A Trial of Wound Irrigation in the Initial Management of Open Fracture Wounds

被引：187

作者：

Bhandari, Mohit ^{[1
,2
,3
]}

Jeray, Kyle J. ^{[12
]}

Petrisor, Brad A. ^{[1
]}

Devereaux, P. J. ^{[2
,3
,4
,5
]}

Heels-Ansdell, Diane ^{[2
,3
]}

Schemitsch, Emil H. ^{[6
]}

Anglen, Jeff ^{[13
]}

Della Rocca, Gregory J. ^{[14
]}

Jones, Clifford ^{[15
]}

Kreder, Hans ^{[6
,7
,8
]}

Liew, Susan ^{[16
]}

McKay, Paula ^{[2
,3
]}

Papp, Steven ^{[9
]}

Sancheti, Parag ^{[17
]}

Sprague, Sheila ^{[1
,2
,3
]}

Stone, Trevor B. ^{[10
]}

Sun, Xin ^{[18
]}

Tanner, Stephanie L. ^{[12
]}

Tornetta, Paul, III ^{[19
]}

Tufescu, Ted ^{[11
]}

Walter, Stephen ^{[2
,3
]}

Guyatt, Gordon H. ^{[2
,3
,4
]}

机构：

[1] McMaster Univ, Div Orthopaed Surg, Dept Surg, Hamilton, ON L8N 3Z5, Canada

[2] McMaster Univ, Dept Clin Epidemiol, Hamilton, ON L8N 3Z5, Canada

[3] McMaster Univ, Dept Biostat, Hamilton, ON L8N 3Z5, Canada

[4] McMaster Univ, Dept Med, Hamilton, ON L8N 3Z5, Canada

[5] McMaster Univ, Populat Hlth Res Inst, Hamilton, ON L8N 3Z5, Canada

[6] Univ Toronto, Div Orthopaed Surg, Toronto, ON M5S 1A1, Canada

[7] Univ Toronto, Hlth Policy Management & Evaluat, Toronto, ON M5S 1A1, Canada

[8] Sunnybrook Hlth Sci Ctr, Toronto, ON M4N 3M5, Canada

[9] Univ Ottawa, Div Orthopaed Surg, Ottawa, ON, Canada

[10] Univ British Columbia, Fac Med, Dept Orthopaed, Vancouver, BC V5Z 1M9, Canada

[11] Univ Manitoba, Dept Surg, Winnipeg, MB R3T 2N2, Canada

[12] Greenville Hlth Syst, Dept Orthoped Surg, Greenville, SC USA

[13] Indiana Univ, Dept Orthoped Surg, Indianapolis, IN 46204 USA

[14] Univ Missouri, Sch Med, Dept Orthoped Surg, Columbia, MO 65211 USA

[15] Ctr Orthoped Res & Educ Inst, Phoenix, AZ USA

[16] Monash Univ, Dept Surg, Melbourne, Vic 3004, Australia

[17] Sancheti Inst Orthoped & Rehabil, Pune, Maharashtra, India

[18] Sichuan Univ, Chinese Evidence Based Med Ctr, Chengdu 610064, Peoples R China

[19] Boston Univ, Sch Med, Dept Orthoped Surg, Boston, MA 02215 USA

来源：

NEW ENGLAND JOURNAL OF MEDICINE | 2015年 / 373卷 / 27期

基金：

加拿大健康研究院;

关键词：

PRESSURE PULSATILE LAVAGE; BENZALKONIUM CHLORIDE; TIBIAL FRACTURES; FLUID LAVAGE; BACITRACIN; BACTERIA; EFFICACY; SOAP; FLOW;

D O I：

10.1056/NEJMoa1508502

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

BACKGROUND The management of open fractures requires wound irrigation and debridement to remove contaminants, but the effectiveness of various pressures and solutions for irrigation remains controversial. We investigated the effects of castile soap versus normal saline irrigation delivered by means of high, low, or very low irrigation pressure. METHODS In this study with a 2-by-3 factorial design, conducted at 41 clinical centers, we randomly assigned patients who had an open fracture of an extremity to undergo irrigation with one of three irrigation pressures (high pressure [>20 psi], low pressure [5 to 10 psi], or very low pressure [1 to 2 psi]) and one of two irrigation solutions (castile soap or normal saline). The primary end point was reoperation within 12 months after the index surgery for promotion of wound or bone healing or treatment of a wound infection. RESULTS A total of 2551 patients underwent randomization, of whom 2447 were deemed eligible and included in the final analyses. Reoperation occurred in 109 of 826 patients (13.2%) in the high-pressure group, 103 of 809 (12.7%) in the low-pressure group, and 111 of 812 (13.7%) in the very-low-pressure group. Hazard ratios for the three pairwise comparisons were as follows: for low versus high pressure, 0.92 (95% confidence interval [CI], 0.70 to 1.20; P = 0.53), for high versus very low pressure, 1.02 (95% CI, 0.78 to 1.33; P = 0.89), and for low versus very low pressure, 0.93 (95% CI, 0.71 to 1.23; P = 0.62). Reoperation occurred in 182 of 1229 patients (14.8%) in the soap group and in 141 of 1218 (11.6%) in the saline group (hazard ratio, 1.32, 95% CI, 1.06 to 1.66; P = 0.01). CONCLUSIONS The rates of reoperation were similar regardless of irrigation pressure, a finding that indicates that very low pressure is an acceptable, low-cost alternative for the irrigation of open fractures. The reoperation rate was higher in the soap group than in the saline group.

引用

页码：2629 / 2641

页数：13