胫腓骨骨折术后深部感染205例分析

Analysis of 205 cases with deep infection after surgery for fracture of tibia and fibula

目的:分析胫腓骨骨折术后深部感染的原因,探讨其防治方法。方法:2002年1月～2009年8月共收治胫腓骨骨折术后深部感染患者205例,予病灶清创,伤口换药,灌洗引流或敞开引流,取出内固定,更换为外固定、皮瓣转移等治疗。结果:205例标本中有110例培养出金黄色葡萄球菌42例(38.18%),绿脓杆菌28例(25.45%),表皮葡萄球菌10例(9.09%),不动杆菌16例(14.55%),大肠埃希菌9例(8.18%),肺炎克雷伯菌5例(4.55%),对头孢类抗生素敏感。患者深部感染均得到控制,随访0.5～4年,11例骨折畸形愈合,6例骨不连,16例膝关节功能障碍,28例踝关节功能障碍。结论:胫腓骨骨折术后深部感染原因是多方面的,宜积极预防,早期发现,及时治疗。

Objective：To analyze the cause and treatment of deep infection after surgery for fracture of tibia and fibula.Methods：Clinic data of 205 cases with deep infection after surgery for fracture of tibia and fibula admitted from Jan 2002 to Aug 2009 were analyzed.All cases were treated with debridement,wound dressing,lavage and drainage or open drainage,replacement of internal fixation with external fixation,flap transfer,etc.Results：Out of 205 samples,110 cases had bacterial infection,including 42 by Staphylococcus aureus（38.18%）,28 by Bacillus aeruginosus（25.45%）,10 by Staphylococcus epidermidis（9.09%）,16 by Acinetobacter（14.55%）,9 by Escherichia coli（8.18%）,and 5 by Klebsiella pneumonia（4.55%）.All were under control,and followed up for half a year to 4 years.Eleven had malunion,6 had nonunion,16 had knee joint malfunction,and 28 had ankle joint malfunction.Conclusions：There are various causes for deep infection after surgery for fracture of tibia and fibula.Active prevention,diagnosis at earliest and promply treatment are important.