烧伤病房肠杆菌科细菌耐药性及其危险因素分析

Objective To study the risk factors of infection of extended-spectrum beta-lactamases (ESBL) -producing strains and drug resistance of Enterobacteriaceae that infected burn patients. Methods A retrospective study was performed on clinical information of 92 patients with Enterobacteriaceae infection in our burn unit from January 2001 to December 2008. The distribution and drug resistance of Enterobacteriaceae , and the detection rate, drug resistance of ESBL-producing strains, and its risk factors of nosocomial infection were analyzed. Data were processed with Chi-square test. Results One hundred and nine strains of Enterobacteriaceae were isolated, with 38 (34.9%) strains of Enterobacter cloacae , 25 (22.9%) strains of Escherichia coli , 22 (20. 2%) strains of Klebsiella pneumoniae , 13 (11.9%) strains of Proteus mirabilis , and 11 (10. 1%) other strains of Enterobacteriaceae . Enterobacteriaceae were moderately or highly resistant to antibiotics except imipenem, resistance rate of which was less than 8. 0%. ESBL-producing strains accounted for 44. 0% in Escherichia coli , and 77. 3% in Klebsiella pneumoniae . Drug-resistance rate of ESBL-producing strains to antibiotics was obviously higher than that of non ESBL-producing strains. Length of hospital stay longer than 20 days, and use of the third-generation cephalosporin longer than 5 days, quinolone antibiotics longer than 7 days, and topical antibiotics longer than 5 days were the risk factors of nosocomial infection caused by ESBL-producing strains, comparing with non ESBL-producing strains, the difference was statistically significant (with χ2 value respectively 5.491 , 4.441, 15. 186, 4. 938 , P values all below 0. 05) . Conclusions Enterobacteriaceae strains in burn unit of our hospital are highly drug resistant, with high lactamase-producing rates, calling for intense monitor to control the risk factors that predispose the infection of ESBL-producing strains in order to lower the infection rate.     

烧伤病房鲍氏不动杆菌耐药性趋势和同源性分析

Objective To monitor genotypes and drug-resistance trend of Acinetobacter baumannii (AB) isolated from burn wards. Methods Twenty-six strains of AB isolated from wound secretion, venous catheter, and blood were collected from burn patients hospitalized in our burn wards from November 2008 to February 2009, and June to September 2010. Homogeneous genotype analysis was performed with repetitive extragenic palindromic PCR, and drug-resistance rate to 13 antibiotics including amikacin, gentamicin, etc. , which were commonly used in clinic, was tested by K-B paper disk diffusion. The data of drugresistance rate were processed with chi-square test. Results ( 1 ) Sixteen AB strains were multi-drug resistant (MDR), 9 AB strains were pan-drug resistant (PDR). Among all strains, the resistance rate to gentamicin, piperacillin, piperacillin/tazobactam, cefuroxime, cefotaxime, ceftazidime, cefepime, ciprofloxacin, imipenem, and meropenem was respectively higher than 90.00%; the resistance rate against cefoperazone/sulbactam was the lowest (11/26, 42.31% ). There were obvious difference among the drug-resistance rates of AB strains to 13 antibiotics (with rates from 42.31% to 100.00% , x 2 = 97. 371, P ＜ 0.05 ). (2)There were 7 genotypes among 26 AB strains, respectively type A ( 17), type B (3), type C (2) , type D (1), type E (1), typeF (1), and typeG (1). Out of the 17 AB strains inAgenotype, 1 strain was from 2008, 1 strain was from 2009, 15 strains were from 2010, and among them 11 strains were collected from wound secretion and 6 strains were obtained from blood and venous catheter. Conclusions AB strains in A genotype are dominant in our burn wards in recent years, which are MDR or PDR to commonly used antibiotics. Cefoperazone/sulbactam is the drug of choice for burn patients with AB infection.     

