骨折内固定术后感染对Smad通路蛋白的影响及与预后的关系
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摘要
目的探讨骨折内固定术后感染对Smad通路蛋白的影响及与预后的关系。方法选取2016年12月至2018年2月于我院行骨折内固定术且术后感染的101例患者为考察对象,并定义为感染组。同时,选取同一时期于我院进行骨折内固定术治疗但术后未感染的110例患者为对照组。统计感染组患者病原学结果;测定并比较两组患者Smad通路蛋白相关指标、免疫功能、炎症因子各指标水平变化;统计感染组患者预后效果。结果 101例行骨折内固定术后感染患者病原菌检测结果提示,病原菌共计检测出142株,其中革兰阳性菌的比例为63.38%(90/142),革兰阴性菌的比例为35.92%(51/142)。感染组患者Smad1/β-actin、Smad2/β-actin、Smad3/β-actin水平均显著高于对照组(P <0.01)。感染组患者CD8~+T淋巴细胞、NK细胞水平显著低于对照组(P <0.01),CD4~+T淋巴细胞水平显著高于对照组(P <0.01)。感染组患者IL-10水平显著低于对照组,CRP、PCT水平显著高于对照组(P <0.01)。101例行骨折内固定术后感染患者均未出现死亡情况,其中10例患者(9.90%)进行再次手术,12例患者(11.88%)后期行保守治疗,7例患者(6.93%)术后出现肌肉萎缩症状。结论骨折内固定术后感染可对患者Smad通路蛋白及机体免疫系统产生更深远的影响,且术后感染以革兰阳性杆菌为主要致病菌。
Objective To investigate the effects of infection after fracture internal fixation on Smad pathway protein and its relationship with prognosis. Methods 101 patients with fracture internal fixation and postoperative infection in our hospital from December 2016 to February 2018 were enrolled and identified as infected group. At the same time,110 patients who underwent fracture internal fixation in our hospital but were not infected after the same period were selected as the control group. The etiological results of the infected patients were analyzed. The changes of Smad pathway protein related indexes,immune function and inflammatory factors in the two groups were measured and compared. The prognostic effect of infection group was counted. Results The results of detection of pathogenic bacteria in 101 patients with infection after internal fixation showed that 142 strains were detected in pathogens,of which the proportion of Gram-positive bacteria was 63.38%(90/142),and the proportion of Gram-negative bacteria was 35.92%(51/142). The levels of Smad1/β-actin,Smad2/β-actin and Smad3/β-actin in the infected group were significantly higher than those in the control group(P < 0.01). The levels of CD8+T lymphocytes and NK cells in the infected group were significantly lower than those in the control group(P < 0.01),and the levels of CD4+T lymphocytes were significantly higher than those in the control group(P < 0.01). The level of IL-10 in the infected group was significantly lower than that in the control group,and the levels of CRP and PCT were significantly higher than those in the control group(P < 0.01). There were no deaths in 101 patients with infection after internal fixation. Among them,10 patients(9.90%)underwent reoperation,12 patients(11.88%)underwent conservative treatment,and 7 patients(6.93%)developed postoperatively muscle atrophy symptoms.Conclusion Infection after internal fixation of the fracture can have a more profound effect on the Smad pathway protein and the body′s immune system,and Gram-positive bacilli are the main pathogens.
