胫骨骨折内侧锁定板固定术后感染的病原菌分布及相关因素分析

Distribution of pathogens causing infections in tibial fractures patients after medial locking plate fixation and influencing factors

目的分析胫骨骨折内侧锁定板固定术后感染的病原菌分布及相关因素,以降低医院感染率。方法对医院2005年1月-2013年1月采用内侧锁定板固定术的375例胫骨骨折患者临床资料进行回顾性分析,分析感染的相关因素,同时取感染患者分泌物培养,分析感染的病原菌分布。结果 375例胫骨骨折患者发生术后感染15例,感染率4.00%;共分离出病原菌15株,其中革兰阳性菌11株占73.33%,以金黄色葡萄球菌、表皮葡萄球菌为主,革兰阴性菌3株占20.00%,以铜绿假单胞菌为主,真菌1株占6.67%;开放性骨折感染率高于闭合性骨折,骨折分型与感染率具有密切关系,GustiloⅡ、Ⅲ型感染率明显高于GustiloⅠ型;开放性骨折、术中切口皮肤受损、骨折分型、高龄、合并糖尿病、住院时间长与胫骨骨折内侧锁定板固定术后感染密切相关(P<0.05)。结论内侧锁定板固定术后感染率较高,影响因素众多,在操作时应选择合适的手术时间,切口选择应因人、因材而宜,开放性骨折患者前期清创到位,可降低感染率。

OBJECTIVE To investigate the distribution of pathogens causing infections in patients with tibial frac- tures after medial locking plate fixation and analyze the influencing factors so as to reduce the incidence of nosoco- mial infections. METHODS The clinical data of 375 cases of tibial fractures who underwent the medial locking plate fixation from Jan 2005 to Jan 2013 were retrospectively analyzed, then the related factors for the infections were analyzed, the secretions specimens obtained from the patients with infections were cultured, and the distribution of isolated pathogens was analyzed. RESULTS Of totally 375 patients with tibial fractures, the postoperative infec- tions occurred in 15 cases with the infection rate of 4.00%. A total of 15 strains of pathogens have been isolated, including 11 （73.33%） strains of gram-positive bacteria, 3 （20.00%） strains of gram-negative bacteria, and 1 （6.67 %） strain of fungus; the Staphylococcus aureus and Staphylococcus epidermidis were dominant among the gram-positive bacteria; the Pseudomonas aeruginosa was the predominant species of gram-negative bacteria. The infection rate of the patients with open fractures was higher than that of the patients with closed fractures, indica- ting that the type of fracture was closely related to the infection rate; the infection rate of the patients with type Gustilo Ⅱ or Ⅲ was significantly higher than that of the patients with type GustiloⅠ. The open fracture, intraop- erative skin damage of incision, type of fracture, advanced age, complication of diabetes, and long hospitalization duration Were closely related to the infections in the patients with tibial fractures after medial locking plate fixation （P〈0.05）. CONCLUSION The incidence of postoperative infections is high after the medial locking plate fixation, and there are a variety of influencing factors; it is necessary to select appropriate operation time, choose the inci- sion type based on the person and material, and put the debridement in place in the primary stage so as reduce the infection rate.