烧伤病房鲍氏不动杆菌耐药性趋势和同源性分析

Objective To monitor genotypes and drug-resistance trend of Acinetobacter baumannii (AB) isolated from burn wards. Methods Twenty-six strains of AB isolated from wound secretion, venous catheter, and blood were collected from burn patients hospitalized in our burn wards from November 2008 to February 2009, and June to September 2010. Homogeneous genotype analysis was performed with repetitive extragenic palindromic PCR, and drug-resistance rate to 13 antibiotics including amikacin, gentamicin, etc. , which were commonly used in clinic, was tested by K-B paper disk diffusion. The data of drugresistance rate were processed with chi-square test. Results ( 1 ) Sixteen AB strains were multi-drug resistant (MDR), 9 AB strains were pan-drug resistant (PDR). Among all strains, the resistance rate to gentamicin, piperacillin, piperacillin/tazobactam, cefuroxime, cefotaxime, ceftazidime, cefepime, ciprofloxacin, imipenem, and meropenem was respectively higher than 90.00%; the resistance rate against cefoperazone/sulbactam was the lowest (11/26, 42.31% ). There were obvious difference among the drug-resistance rates of AB strains to 13 antibiotics (with rates from 42.31% to 100.00% , x 2 = 97. 371, P ＜ 0.05 ). (2)There were 7 genotypes among 26 AB strains, respectively type A ( 17), type B (3), type C (2) , type D (1), type E (1), typeF (1), and typeG (1). Out of the 17 AB strains inAgenotype, 1 strain was from 2008, 1 strain was from 2009, 15 strains were from 2010, and among them 11 strains were collected from wound secretion and 6 strains were obtained from blood and venous catheter. Conclusions AB strains in A genotype are dominant in our burn wards in recent years, which are MDR or PDR to commonly used antibiotics. Cefoperazone/sulbactam is the drug of choice for burn patients with AB infection.     

尿路感染中段尿病原菌的分布及耐药性

Objective To analyze the distribution and antimicrobial resistance of pathogenic bacteria in urinary tract infection (UTI) so as to provide evidence for appropriate selection of antimicrobial agents in clinical practice. Methods From January 2001 to December 2008 in Shanghai Ruijin Hospital, 4683 strains of pathogenic bacteria isolated from urine samples were detected by ATB system; drug susceptibility test was performed with disk diffusion method and pathogenic bacteria distribution and drug resistance was analyzed with WHO NET 5.3 software. Results Among 4683 strains of pathogenic bacteria, most was gram-negative bacilli, accounting for about 77.8%, of which predominant strain was Escherichia coli (68.7%, 3217/4683). The predominant strain of gram-positive bacteria was Enterococcus faecalis, accounting for 10.0% (468/4683). Escherichia coli showed high resistance rates to ampicillin, piperacillin and compound sulfamethoxazole (SMZ-TMP), which were 76.6%, 61.7% and 57.4% respectively, while a low resistance to imipenem, cefoperazone-sulbactam, piperacillin-tazobactam. Enterococcus faecalis showed high resistance rates to erythromycin, gentamicin and levofloxacin, which were 65.8%, 43.2% and 31.1% respectively, and were most susceptive to vancomycin and teicoplanin, both with resistance rates of 0. The susceptibility rate of Enterobacteriaceae to imipenem was 100%. From 2006 to 2008, the detection rate of extend-spectrum ?茁-lactamases ESBLs -producing Escherichia coli in outpatient increased year by year, from 28.7% to 43.3% (P<0.05), whereas no significant change was found in inpatients. The detection rate of (ESBLs)-producing Escherichia coli in inpatients was significantly higher than that in outpatients (P<0.05). The detection rate of ESBLs-producing Escherichia coli was 23.6%. The antimicrobial resistance rate in elderly patients was significantly higher than that in overall antimicrobial resistance rate (P<0.05). Conclusions The predominant bacteria of UTI are still gram-negative bacteria, main of which is Escherichia coli. Bacteria are resistant to a variety of antibiotics. Approximate selection of antibiotics in clinical practice should be made on the basis of susceptibility test results.     

The risk factors of nosocomial infection in severe craniocerebral trauma

Objective:To explore the risk factors of nosocomial infection in severe craniocerebral trauma and the way of prevention.Methods:The clinical data of 387 patients with severe craniocerebral trauma were reviewed.Results:The total nosocomial infection rate of this study was 22.99% .Pulmonary nosocomial infection presented most frequently.The G-bacilli were the most common infectious bacteria.The mortality rate of the infection group was 38.20%.Conclusions:Complications of nosocomial infection affect the prognosis of craniocerebral trauma patients.Nosocomial infection is related to the age of the patients, craniocerebral trauma severity, unreasonable utilization of antibiotics and invasive operations, such as tracheal cannula, mechanical ventilation,urethral catheterization and deep venous catheterization.Patients with severe craniocerebral trauma should be carefully treated and nursed to avoid nosocomial infection.In order to reduce the rate of nosocmial infection,intensive measurement should be adopted.     

