开放性胫骨骨折创面感染病原学特点与愈合影响因素分析
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摘要
目的分析开放性胫骨骨折创面感染患者病原学分布特点及骨折愈合影响因素。方法选取山东大学附属济南市中心医院2014年10月-2017年5月开放性胫骨骨折创面感染患者87例,取所有患者切口渗出物进行病原菌培养与鉴定,并根据患者状况给予对应内固定术治疗,于6个月后进行随访。统计并分析患者骨折愈合情况及其影响因素。结果 87例骨折创面感染患者切口渗出物共检出病原菌127株,以大肠埃希菌、铜绿假单胞菌、金黄色葡萄球菌为主,分别占28.35%(36/127)、15.75%(20/127)、14.17%(18/127);87例患者术后6个月共愈合64例,愈合率为73.56%(64/87),单因素分析结果:致伤原因、骨折分型、受伤至治疗时间、软组织修复时机、是否应用VSD为骨折愈合影响因素(P<0.05);多因素Logistic回归分析结果:软组织二期修复、高能量致伤、骨折分型较高及受伤至治疗时间>6h为影响开放性胫骨骨折愈合的独立影响因素(P<0.05)。结论开放性胫骨骨折患者创面感染病原菌主要为大肠埃希菌、铜绿假单胞菌、金黄色葡萄球菌,影响开放性胫骨骨折愈合的影响因素为软组织二期修复、高能量致伤、骨折分型较高及受伤至治疗时间>6h,临床应针对影响因素及早实施对应干预措施,降低骨折延迟愈合及骨折不愈合发生风险,促使患者及早康复。
OBJECTIVE To investigate the distribution of pathogens isolated from the open tibial fracture patients with wound infection and analyze the influencing factors for healing.METHODS A total of 87 open tibial fracture patients with wound infection who were treated in Jinan Central Hospital Affiliated to Shandong University from Oct 2014 to May 2017 were enrolled in the study,the incision secretions specimens were collected for culture of pathogens,the isolated pathogens were identified,the internal fixation was carried out according to the condition of the patients,and the follow-up was conducted after the fixation for 6 months.The healing status of fracture and influencing factors for the healing were statistically analyzed.RESULTS Totally 127 strains of pathogens were isolated from the incision secretions specimens of the 87 fracture patients with wound infection;Escherichia coli,Pseudomonas aeruginosa and Staphylococcus aureus were the predominant species of pathogens,accounting for 28.35%(36/127),15.75%(20/127)and 14.17%(18/127),respectively.The 6-month follow-up showed that of the 87 patients,64 were healed,with the healing rate 73.56%(64/87).The result of univariate analysis indicated that the causes of injury,fracture classification,interval between injury and treatment,soft tissue repair timing and application of VSD were the influencing factors for the healing of fracture(P<0.05).The result of multivariate logistic regression analysis showed that soft tissue repair in the second stage,high-energy injury,high fracture classification and internal between injury and treatment more than 6 hours were the independent influencing factors for the healing of open tibial fracture(P<0.05).CONCLUSION Ec.oli,P.aeruginosa and S.aureus are the predominant species of pathogens isolated from the open tibial fracture patients with wound infection.The soft tissue repair in the second stage,high-energy injury,high fracture classification and internal between injury and treatment more than 6 hours are the influencing factors for the healing of open tibial fracture.It is necessary for the hospital to take targeted intervention measures according to the influencing factors so as to reduce the risk of delayed union of fracture and nonunion of fracture and promote the early recovery.
