钢板固定术后胫骨骨折患者感染的特点及其危险因素分析

Characteristics and risk factors of postoperative infection in tibial fracture patients after plate fixation

目的探讨钢板固定术后胫骨骨折患者感染的特点并对其危险因素进行分析。方法选择浙江医院2016年1月—2017年3月间收治的202例行钢板固定术的胫骨骨折患者,依据患者术后是否发生感染,将患者分为感染组68例和未感染组134例。制作危险因素调查表,收集2组患者年龄、性别、糖尿病、骨折类型、解剖特点、手术时机、手术方式、术后引流、抗菌药物等资料。采用单因素和Logistic回归分析对收集的数据资料进行分析。结果68例感染者共检测出病原菌38株,革兰阳性菌24株,以金黄色葡萄球菌最多,占41. 7%;然后为表皮葡萄球菌,占20. 8%。革兰阴性菌共14株,占36. 8%。单因素和Logistic回归分析发现糖尿病、骨折类型、解剖特点、手术时机、手术方式、术后引流、抗菌药物是钢板固定术后胫骨骨折患者发生感染的危险因素。结论钢板固定术后胫骨骨折患者易发生感染,其中革兰阳性菌以金黄色葡萄球菌、表皮葡萄球菌感染为主。进一步分析显示糖尿病、骨折类型、解剖特点、手术时机、手术方式、术后引流、抗菌药物是钢板固定术后胫骨骨折患者发生感染的危险因素,临床工作中要重视发生感染的危险因素,减少致残率,促进患者早日康复。

Objective To investigate the characteristics and risk factors of postoperative infection in tibial fracture patients after plate fixation. Methods A total of 202 patients with tibial fractures treated with plate fixation in our hospital from January 2016 to March 2017 were selected. The patients were divided into infection group( 68 cases) and uninfected group( 134 cases) according to postoperative infection condition. A risk factor questionnaire was prepared to collect data on risk factors for infection in both groups: age,gender,diabetes,fracture type,anatomical features,surgical timing,surgical methods,postoperative drainage,and antimicrobial agents. Univariate and Logistic regression analysis were used to analyze the collected data. Results In the infection group,a total of 38 pathogens were detected including 24Gram-positive bacteria and 14 Gram-negative bacteria. The detected Gram-positive bacteria included Staphylococcus aureus( 41. 7%) and Staphylococcus epidermidis( 20. 8%). Univariate and Logistic regression analysis found that diabetes,fracture type,anatomical characteristics,timing of surgery,surgical methods,postoperative drainage,and antimicrobial agents were the risk factors for infection of tibial fracture patients after plate fixation. Conclusion The patients with tibiofibular fractures after plate fixation develop infection easily,and Staphylococcus aureus and Staphylococcus epidermidis are mainly responsible for the infection. The diabetes,fracture types,anatomical features,surgical timing,surgical methods,postoperative drainage,and antibacterial agents are the risk factors for infection in patients with tibial fractures after plate fixation. The risk factors for infection should be emphasized in clinical work to reduce disability,and promote the early recovery of patients.