胫骨平台复杂骨折患者双钢板治疗发生感染的危险因素分析

Risk factors for infection of double plate in the treatment of complex fractures of the tibial plateau

目的观察探讨胫骨平台复杂骨折患者双钢板治疗发生感染的危险因素分析,为临床治疗提供依据。方法选取我院2011年12月至2014年11月收治的530例胫骨平台复杂骨折患者进行回顾性资料分析,其中胫骨平台复杂骨折感染患者105例,胫骨平台复杂骨折未感染患者425例,汇总其高危因素、影像学资料等,对105例胫骨平台复杂骨折感染患者的临床发作特点,是否遗留死腔及骨折水平类型进行总结分析。结果大于50岁,遗留死腔,开放性骨折,遗留死腔,手术时间过长大于150 min是胫骨平台复杂骨折患者发生感染的风险因素,与未发感染相比有明显差异,具有统计学意义(P<0.05)。影像学检查中并发胫骨远端骨折及脊柱骨折均为胫骨平台复杂骨折患者发生感染的风险因素,与未发感染组相比有明显差异,具有统计学意义(P<0.05)。胫骨平台复杂骨折感染患者病原菌类型分析中革兰阳性菌(金黄色葡萄球菌等)比例为97.14%,未合并感染组革兰阳性菌感染比例为64.94%,具有统计学意义(P<0.05)。结论胫骨平台复杂骨折患者双钢板治疗发生感染的危险因素分析。提示年龄偏高,开放性骨折患者,双钢板治疗后遗留死腔及手术时间过长及抗菌药物使用过多,患者曾有糖尿病史均为高危因素,已发生术后治疗故在术前对患者进行适当评估,重点关注高危患者,在围手术期注意组织损伤情况及对症治疗,严密监控血糖等并发情况,应用抗生素积极防治感染,临床可针对胫骨平台复杂骨折感染高危因素的特点进行预见性防治,降低感染发生率。

Objective To investigate the risk factors of double plate in the treatment of complex fractures of the tibial plateau,and provide the basis for clinical treatment. Methods A retrospective analysis was made on 530 cases of complex tibial plateau fractures in our hospital from December 2011 November to,including 105 cases of complex tibial plateau fractures,425 cases of complex fractures of the tibial plateau,and the clinical characteristics of 105 patients with complex fractures of tibial plateau. Results Aged more than 50 years old,left dead space,open fracture,left dead space,the operation time is longer than 150 min is a complicated fracture of tibial plateau,the risk factors of infection,and the infection has been significantly different,with statistical significance（ P〈 0. 05）. The risk factors for the occurrence of infection in patients with complex fractures of the tibial plateau fractures and spine fractures were statistically significant（ P〈 0. 05）. The proportion of gram positive bacteria（ Staphylococcus aureus） was 97. 14% in the patients with complex fractures of the tibial plateau. The proportion of gram positive bacteria was 64. 94%,with statistical significance（ P〈 0. 05）.Conclusions The risk factors for the occurrence of infection in patients with complex fractures of the tibial plateau were analyzed. It is suggested that the high risk factors for the treatment of patients with open fractures,double plate treatment,postoperative time and antibacterial drugs,patients with high risk factors,have a high risk of postoperative treatment,focus on high-risk patients,in the perioperative period of attention to tissue damage and symptomatic treatment. Keywords tibial plateau; complex fractures; dual plate treatment; infection; risk factors; retrospective analysis.