OBJECTIVE To investigate the distribution of pathogens isolated from the open tibial fracture patients with wound infection and analyze the influencing factors for healing.METHODS A total of 87 open tibial fracture patients with wound infection who were treated in Jinan Central Hospital Affiliated to Shandong University from Oct 2014 to May 2017 were enrolled in the study,the incision secretions specimens were collected for culture of pathogens,the isolated pathogens were identified,the internal fixation was carried out according to the condition of the patients,and the follow-up was conducted after the fixation for 6 months.The healing status of fracture and influencing factors for the healing were statistically analyzed.RESULTS Totally 127 strains of pathogens were isolated from the incision secretions specimens of the 87 fracture patients with wound infection;Escherichia coli,Pseudomonas aeruginosa and Staphylococcus aureus were the predominant species of pathogens,accounting for 28.35%(36/127),15.75%(20/127)and 14.17%(18/127),respectively.The 6-month follow-up showed that of the 87 patients,64 were healed,with the healing rate 73.56%(64/87).The result of univariate analysis indicated that the causes of injury,fracture classification,interval between injury and treatment,soft tissue repair timing and application of VSD were the influencing factors for the healing of fracture(P<0.05).The result of multivariate logistic regression analysis showed that soft tissue repair in the second stage,high-energy injury,high fracture classification and internal between injury and treatment more than 6 hours were the independent influencing factors for the healing of open tibial fracture(P<0.05).CONCLUSION Ec.oli,P.aeruginosa and S.aureus are the predominant species of pathogens isolated from the open tibial fracture patients with wound infection.The soft tissue repair in the second stage,high-energy injury,high fracture classification and internal between injury and treatment more than 6 hours are the influencing factors for the healing of open tibial fracture.It is necessary for the hospital to take targeted intervention measures according to the influencing factors so as to reduce the risk of delayed union of fracture and nonunion of fracture and promote the early recovery.
引文
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[12]崔庆,崔浩然,喻东梅,等.开放性骨折伤口感染病原菌分布及耐药率监测[J].中国矫形外科杂志,2010,18(13):1091-1093.
[13]宋倩.老年开放性胫腓骨骨折术后感染的病原菌及耐药分析[J].中国实验诊断学,2017,21(1):115-117.
[14]Zhou J,Tun TN,Hong SH,et al.Development of a prototype wound dressing technology which can detect and report colonization by pathogenic bacteria[J].Biosens Bioelectron,2011,30(1):67-72.
[15]宋玉光,叶蜀新,江伟,等.开放性胫腓骨骨折患者创面感染的病原学分析[J].中华医院感染学杂志,2014,24(6):1479-1480.
[16]Morris BJ,Unger RZ,Archer KR,et al.Risk factors of infection after ORIF of bicondylar tibial plateau fractures[J].JOrthop Trauma,2013,27(9):196-200.
[17]杨争艳,李宗泽,刘文俊,等.胫腓骨开放性骨折创口感染的病原学研究及预防措施[J].中国当代医药,2017,24(19):68-70.
[18]Miramini S,Zhang L,Richardson M,et al.Influence of fracture geometry on bone healing under locking plate fixations:A comparison between oblique and transverse tibial fractures[J].Med Eng Phys,2016,38(10):1100-1108.
[19]黄洪,储辉,俞航,等.影响胫骨Pilon骨折疗效的相关因素分析[J].中国矫形外科杂志,2012,20(6):490-494.
[20]Sathiyakumar V,Thakore RV,Ihejirika RC,et al.Distal tibia fractures and medial plating:factors influencing re-operation[J].Int Orthop,2014,38(7):1483-1488.
[21]赵国平,苏伟,赵劲民,等.影响胫腓骨开放性骨折愈合的多因素分析[J].中国矫形外科杂志,2012,20(14):1268-1271.
[22]Yashwant Singh T,Masood H,Atin J,et al.Minimally invasive plate osteosynthesis of distal tibial fracture using aposterolateral approach:a cadaveric study and preliminary report[J].Int Orthop,2013,37(1):105-111.
[23]Metsemakers W,Handojo K,Reynders P,et al.Individual risk factors for deep infection and compromised fracture healing after intramedullary nailing of tibial shaft fractures:a single centre experience of 480patients[J].Injury,2015,46(4):740-745.
[2]Seyhan M,Unay K,Sener N.Intramedullary nailing versus percutaneous locked plating of distal extra-articular tibial fractures:a retrospective study[J].Eur J Orthop Surg Traumatol,2013,23(5):595-601.
