迟发感染致骨折内固定术后骨折不愈合

Analysis of fracture disunion after the internal fixation caused by delayed infection

目的探讨迟发感染致骨折内固定术后骨折不愈合的危险因素、病原学诊断及处理方法。方法对2003年1月至2007年1月24例内固定术后骨折不愈合的患者细菌学检查、临床表现及抗生素使用情况进行回顾性分析。结果 24例迟发感染骨折不愈合患者分离出病原菌22株,其中革兰阳性球菌16株,革兰阴性杆菌6株。革兰阳性球菌对万古霉素、替考拉宁敏感率达100.0%,革兰阴性杆菌对亚胺培南、美罗培南敏感率达100.0%。患者术后使用抗生素较普遍。结论本组调查的迟发感染所致骨折不愈合患者中,革兰阳性球菌感染多于革兰阴性杆菌,患者除积极的外科治疗外,应以细菌学报告为依据,及时进行合理有效的抗菌治疗。

Objective To study the risk factors, etiological diagnosis and treatment strategy of fracture disunion after the internal fixation caused by delayed infection. Methods A retrospective analysis was performed on the clinical data of 24 patients with fracture disunion after the internal fixation from Jan 2003 to Jan 2007, including bacteriological examination, clinical manifestation and the status of antibiotics administration. Results 22 strains （91. 64%） of pathogenic bacteria were isolated in 24 cases, in which 16 strains were gram positive cocci, 100.0% sensitive to vancomycin and teicoplanin; 6 strains were gram negative bacilli, 100.0% sensitive to imipenem and meropenem. It is common for the patients to use antibiotics after operation. Conclusion In this study, gram positive cocci are pre dominant pathogenic bacteria. It is advisable to perform proper antibacterial drug therapy according to drug susceptibility test results besides active surgical therapy.