bhandari M,Adili A,Schemitsch EH.The efficacy of low-pressure lavage with different irrigating solutions to remove adherent bacteria from bone.J Bone Joint Surg.2001;83-A(3):412.
[23]Lineaweaver W,McMorris S,Soucy D,et al.Cellular and bacterial toxicities of topical antimicrobials.Plast Reconstr Surg,1985,75:394-396.
[24]Gravett A,Sterner S,Clinton JE,et al.A trial of povidone-iodine in the prevention of infection in sutured lacerations.Ann Emerg Med.1987;16:167-171.
[25]张志宏,王辉,孙效棠,等.术前碘伏纱布包扎减少开放性胫腓骨骨折感染的临床意义[J].中国骨与关节损伤杂志,2016,31(12):1321-1322.
[26]Whithouse JS,Gourlay DM,Masonbrink AR,et al.Conservative management of giant omphalocele with topical povidone-iodine and its effect on thyroid function.J Pediatr Surg.2010;45(6):1192-1197.
[27]Anglen JO.Wound irrigation in musculoskeletal injury.J Am Acad Orthop Surg.2001;9(4):219.
[28]Anglen JO,Apostoles S,Christensen G,et al.The efficacy of various irrigation solutions in removing slime-producing staphylococcus.J Orthop Trauma.1994;8(5):390.
[29]Anglen J,Apostoles PS,Christensen G,et al.Removal of surface bacteria by irrigation.J Orthop Res.1996;14:251-254.
[30]Anglen JO,Gainor BJ,Simpson WA,et al.The use of detergent irrigation for musculoskeletal wounds.Int Orthop.2003;27(1):40-46.
[31]Anglen JO.Comparison of soap and antibiotic solutions for irrigation of lower-limb open fracture wounds:a prospective,randomized study.J Bone Joint Surg Am.2005;87:141-122.
[32]Huyette DR,Simpson WA,Walsh R,et al.Eradication by surfactant irrigation of staphylococcus aureus from infected complex wounds.Clin Orthop Relat Res.2004;427:28-36.
[33]Gainor GJ,Hockman DE,Anglen JO,et al.Benzalkonium chloride:A potential disinfecting irrigation solution.J Orthop Trauma.1997;11:121-125.
[34]Moussa FW,Gainor GJ,Anglen JO,et al.Disinfecting agents for removing adherent bacterin from orthopaedic hardware.Clin Orthop.1996;329:255-262.
[35]Tarbox BB,Conroy BP,Malicky ES,et al.Benzalkonium Chloride--A potential disinfecting irrigation solution for orthopaedic wounds.Clin Orthop Relat Res.1998;346(346):255-261.
[36]Conroy BP,Anglen JO,Simpson WA,et al.Comparison of castile soap,benzalkonium chloride,and bacitracin as irrigation solutions for complex contaminated orthopaedic wounds.J Orthop Trauma.1999;13:332-337.
[37]Burd TA,Christensen GD,Anglen JO,et al.Sequential irrigation with common detergents:a promising new method for decontaminating orthopaedic wounds.Am JOrtho.1999;28:156-160.
[38]杜晓龙,宋涛,欧学海,等.苯扎氯铵溶液在GustiloⅢA型开放性胫腓骨骨折中应用的效果观察[J].中国骨与关节损伤杂志,2018,33(2):190-191.
[39]Carver DC,Kuehn SB,Weinlein JC.Role of systemic and local antibiotics in the treatment of open fractures.Orthop Clin North Am.2017;48(2):137-153.
[40]Ince A,Schütze N,Karl N,et al.Gentamicin negatively influenced osteogenic function in vitro.Int Orthop.2007;31:223-228.
[41]Patzakis MJ,Bains RS,Lee J,et al.Prospective,randomized,double-blind study comparing single-agent antibiotic therapy,ciprofloxacin,to combination antibiotic therapy in open fracture wounds.J Orthop Trauma.2000;14:529-533.
[42]Zhu H,Bao B,Zheng X.Is NS-EDTA effective in clearing bacteria from infected wounds in a rat model?Clin Orthop Relat Res.2018;476:1083-1090.
[43]Potter BK.From bench to bedside:irrigation-time for something better than salt water?Clin Orthop Relat Res.2018;476(8):1573-1574.
[44]马翔宇,王东.开放性骨折修复:创面感染、植入物选择及预后评价[J].中国组织工程研究,2015,19(26):4258-4264.