烧伤病房铜绿假单胞菌耐药率及抗菌药使用变化

Objective To study changes in the drug-resistance of Pseudomonas aeruginosa (PA)and the use of antibiotics in burn wards so as to optimize the use of antibiotic in the future. Methods Bacteria were isolated from specimens of blood, venous catheter, stool, sputum, urine, wound tissue from 5717 patients hospitalized in our burn wards within the duration of January 2005 to December 2009. The number of specimens examined and positive rates of bacteria were calculated. Changes in constituent ratio of cocci and bacilli, spectrum of bacteria, the drug-resistance rate of PA, and the usage of antibiotics were analyzed. The number of specimens examined, constituent ratio of cocci and bacilli, drug-resistance rate were processed with chi-square test. Bivariate correlation analysis was performed between the usage of antibiotics and the drug-resistance rate. Results (1) The number of specimens examined showed no statistical difference during the five years ( with rates from 73.2% to 76.1% , x 2 = 5. 583, P ＞ 0.05 ) , while constituent ratio of cocci and bacilli showed statistical difference (with ratios from 105:134 to 169: 126, x 2 =14. 806, P ＜0.01 ). The positive rates of bacteria were increasing in the five years. (2) One thousand six hundred and seventy-five strains were identified during the five years from different kinds of specimens, with 29 from blood, 39 from venous catheter, 3 from stool, 157 from sputum, 13 from urine, and 1434 from wound tissue. Among them, Staphylococcus aureus accounted for 28% to 42% , PA accounted for 10% to 25% , Acinetobacter baumannii accounted for 10% to 19% , and they were the predominant strains. (3)The difference among drug-resistance rates of PA to each kind of 12 antibiotics during the five years were statistically significant (with x2 values from 47. 911 to 308. 095, P values all below 0.01 ). The drug-resistance rates of PA to some antibiotics showed downward trend in the former four years, including amikacin,ceftazidime, and imipenem/cilastatin, but it rebounded in the fifth year. (4) There was descending trend in usage of cefoperazone/sulbactam and levofloxacin, but vancomycin was always used widely. (5) Drug-resistance rates of PA to 7 antibiotics, including amikacin, imipenem/cilastatin, and ciprofloxacin, etc. , were positively correlated with usage of various antibiotics (with r values from 0. 879 to 0. 978, P ＜ 0. 05 or P ＜0. 01). Conclusions In our burn wards, drug-resistant PA was prevalent. Disinfection and isolation measures,appropriate use of antibiotics,etc. can reduce PA infection.     

烧伤病房铜绿假单胞菌耐药率及抗菌药使用变化

Objective To study changes in the drug-resistance of Pseudomonas aeruginosa (PA)and the use of antibiotics in burn wards so as to optimize the use of antibiotic in the future. Methods Bacteria were isolated from specimens of blood, venous catheter, stool, sputum, urine, wound tissue from 5717 patients hospitalized in our burn wards within the duration of January 2005 to December 2009. The number of specimens examined and positive rates of bacteria were calculated. Changes in constituent ratio of cocci and bacilli, spectrum of bacteria, the drug-resistance rate of PA, and the usage of antibiotics were analyzed. The number of specimens examined, constituent ratio of cocci and bacilli, drug-resistance rate were processed with chi-square test. Bivariate correlation analysis was performed between the usage of antibiotics and the drug-resistance rate. Results (1) The number of specimens examined showed no statistical difference during the five years ( with rates from 73.2% to 76.1% , x 2 = 5. 583, P ＞ 0.05 ) , while constituent ratio of cocci and bacilli showed statistical difference (with ratios from 105:134 to 169: 126, x 2 =14. 806, P ＜0.01 ). The positive rates of bacteria were increasing in the five years. (2) One thousand six hundred and seventy-five strains were identified during the five years from different kinds of specimens, with 29 from blood, 39 from venous catheter, 3 from stool, 157 from sputum, 13 from urine, and 1434 from wound tissue. Among them, Staphylococcus aureus accounted for 28% to 42% , PA accounted for 10% to 25% , Acinetobacter baumannii accounted for 10% to 19% , and they were the predominant strains. (3)The difference among drug-resistance rates of PA to each kind of 12 antibiotics during the five years were statistically significant (with x2 values from 47. 911 to 308. 095, P values all below 0.01 ). The drug-resistance rates of PA to some antibiotics showed downward trend in the former four years, including amikacin,ceftazidime, and imipenem/cilastatin, but it rebounded in the fifth year. (4) There was descending trend in usage of cefoperazone/sulbactam and levofloxacin, but vancomycin was always used widely. (5) Drug-resistance rates of PA to 7 antibiotics, including amikacin, imipenem/cilastatin, and ciprofloxacin, etc. , were positively correlated with usage of various antibiotics (with r values from 0. 879 to 0. 978, P ＜ 0. 05 or P ＜0. 01). Conclusions In our burn wards, drug-resistant PA was prevalent. Disinfection and isolation measures,appropriate use of antibiotics,etc. can reduce PA infection.     

