Gustilo Ⅲ型开放性胫腓骨骨折术后感染的病原学及VSD治疗效果研究

Etiology of postoperative infections in patients with Gustilo Ⅲ open tibiofibular fractures and effect of VSD

目的分析Gustilo Ⅲ型开放性胫腓骨骨折术后感染的病原学特点及采用VSD技术控制感染的临床效果,为控制术后感染提供参考。方法选取2012年1月-2016年6月医院收治的Gustilo Ⅲ型开放性胫腓骨骨折患者800例,所有患者初次治疗均采用切开复位内固定治疗,采用彻底清创联合VSD技术治疗,治疗后观察感染患者的病原学特点及白细胞计数、C-反应蛋白、血沉等指标。结果术后骨折感染患者7例,其中男性4例,女性3例,年龄17~65岁,平均(39.24±11.52)岁,7例患者感染时间为术后15~24d,平均(19.03±2.17)d,治疗医师对7例感染患者随访时间为8~24个月,平均(14.79±3.06)个月,均无感染复发者;治疗后骨折愈合时间4~7个月,平均(5.93±1.16)个月;末次随访未见患者患肢出现骨折畸形愈合、功能障碍及骨髓炎等并发症;7例感染患者共分离出16株病原菌,其中革兰阳性菌6株占37.50%,革兰阴性菌8株占50.0%,真菌2株占12.50%;7例感染患者中5例经单次VSD治疗后均Ⅰ期愈合,2例经2次VSD治疗后感染得到控制,所有患者均无内固定移除;7例患者经VSD治疗后14d的白细胞计数、C-反应蛋白、血沉检查结果均显著低于治疗前,差异有统计学意义(P<0.05)。结论对于Gustilo Ⅲ型开放性胫腓骨骨折术后的早期感染,在无骨髓腔感染的前提下,采用VSD治疗可以有效使感染得到控制,并可加快骨折区的周围软组织生长,对减少病程、降低并发症发生率及感染复发率效果显著。

OBJECTIVE To investigate the etiological characteristics of postoperative infections in patients with Gustilo Ⅲ open tibiofibular fractures and observe the clinical effect of VSD on control of the infections so as to provide guidance for prevention of the postoperative infections.METHODS A total of 800 patients with GustiloⅢ open tibiofibular fractures who were treated in the hospital from Jan 2012 to Jun 2016 were enrolled in the study,all of the patients were initially treated with open reduction and internal fixation and were given complete debridement combined with VSD technique.The etiological characteristics of the patients with infections and the indexes such as white blood cell counts,C-reactive protein,and erythrocyte sedimentation rate were observed after the treatment.RESULTS Totally 7 patients had the postoperative infections,including 4 males and 3 females;the patients were aged between 17 and 65 years old,with the mean age （39.24 ＆#177;11.52） years old;the 7 patients were infected after the surgery for 15-24 days,with the mean duration （19.03＆#177;2.17） days.The follow-up duration of the 7 patients with infections ranged between 8 and 24 months,with the mean duration （14.79＆#177;3.06） months,and no patient had recurrent infections.The fracture healing time ranged between 4 and 7 months after the treatment,with the mean time （5.93＆#177;1.16）months.The final follow-up showed that there was no patients with the complications like fracture malunion,dysfunction,and osteomyelitis.A total of 16 strains of pathogens were isolated from the 7 patients with the infections,including 6 （37.50%） strains of gram-positive bacteria,8 （50.0%） strains of gramnegative bacteria,and 2 （12.50 %） strains of fungi.Among the 7 patients with the infections,5 patients met stage Ⅰ healing after the single VSD treatment,the infection in 2 patients was controlled after two times of VSD treatment,and no patient had the internal fixator removed.The white blood cell counts,C-reactive protein,and erythrocyte sedimentation rate of the 7 patients were significantly lower after the VSD treatment for 14 days than before the treatment（P〈0.05）.CONCLUSION As for the GustiloⅢ open tibiofibular fractures patients with early postoperative infections,on the premise of the patients without bone marrow infections,the VSD may effectively facilitate the control of the infections,accelerate the growth of soft tissues surrounding the fracture zone,remarkably shorten the disease course,and reduce the incidence of complications and recurrence rate of infections.