[Ortho] Операция на переднем полукольце таза при налич

[Bruce Ziran]

The absorbable beads are osmotic and may develop a seroma. We are
publishing such in J Trauma, in galleys now, but having said that, the
seroma can be prevented/controlled. THe one thing for sure in this
situation is that one must accept that by definition, the space of
Retzius and any metal in this area will be colonized with bacteria. On
the other hand, colonization does not equal infection. For that
reason, even if a SP catheter is changed, all that does is lower the
CFU load available to colonize or infect the tissue bed. It is like
fighting terrorists in the mountains and caves. They hide all over and
no matter how much one bombs, napalms or whatever, there is always
some left behind to re-colonize. I would suspect that even so, the
reason Matta has such good results is that the true infection rate is
still low. Unfortunately, with infection, the incidence is so low,
that the numbers required to get a sufficiently powered analysis is
too large. Imagine in their series if they have 25 without infection,
but the 26th is the one that gets it. That is a 4% rate, as compared
with an expected 1% incidence. While 400% greater infection rate, it
is still low enough to consider doing.                 

I would agree with dan but beleive the matta approach is quite reasonable.
Also, consider that a pelvic ex fix is quite difficult to maintain. I
am a big fan of exfix and frames, but I hate pelvic fixators and have
not had good success with the pins for longer periods. I like the idea
of trying to get rid of the SP altogether and changing to a foley if
possible. But if forced to place anteriorly, I would use ATB beads.    

Bruce H. Ziran, M.D.
Director of Orthopaedic Trauma
St. Elizabeth Health Center
Associate Professor of Orthopaedic Surgery
Northeast Ohio Universities College of Medicine