烧伤病房鲍氏不动杆菌耐药性趋势和同源性分析

目的 监测烧伤病房鲍氏不动杆菌耐药性趋势和同源性情况.方法收集2008年11月-2009年2月、2010年6-9月笔者单位住院烧伤患者创面、血液和静脉导管分离的鲍氏不动杆菌26株,采用K-B纸片扩散法检测该菌对阿米卡星、庆大霉素等13种临床常用抗生素的耐药性,用重复序列PCR法检测基因分型.对细菌耐药率数据进行x2检验.结果 (1)26株鲍氏不动杆菌中多药耐药菌株16株、泛耐药菌株9株,菌株对庆大霉素、哌拉西林、哌拉西林/他唑巴坦、头孢呋辛、头孢噻肟、头孢他啶、头孢吡肟、环丙沙星、亚胺培南和美罗培南的耐药率均高达90.00%以上;对头孢哌酮/舒巴坦的耐药率最低,为42.31%(11/26).26株鲍氏不动杆菌对13种抗生素的耐药率比较,差异有统计学意义(42.31%～100.00%,x2=97.371,P＜0.05).(2)26株鲍氏不动杆菌共分为7个基因型:A型17株,B型3株,C型2株,D、E、F、G型各1株.17株A型菌株中,2008、2009年各1株,2010年15株;创面来源11株、血液和静脉导管来源共6株.结论笔者单位烧伤病房近年来存在鲍氏不动杆菌同一克隆株A型的流行,对临床常用抗生素呈多药耐药或泛耐药趋势.目前头孢哌酮/舒巴坦是治疗烧伤患者鲍氏不动杆菌感染的首选药物.

Abstract：

Objective To monitor genotypes and drug-resistance trend of Acinetobacter baumannii (AB) isolated from burn wards. Methods Twenty-six strains of AB isolated from wound secretion, venous catheter, and blood were collected from burn patients hospitalized in our burn wards from November 2008 to February 2009, and June to September 2010. Homogeneous genotype analysis was performed with repetitive extragenic palindromic PCR, and drug-resistance rate to 13 antibiotics including amikacin, gentamicin, etc. , which were commonly used in clinic, was tested by K-B paper disk diffusion. The data of drugresistance rate were processed with chi-square test. Results ( 1 ) Sixteen AB strains were multi-drug resistant (MDR), 9 AB strains were pan-drug resistant (PDR). Among all strains, the resistance rate to gentamicin, piperacillin, piperacillin/tazobactam, cefuroxime, cefotaxime, ceftazidime, cefepime, ciprofloxacin, imipenem, and meropenem was respectively higher than 90.00%; the resistance rate against cefoperazone/sulbactam was the lowest (11/26, 42.31% ). There were obvious difference among the drug-resistance rates of AB strains to 13 antibiotics (with rates from 42.31% to 100.00% , x 2 = 97. 371, P ＜ 0.05 ). (2)There were 7 genotypes among 26 AB strains, respectively type A ( 17), type B (3), type C (2) , type D (1), type E (1), typeF (1), and typeG (1). Out of the 17 AB strains inAgenotype, 1 strain was from 2008, 1 strain was from 2009, 15 strains were from 2010, and among them 11 strains were collected from wound secretion and 6 strains were obtained from blood and venous catheter. Conclusions AB strains in A genotype are dominant in our burn wards in recent years, which are MDR or PDR to commonly used antibiotics. Cefoperazone/sulbactam is the drug of choice for burn patients with AB infection.     

