胫骨开放性骨折不同清创时机术后感染的临床研究
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摘要
目的探讨胫骨开放性骨折不同的首次清创时间与术后感染的关系。方法回顾性分析我院自2012年1月至2017年1月收治的215例胫骨开放性骨折患者的临床资料,根据患者自受伤至进入手术室开始清创的时间,将患者分为A、B、C、D四组。四组患者自受伤至进入手术室开始清创的时间分别为A组(T≤6h)、B组(6h24h),通过首次清创时间的不同结合骨折Gustilo-Anderson分型来分析早期清创与延迟清创术后感染率的差别。结果 a)以首次清创时间不同分组比较:A组65例中6例感染,感染率为9.2%;B组95例中9例感染,感染率为9.5%;C组36例中4例感染,感染率为11.1%;D组19例中2例感染,感染率为10.5%。A、B、C、D四组之间相互比较差异无统计学意义(P>0.05)。b)以不同骨折分型(Gustilo-Anderson)分组比较:Ⅰ型62例中2例感染,感染率为3.2%;Ⅱ型98例中8例感染,感染率为8.2%;ⅢA型26例中3例感染,感染率为11.5%;ⅢB型25例中7例感染,感染率为28%;ⅢC型4例中1例感染,感染率为25%。五组之间相互比较差异有统计学意义(P<0.05)。结论胫骨开放性骨折清创时间的延后并不会增加术后的感染率;胫骨开放性骨折清创术后感染主要与骨折严重程度有关。
Objective To investigate the relationship between the time of first debridement and postoperative infection in open tibial fractures.Methods The clinical data of 215 patients with open fracture of tibia admitted from January 2012 to January 2017 were analyzed retrospectively.According to the time from the injury to the operation,the patients were divided into four groups:group A(T≤6 h),group B(6 h24 h)respectively,to analyze the difference of infection rate between early debridement and delayed debridement after the first debridement.Results 6 cases of 65 cases in group A were infected,and the infection rate was 9.2%;9 cases in 95 cases in group B were infected,and the infection rate was 9.5%;4 cases of 36 cases in group C were infected,and the infection rate was 11.1%;2 cases of 19 case in group D were infected,and the infection rate was 10.5%.There was no statistical significance between any of the four groups.Accroding to fracture(Gustilo-Anderson)classification,there were 62 cases of typeⅠ with 2 cases infected,and the infection rate was 3.2%;8 cases of typeⅡcases,and the infection rate was 8.2%;26 cases of typeⅢ A with 3 cases infected,and the infection rate was 11.5%,25 cases of typeⅢ B with 7 cases infected,and the infection rate was 28%,4 cases of typeⅢ C type with 1 case infected,and the infection rate was 25%.There was statistically significant difference between the five groups.Conclusion The prolonged time from injury to debridement of open tibial fractures does not increase the postoperative infection rate.And the postoperative infection of open tibial fractures is mainly related to the severity of fractures.
Objective To investigate the relationship between the time of first debridement and postoperative infection in open tibial fractures.Methods The clinical data of 215 patients with open fracture of tibia admitted from January 2012 to January 2017 were analyzed retrospectively.According to the time from the injury to the operation,the patients were divided into four groups:group A(T≤6 h),group B(6 h
引文
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[2]张军军,郭昭庆,卢占斌,等.清创加碘伏冲洗对降低胸腰椎后路手术感染率的前瞻性研究[J].中国骨与关节损伤杂志,2015,30(3):247-249.
[3]Friedrich PL.Die aseptische versorgung frischer wunden,unter mittheilung von Thier-Versuchen uber die auskeimung-szeit von infectionserregern in frischen Wunden[J].Arch Klin Chir,1898(57):288-310.
[4]朱通伯.处理开放性骨折及关节创伤的新观点[J].中华骨科杂志,1995,15(6):393-396.
[5]罗富.四肢长管状骨开放性骨折首次清创时间与术后感染的关系[D].南宁:广西医科大学,2013.