Objective To investigate the effects of infection after fracture internal fixation on Smad pathway protein and its relationship with prognosis. Methods 101 patients with fracture internal fixation and postoperative infection in our hospital from December 2016 to February 2018 were enrolled and identified as infected group. At the same time,110 patients who underwent fracture internal fixation in our hospital but were not infected after the same period were selected as the control group. The etiological results of the infected patients were analyzed. The changes of Smad pathway protein related indexes,immune function and inflammatory factors in the two groups were measured and compared. The prognostic effect of infection group was counted. Results The results of detection of pathogenic bacteria in 101 patients with infection after internal fixation showed that 142 strains were detected in pathogens,of which the proportion of Gram-positive bacteria was 63.38%(90/142),and the proportion of Gram-negative bacteria was 35.92%(51/142). The levels of Smad1/β-actin,Smad2/β-actin and Smad3/β-actin in the infected group were significantly higher than those in the control group(P < 0.01). The levels of CD8+T lymphocytes and NK cells in the infected group were significantly lower than those in the control group(P < 0.01),and the levels of CD4+T lymphocytes were significantly higher than those in the control group(P < 0.01). The level of IL-10 in the infected group was significantly lower than that in the control group,and the levels of CRP and PCT were significantly higher than those in the control group(P < 0.01). There were no deaths in 101 patients with infection after internal fixation. Among them,10 patients(9.90%)underwent reoperation,12 patients(11.88%)underwent conservative treatment,and 7 patients(6.93%)developed postoperatively muscle atrophy symptoms.Conclusion Infection after internal fixation of the fracture can have a more profound effect on the Smad pathway protein and the body′s immune system,and Gram-positive bacilli are the main pathogens.
引文
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[10]OWEN M T,KEENER E M,HYDE Z B,et al.Intraoperative topical antibiotics for infection prophylaxis in pelvic and acetabular surgery[J].J Orthop Trauma.,2017,13(31):1.
[11]HENKELMANN R,FROSCH K H,GLAAB R,et al.Infection following fractures of the proximal tibia-a systematic review of incidence and outcome[J].BMC Musculoskelet Disord.,2017,18(1):481.
[12]KIM S Y,CHIM H,BISHOP A T,et al.Complications and outcomes of one-bone forearm reconstruction[J].Hand,2017,12(2):140-144.
[2]ZHANG X,ZHAN X,ZOU P,et al.Factors related to infection after fixation in the process of late healed bone fracture[J].Exp Ther Med.,2017,14(2):1126-1130.
[3]BACKES M,SPIJKERMAN I J,DE MUINCK-KEIZER R J O,et al.Determination of pathogens in postoperative wound infection after surgically reduced calcaneal fractures and implications for prophylaxis and treatment[J].J Foot Ankle Surg.,2018,57(1):100-103.
[4]中华人民共和国卫生部.医院感染诊断标准(试行)[J].中华医学杂志,2001,81(5):314-320.
[5]KEPLER C K,VROOME C,GOLDFARB M,et al.Variation in the management of thoracolumbar trauma and postoperative infection[J].J Spinal Disord Tech.,2015,28(4):E212-E218.
[6]LI F L,JIANG C Y,LU Y,et al.Efficacy analysis of two-stage reverse total shoulder arthroplasty for treating postoperative deep infection after surgeries for proximal humeral fractures[J].Journal of Peking University,2016,48(2):263-267.
[7]WIJERATNA M D,MCROBERTS J,PORTEOUS M J.Cost of infection after surgery for intracapsular fracture of the femoral neck[J].Ann R Coll Surg Engl,2015,97(4):283-286.
[8]MOMAYA A M,HLAVACEK J,ETIER B,et al.Risk factors for infection after operative fixation of Tibial plateau fractures[J].Injury,2016,47(7):1501-1505.
[9]HYE Y L,TAE Y J,SANG J P.Evaluation of postoperative complications according to treatment of third molars in mandibular angle fracture[J].J Korean Assoc Oral Maxillofac Surg.,2017,43(1):37-41.
[10]OWEN M T,KEENER E M,HYDE Z B,et al.Intraoperative topical antibiotics for infection prophylaxis in pelvic and acetabular surgery[J].J Orthop Trauma.,2017,13(31):1.
[11]HENKELMANN R,FROSCH K H,GLAAB R,et al.Infection following fractures of the proximal tibia-a systematic review of incidence and outcome[J].BMC Musculoskelet Disord.,2017,18(1):481.
[12]KIM S Y,CHIM H,BISHOP A T,et al.Complications and outcomes of one-bone forearm reconstruction[J].Hand,2017,12(2):140-144.