Spinal epidural abscess: a meta-analysis of 915 patients

Spinal epidural abscess (SEA) was first described in the medical literature in 1761 and represents a severe, generally pyogenic infection of the epidural space requiring emergent neurosurgical intervention to avoid permanent neurologic deficits. Spinal epidural abscess comprises 0.2 to 2 cases per 10,000 hospital admissions. This review intends to offer detailed evaluation and a comprehensive meta-analysis of the international literature on SEA between 1954 and 1997, especially of patients who developed it following anesthetic procedures in the spinal canal. In this period, 915 cases of SEA were published. This review is the most comprehensive literature analysis on SEA to date. Most cases of SEA occur in patients aged 30 to 60 years, but the youngest patient was only 10 days old and the oldest was 87. The ratio of men to women was 1:0.56. The most common risk factor was diabetes mellitus, followed by trauma, intravenous drug abuse, and alcoholism. Epidural anesthesia or analgesia had been performed in 5.5% of the patients with SEA. Skin abscesses and furuncles were the most common source of infection. Of the patients, 71% had back pain as the initial symptom and 66% had fever. The second stage of radicular irritation is followed by the third stage, with beginning neurological deficit including muscle weakness and sphincter incontinence as well as sensory deficits. Paralysis (the fourth stage) affected only 34% of the patients. The average leukocyte count was 15,700/μl (range 1,500–42,000/μl), and the average erythrocyte sedimentation rate was 77 mm in the first hour (range 2–50 mm). Spinal epidural abscess is primarily a bacterial infection, and the gram-positive Staphylococcus aureus is its most common causative agent. This is true also for patients who develop SEA following spinal anesthetics. Magnetic resonance imaging (MRI) displays the greatest diagnostic accuracy and is the method of first choice in the diagnostic process. Myelography, commonly used previously to diagnose SEA, is no longer recommended. Lumbar puncture to determine cerebrospinal fluid protein concentrations is not needed for diagnosis and entails the risk of spreading bacteria into the subarachnoid space with consequent meningitis; therefore, it should not be performed. The therapeutic method of choice is laminectomy combined with antibiotics. Conservative treatment alone is justifiable only for specific indications. Laminotomy is a therapeutic alternative for children. The mortality of SEA dropped from 34% in the period of 1954–1960 to 15% in 1991–1997. At the beginning of the twentieth century, almost all patients with SEA died. Parallel to improvements in the mortality rate, today more patients experience complete recovery from SEA. The prognosis of patients who develop SEA following epidural anesthesia or analgesia is not better than that of patients with noniatrogenic SEA, and the mortality rate is also comparable. The essential problem of SEA lies in the necessity of early diagnosis, because only timely treatment is able to avoid or reduce permanent neurologic deficits. Received: 18 July 2000 / Accepted: 14 September 2000     

Should antibiotics be administered before arthroscopic knee surgery? A systematic review of the literature

AIM To explore the current evidence surrounding the administration of prophylactic antibiotics for arthroscopic knee surgery. METHODS Databases were searched from inception through May of 2018 for studies examining prophylactic antibiotic use and efficacy in knee arthroscopy. Studies with patient data were further assessed for types of arthroscopic procedures performed,number of patients in the study,use of antibiotics,and outcomes with the intention of performing a pooled analysis. Data pertaining to "deep tissue infection" or "septic arthritis" were included in our analysis. Reported data on superficial infection were not included in our data analysis. For the pooled analysis,a relative risk ratio was calculated and χ~2 tests were used to assess for statistical significance between rates of infection amongst the various patient groups. Post hoc power analyses were performed to compute the statistical power obtained from our sample sizes. Number needed to treat analyses were performed for statistically significant differences by dividing 1 by the difference between the infection rates of the antibiotic and no antibiotic groups. An alpha value of 0.05 was used for our analysis. Study heterogeneity was assessed by Cochrane's Q test as well as calculation of the I~2 value.RESULTS A total of 49682 patients who underwent knee ar-throscopy for a diverse set of procedures across 19 studies met inclusion critera for pooled analysis. For those not undergoing graft procedures,there were 27 cases of post-operative septic arthritis in 34487 patients(0.08%) who received prophylactic antibiotics and 16 cases in 10911(0.15%) who received none [risk ratio(RR) = 0.53,95% confidence interval(CI): 0.29-0.99,P = 0.05]. A sub-group analysis in which bony procedures were excluded was performed which found no significant difference in infection rates between patients that received prophylactic antibiotics and patients that did not(P 0.05). All anterior cruciate ligament reconstruction studies used prophylactic antibiotics,but two studies investigating the effect of soaking the graft in vancomycin in addition to standard intravenous(IV) prophylaxis were combined for analysis. There were 19 cases in 1095 patients(1.74%) who received IV antibioitics alone and no infections in 2034 patients who received IV antibiotics and had a vancomycin soaked graft(RR = 0.01,95%CI: 0.001-0.229,P 0.01).CONCLUSION Prophylactic antibiotics are effective in preventing septic arthritis following simple knee arthroscopy. In procedures involving graft implantation,graft soaking reduces the rate of infection.     