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[10]Jedlicka N,Summers NJ,Murdoch MM.Overview of concepts and treatments in open fractures[J].Clin Podiatr Med Surg,2012,29(2):279-290.
[11]王谦.开放性骨折分期治疗理论的临床实践[J].美中国际创伤杂志,2017,16(3):18-22.
[12]Ruedi TP,Buckley RE,Moran CG.AO principles of fracture management[M].2nd ed.New York:Thieme,2007:322.
[13]付慕勇,赵?.228例开放性骨折感染患者病原菌分布及药敏分析[J].中华医院感染学杂志,2011,21(19):4171-4173.
[14]王素凯.胫骨开放性骨折首次清创时间与感染率的相关性研究[D].石家庄:河北医科大学,2017.
[15]Kindsfater K,Jonassen EA.Osteomyelitis in gradeⅡandⅢopen tibia fractures with late debridement[J].J Orthop Trauma,1995,9(2):121-127.
[16]Kreder HJ,Armstrong P.A review of open tibia fractures in children[J].J Pediatr Orthop,1995,15(4):482-488.
[17]Pollak AN,Jones AL,Castillo RC,et al.The relationship between time to surgical debridement and incidence of infection after open high-energy lower extremity trauma[J].J Bone Joint Surg(Am),2010,92(1):7-15.
[18]Ibrahim T,Riaz M,Hegazy A,et al.Delayed surgical debridement in pediatric open fractures:a systematic review and meta-analysis[J].J Child Orthop,2014,8(2):135-141.
[19]Charalambous CP,Siddique I,Zenios M,et al.Early versus delayed surgical treatment of open tibial fractures:effect on the rates of infection and need of secondary surgical procedures to promote bone union[J].Injury,2005,36(5):656-661.
[20]陈大伟,李兵,俞光荣.开放性骨折首次清创时机问题研究进展[J].中华创伤杂志,2009,25(11):1050-1053.
[21]Merritt K.Factors increasing the risk of infection in patients with open fractures[J].J Trauma,1988,28(6):823-827.
[22]郝明,彭阿钦,张英泽,等.开放性骨折清创术中与感染后细菌培养的调查与分析[J].中华创伤骨科杂志,2013,15(7):588-591.
[23]Patzakis MJ,Wilkins J.Factors influencing infection rate in open fracture wounds[J].Clin Orthop Relat Res,1989(243):36-40.
[24]Fletcher N,Sofianos D,Berkes MB,et al.Prevention of perioperative infection[J].J Bone Joint Surg(Am),2007,89(7):1605-1618.
[25]Reuss BL,Cole JD.Effect of delayed treatment on open tibial shaft fractures[J].Am J Orthop(Belle Mead NJ),2007,36(4):215-220.
[26]Chua W,Murphy D,Siow W,et al.Epidemiological analysis of outcomes in 323open tibial diaphyseal fractures:a nine-year experience[J].Singapore Med J,2012,53(6):385-389.
[27]Malhotra AK,Goldberg S,Graham J,et al.Open extremity fractures:impact of delay in operative debridement and irrigation[J].J Trauma Acute Care Surg,2014,76(5):1201-1207.
[28]Nanchahal J,Nayagam D,Al E.The standards for the management of open fractures of the lower limb[M].London:Royal Society of Medicine Press,2012:11-12.
[2]张军军,郭昭庆,卢占斌,等.清创加碘伏冲洗对降低胸腰椎后路手术感染率的前瞻性研究[J].中国骨与关节损伤杂志,2015,30(3):247-249.
[3]Friedrich PL.Die aseptische versorgung frischer wunden,unter mittheilung von Thier-Versuchen uber die auskeimung-szeit von infectionserregern in frischen Wunden[J].Arch Klin Chir,1898(57):288-310.
[4]朱通伯.处理开放性骨折及关节创伤的新观点[J].中华骨科杂志,1995,15(6):393-396.
[5]罗富.四肢长管状骨开放性骨折首次清创时间与术后感染的关系[D].南宁:广西医科大学,2013.
