足踝I类切口手术部位感染的临床分析

Clinical analysis of surgical site infection in patients with type I incision orthopedic foot and ankle surgery

目的 探讨并分析足踝Ⅰ类切口手术部位感染的发病率、临床特征、相关因素及病原菌种类，为预防足踝Ⅰ类切口手术部位感染提供依据。方法 回顾性调查西南医科大学附属医院2011年6月-2015年6月行足踝Ⅰ类切口手术的患者，收集分析发生手术部位感染患者的临床资料，对手术部位感染的发病率、临床特征、相关因素及病原菌种类等情况进行研究。结果 761例足踝Ⅰ类切口手术患者中，发生手术部位感染的患者42例，感染发病率为5.5%。不同年龄、不同性别、麻醉方式、是否吸烟、是否酗酒、是否合并风湿性疾病或痛风、切口数量，以及是否为开放伤转归后的Ⅰ类切口等方面，手术部位感染的发病率差异无统计学意义（P〉0.05）。糖尿病伴周围神经病变的患者手术部位感染发病率明显高于非糖尿病患者（P〈0.05）。手术时间〉3 h的患者相较于手术时间≤1 h的患者，手术部位感染的发病率明显增高（P〈0.05）。术中植入内固定的患者相较于外固定组和无植入组手术部位感染发病率明显增高（P〈0.05）。结论 足踝Ⅰ类切口手术部位感染发病率较高，与足部独特的解剖结构密切相关。糖尿病伴周围神经病变，手术时间长，术中植入内固定等可能是其高危因素。

Objective To investigate and analyze the surgical site infection rate, clinical characteristics, risk factors and pathogens in patients after type Ⅰ incision orthopedic foot and ankle surgery, which may provide a basis for preventing surgical site infection in foot and ankle surgery. Methods Patients undergoing type Ⅰ incision orthopedic foot and ankle surgery from Jun. 2011 to Jun. 2015 were investigated retrospectively. Clinical data of cases with surgical site infection were collected and analyzed. Incidence of surgical site infection, clinical features, risk factors and pathogen distribution were studied. Results Seven hundred and sixtyone patients were undergoing type Ⅰ incision orthopedic foot and ankle surgery, surgical site infection occurred in 42 patients with an infection rate of 5.5%. In terms of age, gender, anesthesia, smoking, drinking, rheumatoid arthritis, gout, number of incisions and recovery after open injuries, no significant difference of surgical site infection rate were found. Diabetes mellitus complicated with peripheral neuropathy increased the risk of surgical site infection compared with nondiabetic patients. Patients who had an operative time more than 3 hours had a greater risk of surgical site infection compared with those less than 1 hours. The presence of intraoperative implants increases the risk of surgical site infection compared with patients with external fixations or without implants. Conclusions Surgical site infection is a common complication for the patients after type Ⅰ incision orthopedic foot and ankle surgery. Diabetes mellitus complicated with peripheral neuropathy, long operation time and intraoperative implants may be the high risk factors for surgical site infection.