[3]Blum ML,Esser M,Richardson M,et al.Negative pressure wound therapy reduces deep infection rate in open tibial fractures[J].J Orthop Trauma,2012,26(9):499-505.
[4]曲野,何和与,张新波,等.老年开放性胫腓骨骨折术后医院感染的病原学特点及危险因素分析[J].中华医院感染学杂志,2017,27(21):4968-4971.
[5]耿琳.开放性胫腓骨骨折术后感染的病原菌及耐药情况分析[J].山东医药,2011,51(34):73-74.
[6]Lack WD,Karunakar MA,Angerame MR,et al.Type IIIopen tibia fractures:immediate antibiotic prophylaxis minimizes infection[J].J Orthop Trauma,2015,29(1):1-6.
[7]Naik MA,Arora G,Tripathy SK,et al.Clinical and radiological outcome of percutaneous plating in extra-articular proximal tibia fractures:aprospective study[J].Injury,2013,44(8):1081-1086.
[8]Ramos T,Jon Karlsson,Eriksson BI,et al.Treatment of distal tibial fractures with the Ilizarov external fixator-A prospective observational study in 39consecutive patients[J].BMC Musculoskelet Disord,2013,14(1):30.
[9]Sigurdsen U,Reikeras O,Utvag SE.The influence of compression on the healing of experimental tibial fractures[J].Injury,2011,42(10):1152-1156.
[10]袁英泽,耿琳.开放性胫腓骨骨折术后感染病原菌的检测与耐药性分析[J].中国药业,2012,21(1):13-14.
[11]王云清,王爱国,朱长喜,等.胫腓骨骨折患者术后切口难愈合的影响因素[J].创伤外科杂志,2015,17(4):365-366.
[12]崔庆,崔浩然,喻东梅,等.开放性骨折伤口感染病原菌分布及耐药率监测[J].中国矫形外科杂志,2010,18(13):1091-1093.
[13]宋倩.老年开放性胫腓骨骨折术后感染的病原菌及耐药分析[J].中国实验诊断学,2017,21(1):115-117.
[14]Zhou J,Tun TN,Hong SH,et al.Development of a prototype wound dressing technology which can detect and report colonization by pathogenic bacteria[J].Biosens Bioelectron,2011,30(1):67-72.
[15]宋玉光,叶蜀新,江伟,等.开放性胫腓骨骨折患者创面感染的病原学分析[J].中华医院感染学杂志,2014,24(6):1479-1480.
[16]Morris BJ,Unger RZ,Archer KR,et al.Risk factors of infection after ORIF of bicondylar tibial plateau fractures[J].JOrthop Trauma,2013,27(9):196-200.
[17]杨争艳,李宗泽,刘文俊,等.胫腓骨开放性骨折创口感染的病原学研究及预防措施[J].中国当代医药,2017,24(19):68-70.
[18]Miramini S,Zhang L,Richardson M,et al.Influence of fracture geometry on bone healing under locking plate fixations:A comparison between oblique and transverse tibial fractures[J].Med Eng Phys,2016,38(10):1100-1108.
[19]黄洪,储辉,俞航,等.影响胫骨Pilon骨折疗效的相关因素分析[J].中国矫形外科杂志,2012,20(6):490-494.
[20]Sathiyakumar V,Thakore RV,Ihejirika RC,et al.Distal tibia fractures and medial plating:factors influencing re-operation[J].Int Orthop,2014,38(7):1483-1488.
[21]赵国平,苏伟,赵劲民,等.影响胫腓骨开放性骨折愈合的多因素分析[J].中国矫形外科杂志,2012,20(14):1268-1271.
[22]Yashwant Singh T,Masood H,Atin J,et al.Minimally invasive plate osteosynthesis of distal tibial fracture using aposterolateral approach:a cadaveric study and preliminary report[J].Int Orthop,2013,37(1):105-111.
[23]Metsemakers W,Handojo K,Reynders P,et al.Individual risk factors for deep infection and compromised fracture healing after intramedullary nailing of tibial shaft fractures:a single centre experience of 480patients[J].Injury,2015,46(4):740-745.