[6]Spencer J,Smith A,Woods D.The effect of time delay on infection in open long-bone fractures:a 5-year prospective audit from a district general hospital[J].Ann R Coll Surg Engl,2004,86(2):108-112.
[7]Namdari S,Baldwin KD,Matuszewski P,et al.Delay in surgical débridement of open tibia fractures:an analysis of national practice trends[J].J Orthop Trauma,2011,25(3):140-144.
[8]Schenker ML,Yannascoli S,Baldwin KD,et al.Does timing to operative debridement affect infectious complications in open long-bone fractures?A systematic review[J].J Bone Joint Surg(Am),2012,94(12):1057-1064.
[9]唐新,周宗科,刘雷,等.延迟清创的胫腓骨开放性骨折围手术期感染防治[J].实用骨科杂志,2010,16(4):264-267.
[10]Jedlicka N,Summers NJ,Murdoch MM.Overview of concepts and treatments in open fractures[J].Clin Podiatr Med Surg,2012,29(2):279-290.
[11]王谦.开放性骨折分期治疗理论的临床实践[J].美中国际创伤杂志,2017,16(3):18-22.
[12]Ruedi TP,Buckley RE,Moran CG.AO principles of fracture management[M].2nd ed.New York:Thieme,2007:322.
[13]付慕勇,赵?.228例开放性骨折感染患者病原菌分布及药敏分析[J].中华医院感染学杂志,2011,21(19):4171-4173.
[14]王素凯.胫骨开放性骨折首次清创时间与感染率的相关性研究[D].石家庄:河北医科大学,2017.
[15]Kindsfater K,Jonassen EA.Osteomyelitis in gradeⅡandⅢopen tibia fractures with late debridement[J].J Orthop Trauma,1995,9(2):121-127.
[16]Kreder HJ,Armstrong P.A review of open tibia fractures in children[J].J Pediatr Orthop,1995,15(4):482-488.
[17]Pollak AN,Jones AL,Castillo RC,et al.The relationship between time to surgical debridement and incidence of infection after open high-energy lower extremity trauma[J].J Bone Joint Surg(Am),2010,92(1):7-15.
[18]Ibrahim T,Riaz M,Hegazy A,et al.Delayed surgical debridement in pediatric open fractures:a systematic review and meta-analysis[J].J Child Orthop,2014,8(2):135-141.
[19]Charalambous CP,Siddique I,Zenios M,et al.Early versus delayed surgical treatment of open tibial fractures:effect on the rates of infection and need of secondary surgical procedures to promote bone union[J].Injury,2005,36(5):656-661.
[20]陈大伟,李兵,俞光荣.开放性骨折首次清创时机问题研究进展[J].中华创伤杂志,2009,25(11):1050-1053.
[21]Merritt K.Factors increasing the risk of infection in patients with open fractures[J].J Trauma,1988,28(6):823-827.
[22]郝明,彭阿钦,张英泽,等.开放性骨折清创术中与感染后细菌培养的调查与分析[J].中华创伤骨科杂志,2013,15(7):588-591.
[23]Patzakis MJ,Wilkins J.Factors influencing infection rate in open fracture wounds[J].Clin Orthop Relat Res,1989(243):36-40.
[24]Fletcher N,Sofianos D,Berkes MB,et al.Prevention of perioperative infection[J].J Bone Joint Surg(Am),2007,89(7):1605-1618.
[25]Reuss BL,Cole JD.Effect of delayed treatment on open tibial shaft fractures[J].Am J Orthop(Belle Mead NJ),2007,36(4):215-220.
[26]Chua W,Murphy D,Siow W,et al.Epidemiological analysis of outcomes in 323open tibial diaphyseal fractures:a nine-year experience[J].Singapore Med J,2012,53(6):385-389.
[27]Malhotra AK,Goldberg S,Graham J,et al.Open extremity fractures:impact of delay in operative debridement and irrigation[J].J Trauma Acute Care Surg,2014,76(5):1201-1207.
[28]Nanchahal J,Nayagam D,Al E.The standards for the management of open fractures of the lower limb[M].London:Royal Society of Medicine Press,2012:11-12.