膝关节后交叉韧带断裂治疗临床分析

目的 对35例膝关节后交叉韧带断裂治疗进行临床分析,重点探讨了有关交叉韧带断裂的治疗问题。方法 经明确诊断后,分析采用胫骨附着处撕脱骨折复位固定手术治疗26例、早期髌韧带中1／3移植重建3例、单纯长腿石膏固定6例。结果 本组病例全部进行随访,随访时间13个月－5年,胫骨附着处撕脱骨折复位固定及髋韧带中1／3移植重建29例为优良、单纯长腿石膏固定6例为差。结论 后交叉韧带断裂后应该及时给予手术修复;膝后外侧手术入路,操作简单,暴露充分;少于3个月的陈旧性病例仍适应手术治疗。     

不同方法重建指尖离断静脉回流的疗效分析

目的：探讨不同方法重建指尖离断静脉回流的疗效。方法：2008年3月-2013年2月收治指尖离断患者80例,38例吻合指侧方静脉重建回流,术中吻合动静脉比例1：1或1：2或2：2,平均1：2;22例吻合指腹静脉重建回流,术中吻合动静脉比例1：1;20例未吻合静脉,术中仅吻合1条动脉,行侧切口或甲床放血。观察各组治疗效果。结果：吻合指侧方静脉组手指全部成活,无一例发生回流障碍;吻合指腹静脉组19例发生静脉危象,其中4例手指坏死;未吻合静脉组20例均发生回流障碍,其中6例手指坏死。58例获随访,随访时间6~28个月。吻合指侧方静脉组32例,指尖外形佳、指腹饱满;吻合指腹静脉组14例,指体轻度萎缩,指甲生长不平整;未吻合静脉组12例,指体萎缩明显。吻合指侧方静脉组指甲生长近平整,长度长于其他两组[（14.4±3.2）mm比（12.5±2.3）mm和（12.2±2.2）mm],远侧指间关节活动度大于其他两组[（63±5）°比（48±3）°和（45±7）°],两点分辨觉小于其他两组[（4.6±0.4）mm比（7.1±1.2）mm和（7.3±0.6）mm],感觉级别高于其他两组[S（3.45±0.39）级比S（2.57±0.42）级和S（2.55±0.49）级],差异均具有显著性（P〈0.05）。吻合指腹静脉组和未吻合静脉组在指甲长度、运动和感觉方面差异无统计学意义（P〉0.05）。结论：吻合指侧方静脉能有效解决指尖再植静脉回流问题,可避免回流障碍,成活率高,促进指甲生长,可恢复 DIPJ 活动度及感觉。     

胫骨干骨折的手术治疗对策

目的：明确不同固定器械在胫骨干不同骨折类型固定中的特点，以指导临床应用。方法：68例胫骨干骨折，行加压钢板螺钉、交锁髓内钉、单侧外固定架固定后，作临床疗效分析。结果：加压钢板固定组42例，感染5例，骨不连1例，平均愈合时间3．8个月；交锁髓内钉固定组13例，无感染及骨不连，平均愈合时间5．4个月；单侧外固定架组13例，骨不连1例，踝关节背伸受限3例，平均愈合时间4．5个月。结论：胫骨骨折交锁髓内钉固定并发症少，功能恢复好，适用范围广，但要注意及时进行动力加压。加压钢板及外固定架固定应选择各自的最佳适应证，以达到理想的疗效。