英国牛津大学Jagdeep Nanchahal小组在研究中取得进展。他们研究了切口负压伤口治疗和标准伤口敷料对严重创伤下肢骨折术后深部伤口感染的影响。2020年2月11日出版的《美国医学会杂志》发表了这项成果。

严重创伤相关骨折手术治疗后，深部伤口感染率很高。目前尚不清楚负压伤口治疗是否能降低这种情况下的感染率。

为了探讨严重创伤下肢骨折手术采用负压伤口治疗或标准伤口敷料治疗的效果，研究组在英国的24家创伤医院进行了一项随机临床试验，2016年7月7日至2018年4月17日，共招募了1548名16岁及以上因严重创伤导致下肢骨折手术的患者。将其随机分组，其中785名接受切口负压伤口治疗，即使用能在伤口产生负压的敷料；763名使用标准伤口敷料。

共有1519名参与者进入最终分析。治疗30天后，负压伤口治疗组的深部伤口感染率为5.84%，标准伤口敷料组为6.68%，差异不显著。治疗90天后，负压伤口治疗组的深部伤口感染率为11.4%，标准伤口敷料组为13.2%，差异亦不显著。两组间的其他5项临床指标亦无显著差异。

总之，对于下肢严重创伤性骨折行手术治疗的患者，采用切口负压伤口治疗与标准伤口敷料相比，深部伤口感染率无显著差异，研究结果不支持在这种情况下使用负压伤口治疗。

附：英文原文

Title: Effect of Incisional Negative Pressure Wound Therapy vs Standard Wound Dressing on Deep Surgical Site Infection After Surgery for Lower Limb Fractures Associated With Major Trauma: The WHIST Randomized Clinical Trial

Author: Matthew L. Costa, Juul Achten, Ruth Knight, Julie Bruce, Susan J. Dutton, Jason Madan, Melina Dritsaki, Nick Parsons, Miguel Fernandez, Richard Grant, Jagdeep Nanchahal

Issue&Volume: 2020/02/11

Abstract:

Importance  Following surgery to treat major trauma–related fractures, deep wound infection rates are high. It is not known if negative pressure wound therapy can reduce infection rates in this setting.

Objective  To assess outcomes in patients who have incisions resulting from surgery for lower limb fractures related to major trauma and were treated with either incisional negative pressure wound therapy or standard wound dressing.

Design, Setting, and Participants  A randomized clinical trial conducted at 24 trauma hospitals representing the UK Major Trauma Network that included 1548 patients aged 16 years or older who underwent surgery for a lower limb fracture caused by major trauma from July 7, 2016, through April 17, 2018, with follow-up to December 11, 2018.

Interventions  Incisional negative pressure wound therapy (n = 785), which involved a specialized dressing used to create negative pressure over the wound, vs standard wound dressing not involving negative pressure (n = 763).

Main Outcomes and Measures  The primary outcome measure was deep surgical site infection at 30 days diagnosed according to the criteria from the US Centers for Disease Control and Prevention. A preplanned secondary analysis of the primary outcome was performed at 90 days. The secondary outcomes were patient-reported disability (Disability Rating Index), health-related quality of life (EuroQol 5-level EQ-5D), surgical scar assessment (Patient and Observer Scar Assessment Scale), and chronic pain (Douleur Neuropathique Questionnaire) at 3 and 6 months, as well as other local wound healing complications at 30 days.

Results  Among 1548 participants who were randomized (mean [SD] age, 49.8 [20.3] years; 561 [36%] were aged ≤40 years; 583 [38%] women; and 881 [57%] had multiple injuries), 1519 (98%) had data available for the primary outcome. At 30 days, deep surgical site infection occurred in 5.84% (45 of 770 patients) of the incisional negative pressure wound therapy group and in 6.68% (50 of 749 patients) of the standard wound dressing group (odds ratio, 0.87 [95% CI, 0.57 to 1.33]; absolute risk difference, −0.77% [95% CI, −3.19% to 1.66%]; P = .52). There was no significant difference in the deep surgical site infection rate at 90 days (11.4% [72 of 629 patients] in the incisional negative pressure wound therapy group vs 13.2% [78 of 590 patients] in the standard wound dressing group; odds ratio, 0.84 [95% CI, 0.59 to 1.19]; absolute risk difference, −1.76% [95% CI, −5.41% to 1.90%]; P = .32). For the 5 prespecified secondary outcomes reported, there were no significant differences at any time point.

Conclusions and Relevance  Among patients who underwent surgery for major trauma–related lower limb fractures, use of incisional negative pressure wound therapy, compared with standard wound dressing, resulted in no significant difference in the rate of deep surgical site infection. The findings do not support the use of incisional negative pressure wound therapy in this setting, although the event rate at 30 days was lower than expected.

DOI: 10.1001/jama.2020.0059

Source: https://jamanetwork.com/journals/jama/article-abstract/2760736