骨折患者内固定术后皮肤感染坏死的临床分析

Clinical analysis of skin infections and necrosis in fracture patients after internal fixation

目的：探讨跟骨骨折患者内固定术后皮肤发生感染坏死原因，以期提高临床治疗水平。方法选取2010年4月－2013年2月152例跟骨骨折内固定术患者为研究对象，对其中出现皮肤感染坏死患者进行相关的影响因素分析。结果所有患者中有19例跟骨骨折发生皮肤感染坏死，发生率为12．5％，感染坏死的时间为术后的4～29 d ，平均为11 d；全部发生在手术切口的皮肤转角处，所有患者经过对症和手术处理后均愈合；切口感染、术前肿胀消除不完全、术中对组织保护不严密、术后未引流、未应用抗菌药物、术后处理不严密、粉碎性骨折感染率分别为41．67％、100．00％、50．00％、36．67％、20．83％、25．58％、17．48％，与同组其他比较差异有统计学意义（P＜0．05）；感染坏死影响因素有切口、手术时机、术中对组织保护、术后引流、抗菌药物应用和术后处理等（P＜0．05）。结论围手术期要做好恰当的处理才能降低跟骨骨折内固定术后皮肤发生感染坏死。

OBJECTIVE To explore the causes of skin infections and necrosis in the calcaneal fractures patients after the internal fixation so as to improve the level of clinical treatment .METHODS A total of 152 calcaneal fractures patients who underwent the internal fixation from Apr 2010 to Feb 2013 were recruited as the study objects ,then the influencing factors for the skin infections and necrosis were analyzed .RESULTS Of all the calcaneal fractures patients ,the skin infections and necrosis occurred in 19 cases with the incidence rate of 12 .5% ,and the time of the infections and necrosis ranged from 4 to 29 days （mean duration ,11 days） ,all occurred at the corner of the skin incision ,and all the infections and necrosis were healed through symptomatic and surgical treatment .The in‐cidence rate of the skin infections and necrosis was 41 .67% in the patients with incision infections ,100 .00% in the patients with incomplete preoperative swelling elimination ,50 .00% in the patients with loose intraoperative protection of tissues ,36 .67% in the patients without postoperative drainage ,20 .83% in the patients without use of antibiotics ,25 .58% in the patients with loose postoperative treatment ,17 .48% in the patients with comminu‐ted fractures ,as compared with other patients in the same group ,the difference was statistically significant （P〈0 .05） .The influencing factors for the skin infections and necrosis included the incision ,timing of surgery ,intrao‐perative protection of tissues ,postoperative drainage ,use of antibiotics ,and postoperative treatment （P〈0 .05） . CONCLUSIONS The appropriate perioperative treatment may contribute to the reduction of incidence of the skin in‐fections and necrosis in the calcaneal fractures patients after the internal fixation .