骨科外固定架相关感染的危险因素及预防

Risk Factors and Preventive Measures of External Fixator-related Infections in Orthopedics

目的分析骨科外固定架相关感染的危险因素,提出预防性管理措施。方法对2005年5月-2007年5月收治的固定架固定各种疾病542例患者进行了回顾性调查分析,密切观察是否有感染出现并对伤口分泌物进行细菌培养。结果542例外固定架固定患者中,总感染率为2.77%,其中肢体延长患者发生伤口感染6例,感染率为8.82%;骨不连和骨缺损患者固定后发生感染3例(5.36%);普通骨折外固定后感染发生率最低,为0.39%。结论外固定架的穿针位置是最常见的感染部位,而耐药性细菌是产生术后感染的最常见菌群,因此增加外固定架的稳定性、加强手术室感染管理,术后伤口充分引流、抗菌药物合理使用等,是预防骨科外固定架相关感染最有效的管理措施。

OBJECTIVE To analyze the major reasons of wound infection after external fixator application and then introduce management measures to prevent following wound infections. METHODS Totally 542 patients adopting external fixators between May 2005 and May 2007 were retrospectively reviewed. All the external fixator-related infections were inspected and the excretions from these infected wounds were collected to perform bacterial culturing. RESULTS The total infection rate of these 542 patients after external fixator application was 2.77%. Among them, six were infected with the bacteria in distraction osteogenesis group and the infection rate was 8.82% ; three were infected in bone un-union and bone defect group and the infection rate was 5.36% ; whilest the common fracture-fixing group got the lowest infection rate of 0.39 %. CONCLUSIONS Wire-crossing positions are the most frequently infected sites after external fixation and the drug-resisted bacteria are the most commonly detected pathogens. Thus, increasing the stability of fixators, enhancing the infection supervision of operation environment, draining the wound thoroughly and using antibiotics rationally are the most effective managing measures to prevent external fixator-related infections in orthopedics.