开放性骨折早期处理与创面细菌学分析

Early treatment for open fractures and quantitative bacteriology analysis in wound surface

目的探讨开放性骨折创面组织细菌数量与感染之间的关系和在清创术中使用聚维碘酮杀菌的效能。方法选取65例65处开放性骨折病例,伤口按Gustilo分类,在清创术前、术后以及清创过程中局部使用聚维碘酮杀菌后三个不同时段,在伤口能代表最污染处切取1·0cm×1·0cm×1·0cm组织块样本进行细菌学检查。按Cooney法进行细菌学定量分析,计算每克组织内细菌菌落生长个数(CFU)。结果(1)术后发生感染15处,总感染率23·1%,其中浅部感染8处,深部感染7处(10·8%);(2)清创前伤口细菌数量>104CFU/g者与细菌数<104CFU/g的感染率比较,差异无显著意义,而清创术后两者的伤口感染率比较,差异有显著意义;(3)聚维碘酮使用前伤口细菌数>104CFU/g有41处,用药后降到29处。结论(1)开放性骨折伤口感染率随软组织损伤程度的加重而明显增加;(2)清创术后创面细菌数量与感染的发生呈正相关,密度>104CFU/g时感染率明显增高;(3)清创术中局部使用聚维碘酮处理开放性骨折伤口,可减少伤口内细菌数量,是防止伤口感染的一种有效手段,但不能代替严格彻底的清创过程。

Objective To investigate the relationship between infection and quantitative bacteriology analysis in wound surface of open fracture by testing the common species, the number of bacterial flora contaminated in the wounds and its change during debridement. Methods 65 cases were classified as gustilo grade. Specimens taken from the wounds at three different time points（before debridement, after using pavidone-iodine and after debridement）were determined qualitative and quantitative by using bacterial culture. Results （1）There were 15 infections in 65 eases with a total rate of 23.1%. Among them 7 cases（ 10.8 % ） were deep infections. （2）After debridement, the rate of wound infection among group over 10^4CFU/g was 47% while 14.6% in group less than 10^4. （3）After using pavidone-iodine, the numbers of group with CFU over 10^4 dropped from 41 to 29. Conclusions （1）A thorough debridement can significantly reduce the number of bacterial and can change their growing environment. This is a key point in preventing infection. （2）The number of bacterial in wounds after debridement has close relation with infection. （3）Pavidone-iodine can be used safely in debridement as bactericide, but can＇t replace a thorough debridement.